"I No Longer Think GLP-1s Are the Answer — The drugs "work" but may be working against us long-term"

[Anonymous]

There are so many drugs I plan to use for life. I’ll never get off Zyrtec. I don’t expect Advil taken for today’s headache to work on one next week. I’ll be on birth control until I’m on hormone replacement. I don’t see myself ever stopping using Tretinoin. Both my parents will be on cholesterol drugs for life, so I expect at some point I will be too.

Why is it that when it comes to weight loss medications people are clutching their pearls at the idea that people won’t eventually stop?

[Anonymous]

Anonymous wrote:Did this guy actually not realize these were lifetime meds? I know that and I’m not a doctor. My guess is that even with the patients who stop taking GLPs and regain the weight, on average they are much more effective than any other method the doctor can offer.

Yes, he does realize this, but most people don't.

The benefits of these drugs cannot be denied when they are taken as intended -- meaning indefinitely. But what happens to the body and mind when these medications are discontinued? This is where the problem lies.

The truth is, most patients don't stay on anti-obesity medications -- I see it in my practice every day. Research shows that three-quarters of patients stop GLP-1 medications within 2 years, many within months. Reasons for discontinuation include cost, side effects, and supply shortages. But one of the most common reasons is that patients simply don't want to take a weight loss medication indefinitely. Many believe they can "beat the system," use them briefly, change their lifestyle, and stop taking them without regaining weight.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:His claim that people who use the drugs lose muscle and don’t gain it back when they stop the drug therapy is concerning.

Has only to do with the speed of weight loss, which can be managed with proper dosing and nutrient intake. The issue is not with the medication.

In theory, yes. In practice, no. I’ve never seen anyone not lose massive amounts of muscle. Sure, it’s possible but it’s just as hard as losing weight and building muscle in a lifelong way - so the old fashioned way is better/safer.

Everyone loses muscle when they lose weight. You can reduce muscle mass loss by lifting and losing at a 1-2 lb per week rate. Nothing to do with the GLP-1…

You are naive and will fight to the end. Continue on your path.

GLP has everything to do with rate, which is what causes the large muscle loss. Gradual lifestyle changes are far more sustainable and healthier on your body.

Sure come back and say they’re not. I really don’t care. Then again I don’t need GLPs. I’m an athlete with a long history of muscle building and lifestyle sustainability. So just like you think popping a pill is magic with no long term data - I think healthy diet and exercise is magic with long term data and sustainability.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Did this guy actually not realize these were lifetime meds? I know that and I’m not a doctor. My guess is that even with the patients who stop taking GLPs and regain the weight, on average they are much more effective than any other method the doctor can offer.

There are a lot of dumb doctors out there.

Even more dumb people who are too stupid to make it into med school.

[Anonymous]

Anonymous wrote:There are so many drugs I plan to use for life. I’ll never get off Zyrtec. I don’t expect Advil taken for today’s headache to work on one next week. I’ll be on birth control until I’m on hormone replacement. I don’t see myself ever stopping using Tretinoin. Both my parents will be on cholesterol drugs for life, so I expect at some point I will be too.

Why is it that when it comes to weight loss medications people are clutching their pearls at the idea that people won’t eventually stop?

You didn't read the OP or the linked article did you? The problem is not the people who take it for life. The problem is the majority of people who take it temporarily.

[Anonymous]

The problem, as he states in part, is that unless the price significantly is lowered, paying for it for life for many people is unsustainable, even though they may dip into their savings to pay for a year or so.

I have an appointment with my doctor to discuss starting a GLP-1 soon and I’m hoping that with the new pill form becoming available the price will be affordable in the long-term for me.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:His claim that people who use the drugs lose muscle and don’t gain it back when they stop the drug therapy is concerning.

Has only to do with the speed of weight loss, which can be managed with proper dosing and nutrient intake. The issue is not with the medication.

In theory, yes. In practice, no. I’ve never seen anyone not lose massive amounts of muscle. Sure, it’s possible but it’s just as hard as losing weight and building muscle in a lifelong way - so the old fashioned way is better/safer.

Everyone loses muscle when they lose weight. You can reduce muscle mass loss by lifting and losing at a 1-2 lb per week rate. Nothing to do with the GLP-1…

You are naive and will fight to the end. Continue on your path.

GLP has everything to do with rate, which is what causes the large muscle loss. Gradual lifestyle changes are far more sustainable and healthier on your body.

Sure come back and say they’re not. I really don’t care. Then again I don’t need GLPs. I’m an athlete with a long history of muscle building and lifestyle sustainability. So just like you think popping a pill is magic with no long term data - I think healthy diet and exercise is magic with long term data and sustainability.

Do you have any citations? Because I do. There’s no evidence that muscle mass loss in GLP-1s is any worse than muscle mass loss from other means.

“There's concern in the general public about how weight loss drugs affect muscle mass, but the presenters emphasize that the data doesn't show GLP-1 analogs have a unique, high level of lean body mass loss compared to other weight loss paradigms.”

https://advances.massgeneral.org/endocrinology/article.aspx?id=1601

I trust Mass General a lot more than I trust an unsubstantiated, anonymous claim on the internet.

[Anonymous]

This guy is just trying to get clicks.
I follow the science.

[Anonymous]

Anonymous wrote:The problem, as he states in part, is that unless the price significantly is lowered, paying for it for life for many people is unsustainable, even though they may dip into their savings to pay for a year or so.

I have an appointment with my doctor to discuss starting a GLP-1 soon and I’m hoping that with the new pill form becoming available the price will be affordable in the long-term for me.

The starting doses have dropped like 70% over the last two years. It will drop more as more competitors enter the market. When Ozempic goes generic in 6 years, the price will be rock bottom.

[Anonymous]

Anonymous wrote:

Anonymous wrote:There are so many drugs I plan to use for life. I’ll never get off Zyrtec. I don’t expect Advil taken for today’s headache to work on one next week. I’ll be on birth control until I’m on hormone replacement. I don’t see myself ever stopping using Tretinoin. Both my parents will be on cholesterol drugs for life, so I expect at some point I will be too.

Why is it that when it comes to weight loss medications people are clutching their pearls at the idea that people won’t eventually stop?

You didn't read the OP or the linked article did you? The problem is not the people who take it for life. The problem is the majority of people who take it temporarily.

This. It's especially problematic for people who are using these drugs to lose small amounts of weight, and who often are not obese to begin with.

It's the same problem with yo-yo dieting we've always had. Thee have always been ways to drop a lot of weight quickly, and there have always been people willing to do these things for a little while in order to achieve a short term goal -- looking a certain way in their wedding day, feeling good in a bikini, etc. But people have always given up on these methods and regained weight, because there is usually sacrifice and discomfort they can't tolerate long-term. GLP1s are no different -- the drugs are pricy, taking them is inconvenient, and many people experience cause effects.

This is the problem with widespread use. The vast majority of people don't actually need these drugs for health reasons, and thus will go off them when they no longer want to sacrifice the money and physical side effects, and those folks will regain the weight.

Gaining and losing substantial amounts of weight multiple times in your life has been shown to have a lot of negative health effects, even when the weight loss is achieved in a healthy way.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:GLP-1s result in more long-term weight loss than diet and exercise alone, which has something like a 90-95% regain rate.

Most people regain a significant portion of weight lost after stopping GLP-1 drugs, often around two-thirds of the total loss within a year, with studies showing roughly 80% regain at least 25% of lost weight and some regaining all of it. While many sustain some weight loss, often around 5-10%, the benefits to heart health and metabolism can reverse as weight returns, highlighting that these medications treat a chronic condition and often require long-term use.

Right, this is the same or better than weight loss through diet and exercise.

No, actually it’s worse. Diet and exercise typically include weights and muscle gain which fight osteoporosis. GLP drugs eat away at muscle as part of the weight loss, increasing your chance of osteoporosis - which btw looks good on no one.

This is the main reason I haven’t tried a GLP1 drug yet. I’d love to lose 20 lbs, but I already have osteopenia and would rather be mildly overweight and strong than thin with bird legs and a hump.

No legit member of the medical establishment is going to recommend a GLP1 for someone who would "love to lose 20 lbs." It's an anti-obesity medication.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Did this guy actually not realize these were lifetime meds? I know that and I’m not a doctor. My guess is that even with the patients who stop taking GLPs and regain the weight, on average they are much more effective than any other method the doctor can offer.

There are a lot of dumb doctors out there.

+1

And this guy is clearly one of them.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Similar with insulin. If you stop taking it you die, so is it really helping?

Being overweight doesn’t kill you unless you are morbidly obese, which is who the drugs are targeted for. If you are taking it to be slim from a healthy/slightly overweight start you will do more harm than good. This isn’t rocket science; it’s just normal logic a reasoning.

Being obese—which like 40% of Americans are—is horrible for you.

True. But most obese people are too poor to afford the drugs - statistically. It’s mainly UMC who want it for vanity who get the drugs.

It's mainly "UMC" who get the drugs, yes -- because they have the good insurance or can afford to pay for it. But it's mainly UMC folks who are obese -- which is a medical condition that causes other illness and injury and even death, let alone harms quality of life and causes misery -- not UMC folks "who want it for vanity."

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:His claim that people who use the drugs lose muscle and don’t gain it back when they stop the drug therapy is concerning.

Has only to do with the speed of weight loss, which can be managed with proper dosing and nutrient intake. The issue is not with the medication.

In theory, yes. In practice, no. I’ve never seen anyone not lose massive amounts of muscle. Sure, it’s possible but it’s just as hard as losing weight and building muscle in a lifelong way - so the old fashioned way is better/safer.

Everyone loses muscle when they lose weight. You can reduce muscle mass loss by lifting and losing at a 1-2 lb per week rate. Nothing to do with the GLP-1…

You are naive and will fight to the end. Continue on your path.

GLP has everything to do with rate, which is what causes the large muscle loss. Gradual lifestyle changes are far more sustainable and healthier on your body.

Sure come back and say they’re not. I really don’t care. Then again I don’t need GLPs. I’m an athlete with a long history of muscle building and lifestyle sustainability. So just like you think popping a pill is magic with no long term data - I think healthy diet and exercise is magic with long term data and sustainability.

Do you have any citations? Because I do. There’s no evidence that muscle mass loss in GLP-1s is any worse than muscle mass loss from other means.

“There's concern in the general public about how weight loss drugs affect muscle mass, but the presenters emphasize that the data doesn't show GLP-1 analogs have a unique, high level of lean body mass loss compared to other weight loss paradigms.”

https://advances.massgeneral.org/endocrinology/article.aspx?id=1601

I trust Mass General a lot more than I trust an unsubstantiated, anonymous claim on the internet.

Seriously?! You want citations for something so well known it dates back 100s of years of conventional wisdom? You are one of those “dumb” people PP mentioned.

Citations won’t convince me. We haven’t had these drugs long enough to even have the data. Remember the miracle drug fen-phen - this is the same. It’s a miracle until it’s not and we see the long term damage. The FDA approved fen-phen and the hype was the same as it is now. Maybe you are too young to remember that.

I should mention I’m in my 50s so I’ve seen the hype before. I’m also knowingly very bias. I’m 5’3” and 130 lbs - although I wear a size 0-2 - so I’m solid muscle, like really solid.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:GLP-1s result in more long-term weight loss than diet and exercise alone, which has something like a 90-95% regain rate.

Most people regain a significant portion of weight lost after stopping GLP-1 drugs, often around two-thirds of the total loss within a year, with studies showing roughly 80% regain at least 25% of lost weight and some regaining all of it. While many sustain some weight loss, often around 5-10%, the benefits to heart health and metabolism can reverse as weight returns, highlighting that these medications treat a chronic condition and often require long-term use.

Right, this is the same or better than weight loss through diet and exercise.

You can do diet and exercise for free and certainly less than the hundreds of dollars per month the drugs cost without insurance.

You lose waaaay more weight on a GLP-1 though. It’s not revolutionary for a chronic illness to require lifelong treatment. No one claims my thyroid medicine is a failure even though my Hashimoto’s means the second I stop taking meds my levels will be abnormal again.

My insurance covers my thyroid medicine.

It seems to me that losing 50.lbs quickly and then regaining 45 lbs quickly is worse than never having lost the weight at all. Again, if you can afford to stay on the GLP-1 and it works for you, great! But I agree with this doctor that for the many, many people that don't plan to stay on it for life it can do more harm than goodm

Does he specify the harm done by taking this medication?