Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Why are these threads in "diet and exercise" when they have nothing to do with either? Move it to health, or maybe beauty.

Were you born stupid or just dropped on your head as a baby or something?

Maybe you should exercise for weight loss, since you clearly have a lot of pent up anger?

That isn’t anger, toots. That’s putting someone in their place. Big difference.

I worry about the long term side effects. My doc put me on fen-phen in the 90s, saying it was perfectly safe. But then it came out that long term use could affect heart health. I got off quickly and thankfully no repercussions, but it was scary at the time.

On a societal level, I think the change will be similar to the advances with IVF and fertility treatments.

Much like how a lot of people are now able to have children who couldn't before these advances, there will now be so many more people who will be able to reach a heathy weight. That's a big win for society from health outcomes to healthcare costs to just the joy of having family members around and living longer and healthier lives.

But it won't work for everyone. And not everyone will choose the cost in terms of side effects and commitment to staying on the drug. Just like not every infertile person chooses to keep doing round after round of IVF until they get a baby and not everyone ultimately ends up pregnant.

So just like we haven't eliminated infertility, I doubt we will eliminate obesity. But I do think it is an incredible scientific advance that is going to change a lot of lives and change society for the better.

Anonymous wrote:

Anonymous wrote:Why are these threads in "diet and exercise" when they have nothing to do with either? Move it to health, or maybe beauty.

Were you born stupid or just dropped on your head as a baby or something?

Maybe you should exercise for weight loss, since you clearly have a lot of pent up anger?

There are a lot of people with poor genetics who eat healthy and exercise regularly. These people are probably fairly healthy and nobody is criticizing them. There are also a lot of other people who eat large amounts of crappy foods and have no discipline when it comes to exercising. These people are destroying their health regardless of whether you think their obesity was caused by some gut syndrome or whatever the latest research says.

To answer OPs question genuinely: no, they won’t eliminate obesity. However, they may, for certain classes of patients, manage obesity successfully for years, provided the patients keep taking the drugs. Keep in mind that obesity is an extraordinarily complex metabolic presentation: as an example, the super morbidly obese have a shockingly high rate of childhood sexual abuse in their health history as compared to the “normal” weight population. And there are genetic markers that are strongly correlated with obesity. There are also metabolic markers that show up in some people’s bloodstreams years before they become clinically obese. Then there are women who have PCOS, who are much more likely to gain weight later. The point is that what the general population sees simplistically as “obesity” is increasingly being viewed as the side effect or outcome of a series of complex and interrelated metabolic and mental processes.

So what that means is that any medical cure to obesity is not likely to be a “one and done” thing. I think this class of drugs will likely work best for those obese patients whose obesity is primarily caused by some sort of not-yet-fully-understood pre-diabetic condition, possibly related to some kind of gut inflammatory syndrome. It will probably also help patients whose obesity started from some other cause but then compounded into a diabetic or pre-diabetic condition. But it won’t be a magic cure, and it will likely require longer-term maintenance doses of the drugs (these can’t be thought of as short-term fixes), even for those patients it does help.

What I am hoping (against realistic hope, unfortunately) is that these class of drugs remove “willpower” from any serious discussion of weight and health. It is mind-boggling to me that people cling to the myth of willpower in this day and age, but particularly in a world where people get a shot and 48 hours later lose a compulsion to eat. Surely this should put to rest the idea that “willpower” is a remotely rational response to obesity. But I think the people who like to mock fat people enjoy their sport too much to give it up even in the face of hard scientific evidence showing how wrong they are.

Also, because I’m sure one of those people will start screaming “put down the chips” in response to this post, I will say ahead of time that I’m not obese. That should not matter at all, but apparently to a lot of DCUMs less discerning readers, words have more weight when uttered by someone who is not obese, and I want to shortcut that tedious nonsense.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:No. I’ve been a personal trainer for 30 years. Masters in Exercise Physiology. No drug will ever work. No fad diet will ever work. No shiny new exercise program will ever work. Healthy, strong bodies are built through hard work and discipline. People may lose for a few months or even years. But it always comes back. Changing your body requires a complete lifestyle change. Few people are willing to put in the effort.

I realize you feel threatened for your livelihood but the empirical evidence suggests these drugs are highly effective.

NP. Empirical evidence? Like the same empirical evidence showing that oxycodone wasn't addictive. Lots of nerds believed that nonsense. Do you honestly think that taking a weight loss drug is going to improve the health of weight challenged individuals?

You seem confused about the meaning of the term "evidence." There was ample evidence pretty early on that Oxy was being diverted and that the anti-tampering measures were inadequate, but regulators ignored the evidence. What happened with the Sacklers was corruption and massive regulatory failure. It was not a problem of evidence.

You also seem confused about how pharmaceuticals and medicine in general work. Semiglutide is a drug that's been improving the lives of people with diabetes since 2012. It was authorized for obesity management in 2021, but the drug has a proven track record of helping people with diabetes pretty dramatically.

I get arguing that regulators can be corrupted and bribed to ignore evidence by drug companies, and that's a problem that needs to be addressed by strong oversight and regulatory reform -- something Americans are politically really bad at demanding.

But you're not making that argument; you seem just to be arguing that pharmaceuticals are bad, which is weird considering that humans now live on average more than twice as long as they did before modern pharmaceuticals began to be invented.

Well they were the ones pushing Oxy based upon BS info provided by Purdue. Wasn't this info based on "studies" conducted by Purdue? Or were the studies legitimate and basically disregarded by regulators?

I don't think anyone is making the argument that pharmaceuticals are necessarily bad. Wait loss drugs seem too good to be true, just like Oxy. Do we even know the long term risks? I think the idea that you can just take a pill and all of a sudden you will lose weight and be healthy is absurd. Americans are obese because they eat massive amount of processed food and simply aren't active. I don't doubt there is a study showing you can lose 3% body fat by taking Semiglutide, and maybe these drugs makes sense for a very small number of weight loss patients. But most obese Americans lack discipline when it comes to diet and exercise and will likely just use these drugs as a crutch instead of actually making long term changes that result in actually being healthier.

Anonymous wrote:These drugs will be less popular once people know the long term effects on organs, fertility, etc.

We do know. There aren’t any.

Anonymous wrote:

Anonymous wrote:It's only good for weight loss while you're taking it. As soon as you stop taking it, the weight comes right back.

Can you take it long term so you don’t regain?

Yes. Those who are taking this for weight loss understand that it is a lifelong medication for weight management just like it is for diabetes. Or at least they should.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:No. I’ve been a personal trainer for 30 years. Masters in Exercise Physiology. No drug will ever work. No fad diet will ever work. No shiny new exercise program will ever work. Healthy, strong bodies are built through hard work and discipline. People may lose for a few months or even years. But it always comes back. Changing your body requires a complete lifestyle change. Few people are willing to put in the effort.

I realize you feel threatened for your livelihood but the empirical evidence suggests these drugs are highly effective.

I agree, in the short term. But, they've been around only a couple of years and are being marketed similar to insulin and other drugs that require regular use for a lifetime. I don't think we know if they are sustainable over a lifetime or what it looks like when other needs and medical issues layer on top. (Not saying I know they won't make a large dent in obesity ... just that it's early.)

Not the PP but FYI most of this class of drugs has been available and in trials for around a decade. It’s just the authorization for weight loss that’s new (except for Mounjaro, which is in fact fairly new).

Before Ozempic the GLP-1 class of drugs wasn’t super effective for weight loss. They’re getting better and better in that regard.

Anonymous wrote:

Anonymous wrote:I know someone who lost over 100lbs on Ozempic and is now at a healthy BMI. Their doctor says they still need the Ozempic due to type 2 diabetes even though they are now completely off their twice a day insulin shots as a result of the weight loss. My question is what will happen if they just keep losing weight? What if they get down to an unhealthy BMI, will the doctor think they should stop the drug then? Is it possible to force yourself to eat more while under the effects of this medication? How important is the drug for diabetics once they've lost so much weight?

The answer is: it’s complicated, personal, and some of this is still being worked out. If they have good glucose levels and are still losing weight, their doctor will probably gradually move them down to a lower dose to reduce the weight loss. But that’s less likely. What is more likely is that their body will eventually settle at a new reasonable set point, where they will need to stay for awhile. They probably won’t (and shouldn’t) move off the drugs quickly. They are still diabetic (although there is a lot of discussion about this now). Essentially they are a diabetic with successfully managed — but not cured — diabetes. There is some question about long-term efficacy of these drugs for maintaining weight loss, but what does seem to be clear is that treating this class of drugs like “diet” drugs (where people go off as soon as they hit goal) doesn’t work. People for whom these drugs are effective likely need to stay on them for long periods of time after weight loss.

It’s great that they’re off insulin — that’s a major health victory.

Thanks for this very thoughtful and informative answer.

Anonymous wrote:These drugs will be less popular once people know the long term effects on organs, fertility, etc.

As compared to actual obesity, they’d have to do a lot worse.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:No. I’ve been a personal trainer for 30 years. Masters in Exercise Physiology. No drug will ever work. No fad diet will ever work. No shiny new exercise program will ever work. Healthy, strong bodies are built through hard work and discipline. People may lose for a few months or even years. But it always comes back. Changing your body requires a complete lifestyle change. Few people are willing to put in the effort.

I realize you feel threatened for your livelihood but the empirical evidence suggests these drugs are highly effective.

NP. Empirical evidence? Like the same empirical evidence showing that oxycodone wasn't addictive. Lots of nerds believed that nonsense. Do you honestly think that taking a weight loss drug is going to improve the health of weight challenged individuals?

You seem confused about the meaning of the term "evidence." There was ample evidence pretty early on that Oxy was being diverted and that the anti-tampering measures were inadequate, but regulators ignored the evidence. What happened with the Sacklers was corruption and massive regulatory failure. It was not a problem of evidence.

You also seem confused about how pharmaceuticals and medicine in general work. Semiglutide is a drug that's been improving the lives of people with diabetes since 2012. It was authorized for obesity management in 2021, but the drug has a proven track record of helping people with diabetes pretty dramatically.

I get arguing that regulators can be corrupted and bribed to ignore evidence by drug companies, and that's a problem that needs to be addressed by strong oversight and regulatory reform -- something Americans are politically really bad at demanding.

But you're not making that argument; you seem just to be arguing that pharmaceuticals are bad, which is weird considering that humans now live on average more than twice as long as they did before modern pharmaceuticals began to be invented.

Well said.

That was a very patient and thoughtful response. I would not have had that level of patience with that poster.

These drugs will be less popular once people know the long term effects on organs, fertility, etc.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What is the long term safety of these drugs? Do we even know? I just don’t think pharmaceuticals are the key to health, lifestyle and diet is a more difficult but proven solution.

Lifestyle and diet are essentially proven advice failures at this point. If you are counseling lifestyle and diet as the sole key to long-term health for obese people, you are flat-out helping your clients have shorter lifespans and likely also setting them up for severe psychological harm.

If doctors were hawking cures for literally any other disease that had a 95% failure rate, we would be bringing them before medical boards for fraud and harm. But that’s what happens for obesity regularly and it is instead a rapacious multi-billion dollar industry. You see elements of that here in DCUM — look how panicked and angry the personal trainers and “diet counselors” of DCUM are about the existence of this class of drugs. Never mind that these folks have been giving failing advice for decades.

If there’s a 95% failure rate for lifestyle and diet, what is the failure rate for semi-glutides? Can people who are size 28 expect to lose weight and keep it off? Is it a no-brainer to take the drugs?

The long-term failure rate is not yet know, but based on the data of the past ten years or so with diabetic patients, it’s likely far, far better than 95%. There are several studies.