Now expand this to other treatments: HIV, PreP, depression/anxiety, ADD, ADHD, you name it. We’ve had data for decades that adherence is the key factor in successfully lowering mortality and increasing quality of life, which in turn increases duration of productive life, which in turn lowers costs in the long run as more people live healthier, longer, more productive lives.
The problem continues to be the pharmaceutical and health insurance industries, particularly in the West. Under pressure to deliver infinite growth forever to shareholders on a quarterly basis, companies have a vested interest in making less medication at a higher price, and lobbying the government to prohibit price negotiations while mandating insurance coverage for many of these drugs.
GLP-1s might be the proverbial straw that broke the camel’s back, but there’s decades of research - and bodies - saying this over, and over, and over again.
Which reminds me: I need to call my new health insurance company to get them to cover my medication, and hopefully extend it to 90 day supplies. Because god forbid that just be an automatic thing for someone who’s taken the same medication daily in some form for a decade without adherence issues.
The article is missing some key points about insurance. An ideal book balances mortality and longevity risks. This cancels out the risk GLP-1s or many other actuarial shifts in mortality. Insurers swap risks, reinsure risks etc to move towards an ideal book. Nice products to balance are pensions and longevity. Problem is that the scale is quite different on a per policy basis, and also very location specific.
The article also misses regarding slippage is that Swiss Re in the link calls it a modest increase And that is mainly due to insurers Not performing the same level of medical intake (accelerated versus full underwriting). Increased competition leads to less profits. That’s pretty straightforward and not per se GLP-1s related.
And then the kicker. For not diversified portfolios of mortality risks. Those have been massively profitable for decades, in line with the general increase in age and health. GLP-1s just expands on that profitable aspect. Did I mention that the long term expected rate of return on an insurers book is quite good?
Insurers can weather a bit of slippage. Reinsurers will kick the worst offenders back in line with their AUC performance, because without diversification Or reinsurance it’s hard to stay in the market. (Capital requirements strongly favor diversification. Mono line is very hard.) That’s why Swiss Re is bringing out such rigorous studies of detailed policy events. Signaling to the reinsurance markets and the insurance companies and their actuaries!
I guess, but this is sort of the same as going on a statin to get your cholesterol down for a better insurance rate. Then going off because of reasons...
And nothing of value was lost. These industries, insurance in particular, pharma coming in a close second, are just parasites, sucking the vitality out of everything by their sick rent seeking and giving crumbs, if that, in return. The faster they can be torn down and liquidated, the better. Maybe helping the overall population boost their wellness with more-or-less miracle drugs like GLP-1s can hasten that.
I think it's unlikely that the quoted 65% of GLP-1 users will go off the drug and resume their unhealthy lifestyle as the drugs go off patent and become more affordable. It's not super inconvenient to stay on, just expensive (today, using the name brand formulations). Users benefit from good health more than they benefit from deceiving life insurers.
Is there any research on whether GLP-1s are also beneficial for generally healthy and not overweight people?
cry more
“mortality slippage†coincides with Sars2 circulating within our population so I bet it has a lot to do with it
Just want to share my own experience since were doing it:
Took Wegovy (Semaglutide) for about 6 months. Barely lost any weight, would occasionally get nauseous.
Then the doc switched me to Mounjaro (Tirzepatide) + Phentermine, and holy shit, I just don’t feel like eating, almost ever. Lost 20kg in 6 months, which is all I needed to lose, never had any side effects. None.
I did feel a little weird/buzzed the first time I took Phentermine, but it went away the next day.
I feel like for many people it’s not really the physical hunger that makes them fat, it’s that annoying voice in your head telling you to snack something for no reason at all. It sometimes felt almost like drug addiction.
Tirz+Phent are great for that.
It varies case by case, but just want to point out that the research agrees with you here, Tirzepatide is more effective than Sema!
No mention of Common Side Effects in the discussion? It was pretty predictable (at least for someone healthcare-field [discovery + regulation]-adjacent all my life), but touched on the notion that the miracle wonder drugs are a provider's worst nightmare. It's a business
> Lost around 14kg using GLP-1s from a D2C provider (no detail on their electronic health record)
Huh? How would one get these electronic health records? I thought each provider keeps these and there's no public database except for vaccines? And it doesn't exist because HIPAA would make it hard?
Is the slippage graph just for net life increase slippage?
Or any slippage?
It caught my eye this explosion in slippage happened years before GLP-1s, and exactly in the year of a global pandemic that had sky-high mortality rates for older people.
More sensationalism. Insurers can simply adjust the policy accordingly to account for patients discontinuing the drug. They can also raise premiums if patients go off the drug, and there can be a cluse that stipulates this. This is literally the job of an actuary to reprice premiums . Insurers take a short-term hit and then adjust premiums to ensure it never happens again. This happened with California fire risk for example. Moreover, this drug will not increase life expectancy by that much even with lifetime patient compliance. The majority of obese people ,especially men, who take these drugs will still be overweight or obese, but just not as much as before.
Mortality slippage has also exploded since the COVID pandemic started... And again, nobody seems to wonder if somehow, a virus that invades the whole body (not just a respiratory virus), repeatedly, is causing death by a thousand cuts...
The blind spot related to COVID is huge. There are lots of health data going haywire since 2020 and everyone seems to find any other reason but COVID for it.
I know that many of the claims are based on clinical data and retention studies, but I find the entire thrust of the post to be incredibly cynical. Fat people often fight the not subtle sensation that a lot of people see them as either a problem/herd to be managed and/or maximally profited from. This is one of those accounts that seems to say the inside part out loud.
The idea that a few pharmas artificially juicing a desperate population [who just want to feel good about themselves and live longer, happier lives for more than many can comfortably afford] is interfering with insurance adjustors ability to maximize profits doesn't leave me heartbroken.
It's precisely this shit that leads to people celebrating when pharma CEOs get tapped.
> Life insurers can predict when you'll die with about 98% accuracy.
I saw this:
https://media.nmfn.com/tnetwork/lifespan/index.html#0
is there anything better?
Looking at the link they give for it, the 98% accuracy isn't for individuals but for aggregate data. That is: they can't predict with 98% accuracy when you or I will die, but they can with a sufficiently large group which averages out all the noise. The phrasing in the article is somewhat unfortunate.
> When someone stops the medication, they'll usually regain the weight they lost
Source? I agree that some people will regain the weight, but "usually" is an unfounded (without some data) generalization.
It's linked in the article.
It probably depends if they also change eating habits. If they change nothing regaining the weight is no surprise.
It's variable. some regain all, other regain less. But they basically all regain some.
Note that right now there's a problem with people staying on GLP1s[0] so it's not quite clear how this could go any other way. Considering the rate of rebound from other lifestyle methods, GLP1 is among the most effective alternatives we have.
GLP1 significantly reduces the risk of many mobidities and is increasingly prescribed to older people.
Also, this is incredibly likely to resolve itself once the drugs become common place after patent expiries, the actuaries will update their tables and the curve will smoothe out.
[0]: https://glp1.guide/content/if-glp1-is-so-great-why-dont-peop...
[1]: https://glp1.guide/content/patent-expirations-for-glp1-recep...
Can someone explain what is being said here in literal terms please. Can you also identify any dark humour or social commentary because I don't know enough to be sure.
Let me try again:
1. People do not stay on GLP1s for long, despite how effective they are
2. People often rebound harder from other forms of weight loss (dieting, temporary lifestyle changes, etc)
3. GLP1 reduces a LOT of health risks linked to obesity (heart disease being the most important IMO)
4. Older people are taking GLP1s in droves
5. Once these drugs are everywhere (they will be soon IMO in < 7 years obesity will probably be ~gone), the effects will get "priced in" to actuary tables.
No social commentary or dark humor intended -- GLP1s aren't miracle drugs but the effects (and relative lack of side effects) is miraculous.
so surreal reading comments... a month after non-stop threads about glp causing a billion issues, everyone is talking about how wonderful they are again.
humanity
What is well studied and has a billion issues is obesity.
Imagine that, people make up bullshit that isn't grounded in reality. Who would have thought!
It's a once in a generation drug with less side effects than most OTC, likely net positive even for healthy weight people. I'd bet within the decade it'll be approved for a whole basket of other benefits - at the least a whole array of immune system disfunctions and a cure-all for addiction.
Likely protective of a wide array of internal organs, likely life extending.
billion issues? i saw some reporting on rare cases of blindness. what else?
1-2 years ago there was considerable skepticism about "taking the easy way out" or unforeseen risks like like with Fenfluramine/phentermine. Now sentiment has changed given that more people realize these drugs are safe and effective.
Pancreas issues and hair loss IIRC?
If GLP-1s are working for people, why do they quit taking them?
They are very expensive
It is well known that people are bad at taking drugs that work for them. This is particularly well studied when it comes to heart medication, the kind where you take it regularly or you die, and yet adherence is often around 50%.
From a quick search, Jarrah et al. (2023) "Medication Adherence and Its Influencing Factors among Patients with Heart Failure: A Cross Sectional Study" [0] discusses some of the relevant details.
Cost.
Seems like insurers should be rating based on your worst health markers, including weight, over the last N years rather than just a current point-in-time snapshot. Someone who somehow has no medical records over the last few years at all that would capture any of that data would be priced on the assumption the past was possibly worse than current.
I don't know the situation in the USA, but in Europe you wouldn't find many young (up to ~35) people who have data on any health markers. And these are the main market.
In 2023, the life insurance industry took in >$3 trillion dollars in premiums.
That same year, it paid out roughly $800B in claims.
TL;DR: there's no violin tiny enough for me to play for the life insurance industry's 'woes'.
yes, there is a reason why BRK.A/B stock has done so well ,even while sitting in tons of cash. Geico is a cash cow.
Well I guess a GLP-1 pacemaker would address this. A lifetime of doses weighs at much as a nickel?
I believe it has to be kept at refrigerated temperatures over its relatively short shelf-life (1 year, I believe).
This blog post is flawed. "Life insurers can predict when you'll die with about 98% accuracy." Is not even properly framed and is found nowhere in the cited report.
Predictions of when you will die need a range in order to be attached to a number like accuracy. The attached report is not about this but about population-level mortality trends.
Yeah was skimming that report too and it doesn't look even related to that claim.
If insurers are suffering from "mortality slippage" because some of their customers purchased insurance while on GLP-1s then later discontinue the medication, then there must also be "mortality slippage" in the opposite direction. There must be customers who were not on GLP-1s when they purchased insurance, but could go on them, extending their lives in a way that is very profitable to the life insurance companies.
Furthermore, there are more people not on GLP-1s than on them (even with the recent surge in popularity) so this population that can give life insurance companies "excess" profits must outnumber those the article describes where the insurance company takes a loss.
Why can't they focus on this profit opportunity?
At least in part, according to the article, because the not-yet-on-GLP1 folks are NOT customers since they are often denied coverage in the first place.
I believe AI along with smart glasses that shows and calculates your daily caloric intake will be a SUBSTITUTE (another option) to the Ozempics.
With AI glasses doing this automatically for you upon seeing what your eating without u having to do anything some people may be shocked to learn how many calories they consume daily.
Currently, it's too time consuming now for the majority to do (i use GPT via texting it or talking to it to keep track as I eat out daily at healthy chains) but if it was done automagically I believe it definitely would be a substitute to Ozempic. I bet some or more would use that easily captured data that's shown to them (in the glasses or on their mobile device) to strive, make and possibly compete with their friends/family to eat less calories and carry less weight on them (be healthier). You can train your body to eat less to a lot less and for some that would definitely help them shed weight. The glasses could as well deduct calories burned from your daily walk, jog, etc.
*Being downvoted hmmm do you think AI by seeing it can't via an image calculate the calories of a burrito bought from Chipolte and other chains? All chains have nutrition information on their websites now that GPT goes and fetches. As for home cooked prepared meals I have taken pics of my food via GPT and it seemed to come close.
You're being downvoted as many people who try to count calories fail to achieve meaningful results. From my own experience, weight gain follows a simple progression.
1. Expected high stress work day -> Coffee w/ food item in the morning
2. Stress during the day -> No exercise + large lunch.
3. Post-day -> door dash due to not feeling up for cooking.
4. Sleep -> Get 6 hours of sleep due to not having the energy to maintain bedtime discipline, getting paged, or late night meetings + childcare obligations.
5. Repeat.
This cycle continues for a few months leading to 10-20 pounds of weight gain, followed by a year long push to rebalance life and lose the weight. There is nothing that a magic calorie counter could do for this cycle other than guilt me over my door dash order at the end of the night.
I think of a calorie tracker as a compass as I navigate an overly calorie-dense world that doesn't make us exert ourselves to the point of caloric deficits any longer.
For the aware user, combined with a scale, it helps normalize estimations of calories which can be incredibly deceptive. For example, try getting a group of people to estimate how many calories are in a store-bought muffin or donut, a bowl of nuts, a sweetened coffee drink from a drive-thru, or their typical bowl of a favorite cereal. I'm used to the casual observer's guess being about 1/3 of the true total if you weigh the item and read the label.
So in your scenario, the calorie counter would be a signal that you need to cut portions or cal density if your weight is going in the wrong direction, not unlike how a compass is just a tool if you're lost - you still need to know how to use it.
Im sure it would alert me to the trend, just as the scale does :) the fundamental problem is whether health is being exchanged for another good “stable income.â€
No calorie counter will stop a ramen quest after 90 hours of work. Unfortunately, I worked in environments where these stretches were obligatory.
People seem to be taking it as given that "someone else preparing the food for you" == "the food is more likely to lead to weight gain".
Why should that be? Is it not possible to order healthy food in? If not this would surprise me as it seems a number of people would be seeking this.
I'm asking as I don't have personal experience.
The ordering out tends to correlate with someone not having the energy or discipline to make what they want themselves. That lack of energy leads to caving on food cravings and overeating.
I recently switched from a major tech company to an academic position and lost 5 pounds in the first month. Simply due to lower stress making the healthy habits seem “easy.â€
Everyone lives and enjoy life as they choose as they should!
For those who are not interested cutting down daily on what they eat this data would not be valuable to them just as the data their phone captures now how many steps you walked in a day.
Myself I eat Cava bowls for lunch that are less then 600 calories, drink 70 percent water (not consuming calories from what I drink) and unsweet tea (zero calories in tea) with some lemonade to sweeten it a bit as the remainder. Other chains you can find similar meals that are less then 600. If you eat as such and keep at (change ur lifestyle for good) it some weight will be lost if the person wants to as well go for a walk on their lunch break. But again all about to how people want to live and enjoy their lives!
People with poor restraint will remain unfazed.
If what you're suggesting worked, then the horrible cancer pics on cig packs would have long eliminated smoking.
well for those mid level to have strong restraint this is going to be helpful!
I already do this with chatGPT but i have to do something vs. just living and glasses doing it automatically.
I did say it will be a substitute to the Ozempics not a replacement.
For those who don't have the will power there's the Ozempics to utilize at their discretion. For those who do have some or a lot of will power to change their lifestyle forever then this is going to be extremely helpful and those types wont be using Ozempics as Im sure such types are using it now.
I agree with you. However, smoking rates have gone down, probably in part because of those pictures and awareness campaigns in general
I can't support this with data, but I'd think the increase in price and compounding effect of more and more people quitting, plus absence of smoking in the media, has had more of an effect
I knew several people for whom the pictures were the "final push" to really quit back when they were first introduced. Not sure if it's easy to get good data to separate out all the factors such as cost, in-your-face warnings, etc. because they all happened more or less at the same time.
As an aside, I watched Poor Things this afternoon, and it came with a "Contains Tobacco Depictions" warning at the start. Never seen that before. No warning for the nudity, sex, or profanity.
I don’t think awareness of caloric intake is the problem, there are standardized labels on most foods (especially the bad ones). Most people who are obese know that the calories make them overweight, but they still have the need to eat food — which is what makes obesity a result of addiction. Similarly meth addicts know that meth is bad for them, but they still do it anyways.
> which is what makes obesity a result of addiction.
Obesity is not (in general) a result of addiction.
Sure and I didnt say it would replace Ozempics rather it's a substitute that would help a portion of the population.
Yet majority of all people have no idea the amount of calories they eat daily. Im sure being shown this automagically will be valuable data to all people just how they choose to use this optional feature to make changes or not.
How often do people control their own diets? That assumes they buy and cook all their own food, which is only true if you live on your own.
> How often do people control their own diets
Maybe I live in a bubble, but I don’t put stuff in my body unwillingly, so yes I control my diet.
It also isn’t rocket science, I know doughnuts have a shit ton of calories and vegetable shortening which will clkg your arteries, so I don’t eat doughnuts. I don’t have to look at the packaging.
Maybe the missing part is a proper education on nutrition in school, but we live in the age of the internet. All the information is there, you can get meal plans, you can figure out what foods are more likely to put you at risk.
Again, I don’t believe awareness is an issue. People know that chips and doughnuts are bad, but they eat them anyways because they are addicted to food which is engineered to be addictive.
> Maybe I live in a bubble, but I don’t put stuff in my body unwillingly, so yes I control my diet.
The example I'm thinking of is cultures with near-religious obligations to listen to their parents. Like Italian-Americans all act like they'd die if they ever ate less than all of their grandmother's cooking or ever changed any of the traditional recipes. Even though the recipes were all invented in 1970 in NYC and have inhumanly large amounts of carbs.
This is a fun read, however-
"Life insurers can predict when you'll die with about 98% accuracy."
This conclusion isn't supported by the linked document. The document instead is talking about expected vs actual deaths among demographic groups as a whole, not individual people. And that expected vs actual is just history + trends. This doesn't mean that insurance can say that Joe Blow is going to die in June of 2027 with "98% accuracy", obviously.
Yeah that was a bizarre line in the article. Not to mention it's meaningless because it doesn't say within what time interval. But even if you assume a year (i.e. predict your age of death) it's obviously false. Life insurers are very much not predicting the year an individual will die and getting it right 98% off the time. That would be absurd.
They can predict it in the sense most people will die within some specified window in which the insurer makes a profit. This is why its so profitable for the insurer. They have a very wide window where it's profitable and the vast majority of people, 98%, fall within this window. .
Put a little differently, they can predict that of your cohort (defined somehow), after June 2027, only X percent of you will still be alive.
Will you be one of them? Click here to find out!
For mortality tables age and sex are pretty much sufficient to get to 98% accuracy.
I can predict pretty well "Will person X die this year" by saying "No". Yeah, this number seems meaningless without more context.
Unless the preson in question is over 102 years. IIRC that is roughly the age when mortality rates on average surpass 50% per year. Up until tha age you can celebrate your birthday and reasonably expect is more likely to still be alive by the next than not.
> This doesn't mean that insurance can say that Joe Blow is going to die in June of 2027 with "98% accuracy", obviously.
Pretty easy to predict if you're willing to make it happen.
Life insurance is just another word for bounty
[flagged]
We’re not evolved to turn down cheap, easy calories by default.
Primate brain want sugar!
I am a disciplined, rational being, and will not eat these 3 donuts. The research indicates it will contribute to the health and aesthetic problems which already ail me.
Primate brain want sugar!
maybe the issue is too many people just have fucked up gut flora. if I ate 3 donuts I'd feel like complete shit
You eat less unhealthy foods on the drugs, so that is actually changing the diet?
you are still eating unhealthy foods, so no the diet has not changed.
Have you ever met a human before?
hahahaha
It sounds like aligning incentives here is requiring the weight stay off for the policy to remain in effect with an annual physical for monitoring, similar to what employers require for health insurance premium reductions. Point in time underwriting is suboptimal considering current state of the art of GLP-1s (unless newer protocols that can update metabolic profiles are delivered soon).
Or life insurers paying for ongoing GLP-1s instead of potentially the health insurer.
But to your broader point, at least in the US, incentive mis-alignment on all healthcare and health insurance is possibly irredeemably broken.
Nailed my broader point. Could we go through contortions to see who is going to pay unreasonable costs for GLP-1s (health insurance, life insurance)? We could, but that's silly accounting to see who still gets to make the profit and who has to end up with the bill for empowering the human to fix their reward center. The shortcut is to provide GLP-1s to everyone who needs them at scale, as inexpensively as possible (to pull forward the improvement in health and quality of life outcomes until improved protocols arrive). The semaglutide patent is about to expire in Canada, China, India, and Brazil, for example.
https://www.labiotech.eu/in-depth/novo-nordisk-semaglutide-p...
I've always felt that there's some trade to be done here, with life and health insurers basically giving glp-1 et all for free bc they lower the cost of everything else
edit: and then Big Annuity lobbying to oppose this
Aren’t “Big Life Insurance†and “Big Annuity†pretty much the same companies?
They are, they're basically mathematical inverses of the same product.
Big Annuity can charge you more, in fact, if it has reason to believe you're going to live unusually long, so playing the GLP-1 dance with them would only be profitable in reverse. Pretend to be the unhealthiest person on the planet, lock in an annuity, then get on the drip stat.
GLP-1s have legitimately changed my life for the better. I've always been very active but have consistently been moderately overweight. A relatively low dose of Semaglitide has helped me lose 40lbs and keep it off. I'm a year and a half in and have had very few side effects, no loss of efficacy, and my muscle mass has increased slightly despite all the negative press about muscle loss. My diet is similar in composition to what it was before, but I probably eat 25% less by volume. Recognizing I'm a sample of one, but my experience is reflected in the research.
I plan on being a GLP-1 for the rest of my life. Perfectly fine with that. It seems like society has more problems with GLP-1s than its users do.
> my muscle mass has increased slightly
how was this measured?
Clinical psychologist here in Norway, and just my subjective experience: People stop GLP1 agonists for the following reasons, in descending order: - They want to enjoy eating again. - Medications are a hassle. - Worry about long-term effects, even if there is no alarming evidence for now. - Price (we are a spoiled/rich country). - Other (like hating needles, feeling bad for taking medications that others need more, being aggressively lazy).
Often, I think that it’s a bad move, as the clinical effect of losing around 20 kg would have to be matched by some extremely high frequency and severe side effects. Overweight is still not sufficiently appreciated for how dangerous it is, especially after they ramped up production so much that there isn't a real shortage anymore.
Ironically, most of the people who respond well to Ozempic and stay on it have few psychiatric problems. But those who almost desperately want to get off it after a while might be those who have a psychological component to their overeating. The obvious suspect then is eating as emotional regulation. So one could extrapolate, at least as a hypothesis, that the ones who have worse life expectancy due to regained weight after a year of usage are the ones who have a double set of problems stacked against them: overweight and emotional problems. That would have a huge effect on longevity.
This is PURE free association though, no deep analysis behind it.
Did you see a decrease in people gambling / drinking when on the medication?
N=1, I'm on ZepBound and in general my brain is less likely to give in to things that give instant satisfaction.
Actually yes. Not as much as with ADHD medication, but obvious subset of addictive personalities that have relief from addictive behaviors (beyond eating addiction) with semiglutide.
How much does it cost right now?
Are there any alternatives coming out soon or generics?
Liraglutide is now available as a generic, but it is the least effective of the big 3 (Semaglutide, Tirzepatide, Liraglutide):
Basically, Tirz > Sema > Lira
https://glp1.guide/content/semaglutide-vs-tirzepatide-clinic...
https://glp1.guide/content/semaglutide-liraglutide-continue-...
https://glp1.guide/content/another-generic-liraglutide-launc...
Grey market from China is around $250/year for tirzepatide
There are group chats with tens of thousands of people and I havent seen any issues with the drug
That's an insane cost reduction -- $250/month is a common gray market price in the US.
For semaglutide, the newest and most potent GLP1.
United States: The main patent is expected to expire around 2032. Monthly Price: $950 - $1,350+ (cash price without insurance)
Norway: The main patent is expected to expire around 2031. Monthly Price: $109 - $301 (cash price equivalent in USD)
> For semaglutide, the newest and most potent GLP1.
Tirzepatide is the most potent GLP1
https://glp1.guide/content/semaglutide-vs-tirzepatide-clinic...
I'll note that in the US that 1000+ is the "list price". For those paying out of pocket, both zepbound and wegovy offer coupons available to anyone taking it down to $500 (and I'll note that discounted price keeps coming down, slowly, as well)
That US price is way too high. No consumer pays that much. You can buy it straight from Novo for $500/mo.
Obesity is highly correlated with other medical conditions, from cancer to diabetes to heart disease. I wonder if there is a point at which it is cheaper for health insurance companies to offer subsidized or even free GLP-1s to patients than pay out for other specialized medications. For example, my insurance covers flu shots in my community every year because it's presumably less expensive to pay for the shots compared to the increased rate of hospitalization that the flu causes.
Fluoridated water? Nah. GLP water.
> I wonder if there is a point at which it is cheaper for health insurance companies to offer subsidized or even free GLP-1s to patients than pay out for other specialized medications
Some do. My insurance requires a prior authorization due to the previous shortage, but it's $12/mo
Medicaid in my state also covers it for $3/mo
Add heart disease and blood pressure meds to the list of "we'd be better off as a group if more people took them as preventatives".
After it goes generic it will be cheaper. right now, it's not.
> For example, my insurance covers flu shots in my community every year because it's presumably less expensive to pay for the shots compared to the increased rate of hospitalization that the flu causes.
In the US, insurance companies are generally legally mandated to cover ACIP recommended vaccines at no cost to the insured, which includes flu vaccines for everyone six months or older without contraindications.
> I wonder if there is a point at which it is cheaper for health insurance companies to offer subsidized or even free GLP-1s to patients than pay out for other specialized medications.
That the NHS is getting to a place where it’ll provide it, I’d say yes.
Everyone likes to bash the US healthcare system, but at the same time it’s remarkable how much subsidized GLP-1 access Americans are getting compared to much of the world. The paradox of discussing healthcare online.
You’re thinking too highly about the incentives of the US healthcare system. Since insurance is tied to your employer (and therefore changing every few years), and most people die on Medicare, there’s not much incentive for insurance companies to pay for preventative care that won’t actually help you for several decades.
That’s one reason the ACA shifted it to a mandatory (in most cases) category: https://www.healthcare.gov/preventive-care-adults/
Minimal, but minimal progress in the US was/is still progress.
> You’re thinking too highly about the incentives of the US healthcare system. Since insurance is tied to your employer (and therefore changing every few years)
Most people don’t change jobs or insurance companies every few years. When they do, it’s often within similar regions and industries so the chances of ending up right back under the same insurance company are significant.
Regardless, the issue is more complicated than your line of thinking. Insurance companies have very small profit margins. Current GLP-1 drugs are expensive, around $1,000 per month.
So each patient on GLP-1 drugs costs an extra $12K per year (roughly) or $120K per decade. That would have to offset a lot of other expenditures to break even from a pure cost perspective, which isn’t supported by the math. So the only alternative would be to raise everyone’s rates.
I know the insurance industry is the favorite target for explaining everything people dislike about healthcare right now, but at the end of the day they can’t conjure money out of nothing to cover everything at any cost demanded by drug makers. These drugs are super expensive and honestly it’s kind of amazing that so many people are getting them covered at all.
Then wouldn’t the government want to subsidize it?
hmm...doesn't this possibly incentivize ozempic subsidies even more?
If you know a "customer" of yours (an individual employee) is only going to be with you until they either change jobs or go on Medicare, then it seems the name of the game then is to make sure that nothing catastrophic happens to them until you can hand them off to someone else.
In which case, they should definitely go on ozempic. Even if the effects of ozempic immediately come off after usage, it's a short-term enough solution that benefits the insurance company, no?
Yes. For very high risk patients, payers do want this. I’ve even heard of some paying pharmacies $100/fill if done on time for select people.
The problem is, prediabetic and folks who may have crossed 7.0 A1C once, and just overweight folks with docs who are willing to play fast and loose are demanding it. Skipping metformin and other first line treatment options that are way cheaper. For those folks, complications might be the next guys problem.
I don’t know if your topic switch was intentional - if so, my apologies and this is just for people outside the US who don’t know…
The article is about life insurance, which is very different from medical insurance.
Medical insurance companies often already go out of their way to pay early to save in the long run (e.g. free preventative care, checkups, etc.). I can’t speak to GLP-1s, but it’s possible that right now there are still active patents when used for obesity that make them crazy expensive for a few more years.
Life insurance is all about models and predictions about when you’re going to die. Any sudden change that massively impacts those models suck, because life insurers are basically gamblers with gobs of historical data they use to hedge their bets.
Medical insurance in the US is not incentivized to save money. In fact it's just the opposite. The ACA requires that 80% of premiums be paid out to medical expenses. If an insurance company encourages people to get preventive care and lowers its expenses, that means they also have to lower premiums. So they actually want costs to be as high as possible since they get to keep 20%.
> Medical insurance companies often already go out of their way to pay early to save in the long run
Literally LOLed when I read this. Health insurance companies might pay lip service to this and make some token gestures like free preventative care, but in my experience health insurance companies frequently shoot themselves in the foot by denying care that later ends up costing them even more when the patient's untreated condition worsens.
It's not a gamble, it's an application of the law of large numbers. But yes, changes in the underlying assumptions (e.g. mortality rates) can make the whole calculation untenable.
We have no idea what the long tern actuarial numbers are of 30 year GLP-1 use though.
Well no, obviously not, but we do have 20 years of data, and aside from a still-tiny-but-slightly-elevated thyroid cancer risk, there’s really not much showing up in that data.
You presume incorrectly. The flu vaccine has been covered for free because the federal government required it. RFK Jr. fired the entire CDC panel that created the requirement and replaced them with antivaxers. There’s a good chance it won’t be covered soon.
Covered for the patient yes. For free, no.
Are you disputing that the patient with insurance does not have to pay anything or raising a non sequitur about “someone†needing to pay for it?
I don't think GLP-1s are particularly expensive, so my top preference would be to just see them easily available. While not quite the same, it's a win that Rogaine/Minoxidil were once prescription-only but for a long time now can be bought at any grocery store and taken to the self-checkout. Still, I think the subsidy approach has been done for smoking problems via nicotine products before, and e.g. nicotine gum cost never seemed that high to me (especially compared to cigarettes).
But it's also worth remembering the relative risks involved. Obesity isn't quite the ticking time bomb / public menace it's often made out to be... For smoking, you'll find studies with relative risk numbers for lung cancer over 5 for casual 1-4 times a day smokers, and the number quickly exceeds 20 for heavier smokers. In contrast, with obesity, the most severe relative risks for things like heart disease or diabetes you'll find topping out around 4 to 5 for the most obese, even then often under 3, with milder 1.1 to 2 for the bulk of obese people. (Here, ~31% of the US has BMIs between 30-40, and ~9% have BMIs over 40.) For other harms, like there was a study on dementia a few years back, you'll also find pretty mild (1.1ish) relative risks, but these end up being similar with other factors like "stress", "economic status", or "low educational attainment". Just some thought for people thinking about subsidizing or providing free stuff, the cost tradeoff with paying for other things later might not work out so neatly, and there's reason to not focus solely on obesity but also do the same sort of analysis with other factors and severity of a factor as well.
yeah this is true. When people say that obesity is worse than smoking, I'm like "Have you looked at the actual stats on this?"
> I don't think GLP-1s are particularly expensive
On-patent GLP-1s (all of them right now) are actually extremely expensive. Right around $1000 per month.
I don’t want to discourage anyone who needs them from seeking treatment, but their discontinuation rate can be somewhat higher than you’d think from a life-changing drug because many people don’t like certain effects or even encounter side effects.
Weight loss drugs are also a challenging category for OTC because they’re a target of abuse. People with eating disorders and body dysmorphia already seek out black market GLP-1s at a high rate and it would be a difficult situation if they could pick them up impulsively from the medicine aisle. It’s also common for people to misuse OTC medications by taking very high doses hoping for faster results, which has to be considered.
There’s a libertarian-minded angle where people say “Who cares, that’s their own problem. Medications should be free for everyone to take.†I was persuaded by those arguments when I was younger, but now I have a very different perspective after hearing about the common and strange world of OTC medicine abuse from my friends in the medical field. Just ask your doctor friends if they think Tylenol should still be OTC if you want to hear some very sad stories.
I pay about $40/month for mine, grey market from china
$1000/mo is very high, yeah, but Ozempic isn't the only thing in town. My price info is from looking at https://www.brellohealth.com/ and similar ($133/mo semaglutide, $166/mo tirzapatide) -- i.e. just getting a prescription for compounded semaglutide. Reading anecdotes on twitter and elsewhere about grey market sources suggest the prices can be even lower. The innovation of Ozempic having the dose in a ready-to-go single-use injector is probably not worth an extra ~$900/mo for most people if they have to pay for it themselves, and if these things were available on shelves (or just over the counter, like sudafed (pseudoephedrine version)) you'd probably see that reflected.
> it would be a difficult situation if they could pick them up impulsively from the medicine aisle
It would be a different situation, not necessarily any more or less difficult. Anorexics and bulimics are already in difficult situations. Without research into the actual patterns of GLP-1 abuse and their problems, I'd still bet on it being a better situation. That is, abusing GLP-1s is probably better than destroying your esophagus from bulimia. But perhaps not.
I was persuaded by libertarian-minded arguments when I was younger, too -- though not typically ones framed from "who cares", but rather those rooted in a framework of freedom. People will always be free to destroy themselves in numerous ways, singling these things out to try and curtail destructive use is an unprincipled exception. Furthermore, the methods typically available for such curtailing (laws, law enforcement, and medical gatekeeping) are crude, heavy-handed, and often inconsistently applied themselves, leaving a lot to be desired in preventing abuse while certainly doing a good job impeding legitimate use which causes harm. When you go drug by drug, we also see the argument from other countries with laxer (or no) regulation not becoming anything like what you might predict if you just listen to what medical professionals say will happen if you got rid of requiring them as middlemen.
I'm older now, and I still believe such arguments, for the most part, despite direct experience with people trapped in cycles of abuse, not just anecdotes from people with an incentive in perpetuating the current system. (If you want sad stories, you can hear them from all sorts of people, not just from doctors. If you want tragedy, open your eyes, it's everywhere. Nevertheless such things by themselves aren't evidence and shouldn't weigh strongly in policy decisions.)
The first qualifier to unpack "for the most part" is that I think if society turned a lot more totalitarian, it would be possible to actually prevent almost all abuse. But if we did, we would also need to crack down on already legal and available things. You bring up tylenol, but I raise you alcohol. I don't drink, I think it's bad for you, tens of thousands of deaths each year support my claim, I don't even need all the rest of the non-death negatives affecting/afflicting far more. I'm not going to advocate making it as illegal as fentanyl. I do think there's a missing consistency here though and it's better for policies to be consistent. But consistency and the medical industry mix as well as oil in water. Modafinil, a stimulant that seems as harmless as caffeine, is regulated in the US as Schedule IV (same as Valium, which Eminem and many others were famously addicted to). But adrafinil isn't regulated that way, you used to be able to get it OTC / ordering online e.g. from walmart pharmacy, there's even an over-priced energy drink containing it now https://adraful.com/ yet it metabolizes to modafinil. Fladrafinil works similarly, is unregulated, and you can buy it in powder form by the gram on Amazon. Or just get modafinil from grey market sites (not even on the dark web) that ship generics from India because its status is never enforced, and save your liver some effort.
The second qualifier is that restricting access can sometimes be a good thing, and worth it on margin, when such restriction is considerately targeted and probably temporary. Part of the cycle of abuse for a lot of people is voluntarily committing themselves to a rehab center where their freedom of choice and access to many things is severely restricted for a while, and after enough cycles, it can work out in the end. That's a targeted restriction on the individual level, and having it forced on someone (involuntary commitment) is something hard to do and generally requires other harmful crime. Since fentanyl was brought up in the other reply chain, it's notable that this year fentanyl related deaths in the US continue to decline, this year by quite a lot. NPR gives 8 guesses as to why that is, with the top one being increase of access (just as I want for everything) for naloxone, which can reverse overdoses: https://www.npr.org/2025/03/24/nx-s1-5328157/fentanyl-overdo... Notably none of the theories are directly related to restricting access on top of current efforts, only in reason 2 (weakened product) do they suggest that some have thought the current enforcement in China, Mexico, and the US might be a factor in that. (I would have naively guessed as one of my theories that the current administration's various efforts could have something to do with it.) And notably none of the theories, except weakly 2 (weakened product) and 7 (skillful use) suggest that removing the barriers to getting fentanyl would lead to significantly more deaths. So while I think there's room for the government to make targeted time-limited society-level decisions that can produce marginal benefits by restricting access to something, the current poster child case of fentanyl doesn't seem like a strong candidate to support that view for either it or other drugs (especially those with more positive uses). (Indeed, a common libertarian point is that a lot of fentanyl harm specifically is because of reduced access to other drugs, so users get surprise-fentanyl from their illicit sources. And no, people getting those other drugs is not from growing up with the dark web, it's still often just "I know a guy who knows a guy" -- or just strolling down to various bus stop hubs in major cities like Seattle and looking for the loiterers with hoodies.)
> On-patent GLP-1s (all of them right now) are actually extremely expensive. Right around $1000 per month.
what does that mean? in the UK it's for sale from numerous national-chain pharmacies on a private prescription (ie the pharmacy is selling it commercially and customers are paying cash, no insurance and no state subsidy) for less than $US270/month. it seems unlikely to me that the pharmacies or the manufacturers are taking a loss on this, and the UK has at least as strict drug quality standards as the US.
sounds like the US monopoly-holders are just charging a lot more because they can, because the insurance system obfuscates prices and gives everyone involved cover to rip off patients?
People who want to misuse the medication are going to be the ones most willing and able to jump through the bureaucratic hoops. Increasing the difficulty to get the medication will only make it more difficult for legitimate users and won't decrease abuse. In 1920, 1970, and now, heroin was legal, illegal with minimal enforcement, and illegal with harsh enforcement (except in SF), and the same percentage of the population was addicted at each time.
Doctors' jobs are to deal with the cases that go wrong. These anecdotes have no relevance without actual data on how often these problems occur.
> People who want to misuse the medication are going to be the ones most willing and able to jump through the bureaucratic hoops
This thinking seems correct to people who grew up knowing about the dark web, Silk Road, and who believe they could access any substance they want if they wanted it.
It is not accurate for the majority of the population. For the average person, misuse of drugs isn’t a calculated decision. It’s one of convenience and opportunity.
> In 1920, 1970, and now, heroin was legal, illegal with minimal enforcement, and illegal with harsh enforcement (except in SF), and the same percentage of the population was addicted at each time.
This is a very misleading statistic for multiple reasons, as if it was engineered for the purpose of obscuring the problem.
Why pick 3 separate dates and limit only to 1 drug? There is a massive opioid epidemic that was fueled by increased availability of different forms of opioids beyond heroin. In the 1920s and 1970s they didn’t have OxyContin being diverted, Fentanyl flowing into drug distribution networks, or even Kratom products available at the local gas station. The availability and convenience of these different opioids has unquestionably increased opioid addictions.
Even more recently, the widespread legalization of marijuana has led to an increase in the number of daily users and the doses that people consume, even thought the libertarian arguments maintained that no such thing would happen.
At this point I can’t buy any arguments that claim that availability of drugs has no impact on misuse or addiction.
> The availability and convenience of these different opioids has unquestionably increased opioid addictions.
You are making my point for me. The harsh restrictions on opioids haven't actually decreased the availability for addicts who are willing to go to black markets and risk dangerous injectibles and fent laced street drugs. All the restrictions have done is make it much more difficult for legitimate users like me. I broke my collar bone a few years back and was barely given any pills and had to live with a lot more pain than I should have. And the justification is that these harsh restrictions make it harder for addicts to get it, but as you pointed out, it actually doesn't even do that.
As for marijuana I would bet that the increase in the number of users has been more due to the decrease in public perception of how harmful it is rather than from its legalization. Is the usage increase limited to the states where it has been legalized? Furthermore, it doesn't matter if the usage increases, only if the problematic usage increases. Is there any indication that this increase corresponds to more serious potheads or just more casual smokers?
The problem (not new with GLP-1s) is that people lose weight, get life insurance, and then regain.
The biggest part of that equation is regain part. Most people quit GLP-1s because of costs. Let's fix that.
i have hard time believing ppl go through all that only to sign up for cheap life insurance.
"Measuring" people for the sake of insurance just sounds hard. Partly because people are complex but also because people just hate being measured.
Get ready for health/weight based credit scores, Its probably a genuinely good idea.
I think they quit also because they see it is working and no longer feel like they need to use it
I don't know, I tend to notice the effect wears off over time. Not sure it's a good idea to consume it permanently. Perhaps a better use would be for short periods to course correct.
I’ve been on it for years, at a lower dose though, the counter action by the body is probably dose dependent so my theory is lower for longer is more sustainable. I think people get attached to the rapid weight loss, coupled with the high expensive, incentivizes higher doses. I take gray market supply and it’s rather cheap.
Also it should be mostly used as an adjunct to strict diet and exercise.
Anecdotally, the dose required to maintain a stable weight seems to be lower than the dose required to lose weight. Most people tend to regain some weight when going cold turkey.
The safety profile of the drugs with diabetics, and the health benefits that come from the associated weight loss may make permanent use a net benefit for most people. There appears to be little, if any, "course correction" effect from taking it for short periods of time.
It depends how you define "short period of time". When I started, I lost 40kg in a matter of 5 months. Is that short? If you develop a tolerance to the product, then it doesn't protect you long term from gaining back weight, combined with you losing the option to do a rapid descent.
I am not saying that those variations are great from a health point of view, but they are certainly not as bad as staying obese.
According to all the studies, this is absolutely the worst thing that you can do. GLP-1s are revolutionary, but when you go on them, you should intend to stay on them for life. When patients first go on them, they lose both muscle and fat, and when they go off them, they regain just fat, and in many cases they're in a worse situation than they would be if they hadn't gone on them in the first place.
Letting your weight fluctuate up and down in giant swings is, in many ways, harder on the body than just staying at a steady weight, even if it's overweight.
This is nearly perfectly wrong.
There’s nothing in these drugs that makes you lose more muscle than fat, you don’t lose any more muscle than if you do a regular diet, not even slightly.
Second, the drugs don’t do anything to cause you to gain back mostly fat, and people going off them have more success, not less, than your average person who loses weight rapidly whether through diet or other means.
The average person who is 50lbs overweight because they gained 5lbs a year for a decade will lose all of that weight within 6 months with nearly entirely positive side effects, and if they stop taking it, will regain a bit less than they did before, meaning it would take another decade to get back to where they were. That is unequivocally a huge net positive.
It’s not like Testosterone which does have dramatic negative effects when taken long term and can cause dependency.
It also happens to be extremely effective at reducing bad habits, and yes those habit changes persist after quitting - not perfectly, but surprisingly so. This even works for smoking, drinking, and gambling.
GLP-1 definitely doesn’t prevent you increasing your percentage of total calories from protein, and doing regular resistance exercise. That was the advice from my doctor, and while I’m only 2 months in, weekly scans have not yet shown any significant decrease in lean mass. I don’t see any reason why they would, as long as I continue eating protein and lifting heavy things.
Can you explain what you mean? What you say seems to strictly contradict how the meds are supposed to work.
People find they need to increase to higher tolerable doses to ensure their hunger is satiated. But also, you need to increase your protein and fiber intake to maintain that satiation. I tried going up to 10mg and I had such a sick feeling. 5mg I could tolerate. Some people are up 15mg.
Are the long-term (>20 years) effects of taking GLP-1s really all that well understood? Because that's kind of what you're suggesting here.
Making millions of people dependent on a drug to maintain basic health does not strike me as the best of ideas regardless. I understand why it's a good idea for many from an individual perspective and I'm not judging anyone, but from a societal perspective it does not seem like a reasonable solution.
Why not? We have an overweight and obesity epidemic that has persisted through everything else we've gotten enough political capital to try thus far. The "miracle" drug is the most promising direction we've had in a long time. Whatever possible adverse long term effects have to be (plausibility they actually happen) x (harm they cause) > known harms of being overweight.
The scale of the solution is allowed to match the scale of the problem which is on the order of 2/3 of adults or 200,000,000 people.
Well, don't say you weren't warned when it turns out the miracle is not such a miracle after all and it all massively backfires in a few decades, at which point you're still going to have to actually fix the real underlying causes.
The class of drugs having a 2+ decade negative health effect greater than the negative health effect of obesity over the same period, without any obvious short-to-medium health effect, is likely to be small.
I realize this is a fraught question, because not everyone is overweight by choice (whether due to a subsisting on whatever they can afford, time, genetics, injury, etc,.) but I believe that insurers are able to consider whether someone smokes cigarettes when setting premiums for ACA based healthcare. With the above caveats that would make this difficult, it would be nice if we could treat "voluntary" obesity similarly.
I think the article is making the point that that is what they have traditionally been able to do but they no longer can. Since the magic drugs are giving people the will power to be able to make these changes.
The article is about life insurance, not health insurance (I should have made it clear I was talking about health insurance).
So... There's a miracle drug powerful enough to robustly lower people's all cause mortality, but since health insurance and life insurance are industries with vastly different time preferences, this is not a good thing for the life insurers because people just keep getting off the magic longevity drug and screwing up their predictions. Because, admittedly, it kind of sucks in the moment to be on.
And I'm guessing just based on my own experience paying for term life that the actual premia differences aren't actually enough in most cases for the life insurer to simply pay out of pocket themselves; the differences probably add up to a few hundred per year per customer, whereas a year's worth of a GLP-1 agonist probably costs a couple thousand (for now, in 2025, and probably dropping rapidly).
Huh. Second order implementation details aside, this is an extremely fortunate turn of events for us.
> And I'm guessing just based on my own experience paying for term life that the actual premia differences aren't actually enough in most cases for the life insurer to simply pay out of pocket themselves; the differences probably add up to a few hundred per year per customer, whereas a year's worth of a GLP-1 agonist probably costs a couple thousand (for now, in 2025, and probably dropping rapidly).
I wonder why life insurance isnt funding more research into things like metformin, where we have amazing long standing data but haven't done the real research. See: https://www.afar.org/tame-trial
Because metformin is super unpleasant.
> admittedly, it kind of sucks in the moment to be on
I don’t think that’s a typical experience for most people, other than the price
There's often side effects, including nausea, diarrhea, headaches, bloating, discomfort, etc.
As far as I can tell from forums, it's not like 5% have the side effects, it's like 80-90%.
But for the first time in decades, I felt full. I didn't want to finish a meal, it was too much.
My body regulated my food intake in what felt like a natural way.
I hadn't even realized my body had somehow lost that fundamental mechanism of appetite control. It made me realize I wasn't weak willed, something is different about my body than other people.
But it comes with a price. The side effects I had were quite bad and so I stopped (though I now read that if I switch to a different brand, I might be ok).
I often didn't want to leave the house due to a dicky tummy. It could come/go in waves. But often can last a whole week.
Plus you've got to inject yourself every week. Often you can't drink as it makes you sick. Even when you're doing everything 'right' you can feel a bit off.
If you do over-indulge (with food or drink) the side effects can sometimes be massively amplified and you feel terrible for days.
So amazing in some ways, but it's not like taking a vitamin tablet. There are costs and making one slip up can result in suddenly feeling awful for a day or two.
Perhaps I was just particularly prone to the side effects, but it seems to happen to a lot of people (I found Mumsnet threads about it useful, they are quite revealing as they seem to be fairly honest and willing to share their experiences)
From the people I know on trizepitide, side effects were strongest when upping the dosage in the protocol, particularly two days after. The advice I have received while considering it:
- change your diet. you can't eat the same food at the same volume. or even is smaller volume if the food is a burger, etc.
- watch your drinking, your tolerance for alcohol is reset, and again on the volume thing
- drink a lot of water. apparently opposite to all the volume warnings above, lol
- split dosage and inject twice a week. (i dunno, talk to your doctor. also this only works when you have a vial and not the auto-injectors, though apparently the autoinjectors are way more expensive)
On the other hand, when i ask about what happens if you go on a bender and eat two burgers and lots of fries and drink a six pack?? From people that used to gladly do that: "gross, why would i do that?" That there is the real change.
I had more side effects ramping up the dose than after a while at the same dose. But they were all fairly mild. (I'm on 5mg/week of Tirzepatide; higher doses probably have more side effects.)
> If you do over-indulge (with food or drink) the side effects can sometimes be massively amplified and you feel terrible for days.
Never had anything like that.
The one thing that helped blunt the side effects for me was cannabis. Just a few puffs at night on the three nights after my injection made a huge difference.
I wouldn't recommend that to everyone, but it helped a lot for me.
> As far as I can tell from forums, it's not like 5% have the side effects, it's like 80-90%
This is likely a sampling error, and you see it with all drugs to some extent. No-one goes on a forum to announce to the world that they’re not having any side effects from [whatever].
> As far as I can tell from forums, it's not like 5% have the side effects, it's like 80-90%.
Happy people with no issues are less likely to post, or post as often.
That said, much sympathy for the people who do experience particularly bad side effects.
They aren't even that awful in maintenance -- just expensive. The unpleasant part is when you're increasing the dose. After a while at the same dose, it's more or less unnoticeable IMO.
I wouldn’t say unnoticeable, but rather a trade-off that’s fine. My stomach is definitely more sensitive, can’t handle coffee in the morning anymore, etc. It probably depends on the person.
Unnoticable meaning doesn't have any effect at all, or just no bad side effects?
Just in terms of bad side effects. Hunger was still suppressed. (Might be worse on the higher doses, I'm not on a very high dose.)
As in I cannot identify anything wrong with me most of the time while on them.
Can you explain what sucks about being on the prescriptions?
Tried to list them all here:
https://glp1.guide/content/are-glp1-side-effects-all-the-sam...
It was a while ago, but IMO the list still plays
Hi there - Mounjaro user here. I've been using it for about a year at this point.
I feel sick for three days in a row after taking it. Even after several months on the same dose. I get horrible gut cramps, sour stomach, near constant nausea, and occasionally vomiting and diarrhea. I have to take my shot on Thursday night because I'll feel bad the next day and supremely sick the next two days. If I took it earlier or later in the week it would absolutely impact my ability to work during the work week.
It has had amazing effects. I've lost about 60 lbs in the last year and my A1c is now around 6.2.
It's a very effective drug, but it is brutal on my body. I'm not sure anything in the medication is causing the weight loss. It just makes me feel so sick that even if I'm hungry I don't feel like eating.
I’m curious what your diet is like, especially at the end of the week when the medicine is weakest. If I eat dairy, sugar, etc in the day or two before my semaglutide, I feel similarly.
It's typically a salad for lunch, usually lean protein over a complex carb for dinner (latest this week was slow cooked pulled chicken over brown rice), and typically a piece of fruit and a hard boiled egg for breakfast.
The hardest part about this diet for me has been finding sources of protein that get me at my goal with the small sizes of the meals I do eat.
I don't know how overweight you are, but could you not just reduce the dose to get fewer side effects & still have reasonable weight loss? & Did you try other GLP-1s?
I've lost 120 lbs from my peak weight. I have about 130 to go before I'm comfortable with my weight. I was severely overweight, now I'm just very overweight.
I am at the second dose up from the starting dose (5 mg vs 2.5mg), and the side effects are about the same between the two doses. They didn't start out that way, but they ended up at about the same level of misery.
I tried Trulicity when it first came out. It was not as effective, but the side effects for me personally were less.
I'm on Mounjaro for type 2 diabetes, not weight loss, so my main focus is on how it treats my t2d. The weight loss is a nice side benefit.
These are pretty extreme side effects for being on the drug thus long.
What dosing are you on? If you’re still doing 2.5mg (smallest available in the auto injectors) perhaps try a compounding pharmacy for a month or two and you can experiment with lower doses and a different dosing schedule?
During my peak weight loss period I found that matching my injection schedule to the 5 day half life of Tirzepatide and adjusting the dose downwards to match this schedule helped with any side effects - including the “fading†of effects those last 2 or 3 days for me. There are half life calculator spreadsheets available on the internet that can help dial it in and keep your theoretical concentration more flatline vs peaks and valleys.
The current dosing regime is based on the single FDA trial that LLY did and is certainly not going to be the common practice a decade from now. It’s largely designed around patient compliance than anything else.
That said - everyone responds to this drug much differently. My little group I’m in is all over the map. Some folks lose weight consistently with tiny doses every 2 weeks, some are going above the recommended maximum weekly dose.
I also found food choices matter. A lot. The best part of tirz for me was being given mental space to stop eating shit food and start eating “clean†consistently. When on high dosing I absolutely would have a bad day if I decided to take my shot and then eat a typical American diet later.
The primary mode of action from the drug is simply you eat less. But it shouldn’t be due to you feeling too sick to keep anything down. That sounds pretty horrible.
I wouldn't trust a compounding pharmacy with making this given some of the truly horrible horror stories I've heard, and I'm on it primarily for type 2 diabetes. This is the minimal dose that keeps my A1c and blood sugar where my internal medicine doctor wants them. The weight loss is a welcome side effect. That said, I have lost about 120 lbs in the last two years, so something I was doing before I got on Mounjaro was working. Mounjaro just helped make it consistent.
tbqh being extremely overweight sucks in a whole lot of ways. While the side effects sound miserable, they will only be temporary. The damage done to my body and metabolism as a result of being this heavy for this long piles up every day, so if I have to suffer like this then I'd rather do that than have a stroke and die in front of my family.
I mean no offense, but you have a fairly substantiated body of evidence that something in the medication is causing the weight loss. The side effects do sound really shitty though.
It makes you feel less hungry. It doesn’t burn fat. Eat less + exercise = weight loss
The effects of the drug have helped me lose weight in two ways - one intentionally and one as a side effect.
The medication does make me feel fuller faster, so I eat less when I do eat, and I stay fuller longer. This helps me lose weight because it reduces the number of calories I consume.
The side effects make me feel so sick in those days after that I am effectively fasting all day (I have a small dinner, but keep drinking water so I don't dehydrate). That helps in losing weight.
That said, my original comment was meant slightly tongue in cheek - I know it is effective, but sometimes it's kind of darkly fully to think feeling bad from it is having the highest impact.
These medications don't work in the way many people think. The drug doesn't make you "lose weight" in the sense that it causes the body to excrete fat. Rather it interferes with the constants in the gut/brain signaling/programming system such that your brain doesn't want to eat as much. That in turn leads typically to weight loss.
I'm just reporting my cached knowledge of people saying they experienced some adverse side effects. Also injections are not fun, even though they are probably a lot less annoying than they look.
In the 10 or so people I know who are on it, nearly all actually seem to enjoy it - reduced addictive tendencies/bad habits, appetite control, and reduced allergies seem to pretty well outweigh the minor side effects.
Subcutaneous shots with insulin needles are basically painless. You don't even feel a prick, it's just a little pressure and then it slides in. When you get a shot at the doctor it's painful because they're intramuscular.
I've taken these and self injected, and it was surprising that I really felt nothing - no pain at all. I suppose because they recommend in stomach, and it's not in muscle, etc.
Once daily pills will very likely replace injections in the near future.
Eli Lilly will soon release key data on its weight loss pill orforglipron - https://news.ycombinator.com/item?id=43465346 - March 2025
There's already Rybelsus. It's a bit more of a pain though as it needs to be taken on an empty stomach and you then need to wait 30-60 minutes before eating.
Looks like the benefit of orforglipron is you can take it whether you’ve eaten or not.
There's an auto-injector mechanism, at least with my brand; you don't need to needle yourself
These tend to cost more than self-injecting. Maybe your insurance covers it and you don't care.
Ah, auto-injectors, a curious piece of technology. I've always wondered how it is to actually use one since we had these in everyone's medkit in the German army, loaded with nerve agent antidotes. Just slam it on you leg and inject through the pants were the instructions... Kinda grisly, I guess it's less emotionally charged for a weight loss drug!
For drugs like these it isn't that different from a normal injection.
The pen has about 4 doses in it so you twist it to set your dose. You attach a needle tip to the pen and give yourself a poke, press an inject button on the top and a spring loaded ratchet system pumps in the dose amount you set (making a wonderful ticking noise as it progresses). Pull out and toss the needle and put it back in the fridge for next week.
I do manual injection which involves doing the full prep work. It takes about 3x as long to setup but is still only about a 3-5 minute process in total.
A once-weekly subcutaneous injection is not a big deal for most people I think, outside of those who are very afraid of needles. It's a tiny needle and you don't even feel it. I've given injections to people who are afraid of needles, and they sometimes close their eyes in fear and are begging me to "just get it over with" without even realizing that I'm already done. Anyway, all this to say that outside of needle-phobic people I think the annoyance of the injections is probably not the reason people stop taking GLP-1 agonists.
You don’t feel it most of the time, it’s actually random with the sparse placement of nerves. Maybe 1 in 5 still sting a bit.
> It's a tiny needle and you don't even feel it.
I'll add that while it isn't a big deal, I definitely feel the needle; sometimes worse than others. (I'm using 8mm 30 gauge needles.)
You have to inject it correctly, it needs to be injected in the fat and with the right angle.
If you have very little body fat, your glutes are probably a better place.
Source: I take HCG and have to use injection 2x a week. 27G is my favorite..
https://medneedles.ca/products/1ml-27g-x-1-2-sol-care%E2%84%...
It is correct (belly). :-) I think I remember it being less painful when I was fatter? The 30G/8mm needles I'm using are smaller than your 27G/13mm needles in both dimensions; should be better, if anything. Again, it's not a big deal, but I feel it.
It’s mostly random and some people do feel it more than others.
It’s a rapidly absorbed peptide suspended in water, it could even be used with a transdermal patch, so it doesn’t matter that much where it gets in or how deep. Best to avoid painful areas though.
As someone who is mildly needle-phobic, I'll agree it's no big deal, but you definitely can feel it, and if you hit a blood vessel by accident, there's a (mostly painless) bump and 2-3 week bruise at the injection site, which might be a major issue for some.
You can get a vein finder to avoid that
Be sure to pull back on the plunger and ensure there the needle is not in a blood vessel (pulling back will draw blood into the thing and you will see).
You do not want the drug meant to subcutaneous to go into the blood steam. This is true for GPL-1s (all peptides for that matter), as well as insulin, and definitely mRNA vaccines.
Mounjaro uses a single use fully autometed injector--clean your skin, remove the cap, press the injector against your skin, then press a button. A springloaded needle penetrates you skin and a spring loaded plunger injects the medicine. You have no way to pull backthe plunger to see if you are in a vein/artery.
I've never used Ozempic, but my understanding was it used a device similar to insulin pens--dial you dosage, attach needle, insert needle, press at the base of the pen to inject the selected amount. Also no way to pull back to see if you hit a vein/artery.
>There's a miracle drug powerful enough to robustly lower people's all cause mortality
Did I misread the article, my TL;DR of the article is that GLP-1 reduce the indicators or mortality without modifying the actual mortality (because most users return to normal indicators within about 2 years).
The drugs do not reduce mortality much or even at all. Such drugs may improve quality of life though. Except for severe obesity, 40+ BMI, life expectancy is not lowered much in men and even less in women in the setting of obesity. It's just that being obese makes all sorts of markers worse, yet people do not die much sooner. It's more about improving quality of life.
No, it's a miracle drug that drops mortality by a ton. The indicators aren't being faked. The weight causes the mortality, and the weight loss reduces it, and the weight regain reintroduces it. GLP1RAs introduce some noise to the indicators but not enough to cause what you're implying.
"If we assume about 65% of people who start GLP-1 medications quit by the end of year one, that creates a big problem. When someone stops the medication, they'll usually regain the weight they lost, and in two years, most of those key health indicators (like BMI, blood pressure, blood sugar and cholesterol) bounce back to their starting point. "
So in addition to the quitters returning back to normal after they got life insurance underwritten when they were healthy, we have the unknown of the longevity of people on the glp-1 drugs.
Except for extreme obesity, it is about the same as people not on the drugs . Even moderate obesity only lowers life expectancy by a few years in men and about none in women. of course, quality of life will may be worse. Obesity only meaningfully lowers life expectancy at a BMI of 40-45+ for men
> because most users return to normal indicators within about 2 years
Because they stop taking GLP-1s after 1-2 years, not, it seems, because the meds stop working.
They do? I was under the impression people stopped taking them because they’re massively expensive. And weekly injections is a bit annoying (though should be less annoying than diabetes or death or whatever else).
There is a set of the population, and not a small one, that will quit the drug as soon as they hit the weight they feel is good enough. Even if they can afford it and are used to the shots they just feel that it is done and don't feel like they'll rebound (although most do) once off it.
Subtly different: you read "most...return to normal...within 2 years", it says "When someone stops the medication, they'll [return to baseline]"
Then from there, I click through the 65% #, assuming they have a good study on 65% of people stop after a year. Nah, they don't. It's super complex but tl;dr: specific cohort, and somehow the # getting on it in year 2 is higher than the # of people who quit in year 1.
I have a weak to medium prior, after 10m evaluating, that the entire thing might be built on more sand than it admits.
Lot of little slants that create an absolute tone - ex. multiple payouts over the "lifetime" of a life insurance policy. (sure, it's technically possible)
Also there's no citation for the idea this mortality slippage happened because of GLP-1, and it's been out for...what...a year? Maybe two?
That's an awful lot of people who were about to die, saved in the nick of time by...losing weight? Again, possible, I'm sure it even happened in some cases.
Enough to skew mortality slippage from 5.3% to 15.3%?
I thought they were 98% accurate?
Wait...is the slippage graph net life increase slippage? Or any slippage?
Because it's very strange this explosion happened in exactly the year of a global pandemic that had sky-high mortality rates for older people.
Since it's so new, of course there aren't any long-term data on GLP-1 takers. However, relying on prior knowledge about people who are good on the metrics, it can be presumed that they will do fine. And won't create financial risk for the insurer due to passing on earlier than expected. But only if they keep taking their meds and/or fix any underlying behavioral and health issues that made them obese in the first case!
Regarding the graph about slippage: yes, that looks like the Covid peak. However, even assuming this recent trend is an anomaly, the industry is in a changing landscape and needs to adapt. New metrics and criteria, and the fastest mover will capture the market. Business as usual.
I don't feel sad except for the people who managed to bring their health issues under control and now can't get life insurance.
GLP-1 isn’t new - the first trials were 20 years ago & there’s a lot of long term data from its use in diabetes management, prior to the weight loss application.
It's a maintenance medicine, not a cure, so if people stop taking it, they return to the same problems they had without it.
> if people stop taking it, they return to the same problems they had without it
Source? Everyone I know who stopped taking it rebounded a bit, but not to where they were. And no literature shows 100% rebound to my knowledge.
I mean roughly in reference to the underlying mechanism it directly addresses, not all the downstream effects. And even that was, admittedly, sloppy, because there's some complex feedback loops involved. I guess it would be more accurate to say it is a maintenance medicine and not a complete cure, and so stopping taking it unmasks the continuing condition that is treating.
> stopping taking it unmasks the continuing condition that is treating
Some of the prediabetics I knew who stopped taking it (N = 2) stopped being prediabetic (N = 1).
And it's under-commented upon because it's counterintuitive, but most people stop taking it. Like, two year continuation of use is about 25%.
That's kinda wild, because it seems like holy shit if you're taking a drug that lets you drop 10-20% of your body weight from obese down to normal why would you stop taking it, but people do.
Cost is a big factor. When it becomes generic then I suspect people will stay on it for a lot longer.
Side effects? Also many might not be able to afford it long term as it's quite expensive.
Because the pharmacy will refuse to sell it to you.
Source: UK based friend who says the pharmacy will refuse to sell them once they fall under BMI 25 (still overweight). They'd prefer to be on the tiny maintenance dose but it seems to be very hard to achieve (unless you're going off the market completely).
Because it costs $1000/mo and insurance wants to make it as hard as possible to get that covered because they cannot afford to pay $1000/mo * 45% of Americans without doing things to their rates that are forbidden by the ACA and, for that matter, any approximation of good sense. If people cannot afford an additional $450/mo each on average for their health care, how do you cover a critical long-term $1000/mo drug that 45% of the population needs?
Gating it behind mandatory expensive, difficult-to-schedule appointments with a specialist who is in abruptly short supply where the insurance company is doing their damndest to kick as many of them off their network as they can without getting caught to keep the shortage going is certainly part of that strategy. And the result is “people do not stay on the drugâ€, which is their goal, and if they don’t meet that goal they have an even bigger problem and can’t continue to exist as a functioning company.
Because they're now "normal", so why would they continue paying for it, taking unpleasant injections, and enduring the side effects?
In this sense it's like any diet: they "work", but if you don't permanently modify your food intake, the weight comes back as soon as you go off the diet.
Another way of putting it is that people achieve their goals and wind down the usage of the drug that got them there.
I think that in a few more years the number may stay at 25% (or whatever) but that the makeup of the 25% may be different. That is, people will go off it and back on it if they see their progress reverse but that will happen to different people at different times.
For a single person, perhaps fortunate. What about in aggregate? What if the math is so bad that your life insurer goes bankrupt?
... I just switch life insurance providers?
Seriously, that's just not that big of a deal. It takes like a few days at most for simple term life. Can't speak to the other policies, which I understand are mostly tax vehicles anyway, but it's not hard to simply get a new life insurance policy if your current one goes kaput.
That’s a pretty bad deal if you’re 10 years into a 20-year term, and your rates were determined prior to a decade of inflation and new pre-existing conditions.
I admit that's unfortunate. I don't think that was a "bad deal" in the sense that anyone grievously misled you or anything.
I would feel bummed out, but not angry or like I actually got ripped off, in other words. When I signed up for the 20-year term, part of what I was being asked to do was estimate how likely I think it is for this firm to actually be around for that full 20 years. That's just part of the game.
You will be going through underwriting again, your new rate will be based on starting at an older age, and you'll have a new exclusion period begin (unless there are some provisions which prevent these in the event of a company failure). Hopefully you haven't had any significant health conditions present themselves since the original policy went into effect.
Insurance companies will find any and every reason to not insure you. A slight change in lifestyle could mean you are no longer covered.
With term life insurance specifically the lifetime policy premiums are typically so low relative to the value of the policy that there's a natural bias towards insuring generally healthy people. Its not uncommon to see policies that are something like $40/month for 20 years ($9600 in premiums) for a $1mm death benefit, for example.
People with more complex medical conditions often can get life insurance from smaller, specialized providers... and at much higher rates. But the big mass-market players offering inexpensive term life products are only offering them that cheaply because they really control the risk profile during underwriting.
... and the question was about the aggregate effect. What happens if all life insurers go bankrupt?
That is great, they are by definition a net negative on the economy as a whole? You shouldn't gamble on your own health.
Life insurance, in the past, was frequently illegal.
I'd argue that it should be illegal again, as a moral hazard (directly contributing to countless murders and other schemes) and as a particularly morbid form of gambling.
Perhaps some life insurance products fall into that category. For many families, though, term life insurance plays a big part into ensuring financial security if one income earner dies prematurely.
Oh come on, you can't be serious.
It's not a gamble, you transfer your risk to a collective.
If you want to gamble on your health then you want a tontine, not life insurance.
Every single life insurer? All at once?
Jeez.... I guess in that scenario I become a billionaire because it will be very easy to scoop up some VC money to snoop up some of those newly unemployed actuaries to monopolize the market at a profit margin an order of magnitude larger than any of my now non-existent competition, because this is a financial product and doesn't require months of building a factory or something to offer.
If you think it's that simple, you have no idea what you're talking about.
How many years experience do you have in the insurance industry that you're so confident to talk like this?
> because this is a financial product and doesn't require months of building a factory or something to offer.
How many financial instruments have you launched? If the answer is zero, you should refrain from any conversations on the topic because your opinion literally means nothing.
I do actually think it's that simple, yes. Term life is just not that complicated a product at heart.
Onus is on you to prove that if every single life insurance provider was suddenly Thanos snapped out of existence tomorrow, we wouldn't see a swarm of hungry financial professionals swoop right back in to recreate the service within weeks. That seems like a laughable claim to me, but maybe you know something I don't.
(Edit, for future readers: ecb_penguin seems to have missed the question earlier in the thread I was responding to:
>... and the question was about the aggregate effect. What happens if all life insurers go bankrupt?
Emphasis mine. This was to clarify that yes, the original commenter meant literally all providers.)
Ok, so you have no experience and you're just making things up.
> Term life is just not that complicated a product at heart
Sure, it's easy if you don't know what you're talking about and just make stuff up!
> Onus is on you to prove that if every single life insurance provider was suddenly Thanos snapped out of existence tomorrow
Literally nobody said that would happen. Now you're arguing points that nobody made.
You have no experience in the area, arguing things nobody said. You're perfect for VC money, lmao.
> That seems like a laughable claim to me
Nobody made that claim. Why are you laughing at things nobody is saying? That's weird.
> That seems like a laughable claim to me, but maybe you know something I don't.
I would 100% guarantee people that have worked in an industry know more about it than you do.
Textbook demonstration of the Dunning-Kruger effect. You have no knowledge or experience in an area, but you're confident you know how it works, moreso than the actual experts. https://en.wikipedia.org/wiki/Dunning%E2%80%93Kruger_effect
"the Dunning–Kruger effect is the thesis that those who are incompetent in a given area tend to be ignorant of their incompetence, i.e., they lack the metacognitive ability to become aware of their incompetence. This definition lends itself to a simple explanation of the effect: incompetence often includes being unable to tell the difference between competence and incompetence."
I think this very accurately sums up your comments.
Well jeez, that sounds awful. Thank goodness I've always been great at everything I've done so I never gave to face this.
I was on Mounjaro for two months. I was also dieting and walking 10k steps a day. I lost 25 lb and my A1C went down to 5.0 from 5.7. All my cholesterol numbers were in range. I stopped taking it and lost 25 more. I haven’t regained the weight. People who gain it back did not learn the lesson and did not effectively change their habits. You need the discipline - and a good support system. But if you don’t have that and continue old habits then you will gain weight back. The original problem isn’t solved.
I lost almost 15 kg (~33 lbs) over the last two months and I didn't even try that hard. I never had problems with my weight, but over the last few years it slowly crept up to ~107kg (at ~1.95cm), at which point I realised I had to do something. Reasonably sure I could do a The Machinist Christian Bale if I wanted to.
I also quit smoking with relatively little effort twice (once in my early 20s, and then again a few years ago after I picked up smoking again during COVID). It wasn't easy-easy, but if I hear the struggles some other people go through, it was relatively easy.
Some people are just wired different. I have plenty of other issues, but on this sort of thing, for whatever reason I seem to be lucky.
> People who gain it back did not learn the lesson
Considering it took you a miracle drug to learn the lesson, that seems like a humorously arrogant take.
This is akin to saying a severely anxious person should be able to take an SSRI for a few months, learn how to change their thinking, and stay off antidepressants for the rest of their life. So simple. Must be their fault if they can't pull it off.
Perhaps that works for some people. I'm glad it seems to have worked for you. But the facts of the world we live in show that it doesn't work for most. "Learn the lesson and be disciplined!" is not effective advice.
I feel like your example shows the inverse of what you want. SSRI are actually great at helping the person develop healthy mechanisms (compared to GLP-1s), because they reduce the mood swings & negative thoughts, allowing the person to be more productive & be more involved in their therapy, in reading, journaling, doing sports, etc. It's just that it might take two or three years and not months, which is fine because SSRI also have much more limited side effects compared to GLP-1s.
GLP-1s don't do that directly.. but at least they might help people move more, and give them confidence to do more for their health instead of seeing it as a lost cause.
The analogy to your example is that someone who has to take Mounjaro for diabetes will always have to take it even after losing say 100 pounds. Or Metaformin even.
GLP-1 in those cases helps manage the problem better.
But for those who are not in those cases where Type 2 Diabetes has sunk in, then they need to use the opportunity to get better while on it and kick themselves into high gear or they will have learned nothing from the experience
That is the ideal model for treatment of those types of mental health disorders. Often patients have blockers that prevent them from resolving underlying issues. But through a drug they can get into a headspace that allows them to work through them with talk therapy, and then learn new habits and eventually go off the drug.
In practice, this doesn't happen that often, no, but it's a theoretical goal. Probably because we're in the pre-GLP-1 era with regard to mental health meds. Maybe that will change.
suprised your a1c was only 5.7 despite being obese .
From what I understand you don’t have to be obese and have type 2 diabetes. In my case, I was obese and did not have diabetes but I might have been going down that road
How long ago was this?
I started in Aug 2024 and stopped in Oct 2024. I paid for it from one of the pharmacies that made it in Florida. I injected myself with insulin needles that they send you.
Depends on your ultimate high's. That's a pretty good indication of diabetes (any form).
I've had pretty good hb1ac's when my blood sugar's were all over the place and in no way healthy.
I've seen so many reports of people losing weight one way or another, and saying they kept it off, and I think only once has it been more than a year. Usually under 6 months.
Personally I lost a ton of weight doing full-on keto (I specify, because some people just kinda cut out carbs) and then kept it off for over 2 years. But I put the weight back on after that, albeit slowly (over the course of maybe 7 years).
I've also done Mounjaro, and I can keep it off a while after I go off it, but not that long.
YES, you have to change your habits, maybe lifestyle, maybe deal with other issues in order to keep it off. But I think, not only is that difficult, it's not a "you did it and you're done" deal. It's easy to slip backwards, and I won't make any claims about you personally, but for anyone who's kept it off for less than a year, I think the good money would be on it coming back within another year. I doubt someone is "out of the woods" even two years on.
I don’t see myself gaining 50 lb back. I would have to eat a TON which I don’t
> People who gain it back did not learn the lesson and did not effectively change their habits. You need the discipline
This is deeply misguided. I’m glad that the little assist was enough for you, but if “healthy habits†were enough then people who’d lost weight the traditional way would keep it off.
Further, unless you’ve been off it for more than six months, I’d hold your judgement on this one.
I have been off since Oct 2024. Also, I did continue to lose weight the traditional way.
After I stopped, a coworker told me about Vida which my work offers as a health benefit.
Using the Vida service where I got a registered dietician to show me what to eat, I tracked my food and water intake and tracked my exercise. I had protein and fiber goals to hit.
You can’t do it all on the medicine - it is a lifestyle change. The medicine was the catalyst but not the reason I kept the weight off. I wanted it. But because I wanted it, I wanted to use the support system that my work paid for.
I think there is a lesson to be learned here
I know some serious cases where there were non-habitual problems but... "healthy habits" is nothing to laugh about. People literally are what their habits are. All of our behaviour is habits, and changing behaviour takes time and effort.
The good news is that it is not impossible, and it really is possible to change bit by bit for most people suffering from obesity.
I don't think somebody who walks 10k+ a day, maybe goes to gym a couple of time a week, limits calorie intake to a comfortable and reasonable 2000 kcal per day, would suddenly bounce back to 130kg!
> but if “healthy habits†were enough then people who’d lost weight the traditional way would keep it off.
That's because a lot of the "traditional way" methods are pseudoscience at best, outright quackery that's going to send you into serious malnutrition issues or eating disorders at worst. Every two or three months you see a new diet fad pushed through the yellow press rags, and none of it anywhere near being considered scientifically valid - usually it's some VIP shilling some crap story to explain how they lost weight, of course without telling the people that they have the time for training and the money to pay for proper food, 1:1 training and bloodwork analysis.
I would have thought the "traditional way" would simply be eat less, move more (by changing your habits of course).
GLP-1 makes you want to eat less. So you are correct.
Giving people the magic cheat code drug seems antithetical to helping them develop the habits and discipline for long term lifestyle change.
A lesson often learned painfully: in most cases there isn't a reward for doing things the hard way. You could argue that a magic weight loss drug will prevent people from making important lifestyle changes, but all else equal, a magic drug that helps you lose weight with seemingly no other downsides is an obvious net win for health. Losing weight once you put pounds on is hard, for both mental and physical reasons, and even just being able to lose weight is probably a huge help as it puts in reach what many consider to be intangible after years of failure.
I haven't tried a GLP-1 agonist myself because I'm not exactly severely overweight, but I do absolutely struggle to keep weight off. It's amazing how easy it is to re-gain weight and how hard it is to keep it off. If the worst side-effect of GLP-1 agonists is that it makes life insurance quotes harder, whatever; I think it's totally acceptable that some people will still struggle with improving their habits, I don't think it's likely to make it any worse. In my opinion I suspect it is likely to make it a bit better, by helping you break out of the cycle.
P.S.: since there is some neighboring discourse about whether being fat is a disease or a lifestyle choice, I'll just say this: I don't personally think it matters. I don't think arguing this distinction will actually help anyone. I don't really care for body positivity and I don't make excuses for my poor habits or being overweight, but I still don't think it makes losing weight much easier.
Depends on your circumstances. If you're a bit overweight and want to lose weight: it's perhaps not helpful. If you're obese and everything just seems hopeless: fuck it – do anything that will bring your weight down to a manageable level first, and then start working on habit and lifestyle changes. Energy levels, the motivation of seeing progress, and that type of thing are hugely important.
I'd be okay with that so long as nobody can have Nicorette, the birth control pill, or Viagra. I don't have a problem refraining from smoking, I've never gotten pregnant, and my dick works, so it must be some innate discipline in me that others must learn, so no meds for them.
See how ridiculous that sounds?
Giving people the magic antibiotic cheat code seems antithetical to helping them develop habits and discipline to avoid bacterial infection.
You could apply this same stupid logic to many medications.
Blood pressure medication comes to mind.
People have to believe in free will or they go crazy. Admitting that we’re just a bag of hormones and electric signals means our whole system of morality is built on sand and that’s a scary door to open.
That's a great idea!
Can you show me what we're doing in USA to help children and people develop the habits and discipline for long term lifestyle change?
Because I've never learned anything about nutrition, macros, high sugar content and all of the healthy food I should learn to eat on my own.
We did not have home classes in any of my education in US at all, they were a thing in the past but that wasn't a thing in my middle hs or hs or college at all in NY in 90s/2000s.
All of my bad habits were from my parents and they were not good eaters.
Yep, that’s key. That’s the lesson I learned as I commented above as GP.
My work offered me five visits with a dietician and then I got a health coach and a nurse all paid for and monitoring me on the side through the Vida service. Not everyone has that
Why is obesity the only disease that taking medicine for is “cheating� Which is more important: instilling your particular version of “discipline†into people, or saving billions in healthcare costs and millions of lives from suffering?
People grew up making fun of others for being overweight. Suddenly a medication making it treatable (and possibly providing an explanation for why the prevalence of obesity skyrockets in developed countries) validates the idea that it's a medical condition.
Relatedly: it validates that people are assholes for making fun of others who are overweight. And not many people like feeling like an asshole.
Edit: starlevel004 is right.
Correction: Lots of people like feeling like an asshole. They don't like being called out for it or being wrong.
It's not. I'd put most addictions in that category. And instilling discipline in people is a good thing that benefits them in myriad ways.
You are free to put addictions in whichever category you prefer. The medical community does not: we treat addiction with medication as well.
[flagged]
Taking medicine is a lifestyle choice.
lol
Cheat code was probably not the best term for it, I'll admit. I don't fault anyone for chosing to try GLP-1s and the cause of obeseity isn't particularly on the individual given the prevailance of ultra processed foods and car transportation in our society. That all being said, regaining most, if not all, the weight has been a historical issue around weight loss treatments because they're not durable. The way we're proceeding with GLP-1s feels short-sighted and potentially unethical if we're setting people up for rebound failure to line the pockets of big pharma.
Would you say the same about blood pressure medications, diabetes medications, cholesterol medications, thyroid hormone replacement, antidepressants, mood stabilizers, antipsychotics, anti-anxiety medications, immunosuppressants, DMARDs, corticosteroids, anticonvulsants, Parkinson’s medications, multiple sclerosis treatments, blood thinners, and heart failure medications? All of them set people up for rebound failure if they stop taking them for the chronic condition they started them for.
I wouldn't group those together at all for the sake the argument. Take antidepressants for example. We're at the point of reexamining if we actually understand the consequences of long term usage of them. My personal experience was that my long term usage definitely came with issues and it's taken me a few years to feel like my emotional range has returned to a stabe baseline after going off them. I likely would have been better off using them short term. Depressiom is also quite similar to obesity in the sense that helping people develop the durable non-medical interventions while being treated with drugs would go further than just treating them with drugs alone.
Contrast this with Parkinson's which is a neurodegenerative disease with no known non-pharmacutical treatments and even the pharmacutical ones lose effectiveness as it progresses as they only treat symptoms, not the disease itself.
> go further than just treating them with drugs alone
This is precisely what the FDA guidance contains: that GLP1s be mixed with lifestyle modifications.
It’s usually a self inflicted disease. Your own actions cause it most of the time
Which other self-inflicted medical conditions do we deny medical care for?
Good point. The main root cause of obesity is too many calories. Usually, obesity and the symptoms / diseases that come with it improve / go away when eating less calories. Does any human technically need medication to eat less calories?
> Does any human technically need medication to eat less calories?
Chronically obese people, who are prescribed GLP1s to enable them to eat fewer calories. Are you interested in the reasons why people are unable to eat fewer calories without medication? It’s a pretty fascinating problem, one that intersects genetics, environment, and culture.
Yes. Gut microbes has already been shown to have a great impact on how we metabolize by what med we take, what we eat or drink and intake from our environments (micro-plastics, etc).
There is no single main root cause for obesity. We just combine it as one because there isn’t a lot of long term research or funding for it right now. There is a lot of sigma against obesity and people keep blaming other people instead.
Thyroid hormone disorders have been linked to cause weight gains. This can’t be fixed by simply eating less, it can literally do far more damage.
Medications have been linked to cause weight gain as side effects. This wouldn’t do anything to eat less until they stop taking meds and for some, they cannot do that.
Americans’ increasing desire for sweets have increased the sugar content in all of our food including the fruits and vegetables over time. We’ve intentionally bred our healthy stuff to be sweeter. So eating less can make us even more hungrier because we go into sugar crush without realizing it. Changing diets is difficult without us doing all sorts of calculations of finding the right cheap healthy food at the right store and that is you are lucky enough to have any.
This just pops up in my RSS today, which is an interesting read but not yet relevant to humans: https://newatlas.com/health-wellbeing/amino-acid-cysteine-re...
We prescribe alcoholics with medicine to help them curb their alcohol intake, but if they do not learn the discipline to not drink then they can end up back where they started after getting off the medicine. But I don't think either drugs for alcoholism or obesity should be denied to anyone. However there are other tools to supplement with to help learning discipline.
>However there are other tools to supplement with to help learning discipline.
The current FDA guidelines support your assertion that GLP1s should be prescribed in addition to other tools to help people change their eating habits.
What the FDA does not prescribe is moralism, which is what “help learning discipline†tends to imply. If you didn’t intend to frame your argument in terms of moralism, you might consider a different word choice.
Not sure how else to word it. "help people change their habits" vs. discipline to change their habits - what's charged about the word 'discipline'?
In English, we “instill discipline†in children. When we talk to and about adults, we talk about the confluence of factors that influence habits and help people change them. Discipline implies that an adult, who is otherwise fully functioning and subject to the demands of the world, is lacking an essential attribute. Whatever you might feel about this explanation, we already observe from science and medicine that “instilling discipline†on its own has not stalled the obesity epidemic.