I understand that $25 may have been an introductory loss leader but $1k seems insane and short sighted given the size of the market this drug potentially has.
The US healthcare system is systematically broken. I've sworn off doing business in that sector because the cultural attitude that insurance companies have towards payment has infected everything. You can't trust anything anyone says about how much they will pay for something. Some kind of drawn-out, adversarial process around payment collection is the expectation.
Sorry for that rant I am a bit traumatized by my experiences trying to do business in the US healthcare industry.
It is absolutely insane what insurance companies will actually pay for - mine was fulling willing to pay $1250 for a simple ultrasound procedure at a hospital facility vs $150 at a specialty clinic. I made the smart decision to have it done at the clinic but it isn't like I'm going to be rewarded for that decision by paying lower premiums.
The hard way - I looked up the average price for the procedure and pestered them for up front pricing. When they told me what they were going to charge I walked out of the facility without another word and went to the local clinic.
I also let my doctor know that I was extremely displeased about his referral to that facility when there were cheaper alternatives.
The insurance companies have huge discounts, even 90% for many procedures. The price list is usually for uninsured people, not what is ever paid by insurance.
Surely there is a formula that can solve for an optimum price that will maximize revenue by making it cheap enough for a certain segment of the population to pay for out of pocket. I don't have diabetes and I'm not morbidly obese, but I have struggled with my weight, and, frankly, given the hype, I'd try it on my own if it were something like $100/mo.
Maybe 10% of people like you would also pay for it at $1000/mo, and they're already solving for optimum profit (not revenue - presumably they have some marginal costs).
Maybe they can capture the $1000/mo market first and then offer something very similar to those who are interested at $100/mo. Or they have capacity constraints where they can't scale up manufacturing to supply everyone who would buy it at $100, but they can validate their process at the higher price first.
They are currently unable to produce enough of these medications, so charging a fortune for it makes sense to them. Private enterprise is stepping in to fill the gap via US "compounding pharmacies", with all the potential safety risks that entails.
The story itself doesn't mention TikTok at all, it's really strange that the headline makes it the key aspect of the article.
edit now the title here has changed, but it's still strange The Independent list that as the most important part. Guess it's normal click bait tactics.
> When someone takes an anti-obesity medication like Mounjaro, the amount of fat the body wants to maintain is re-regulated, usually to a lower weight. “When you take the medication away, that defended fat mass goes back up, and weight is regained,” Jastreboff said. “In order to continue to maintain the new re-regulated defended fat mass, and weight reduction, you have to continue taking the medication.”
This doesn’t seem worth it to me. I’m sure a lot of people would like to lose 25lbs but you’re making a deal with the devil to get it. It almost makes me think they design these drugs to make a recurring revenue stream instead of fixing the issue permanently.
The real problem is not as a weight loss drug, but as a way to regulate diabetes. My girlfriend is on it, because the other medications don't work outside of insulin which has it's own difficulties. The sudden raise in price and her insurance refusing to pay for it means she either has to do it out of pocket or try and switch to something else which may or may not work.
The real problem with using it as a weight loss is that it doesn't solve the underlying problem. Mounjaro makes it so that you can't eat. Eat too much and you get sick (seriously like 2 bites and you're done eating). Overeating is a psychological problem. The drug doesn't fix you wanting the food, it just makes it so that you can't eat it. Take the barrier away, and you're back to where you started.
It seems strongly linked and such links are quickly extinguished. If there is a delay and randomness on getting sick it’ll be weakly linked and more durable.
It doesn't really work like that. The way it was explained to me, it slows your digestion down so you feel/are fuller for longer. It took a lot less for me to be satiated and effectively eliminated any kind of binge eating, but it wasn't because it made me nauseous; I just felt full. Once I got off the drug, I started eating more again.
There are side effects, especially initially with loose stool and some nausea, but generally they don't last. I'm sure they persist with some but that's effectively every medication. The goal isn't to change the relationship with food where it makes one physically ill when seeing or eating food
EDIT: My experience is with Ozempic, not Mounjaro. They may work differently
> Eat too much and you get sick (seriously like 2 bites and you're done eating).
While I’ve know some people experience more severe GI issues or nausea with the drug, this is quite the exaggeration. A drug that made it difficult or impossible to actually consume enough food to survive (more than “two bites”) would be wildly unsafe to prescribe.
Not at all short term. This is EXACTLY what fasting is. In fact a pill you could take in the morning that would suppress your appetite for 24 hours would be fantastic. You could use it three days a week with no ill effects and loose weight.
The comment I was replying to was talking about Mounjaro, which is a weekly injectable - and thus no way to do it for only three days a week. In that context, if Mounjaro made it impossible to eat to the degree the commenter described, it would be wildly unsafe (because of how long each shot lasts).
That “yo-yo effect” is frequently seen with people who try to lose significant amounts of weight.
If you take the perspective of someone who has struggled with weight loss in the past (especially if prior results were not great and had trouble keeping the weight off anyways) - it’s not so much of a deal with the devil, if the drug actually works.
>“In order to continue to maintain the new re-regulated defended fat mass, and weight reduction, you have to continue taking the medication.
I mean surely that can't be a 100% always the case, I would think it is either continue to take the medication or do a strenuous weight reduction program / eat less + exercise.
but why is that important, because some people might be so obese that they need to lose 25 lbs (maybe more, just following what was written) to get to a point where the exercise part of that equation is at all doable.
It is tough, but that initial "whoosh" can be the momentum someone needs to help them continue/maintain healthy habits they built during that time.
I was put on Ozempic last year for a short amount of time. That, combined with changing of diet and starting an exercise routine, lead me to lose ~60 pounds in a relatively short amount of time (~8 months). I'm not taking the medication anymore and I did gain about 20 pounds back, but it's a lot easier going on a walk or run when you're carrying net 40 fewer pounds.
Willpower and discipline are simple things but they're not easy. In my opinion, it's important that the patient uses it as boost instead of a crutch and don't get too discouraged if/when they wean off and gain some weight back.
It may be a cynical take but I highly doubt most people searching for this drug are going to do what you have done. Props to you for sure but I fear this will just create another cycle of dependence that only benefits the company manufacturing the drug.
It absolutely can be something that creates a cycle of dependence but I tend to look at it as harm reduction at that point. Weekly injections aren't a fun process though and, at least for me, I was striving to be off any/all medication. Being told you're effectively Type II at 34 was not a fun experience for me and I've been trying to control/put it into remission without having to take Metformin and Ozempic.
To be clear, I'm not intending to shame or throw shade at those who take or need the drugs, I just want to do all in my power avoid them as much as I can.
I'm glad you were able to use Ozembic in that way, to me, that's the best use case. However, I don't see that being the norm, if you can just take Ozembic and keep those 60 pounds off permanently as long as you can afford it, then people are just going to do that
For a lot of people, being obese impacts their ability to live an active lifestyle and desire to be social, which causes them to sit around and eat more, causing them to get fatter in a vicious cycle. Breaking the cycle for these people will have long term benefits.
Other people just have a disorder, where they literally don't feel the full signals that normal people do, so they only feel "full" when their stomachs are stuffed to discomfort. These people are already consigned to a life of suffering, either from being obese or from constant hunger and an inability to have a normal relationship with food. In this case being on a medication for the rest of your life is the lesser of two evils.
The biggest problem using these drugs for weight loss is they need to be used as part of a program that also includes making lifestyle changes. If you don't push the changes and just do things to your limits, when you stop the drug, your unchanged habits make you gain the weight back.
This is one of the biggest things people with obesity struggle with. This is seen as a miracle cure for obesity because it doesn't require work, just a weekly injection and watch the weight melt off. But making lifestyle changes (changing eating habits, increasing activity, etc) is the most reliable way to make this a permanent fix.
But that's putting the patient to work and they don't want that.
That's just not really true. People tend to gain weight and stabilize. It's not like they suddenly get will power. Most everyone has a weight they will end up at if they eat to satiation. These drugs lower that weight.
Of course will power and environment changes can keep you at a lower weight but it's a constant struggle against your body.
I take Wegovy for obesity, and it completely changes my behaviour. I don't often think about food any more, and when I do, I am quite happy preparing a small amount of healthy food. Not only that, I have more energy so I maintain a far more active lifestyle.
Given that I can go for months without those "bad habits", but if I stop taking it they come back, I think they're more than habits. Habits break if you stop doing them for a while, these compulsions don't. Until I took this drug, I didn't know what it was like to be able to not constantly think about food and being hungry. I've been overweight for nearly my entire life since I was a breastfeeding baby, and this is the first time in my life that I don't feel like I'm being held hostage to my hunger.
I have lost weight and maintained a healthy weight for periods of time, but I'm just hungry the whole time and eventually the hunger starts beating my willpower.
For what it's worth I also have problems with anxiety. Similarly I tried years of therapy/mediation/mindfulness/etc. to get rid of my anxiety but it never went away until I took sertraline. Now, I live a pretty much anxiety-free life as long as I take a pill a day.
One of the dramatic effects I’ve noticed is I finally know what being truly hungry feels like. I can differentiate between appetite and hunger. I used to think it was odd how people would turn down food when it’s offered to them. Either my hunger cues were so strong, or my lack of self control has made me absolutely unable to restrict my intake long enough to reduce my weight in a meaningful way. This drug is essentially turning down my hunger drive and now I get it when someone turns down food offered to them. It’s also given me control over what I eat since I don’t have those wild hunger pangs telling me to eat way too much or to eat the wrong thing. Feeling hungry was like this “emergency” that I had to resolve as quickly as possible.
I probably need to see a therapist that can help with my eating habits, and this has highlighted that for me.
The thing is that, at least as far as we know, these drugs don't have any direct effect on the brain. Any effect they have is apparently from adjusting hormone levels and possibly some metabolic effects.
It's also interesting that they were designed to treat diabetes then we also discovered they reduce hunger. My guess is that we may have assumed the cause-effect relationship is more straightforward than it actually is.
I also want to see what happens if we take the people who criticise us for relying on a drug instead of willpower/mental conditioning, then give them a drug that does the opposite of these ones. My guess is they'll overeat and get fat. Much like animals do in animal studies. Ignoring your body constantly telling you to eat is almost impossibly hard over the long term.
Humans have a tendency to assume that we have much more free will than any kind of scientific evidence tends to show.
In my experience, if you're going to use GLP-1 RA for weight loss, it needs to be part of a larger program of changes, including lifestyle changes. That you have to lead the charge on. The people that say losing weight on these means you gotta take it for the rest of your life, they're wrong. It eventually stops having that effect on you. It certainly makes the process of changing things a lot easier, and it buys you a lot of time to adopt those changes. But if you don't put in the mental work and reshape your lifestyle to this new body, you're going to have a bad time later regardless of if you're still on it or not.
I've taken various GLP-1 RA over a decade for glycemic management (I'm on Mounjaro now). They still work great for this. But I have to do the work to maintain my body, now.
> (If you accept that obesity kills, reducing obesity saves everyone’s money and lives)
That seems like a ... strange argument.
If that is a very poorly phrased way of saying that reducing obesity will extend peoples' working lives, that's certainly true.
But otherwise, everyone dies in the end. Is it really that much more expensive to die as a middle aged overweight person than a healthy weight old person?
Argument doesn't really make sense. If you are trapped in a fire and the fire department kicked down your door and carried you out would you argue they really didn't save your life as you will die eventually anyway?
Yes. It's more expensive because of several issues that happen to obese people that don't happen to healthy weight people. Specifically dramatically increased inflammation of pretty much their entire body due to decomposing fat cells.
And those higher costs get socialized through insurance and taxes.
The obese are mad at the diabetics, the diabetics are mad at the obese, while they should be mad at their failure of politicians who won’t regulate the drug market like any other functioning democracy. It’d be funny if it wasn’t so tragic
Saying food is the cause of obesity is boiling down the visible aggregate effect of a million different things into one big cause. I eat pretty much nothing but garbage food -- pizza, wings, burgers, subs: just salt and grease. And I went from 220 to 120 and stayed there doing it. It's a meme at this point that when we go to restaurants with friends it's the skinny people ordering apps and burgers and the overweight people get salads. The difference is that all the skinny people get full and leave half their meal on the plate. For most of my life I was dumbfounded that this could happen and they must be forcing themselves to stop or something but nope, I hit the wall same as the rest of them now. No issues with cholesterol or blood pressure either.
So we 1000% should deal with the amount of crap that's in our food but I don't think it'll be the cure-all that people expect.
The problem is that we're not talking about well educated adults making a conscious decision about eating shit food and ruining their lives. We're talking about entire generations of kids who don't know better being purposefully fed addictive food which will ruin their health.
> I eat pretty much nothing but garbage food -- pizza, wings, burgers, subs: just salt and grease. And I went from 220 to 120 and stayed there doing it
Fast forward 10 years later and you'll get a very concerning blood work result. (I don't wish it on you but the web is full of "fat/skinny/I only eat junk food and I was healthy until I hit 45 and discovered XYZ is 5 times over the recommended limit" stories)
Also you might have a damaged thyroid or other similar health issues, I know a few people coming from an industrial region known for pollution, they have more thyroid issues than the average, as a result they can eat 6+ times a day and much more calories than you'd expect while not packing a gram of fat.
I can put down enough calories in a meal to make a garbage truck blush. It's not necessarily that skinny people (or somewhat squishy people who carry it discreetly in my case) don't eat all of their food. It can also be that when you see me down a trashcan lid of nachos, it's my treat for the week (or two) and I accommodate for that in my normal habits.
Personally I’d like to thank the food industry for creating all these amazing products. I don’t think it’s anyone’s fault that some people find it very difficult to control the urge to eat too much, and I definitely don’t think I should be punished for that by making tasty food more expensive/harder to find.
Personally I'd like to thanks latin american cartels for making heroin feel so good, I don’t think it’s anyone’s fault that some people find it very difficult to control the urge to consume heroin, and I definitely don’t think I should be punished for that by making heroin more expensive/harder to find.
Once your body is ravaged by years of junk food you're an addict in the medical sense of the term. When you give a soda that contains 2x the daily recommended amount of sugar to a kid because "it tastes good" you're sabotaging their future health.
They don't make the food taste good to make you enjoy good food, they make food addictive to make you keep consuming.
But again, if the best economical system of the galaxy in the richest country of the universe can't guarantee basic things such as feeding yourself properly I'd say you have quite a big problem
When do we start acting ? 50% obesity ? 75% ? It's already the top 1 cause of death (cardiovascular disease). What does it say about our society ? Looking at it from the outside makes it look like sabotage if not suicide, very few people profit from it, and in the long run everybody loses
That doesn’t explain why the rate of obesity has increased so dramatically over just a few decades. Like most widespread changes there are many root causes simply producing a massive surplus of food being an obvious requirement.
If you’re selling food, getting people to consume more is simply more profitable. Various mechanisms kick in after someone gains weight to maintain that weight. Which is why the drug mentioned can be so effective impacts the underlying feedback loop.
People don’t suddenly have less self control. Of course you could lose weight by eating less than your body urges you too. That has nothing to do with why more people are obese now though.
That's what we get after decades and decades of marketing targeting kids... large scale behaviour changes.
Look at how tobacco was advertised, it was the same thing, now most of us know smoking is very detrimental to your health and addictive. I wonder when people will realise they're pulling the same shit for food
I agree ”only” isn’t the best descriptor. Still it’s clear it isn’t simply people eating a constant amount rather calorie consumption is significantly increasing with age.
Weight gain doesn’t seem to be a metabolic issue, rather on average people eat just a little more and gain just a little more weight every single year and metrics like obesity and morbid obesity smooth over this underlying trend as even the morbidly obese still tend to gain weight.
How do you know this? As the adage goes: ...good times make weak men...
We've had good times in the late part of the 20th century. We now have weak lazy people in addition to abundance of shit food. We absolutely live in a time of over acceptance. In the old days it would be: "Hey man, you're getting fat. That's not ok". Not it's all about sitting down and listening to excuses with our legs folded.
Self control is a statistically significant factor representing around a 4% difference in body weight on average. But it doesn’t explain why things have changed.
We banned heroin because it being readily available leads to loads of people getting addicted to it. Even with it being illegal, lots of people still end up addicted to it. No matter your views on prohibition, it's pretty obviously not a good idea to encourage heroin use due to the risk of addiction.
Yet we do precisely that with salty sugary foods, with many of them advertised specifically towards children.
My theory is over work, stress and a general feeling of being overwhelmed. It seems that there is never time to just relax and move at a normal pace anymore.
That's not quite a tautology. A tautology would be: the reason people are rich, is because they are wealthy.
What he's essentially saying is: people are fat, because they eat too much. "Eating too much" does not necessarily or literally mean "fat". Likewise, "making more money than you spend" is not another way of saying "rich", as it's possible you can "make more money than you spend" and still not be rich.
The answers that are interesting and worth discussing, are things like the introduction of hyperpalatable foods, excess oxidized omega 6 polyunsaturated fats, excess carbohydrates, excess fructose, etc., the debates rage on.
The answer that is not interesting is simply saying that people take in more calories than they expend, because it it tautologically true. People now are more health-conscious than at any point in human history. Basically no one wants to be fat, yet most people are, and we have far higher rates of chronic disease.
You're entitled to find his or anyone's answer not interesting, but what he said is not a tautology. Just because it's obvious does not make it tautological. But in any case, the matter really is as simple as people eating too much nowadays. Evolutionary speaking, we didn't eat 3 meals every day, let alone all highly calorie packed ones. Food was also relatively quite scarce for much of civilization, until modern preservation techniques like refrigeration came along. Heck, we didn't have many of the palatable foods that we have today, just 50 years ago, and those which we did were not in the same abundance as they are today.
Fact of the matter is, no one wants to accept that they eat too much, nor do they want to eat less when it is pleasureful, nor do they want to work at changing their habits. But it is very much a cause behind modern diseases.
Our ancestors often had an abundance of food and ate quite a lot every day even if it was relatively more expensive. But, it’s harder to be obese and have by todays standards an extremely active lifestyle.
Not only do you run into limits on the digestive system but carrying extra weight means spending more energy moving that weight around. The classic lumberjack breakfast is just an insane amount of food, but you didn’t see a lot of fat lumberjacks in the 1850’s.
Our ancestors did not often have an abundance of food or eat a lot every day. Most Romans only ate 1 meal a day, and our evolutionary ancestors regularly faced days without food. Fatness was historically a signal of wealth. It was even rare to find someone fat as recent as the 1800s as you noted (and the reason had less to do with exercise than caloric intake).
Really, the abundance of food didn't start happening until recent times with modern preservation techniques, industrial farming, and food processing (which also allowed for more calorie packed foods). The tractor wasn't even widespread until the 1910s, when it took 1.5 hours for horses to plow an acre of farmland. Nowadays it takes 5 minutes.
"Choose" is the wrong word but you can certainly decide to change your weight, just as you can decide to give up smoking.
It's hard to give up an addiction, and yes the companies peddling the addiction as an avenue to profit need to face a reckoning. But at the individual level, we can all choose what weight we want to be. Fatalism doesn't help anyone.
The statistics for long term ie 10+ year weight loss are abysmal. Only around 20% of people in random trials maintain 10+% weight reduction for even 1 year.
People can very much choose to lose weight, but it seems odd to say most people are then “choosing” to gain weight again. That said willpower does seems to account for a small percentage of overall weight so it very much does play a role.
> The statistics for long term ie 10+ year weight loss are abysmal
Great - now do cigarettes. If you'd prefer to skip the math though, the CDC states "Fewer than one in ten adult cigarette smokers succeed in quitting each year".
I don't think it's completely unfair to compare quitting smoking with weight loss.
That’s just the first year, only something like 2% of people who lose weight keep it off for 10 years.
People maintained weight loss for 1 year are simply much more likely to regain weight in the next year than people who quit smoking for 1 year are likely to start smoking again over the next year and that trend stays consistent over time.
With the exception of the Great Depression and the second world war, average weights have been increasing in the USA for more than a century. We talk about this as if it's a recent shift, because we finally went from being nearly-universally-underweight to nearly-universally-obese, but the increase is relatively steady and very long term.
It's also present in all wealthy countries. The US led the way by being wealthier earlier, but all countries that have wealth see a steady rise in average weight over time.
Obesity is a systemic problem that did not exist in a systemic way a few decades ago. Trying to solve a systemic problem by blaming individuals in a large system has never worked.
Obese people are addicted to sugar because it's cheap, it doesn't spoil and it's in everything.
I recommend reading the mounjaro studies where they assigned a dietician and exercise to both the study group and the control. The mounjaro arm lost 22% while the placebo arm couldn’t lose more than a few pounds. There’s more to it than a moral failing.
While factually you are right, obesity is simply the result of consuming more calories than you burn, I think it's a little deeper than you present it. Obesity has become far more prevalent over the last few decades. I think it's related to overwork, stress and the general pointlessness of life that so many people feel. It's a mental illness paired with a will power issue.
Im well built, look decent with my shirt off and have a pretty good life but I hit a wall sometimes and just stress eat a gallon of ice cream. Lifting heavy weight for reps allows me to stay slightly ahead of my calorie consumption. I can see how a slightly more stressful life, less income and less time to work out could turn into a slippery slope where I would eat myself sick. I guess what I'm trying to say is that life is complicated. But your point stands.
They should be mad at themselves for failing to take ownership over their own lives and health. But no, its someone elses fault that they eat an entire box of oreos every night.
That only works if you consider that everyone starts life as a well educated and healthy adult
When you factor in junk food marketing targeted to kids it starts to be a bit different. Then you add lobbies fighting to keep fast food in schools, the sugar industry, "fat makes you fat" and other clearly bs takes ...
Is it because 5 years old kids can't put the box of oreo down ? They must be stupid right ? Why can't they possess high level long term thinking ??? Don't they know about insulin resistance ? and calories ?
Tragic to observe the typical Dallas Buyers Club dynamic at play. People are coordinating online and locally and doing border runs for the Mexico-available GLP-1 predecessors.
The Mounjaro patent appears to be until '39, with no generics available at the moment.
As one of the patients states in the article, obesity may very well lead them to diabetes. People will die. And with the shortage affecting current diabetics, they are dying now.
Not only unreliable, but ignorant. There is so much in hormone responses and often-undiagnosed conditions that makes "just eat less" absolutely irrelevant to many people.
If you're paying for insurance in the US you are paying for them. Check out how insurance pools work. Society, even a wild capitalist society, benefits from healthier members.
I'm a former professional athlete and am currently, in my middle age, in better shape than most, including youths in their 20s, with blood tests to prove it.
When I was making weight, it was extremely difficult to find the balance to fine-tune the diet. Those 400 grams for me were just as difficult to shed, while performing to task. And I had a professional team behind me.
Consumerist civilization is obsessed with the magic pill, we agree on that. A pharma subscription for life is not the solution. However, I personally know, and there are people like that commenting in this post, individuals that were unlucky to be born obese. If you are going to take a grand statement position, familiarize yourself with what that does to a hormonal system. And that is only one sub-case of many where obesity is completely outside of an individual's control.
With industrialized food, including sugar, HFC and carbohydrate lobbying corrupting the policy in the US for longer than 70 years, and that is a number simply of convenience, since we have easily accessible records of such industry lobbying, obese individuals are not the cause of the problem.
Having more tools to address obesity is a good thing. Hopefully, one arrow of many towards a systemic approach.
When the demand is enough, some overseas companies will start producing it without permission. Russia has announced that it will not honor patents from "unfriendly" countries, so they might as well start making these drugs in large amounts to make up for their declining gas revenues.
Cynically speaking, main reason people lose weight, is looks and advantage in dating it gives (unless they are morbidly obese and at risk of severe illness or death due to that, of course).
If there was a $25 a month drug that lets everyone become skinny, then what's the point? Advantage will cease to exist.
Nearly all people can bathe regularly now but hygiene is still valued for dating and there's also the more important point regarding health than you're letting on. $25 a month is cheaper than insulin and far cheaper than open heart surgery.
Perhaps some people have that mindset, but a lot of people do it for health. And I know some people may find that BS, but if you have ever lost significant amounts of weight before, you know how much better you feel and function.
Mounjaro is not an obesity drug. It's a type 2 diabetes drug. Do not call it an obesity drug.
The headline is editorialized. The linked article's headline: The ‘next Ozempic’ became a social media sensation. Then everything changed
The coupon didn't go away. The coupon's terms changed. I'm using the coupon now. Because I have type 2 diabetes. The coupon changed because people were using it to get the drug for off-label use. The drug wasn't taken away from people trying to lose weight by jacking up the cost. The drug shouldn't have been dispensed in this way to begin with.
Lilly is seeking to get approval of tirzepatide under a different label as a weight loss drug, similar to how Ozempic and Wegovy exist, as well as Victoza and Saxenda.
If you want a GLP-1 RA (this drug class) for weight loss, go get Wegovy or Saxenda, which are a version of these drugs approved for weight loss for those with a BMI over 30, or wait for the tirzepatide version. Leave the diabetes drugs alone.
And to be clear: This drug isn't helping diabetics by helping them lose weight. It helps diabetics regulate blood glucose. It slows the release of glucose from the liver as well as promotes the release of insulin from the pancreas. Weight loss due to slowed stomach emptying is a side effect.
People aren’t stupid. Mounjaro is the most effective weight loss drug in existence. Better than wegovy and the other brand name semaglutides. If you think FDA approval is going to stop people from wanting and getting it you’re sorely mistaken.
Yeah, feel free to spend the $1200/mo for it then. Because that's off-label use when there are drugs in this class with on-label weight loss use. And sometime this year, tirzepatide is expected to be among them.
The coupon was changed because people were abusing it. This drug is approved for diabetes, not weight loss.
Yes, this is what Novo Nordisk did with Victoza around 2014 with the release of Saxenda. And then again with Ozempic around 2021 with Wegovy. These weight loss versions exist. And there will be one likely this year based on tirzepatide from Lilly (I haven't looked up if they have a name for it yet).
I care that many people I know are losing glycemic control because they're going on a waiting list for their medication while Kim K and Elon Musk and TikTok promote easy mode cosmetic weight loss.
if someone is 'losing glycemic control' because they can't get a specific new en-vogue med, then their doctor is doing a poor job.
there is a very big problem with blaming the suffering who find relief with this drug -- regardless of what their ailment is -- rather than blaming the systems and processes that lead to a supposed shortage that urged a price adjustment.
forgive me for diving into conspiracy for a second here..
do you really think for a second that the pharmaceutical groups responsible for this class of drug do not have the facilities to ramp up production?
They absolutely do -- the problem here is that since it's a gold-mine there is even more cash capture to occur with an added scarcity element, hence the price adjustment.
The price adjustment wasn't to champion the diabetics over the obese, it was to make more MONEY.
You are among the people just learning about this class of drug. It's been around since 2004 (Byetta). I've been taking it since 2012 (Victoza). Even then, it was known to promote weight loss (Saxenda approved around 2014).
This is not a new hotness. And many diabetics have used this drug class for a long time.
And yeah, you're jumping into conspiracy theory. Ramping up production would likely take significant investment. Do they have the resources? Probably. But given the weight loss benefit is temporary (seriously, it is, ask anyone who has used one of these drugs for a significant amount of time), do you think they're going to sink significant investment into production when demand is going to wane in a few years? Well, you see, their investors are going to say no, and they hold the final say.
"Diabetes patients think people with obesity are stealing their drug, as it’s currently only approved for the treatment of T2D (though FDA approval for the treatment of obesity may come as soon as this summer.) People with obesity are angry that obesity isn’t recognized as a disease. And users who can’t afford it say they’ve been abandoned by Big Pharma."
Always amazing when an article is verified in real time
It's weird for anyone to "feel abandoned by Big Pharma" when you abused a coupon to get a drug for off-label use, and terms were changed to match its on-label use. Especially when there's versions of these drugs with on-label use for weight loss.
Brand new drugs tend to take a while to get on insurance formularies. I believe Mounjaro is still missing in most formularies. Lilly wants people on their drug, not the competition.
This is not only an American issue. I've seen people in the UK struggle to get access to treatments and devices through the NHS. Canada tends to follow what the US is doing even though they have their more socialized system. It all tends to be a bit of a mess with brand new drugs and devices. And Mounjaro is new as of last year (approval less than a year ago?).
No, drug approval takes time everywhere with a health care system. Heck I've been on methylphenidate for my ADHD for almost 15 years now, and it's still off-label when prescribed to an adult in the UK according to the NICE.
> If you want a GLP-1 RA (this drug class) for weight loss, go get Wegovy or Saxenda, which are a version of these drugs approved for weight loss for those with a BMI over 30, or wait for the tirzepatide version. Leave the diabetes drugs alone.
Definitely think it's forgiveable and even rational to be upset that droves of people are creating shortages of a medicine you need with off-label use, however legitimate.
I'm not saying that the feelings are unjustified. I just thought it was interesting to see the article confirmed so quickly. If I needed a medication intendeded for my illness and couldn't get it I would feel the same way.
With very few exceptions obesity is simply the result of eating more calories than needed for a long time. Very obese people eat a LOT of food. 10,000 calories/day for years is not uncommon.
Thermodynamics obviously holds, but I'm unsure what you implication is. If it is that the obese should simply eat less, that doesn't seem terribly useful though it is completely true.
The implication is that obesity is not a disease, it is actually the human body working as intended by storing the excess energy as fat for future use.
A friend that is a doctor specialized in metabolic problems told me that around 5% of the cases of obesity have some medical cause, not eating too much. 5% is low, but it is a lot more than "very few exceptions". (Disclaimer: the number is for Europe, I have no idea what is in US)
Technically right is the most reliable kind of right, but in this case “too much” means that someone’s body responds differently than expected to the same amount of food.
It’s true that the extra stored fat might must come from calories not used or excreted elsewhere, but that might be because their body is very poor at making immediate use of the calories as energy or is unusually efficient at storing energy that might otherwise be used. To put a number to it, a 2000 calorie diet as normally recommended may leave them depleted of energy and increasingly fat.
It can take years to discover that kind of “outside the norm” issue, and obesity can easily set in before its recognized let alone addressed. And of course, once obesity does become a part of someone’s life, there’s a whole spiral of challenges that make it hard to overcome. Even moreso when your body doesn’t work normally.
Well, blood sugar contains energy that has to come from somewhere, too, but one would hardly say this means type 2 diabetes is fundamentally caused by eating too much. Shoot, tumors contain energy that has to come from somewhere...
Of course, you could rightly reply that there are a lot of complicated things that happen between the food and the problem, and while those diseases require an energy surplus, that neither causes them, nor does trying to naively eliminate the energy surplus fix them. Contrary to popular wisdom, the same is true of obesity.
The idea that obesity could be avoided or cured with a little bookkeeping and self control is laughable to just about anyone who has tried. Telling obese people to eat less is like telling depressed people to get over it. You'd be astonished by how ultimately impossible that is if you haven't been there.
Type 2 diabetes is fundamentally caused by eating too much of carbohydrates. Most type 2 diabetics can put the condition into remission by changing their diet.
There are many people who have cured their obesity with a little bookkeeping and self control. Sue Reynolds and David Goggins are a couple of prominent examples, but there are many others. It's not easy, but it's certainly possible.
> Type 2 diabetes is fundamentally caused by eating too much of carbohydrates. (Emphasis mine)
Fructose, specifically, is the going theory. And I'm a big fan of Virtahealth specifically, and Dr. Fung's approach for treating type 2 diabetes generally. :)
However, I'd disagree that we know that that's what causes it. We know that treats it. Cancer is not caused by a lack of chemotherapy, and I think chemotherapy is a good analogy for the fasting and low carb approach in this situation. It is a treatment, not a generally normative lifestyle.
But my point is actually more limited, and you actually sort of made it for me by adding the detail about carbohydrates. To wit: just because sugar requires energy, does not mean that you got too much sugar by bringing in too much energy. It's not that simple. You won't get the disease by eating too much protein, for example (you'll get protein poisoning ;) ). You get the disease as a result of liver dysfunction, which you exacerbate and possibly cause by eating too much fructose. It's a control mechanism problem and an injury problem -- the fact that energy is involved (even required!) does not make that the central issue.
Cancer requires energy for growth, but that doesn't make energy the central problem. Blood sugar requires energy for dysregulated high levels, but that doesn't make energy the central problem. Fat requires energy for dysregulated growth, but that doesn't make energy the central problem. That's something you have to demonstrate, and rigorous attempts to demonstrate it fail.
> There are many people who have cured their obesity with a little bookkeeping and self control ... David Goggins
Citing David Goggins as an example of "a little bookkeeping and self control" is hilarious to me. I've read his book. I love his talks. But the guy is about as heroic and extreme as it is possible to get, and that is far from the only thing he did.
I have yet to see a type 2 diabetic who didn't eat excessive quantities of carbohydrates before developing the condition. The details of the exact causative mechanism are interesting, but largely irrelevant from a prevention perspective.
My point is that David Goggins is nothing special. He isn't a superhero from the planet Krypton. Anyone can choose to do those things (or at least lesser versions of them). Some people just prefer to sit on the couch eating cookies.
The entire purpose of fat is to store excess energy for future use because over human evolution food supply was unreliable enough for this to create an evolutionary advantage. Getting fat from eating a lot of food is completely predictable.
"The idea that obesity could be avoided or cured with a little bookkeeping and self control"
It absolutely can. Again people just don't want to feel bad about not having enough self control.
It can’t. There are many people who, if they simply scaled down their diet without otherwise modifying their nutrient intake/lifestyle, start having health problems well before they lose weight. Hot flashes, fainting, severe stomach pains, nausea.
This sounds false to me. I suppose for someone used to eating 10 to 20 thousand calories per day suddenly going to 1500 would be stressful but if gently tapered no one should have any issues.
I mean the obvious counterexample is someone who eats 1500 calories of real food and 2500 calories of junk food a day. If you scale that down by half you start getting all sorts of nutrient deficiencies well before hitting your target weight.
But there are subtler versions of this. People who live in food deserts, only have access to iceberg lettuce and freezer-burned tomatoes as produce are gonna have a tough time getting all the nutrients they need in 2000 calories or less. There’s also others who have very specific dietary needs that they’re not yet aware of.
> The entire purpose of fat is to store excess energy for future use
That isn't true. Though it's a primary use, the opening paragraph of the wikipedia article on fat outlines that it actually has many biological functions (and is properly thought of as an organ!): https://en.wikipedia.org/wiki/Adipose_tissue
> ... because over human evolution food supply was unreliable enough for this to create an evolutionary advantage. Getting fat from eating a lot of food is completely predictable.
Not at all. While fat does have a primary function as an energy reserve, that does not mean that unregulated growth is a simple matter of putting too much energy into the system. After all, just as in nature there are times of famine, there are also times of feast. It would be pretty disadvantageous for animals to have no regulation on their fat growth in times of abundance. Something more has to go wrong to cross the line from "saving for a rainy day" to "killing you". Animals don't eat until they damage their stomachs, do they? Not generally. Why does it make any more sense that they should eat until they damaged their endocrine systems?
An interesting counterpoint: bears hibernate. In preparation for doing so, they become fat by eating a lot. Now, they do this, not just any time of the year when food is abundant, but specifically in the fall as they prepare for the winter. Are they just lucky that food happens to be abundant every fall? Or is something else going on? What happens in years of famine? Do they still manage to get fat so they can hibernate?
Another interesting counterpoint: Pregnant women eat a lot and put on weight. Why do they do that? Is it because more food is available? Or is something else going on?
One last counterpoint. Bodybuilders put on a lot of muscle, which also takes energy, and they eat a ton to support that growth. Why is it that if I eat an extra steak, my flab gets bigger, but when Ahnold eats one, his biceps get bigger?
Obesity is dysregulated growth. While growth does require energy, it is in the failed regulation of that growth that you will find the best explanation for the disease.
" It would be pretty disadvantageous for animals to have no regulation on their fat growth in times of abundance. Something more has to go wrong to cross the line from "saving for a rainy day" to "killing you". ""
I really can't blame you for assuming this, but it actually turns out that food was scarce enough in human history that humans never actually evolved a limit on how much fat we will store. If we keep consuming a caloric surplus the body will keep creating fat to store it. This is the body working as intended. Things would be different if humans had a more reasonable max body fat percentage.
Anyone can build muscle instead of flab if they do sufficient resistance training and eat enough protein. Gains will tend to be slower for women and older people. Arnold Schwarzenegger used a lot of steroids and other PEDS which can certainly accelerate gains, but aren't worth the side effects and legal risks for most people.
>>"The idea that obesity could be avoided or cured with a little bookkeeping and self control"
> It absolutely can.
No it can't. ;)
Well, not always. I've experienced both sides of this: an effortless loss of 60 lbs with easy diet changes and bookkeeping over the course of a year and a half. And a few years later, an abject failure as the same strategy -- a moderate calorie restriction -- resulted in such profound physical distress that I developed psychological problems long before I made any physical progress.
Sometimes it's easy. Sometimes it's impossible.
My story is far from atypical. It's common. Practically universal. Everyone, just about everyone, who tries to lose weight, using any strategy, succeeds over a period of months, and fails over a period of years. The reason is that the underlying control mechanism is in a different condition, in different people who may be the same weight.
> people just don't want to feel bad about not having enough self control.
I know you're really attached to the energy imbalance theory of obesity. People often are. But I'd like to suggest that this comment suggests you may have a different motivation for believing in it than just that you find the evidence persuasive.
I often wonder why people get so attached to a theory that I think is in such obvious evidential crisis. A need to believe a simple solution will be there when they need it? A traumatic dieting experience that they need to believe was necessary and useful and healthy? Maybe it worked for them once and they're universalizing their experience? A desire for moral superiority? The fact that deliberately oversimplifying things makes for slam dunk messages on forums?
I don't know, but diet is one of those weird topics where people are attached to their opinion with the religious fire of a thousand suns. While I know I won't change your mind, it does seem fair to point out that your statements are both hyperbolic and inaccurate, and that's not a good sign.
"I know you're really attached to the energy imbalance theory of obesity. "
It isn't a theory, it is a fact. It is basic thermodynamics. The human body requires a constant amount of energy for basic operation and activity. Any excess is stored as fat for future use. Creating fat requires calories that HAVE to come from food. Eat few enough calories and you WILL lose weight. Eat zero and you WILL die. Eat 20,000/day for a year and you WILL get very fat.
A good example of this is this man went 382 days without eating
He had a calories surplus for long enough to weigh 207kg. While not eating his body consumed energy in his fat to stay alive and he got down to 81kg. ((207-87)kg * 7700 calories/kg)/382 days = 2539 calories/day, which is a very plausible number.
The problem, which I can't work out if you know about but ignoring or are ignorant of, is that humans have inordinately strong control systems to maintain some state, as well as hugely influential effects from e.g. a gut biome.
To say "it's just thermodynamics" might be right as far as the physics goes, but it doesn't recognise that biological drives overwhelm everything. It's hugely complicated how energy expenditure and steady state energy consumption interacts with weight gain, not least because the body will invariably work to make your actions as efficient as possible to maintain weight. For example, observational studies of hunter societies that might travel large distances daily, energy requirements bear little relation to daily activity after any transition time has elapsed when compared to relatively inactive Western counterparts. These people can't just will their activities to be less efficient if they hypothetically wanted to consume more energy.
Ultimately, the biology will decide what the effect of any intervention is, regardless of how motivated or not you are. Any advice that doesn't explicitly factor that in is just hot air.
This is absolutely false. The human body must always consume a minimum amount of energy for basic maintenance. See https://en.wikipedia.org/wiki/Basal_metabolic_rate. While it does vary it also has a hard lower limit.
The basic metabolic rate varies between individuals. One study of 150 adults representative of the population in Scotland reported basal metabolic rates from as low as 1,027 kilocalories (4,300 kJ) per day to as high as 2,499 kilocalories (10,460 kJ); with a mean BMR of 1,500 kilocalories (6,300 kJ) per day.
When I typed that I was thinking of the basal metabolic rate, which is relatively constant for a person. Think of it as the calories a coma patient would need to stay alive.
Calories In Calories Out (CICO) doesn't explain obesity. You are dealing with biochemical machines (humans). CI enters this biochemical machine; here, the signal system should be effective to 'equalize'. Otherwise, you get all kinds of problems: obesity, t2d, cardiovascular events, etc.
These new generation of drugs (semaglutide, tirzapatide) deal with the signaling system (endocrine signaling, that is).
"Calories In Calories Out (CICO) doesn't explain obesity."
Yes it does, because it is basically just repeating basic laws of thermodynamics. Obesity is actually just the body working as intended by storing the excess energy for future use during a famine. CICO is why obesity used to be very rare in past when calories were expensive and is now common when calories are very cheap and artificially delicious.
Well, two conceptions of human beings are in conflict: (a) humans are controlled by their own "will" (b) signaling system (biochemical interactions) control stuff. (a) is a cultural intuition. Now many life sciences researchers sell us a hybrid version: both (a) and (b) are true.
I very much doubt the accuracy of calorie consumption data that article is based on. CICO is so fundamental that I would propose that the current rate of obesity is proof that average net calorie surplus has increased.
I agree with you, but have a few qualifiers about it.
I decided I want to lose weight for the third time in my life. A few weeks I was probably eating 5,000 calories a day. I’ve lost 15 pounds in three weeks. Basically before every day I’d eat and eat and never ever feel full. My stomach would hurt, I’d throw up every day, I felt tired and shitty every single day.
Now I can barely managed to eat 1400 calories a day. I’m eating red meat and kimchi, basically. That’s my diet. Once a week I’ll crave a nice big salad with mushrooms and olives and ranch dressing. I feel great. If I try to exceed that calorie amount I’ll feel super satiated (not full, like physically full) and stop mid bite, and save the rest for later. It feels like a long dormant part of my mind that controls calorie intake suddenly has a voice again and that voice has been drowned out for years.
So I mean it’s easy to say “it’s just calories”, but why when I eat a standard American diet am I craving thousands of extra calories per day and that stops when I eat like this? Even stranger, why do I relapse into these habits when I eat even a small amount of food like French fries or ice cream, over and over again? I know precisely why I’m fat, exactly what to do to lose weight, it’s not even difficult, but unless I have a very strong motivation to lose it I just don’t.
Most people don’t even have the requisite knowledge of how to deal with hunger cravings and get themselves in a state where they’re losing at all. They’ll eat chicken breast and a salad with no dressing then wonder why they feel awful because they’re not getting nourishment, then binge on ice cream. So how is the average person supposed to lose weight?
From high school through nearly all of my adult life I’ve been obese. For the last several years my weight has barely fluctuated, but it’s fluctuated between caution about being underweight and a few pounds “overweight” that barely even count. I’ve eaten almost exactly the same the whole time. The two factors which changed:
- I take ADHD meds, amphetamines, which are appetite suppressants. They haven’t made me eat less, and they’ve reinforced “bad” eating habits I used to have before I lost so much weight, specifically reinforcing my tendency to eat one, large, meal per day.
- I’m much more active than I used to be, because I got a pup who needs the activity and with whom I like to be active.
My caloric intake is about the same as it’s always been. Once I actually paid attention to it I realized it wasn’t even very high. I very seldom reach the recommended 2000 calories diet metrics are based on. I still don’t understand how eating that way made me obese, but I have to assume now I was just absurdly sedentary.
I got lectures like this about caloric intake for years and always found it interesting but confusing! How was I so fat and never eaten much?
I’m not saying this applies to anyone else, but it’s bothered me for decades that I’d been told calories in -> obesity meanwhile my own caloric intake had next to nothing to do with my body mass.
Odds are you are consuming more than 2000 kcal/day. Most people underestimate. Have you tried weighing and recording everything you consume for a couple weeks?
Anyone who wants to lose weight should start with a resting metabolic rate test in order to establish a baseline. You just sit in a chair for a few minutes while a machine measures your inhaled and exhaled gasses to calculate energy expenditure. If you consume fewer calories than your RMR then it is impossible to not lose weight.
This is a confusing response. I do not want to lose weight. I had to pay more attention so I could stop losing weight. Your advice might be good for someone with a different problem, but (1) I don’t have that problem and (2) I addressed the problem I did have by eating more.
People are notorious for underestimating how many calories they are eating. Modern food is so cheap and delicious it isn't hard to eat 1000 calories in a few minutes. I lost weight by only eating food with accurate calorie information available that I could weight to the gram. I then used MyFitnessPal to track it and keep a 1000 calorie/day deficit.
I’m eating basically the same food, basically the same quantities, and I did start paying attention to the calories. Amusingly I started paying closer attention when I was worried about losing too much weight, and when I found myself frequently craving sweets (which I very seldom have since I was a kid).
The simple act of tracking things - even with no intent to change - typically makes me eat far less, or do the activity far more. Anecdotes with friends makes me believe this is quite common.
There is literally no way to take in more calories than you expend and not gain weight - short of hyper-specific and exceedingly rare medical conditions you'd be quite aware of.
Some people find this easier or harder than others due to a whole host of factors. Physics is physics though, and there is no way to run a calorie deficit and not lose weight. It's why this drug class is so interesting/popular - it lowers the bar for many people, making the effort of taking in less calories than they expend much easier to achieve.
> The simple act of tracking things - even with no intent to change - typically makes me eat far less, or do the activity far more.
When I started tracking things so closely, I was already concerned that I’d been losing weight and feeling very strong cravings for sweets which I don’t usually care for. The effect wasn’t that I ate less: I started making an effort to eat more, again much like I used to eat. The biggest change is that eating enough has been a concerted effort rather than fairly automatic.
I reached about 350 lb, and my current weight is just shy of 190. I’m eating almost exactly the same, with some minor adjustments for taste changing over time. What I eat now would still be ill advised for anyone trying to lose weight. The thing that changed is I burn a lot more calories than I used to. Everyone pointing out this basic fact is right, but the focus on calories in is wrong in my case, and I find it pretty odd to totally dismiss the calories burned factor.
No one is dismissing calories burned, it is the calories out part of CICO but it is vastly easier to reduce caloric intake than to increase caloric burn. as an example for me it takes an hour of walking to burn 400 - 600 calories.
1 in 3 people in the US are obese. It is not just about eating more calories than needed for a long time. The story is much much more complicated then that given that 1 in 3 people are obese.
It's like saying an overdose on heroin is simply someone doing too much heroin at a time.
"It is not just about eating more calories than needed for a long time."
Yes it is. It really is as simple as that, people just don't want to hear it. Historically food was scarce that it was nearly impossible to sustain a calorie surplus long enough to get fat. But some people did, that is why the rich used to be called "fat cats" but now calories are so cheap and delicious and lifestyles are so sedentary that it is very easy for almost anyone to sustain the caloric surplus needed to become very fat. I had a cousin who reached 650 pounds and then died. He would spend hours every day eating and almost as long shitting.
>Yes it is. It really is as simple as that, people just don't want to hear it. Historically food was scarce that it was nearly impossible to sustain a calorie surplus long enough to get fat. But some people did, that is why the rich used to be called "fat cats" but now calories are so cheap and delicious and lifestyles are so sedentary that it is very easy for almost anyone to sustain the caloric surplus needed to become very fat.
I'm skinny so I'm unbiased. There is nothing I "don't" want to hear because I'm literally not affected by it. Thus, I assure you I have more information than you. Read below:
Your reasoning is on anthropological timescales, which while technically true, doesn't explain why people were still skinny in the 80s and before. There was an actual turning point AFTER the 80s... A huge shift in weight gain where MODERN and well-fed people suddenly got heavier. Something happened with the food supply starting with the US.
We only have correlative studies that match a number of things with the sudden change in weight. Thus no causative confirmation on the exact source. Our educated guess says that it has to do with processed foods. Processed foods streamline calorie absorption to unnatural levels leading to unnatural weight gain.
The article above mentions a number of other factors that I think are possible.
But a reader questions the methodology of the researchers: “My main concern is that the calories are almost assuredly self-reported, which is notoriously unreliable.” Another reader agrees:
In the 1980s, we weren’t walking around with a computer in our pockets to look up accurate calorie counts for everything that allowed us to store an accurate list of everything we’ve eaten and compute the calories based on that database. It was 100% self-reporting and calorie lookups “from memory” or done manually (complete with calculations) long after the fact. So the reports based on that old data might be suspect.
But another reader notes:
The study authors addressed that point somewhat:
Whether self-reported dietary intake accurately reflects an individual’s true dietary intake has been questioned. Indeed, doubly-labelled water studies typically show that individuals underreport their energy intake, and that the magnitude of the underreporting may be larger in people who are obese.
Lots of stretching of the imagination here in attempt to fill in the gaps in your bias. I mean you had to dig for this stuff in order to support your stance. Why not let the facts change your conclusions as an unbiased person should?
The fact of the matter is, people weighed less in the 80s then they do today. No amount of stretching can change this quantitative measurement. So something must've changed. What changed?
You can continue to talk about calories in and calories out just like we can blame the overdose problem on people doing too much heroin. Again, while YOU can do that, it's not a very useful position.
"The fact of the matter is, people weighed less in the 80s then they do today. "
Because they ate less. Portions were smaller, Food wasn't marketed as much.
"No amount of stretching can change this quantitative measurement."
Self-reported calorie intake is not a reliable quantitative measure.
"You can continue to talk about calories in and calories out just like we can blame the overdose problem on people doing too much heroin."
I really don't understand why you think this statement proves. A heroin overdose IS caused directly by an excess amount of heroin in a given time interval, just like obesity IS caused directly by excessive calories in a given time interval. The time interval for obesity is years instead of hours.
Heroin and obesity are indirectly caused by people getting addicted to the dopamine levels consuming them cause.
You sound a tad like a 9/11 truther insisting on some over complex conspiracy theories to explain something fairly straightforward.
>I really don't understand why you think this statement proves. A heroin overdose IS caused directly by an excess amount of heroin in a given time interval, just like obesity IS caused directly by excessive calories in a given time interval. The time interval for obesity is years instead of hours.
This is the part you're not getting. You DIRECTLY say you don't understand here, and I am here to confirm that you in actuality DO NOT understand.
A heroin overdose IS directly a result of too much heroin within a time interval. But that answer is too obvious and PEDANTIC. You would be stupid to characterize the opiate epidemic as just people doing too much heroin and that they should do less to improve their health. "Yeah that's the problem with opiates in America, people doing too much of it, I know you guys don't like to hear it, but it's the truth. Just control yourself and do less"
Obviously it's more than that. There's a problem with tolerance, with addiction, the fact that opiates were introduced as addictive pain killers by Purdue Pharma under the name Oxycontin. The story of heroin is much more then the completely idiotic characterization of just "doing too much."
So to bring it back around. The the situation is MUCH more complex then people eating more and becoming fatter.
>You sound a tad like a 9/11 truther insisting on some over complex conspiracy theories to explain something fairly straightforward.
I'll just be blunt. You sound like a fucking idiot for regurgitating something SO OBVIOUS. Look, you're not actually an idiot, so stop acting like one and stop calling me a 9/11 truther.
What's even stupider is that when I tell you that while TECHNICALLY more calories in does make you fatter there's clearly something else going on. Do you see the connection with the metaphor here with heroin? Heroin isn't just about people doing too much of it. There's many underlying reasons here for WHY something happens.
I have experience in this area with people who are overweight. Even the simple answer of calorie density in processed foods increasing due to industrial food manufacturing after the 80s leads to fatter people is a better characterization here.
However that answer above ^^ is inline with your simplistic calorie in-out logic so maybe that explanation can help you "get it".
"I'll just be blunt. You sound like a fucking idiot for regurgitating something SO OBVIOUS"
First, don't be so rude. You think what I'm stating is obvious but there is an entire industry built to deny it. Even on this thread there are people who deny it.
Don't be rude? You compared me to a 9/11 truther. We're done here. I'm rude in response to your rudeness. I'm wrong though, I shouldn't be rude in response to you.. The proper thing to do is to end the conversation. Good day.
Your explanations are simplistic you fail to see nuance and complexity within reality. I find your outlook on things to also be delusional. You think things are simple and well understood but that's just a reflection of your ignorance.
Not trying be insulting or anything like that but this is just what it is.
Just to drill it home. How stupid does a person have to be to think that comparing someone to a 9/11 truther isn't rude? You have to be pretty stupid.
> Mounjaro is not an obesity drug. It's a type 2 diabetes drug. Do not call it an obesity drug
This is an absurd argument. It's a drug. It has specific metabolic affects in humans that are valuable to people's health, among which are the control of blood glucose levels, and control of appetite and nutrient uptake, leading to loss of excess weight. That it is currently labeled only for Type 2 diabetes is a marketing decision by the manufacturer, not a characteristic of the drug.
Or, to put this another way: the drug is doing exactly the same thing whether you measure its effectiveness with a glucometer, or with a bathroom scale.
> That it is currently labeled only for Type 2 diabetes is a marketing decision by the manufacturer, not a characteristic of the drug.
Regulatory approval. It is a diabetes drug because it has been evaluated as such, including understanding the primary effects and side effects at various dosing levels. Mounjaro is prescribed to diabetics from 2.5mg to 15mg in increments of 2.5mg and titrated based on needs and goals.
Typically, weight loss versions of these drugs (Saxenda and Wegovy) are dosed higher than their diabetes counterpart, and are just titrated to maximum dose over time to maximize weight loss benefits. So evaluation is based on this, and approval follows this.
Various drugs do get used for off-label purposes, but the drug makers can't promote this because their marketing claims are regulated. This is why the coupon terms were changed.
Coupon terms changed because drug makers can't promote this? Can you help me understand why the ability to promote would have any bearing on a coupon's terms?
Allowing the coupon to be used for the treatment of obesity is an implicit approval for the drug to be used in this way, and coupons are a form of marketing. Lilly cannot approve nor market this drug in a way that is off-label. This is why when Lilly talks about testing tirzepatide for weight loss, they say tirzepatide and not Mounjaro. Whenever you see articles mentioning Mounjaro for weight loss, these are statements not originating from Lilly.
Mounjaro will have FDA approval for obesity this year. GP’s dogmatic stance that “Mounjaro is not an obesity drug!!” is soundly rejected by the available evidence.
Mounjaro will never be approved for obesity. The documentation for dosing is for diabetes. If the trend follows with how Novo Nordisk has released their versions of this, dosing for weight loss will be different than dosing for diabetes care, and so it must be under a whole new label.
Mounjaro is a trade name for a diabetes drug and that won't change. So no, it is not soundly rejected.
It's not as simple as "SQUIRT JUICE INSIDE ME GET THINNER AND CURE DIABETES". There's a lot more to this than you seem to understand.
Tirzepatide will have FDA approval for obesity this year. GP’s dogmatic stance that “Mounjaro is not an obesity drug!!” is overwhelmingly rejected by the available evidence.
Sometimes you need to examine subtext a little closer.
Obviously this person is (reasonably) upset* that off-label use is muscling out on-label use, when the two uses are of two very different classes.
Their issue isn't just the fact that the common vocabulary has switched to focusing on weight loss, it's the general shift in where the supply is going that's accompanies said shift in vocabulary
Being overweight is a serious health issue, but Type 2 diabetics were using it in a way that was much more acutely pressing, with much fewer alternatives. It's not hard to understand why diabetics would feel upset/threatened by a secondary off-label use of such a different class.
* I read it as upset as the situation, not at those who are overweight to be clear
I'm aware that you're upset because of shortages in the medicine you need.
I think your beef should be with the pharma company seeking to maximize profits by constraining supply such that they are easily overwhelmed by off-label use, not with people seeking effective medical treatment.
There's a common meme among what I've seen from diabetics complaining about the shortages: that this is a tik-tok thing, or prompted by some celebrity, and the medicine is being take by people trying to lose ten lbs. I don't think any of that is true. Doctors are prescribing this for people who have medical conditions that make them dramatically overweight. My mother found relief from lipedema after decades of pain thanks to mounjaro, and she's facing the same shortages you are. She's done the half-doses and the quarter-doses and stretched them out until the pain came back.
Mounjaro is the best drug for a number of conditions, both the approved diabetes and some number of not-yet-approved conditions. Eli Lilly is maximizing profits in a way that leaves people with Type 2 diabetes and other painful conditions suffering. There's no need to blame social media for Eli Lilly's shortcomings.
How many? Enough to make this comment anything other than a meaningless anecdote?
I'm over 375lbs and nobody will prescribe it for me.
There's my counter-anecdote.
There are online providers that are effectively just pill mills for these drugs if you're actually interested. They're' expensive though... https://joinnextmed.com/weight_loss
How tall are these <150lbs people? How old? Are they men or women? Do their doctors think they show signs of possibly getting diabetes in the future? Obviously if there's a 5'10" 25 year old male with negligible risk of diabetes, they should keep their current weight or even increase it slightly by changing their body composition from majority fat to majority muscle by doing exercise. If someone's short, old, can't exercise for some reason, and might get diabetes at some point, there could be a role for a drug there.
pharma company seeking to maximize profits by constraining supply
They have a monopoly on the drug, what's the evidence they are constraining supply? It makes no sense, the price is set, the more they supply the more money they make.
I think what's meant here it's that the manufacturer chose to target specific patient groups (T2D) and commercial insurances to get the highest profit per dose.
About 40% of adults in the US are obese, they could have made the drug available at much lower cost and get their profits from economies of scale. Instead, the production is low and the focus is narrow.
It's not always the case that production is made intentionally low. There are actual limits to how much times a chemical/biochemical production process can be run in a given year. I'm actually learning this the hard way with one biotech project.
The alternative might be a $200 million dollar production facility which may not even be feasible to cater to the excess of consumers. Or which may be too excessive for the excess of consumers targeted.
They also probably don't want to put significant investment in boosting production knowing that will be temporary since the weight loss effects aren't permanent. As someone who has been on GLP-1 RA for a decade, starting with Victoza, and now on Mounjaro, those weight loss benefits have no effect on me anymore. Delayed gastric emptying and appetite suppression is so far reduced that it might as well not be a thing anymore. But I don't use this drug for weight loss, I take it for glycemic management, and it still works great for that. I have to do the work to continue my weight loss and maintenance.
Yeah, these drugs aren't new but the wide world is just learning about the weight loss aspect. So they don't know this is a temporary solution.
I feel like you're splitting hairs. The intended purpose of GLP-1 drugs is to improve A1C in existing diabetic patients. Weight loss is directly correlated with that, because if your body is properly expending glucose, then the excess will not be stored as fat, or sit around in your blood stream in the case of diabetics.
Do you even know what A1c is? Or how GLP-1 RA achieves this goal?
GLP-1 RA does NOT achieve a reduced A1c through weight loss. It achieves improved glycemic control by slowing the release of glucose into the blood as well as promoting increased production of insulin in response to glucose. The overall result is a reduction in blood glucose.
A1c is a measure of your glycemic health that spans around 90 days with heavier weight on more recent trends. It's like a longer blood glucose average measurement. There are actually algorithms that can calculate an estimate of your A1c based on blood glucose trends, which is referred to GMI (glucose management indicator).
The gastric effects leading to feeling full sooner and longer are a side effect and is what leads to weight loss. It also fades with time. Having been on various GLP-1 RAs over a decade, they don't provide this benefit to me anymore. Even with Mounjaro also being a GIP, it's just doing its primary job for me.
Is artificially partitioning what is almost certainly the same medication (with the same manufacturing process) into two separate product lines actually a Good Thing? This means that when Mounjaro has supply problems even with the split, diabetics won't be able to get it because part of the supply is inaccessible to them since it is dedicated to a different "product".
Instead we should advocate for the real solution, which is to demand the manufacturer drastically increase production - Mounjaro along with Semaglutide have literally capital-S Solved one of the most urgent health epidemics of the 21st century, and the solution isn't to shame people for using it, the solution is to make it available to anyone who needs it.
I'm quite certain a large fraction of the HN userbase still believes that people can do independent business without being forced along one direction or another.
Significantly increasing production for a temporary benefit is going to require significant investment. Since it is a temporary benefit, it's probably not worth that significant investment. Because eventually the demand will falter.
And yeah, the weight loss benefit is a temporary benefit. It may last a few years, but it fades. This is not a new drug class. The weight loss aspect to it is also not new (Saxenda, the weight loss variant of Victoza, released in 2014). Liraglutide was in trials for weight management when I started Victoza. That was a decade ago. I'm on Mounjaro now for glycemic management and it works great for that. But it's not doing anything for appetite, delayed gastric emptying, etc.
Tirzepatide is in testing. The weight loss variant will not be called Mounjaro. If they follow similar patterns from Novo Nordisk with Saxenda and Wegovy, dosing will be different for the weight loss variant, which means it won't carry the same label.
The manufacturing process seems to be reasonably efficient. See "Kilogram-Scale GMP Manufacture of Tirzepatide Using a Hybrid SPPS/LPPS Approach with Continuous Manufacturing"[1] Yields are apparently good. There are drugs which require many processing steps with low yields at each step, and those really are expensive to make. But not this one, it seems. A kilogram of the stuff is about 100,000 to 200,000 doses, so this is not an inherently expensive material.
These new weight loss medications are the solution to obesity. Imo this is one of the biggest medical advances of the century and at least in urban areas of wealthy countries, I don’t think we’ll see obese people anymore in 10 years.
The pharma companies realized they’ve got something truly revolutionary so they took the old tried and true drug dealer strategy. Get ‘em hooked for free/cheap and then bump the price to capture the value. Can’t say it’s surprising, they’re just following the incentives. And as the link goes through, these drugs have the potential to be worth many billions of dollars over their lifespan.
Are they the solution to obesity? I'm curious as to whether the weight stays off long term. 10 or more years at least or else it's just another bandaid. What we need is better access to nutritious food that doesn't take up so much of folk's scant downtime and tight income. I understand there's lots of reasons people are obese that aren't just laziness, but the drug doesn't solve those either. They're still not getting the nutrition they need. It's an improvement having poor nutrition with a lower BMI rather than poor nutrition and their current BMI, but not any kind of solution in my opinion.
Depressed people take ssri’s their entire life. People with ADHD take adderal or the like. I don’t see any reason to think of obesity as a different type of disease. Some people just find it extremely difficult to keep off weight, it doesn’t matter what kind of food they’re eating. Yes they could eat less, just like I could keep my thermostat at 45 in the winter to save on my heating bill. But that’s not a realistic solution for most obese people.
> I don’t see any reason to think of obesity as a different type of disease.
Because it's man made and completely avoidable. Look at tobacco for example, it was the exact same thing until it wasn't because we woke up and decided to act on the issue
Helping currently obese people to get out of the loop is good, breaking the system we built that make more and more people obese would be better.
Also, being obese is only a part of the complications of eating shit and not exercising, the rest of the symptoms will catch up eventually, there are no magic pills
> breaking the system we built that make more and more people obese would be better.
The system exists because people like it. I don't think it's possible to break it at this point considering how people normally react to having their life made worse. You can't stop people from eating what they want, but these drugs make it possible to change what they want.
> You can't stop people from eating what they want,
You can certainly stop advertising junk food to kids, that would be a good start. You can also regulate things you know, like not having your entire daily sugar requirement in a single can of soda
Btw if you still eat the same garbage you'll still absolutely wreck your body, obese or not, you'll need a diabetes pill, a cardiovascular disease pill, a blood pressure pill, a kidney boosting pill, &c. You are what you eat, quite literally.
If the weight stays off even after 10 years on the drug, then that's great in my book. Nicotine, caffeine, and bariatric surgery all reduce your appetite in the short run, but your body eventually adapts and your weight starts climbing again. Until we've got more than a couple years of data, I'm not holding out hope that this drug won't eventually lose its punch for maintaining a lower weight.
The main problem to my mind is that cheap, easy, accessible foods are high in both fat and carbs. Fat is satiating, but super calorie dense. Carbs are less calorie dense, but spike your blood sugar. After your blood sugar levels drop, your body signals that you're hungry again in spite of the fact that you've eaten plenty of calories. So now you're starving again and you've surpassed the number of calories you can reasonably utilize without storing it as fat. Add in the fact that evolution hasn't even begun to catch up with the current situation where calories are not a scarce resource (in the US and similar countries) and your body is screaming to eat while the eating's good. This causes you to comsume way too many calories and nowhere near enough vitamins and minerals.
It's a lot of work to eat right anymore. You're working 40 hours a week if you're lucky, you're exhausted and feel like shit and you may not even be able to afford what you need to be eating to maintain a healthy weight.
And, just to make things more fun, there's 1000 sources telling you 1000 different things about what you should and shouldn't eat to be healthy. Cholesterol is bad for you - wait, no it isn't. Eat whole grains. No, don't, that's sugar! Eat fruit. Oh no, fruit is basically all sugar. No it isn't, it's full of fiber and that cancels out the sugar. Don't eat fats, except unsaturated fats, but those are calorie dense. Vegetable oil is unsaturated, but that's bad for you too in a different way.
It's damn frustrating. If it were as easy as just eating less, no one would be obese. Back to the point of the article, however, I don't think it's as simple as taking a magic pill. How many miracle weight loss drugs have come and gone over the last decade? I'm not holding my breath that this is the one that will turn out to work forever with no severe downsides.
It’s funny because I signed up to get Wegovy shots and still haven’t gotten approval, but I started dieting in preparation and I’ve lost 15 pounds this month. I’m eating red meat and the authentic, bubbly living kimchi from the Asian market that they keep in a stinky fridge separate from everything else.
But people act like I have three heads when they ask me how I lost weight and I answer honestly. They just feel like it has to be a net negative somehow, that it’s not allowed that I eat prime ribeyes (just one, I’m not that hungry m) every night and lose weight.
A month ago I was throwing up every day and eating 5000+ calories per day. I hope I don’t go back this time.
> How many miracle weight loss drugs have come and gone over the last decade?
Realistically, none. These are the only ones that have ever been found to actually work, everything else is either homeopathy or has terrible side effects. I agree that having food that tastes better is the main culprit for the obesity epidemic, but I don't think the answer is making tasty, addictive, food harder to access. Those foods are popular because people like them, they bring people happiness. It absolutely is a lot of work to eat right, but it doesn't have to be with these drugs.
I'm certainly not advocating making those foods more difficult to access. Exactly the opposite, in fact. I think we need to make access to healthier food cheaper and easier.
As far as there being no severe side effects, it looks like semaglutide was looked at for medical use in 2012 and didn't go to clinical trials until 2016. Then there's tirzepatide, which I think is the part that's the big breakthrough recently, wasn't approved for use until the end of 2021. I don't believe we have the data yet to really say that it's safe long-term. I sure hope it is, but this is a very new treatment.
> Or is the argument that the [everything else] to calorie ratio should be higher?
Yep, that.
My understanding of this argument (which for the record, I'm loosely convinced is probably true, but probably isn't the only, and maybe not the main, factor) is that your body's hungry signal is it needs non-calorie nutrients, but our food is less nutrient dense so you get a lot more calories than your body is prepared to handle for a given quantity of nutrients.
If this were right, you could cure your obesity by mixing the right multivitamin into your food? It seems like if fixing some nutrient deficiency were all it took, we’d have figured it out ages ago.
> 10 or more years at least or else it's just another bandaid.
I wonder what the long-term health outcomes would be between two groups: one group that was obese the whole time, and another group whose obesity was delayed by ten years.
I suspect the latter group would end up having fewer negative health outcomes over the course of their life - 10 years of essentially “reduced wear and tear” on different systems in their bodies. That is to say - even if it’s a bandaid, it may still be really useful for public health.
I expect they would as well. However, I was replying to a comment that claimed this drug or something similar could be the solution to obesity and I have serious doubts about that. An improvement in health and longevity, even if it's substantial, is not the same as a solution. For example, if we discovered a drug that delayed severe illness/death from cancer for 5 years, it certainly wouldn't be called a solution to cancer. It would be amazing for sure, but that doesn't solve the cancer problem.
People saying that you have to be on X drug forever to solve your problem as if it's some silver bullet argument think.... what exactly about Type I diabetics who need to inject insulin every day, forever, to solve their problem?
I get where you're coming from and want to clarify that my issue is not that you may have to stay on it for the rest of your life. I'm concerned that even while on the drug, your body could get accustomed to it, and you'd end up eating the same as before taking the drug. This happens a lot with bariatric surgery. I realize that that's due to the elasticity of the stomach, but the body adapts and with many medications that have weight loss as a side effect, your body eventually sorts itself out and you start gaining weight again.
I take Mounjaro. For obesity. I thought back in '05 when I first started learning about DPP-4 inhibitors it wouldn't be too long before we realized obesity/T2DM were aspects of the same whole, but it'd take decades before we got to an effective therapy.
This is pretty much it. Zero side effects (other than the side effects from losing weight too fast, still have to pay attention to diet). We'll see if there's long term pancreatic/other issues down the line; but comparing risk against obesity, I still feel like I come out ahead on risk.
I expect to be taking some low level of a GLP/GIP/next-twincretin/next-tricretin forever. If I didn't now; I figure I'd keep running and dieting and meditating to steel my willpower; continue slighty overeating and slowly gaining fat and insulin resistance. And then I'd still end up taking a GLP/GIP years down the line after I finally developed T2DM.
I'd gladly spend $12k/year for the extra healthspan, and it seems many, many people are prepared to do the same.
…no? Exercising 2h/week (close to the minimum) costs 100 hours per year, at $100/hr that’s close to 10k already and that doesn’t include the attention cost, or anything to do with diet
Every human still needs at least that amount of exercise (and ideally a lot more) to avoid cardiopulmonary disease, age related strength, balance, and bone density deterioration, and a myriad of other health issues, even if we could take a pill to cure obesity.
If you have to do it anyway to have a long healthspan, and it generally has the side effect of assisting in controlling weight, then why lean on the costly drug?
Exercising has nothing to do with weight loss, although it’s still good for you with obvious benefits. Just losing weight is in my experience purely diet if you’re living any sort of standard American lifestyle where you’re really sedentary, or even moderately active. Maybe if you were like thru hiking you’d lose weight from exercise?
This is completely absurd in my personal experience. The amount of long duration, low intensity cardio I do has a massive effect on decreasing my weight with no dietary changes.
Beware personal experience. When I was in my 20s and 30s your statement was true for me as well. Now in the second half of my 40s, my body compensates for arbitrary amounts of exercise (HIIT+hiking) by increasing my appetite and I reliably weigh 20-30 pounds more than I did when younger. I briefly tried one of the medications mentioned in this article and it wasn't magic: all it did is make my appetite and metabolism operate more like it did when I was 20s/30s.
The Semaglutide patents expire in 2029 and it's already available (borderline illegally) from China via compounding pharmacies. Tirzepatide doesn't expire until 2037, unfortunately.
The solution to obesity is a lifestyle change, or dealing with the underlying (psychological) problems. I'm all for aiding people in their lifestyle changes, through medicine or other means, but there is no drug that can fix obesity. Medicating obesity is like taking pills to make smoking healthy.
This is just the next step in the ultimate dream, losing weight without putting in effort necessary. If you need to keep taking pills to keep your healthy weight, you're just suppressing symptoms of something bigger.
I've never met anyone who just managed to lose lots of weight and maintain their healthy weight all by themselves. Combating obesity requires huge changes to one's lifestyle, with months or even years of feeling (slightly) hungry as a side effect. Very few people have such discipline.
It's not a measure of willing, it's about access to treatment that isn't a nice, quick, profitable pill that you end up hooked on.
But that's the point... These drugs simply make you less hungry. They take what was the herculean task of eating less than your body urges you to and turns it into feeling totally stuffed after 1000 calories a day. It's no longer a question of willpower or suffering all day feeling hungry.
This isn't about morality. Quitting any addiction is objectively difficult and most people need several attempts before it sticks. I have no illusion that you can "just" lose weight.
Making people chemically dependent on a drug to keep themselves healthy is optimising for the wrong solution. It's quick and easy but it mostly serves to keep insurance and drug company profits up.
I certainly believe that these drugs can be useful as a means of gaining an intermediate result (which can significantly reduce the immediate risk of many diseases) during treatment, but that's not how people treat them; people treat them as a magical fix for obesity and that's simply not healthy.
I agree with you regarding the general population.
I also hope we can agree that not everyone attains meaningful weight loss with just diet and exercise. The human body is incredibly complex, with a spectrum of natural compositions, metabolisms, etc. Your post dismissing these nuances risks being interpreted as “thin privilege” (my wife is a Dietitian and taught me the concept).
For what it’s worth, I’m against treating drugs like this as a first line of defense against obesity; it should be seen as the last step before bariatric surgery, and only used under the direction of a competent and ethical health professional.
and many of us can’t take anyone seriously who dismisses nuance in one of the most incredibly complex topics which involve: biology, psychology, economics, etc… as you did in your original post.
There's also an enjoyment asymmetry. I'm 6', 175 lb. If I were 5'2" and ate the same way I'd be fat. My structure gives me the ability to enjoy life more than a smaller person (at least tastewise), and if they eat exactly as much as I do I can tell them they lack self-discipline.
No it's not. You can avoid getting fat by not overeating, but if you do end up getting fat you can cure it with diet and exercise. You can't cure AIDS.
To a first approximation, losing weight isn't possible in the long term. There is enormous social pressure not to be fat. Yet the vast, overwhelming majority of people who try, cannot do it.
This is true, and I frankly don't believe anyone that says there are conditions which make weight loss impossible, since I've lost 90 pounds myself and kept it off by changing my diet and moderating calorie input, a grueling and on-going process.
Regardless, I am very happy to see that there are effective weight-loss treatments that will be available soon, because losing weight is incredibly hard, and it's been shown definitively at this point that something is causing most Americans to be fat (not just Americans anymore either), it negatively impacts their lives, and for one reason or another they are unable to lose the weight without help.
Pro tip, you (some percentage of you) can (for some definition of can) lose weight for free (your mileage may vary) with no drugs at all.
The fact that these drugs exist and work demonstrates the hormonal link that decades of research has shown is there.
Also, the prices of healthy food is much higher than the prices of unhealthy food thanks to subsidies and scale. But that's secondary to the fact that many people actually can't just "eat less" the way others can.
I hope that your ignorance and attitude here is somehow restrained as you encounter people in life, and that you never find yourself facing any sort of medical issue or on any medicine that puts you behind a lifelong eight-ball.
You could read about catabolism and metabolic suppression, or lupus, or lipedema, or just carry on, but please, don't be mean to people in real life.
They’re expecting the insurance companies to pay for it. Many/?most? Insurance companies don’t pay for weight loss medication. They’re likely trying to get people to push for this coverage, which will of course drive up healthcare insurance. Regardless, I’ll pay the $1000/month out of pocket if necessary.
I think it's going to be an interesting fight. By the standards the drug companies want to use, at least 1/3 of the US population might be diagnostically suited for a GIP prescription, which, as current understood, they would have to take every month for the rest of their lives. At $1000/month, treating half that cohort would add 15% to the US health care bill. That ain't gonna happen without a fight.
One of the flaws of our culture is that we madly overrate convenience. We think everything should be as easy as possible. It is taken as self evident but if you spend some thought on it it is hard to escape how important effort and accomplishment are. If we learn how to push ourselves we can take on slightly larger goals every time. Don't take my words as some kind of expert on the topic, if anything it reminds me constantly how damn lazy I am and how much worse it got. What kind of challenge you take up or find yourself in doesn't matter, it is all the same discipline. If I'm not careful the significant other will do all the house chores, cook the food and pay for everything. Imagine how appealing that sounds! This comment could have been a very lengthy article full of good references, the kind I haven't written in a long time. For this audience it could have used programming as it's context. What if after learning to read and write we would all learn to use a cli? Anyone could learn basic SQL and if we ever get the tools sorted out we could all consume API's. Very little effort and a huge reward. In stead some of us have to fight the html forms so that a baby can make very limited use of it. Lets have them type their name and their email and their address by hand? What horrific waste of time?
We already force people to go to school and in some countries you have to join the military but after that we are free to never exercise again and stuff our face with any kind of food we want the year round. If we are financially successful we will never have to use our brain. Can get drunk and stoned every day.... wonderful? You can smoke, drink coffee and watch tiktok indefinetly... at least until any kind of challenge presents it self. Then ur fucked. Not very funny in a personal context but as a society or a culture things should get rather bizarre as we pile up more and more convenience. We already have to import people to do the work.
It seems cheap universal healthcare isn't as hard as it seems. Putting out a small fire and cleaning up is cheaper than letting the entire city burn down before doing anything.
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[ 2.3 ms ] story [ 407 ms ] threadSorry for that rant I am a bit traumatized by my experiences trying to do business in the US healthcare industry.
I also let my doctor know that I was extremely displeased about his referral to that facility when there were cheaper alternatives.
Maybe they can capture the $1000/mo market first and then offer something very similar to those who are interested at $100/mo. Or they have capacity constraints where they can't scale up manufacturing to supply everyone who would buy it at $100, but they can validate their process at the higher price first.
Seems like a supply chain problem
$25 was the patient support program for diabetes. That still exists.
The drug isnt approved for obesity, so they dont get access to the program. Its actually illegal for the company.
This is a case of the company stopping people from doing something they shouldnt have been doing in the first place.
Mounjaro Linux
edit now the title here has changed, but it's still strange The Independent list that as the most important part. Guess it's normal click bait tactics.
This doesn’t seem worth it to me. I’m sure a lot of people would like to lose 25lbs but you’re making a deal with the devil to get it. It almost makes me think they design these drugs to make a recurring revenue stream instead of fixing the issue permanently.
That would require a major cultural shift, we're far far away from that
The real problem with using it as a weight loss is that it doesn't solve the underlying problem. Mounjaro makes it so that you can't eat. Eat too much and you get sick (seriously like 2 bites and you're done eating). Overeating is a psychological problem. The drug doesn't fix you wanting the food, it just makes it so that you can't eat it. Take the barrier away, and you're back to where you started.
Shouldn't it _eventually_ have a pavlovian effect where you associate all food with nausea?
There are side effects, especially initially with loose stool and some nausea, but generally they don't last. I'm sure they persist with some but that's effectively every medication. The goal isn't to change the relationship with food where it makes one physically ill when seeing or eating food
EDIT: My experience is with Ozempic, not Mounjaro. They may work differently
While I’ve know some people experience more severe GI issues or nausea with the drug, this is quite the exaggeration. A drug that made it difficult or impossible to actually consume enough food to survive (more than “two bites”) would be wildly unsafe to prescribe.
The comment I was replying to was talking about Mounjaro, which is a weekly injectable - and thus no way to do it for only three days a week. In that context, if Mounjaro made it impossible to eat to the degree the commenter described, it would be wildly unsafe (because of how long each shot lasts).
Many would argue that drugs like this and Ozempic are showing that overeating is more of a hormone problem then a psychological problem.
If you take the perspective of someone who has struggled with weight loss in the past (especially if prior results were not great and had trouble keeping the weight off anyways) - it’s not so much of a deal with the devil, if the drug actually works.
I mean surely that can't be a 100% always the case, I would think it is either continue to take the medication or do a strenuous weight reduction program / eat less + exercise.
but why is that important, because some people might be so obese that they need to lose 25 lbs (maybe more, just following what was written) to get to a point where the exercise part of that equation is at all doable.
I was put on Ozempic last year for a short amount of time. That, combined with changing of diet and starting an exercise routine, lead me to lose ~60 pounds in a relatively short amount of time (~8 months). I'm not taking the medication anymore and I did gain about 20 pounds back, but it's a lot easier going on a walk or run when you're carrying net 40 fewer pounds.
Willpower and discipline are simple things but they're not easy. In my opinion, it's important that the patient uses it as boost instead of a crutch and don't get too discouraged if/when they wean off and gain some weight back.
To be clear, I'm not intending to shame or throw shade at those who take or need the drugs, I just want to do all in my power avoid them as much as I can.
Other people just have a disorder, where they literally don't feel the full signals that normal people do, so they only feel "full" when their stomachs are stuffed to discomfort. These people are already consigned to a life of suffering, either from being obese or from constant hunger and an inability to have a normal relationship with food. In this case being on a medication for the rest of your life is the lesser of two evils.
This is one of the biggest things people with obesity struggle with. This is seen as a miracle cure for obesity because it doesn't require work, just a weekly injection and watch the weight melt off. But making lifestyle changes (changing eating habits, increasing activity, etc) is the most reliable way to make this a permanent fix.
But that's putting the patient to work and they don't want that.
Of course will power and environment changes can keep you at a lower weight but it's a constant struggle against your body.
Given that I can go for months without those "bad habits", but if I stop taking it they come back, I think they're more than habits. Habits break if you stop doing them for a while, these compulsions don't. Until I took this drug, I didn't know what it was like to be able to not constantly think about food and being hungry. I've been overweight for nearly my entire life since I was a breastfeeding baby, and this is the first time in my life that I don't feel like I'm being held hostage to my hunger.
I have lost weight and maintained a healthy weight for periods of time, but I'm just hungry the whole time and eventually the hunger starts beating my willpower.
For what it's worth I also have problems with anxiety. Similarly I tried years of therapy/mediation/mindfulness/etc. to get rid of my anxiety but it never went away until I took sertraline. Now, I live a pretty much anxiety-free life as long as I take a pill a day.
I probably need to see a therapist that can help with my eating habits, and this has highlighted that for me.
It's also interesting that they were designed to treat diabetes then we also discovered they reduce hunger. My guess is that we may have assumed the cause-effect relationship is more straightforward than it actually is.
I also want to see what happens if we take the people who criticise us for relying on a drug instead of willpower/mental conditioning, then give them a drug that does the opposite of these ones. My guess is they'll overeat and get fat. Much like animals do in animal studies. Ignoring your body constantly telling you to eat is almost impossibly hard over the long term.
Humans have a tendency to assume that we have much more free will than any kind of scientific evidence tends to show.
I've taken various GLP-1 RA over a decade for glycemic management (I'm on Mounjaro now). They still work great for this. But I have to do the work to maintain my body, now.
Capitalism, ho!
(If you accept that obesity kills, reducing obesity saves everyone’s money and lives)
That seems like a ... strange argument.
If that is a very poorly phrased way of saying that reducing obesity will extend peoples' working lives, that's certainly true.
But otherwise, everyone dies in the end. Is it really that much more expensive to die as a middle aged overweight person than a healthy weight old person?
And those higher costs get socialized through insurance and taxes.
Supply chain issues
And the food industry, the real root cause of all of this
So we 1000% should deal with the amount of crap that's in our food but I don't think it'll be the cure-all that people expect.
> I eat pretty much nothing but garbage food -- pizza, wings, burgers, subs: just salt and grease. And I went from 220 to 120 and stayed there doing it
Fast forward 10 years later and you'll get a very concerning blood work result. (I don't wish it on you but the web is full of "fat/skinny/I only eat junk food and I was healthy until I hit 45 and discovered XYZ is 5 times over the recommended limit" stories)
Also you might have a damaged thyroid or other similar health issues, I know a few people coming from an industrial region known for pollution, they have more thyroid issues than the average, as a result they can eat 6+ times a day and much more calories than you'd expect while not packing a gram of fat.
Once your body is ravaged by years of junk food you're an addict in the medical sense of the term. When you give a soda that contains 2x the daily recommended amount of sugar to a kid because "it tastes good" you're sabotaging their future health.
They don't make the food taste good to make you enjoy good food, they make food addictive to make you keep consuming.
It tastes bad compared to junk food the same way caffein is bland compared to cocaine, ie. you have to be addicted and in denial to believe it
I would say properly cooked, fresh healthy food tastes better than junk food. But most people don't have time for that.
But again, if the best economical system of the galaxy in the richest country of the universe can't guarantee basic things such as feeding yourself properly I'd say you have quite a big problem
When do we start acting ? 50% obesity ? 75% ? It's already the top 1 cause of death (cardiovascular disease). What does it say about our society ? Looking at it from the outside makes it look like sabotage if not suicide, very few people profit from it, and in the long run everybody loses
If you’re selling food, getting people to consume more is simply more profitable. Various mechanisms kick in after someone gains weight to maintain that weight. Which is why the drug mentioned can be so effective impacts the underlying feedback loop.
That's what we get after decades and decades of marketing targeting kids... large scale behaviour changes.
Look at how tobacco was advertised, it was the same thing, now most of us know smoking is very detrimental to your health and addictive. I wonder when people will realise they're pulling the same shit for food
Young kids are more likely to be obese but it’s only 22.2% for 12 - 19 year olds vs 44.3% among adults aged 40 to 59.
"only" is quite an understatement, having a quarter of your youth being physically disabled is quite alarming
Weight gain doesn’t seem to be a metabolic issue, rather on average people eat just a little more and gain just a little more weight every single year and metrics like obesity and morbid obesity smooth over this underlying trend as even the morbidly obese still tend to gain weight.
How do you know this? As the adage goes: ...good times make weak men...
We've had good times in the late part of the 20th century. We now have weak lazy people in addition to abundance of shit food. We absolutely live in a time of over acceptance. In the old days it would be: "Hey man, you're getting fat. That's not ok". Not it's all about sitting down and listening to excuses with our legs folded.
Yet we do precisely that with salty sugary foods, with many of them advertised specifically towards children.
Other countries outlaw advertising drugs to consumers?
Other countries have lower rates of industrial injuries leading to lower rates of painkiller dependence?
Other countries have functioning social safety nets leading to less deaths of despair?
What a strange way to say "they're more salty/sweet and fat", which are all know to trigger food addictions
If you think coke taste better than water you're an addict in denial
What he's essentially saying is: people are fat, because they eat too much. "Eating too much" does not necessarily or literally mean "fat". Likewise, "making more money than you spend" is not another way of saying "rich", as it's possible you can "make more money than you spend" and still not be rich.
The answer that is not interesting is simply saying that people take in more calories than they expend, because it it tautologically true. People now are more health-conscious than at any point in human history. Basically no one wants to be fat, yet most people are, and we have far higher rates of chronic disease.
Fact of the matter is, no one wants to accept that they eat too much, nor do they want to eat less when it is pleasureful, nor do they want to work at changing their habits. But it is very much a cause behind modern diseases.
Not only do you run into limits on the digestive system but carrying extra weight means spending more energy moving that weight around. The classic lumberjack breakfast is just an insane amount of food, but you didn’t see a lot of fat lumberjacks in the 1850’s.
It's hard to give up an addiction, and yes the companies peddling the addiction as an avenue to profit need to face a reckoning. But at the individual level, we can all choose what weight we want to be. Fatalism doesn't help anyone.
People can very much choose to lose weight, but it seems odd to say most people are then “choosing” to gain weight again. That said willpower does seems to account for a small percentage of overall weight so it very much does play a role.
Great - now do cigarettes. If you'd prefer to skip the math though, the CDC states "Fewer than one in ten adult cigarette smokers succeed in quitting each year".
I don't think it's completely unfair to compare quitting smoking with weight loss.
People maintained weight loss for 1 year are simply much more likely to regain weight in the next year than people who quit smoking for 1 year are likely to start smoking again over the next year and that trend stays consistent over time.
It's also present in all wealthy countries. The US led the way by being wealthier earlier, but all countries that have wealth see a steady rise in average weight over time.
Obese people are addicted to sugar because it's cheap, it doesn't spoil and it's in everything.
Im well built, look decent with my shirt off and have a pretty good life but I hit a wall sometimes and just stress eat a gallon of ice cream. Lifting heavy weight for reps allows me to stay slightly ahead of my calorie consumption. I can see how a slightly more stressful life, less income and less time to work out could turn into a slippery slope where I would eat myself sick. I guess what I'm trying to say is that life is complicated. But your point stands.
When you factor in junk food marketing targeted to kids it starts to be a bit different. Then you add lobbies fighting to keep fast food in schools, the sugar industry, "fat makes you fat" and other clearly bs takes ...
What happened between the 50s and today that made < 12 year old obesity for from 5% to 20% ? https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6002a2.htm
Is it because 5 years old kids can't put the box of oreo down ? They must be stupid right ? Why can't they possess high level long term thinking ??? Don't they know about insulin resistance ? and calories ?
The Mounjaro patent appears to be until '39, with no generics available at the moment.
As one of the patients states in the article, obesity may very well lead them to diabetes. People will die. And with the shortage affecting current diabetics, they are dying now.
How scary! If only there was a reliable way for patients to prevent this disease :-(
I agree with your that's why you see many obese people in parts of the world with food shortages.
I'm a former professional athlete and am currently, in my middle age, in better shape than most, including youths in their 20s, with blood tests to prove it.
When I was making weight, it was extremely difficult to find the balance to fine-tune the diet. Those 400 grams for me were just as difficult to shed, while performing to task. And I had a professional team behind me.
Consumerist civilization is obsessed with the magic pill, we agree on that. A pharma subscription for life is not the solution. However, I personally know, and there are people like that commenting in this post, individuals that were unlucky to be born obese. If you are going to take a grand statement position, familiarize yourself with what that does to a hormonal system. And that is only one sub-case of many where obesity is completely outside of an individual's control.
With industrialized food, including sugar, HFC and carbohydrate lobbying corrupting the policy in the US for longer than 70 years, and that is a number simply of convenience, since we have easily accessible records of such industry lobbying, obese individuals are not the cause of the problem.
Having more tools to address obesity is a good thing. Hopefully, one arrow of many towards a systemic approach.
The headline is editorialized. The linked article's headline: The ‘next Ozempic’ became a social media sensation. Then everything changed
The coupon didn't go away. The coupon's terms changed. I'm using the coupon now. Because I have type 2 diabetes. The coupon changed because people were using it to get the drug for off-label use. The drug wasn't taken away from people trying to lose weight by jacking up the cost. The drug shouldn't have been dispensed in this way to begin with.
Lilly is seeking to get approval of tirzepatide under a different label as a weight loss drug, similar to how Ozempic and Wegovy exist, as well as Victoza and Saxenda.
If you want a GLP-1 RA (this drug class) for weight loss, go get Wegovy or Saxenda, which are a version of these drugs approved for weight loss for those with a BMI over 30, or wait for the tirzepatide version. Leave the diabetes drugs alone.
And to be clear: This drug isn't helping diabetics by helping them lose weight. It helps diabetics regulate blood glucose. It slows the release of glucose from the liver as well as promotes the release of insulin from the pancreas. Weight loss due to slowed stomach emptying is a side effect.
The coupon was changed because people were abusing it. This drug is approved for diabetes, not weight loss.
there is a very big problem with blaming the suffering who find relief with this drug -- regardless of what their ailment is -- rather than blaming the systems and processes that lead to a supposed shortage that urged a price adjustment.
forgive me for diving into conspiracy for a second here..
do you really think for a second that the pharmaceutical groups responsible for this class of drug do not have the facilities to ramp up production?
They absolutely do -- the problem here is that since it's a gold-mine there is even more cash capture to occur with an added scarcity element, hence the price adjustment.
The price adjustment wasn't to champion the diabetics over the obese, it was to make more MONEY.
This is not a new hotness. And many diabetics have used this drug class for a long time.
And yeah, you're jumping into conspiracy theory. Ramping up production would likely take significant investment. Do they have the resources? Probably. But given the weight loss benefit is temporary (seriously, it is, ask anyone who has used one of these drugs for a significant amount of time), do you think they're going to sink significant investment into production when demand is going to wane in a few years? Well, you see, their investors are going to say no, and they hold the final say.
Always amazing when an article is verified in real time
> If you want a GLP-1 RA (this drug class) for weight loss, go get Wegovy or Saxenda, which are a version of these drugs approved for weight loss for those with a BMI over 30, or wait for the tirzepatide version. Leave the diabetes drugs alone.
Definitely think it's forgiveable and even rational to be upset that droves of people are creating shortages of a medicine you need with off-label use, however legitimate.
It’s true that the extra stored fat might must come from calories not used or excreted elsewhere, but that might be because their body is very poor at making immediate use of the calories as energy or is unusually efficient at storing energy that might otherwise be used. To put a number to it, a 2000 calorie diet as normally recommended may leave them depleted of energy and increasingly fat.
It can take years to discover that kind of “outside the norm” issue, and obesity can easily set in before its recognized let alone addressed. And of course, once obesity does become a part of someone’s life, there’s a whole spiral of challenges that make it hard to overcome. Even moreso when your body doesn’t work normally.
Of course, you could rightly reply that there are a lot of complicated things that happen between the food and the problem, and while those diseases require an energy surplus, that neither causes them, nor does trying to naively eliminate the energy surplus fix them. Contrary to popular wisdom, the same is true of obesity.
The idea that obesity could be avoided or cured with a little bookkeeping and self control is laughable to just about anyone who has tried. Telling obese people to eat less is like telling depressed people to get over it. You'd be astonished by how ultimately impossible that is if you haven't been there.
https://www.virtahealth.com/research
There are many people who have cured their obesity with a little bookkeeping and self control. Sue Reynolds and David Goggins are a couple of prominent examples, but there are many others. It's not easy, but it's certainly possible.
https://suereynolds.net/book/ https://davidgoggins.com/book/
Fructose, specifically, is the going theory. And I'm a big fan of Virtahealth specifically, and Dr. Fung's approach for treating type 2 diabetes generally. :)
However, I'd disagree that we know that that's what causes it. We know that treats it. Cancer is not caused by a lack of chemotherapy, and I think chemotherapy is a good analogy for the fasting and low carb approach in this situation. It is a treatment, not a generally normative lifestyle.
But my point is actually more limited, and you actually sort of made it for me by adding the detail about carbohydrates. To wit: just because sugar requires energy, does not mean that you got too much sugar by bringing in too much energy. It's not that simple. You won't get the disease by eating too much protein, for example (you'll get protein poisoning ;) ). You get the disease as a result of liver dysfunction, which you exacerbate and possibly cause by eating too much fructose. It's a control mechanism problem and an injury problem -- the fact that energy is involved (even required!) does not make that the central issue.
Cancer requires energy for growth, but that doesn't make energy the central problem. Blood sugar requires energy for dysregulated high levels, but that doesn't make energy the central problem. Fat requires energy for dysregulated growth, but that doesn't make energy the central problem. That's something you have to demonstrate, and rigorous attempts to demonstrate it fail.
> There are many people who have cured their obesity with a little bookkeeping and self control ... David Goggins
Citing David Goggins as an example of "a little bookkeeping and self control" is hilarious to me. I've read his book. I love his talks. But the guy is about as heroic and extreme as it is possible to get, and that is far from the only thing he did.
My point is that David Goggins is nothing special. He isn't a superhero from the planet Krypton. Anyone can choose to do those things (or at least lesser versions of them). Some people just prefer to sit on the couch eating cookies.
Eating too much is literally what causes type 2 diabetes.
"The idea that obesity could be avoided or cured with a little bookkeeping and self control"
It absolutely can. Again people just don't want to feel bad about not having enough self control.
It can’t. There are many people who, if they simply scaled down their diet without otherwise modifying their nutrient intake/lifestyle, start having health problems well before they lose weight. Hot flashes, fainting, severe stomach pains, nausea.
But there are subtler versions of this. People who live in food deserts, only have access to iceberg lettuce and freezer-burned tomatoes as produce are gonna have a tough time getting all the nutrients they need in 2000 calories or less. There’s also others who have very specific dietary needs that they’re not yet aware of.
That isn't true. Though it's a primary use, the opening paragraph of the wikipedia article on fat outlines that it actually has many biological functions (and is properly thought of as an organ!): https://en.wikipedia.org/wiki/Adipose_tissue
> ... because over human evolution food supply was unreliable enough for this to create an evolutionary advantage. Getting fat from eating a lot of food is completely predictable.
Not at all. While fat does have a primary function as an energy reserve, that does not mean that unregulated growth is a simple matter of putting too much energy into the system. After all, just as in nature there are times of famine, there are also times of feast. It would be pretty disadvantageous for animals to have no regulation on their fat growth in times of abundance. Something more has to go wrong to cross the line from "saving for a rainy day" to "killing you". Animals don't eat until they damage their stomachs, do they? Not generally. Why does it make any more sense that they should eat until they damaged their endocrine systems?
An interesting counterpoint: bears hibernate. In preparation for doing so, they become fat by eating a lot. Now, they do this, not just any time of the year when food is abundant, but specifically in the fall as they prepare for the winter. Are they just lucky that food happens to be abundant every fall? Or is something else going on? What happens in years of famine? Do they still manage to get fat so they can hibernate?
Another interesting counterpoint: Pregnant women eat a lot and put on weight. Why do they do that? Is it because more food is available? Or is something else going on?
One last counterpoint. Bodybuilders put on a lot of muscle, which also takes energy, and they eat a ton to support that growth. Why is it that if I eat an extra steak, my flab gets bigger, but when Ahnold eats one, his biceps get bigger?
Obesity is dysregulated growth. While growth does require energy, it is in the failed regulation of that growth that you will find the best explanation for the disease.
I really can't blame you for assuming this, but it actually turns out that food was scarce enough in human history that humans never actually evolved a limit on how much fat we will store. If we keep consuming a caloric surplus the body will keep creating fat to store it. This is the body working as intended. Things would be different if humans had a more reasonable max body fat percentage.
https://en.wikipedia.org/wiki/List_of_heaviest_people
https://peterattiamd.com/rickjohnson2/
Anyone can build muscle instead of flab if they do sufficient resistance training and eat enough protein. Gains will tend to be slower for women and older people. Arnold Schwarzenegger used a lot of steroids and other PEDS which can certainly accelerate gains, but aren't worth the side effects and legal risks for most people.
https://www.essentiallysports.com/us-sports-news-bodybuildin...
> It absolutely can.
No it can't. ;)
Well, not always. I've experienced both sides of this: an effortless loss of 60 lbs with easy diet changes and bookkeeping over the course of a year and a half. And a few years later, an abject failure as the same strategy -- a moderate calorie restriction -- resulted in such profound physical distress that I developed psychological problems long before I made any physical progress.
Sometimes it's easy. Sometimes it's impossible.
My story is far from atypical. It's common. Practically universal. Everyone, just about everyone, who tries to lose weight, using any strategy, succeeds over a period of months, and fails over a period of years. The reason is that the underlying control mechanism is in a different condition, in different people who may be the same weight.
> people just don't want to feel bad about not having enough self control.
I know you're really attached to the energy imbalance theory of obesity. People often are. But I'd like to suggest that this comment suggests you may have a different motivation for believing in it than just that you find the evidence persuasive.
I often wonder why people get so attached to a theory that I think is in such obvious evidential crisis. A need to believe a simple solution will be there when they need it? A traumatic dieting experience that they need to believe was necessary and useful and healthy? Maybe it worked for them once and they're universalizing their experience? A desire for moral superiority? The fact that deliberately oversimplifying things makes for slam dunk messages on forums?
I don't know, but diet is one of those weird topics where people are attached to their opinion with the religious fire of a thousand suns. While I know I won't change your mind, it does seem fair to point out that your statements are both hyperbolic and inaccurate, and that's not a good sign.
It isn't a theory, it is a fact. It is basic thermodynamics. The human body requires a constant amount of energy for basic operation and activity. Any excess is stored as fat for future use. Creating fat requires calories that HAVE to come from food. Eat few enough calories and you WILL lose weight. Eat zero and you WILL die. Eat 20,000/day for a year and you WILL get very fat.
A good example of this is this man went 382 days without eating
https://www.diabetes.co.uk/blog/2018/02/story-angus-barbieri...
He had a calories surplus for long enough to weigh 207kg. While not eating his body consumed energy in his fat to stay alive and he got down to 81kg. ((207-87)kg * 7700 calories/kg)/382 days = 2539 calories/day, which is a very plausible number.
To say "it's just thermodynamics" might be right as far as the physics goes, but it doesn't recognise that biological drives overwhelm everything. It's hugely complicated how energy expenditure and steady state energy consumption interacts with weight gain, not least because the body will invariably work to make your actions as efficient as possible to maintain weight. For example, observational studies of hunter societies that might travel large distances daily, energy requirements bear little relation to daily activity after any transition time has elapsed when compared to relatively inactive Western counterparts. These people can't just will their activities to be less efficient if they hypothetically wanted to consume more energy.
Ultimately, the biology will decide what the effect of any intervention is, regardless of how motivated or not you are. Any advice that doesn't explicitly factor that in is just hot air.
If energy intake matches energy needs then body fat percentage stays the same.
If energy intake exceeds energy needs then body fat percentage increases as the body stored the excess as fat.
If energy needs exceed energy intake then body fat percentage decreases as fat is used as fuel.
https://en.wikipedia.org/wiki/Basal_metabolic_rate
no, it doesn't. the amount it uses for basic operation and activity will change. shrinking in response to your attempts to lose weight.
The basic metabolic rate varies between individuals. One study of 150 adults representative of the population in Scotland reported basal metabolic rates from as low as 1,027 kilocalories (4,300 kJ) per day to as high as 2,499 kilocalories (10,460 kJ); with a mean BMR of 1,500 kilocalories (6,300 kJ) per day.
https://www.ncbi.nlm.nih.gov/books/NBK572145/
These new generation of drugs (semaglutide, tirzapatide) deal with the signaling system (endocrine signaling, that is).
Yes it does, because it is basically just repeating basic laws of thermodynamics. Obesity is actually just the body working as intended by storing the excess energy for future use during a famine. CICO is why obesity used to be very rare in past when calories were expensive and is now common when calories are very cheap and artificially delicious.
That's just an extreme example. The real culprit is processed foods.
You don't know that.
I decided I want to lose weight for the third time in my life. A few weeks I was probably eating 5,000 calories a day. I’ve lost 15 pounds in three weeks. Basically before every day I’d eat and eat and never ever feel full. My stomach would hurt, I’d throw up every day, I felt tired and shitty every single day.
Now I can barely managed to eat 1400 calories a day. I’m eating red meat and kimchi, basically. That’s my diet. Once a week I’ll crave a nice big salad with mushrooms and olives and ranch dressing. I feel great. If I try to exceed that calorie amount I’ll feel super satiated (not full, like physically full) and stop mid bite, and save the rest for later. It feels like a long dormant part of my mind that controls calorie intake suddenly has a voice again and that voice has been drowned out for years.
So I mean it’s easy to say “it’s just calories”, but why when I eat a standard American diet am I craving thousands of extra calories per day and that stops when I eat like this? Even stranger, why do I relapse into these habits when I eat even a small amount of food like French fries or ice cream, over and over again? I know precisely why I’m fat, exactly what to do to lose weight, it’s not even difficult, but unless I have a very strong motivation to lose it I just don’t.
Most people don’t even have the requisite knowledge of how to deal with hunger cravings and get themselves in a state where they’re losing at all. They’ll eat chicken breast and a salad with no dressing then wonder why they feel awful because they’re not getting nourishment, then binge on ice cream. So how is the average person supposed to lose weight?
- I take ADHD meds, amphetamines, which are appetite suppressants. They haven’t made me eat less, and they’ve reinforced “bad” eating habits I used to have before I lost so much weight, specifically reinforcing my tendency to eat one, large, meal per day.
- I’m much more active than I used to be, because I got a pup who needs the activity and with whom I like to be active.
My caloric intake is about the same as it’s always been. Once I actually paid attention to it I realized it wasn’t even very high. I very seldom reach the recommended 2000 calories diet metrics are based on. I still don’t understand how eating that way made me obese, but I have to assume now I was just absurdly sedentary.
I got lectures like this about caloric intake for years and always found it interesting but confusing! How was I so fat and never eaten much?
I’m not saying this applies to anyone else, but it’s bothered me for decades that I’d been told calories in -> obesity meanwhile my own caloric intake had next to nothing to do with my body mass.
Anyone who wants to lose weight should start with a resting metabolic rate test in order to establish a baseline. You just sit in a chair for a few minutes while a machine measures your inhaled and exhaled gasses to calculate energy expenditure. If you consume fewer calories than your RMR then it is impossible to not lose weight.
There is literally no way to take in more calories than you expend and not gain weight - short of hyper-specific and exceedingly rare medical conditions you'd be quite aware of.
Some people find this easier or harder than others due to a whole host of factors. Physics is physics though, and there is no way to run a calorie deficit and not lose weight. It's why this drug class is so interesting/popular - it lowers the bar for many people, making the effort of taking in less calories than they expend much easier to achieve.
When I started tracking things so closely, I was already concerned that I’d been losing weight and feeling very strong cravings for sweets which I don’t usually care for. The effect wasn’t that I ate less: I started making an effort to eat more, again much like I used to eat. The biggest change is that eating enough has been a concerted effort rather than fairly automatic.
It's like saying an overdose on heroin is simply someone doing too much heroin at a time.
Yes it is. It really is as simple as that, people just don't want to hear it. Historically food was scarce that it was nearly impossible to sustain a calorie surplus long enough to get fat. But some people did, that is why the rich used to be called "fat cats" but now calories are so cheap and delicious and lifestyles are so sedentary that it is very easy for almost anyone to sustain the caloric surplus needed to become very fat. I had a cousin who reached 650 pounds and then died. He would spend hours every day eating and almost as long shitting.
I'm skinny so I'm unbiased. There is nothing I "don't" want to hear because I'm literally not affected by it. Thus, I assure you I have more information than you. Read below:
https://www.theatlantic.com/health/archive/2015/09/why-it-wa...
Your reasoning is on anthropological timescales, which while technically true, doesn't explain why people were still skinny in the 80s and before. There was an actual turning point AFTER the 80s... A huge shift in weight gain where MODERN and well-fed people suddenly got heavier. Something happened with the food supply starting with the US.
We only have correlative studies that match a number of things with the sudden change in weight. Thus no causative confirmation on the exact source. Our educated guess says that it has to do with processed foods. Processed foods streamline calorie absorption to unnatural levels leading to unnatural weight gain.
The article above mentions a number of other factors that I think are possible.
But a reader questions the methodology of the researchers: “My main concern is that the calories are almost assuredly self-reported, which is notoriously unreliable.” Another reader agrees:
But another reader notes:The fact of the matter is, people weighed less in the 80s then they do today. No amount of stretching can change this quantitative measurement. So something must've changed. What changed?
You can continue to talk about calories in and calories out just like we can blame the overdose problem on people doing too much heroin. Again, while YOU can do that, it's not a very useful position.
https://www.diabetes.co.uk/blog/2018/02/story-angus-barbieri...
"The fact of the matter is, people weighed less in the 80s then they do today. "
Because they ate less. Portions were smaller, Food wasn't marketed as much.
"No amount of stretching can change this quantitative measurement."
Self-reported calorie intake is not a reliable quantitative measure.
"You can continue to talk about calories in and calories out just like we can blame the overdose problem on people doing too much heroin."
I really don't understand why you think this statement proves. A heroin overdose IS caused directly by an excess amount of heroin in a given time interval, just like obesity IS caused directly by excessive calories in a given time interval. The time interval for obesity is years instead of hours.
Heroin and obesity are indirectly caused by people getting addicted to the dopamine levels consuming them cause.
You sound a tad like a 9/11 truther insisting on some over complex conspiracy theories to explain something fairly straightforward.
This is the part you're not getting. You DIRECTLY say you don't understand here, and I am here to confirm that you in actuality DO NOT understand.
A heroin overdose IS directly a result of too much heroin within a time interval. But that answer is too obvious and PEDANTIC. You would be stupid to characterize the opiate epidemic as just people doing too much heroin and that they should do less to improve their health. "Yeah that's the problem with opiates in America, people doing too much of it, I know you guys don't like to hear it, but it's the truth. Just control yourself and do less"
Obviously it's more than that. There's a problem with tolerance, with addiction, the fact that opiates were introduced as addictive pain killers by Purdue Pharma under the name Oxycontin. The story of heroin is much more then the completely idiotic characterization of just "doing too much."
So to bring it back around. The the situation is MUCH more complex then people eating more and becoming fatter.
>You sound a tad like a 9/11 truther insisting on some over complex conspiracy theories to explain something fairly straightforward.
I'll just be blunt. You sound like a fucking idiot for regurgitating something SO OBVIOUS. Look, you're not actually an idiot, so stop acting like one and stop calling me a 9/11 truther.
What's even stupider is that when I tell you that while TECHNICALLY more calories in does make you fatter there's clearly something else going on. Do you see the connection with the metaphor here with heroin? Heroin isn't just about people doing too much of it. There's many underlying reasons here for WHY something happens.
I have experience in this area with people who are overweight. Even the simple answer of calorie density in processed foods increasing due to industrial food manufacturing after the 80s leads to fatter people is a better characterization here.
However that answer above ^^ is inline with your simplistic calorie in-out logic so maybe that explanation can help you "get it".
First, don't be so rude. You think what I'm stating is obvious but there is an entire industry built to deny it. Even on this thread there are people who deny it.
Just because you honestly reminded me of their need for overly complicated explanations of well understood things.
Your explanations are simplistic you fail to see nuance and complexity within reality. I find your outlook on things to also be delusional. You think things are simple and well understood but that's just a reflection of your ignorance.
Not trying be insulting or anything like that but this is just what it is.
Just to drill it home. How stupid does a person have to be to think that comparing someone to a 9/11 truther isn't rude? You have to be pretty stupid.
Again not being rude. Just telling it like it is.
Off label prescribing is extremely common, to treat specific drugs as special in that regard is silly.
Part of getting approval for on-label use of these drugs is understanding this part of it.
This is an absurd argument. It's a drug. It has specific metabolic affects in humans that are valuable to people's health, among which are the control of blood glucose levels, and control of appetite and nutrient uptake, leading to loss of excess weight. That it is currently labeled only for Type 2 diabetes is a marketing decision by the manufacturer, not a characteristic of the drug.
Or, to put this another way: the drug is doing exactly the same thing whether you measure its effectiveness with a glucometer, or with a bathroom scale.
Regulatory approval. It is a diabetes drug because it has been evaluated as such, including understanding the primary effects and side effects at various dosing levels. Mounjaro is prescribed to diabetics from 2.5mg to 15mg in increments of 2.5mg and titrated based on needs and goals.
Typically, weight loss versions of these drugs (Saxenda and Wegovy) are dosed higher than their diabetes counterpart, and are just titrated to maximum dose over time to maximize weight loss benefits. So evaluation is based on this, and approval follows this.
Various drugs do get used for off-label purposes, but the drug makers can't promote this because their marketing claims are regulated. This is why the coupon terms were changed.
Mounjaro is a trade name for a diabetes drug and that won't change. So no, it is not soundly rejected.
It's not as simple as "SQUIRT JUICE INSIDE ME GET THINNER AND CURE DIABETES". There's a lot more to this than you seem to understand.
It kind of is that simple. Tirzepatide has three main functions: Hunger suppression, slower digestion, and increased insulin sensitivity.
For a large portion of people who are overweight, this will get them thinner and in some cases reverse t2 diabetes.
Obviously this person is (reasonably) upset* that off-label use is muscling out on-label use, when the two uses are of two very different classes.
Their issue isn't just the fact that the common vocabulary has switched to focusing on weight loss, it's the general shift in where the supply is going that's accompanies said shift in vocabulary
Being overweight is a serious health issue, but Type 2 diabetics were using it in a way that was much more acutely pressing, with much fewer alternatives. It's not hard to understand why diabetics would feel upset/threatened by a secondary off-label use of such a different class.
* I read it as upset as the situation, not at those who are overweight to be clear
I think your beef should be with the pharma company seeking to maximize profits by constraining supply such that they are easily overwhelmed by off-label use, not with people seeking effective medical treatment.
There's a common meme among what I've seen from diabetics complaining about the shortages: that this is a tik-tok thing, or prompted by some celebrity, and the medicine is being take by people trying to lose ten lbs. I don't think any of that is true. Doctors are prescribing this for people who have medical conditions that make them dramatically overweight. My mother found relief from lipedema after decades of pain thanks to mounjaro, and she's facing the same shortages you are. She's done the half-doses and the quarter-doses and stretched them out until the pain came back.
Mounjaro is the best drug for a number of conditions, both the approved diabetes and some number of not-yet-approved conditions. Eli Lilly is maximizing profits in a way that leaves people with Type 2 diabetes and other painful conditions suffering. There's no need to blame social media for Eli Lilly's shortcomings.
I know multiple people < 150 lbs who have gotten scrips for it with no history of diabetes.
They have a monopoly on the drug, what's the evidence they are constraining supply? It makes no sense, the price is set, the more they supply the more money they make.
The alternative might be a $200 million dollar production facility which may not even be feasible to cater to the excess of consumers. Or which may be too excessive for the excess of consumers targeted.
Yeah, these drugs aren't new but the wide world is just learning about the weight loss aspect. So they don't know this is a temporary solution.
GLP-1 RA does NOT achieve a reduced A1c through weight loss. It achieves improved glycemic control by slowing the release of glucose into the blood as well as promoting increased production of insulin in response to glucose. The overall result is a reduction in blood glucose.
A1c is a measure of your glycemic health that spans around 90 days with heavier weight on more recent trends. It's like a longer blood glucose average measurement. There are actually algorithms that can calculate an estimate of your A1c based on blood glucose trends, which is referred to GMI (glucose management indicator).
The gastric effects leading to feeling full sooner and longer are a side effect and is what leads to weight loss. It also fades with time. Having been on various GLP-1 RAs over a decade, they don't provide this benefit to me anymore. Even with Mounjaro also being a GIP, it's just doing its primary job for me.
Mounjaro is a drug that causes weight loss. Is that better?
Is artificially partitioning what is almost certainly the same medication (with the same manufacturing process) into two separate product lines actually a Good Thing? This means that when Mounjaro has supply problems even with the split, diabetics won't be able to get it because part of the supply is inaccessible to them since it is dedicated to a different "product".
Instead we should advocate for the real solution, which is to demand the manufacturer drastically increase production - Mounjaro along with Semaglutide have literally capital-S Solved one of the most urgent health epidemics of the 21st century, and the solution isn't to shame people for using it, the solution is to make it available to anyone who needs it.
I'm quite certain a large fraction of the HN userbase still believes that people can do independent business without being forced along one direction or another.
And yeah, the weight loss benefit is a temporary benefit. It may last a few years, but it fades. This is not a new drug class. The weight loss aspect to it is also not new (Saxenda, the weight loss variant of Victoza, released in 2014). Liraglutide was in trials for weight management when I started Victoza. That was a decade ago. I'm on Mounjaro now for glycemic management and it works great for that. But it's not doing anything for appetite, delayed gastric emptying, etc.
It's in round 2 of phase 3 clinical testing as an obesity drug, and will probably have full approval this summer.
The manufacturing process seems to be reasonably efficient. See "Kilogram-Scale GMP Manufacture of Tirzepatide Using a Hybrid SPPS/LPPS Approach with Continuous Manufacturing"[1] Yields are apparently good. There are drugs which require many processing steps with low yields at each step, and those really are expensive to make. But not this one, it seems. A kilogram of the stuff is about 100,000 to 200,000 doses, so this is not an inherently expensive material.
Patent expiration in 2036.
[1] https://pubs.acs.org/doi/10.1021/acs.oprd.1c00108
These new weight loss medications are the solution to obesity. Imo this is one of the biggest medical advances of the century and at least in urban areas of wealthy countries, I don’t think we’ll see obese people anymore in 10 years.
The pharma companies realized they’ve got something truly revolutionary so they took the old tried and true drug dealer strategy. Get ‘em hooked for free/cheap and then bump the price to capture the value. Can’t say it’s surprising, they’re just following the incentives. And as the link goes through, these drugs have the potential to be worth many billions of dollars over their lifespan.
Because it's man made and completely avoidable. Look at tobacco for example, it was the exact same thing until it wasn't because we woke up and decided to act on the issue
Helping currently obese people to get out of the loop is good, breaking the system we built that make more and more people obese would be better.
Also, being obese is only a part of the complications of eating shit and not exercising, the rest of the symptoms will catch up eventually, there are no magic pills
The system exists because people like it. I don't think it's possible to break it at this point considering how people normally react to having their life made worse. You can't stop people from eating what they want, but these drugs make it possible to change what they want.
You can certainly stop advertising junk food to kids, that would be a good start. You can also regulate things you know, like not having your entire daily sugar requirement in a single can of soda
Btw if you still eat the same garbage you'll still absolutely wreck your body, obese or not, you'll need a diabetes pill, a cardiovascular disease pill, a blood pressure pill, a kidney boosting pill, &c. You are what you eat, quite literally.
This will never happen in the US. I wouldn't mind, by anyone who votes for this would be dead in the water politically.
The main problem to my mind is that cheap, easy, accessible foods are high in both fat and carbs. Fat is satiating, but super calorie dense. Carbs are less calorie dense, but spike your blood sugar. After your blood sugar levels drop, your body signals that you're hungry again in spite of the fact that you've eaten plenty of calories. So now you're starving again and you've surpassed the number of calories you can reasonably utilize without storing it as fat. Add in the fact that evolution hasn't even begun to catch up with the current situation where calories are not a scarce resource (in the US and similar countries) and your body is screaming to eat while the eating's good. This causes you to comsume way too many calories and nowhere near enough vitamins and minerals.
It's a lot of work to eat right anymore. You're working 40 hours a week if you're lucky, you're exhausted and feel like shit and you may not even be able to afford what you need to be eating to maintain a healthy weight.
And, just to make things more fun, there's 1000 sources telling you 1000 different things about what you should and shouldn't eat to be healthy. Cholesterol is bad for you - wait, no it isn't. Eat whole grains. No, don't, that's sugar! Eat fruit. Oh no, fruit is basically all sugar. No it isn't, it's full of fiber and that cancels out the sugar. Don't eat fats, except unsaturated fats, but those are calorie dense. Vegetable oil is unsaturated, but that's bad for you too in a different way.
It's damn frustrating. If it were as easy as just eating less, no one would be obese. Back to the point of the article, however, I don't think it's as simple as taking a magic pill. How many miracle weight loss drugs have come and gone over the last decade? I'm not holding my breath that this is the one that will turn out to work forever with no severe downsides.
But people act like I have three heads when they ask me how I lost weight and I answer honestly. They just feel like it has to be a net negative somehow, that it’s not allowed that I eat prime ribeyes (just one, I’m not that hungry m) every night and lose weight.
A month ago I was throwing up every day and eating 5000+ calories per day. I hope I don’t go back this time.
Realistically, none. These are the only ones that have ever been found to actually work, everything else is either homeopathy or has terrible side effects. I agree that having food that tastes better is the main culprit for the obesity epidemic, but I don't think the answer is making tasty, addictive, food harder to access. Those foods are popular because people like them, they bring people happiness. It absolutely is a lot of work to eat right, but it doesn't have to be with these drugs.
As far as there being no severe side effects, it looks like semaglutide was looked at for medical use in 2012 and didn't go to clinical trials until 2016. Then there's tirzepatide, which I think is the part that's the big breakthrough recently, wasn't approved for use until the end of 2021. I don't believe we have the data yet to really say that it's safe long-term. I sure hope it is, but this is a very new treatment.
Yep, that.
My understanding of this argument (which for the record, I'm loosely convinced is probably true, but probably isn't the only, and maybe not the main, factor) is that your body's hungry signal is it needs non-calorie nutrients, but our food is less nutrient dense so you get a lot more calories than your body is prepared to handle for a given quantity of nutrients.
I wonder what the long-term health outcomes would be between two groups: one group that was obese the whole time, and another group whose obesity was delayed by ten years.
I suspect the latter group would end up having fewer negative health outcomes over the course of their life - 10 years of essentially “reduced wear and tear” on different systems in their bodies. That is to say - even if it’s a bandaid, it may still be really useful for public health.
This is pretty much it. Zero side effects (other than the side effects from losing weight too fast, still have to pay attention to diet). We'll see if there's long term pancreatic/other issues down the line; but comparing risk against obesity, I still feel like I come out ahead on risk.
I expect to be taking some low level of a GLP/GIP/next-twincretin/next-tricretin forever. If I didn't now; I figure I'd keep running and dieting and meditating to steel my willpower; continue slighty overeating and slowly gaining fat and insulin resistance. And then I'd still end up taking a GLP/GIP years down the line after I finally developed T2DM.
I'd gladly spend $12k/year for the extra healthspan, and it seems many, many people are prepared to do the same.
If you have to do it anyway to have a long healthspan, and it generally has the side effect of assisting in controlling weight, then why lean on the costly drug?
Pharma companies arent allowed to have copay programs for off label use.
Promoting off-label use is why Pfizer was fined $3B. Its illegal.
This is just the next step in the ultimate dream, losing weight without putting in effort necessary. If you need to keep taking pills to keep your healthy weight, you're just suppressing symptoms of something bigger.
> Medicating obesity is like taking pills to make smoking healthy.
This is wrong though. Eating is not unhealthy. Overeating is. These drugs stop people from overeating.
It's not a measure of willing, it's about access to treatment that isn't a nice, quick, profitable pill that you end up hooked on.
Making people chemically dependent on a drug to keep themselves healthy is optimising for the wrong solution. It's quick and easy but it mostly serves to keep insurance and drug company profits up.
I certainly believe that these drugs can be useful as a means of gaining an intermediate result (which can significantly reduce the immediate risk of many diseases) during treatment, but that's not how people treat them; people treat them as a magical fix for obesity and that's simply not healthy.
I also hope we can agree that not everyone attains meaningful weight loss with just diet and exercise. The human body is incredibly complex, with a spectrum of natural compositions, metabolisms, etc. Your post dismissing these nuances risks being interpreted as “thin privilege” (my wife is a Dietitian and taught me the concept).
For what it’s worth, I’m against treating drugs like this as a first line of defense against obesity; it should be seen as the last step before bariatric surgery, and only used under the direction of a competent and ethical health professional.
This is easier for some people but not a solution for the general population.
Similarly, eating less is easier for some people while others are genetically or psychologically predisposed to eating more than they need.
Regardless, I am very happy to see that there are effective weight-loss treatments that will be available soon, because losing weight is incredibly hard, and it's been shown definitively at this point that something is causing most Americans to be fat (not just Americans anymore either), it negatively impacts their lives, and for one reason or another they are unable to lose the weight without help.
The fact that these drugs exist and work demonstrates the hormonal link that decades of research has shown is there.
Also, the prices of healthy food is much higher than the prices of unhealthy food thanks to subsidies and scale. But that's secondary to the fact that many people actually can't just "eat less" the way others can.
Let me give you an example of something that humans really can't do. "Humans can't breathe unassisted underwater". See the difference?
You could read about catabolism and metabolic suppression, or lupus, or lipedema, or just carry on, but please, don't be mean to people in real life.
We already force people to go to school and in some countries you have to join the military but after that we are free to never exercise again and stuff our face with any kind of food we want the year round. If we are financially successful we will never have to use our brain. Can get drunk and stoned every day.... wonderful? You can smoke, drink coffee and watch tiktok indefinetly... at least until any kind of challenge presents it self. Then ur fucked. Not very funny in a personal context but as a society or a culture things should get rather bizarre as we pile up more and more convenience. We already have to import people to do the work.
It seems cheap universal healthcare isn't as hard as it seems. Putting out a small fire and cleaning up is cheaper than letting the entire city burn down before doing anything.
That’s sure to make everything better for everyone.