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.
Having ADHD myself, and a bunch of friends who also have it, I have noticed that the people with this condition rarely have a healthy relationship with food. There is either a tendency to overeat indulgent foods, or a tendency to not think about food that much.
I have also heard about people with ADHD being on GLP1 agonists that it does a lot for their reward seeking behavior and impulse control.
This makes me wonder two things:
- Whether at some point these molecules will also start being used for ADHD and addiction treatment in general. I think they hold a lot of promise for issues rooted in the reward system.
- Whether a sizable portion of people who struggle with their weight have co-morbid ADHD which creates or worsens their overeating issues.
Have you noticed anything along these lines in your practice?
As someone with diagnosed ADHD. I fully agree. There's some background thread that says "you, now, eat". It's almost impossible to shut off.
That being the case, the same behaviours have led me to a compulsive need to plan meals. Doing so has helped me lessen (not eliminate) food noise. Anecdotally, I've noticed with others as well, that this is the way. Prep - be fine. Don't prep - eat a small village.
Also ADHD here, and same thing for me. Hyperfixating on meal planning and strength training has pretty much saved me. It's hard, and I still have to fight food noise daily, but having everything pre-prepped means I have easy, friction free healthy choices instead of reaching for a bag of chips and downing the entire thing while sitting at my desk, or not having the executive function necessary to cook an un-prepped, unplanned dinner and just eating a whole pizza instead.
I also used to binge, and meal planning and pre has also helped with that, as I tend to have periods of either really high food drive, or almost no food drive at all leading to not eating for an entire day, then downing 3000+ calories in one meal.
ADHD sucks. It's often trivialized in pop culture, but it makes life so difficult, and those real difficulties are almost never talked about.
I am a strong believer that the biggest "thing" in ADHD is the challenge with sustained goal-focused behavior. And that is in large part due to how fucking hard it is to stay on task when you have ADHD. It's not uncommon to hear people like you who are able to keep control by focusing on the few things that make the most sense and are the most motivating. And even with a perfect target for behavior, it's a battle to keep at it. That is why I think a lot of people get adult-onset ADHD diagnoses—because they are burned out from spending 2x the energy to keep their life and behavior on track.
As I wrote to another person here: Yes. Not as much as with ADHD medication, but there is an obvious subset of addictive personalities that find relief from addictive behaviors (beyond eating addiction) with semaglutide.
But to add to this, I feel like there are different kinds of addictive behaviors at play that are more susceptible to one medication or the other and are based on different systems.
For instance, the food-craving reduction in GLP-1 is almost certainly not just related to reward and goal-seeking behavior. It literally affects hormone signaling for satiety, and slows down the movement of food through the stomach, and affects, globally in the body, responses to metabolic signals. And it probably has a global effect on the way every cell in the body works, which might be why there are positive health effects beyond just the weight loss.
ADHD medication, on the other hand, targets the goal-directed activity system directly. It seems much more likely to me that reduced appetite is just as much driven by the focus and "let's get shit done" mode that is artificially increased with dopamine. Both result in reduced eating but through massively different pathways. Basically, you pay attention to the biggest wave in the pond (the waves in the pond being a metaphor for all the things your brain COULD pay attention to). So when the goal-stuff gets increased in size, the food-seeking is automatically smaller by comparison, and less likely to drive your behavior and thinking.
I don't think I can say that there is much of a pattern between ADHD and overeating, just based on how easily I can predict if someone is overeating or not if I know they have ADHD. That is, it would be a coin toss.
The simplistic answer would be: Semaglutide reduces addictive behavior if it's driven by emotional regulation needs, and ADHD medication reduces pure drug-like craving. As seen in studies where people that start lisdexamfetamine (ADHD medication common in the EU) have a huge reduction in actual amphetamine abuse.
Case in point: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...
Findings In this Swedish nationwide cohort study of 13 965 individuals, lisdexamphetamine was significantly associated with a decrease in risk of hospitalization due to substance use disorder, any hospitalization or death, and all-cause mortality.
> I don't think I can say that there is much of a pattern between ADHD and overeating, just based on how easily I can predict if someone is overeating or not if I know they have ADHD. That is, it would be a coin toss.
Person you responded to suggested P( overeating | undereating ) as opposed to your P( overeating ). I expect the effects of those two conditions would tend to cancel each other out in observations.
> As seen in studies where people that start lisdexamfetamine (ADHD medication common in the EU) have a huge reduction in actual amphetamine abuse.
Perhaps I misunderstand you but lisdexamfetamine _is_ an amphetamine. That reads like saying that people prescribed an opiate exhibit reduced opiate abuse. It seems either tautological (not abuse because permitted) or obvious (cooperative supervised use reduces bad things happening) or perhaps related to drug safety (A simply being safer to use than B).
Regarding under- and over-eating: it seems you think I am a simple mathematical average that doesn't factor that in. I stand by my observation, as and observation, not fact.
Lisdexamfetamine is not amphetamine—not chemically, not in terms of its half-life, not in subjective experience, and not in any study that tracks behavioral or long-term effects. At best, it's a prodrug of an enantiomer of amphetamine.
You are also mistaken about the study. Reading even the abstract would clear that up for you.
Let me clean up the unnecessary, convoluted language before I answer:
Q: Does it stop being called "abuse" once a doctor prescribes it?
A: No. The prescription stopped hospitalizations due to amphetamine overdose.
Q: Is it simply safer to use drugs with a doctor's help?
A: That was not answerable based on the study's design. It is also not a useful question to ask in this context, since it's comparing apples and oranges. Some of the worst cases of drug abuse are created and maintained by doctors. However, taking drugs collaboratively with a doctor is probably safer on average than getting them from random webpages.
Q: Is this specific amphetamine safer than others?
A: Yes, as is the case with any substance we ingest. You can quibble over the details, but beer is safer than hard liquor. Likewise, different medications in the same category or receptor affinity group have different LD_{50} doses (the ratio of the clinically effective threshold to the threshold where 50% of subjects would die).
> it seems you think I am a simple mathematical average
No, I was merely inquiring after what appeared to be a misunderstanding but apparently wasn't.
> Lisdexamfetamine is not amphetamine
Just to clarify, this topic is always needlessly confusing because "amphetamine" is used to refer to both a distinct chemical as well as an entire class of chemicals. Lisdexamfetamine is _an_ amphetamine in exactly the same way that codeine is an opiate (ie a prodrug of).
I'm not sure why you think I'm mistaken about the study nor why you are so condescending about a misunderstanding rooted in terminology. You yourself state that it is about relative drug safety and the study is also quite clear about this so it would seem that we were in agreement all along.
Because I get triggered when people are illogical while using excessively complicated language and do not try to understand the points being made. Like in this comment, I clearly laid out all the ways I think lisdex != amphetamine. But you are once again answering in an obvious way without engaging my points.
If you look elsewhere in my comments, I have no problem calling myself an idiot when I make mistakes. But I hate the noise that is bad faith arguing concealed in fancy words.
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.
Appropriately enough, (most) ADHD medications also tend to suppress appetites. So much so that weight loss is perhaps the most serious side effect for ADHD meds in children.
I can't drink whatsoever now. I've been on Wegovy for ~4 months. I used to be a VERY light drinker, i.e. like 10 drinks per YEAR (rum and diet coke, glass of wine, or 2-3 beers in a night). I would usually get a drink when my band played. A month or so ago, I got a bourbon, which I'll happily sip for an hour while talking, and I had to force it down, and left over half of it. Same with a beer; I went to a baseball game with some friends, someone bought the group some drinks, and it was disgusting.
It was like whatever enjoyment lightbulb that is usually activated was completely unscrewed, or like trying it for the first time as a kid when an adult lets you try a sip on a holiday. Just sitting here typing and thinking about it has me slightly nauseated. I've been telling people recently I CAN'T drink because of some new medicine I've started.
When I took Adderall in college a few times I had a very similar feeling. You could have told me my favorite restaurant was giving away my favorite food, and it would have been nauseating while I was on the meds.
I believe you 100%. I have a history of substance abuse with bad consequences. I quit alcohol and now my drug is food. People tell me I'm a "supertaster." I can taste many of the ingredients in my food that others can't.
I also have BPD and am in therapy for it, but man. Food is the drug that always works. When I get into a certain mode, it's like I don't care that I'm overweight and have high blood pressure. I just crave the deliciousness and the "full feeling." And it never fails to work! I always feel more calm and happy after I eat.
Reminds me of a client I had once. He said that the only thing that made him reset was to "pig out" with a carb-overdose, then just sit in front of the TV with a sugar high.
Incidentally, I had been nagging him about trying ANYTHING (in addition to the therapy we were doing to find a life goal he believes in) that might help him get SOME help. Be it Adderall or Ozempic. But people are complex, and at best, a person is a Venn diagram with massive overlapping "biological susceptibility," "life situation," "negative thinking style," and inertia. The best one can do is to pull at as many threads as possible to hope the suffering unravels. So one of the threads one can pull at are medication.
Not to give advice, but just for shits and giggles, look into "vulnerable narcissism." Many describe stuff like you do and fit those traits. And don't give a shit about the negative associations and stereotypes regarding this personality. I love narcissists! It's one of the coolest personalities there is! But when you are not allowed to be proud of yourself, and all the desire for status and power gets refocused onto self-hate and learned helplessness, then it's a monster of a situation. Had so many people become awesome versions of themselves when they stop being so afraid of being arrogant :) .
Just to remember when you read about it, that the descriptions are only in the context of things having gone wrong. Every trait can manifest as something good or negative. Even psychopaths can have good and prosocial lives. For instance, some of the best ambulance workers often have high loading on psychopathy, and that makes them better at their job. Because they don't get scared. I’d rather be picked up by an ambulance worker that is curious and thinks the situation is interesting than one that is panicking and losing due to anxiety and empathy overload.
This is just a long-shot association/pattern I noticed, though. It's not worth a dime more than the sentences you put into the machine. :P
Do you have any thoughts on GLP-1s for ADHD? I have tried the stimulants (legally) without success, and am reluctant to try the non-stimulants since their success rate seems pretty poor and side effects seem worse.
I answered it a couple of places in this thread already, but the short answer is yes, and GLP1 is not usually a good way to core ADHD treatment.
However, if you tried stimulants without success, this would be my descending list of things that need to be sorted out:
- Have you tried multiple types of medication? A lot of people give up after 1 or 2 different types. But I have seen MANY people who get completely new lives, but only after the 5th type they tried that matched their biology.
- Do a diagnostic re-evaluation to make sure that one is not misdiagnosing ADHD (the most common confusion is anxiety and personality).
- Map out the life situation. Circumstances might be a stronger explanation of the situation than internal psychological vulnerabilities.
- Make sure that you get a blood-mirror (Norwegian concept) so you know you have proper absorption/amount in blood.
Can you talk about people who discontinue for GI side-effects? I understand they are present for a short duration, but have heard anectdata that they persist for months for some people.
Have you observed persistent GI side-effects in your own practice, and if so, do you believe these are legitimate? Or… are they a social cover for individuals to get back to eating for psychological coping?
It's not just GI side effects. Semaglutide is genuinely GI TOXICITY. That's why it's EXTREMELY important to ramp slowly. So yeah, it's a thing. But for basically everybody, it's manageable with slow and controlled ramping of dosage. There has been hard to find any lasting danger if you ramp slowly.
There has been almost a hysteria, it seems, regarding "Pancreatitis." And when I see multiple diagnoses, medications, and reports associated with Pancreatitis, I recognize a pattern I have seen many times before. Both the mental health and medical fields have periodic fixations on certain symptoms or diffuse diagnosis, and when it has the "wave-like" pattern like this, I am willing to bet it's just the latest version of "Fatigue," "Whiplash," "Repetitive Strain Injury", "lactose intolerance" or the dental amalgam controversy. Don't get me wrong. These are real things. But sometimes they just balloon beyond anything reasonable, and an unreasonable amount of people suddenly get diagnosed with it or suspect they have it. Pancreatitis is giving me that vibe over the last year or so. Copy paste this for "Stomach Paralysis".
But let's say the social benefit of alcohol has a value of 100 and a health risk score of 100. I would say that GLP-1 agonists have a health value of 500 and a risk score of 20. Nothing is without risk, but mathematically speaking, if you are overweight, I would be 25x more positive about injecting myself with Ozempic than alcohol... mathematically at least.
And to answer your question, I personally haven't seen many people stop early due to GI symptoms. And if they did stop early, I would think it was because they genuinely had a physical negative response that was horrible for them. Anecdotally, I feel the people that stop so they can get back to eating usually last at least 6 months, and probably more. I am 100% in agreement with the studies that many stop at around 1 year. So if someone stopped at 2 months, I would belive them when they said it was due to GI symptoms. But if they stopped at 1 year and CLAIMED it was due to GI symptoms, I would doubt; and guess that it was driven by missing food.
Please note that I am speculating wildly, and this is just PURELY anecdotal and stream of consciousness.
It’s unlikely new meds will be approved this year (unless the FDA really does speed up approval processes)
I made a tool to compare prices: https://www.glpwinner.com/
If you’re on name brand without insurance coverage you’re sitting around $499 a month. On compounded you can get between $150-300 a month. If you live somewhere expensive like the bay and eat out a lot you are likely saving money by being on the medication.
>Novo Nordisk’s lawyers requested a refund for the paid 2017 maintenance fee of $250 Canadian dollars ($185) because the company wanted more time to see if it wanted to pay it, according to letters included in the documents.
>Two years later, the office sent a letter saying the fee, which now included a late charge bringing the total to CA$450, was not received by the prescribed due date.
>Novo Nordisk had a one-year grace period to pay, but never did, and so its patent lapsed in Canada. It lapsed in 2020 when the fee was not received, but it doesn’t expire until January.
Can't find the post on Reddit right now, but someone broke all three down and it is more nuanced. They act slightly differently in different areas.
Before I started experiments on "my lab rat" with retatrutide, I found that combination of the about half max dose of semaglutide and 1/3 of Max dose of tirzepatide had the best combination of losing weight and lowering side effects. But another "lab rat" did not respond that well to this combo and we keep adjusting it.
Retatrutide so far looks the most compatible, but it is sample of 1.
Retatrutide looks to be very effective, but it's not possible to get legally/safely at this point. TONS of experience/knowledge in the r/retatrutide subreddit though, a lot of pretty conscientious consumers in there that have done their research, but obviously impossible to recommend outside of finding a sanctioned study to join.
That said, Reta is a triple agonist[0] and it seems to be quite amazing with good muscle retention as well -- it's unclear if this is just the people who are taking it being more likely to be gym goers. Up until now the only formulation I've seen that specifically targets preserving muscle is GLP1s in combination with bimagrumab[1].
This is where I failed as a psychologist because I don't have extensive training in pharmacodynamics, so I forgot that "potent" is a specific term in that world. What I meant was: I subjectively believe that Semaglutide is the best choice for weight loss, given the overall profile and response in my subjective clinical experience.
A fancy way of saying: I *think* Semaglutide is best.
Ah -- the linked research trial contains evidence that it is not the best, Tirzepatide is more effective.
Unless you mean that Semaglutide worked best for you, right now the research points at Tirzepatide being most effective for weight loss (says nothing about t2d though).
Yeah, the drug + the injector together are the patentable thing. When the first patent nears expiration, they work on an iteration of the injector or a time release change for the drug, then they get another few decades of product monopoly.
They have also made a business of either stifling or “catch and kill”ing of the generics for their products. It’s cheaper to pay off a generic manufacturer to not compete with the new thing than it is to lose price elasticity of the n non-generic.
> Drug manufacturers listed 22 patents after FDA approval of the 10 products in the cohort...Post-approval patents only extended the duration of protection on 2 products (median 4.6 years.
This is makes sense if there is actually something novel to add [keeping in mind the authors are treating any IP as if it protects the entirety of the product. A sugar coating or whatever wont protect the non-sugar coated pill.
To the extent I agree with the paper, it is that the 30 month hold is weaponized and should be reviewed and the issue with settlements should be addressed
Like I said above, they don't extend exclusivity or prevent practice of expired IP. All you have to do is not infringe the new IP. this is what the article says too. I disagree with their greater claim; The patents aren't rocket science- most are extremely easy to read, and the authors are hiding behind weasel worlds like "may" and "could"
There are some bad patents that should never have been granted, like Novartis' famous 631 patent [1]. However, those are the exception, not the rule. If you want to put a generic drug into an auto injector, there are a dozen generic autoinjector companies looking to take your money. Drug + autoinjector does not pass the US patent office non-obviousness test (for obvious reasons). What gets patents is custom design features - bells and whistles. New features are part of the roadmap because customers will prefer them over competition without them, not because it magically extends prior IP (that isn't a thing).
There are dozens of autoinjector manufacturers, and generics can and do change manufacturers. It looks like semaglutide uses an off the shelf Yposomate pen, although Novo Nordisk uses different injectors depending on the country and indication.
Novo Nordisk also has an in house pen, but this would not prevent someone from competing, unless patients simply prefer that design to a generic one.
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)
I'm no fan of the patent system, but "patent system promises spoils for coming up with great new drug, companies comes up with great new drug, companies gets spoils" is exactly how it's supposed to work. Yes, it's sucks that you have to pay, but that's how you incentives getting the wonder drugs invented in the first place. (I have my own take on this, but if anything this is a 'textbook case' in favour of the patent system.)
Eminent domain would still require fair compensation to the company, so you'd have to pay them more or less what they'd lose from not having the patent anymore.
(Though I think the term you might be looking for is 'compulsory licensing' or so? Not sure.)
Depending on how transformative the effects are (and the price drop possible upon genericisation) then there could be a compulsory licensing trade to do here.
The drug companies are presumably pricing optimally for profit (but not for maximum public benefit, for which the optimum price is ~0). You could calculate the net present value of the drug companies' total profits attributable to the patent, add on 10% as a bonus, and pay them off. If the welfare gains of having cheap drugs are genuinely greater than the value of the patent to the holder, this would be win/win.
Citation needed for the idea that zero is the optimal price for public benefit. Among other issues, I expect medication compliance would be higher when the patient has to pay for the medication.
I think we probably have data on that (at least in general). That is assuming people react to out-of-pocket payments, and not to how much their insurance or the NHS etc is paying.
That is exactly what I have in mind. "Eminent domain" doesn't mean just taking things with no recompense, but I don't think the company should be entitled to profit maximization at the expense of literally billions of people worldwide.
If this research was done fully via the public system in the first place, it would be an easier nut to crack. I mean, some of it is already, and that’s the absolute worst scenario: the public paid for it via taxes, and now has to pay for it privately after the fact.
No. Fair compensation means that the company doesn't end up with a loss, and gets rewarded, but it doesn't mean "give them as much money as they could otherwise extract by exploiting the monopoly that the patent gives them on the market".
And withholding access to drugs that would extend everyone's lifespan by several years to maximize profits doesn't seem fair to me either. In fact, it's outright sociopathic.
These drugs are covered for the people whose lifespans would be extended by having them! They pay nothing! The situations where insurers/medicaid don't want to pay are more marginal cases. And even then, it's like, 1/5 the cost of child care in a major metro and only getting cheaper. If you're going to use an extraordinary mechanism to seize private property, it better have outsized impact -- seize surface parking lots and sell them to developers to build more housing.
Patents are a form of artificial monopoly that only exists because the people (acting through their government as a representative of their will) decided to have them, and did so because they presumably are a net social benefit. Consequently, governments are not obligated to treat them as sacrosanct, and most certainly not in a case where they are not beneficial to public interests.
It's a social contract between the people and the enlightened. The people always win on a long enough timeline. But the deal is there should be some sliver of reward for a brief window of time to those who bring permanent light into our lives.
The "enlightened" are the scientists who actually developed this stuff, not the CEOs and corporate shareholders collecting economic rent from other people's hard work who pocket the vast majority of the profits. If we only had to fairly pay the people who actually did the useful work and not all the capitalist deadweight, these drugs would be orders of magnitude cheaper.
Liraglutide isn't fully comparable. On aspect that's a lot touch for many is it's a daily injection. More needles is a turn off for some that can manage 1x/week.
It’s one people need to consider, but it’s one that the people needing it the most won’t do.
It’s a massive problem for several of my friends who are doctors. Patients start on something that works incredibly well for them then their insurance pushes them to Litaglutide and they loose all of their progress.
Some of it comes down to a fear of needles, some of it comes down to non-compliance, some of it comes down to access.
Daily injections are fatiguing on people. Its a big challenge with diabetes management.
I used to be prescribed Victoza (for diabetes). When liraglutide (the generic) went off-patent, every pharmacy reported that both Victoza and liraglutide were "no longer available".
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.
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.
Actually from what I have heard, GLP-1 are maybe the first category of drugs which have impact within the median tenure of people on a medical plan (~2 years). It is so significant that you can see ROI within that window which justifies in subsidizing/encouraging patients to use it.
Doesn't disagree with your original claim that there is low incentive for any private insurance to care regarding longevity, but figured I could add some color
This misunderstands how employer-provided insurance works for most people. Large employers sign up with a company like Cigna to provide a network and administrative process. But the actual healthcare is covered by the employer. So really, Cigna or BCBS don't really give a rip if you're taking a bunch of money out of the pool.
USA: That’s the case if your company is “self-insured”. Some are, some aren’t. I imagine there are financial requirements to self-insure but I’ve never looked.
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.
If you were guaranteed 5% over the total cost of the medical services provided as profit, would you want people to have expensive or cheap medical. Are?
The health insurance companies are paid as a percentage of the amount of care that flows through them. So healthier customers means their profit is 5% of SMALLER_NUMBER.
> 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.
A night in the hospital is easily $12k almost anywhere in the U.S.
People with chronic health conditions spend an inordinate amount of time at the doctor and in hospitals. That could save a significant amount of money if that’s reduced or eliminated. Not to mention the time savings.
I could be wrong, but all things being equal doesn’t it make sense to spend $12k/year on medication than $12/year on doctor and specialist visits in addition to medication?
A one off anecdote here - I ended up in hospital for a TIA. I'm in Australia, and this is a public hospital. Free in other words. I have never seen so many seriously obese people in my life. They were all occupying hospital beds. I swear at least half the beds were use occupied by them. Meanwhile, we have ambulance lining the ramps of hospitals, with patients in them, waiting for bed to become free.
To put the this in perspective, where I live spends about $10,000/yr/person on health. That's all kinds of health. I'm not sure $5,000/yr (which is about the price here) of GLP-1 would be a generate proportionate decline, but I would not write it off. The $10K is paid by everybody, the $5k would only be for the obese.
I haven't changed jobs and I've had three different health insurance companies in as many years, all of which needed new prior auths for Trulicity/Mounjaro.
> [...] along with the lack of health education in schools.
I don't think that's too much of a factor?
I mean, check how much (or rather how little) people learn of the stuff that _is_ covered in school. Tweaking the curriculum would just mean that instead of not paying attention in algebra, students would not pay attention in 'health education class'.
In my school there was a strong emphasis on what a healthy diet is baked into the curriculum. Along with my family's relatively healthy cooking, that set me up for cooking and eating well on my own through college and life after that. I would edge away from takes related to "it just wouldn't work"
I mean the education system is its own mess for other reasons, but it's not a complete failure
The effectiveness of "health education" is somewhere between extraordinarily modest and nonexistent. It's not that people don't know what's healthy, it's that when it comes time to resist compulsion that is difficult, uncomfortable, and undesirable.
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 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.
Maybe true in US, but here in Europe ie my health insurance gives me rebate on my gym membership (any gym). With some more automated low cost gyms I can get back up to 50% back. This seems like a similar case.
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%.
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.
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.
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.
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?
≥At this point I can’t buy any arguments that claim that availability of drugs has no impact on misuse or addiction.
I don't much care whether more people are addicted or not. When alcohol was illegal, booze dealers had machine gun fights in broad daylight on Main Street over it. When's the last time you heard about machine gun fights over whiskey?
Legalize it all. Heroin, cocaine, meth... sell it retail out of liquor stores in plain wholesale packaging. Manufactured by pharmaceutical companies, supervised by pharmaceutical engineers, unadulterated by poisons, measured doses, and include a dose of the antidote in the box. Make the junkies pay a deposit on a red plastic sharps container for their disposable needles.
I do not care how bad you think things will get... they're already that bad, but right now you're able to pretend that they're not. For every soccer mom addicted to oxy that you save, ten undesirables are dying of overdoses of fent in some filthy truck stop restroom somewhere. And we're spending half a trillion every year to do it, too.
> 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?
The typical grey market buyer exclusively buys vacuum or inert gas sealed sterile vials that contain pre-measured lyophilized powder and then uses BAC water from medical supply stores (or just Amazon) for reconstitution transferring from one vial to the other with a fresh needle.
$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.)
I think the short answer is that these drugs are only cost effective when applied to people actually experiencing costly diseases, rather than simply being obese. A large part of that has to do with the drugs being very expensive still.
It's never cheaper for insurance to buy something for everyone. There's extra administrative costs to them being the middle man, so it makes much more sense for insurance to incentivize you to buy it yourself, through premium pricing.
For example, fire extinguishers and security cameras will reduce crime by more than their costs, but instead of charging you for them, plus administrative costs, and shipping them to you, your insurance provider will offer you a discount if you have them. (Really it's a price increase if you don't have them, but regulators don't like it when they call it that.)
Not everyone will benefit from GLP-1, so in this case, the most beneficial solution would be to charge higher premiums for anyone that could benefit from GLP-1 but doesn't use it.
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.
> 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.
Fuck that, not everybody here has massive self-control (on top of other mental) issues. Keep your chemical shit with bad side effects away from me and my kids, we know how to live well and raise kids similarly.
> 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
> 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.
Look at CAR-T therapies (your cells are reprogrammed to fight your cancer). Insured patients got access in the US long before, and to a broader degree, than national healthcare systems.
Today, CAR-T utilization in cancers like lymphoma are double those of Europe in many cases. Interestingly the UK is one of the highest in Europe (despite the controversy over cancer drug spending).
While true that the US has uninsured and not all insurance is equal, suffice to say you stand a better chance to get access to new technologies in the US than most countries.
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 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.
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.
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.
I would say that in at least some cases over eating and anxiety are both symptoms of underlying problems. Stress, emotional issues, and trauma can all lead someone to either of the two.
As someone that uses food as a coping mechanism for stress, I agree with the GP - if the underlying problem isn't resolved, the weight will come back.
I think there is a big difference when one still ultimately requires a physical act in the end and one is all mental.
You can much more easily use the physicality of your surroundings to physically deny yourself the food than you can deny yourself anxious thoughts.
With eating there are 2 components to it, mental and physical, so you have more opportunities and more options and avenues to potentially control it.
The additional options to control it should IMO make it at least some amount easier to control in the end since some people may be able to take advantage of physical controls to limit themselves where that's not an option for anxiety.
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
As someone who took SSRIs for a while my plan w my doctor was always to use meds for support as I developed a toolkit to deal with my emotions without medication and then to re-evaluate periodically to see if the meds were still necessary. It took a few years, but eventually we weaned me off. I'm glad we did, now that my life is in a better place and I'm a bit more agile with my thinking I'm quite glad to be rid of all the gross side effects of the drug, but when I was having a rough time those side effects were well worth the stabilization the drug brought me.
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.
How are people so consistently wrong about GLP-1s? The side effects are minuscule in comparison to SSRI’s and the effects on improving habits are massive.
GLP-1 - Mild nausea, always temporary and in the beginning, easy to avoid by tapering dose. Extremely effective.
SSRI - about 10% chance of major sexual disfunction, often permanent, significant likelihood of sleep disturbance, majority get blunted emotions. Debatably effective.
As someone who's currently experiencing significant and crippling gastroparesis due to GLP-1's, being reductive about the side effects is not particularly helpful.
Lower your dose a little? Gastroparesis is a choice on these and only at high doses for long periods, you get signs weeks in advance and you choose to stay on a high dose. Myself never experienced it even when I had extremely strong effects (near 500 cals a day for a few weeks), but I did have some slowness, I lowered my dose and was fine.
It’s trivial to look this up which is funny - I double checked everything i said, so I know it’s true, and never claimed you’re making things up. But you are claiming I’m making things up while obviously not even doing basic research.
Very wrong analogy. Anxiety is not something that you gain by buying junkfood due to low budget or laziness or simply being raised with very wrong values re food and health. On the other hand, every single ice cream, pizza, burger with fries, cupcake or beer contributing to resulting weight is a voluntary choice (with some mental drama around).
There is simply no way around the simple fact that there is only 1 way to eating well long term - that is lesser, more healthy portions. GLP1 may show a person what things could and should look like, what is achievable but the path needs to be walked by themselves. The alternative is either lifelong consumption of this chemical with various bad side effects or premature death (or both, to be seen since nobody has a clue).
You need to remember that people experience reality differently. For you eating the healthy number of calories may be easy. For others it very much is not. I have heard it described as leaving your thermostat at 45 in the winter to save money on your gas bill. Sure, you could do it, but it would cause a lot of suffering. GLP-1s are able to change the way people experience hunger so that it only feels like the thermostat is at 65 instead of 45.
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.
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 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.
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.
For most people that is very true, I have seen it repeatedly.
I don't know what my secret is, I lost 100lb and have kept it off for a good 5 years now. But it is a bit of an uphill battle. If I wanted to, I could easily just give in to temptation and slip right back but it hasn't happened yet.
No offense, but that's not particularly impressive and you're bragging about your discipline a bit prematurely. It's highly likely in the next ten years you will regain most of the weight back.
I've known many, many, people to lose weight via extreme diets such as keto. Such diets are unsustainable for almost everyone. It will work for a year or two, but inevitably, they will falter. Often it only takes a very small amount of stress - maybe a hard project at work.
I have never met anyone who uses something like keto successfully. It has always failed, with everyone I've talked to. That doesn't your diet is as extreme as keto. But, it does mean you're not out of the woods, and your perspective on this isn't exactly trustworthy.
My partner on this medicine over a period of two years went from 300 to 197. They have not gained it back after stopping. Their diabetes was reversed and is now in prediabetes. They still has to take Metformin.
In order for me to gain all that weight back, I would have to eat a ton of calories per day and completely stop moving/exercise.
It’s been nearly a year since I started losing all that weight and I haven’t slide back on my diet. It does take discipline
> In order for me to gain all that weight back, I would have to eat a ton of calories per day and completely stop moving/exercise.
Yes, this is what usually happens. You've spent far, far more time with those calories than without.
> It’s been nearly a year
Okay, that's not a very long time is my point. It's much too early to think it's over.
I'm not saying that it's not possible to get off GLP-1s and maintain a good lifestyle. I'm saying that I don't think it's a moral failing or a lack of... sigh... "discipline" if people need to be on these drugs for life. Frankly, I think it's very rich that a baby skinny person is lecturing us on discipline. You've been doing this for less than a year. Discipline means sticking to habits for a long period of time, even when times are tough. I would not classify less than a year as that.
First off I just wanna say awesome and I send positive energy to you and you’re gonna do great.
But then I just wanna talk about how long life is in terms of weight gain! Even two years is an “short” amount of time!
Last month, I looked over my doc where I keep track of my weight and I’ve been gaining about 1 pound a year since I started tracking it… 20 years ago. That’s a significant amount and I maybe have 30 years left to go! (this comment is not about you specifically, just musing on how long life is in terms of weight gain)
I know! I am totally aware. My FIL died sitting in a recliner basically from age 55 to 70. He didn't move, didn't watch what he ate. We saw that happen over a long period until he died about 3 years ago. It started with toes, then loss of a leg.
Since that happened, it really kicked us into motion plus shaking the COVID funk!
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
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.
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.
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.
Sure, but the bigger question is: does this matter?
If we think about it longer than, say, 5 seconds, we will realize no, it does not.
Your particular desire for punishment is not really relevant to anything. That's not how medicine operates, and that's a good thing. You're attempting to make a moral argument here. Moral arguments are usually stupid and worthless - try making a different argument.
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.
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.
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.
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
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.
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.
> 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 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!
Some people DO keep it off. Ive never been obese but ive been overweight, extremely unhealthy, pre diabetic, couch-potato for years at a time. For me, it's always a matter of getting into the mindset that these things are not just "not good," they are literally poison for me!
I've seen a few obese friends of mine lose weight and gain it back. And while I can't put words in their mouths, I have never noticed them have the attitude that "being obese will kill me."
> 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.
The problem is, most people aim way too high in their weight-loss target and sending their bodies into starvation mode, which will lead the body to reacquire the lost body fat as soon as possible - aka when people are happy with their body weight and scale up their food intake to caloric neutral again.
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.
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.
Yeah that's quite short. Healthy weight loss is typically in the ~.5-1 kg/week, while this is an extended period at 2-4x that rate. The effect that will have will largely depend on what your starting weight is, but unless you're starting significantly north of 140kg, it seems like the amount of muscle (and maybe bone density?) loss would be pretty severe.
I have found the same thing, but my experience (YMMV; not recommended that you take my advice!) is that a one week break almost entirely resets it.
I now take a one week break every few months and have not noticed any decline in effects over time.
My suggestion would be to find an endocrinologist that specialises in obesity and these weight loss drugs. They will have dealt with patients who have experienced tolerance and have developed ways to work around it from real life experience. Obviously well-studied protocols with evidence would be preferable, but with how new these drugs are there hasn't been long enough to collect it yet.
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.
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.
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.
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.
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.
For obese people: probably. The overall health benefits for overweight people are a lot less clear. Being merely overweight (rather than obese) is not that strongly associated with negative health effects.
Look, I hope you're right. If in 20 years time we look back at these comments and no negative effects have manifested then I'll happily buy you a beer to celebrate. Hell, I'll buy you an entire crate of beer. But I think this is one hell of a risk to take.
The obesity trend has happened almost in lockstep with the proliferation of highly processed foods. Butter and animal fats being replaced with low quality, hydrogenated vegetable oils. Cane sugar being replaced with high fructose corn syrup and other highly processed sweeteners. Sodas and sugary juices replacing water. Food like substances with little to no nutritional value designed solely for taste and texture.
These things are calorically dense while containing nothing the body needs to thrive (though the calories will allow it to survive). They are easy to eat in large amounts and leave you feeling hungry. And unfortunately, these are the most affordable and readily available foods in the United States.
I don't think this is a conspiracy. It's just capitalism. These low quality ingredients are cheap and extremely shelf stable. In addition, the government subsidizes the production of this garbage.
So to say obesity has persisted through everything we've tried is a bit backwards. It would be more accurate to say "a percentage of the population has managed to avoid obesity despite all of the things we've tried."
- Make healthier food options more affordable and readily available
- Better nutrition education
- And if you really want to get the government involved, ban the use of some additives, oils, sweeteners, and dyes that allow the creation of many of these highly processed foods
I agree with every word of your analysis and I agree that we've tried basically nothing. But this is why I talked about political capital—every one of your suggestions has been available for the last twenty years and nothing has come of it and the problem continues to get worse. When you say something like, "healthy food should be more affordable and readily available" you'll get a lot of nods of agreement but when it comes time to turn that idea into actual policy everyone gets cold feet. Proposals like price caps for whole foods, subsidies for meals that meet some threshold of healthy, sin taxes for unhealthy foods, outright bans of certain ingredients the votes dry right up.
But people want Ozempic, they will actively seek it out, and in numbers that can actually make a dent in the problem. In a way that people don't seek out healthy alternatives or exercise. Because people don't want to be healthy, they want to be skinny. You can't control people, you can only respond to them and, ya know, whatever works man.
> healthy food should be more affordable and readily available
I think there's more than one way to achieve that. It doesn't have to be bans or subsidies. A lot of it has to do with education and competition. Unfortunately, they are kind of a circular dependency.
- There's so much cheap, highly processed food out there. The companies pay for prime real estate on the shelves and expensive marketing. It is chemically engineered to exploit your pleasure senses when you eat it. That is a hard beast to fight without proper education. And not just the food pyramid, but in depth explanations on why you should avoid it and what to eat instead. There are large groups of the population that have no idea that pop tart or cereal are not a healthy breakfast option.
- If there were more companies creating and promoting healthy, less-processed food options, the price would naturally comedown due to competition. But without the education, these products just do not sell as well. If I gave you some natural peanut butter or almond butter (just almonds or peanuts - 1 ingredient) and I gave you a jar of a more common peanut butter like JIF (sugar + hydrogenated oil for better consistency) and you had no other information at all, you're choosing JIF 10 out of 10 times. It's cheaper, it taste better, and you don't have to stir it. These megacorps prey on that lack of knowledge.
More education -> make better choices when buying -> more companies selling those choices -> cheaper prices on those choices.
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.
Dieting is hard and we still under emphasize the mental and emotional aspects of it. I've found that the easier to "be good" at dieting during the 30 minutes of weekly grocery shopping then during every hour of every day at the house. I try hard to just never buy things that I'm likely to overeat or are super calorie dense because I know I can't eat potato chips responsibly.
It's very true, but it's more difficult when you live right by the grocery store, the office has free food and snacks, and DoorDash is right there when you "need" it.
I'll echo that addiction feeling! It's amazing to me, how when I ignore the "it's time to eat" feeling (which isn't easy to do!) it suddenly starts to get weaker and even goes away...almost as if I wasn't really hungry at all!
I'm aware, and I was hesitant to use it when the doc first prescribed it. Personally I'm not so worried about this anymore, there are days when I don't take it (either forget or wake up too late in the day) and I don't feel any different. I never felt like I craved it or had any sort of rewarding feeling upon taking it. I never took Adderall so I can't compare, but from what I know the mental effects of Phentermine are much weaker.
Usually it's prescribed for no more than 3 months, but the doc recommended taking it for longer. He mentioned that addiction risk is negligible for most people. Very solid doctor who specializes in those thing, so I took his word for it after a bit of Googling.
But I had a lot of muscle mass to begin with, due to years of bodybuilding. And I still have significant muscle after the diet, despite of not touching a weight during all this time (I know I should have). People still ask me about my lifting routine even though I didn't lift in like 2+ years.
Knowing myself, it'll come back within a couple of months of lifting weights and getting proper protein, once I get back to it. And I plan on doing exactly that. Being fat kind of made me lose motivation to go to the gym. It's a vicious cycle I imagine many fat people struggle with. So I prioritized losing fat first and foremost.
I wouldn't say "starving yourself", there's no reason to believe it's different from any other diet (except it's easier to stick to). If you get enough calories, prioritize protein, do some resistance training and get proper sleep, you can minimize muscle loss and in some cases even gain muscle while losing fat.
Maybe more of a misinterpretation by AI and/or author than full on hallucination.
"Life insurers can predict when you'll die with about 98% accuracy."
"98%" appears in the citation[1], but as the ratio of actual deaths to expected deaths. (i.e. 98% of the deaths they expected actually occurred.) Some months that figure was ~104%, so it's not a measure of accuracy.
I saw that too and thought the utm_source=chatgpt was pretty funny, since I only noticed it when I was pasting the link into chatgpt myself to get it to tell me where the "98% accurate" claim was coming from.
Anyway, it's a pretty vague statement. What it sounds like it's saying is for the average person they can predict when they will die, and you have to decide if they mean the day, the year or the decade. But chatgpt gave me an interpretation that seems to make more sense:
> The 98 % figure is about aggregate forecasting, not clairvoyance. It means that when an insurer predicts, say, 10 000 deaths across its book in 2024, the actual count typically falls within roughly ±200. For any single customer, the prediction is still just a probability curve, not a calendar appointment with the Grim Reaper.
It's extremely incorrect. 98% accuracy on when "you'll" die would imply an R^2 of 0.98 for individual-level lifespan predictions. We are nowhere close to that.
It could mean a lot of things. It could mean "We think you'll die at 87+-5 years" and counting it as a success if you die anywhere in that age range for instance which I could believe they can predict the vast majority of the time. I doubt they are referring to the R Squared.
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.
I don't think this is addressing the thrust of the article, which is that Life Insurance companies are getting "fooled" by patients who on paper are healthier then they are in reality. Someone on PreP to prevent getting HIV is as healthy on paper as they are in reality as far as I can see.
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.
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.
Huh. I’m at a healthy weight but I’m taking retatrutide for IBS and it’s working wonders. Very low dose, though. I originally tried it with semaglutide before the weight loss craze kicked off and the first few days of the week were worse and the latter half of the week was better, so that didn’t make sense for me to stay on.
Can you say more about retatrutide for IBS? My IBS is debilitating to the point where I usually refuse to eat food on week-long work trips, because the unplanned emergency toilet trips wreak havoc with my schedule and ability to sit in meetings all day. I'd never heard there was a solution to it.
Sure, and I totally get your issues. I was a damned wedding photographer and I'd only eat towards the very end of the night, and still had a few iffy days.
As I stated, I originally tried semaglutide with no luck. I didn't try tirzepatide. I've been taking a very low dose of retatrutide - about .5mg twice a week. It seemed to be waning in effectiveness a bit so I upped the dose to 2mg/week for now. It's a night and day difference. Most days I go to the bathroom maybe two times, as opposed to the maybe 5-10 times I would need to unmedicated.
To be clear, this isn't an approved use of the medications (and retatrutide isn't approved at all yet, though it pretty clearly will be). However, they slow down gut motility - and as a bonus for your refusing to eat during week-long work trips, they'd probably at least help with that too, in terms of hunger.
Maybe in the first few weeks, but their half-life is 7 days. You're not doing much besides making a hassle for yourself if your doing that after the first couple of weeks
I'm not on any medications, and I've never been able to handle tea in the morning. Green, black, iced, hot, matcha. It always makes me feel nauseated unless I've eaten breakfast first. I always drink black coffee though, without problems.
I’ve been on 15mg (the highest dose) of Zepbound for the past six months. As of right this second I’ve lost 74 pounds since September 2024 when I switched to Zepbound after having a terrible experience with Ozempic/Wegovy and gaining from 260-308.
I notice no ill effects, I just had my three month checkup with the doctor and he thinks I’m good on maintenance mode at max dose, I’ve still got about 34 pounds as my total weight loss goal. Really an ideal case.
For my wife on the other hand she just has constant diarrhea which she blames on the drug, and is only on 5mg. She also gets headaches from the medicine. She’s lost only 20 pounds, even though she needs to lose another 120 or so to be “healthy weight”.
However, before she started taking Zepbound she was only able to walk a few hundred feet at a time, because her back hurt so terribly. The anti inflammatory “side effects” she’s experiencing have massively improved her quality of life, even without huge amounts of weight loss.
I'm sorry to hear about your wife's issues with it. My experience was completely the opposite. Since glp-1s slow gastric emptying they've completely ameliorated my IBS-D. It's been marvelous
I'm on 2.5mg and I just got sulfur burps, which, to me, is the worst side-effect of the lot. I've also gotten terrible diarrhea previously, even on the lowest dose, I've started and stopped it around five times. Hopefully fifth time's the charm, but yes, side-effects very much depend on the person. I have friends on 10mg and 15mg and they're fine.
My lowest sleeping heart rate is now at least 10 beats higher than before starting (it comes down during the week to about 10 over)
The night after taking the injection my sleep is crap, and the heart rate is 5+ higher again
I have lost 20lbs since mid March with no real effort, and we’re about to do some blood tests for specific cholesterol numbers, which was one of the reasons to try this out.
Like if your stomach really hated taco bell and you start taking a pill and now you get the same effect from artificial sweeteners you don't care because you're still within what's normal.
That's the level of side effects these things have.
Parent is not saying hunger supression is a bad side effect, they just clarify that the difference in noticabeality talked about a few comments up refers to the bad ones - but the good one's remain the same.
Pharmaceuticals generally do not drop in price while they are under patent. They will lobby like crazy to get on the approved 3rd party payment schemes though as that makes it "affordable" to more as then everybody pays regardless of wether you use or not.
And a treatement that you have to continue forever or fall back? Pure gold!
Insurers certaily don't mind you living longer. More payments, less payouts. They just need to update their predictive models or coverage policies to safeguard their margins. The 'problem' is transitory.
> Insurers certaily don't mind you living longer. More payments, less payouts.
There are times when this is a problem, but even then it isn't the insurance companies that are complaining. There was a big "problem" during the beginning of the AIDS epidemic. For reasons I don't quite understand, the holder of the policy (the insured) can sell their policy to a random third party. The seller sells because they need immediate cash for end of life hospice treatment. The buyer buys because they know this person is about to die and they are going to get a cash payout of more than they paid for. This was a guaranteed payout because there was no treatment. This was a rare example of an investment with zero risk and high return. If you got the virus, you were going to be dead in a few months. This is a win-win for both the deceased and the new buyer, and it is neutral for the life insurance company because either way they have to pay the same amount to someone at the time of death.
The arrival of AZT cocktails threw a monkey wrench into the whole plan because suddenly a guaranteed death is no longer guaranteed and it leads to an ethical quandary because the "investor" doesn't get a return for their "investment" unless that person dies, and now they are literally wishing death on someone. (see also: There is no such thing as a risk free investment.)
Which of these are issues that diabetic/pre-diabetic/obese people would be likely to suffer from anyway?
And which of them are issues that people massively changing their diet and dropping weight, while also making lifestyle changes like exercising more (due to finding it easier after losing weight) would be likely to experience?
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.
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.
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.
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.
Yeah, both Ozempic and Trulicity have automated systems like this, just press a button and pop. Is there even a way to hit a vein? The needle is not very deep (it's subcutaneous, just barely under the skin). And it's the stomach, which AFAIK, doesn't have a lot of exposed veins?
Either way super simple and quick. Fairly painless. I had a weird rash one time, but apart from that a total of about 15 injections haven't had any issues on either Ozempic or Trulicity in terms of injections. Others may have difficulties, but it's been super easy IMO.
You can get these drugs with a vial and needles and it’s cheaper that way. Not familiar with the autoinjectors, but the instructions when using a vial and insulin needles is definitely to pull back.
Peptides don’t have the same negatives as say insulin, but preferable to not have them in your bloodstream nonetheless.
Mounjaro uses very different designs across the world. The UK has an included needle; here in Germany you need to get them yourself, and neither is an auto-injector.
I understand if you have an autoinjector, you _can't_ do this, but this is how I was trained to give injections as an EMT-B (and paramedic training provided by the Army, as I was an Army medic).
Not sure why you are being downvoted. Some of the people using the brand name medication have some sort of auto-pen style injection but anyone using generics simply injects with an insulin pin. I always just pull back on the plunger (aspirate) before injecting. I currently take 18 shots a week (I'm very pro better living through chemistry) and do this every time. No issues.
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.
I take 18 shots a week - Big fan of better living through chemistry
I don't even notice the SubQ shots anymore. The only annoying part is I have to lean forward to find enough belly fat when I shoot there.
Still not a huge fan of the IM injections into my legs but we all suffer for our art.
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.
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.
I was a heavy alcoholic, and the ability to quite drinking was... amazing.
Now that I'm off, I just remind myself I never want to get back at that dark place, but I'm so very glad it made quitting just... happen. It's wild how easy it was. A little mental control in terms of "no, don't go to the liquor store" but it was habit more than physical addition at that point. This was with Rybelsus. Sober 4.5 years now. It was definitely not an intended side effect but I'm glad I was rx'd when I was. I was not in a good state.
Crazy to hear all these stories. My wife’s friend was a pack a day smoker for a decade that had transitioned into a heavy vape smoker, normal weight but couldn’t get off vaping despite trying. She tried Tirz to see if it would help and after only about 3 months she quit entirely, now completely smoke free for two months.
I'm on semaglutide for weight loss purposes, while having no other health issues relevant here.
I don't think it's made any difference to any addictive tendencies or my bad habits (and with ADHD, those certainly exist). It certainly helps with the appetite of course.
This is definitely anecdotal evidence, but it's wise to hold on longer for more data to come in before advocating for it on those grounds alone.
I’ve lost 80 pounds before GLP-1s were a thing and didn’t gain this superpower, and the last time I lost weight (about ten years ago) I went from front line desktop support to teaching myself to code and getting a job as a software engineer, so honestly maybe it’s just “not having sleep apnea”, then when I regained the weight it felt like I lost some IQ points. So you may be on to something. Also it seems to generally reduce inflammation.
My heartburn I suffered from is completely gone but that’s because I just absolutely stuffed my face, I felt like I could never eat enough food.
I had terrible side effects with Ozempic but have had minimal side effects with Zepbound that have disappeared over time. I just wake up on Thursdays and inject it first thing.
The auto pen misfired the other day and I called Eli Lilly and they immediately emailed me a voucher for a free 4 pack of the shots. It’s also eliminated my sleep apnea (via the weight loss).
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.
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.
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.
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’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.
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.
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.
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 funny to think feeling bad from it is having the highest impact.
I cant think of anything.
I take 18 shots a week, including the GLP-1 shot once a week. I don't even notice it.
I even give my wife her shot. Gotten to the point where I don't have a lot of belly fat to inject into so I have to lean forward but that's really it. I've never had a side effect from GLP-1. No nausea, nothing. Only side effect is I now have the will power not to kill a pint of ice-cream after 6pm. Its been 100% a willpower increase for me vs a physical change. Started in January at 240lbs. 210.8lbs as of this morning. Every ab is defined. Stuff is great, no idea why anyone would want to come off.
I can still eat whatever I want I just choose not to. For example, had burgers, fries and ice-cream for lunch on Saturday with the family and then just a protein shake for dinner.
I also don't snore anymore. I used to snore terribly, my wife would wake me up at least once a night to tell me to roll over. Not at all now.
Most importantly, even though I am on a ton of test and deca, my blood pressure is normal, and my cholesterol has actually gone down.
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.
So, in a way it tortures you so much, that your brain/psyche has no other choice to very quickly adapt to it and stop you from doing the old habits that used to give comfort and joy?
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.
> 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].
I’m sorry, but as one of the rare (decently) fit & nondiabetic people that have taken these drugs I’m going to call out your comment a bit.
While I have no doubt that obese people have gradually made appetite control harder for themselves, the full feeling you get on GLP meds is in no way the way us normal-weight people feel.
I too, could easy eat a whole bag of doritos after some pizza and then decide I want ice cream. I don’t do that because I know it’s an awful idea and so I maybe just have a pickle after the pizza instead.
On GLP-1 medications at a decent dose I don’t know if I could force myself to eat anything after half of my normal serving of pizza.
That’s not the way the rest of us normally are apart from rare exceptions, I assure you.
Yeah but right now we're just arguing about how strong each person's feeling of "I could eat more" is.
Personally, I really like how, on the medication, it's easy to say "nah, I'd better not". Off the medication, it's impossible, as I have to eat whatever is in front of me, or I won't stop thinking about it.
Sure, obviously there's no real way to compare that. I was just pointing out that the way it makes people feel isn't natural - as in, that's not how most skinny people feel either.
I apologize for ruining your day, that wasn't my intention. As I stated in my post I don't doubt that obese people have screwed up that signaling over time. Are your cravings off medication worse than mine? Probably. We'd pretty quickly get in to a "Is your green my green?" type discussion talking about that, which obviously has no conclusion. However, I've seen many, many people repeat something along the lines of "Wow, I guess this is what skinny people feel like all the time!" in reference to these medications. I was just pointing out that it absolutely is not how we feel, and I'm one of the fairly rare people out there that can confirm 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.
>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).
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.
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.
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.
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 drug”, 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 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).
I'll dispute that, I work for one of the online pharmacies and we won't stop selling it to you once you've reached BMI 25. We do have criteria to guard against sudden or extreme weight loss, but I think the BMI criterion for that is something like < 20 BMI (don't quote me on that, as I'm not sure, but it's not 25).
We'll also keep you on a small maintenance dose if you want, that's a conversation you'll have with your clinician and they'll judge whether it's medically appropriate. As far as I know, there's usually no reason to prevent you, though.
You can also think about it the other way - if a drug caused you to lose 10-20% of your body weight, and you're now at a good body weight after 2 years, why would you want to lose another 10-20% body weight?
I understand that's not really how it works, but people often go very much by feel more than anything else.
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.
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.
It's not like it's impossible unmedicated. Plenty of people have and will do it. Obviously most people are unable to. I was always surprised just how few prediabetics did though.
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.
"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
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.
Ok, sure - but are diabetes patients representative of the whole target market for GLP-1? And there will still be an uncomfortable variable that controls the outcome - patient compliance. That's what makes life insurers woozy.
I didn't have look on the studies but I would not be surprised if a decent amount of participants were completely healthy individuals. And maybe (more from random sampling) some unsuspicious mildly overweight without other problems. Especially in the earlier cohorts of testing.
I've been on GLP-1 for a month and my triglycerides halved, and my cholesterol dropped to the levels it was in my twenties. If that's not a predictor of lower mortality, there's something wrong with our fundamental medical knowledge.
Yes, I lost around 4kg. Though the triglycerides and cholesterol are mostly because I stopped eating sweets and fatty foods, not because of the weight loss itself.
> 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
I think this is pretty far off the cusp and seems like a bit of reddit logic "health insurance is scam, internet said so".
Health insurance is one of the rare services where incentives between consumer and business are well aligned. The vast majority of people are healthy. Healthcare is expensive in the US because the uninsured population continues to rise out of "they're not making me pay for it": There are entire tranches (in the US) also don't buy insurance and use the ER and abuse EMTALA for their primary care (most of this is actually unintentional in my opinion, it's less educated populations in the US who are repeatedly taken advantage of and left to ride on government, which is extremely eye-wateringly bad at spending money). Personal experience here working in an ER.
The real pathway in the US to success is getting those populations onto private health insurance. Obama tried a heavy handed "health insurance mandate" that hilariously somehow passed the supreme court, but was so laughable mis-aligned with American ideals even Biden wouldn't enforce it.
What is apparent though is these populations are completely willing to pay bills like their cell service, gasoline, car payments, etc before investing in the most important thing (their health). This gives me hope there is a way forward by riding these perceived essential services somehow. I'm not really sure what the answer is here, but there is at least opportunity for some creative solutions.
I also think the disagreement here between red vs blue isn't the outcome: both want people to be healthy. Red doesn't want single payer, whereas blue does. Red ignores the fact these systems don't exist, blue ignores the fact that no other country in the world has the diversity of America and there are not functional examples.
I thought about it quite a bit and I came to conclusion that it is not 100% alignment between consumer and insurance, like it would appear on the surface. To me it seems insurance in the long term is interested in health services becoming more expensive (bigger pie they can manage), but steadily. I.e. it will affect insurance negatively if costs will suddenly increase by alot in a single year while premiums are locked in. But if it will keep inflating steadily and predictable - it only gives them a larger chunk of cash to manage and profit from. There are of course limits, so it needs to align with income inflation to avoid situation where their pie is shrinking because people/government simply can't afford it anymore.
These types of arguments are somewhat worthless when they're not made in context to obesity.
What I mean is, you should be comparing the risk of GLP-1s versus the risk of obesity, because realistically this is the vast majority of people's risk analysis criteria here.
Obesity increases your risk of CVD, metabolic syndrome, diabetes, liver disease, kidney disease, joint diseases, and overall mortality. CVD, in particular, is the number 1 cause of death in many developed countries.
Like all drugs, GLP-1s come with risk. This fact, however, is worthless. We must ask if it is less risky than the aggregate sum of the above diseases. I think the answer is overwhelming yes.
Therefore, obese people should probably consider GLP-1 medications. Particularly if they have tried, and failed, weight loss before. Which every obese person has.
In addition, when considering the downside of medication, we MUST compare it to the alternatives. Many obese people are already on multiple life-long medications. Statins, hypertension medication, insulin and other diabetes management drugs, etc.
Not only do these medications require significantly more management than a GLP-1, but they, too, come with their own set of risks, which we must then add to the risk of disease.
I, personally, have taken multiple chemotherapy drugs to cure my cancer. These drugs make GLP-1s look like nothing. They have damaged my body in irreversible ways. They've aged my blood, exposed me to extreme levels of known carcinogens, raised my risk of mortality, and overall lowered my quality of life.
However, I am thankful for them. Yes, my risk of mortality is much higher. But, compared to cancer, which has a 100% chance to kill me, it was a worthy tradeoff.
Your citation measures 15-year mortality in adults 20-49. The P values for BMI's relationship with all-cause mortality and cardiac mortality were 0.071 and 0.030 respectively. It compares BMI against waist circumference and body fat percentage and suggests that the latter measures are better. I think it's misleading to say that "weight is not a primary predictor of health" based on this evidence.
First, the paper is talking about BMI rather than weight.
Second, what most people mean by "weight" in ordinary conversation is closer to body fat percentage than it is to BMI: Arnold Schwarzenegger was famously obese by BMI, but anybody who called him overweight during a conversation at the pub would likely be told he doesn't count.
Thirdly, the paper was close to statistical significance, even looking at young people and even with a cohort of a bit under 5000 people, so it doesn't rule out a correlation with BMI either (although yes, it does suggest BMI is a proxy for body fat, but this isn't a controversial statement).
Fourthly, GLP-1 agonists do reduce body fat[0], and body fat is the measure suggested by the paper you cited as being better than BMI.
I would appreciate citations. I'm a doctor on GLP-1s,who had previously convinced my mother to commence the same. In her case, it was driven clearly by failure of other methods to control her obesity and worsening liver fibrosis, on top of pre-existing diabetes. On my end, no such issues at present, but I consider it safe enough that it's a first-choice approach to robust weight loss, and I personally use it in conjunction with diet and exercise.
"Relatively high levels of significant side effects" is a vague and unhelpful claim:
High compared to what? What counts as a significant side effect here? What actually are the side effects in question? Are those side effects permanent and irreversible? Can they be avoided by adjusting the dose? Dozens of such considerations come into play.
No drug I'm aware of is perfectly safe, and I know many drugs indeed.
To the best of my knowledge, the combined risk of taking semaglutide utterly pales in comparison to the clear and present harms of obesity. The only clear downside is cost, and while I'm lucky enough to to have access to cheaper sources, they're not even that expensive when you consider the QOL and health benefits.
> Conclusion: Semaglutide displays potential for weight loss primarily through fat mass reduction. However, concerns arise from notable reductions in lean mass, especially in trials with a larger number of patients.
That's a significant long-term damage to health, quite possibly permanent for 40+ patients.
That's simply how the body reacts to a caloric deficit, without additional exercise. If you combine both IFT and resistance exercise, you find no muscle loss at all:
>Based on contemporary evidence with the addition of magnetic resonance imaging-based studies, skeletal muscle changes with GLP-1RA treatments appear to be adaptive: *reductions in muscle volume seem to be commensurate with what is expected given ageing, disease status, and weight loss achieved, and the improvement in insulin sensitivity and muscle fat infiltration likely contributes to an adaptive process with improved muscle quality, lowering the probability for loss in strength and function*
Interpreting the risks and benefits of medication isn't a trivial exercise, if you're driven by a handful of studies or ignorant of the wider context, then it's easy to be mislead.
> That's an apple to oranges comparison, because there's nothing preventing someone from taking Ozempic from exercising on the side.
Strongly disagree on this. If there was nothing preventing the patient from changing their diet and physical activity / exercise level they could lose the fat through diet and exercise without resorting to taking semaglutides in the first place. Withdrawal studies show that there is a clear tendency for the weight to rebound after withdrawal from semaglutide use, therefore it's very hard to argue that it is the weight / fat mass alone blocking patients from indulging in a healthier lifestyle.
Semaglutide may help manage sustained weight loss by e.g. reducing the effect of reduced leptin baseline, however overall I remain highly skeptical of possibility for semaglutides to be "a first-choice approach to robust weight loss".
That has nothing to do with GLP-1 agonists and everything to do with the fact that rapid weight loss without exercise and sufficient protein intake leads to substantial lean mass reduction.
It's still better unless you were woefully weak, in which case a doctor should have prescribed adequate nutrition and physical activity.
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.
Maybe in some platonic ideal, but in practice a) consumers (and even brokers) aren’t that sophisticated, and b) likelyhood of the company being around in 20 years isn’t baked into the price. When I shopped for insurance there were only 3 options with contract terms that passed muster, and all three companies are large ones that I’d expect to be around in 20 years to a degree that has no relation to the price quotes I got.
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.
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.
Yes, some life insurance companies can make mistakes or get unlucky. after a few went bankrupt from whatever you are imagining, you'd think that the remaining companies would change their risk models or simply charge higher premiums?
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 think you are misunderstanding the counterfactual.
Right now, it would be hard for an amateur to make a living starting up a new life insurance company, because there's lots of competent competition.
However, _if_ all existing life insurers went bankrupts, then, yes, you could easily make a killing by starting a new slightly less incompetent life insurance company.
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.
No. Many people have family/kids and want to care for them, and their plan A is to work until retirement. If they die prior to that, the family/kids would be in dire straits. That's plan B, the issue life insurance solves perfectly well.
That, in fact, is the general (and beneficial) function of insurance: You only need to provision for the expected loss (plus some fee for the insurance), not the maximum loss (which many people could not afford).
Suppose you want to insure your home against fire, which could create damage of say $1m with probability 0.1%.
Without insurance, you'd have to put aside savings of $1m (the maximum loss), that would remain untouched with 99.9% probability, and be used to cover the fire damage otherwise.
With insurance, you'd pay the insurer $1m * 0.1% = $1000, plus a bit on top to cover their cost and profit. In case of fire, they cover your loss. Everyone wins.
So, with insurance you replace provisioning for the maximum loss by provisioning for the expected loss plus a fee.
(That's why one should not get insurance for small items (where one can cover the max), such as baggage or mobile phones or so, but for large items, such as house, life, health).
Oh, that's what you mean. Yes, insurance is there to smooth out risks. And I agree that items you can self-insure, you probably should.
Similarly, I can't really understand insuring against expenditures that are certain. Eg insuring for the cost of routine pregnancy (as opposed to insuring for complications only). Or even worse: yearly allowances like 100 dollars flat for new glasses: just decrease my insurance premiums by that 100 dollars, please. (Unless it's a tax dodge, then it makes sense.)
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.
It doesn't matter whether your counterparty for your insurance is a collective or a single individual like Warren Buffett.
The 'collective' part is a distraction when trying to understand insurance.
Similar for insurance to work you don't need to have a group of people who are in the same situation as you: in principle an insurer can work out the risks, even if you are in a unique situation.
It's just that working these things out costs time and money, so it's cheaper for you, if you are like everyone else.
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.
In the US, a reasonable estimate is dozens of murders per year. I don't know if we can do any better without running a study: There's no good data easily available; the murder clearance rate in the US is now quite low; most insurance killings are, of course, staged to look like accidents.
It's not different time preferences. According to time preference theory the insurers have perfect information about the future so they would have taken the change in lifespan induced by GLP-1 into account before it was even invented. The assumption that mistakes are impossible is one of the core foundations of neoclassical economics. In time preference theory the bias towards the present or future is a moral issue that you get beaten over with to enact a just world fallacy.
In liquidity preference theory insurers do not have perfect information so they must make a tradeoff between collecting information and acting on the information they already have. There will be a bias towards the present and the past, because more information is available about the past and present than the future. What's being "discounted" is uncertainty, not time. Hence there is also a general bias towards stability and conservatism (sticking with existing decisions, even if they are bound to become obsolete).
Now let's apply this to the article:
The insurers don't know if you can stick with your weight loss, so they will conservatively deny coverage until they are certain that they know your health/risk profile. According to time preference theory this would never happen since the insurer already knows whether you will succeed at weightloss or not.
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.
Day to day I use a home body composition scale (Withings Body Scan), the results of which have been corroborated by two Dexascans I've done at my gym a little less than a year apart.
For me personally, the little bit of help in the form of forward progress on weight loss has given me a reason to be a little more methodical in my strength training, and I'm seeing a slow but consistent payoff. And as far as I can tell, I'm not fighting an uphill battle in terms of adding muscle mass at all because of the GLP-1.
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.
> They switched from 30-day to 90-day refills. Suddenly, patients had to think about their medication four times a year instead of twelve. Adherence rates shot up almost immediately.
When I have a “refill” (here in Australia we call them “repeats”) due, my pharmacy sends me an SMS… I just reply “yes please” and that goes straight to the pharmacist who dispenses, and I get another SMS telling me the dispensed medication is ready to pick up
I’m on tirzepatide and I’m committed but I’m “going a bit slow” because the side effects started to get a bit too much. Still, my base expectation is I’m taking a GLP-1 agonist for the rest of my life, unless my doctor tells me I have to stop for some reason, or I somehow go bankrupt and can’t afford it any more.
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.
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.
We already do something similar with smoking cessation. They, essentially, pay you to quit smoking.
The social difference is that we frame smoking as an addiction, and smokers as victims of the Tobacco industry. But we frame obesity as a moral failing. So, the former we're ready to jump in and help. But, the latter, we are much more hesitant.
Theoretically, economic outcomes would override these social and moral effects. But leadership is often stupid, so we'll see.
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
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.
I think the difference is people generally get Life Insurance when they are younger (I'm guessing frequently when they have kids, that is when I got it at least) but get Annuities when they are a senior. I don't know anyone my age who is purchasing an annuity now, though I suppose there must be someone who would be willing to sell it.
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.
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.
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.
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).
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.
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.
The last thing I will ever give a rats ass about is insurance companies. They are the scourge of this earth but they have used legislation to embed themselves in our every day lives.
I live in California and have no claims ever. My home insurance has doubled in 4 years to almost $4000 a year. My car insurance is about $2800/yr.
So I hope insurance companies break. Like Danerys said in Gamr of Thrones, I hope someone breaks the wheel.
$4000/year might be a lot or a little. If you own a $5m house up against a forest it's probably a bargain. The car price could reflect a bunch of factors.
Pay some broker for a one-off consultation to advise you on how to save money.
Reality is insurance companies are now going though a cycle of "price in the actual risk" rather than "drop prices to gain customers"
So you pay less than 1% of the cost to rebuild your home per year in home insurance, in a state that regularly has fires, floods, and earthquakes? That seems fair to me
"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.
You definitely (at least in the US) need income (or an income proxy like zip code). Mississippi has a life expectancy ~10 years less than Massachusettes.
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.
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.
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. .
Call me cynical but it wouldn't surprise me if insurers somehow tried to leverage this "crisis" into some sort of "get written into law, guaranteed profits forever" play the way that health, home and auto have.
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.
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
The reason insurers ask about weight loss is that it could be a sign of a (severe) undiagnosed medical condition - e.g. they should be contacting a doctor(!)
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.
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.
1. Exactly the type of "side effect" that people will report because they lost hair (because lots of people experience hair loss whether they are on a GLP1 or not)
2. A fairly minor side effect that wouldn't be a strong reason to not prescribe.
Pancreas issues were worried about, but those worries (so far) appear to be unfounded. https://pmc.ncbi.nlm.nih.gov/articles/PMC6382780/ is a meta-analysis of 12 studies (36k patients) over 2 years that showed no evidence of increased pacreatic issues, and https://pubmed.ncbi.nlm.nih.gov/38175642/ is a 7 year analysis of ~33k patients that also shows no increase in issues.
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.
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.
I know a couple who self identify as foodies and they started taking it for weight loss. They now complain that date night is no fun because they don't enjoy the food. They have not yet dropped the meds but I can see it happening soon.
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.
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 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...
The topic of per-country pricing was mentioned several times.
I was wondering how big the price differences would be so I set up a quick form to collect some data points from several countries and for several products.
It would be cool if you could provide some data - I would then share it back as a reply to this thread within 1-2 days after closing the survey. The latest data entry will be possible on Sunday.
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.
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.
Is the rise of GLPs yet another case of Neal Stephenson called it again? I'm rereading Anathem and struck by similarities of Allswell and the psychoactive components of GLPs. In the book, Allswell is a drug that gives people a sense of calm and well being, and is genetically engineered into food in a way that puts water fluoridation to shame. Otoh, the lower-caste slines of Arbre are also overweight so maybe the parallels are limited.
> 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?
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.
The idea is that the insurer doesn't even know the customer is on glp1, and I guess doesn't require a full physical often enough to reprice frequently.
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.
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.
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.
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.
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.
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.
In 2013, my weight was around 48kg, and I increased it to 55kg through fitness and dietary control. In 2016, my body shape reached its peak at 60kg, with a body fat percentage of 12%. In 2022, my weight was 63kg, but my body fat percentage was around 22%. I still managed to regain a weight of around 57kg and a body fat percentage of 18% through fitness and dietary control.
I just want to emphasize that controlling diet is very important for shaping the body, and the method of controlling diet is to calculate the calories of food. Only then will you realize what foods you should consume. For example, when you are thirsty but don't want to drink pure water, you want to drink a beverage with a taste like coffee or tea. If you understand the calorie percentage of these foods, you can know that if you choose coffee, it's best to drink an Americano, and if you prefer tea, you can drink almost all types of tea. Even tea is considered beneficial for weight loss. Find tea here,https://teayucafe.com/
The reason why many people fail to achieve their weight change goals by calculating calories is that they cannot persist. Remember, this is a long process.
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.”
No calorie counter will stop a ramen quest after 90 hours of work. Unfortunately, I worked in environments where these stretches were obligatory.
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.”
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!
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 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.
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 don't mean to be overly harsh, but saying "just changing their diet" is quite ignorant. There's been a huge amount of research into the challenges of weight loss, so it should be (more) common knowledge by now that it's not just about deciding to do it and "having discipline" - it takes much more than that, both physically and psychologically.
I understand where you're coming from, though, I used to think the same - I remember a specific situation where an obese person next to me was breathing heavily from doing something easy and me thinking "how do you hear yourself breathing audibly from doing almost nothing and not decide and just change it". Unfortunately, I got into a situation where I now understand the issue and am struggling to lose weight, despite hearing myself breathing audibly after picking up something from the floor and all the rational understanding and knowledge of what I need to do.
IMO, in a lot of cases, the first step should be going to a therapist.
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.
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.
Having ADHD myself, and a bunch of friends who also have it, I have noticed that the people with this condition rarely have a healthy relationship with food. There is either a tendency to overeat indulgent foods, or a tendency to not think about food that much.
I have also heard about people with ADHD being on GLP1 agonists that it does a lot for their reward seeking behavior and impulse control.
This makes me wonder two things:
- Whether at some point these molecules will also start being used for ADHD and addiction treatment in general. I think they hold a lot of promise for issues rooted in the reward system.
- Whether a sizable portion of people who struggle with their weight have co-morbid ADHD which creates or worsens their overeating issues.
Have you noticed anything along these lines in your practice?
As someone with diagnosed ADHD. I fully agree. There's some background thread that says "you, now, eat". It's almost impossible to shut off.
That being the case, the same behaviours have led me to a compulsive need to plan meals. Doing so has helped me lessen (not eliminate) food noise. Anecdotally, I've noticed with others as well, that this is the way. Prep - be fine. Don't prep - eat a small village.
Also ADHD here, and same thing for me. Hyperfixating on meal planning and strength training has pretty much saved me. It's hard, and I still have to fight food noise daily, but having everything pre-prepped means I have easy, friction free healthy choices instead of reaching for a bag of chips and downing the entire thing while sitting at my desk, or not having the executive function necessary to cook an un-prepped, unplanned dinner and just eating a whole pizza instead.
I also used to binge, and meal planning and pre has also helped with that, as I tend to have periods of either really high food drive, or almost no food drive at all leading to not eating for an entire day, then downing 3000+ calories in one meal.
ADHD sucks. It's often trivialized in pop culture, but it makes life so difficult, and those real difficulties are almost never talked about.
I am a strong believer that the biggest "thing" in ADHD is the challenge with sustained goal-focused behavior. And that is in large part due to how fucking hard it is to stay on task when you have ADHD. It's not uncommon to hear people like you who are able to keep control by focusing on the few things that make the most sense and are the most motivating. And even with a perfect target for behavior, it's a battle to keep at it. That is why I think a lot of people get adult-onset ADHD diagnoses—because they are burned out from spending 2x the energy to keep their life and behavior on track.
Do you have kids? Even when I meal prep, tasty kids foods draws me in like a bug to a night time light.
As I wrote to another person here: Yes. Not as much as with ADHD medication, but there is an obvious subset of addictive personalities that find relief from addictive behaviors (beyond eating addiction) with semaglutide.
But to add to this, I feel like there are different kinds of addictive behaviors at play that are more susceptible to one medication or the other and are based on different systems.
For instance, the food-craving reduction in GLP-1 is almost certainly not just related to reward and goal-seeking behavior. It literally affects hormone signaling for satiety, and slows down the movement of food through the stomach, and affects, globally in the body, responses to metabolic signals. And it probably has a global effect on the way every cell in the body works, which might be why there are positive health effects beyond just the weight loss.
ADHD medication, on the other hand, targets the goal-directed activity system directly. It seems much more likely to me that reduced appetite is just as much driven by the focus and "let's get shit done" mode that is artificially increased with dopamine. Both result in reduced eating but through massively different pathways. Basically, you pay attention to the biggest wave in the pond (the waves in the pond being a metaphor for all the things your brain COULD pay attention to). So when the goal-stuff gets increased in size, the food-seeking is automatically smaller by comparison, and less likely to drive your behavior and thinking.
I don't think I can say that there is much of a pattern between ADHD and overeating, just based on how easily I can predict if someone is overeating or not if I know they have ADHD. That is, it would be a coin toss.
The simplistic answer would be: Semaglutide reduces addictive behavior if it's driven by emotional regulation needs, and ADHD medication reduces pure drug-like craving. As seen in studies where people that start lisdexamfetamine (ADHD medication common in the EU) have a huge reduction in actual amphetamine abuse.
Case in point: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/... Findings In this Swedish nationwide cohort study of 13 965 individuals, lisdexamphetamine was significantly associated with a decrease in risk of hospitalization due to substance use disorder, any hospitalization or death, and all-cause mortality.
> I don't think I can say that there is much of a pattern between ADHD and overeating, just based on how easily I can predict if someone is overeating or not if I know they have ADHD. That is, it would be a coin toss.
Person you responded to suggested P( overeating | undereating ) as opposed to your P( overeating ). I expect the effects of those two conditions would tend to cancel each other out in observations.
> As seen in studies where people that start lisdexamfetamine (ADHD medication common in the EU) have a huge reduction in actual amphetamine abuse.
Perhaps I misunderstand you but lisdexamfetamine _is_ an amphetamine. That reads like saying that people prescribed an opiate exhibit reduced opiate abuse. It seems either tautological (not abuse because permitted) or obvious (cooperative supervised use reduces bad things happening) or perhaps related to drug safety (A simply being safer to use than B).
Regarding under- and over-eating: it seems you think I am a simple mathematical average that doesn't factor that in. I stand by my observation, as and observation, not fact.
Lisdexamfetamine is not amphetamine—not chemically, not in terms of its half-life, not in subjective experience, and not in any study that tracks behavioral or long-term effects. At best, it's a prodrug of an enantiomer of amphetamine. You are also mistaken about the study. Reading even the abstract would clear that up for you.
Let me clean up the unnecessary, convoluted language before I answer: Q: Does it stop being called "abuse" once a doctor prescribes it? A: No. The prescription stopped hospitalizations due to amphetamine overdose.
Q: Is it simply safer to use drugs with a doctor's help? A: That was not answerable based on the study's design. It is also not a useful question to ask in this context, since it's comparing apples and oranges. Some of the worst cases of drug abuse are created and maintained by doctors. However, taking drugs collaboratively with a doctor is probably safer on average than getting them from random webpages.
Q: Is this specific amphetamine safer than others? A: Yes, as is the case with any substance we ingest. You can quibble over the details, but beer is safer than hard liquor. Likewise, different medications in the same category or receptor affinity group have different LD_{50} doses (the ratio of the clinically effective threshold to the threshold where 50% of subjects would die).
> it seems you think I am a simple mathematical average
No, I was merely inquiring after what appeared to be a misunderstanding but apparently wasn't.
> Lisdexamfetamine is not amphetamine
Just to clarify, this topic is always needlessly confusing because "amphetamine" is used to refer to both a distinct chemical as well as an entire class of chemicals. Lisdexamfetamine is _an_ amphetamine in exactly the same way that codeine is an opiate (ie a prodrug of).
I'm not sure why you think I'm mistaken about the study nor why you are so condescending about a misunderstanding rooted in terminology. You yourself state that it is about relative drug safety and the study is also quite clear about this so it would seem that we were in agreement all along.
Because I get triggered when people are illogical while using excessively complicated language and do not try to understand the points being made. Like in this comment, I clearly laid out all the ways I think lisdex != amphetamine. But you are once again answering in an obvious way without engaging my points.
If you look elsewhere in my comments, I have no problem calling myself an idiot when I make mistakes. But I hate the noise that is bad faith arguing concealed in fancy words.
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.
Appropriately enough, (most) ADHD medications also tend to suppress appetites. So much so that weight loss is perhaps the most serious side effect for ADHD meds in children.
Yea, it's specifically warned against. Kids will just plain forget to eat on ADHD meds, which is kinda bad.
I could never eat lunch or sometimes dinner if I took it. I gained like 30 healthy pounds after stopping it at the end of my teens.
I can't drink whatsoever now. I've been on Wegovy for ~4 months. I used to be a VERY light drinker, i.e. like 10 drinks per YEAR (rum and diet coke, glass of wine, or 2-3 beers in a night). I would usually get a drink when my band played. A month or so ago, I got a bourbon, which I'll happily sip for an hour while talking, and I had to force it down, and left over half of it. Same with a beer; I went to a baseball game with some friends, someone bought the group some drinks, and it was disgusting.
It was like whatever enjoyment lightbulb that is usually activated was completely unscrewed, or like trying it for the first time as a kid when an adult lets you try a sip on a holiday. Just sitting here typing and thinking about it has me slightly nauseated. I've been telling people recently I CAN'T drink because of some new medicine I've started.
When I took Adderall in college a few times I had a very similar feeling. You could have told me my favorite restaurant was giving away my favorite food, and it would have been nauseating while I was on the meds.
Same with Naltrexone
Well, that one is used for alcohol abuse disorders.
I believe you 100%. I have a history of substance abuse with bad consequences. I quit alcohol and now my drug is food. People tell me I'm a "supertaster." I can taste many of the ingredients in my food that others can't.
I also have BPD and am in therapy for it, but man. Food is the drug that always works. When I get into a certain mode, it's like I don't care that I'm overweight and have high blood pressure. I just crave the deliciousness and the "full feeling." And it never fails to work! I always feel more calm and happy after I eat.
Reminds me of a client I had once. He said that the only thing that made him reset was to "pig out" with a carb-overdose, then just sit in front of the TV with a sugar high.
Incidentally, I had been nagging him about trying ANYTHING (in addition to the therapy we were doing to find a life goal he believes in) that might help him get SOME help. Be it Adderall or Ozempic. But people are complex, and at best, a person is a Venn diagram with massive overlapping "biological susceptibility," "life situation," "negative thinking style," and inertia. The best one can do is to pull at as many threads as possible to hope the suffering unravels. So one of the threads one can pull at are medication.
Not to give advice, but just for shits and giggles, look into "vulnerable narcissism." Many describe stuff like you do and fit those traits. And don't give a shit about the negative associations and stereotypes regarding this personality. I love narcissists! It's one of the coolest personalities there is! But when you are not allowed to be proud of yourself, and all the desire for status and power gets refocused onto self-hate and learned helplessness, then it's a monster of a situation. Had so many people become awesome versions of themselves when they stop being so afraid of being arrogant :) .
Just to remember when you read about it, that the descriptions are only in the context of things having gone wrong. Every trait can manifest as something good or negative. Even psychopaths can have good and prosocial lives. For instance, some of the best ambulance workers often have high loading on psychopathy, and that makes them better at their job. Because they don't get scared. I’d rather be picked up by an ambulance worker that is curious and thinks the situation is interesting than one that is panicking and losing due to anxiety and empathy overload.
This is just a long-shot association/pattern I noticed, though. It's not worth a dime more than the sentences you put into the machine. :P
Do you have any thoughts on GLP-1s for ADHD? I have tried the stimulants (legally) without success, and am reluctant to try the non-stimulants since their success rate seems pretty poor and side effects seem worse.
I answered it a couple of places in this thread already, but the short answer is yes, and GLP1 is not usually a good way to core ADHD treatment.
However, if you tried stimulants without success, this would be my descending list of things that need to be sorted out:
- Have you tried multiple types of medication? A lot of people give up after 1 or 2 different types. But I have seen MANY people who get completely new lives, but only after the 5th type they tried that matched their biology. - Do a diagnostic re-evaluation to make sure that one is not misdiagnosing ADHD (the most common confusion is anxiety and personality). - Map out the life situation. Circumstances might be a stronger explanation of the situation than internal psychological vulnerabilities. - Make sure that you get a blood-mirror (Norwegian concept) so you know you have proper absorption/amount in blood.
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I'm in the exact situation you describe:
Overweight due to emotion-eating and stress-eating, taking GLP1.
Now I can binge-eat until I'm full or sick (mostly sick) and maintain weight. If I'd go off GLP1 now my weight would skyrocket.
Can you talk about people who discontinue for GI side-effects? I understand they are present for a short duration, but have heard anectdata that they persist for months for some people.
Have you observed persistent GI side-effects in your own practice, and if so, do you believe these are legitimate? Or… are they a social cover for individuals to get back to eating for psychological coping?
It's not just GI side effects. Semaglutide is genuinely GI TOXICITY. That's why it's EXTREMELY important to ramp slowly. So yeah, it's a thing. But for basically everybody, it's manageable with slow and controlled ramping of dosage. There has been hard to find any lasting danger if you ramp slowly.
There has been almost a hysteria, it seems, regarding "Pancreatitis." And when I see multiple diagnoses, medications, and reports associated with Pancreatitis, I recognize a pattern I have seen many times before. Both the mental health and medical fields have periodic fixations on certain symptoms or diffuse diagnosis, and when it has the "wave-like" pattern like this, I am willing to bet it's just the latest version of "Fatigue," "Whiplash," "Repetitive Strain Injury", "lactose intolerance" or the dental amalgam controversy. Don't get me wrong. These are real things. But sometimes they just balloon beyond anything reasonable, and an unreasonable amount of people suddenly get diagnosed with it or suspect they have it. Pancreatitis is giving me that vibe over the last year or so. Copy paste this for "Stomach Paralysis".
But let's say the social benefit of alcohol has a value of 100 and a health risk score of 100. I would say that GLP-1 agonists have a health value of 500 and a risk score of 20. Nothing is without risk, but mathematically speaking, if you are overweight, I would be 25x more positive about injecting myself with Ozempic than alcohol... mathematically at least.
And to answer your question, I personally haven't seen many people stop early due to GI symptoms. And if they did stop early, I would think it was because they genuinely had a physical negative response that was horrible for them. Anecdotally, I feel the people that stop so they can get back to eating usually last at least 6 months, and probably more. I am 100% in agreement with the studies that many stop at around 1 year. So if someone stopped at 2 months, I would belive them when they said it was due to GI symptoms. But if they stopped at 1 year and CLAIMED it was due to GI symptoms, I would doubt; and guess that it was driven by missing food.
Please note that I am speculating wildly, and this is just PURELY anecdotal and stream of consciousness.
How much does it cost right now?
Are there any alternatives coming out soon or generics?
It’s unlikely new meds will be approved this year (unless the FDA really does speed up approval processes) I made a tool to compare prices: https://www.glpwinner.com/ If you’re on name brand without insurance coverage you’re sitting around $499 a month. On compounded you can get between $150-300 a month. If you live somewhere expensive like the bay and eat out a lot you are likely saving money by being on the medication.
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)
Canada: January 2026(!)
Novo lawyers messed up, didn't renew the patent filing over a payment dispute. Hilarity is ensuing.
https://www.cnbc.com/2025/07/09/hims-hers-generic-semaglutid...
And once generics for GLP-1s are going in Canada, Section 804 of the FD&C act becomes VERY interesting: https://www.fda.gov/about-fda/reports/importation-program-un...
Reimports of generics from Canada into the US here. we. go.
All over 250 CAD
>Novo Nordisk’s lawyers requested a refund for the paid 2017 maintenance fee of $250 Canadian dollars ($185) because the company wanted more time to see if it wanted to pay it, according to letters included in the documents.
>Two years later, the office sent a letter saying the fee, which now included a late charge bringing the total to CA$450, was not received by the prescribed due date.
>Novo Nordisk had a one-year grace period to pay, but never did, and so its patent lapsed in Canada. It lapsed in 2020 when the fee was not received, but it doesn’t expire until January.
LOL, that must be one of the biggest fuck ups in pharmaceutical industry.
> For semaglutide, the newest and most potent GLP1.
Tirzepatide is the most potent GLP1
https://glp1.guide/content/semaglutide-vs-tirzepatide-clinic...
Can't find the post on Reddit right now, but someone broke all three down and it is more nuanced. They act slightly differently in different areas.
Before I started experiments on "my lab rat" with retatrutide, I found that combination of the about half max dose of semaglutide and 1/3 of Max dose of tirzepatide had the best combination of losing weight and lowering side effects. But another "lab rat" did not respond that well to this combo and we keep adjusting it.
Retatrutide so far looks the most compatible, but it is sample of 1.
Retatrutide looks to be very effective, but it's not possible to get legally/safely at this point. TONS of experience/knowledge in the r/retatrutide subreddit though, a lot of pretty conscientious consumers in there that have done their research, but obviously impossible to recommend outside of finding a sanctioned study to join.
That said, Reta is a triple agonist[0] and it seems to be quite amazing with good muscle retention as well -- it's unclear if this is just the people who are taking it being more likely to be gym goers. Up until now the only formulation I've seen that specifically targets preserving muscle is GLP1s in combination with bimagrumab[1].
[0]: https://glp1.guide/content/a-new-glp1-retatrutide/
[1]: https://glp1.guide/content/preserving-muscle-glp1s-with-bima...
I've had pretty good results on Tirz, definitely interested in how Reta will compare.
This is where I failed as a psychologist because I don't have extensive training in pharmacodynamics, so I forgot that "potent" is a specific term in that world. What I meant was: I subjectively believe that Semaglutide is the best choice for weight loss, given the overall profile and response in my subjective clinical experience.
A fancy way of saying: I *think* Semaglutide is best.
Ah -- the linked research trial contains evidence that it is not the best, Tirzepatide is more effective.
Unless you mean that Semaglutide worked best for you, right now the research points at Tirzepatide being most effective for weight loss (says nothing about t2d though).
No, for my patients. Again. Purely subjective and anecdotal.
> United States: The main patent is expected to expire around 2032. Monthly Price: $950 - $1,350+ (cash price without insurance)
While 2032 seems very far away now, its actually remarkably soon in the grand scheme of society.
My understanding is one of their defendable moats is the patent not on the compound itself, but on the injectors. Which is far longer.
Yeah, the drug + the injector together are the patentable thing. When the first patent nears expiration, they work on an iteration of the injector or a time release change for the drug, then they get another few decades of product monopoly.
They have also made a business of either stifling or “catch and kill”ing of the generics for their products. It’s cheaper to pay off a generic manufacturer to not compete with the new thing than it is to lose price elasticity of the n non-generic.
This is not correct. New patents cover the new combination, but don't prevent practice of the old combination
Scroll down to the area referencing footnote 9 in this article
https://pmc.ncbi.nlm.nih.gov/articles/PMC11457043/
That articulates it better than I will
PS, I read the rest of the paper.
Here are some choice parts:
> Drug manufacturers listed 22 patents after FDA approval of the 10 products in the cohort...Post-approval patents only extended the duration of protection on 2 products (median 4.6 years.
This is makes sense if there is actually something novel to add [keeping in mind the authors are treating any IP as if it protects the entirety of the product. A sugar coating or whatever wont protect the non-sugar coated pill.
To the extent I agree with the paper, it is that the 30 month hold is weaponized and should be reviewed and the issue with settlements should be addressed
Like I said above, they don't extend exclusivity or prevent practice of expired IP. All you have to do is not infringe the new IP. this is what the article says too. I disagree with their greater claim; The patents aren't rocket science- most are extremely easy to read, and the authors are hiding behind weasel worlds like "may" and "could"
There are some bad patents that should never have been granted, like Novartis' famous 631 patent [1]. However, those are the exception, not the rule. If you want to put a generic drug into an auto injector, there are a dozen generic autoinjector companies looking to take your money. Drug + autoinjector does not pass the US patent office non-obviousness test (for obvious reasons). What gets patents is custom design features - bells and whistles. New features are part of the roadmap because customers will prefer them over competition without them, not because it magically extends prior IP (that isn't a thing).
https://www.fiercepharma.com/pharma/regeneron-advances-antit...
> one of their defendable moats is the patent not on the compound itself, but on the injectors. Which is far longer.
That is very typical in the drug/medical industry. To the point where it is sometimes (often? usually?) an intentional strategy.
https://sites.uclawsf.edu/evergreensearch/
where do you get that?
There are dozens of autoinjector manufacturers, and generics can and do change manufacturers. It looks like semaglutide uses an off the shelf Yposomate pen, although Novo Nordisk uses different injectors depending on the country and indication.
Novo Nordisk also has an in house pen, but this would not prevent someone from competing, unless patients simply prefer that design to a generic one.
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.
Lilly also offers it direct to consumer for $500/mo
Lilly offers Tirzepatide for that price, yes. GP is explicitly talking about Semaglutide, though.
Yes.
If these things really boost life expectancy that much, this sounds like a textbook case for eminent domain.
I'm no fan of the patent system, but "patent system promises spoils for coming up with great new drug, companies comes up with great new drug, companies gets spoils" is exactly how it's supposed to work. Yes, it's sucks that you have to pay, but that's how you incentives getting the wonder drugs invented in the first place. (I have my own take on this, but if anything this is a 'textbook case' in favour of the patent system.)
Eminent domain would still require fair compensation to the company, so you'd have to pay them more or less what they'd lose from not having the patent anymore.
(Though I think the term you might be looking for is 'compulsory licensing' or so? Not sure.)
Depending on how transformative the effects are (and the price drop possible upon genericisation) then there could be a compulsory licensing trade to do here.
The drug companies are presumably pricing optimally for profit (but not for maximum public benefit, for which the optimum price is ~0). You could calculate the net present value of the drug companies' total profits attributable to the patent, add on 10% as a bonus, and pay them off. If the welfare gains of having cheap drugs are genuinely greater than the value of the patent to the holder, this would be win/win.
Citation needed for the idea that zero is the optimal price for public benefit. Among other issues, I expect medication compliance would be higher when the patient has to pay for the medication.
I think we probably have data on that (at least in general). That is assuming people react to out-of-pocket payments, and not to how much their insurance or the NHS etc is paying.
That is exactly what I have in mind. "Eminent domain" doesn't mean just taking things with no recompense, but I don't think the company should be entitled to profit maximization at the expense of literally billions of people worldwide.
Eminent domain would be on a jurisdiction by jurisdiction basis. No country has 'billions of people'.
It adds up to the same thing in aggregate.
But also, if you change it to "millions of people", the point is no less valid.
If this research was done fully via the public system in the first place, it would be an easier nut to crack. I mean, some of it is already, and that’s the absolute worst scenario: the public paid for it via taxes, and now has to pay for it privately after the fact.
The public isn't paying for the phase 2 and phase 3 trials.
Imagine that incentive for R&D.
“If you invest hundreds of millions and it turns out to be life changing, we’re going to seize it”
Eminent domain implies fair compensation.
The point is that you don't get to withhold the drug from people to maximize profits.
Wouldn't fair compensation more or less be equivalent to medicaid paying for the drug? And if so, why eminent domain it?
No. Fair compensation means that the company doesn't end up with a loss, and gets rewarded, but it doesn't mean "give them as much money as they could otherwise extract by exploiting the monopoly that the patent gives them on the market".
Doesn't seem fair to me.
And withholding access to drugs that would extend everyone's lifespan by several years to maximize profits doesn't seem fair to me either. In fact, it's outright sociopathic.
These drugs are covered for the people whose lifespans would be extended by having them! They pay nothing! The situations where insurers/medicaid don't want to pay are more marginal cases. And even then, it's like, 1/5 the cost of child care in a major metro and only getting cheaper. If you're going to use an extraordinary mechanism to seize private property, it better have outsized impact -- seize surface parking lots and sell them to developers to build more housing.
The people can wait seven years for the patent to expire.
Patents are a form of artificial monopoly that only exists because the people (acting through their government as a representative of their will) decided to have them, and did so because they presumably are a net social benefit. Consequently, governments are not obligated to treat them as sacrosanct, and most certainly not in a case where they are not beneficial to public interests.
It's a social contract between the people and the enlightened. The people always win on a long enough timeline. But the deal is there should be some sliver of reward for a brief window of time to those who bring permanent light into our lives.
The "enlightened" are the scientists who actually developed this stuff, not the CEOs and corporate shareholders collecting economic rent from other people's hard work who pocket the vast majority of the profits. If we only had to fairly pay the people who actually did the useful work and not all the capitalist deadweight, these drugs would be orders of magnitude cheaper.
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...
Liraglutide isn't fully comparable. On aspect that's a lot touch for many is it's a daily injection. More needles is a turn off for some that can manage 1x/week.
Daily needles vs 12K a year is a tradeoff many people may consider. Especially if insurance companies mandate Liraglutide as a first line treatment.
It’s one people need to consider, but it’s one that the people needing it the most won’t do.
It’s a massive problem for several of my friends who are doctors. Patients start on something that works incredibly well for them then their insurance pushes them to Litaglutide and they loose all of their progress.
Some of it comes down to a fear of needles, some of it comes down to non-compliance, some of it comes down to access.
Daily injections are fatiguing on people. Its a big challenge with diabetes management.
I used to be prescribed Victoza (for diabetes). When liraglutide (the generic) went off-patent, every pharmacy reported that both Victoza and liraglutide were "no longer available".
The generic manufacturers get paid not to make it.
https://www.theatlantic.com/ideas/archive/2023/06/pharmaceut...
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.
How do you ensure the safety and consistency of anything?
Asking for a friend.
That's the darknet level of drug addicts safety. For poor & desperate much better than nothing, but certainly not without its own risks
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.
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.
It's a shame the contracts you'd need to set the right incentives are probably illegal.
Actually from what I have heard, GLP-1 are maybe the first category of drugs which have impact within the median tenure of people on a medical plan (~2 years). It is so significant that you can see ROI within that window which justifies in subsidizing/encouraging patients to use it.
Doesn't disagree with your original claim that there is low incentive for any private insurance to care regarding longevity, but figured I could add some color
This misunderstands how employer-provided insurance works for most people. Large employers sign up with a company like Cigna to provide a network and administrative process. But the actual healthcare is covered by the employer. So really, Cigna or BCBS don't really give a rip if you're taking a bunch of money out of the pool.
USA: That’s the case if your company is “self-insured”. Some are, some aren’t. I imagine there are financial requirements to self-insure but I’ve never looked.
So what you're saying is when I file a claim and it's paid (precious miracle that that is) it comes from my employer and not the insurance company?
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.
If you were guaranteed 5% over the total cost of the medical services provided as profit, would you want people to have expensive or cheap medical. Are?
can you explain this statement to me more? I think i'm missing something
The health insurance companies are paid as a percentage of the amount of care that flows through them. So healthier customers means their profit is 5% of SMALLER_NUMBER.
> 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.
A night in the hospital is easily $12k almost anywhere in the U.S.
People with chronic health conditions spend an inordinate amount of time at the doctor and in hospitals. That could save a significant amount of money if that’s reduced or eliminated. Not to mention the time savings.
I could be wrong, but all things being equal doesn’t it make sense to spend $12k/year on medication than $12/year on doctor and specialist visits in addition to medication?
A one off anecdote here - I ended up in hospital for a TIA. I'm in Australia, and this is a public hospital. Free in other words. I have never seen so many seriously obese people in my life. They were all occupying hospital beds. I swear at least half the beds were use occupied by them. Meanwhile, we have ambulance lining the ramps of hospitals, with patients in them, waiting for bed to become free.
To put the this in perspective, where I live spends about $10,000/yr/person on health. That's all kinds of health. I'm not sure $5,000/yr (which is about the price here) of GLP-1 would be a generate proportionate decline, but I would not write it off. The $10K is paid by everybody, the $5k would only be for the obese.
I haven't changed jobs and I've had three different health insurance companies in as many years, all of which needed new prior auths for Trulicity/Mounjaro.
Then wouldn’t the government want to subsidize it?
A government for and by the people would, yes. This doesn't describe the US government though.
We do not want tens of millions of people excreting GLP via waste products into our environment. Hormones and others are already effing things up.
Elon Musk suggested it. The fast food Industry has ppl addicted along with the lack of health education in schools.
> [...] along with the lack of health education in schools.
I don't think that's too much of a factor?
I mean, check how much (or rather how little) people learn of the stuff that _is_ covered in school. Tweaking the curriculum would just mean that instead of not paying attention in algebra, students would not pay attention in 'health education class'.
In my school there was a strong emphasis on what a healthy diet is baked into the curriculum. Along with my family's relatively healthy cooking, that set me up for cooking and eating well on my own through college and life after that. I would edge away from takes related to "it just wouldn't work"
I mean the education system is its own mess for other reasons, but it's not a complete failure
Maybe, though in your case, your family's cooking (and other background) probably already determined your fate.
The effectiveness of "health education" is somewhere between extraordinarily modest and nonexistent. It's not that people don't know what's healthy, it's that when it comes time to resist compulsion that is difficult, uncomfortable, and undesirable.
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 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.
The important part is the short term gains, and the people making them jumping away on a golden parachute before the long term consequences kick in.
Maybe true in US, but here in Europe ie my health insurance gives me rebate on my gym membership (any gym). With some more automated low cost gyms I can get back up to 50% back. This seems like a similar case.
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%.
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.
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.
> 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.
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?
≥At this point I can’t buy any arguments that claim that availability of drugs has no impact on misuse or addiction.
I don't much care whether more people are addicted or not. When alcohol was illegal, booze dealers had machine gun fights in broad daylight on Main Street over it. When's the last time you heard about machine gun fights over whiskey?
Legalize it all. Heroin, cocaine, meth... sell it retail out of liquor stores in plain wholesale packaging. Manufactured by pharmaceutical companies, supervised by pharmaceutical engineers, unadulterated by poisons, measured doses, and include a dose of the antidote in the box. Make the junkies pay a deposit on a red plastic sharps container for their disposable needles.
I do not care how bad you think things will get... they're already that bad, but right now you're able to pretend that they're not. For every soccer mom addicted to oxy that you save, ten undesirables are dying of overdoses of fent in some filthy truck stop restroom somewhere. And we're spending half a trillion every year to do it, too.
> 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?
I pay about $40/month for mine, grey market from china
How do you mix the powder for injection?
The typical grey market buyer exclusively buys vacuum or inert gas sealed sterile vials that contain pre-measured lyophilized powder and then uses BAC water from medical supply stores (or just Amazon) for reconstitution transferring from one vial to the other with a fresh needle.
How do you find a grey market source?
$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.)
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?"
Smoking is pretty good for pension systems.
https://www.cbsnews.com/pittsburgh/news/west-virginia-insura...
I think the short answer is that these drugs are only cost effective when applied to people actually experiencing costly diseases, rather than simply being obese. A large part of that has to do with the drugs being very expensive still.
It's never cheaper for insurance to buy something for everyone. There's extra administrative costs to them being the middle man, so it makes much more sense for insurance to incentivize you to buy it yourself, through premium pricing.
For example, fire extinguishers and security cameras will reduce crime by more than their costs, but instead of charging you for them, plus administrative costs, and shipping them to you, your insurance provider will offer you a discount if you have them. (Really it's a price increase if you don't have them, but regulators don't like it when they call it that.)
Not everyone will benefit from GLP-1, so in this case, the most beneficial solution would be to charge higher premiums for anyone that could benefit from GLP-1 but doesn't use it.
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.
> 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.
Fluoridated water? Nah. GLP water.
Fuck that, not everybody here has massive self-control (on top of other mental) issues. Keep your chemical shit with bad side effects away from me and my kids, we know how to live well and raise kids similarly.
Yes, I don't want any medicine I don't need forced down on me
After it goes generic it will be cheaper. right now, it's not.
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".
For the first insurer for the first year, sure. But just within few years their premium will drop if population start getting less sick.
> 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
> 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.
Not to put too fine a point on it but Americans are one of the primary markets for these drugs because the obesity problem is especially acute.
It’s not just GLP-1s.
Look at CAR-T therapies (your cells are reprogrammed to fight your cancer). Insured patients got access in the US long before, and to a broader degree, than national healthcare systems.
Today, CAR-T utilization in cancers like lymphoma are double those of Europe in many cases. Interestingly the UK is one of the highest in Europe (despite the controversy over cancer drug spending).
While true that the US has uninsured and not all insurance is equal, suffice to say you stand a better chance to get access to new technologies in the US than most countries.
Subsidized by whom?
> it’s remarkable how much subsidized GLP-1 access Americans are getting
Mounjaro is between 25-50% of the US price in other countries
I was referring to insurance coverage. Most people aren’t paying that inflated price.
Whenever you see a very large number for a medication or service in the United States, the patient doesn’t actually pay that number.
Companies generally have separate coverage programs for people paying out of pocket that drastically reduces the patient pay amount.
Those giant numbers attached to medications are virtually never paid by the patient.
It’s hard to find hard data on this but this[0] seems to think 20-30% of plans will cover for obesity.
The Lily and Novo Nordisk coupons seem to have quite short availability windows, according to several years of reading the various related subreddits.
The cost difference here is real.
0: https://www.goodrx.com/insurance/health-insurance/weight-los...
What about not ingesting shit
[flagged]
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?
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 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.
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.
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.
You think that controlling your anxiety and controlling what you put into your mouth are equal things?
I would say that controlling what you put into your mouth is easier than controlling your anxiety.
I would say that in at least some cases over eating and anxiety are both symptoms of underlying problems. Stress, emotional issues, and trauma can all lead someone to either of the two.
As someone that uses food as a coping mechanism for stress, I agree with the GP - if the underlying problem isn't resolved, the weight will come back.
When "putting something in your mouth" is the result of a mental component, is there a difference?
I think there is a big difference when one still ultimately requires a physical act in the end and one is all mental.
You can much more easily use the physicality of your surroundings to physically deny yourself the food than you can deny yourself anxious thoughts.
With eating there are 2 components to it, mental and physical, so you have more opportunities and more options and avenues to potentially control it.
The additional options to control it should IMO make it at least some amount easier to control in the end since some people may be able to take advantage of physical controls to limit themselves where that's not an option for anxiety.
>I would say that controlling what you put into your mouth is easier than controlling your anxiety
Then explain why people have so much trouble with it without resorting to a thought-terminating cliche
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
As someone who took SSRIs for a while my plan w my doctor was always to use meds for support as I developed a toolkit to deal with my emotions without medication and then to re-evaluate periodically to see if the meds were still necessary. It took a few years, but eventually we weaned me off. I'm glad we did, now that my life is in a better place and I'm a bit more agile with my thinking I'm quite glad to be rid of all the gross side effects of the drug, but when I was having a rough time those side effects were well worth the stabilization the drug brought me.
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.
How are people so consistently wrong about GLP-1s? The side effects are minuscule in comparison to SSRI’s and the effects on improving habits are massive.
SSRIs barely have side effects
GLP-1 - Mild nausea, always temporary and in the beginning, easy to avoid by tapering dose. Extremely effective.
SSRI - about 10% chance of major sexual disfunction, often permanent, significant likelihood of sleep disturbance, majority get blunted emotions. Debatably effective.
Not really comparable.
As someone who's currently experiencing significant and crippling gastroparesis due to GLP-1's, being reductive about the side effects is not particularly helpful.
Lower your dose a little? Gastroparesis is a choice on these and only at high doses for long periods, you get signs weeks in advance and you choose to stay on a high dose. Myself never experienced it even when I had extremely strong effects (near 500 cals a day for a few weeks), but I did have some slowness, I lowered my dose and was fine.
I've never heard of the sleep disturbance thing, and I think you just made up the permanence of the sexual disfunction thing
It’s trivial to look this up which is funny - I double checked everything i said, so I know it’s true, and never claimed you’re making things up. But you are claiming I’m making things up while obviously not even doing basic research.
Very wrong analogy. Anxiety is not something that you gain by buying junkfood due to low budget or laziness or simply being raised with very wrong values re food and health. On the other hand, every single ice cream, pizza, burger with fries, cupcake or beer contributing to resulting weight is a voluntary choice (with some mental drama around).
There is simply no way around the simple fact that there is only 1 way to eating well long term - that is lesser, more healthy portions. GLP1 may show a person what things could and should look like, what is achievable but the path needs to be walked by themselves. The alternative is either lifelong consumption of this chemical with various bad side effects or premature death (or both, to be seen since nobody has a clue).
You need to remember that people experience reality differently. For you eating the healthy number of calories may be easy. For others it very much is not. I have heard it described as leaving your thermostat at 45 in the winter to save money on your gas bill. Sure, you could do it, but it would cause a lot of suffering. GLP-1s are able to change the way people experience hunger so that it only feels like the thermostat is at 65 instead of 45.
> 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.
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.
Someone who had to take a drug to learn how to control their weight should not be lecturing others on how to do it.
Posting what I posted below:
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
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.
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.
For most people that is very true, I have seen it repeatedly.
I don't know what my secret is, I lost 100lb and have kept it off for a good 5 years now. But it is a bit of an uphill battle. If I wanted to, I could easily just give in to temptation and slip right back but it hasn't happened yet.
I don’t see myself gaining 50 lb back. I would have to eat a TON which I don’t
A small energy surplus over time is enough
You have to eat 500 extra calories per day for 7 days to gain a pound. Thats basically two 20oz cokes per day. I used to drink that
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.
No offense, but that's not particularly impressive and you're bragging about your discipline a bit prematurely. It's highly likely in the next ten years you will regain most of the weight back.
I've known many, many, people to lose weight via extreme diets such as keto. Such diets are unsustainable for almost everyone. It will work for a year or two, but inevitably, they will falter. Often it only takes a very small amount of stress - maybe a hard project at work.
I have never met anyone who uses something like keto successfully. It has always failed, with everyone I've talked to. That doesn't your diet is as extreme as keto. But, it does mean you're not out of the woods, and your perspective on this isn't exactly trustworthy.
My partner on this medicine over a period of two years went from 300 to 197. They have not gained it back after stopping. Their diabetes was reversed and is now in prediabetes. They still has to take Metformin.
In order for me to gain all that weight back, I would have to eat a ton of calories per day and completely stop moving/exercise.
It’s been nearly a year since I started losing all that weight and I haven’t slide back on my diet. It does take discipline
> In order for me to gain all that weight back, I would have to eat a ton of calories per day and completely stop moving/exercise.
Yes, this is what usually happens. You've spent far, far more time with those calories than without.
> It’s been nearly a year
Okay, that's not a very long time is my point. It's much too early to think it's over.
I'm not saying that it's not possible to get off GLP-1s and maintain a good lifestyle. I'm saying that I don't think it's a moral failing or a lack of... sigh... "discipline" if people need to be on these drugs for life. Frankly, I think it's very rich that a baby skinny person is lecturing us on discipline. You've been doing this for less than a year. Discipline means sticking to habits for a long period of time, even when times are tough. I would not classify less than a year as that.
Okay will report back in one year.
First off I just wanna say awesome and I send positive energy to you and you’re gonna do great.
But then I just wanna talk about how long life is in terms of weight gain! Even two years is an “short” amount of time!
Last month, I looked over my doc where I keep track of my weight and I’ve been gaining about 1 pound a year since I started tracking it… 20 years ago. That’s a significant amount and I maybe have 30 years left to go! (this comment is not about you specifically, just musing on how long life is in terms of weight gain)
I know! I am totally aware. My FIL died sitting in a recliner basically from age 55 to 70. He didn't move, didn't watch what he ate. We saw that happen over a long period until he died about 3 years ago. It started with toes, then loss of a leg.
Since that happened, it really kicked us into motion plus shaking the COVID funk!
I wish you the best as well
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
A lot of skinny people with a family history of diabetes find that they can become diabetic/pre-diabetic as they age.
The trick to avoid it is to put on muscle mass, which regulates your blood glucose levels.
Thank you. I will keep monitoring my A1C and lifting weights
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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.
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.
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.
> 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.
Almost all diets are not durable or sustainable. This is not unique to weightloss drugs - most people who lose weight, regain it.
It’s usually a self inflicted disease. Your own actions cause it most of the time
Sure, but the bigger question is: does this matter?
If we think about it longer than, say, 5 seconds, we will realize no, it does not.
Your particular desire for punishment is not really relevant to anything. That's not how medicine operates, and that's a good thing. You're attempting to make a moral argument here. Moral arguments are usually stupid and worthless - try making a different argument.
Which other self-inflicted medical conditions do we deny medical care for?
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.
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...
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.
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Taking medicine is a lifestyle choice.
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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
Michelle Obama started a campaign to reduce childhood obesity and the right collectively lost their mind.
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?
yeah lets stop giving antidepressants as well
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.
People have to believe in free will, they have no choice (because there is no free will).
I didn't want to write this comment, but had no choice either.
Giving people the magic antibiotic cheat code seems antithetical to helping them develop habits and discipline to avoid bacterial infection.
> 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!
Some people DO keep it off. Ive never been obese but ive been overweight, extremely unhealthy, pre diabetic, couch-potato for years at a time. For me, it's always a matter of getting into the mindset that these things are not just "not good," they are literally poison for me!
I've seen a few obese friends of mine lose weight and gain it back. And while I can't put words in their mouths, I have never noticed them have the attitude that "being obese will kill me."
> 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.
The problem is, most people aim way too high in their weight-loss target and sending their bodies into starvation mode, which will lead the body to reacquire the lost body fat as soon as possible - aka when people are happy with their body weight and scale up their food intake to caloric neutral again.
There is no such thing as starvation mode. If you consistently don't overeat, you won't gain your weight back.
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 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.
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.
Yeah that's quite short. Healthy weight loss is typically in the ~.5-1 kg/week, while this is an extended period at 2-4x that rate. The effect that will have will largely depend on what your starting weight is, but unless you're starting significantly north of 140kg, it seems like the amount of muscle (and maybe bone density?) loss would be pretty severe.
I have found the same thing, but my experience (YMMV; not recommended that you take my advice!) is that a one week break almost entirely resets it.
I now take a one week break every few months and have not noticed any decline in effects over time.
My suggestion would be to find an endocrinologist that specialises in obesity and these weight loss drugs. They will have dealt with patients who have experienced tolerance and have developed ways to work around it from real life experience. Obviously well-studied protocols with evidence would be preferable, but with how new these drugs are there hasn't been long enough to collect it yet.
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.
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.
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.
i have hard time believing ppl go through all that only to sign up for cheap life insurance.
I think they quit also because they see it is working and no longer feel like they need to use it
"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.
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.
For obese people: probably. The overall health benefits for overweight people are a lot less clear. Being merely overweight (rather than obese) is not that strongly associated with negative health effects.
Look, I hope you're right. If in 20 years time we look back at these comments and no negative effects have manifested then I'll happily buy you a beer to celebrate. Hell, I'll buy you an entire crate of beer. But I think this is one hell of a risk to take.
"We've tried nothing and we're all out of ideas"
The obesity trend has happened almost in lockstep with the proliferation of highly processed foods. Butter and animal fats being replaced with low quality, hydrogenated vegetable oils. Cane sugar being replaced with high fructose corn syrup and other highly processed sweeteners. Sodas and sugary juices replacing water. Food like substances with little to no nutritional value designed solely for taste and texture.
These things are calorically dense while containing nothing the body needs to thrive (though the calories will allow it to survive). They are easy to eat in large amounts and leave you feeling hungry. And unfortunately, these are the most affordable and readily available foods in the United States.
I don't think this is a conspiracy. It's just capitalism. These low quality ingredients are cheap and extremely shelf stable. In addition, the government subsidizes the production of this garbage.
So to say obesity has persisted through everything we've tried is a bit backwards. It would be more accurate to say "a percentage of the population has managed to avoid obesity despite all of the things we've tried."
- Make healthier food options more affordable and readily available - Better nutrition education - And if you really want to get the government involved, ban the use of some additives, oils, sweeteners, and dyes that allow the creation of many of these highly processed foods
I agree with every word of your analysis and I agree that we've tried basically nothing. But this is why I talked about political capital—every one of your suggestions has been available for the last twenty years and nothing has come of it and the problem continues to get worse. When you say something like, "healthy food should be more affordable and readily available" you'll get a lot of nods of agreement but when it comes time to turn that idea into actual policy everyone gets cold feet. Proposals like price caps for whole foods, subsidies for meals that meet some threshold of healthy, sin taxes for unhealthy foods, outright bans of certain ingredients the votes dry right up.
But people want Ozempic, they will actively seek it out, and in numbers that can actually make a dent in the problem. In a way that people don't seek out healthy alternatives or exercise. Because people don't want to be healthy, they want to be skinny. You can't control people, you can only respond to them and, ya know, whatever works man.
> healthy food should be more affordable and readily available
I think there's more than one way to achieve that. It doesn't have to be bans or subsidies. A lot of it has to do with education and competition. Unfortunately, they are kind of a circular dependency.
- There's so much cheap, highly processed food out there. The companies pay for prime real estate on the shelves and expensive marketing. It is chemically engineered to exploit your pleasure senses when you eat it. That is a hard beast to fight without proper education. And not just the food pyramid, but in depth explanations on why you should avoid it and what to eat instead. There are large groups of the population that have no idea that pop tart or cereal are not a healthy breakfast option.
- If there were more companies creating and promoting healthy, less-processed food options, the price would naturally comedown due to competition. But without the education, these products just do not sell as well. If I gave you some natural peanut butter or almond butter (just almonds or peanuts - 1 ingredient) and I gave you a jar of a more common peanut butter like JIF (sugar + hydrogenated oil for better consistency) and you had no other information at all, you're choosing JIF 10 out of 10 times. It's cheaper, it taste better, and you don't have to stir it. These megacorps prey on that lack of knowledge.
More education -> make better choices when buying -> more companies selling those choices -> cheaper prices on those choices.
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.
Dieting is hard and we still under emphasize the mental and emotional aspects of it. I've found that the easier to "be good" at dieting during the 30 minutes of weekly grocery shopping then during every hour of every day at the house. I try hard to just never buy things that I'm likely to overeat or are super calorie dense because I know I can't eat potato chips responsibly.
It's very true, but it's more difficult when you live right by the grocery store, the office has free food and snacks, and DoorDash is right there when you "need" it.
This is the way. Why give yourself the temptation when one slip-up can ruin the whole thing for yourself?
I'll echo that addiction feeling! It's amazing to me, how when I ignore the "it's time to eat" feeling (which isn't easy to do!) it suddenly starts to get weaker and even goes away...almost as if I wasn't really hungry at all!
It varies case by case, but just want to point out that the research agrees with you here, Tirzepatide is more effective than Sema!
You need to be careful with phentermine. Unlike the GLPs it very much is physically addictive, basically just adderall.
I'm aware, and I was hesitant to use it when the doc first prescribed it. Personally I'm not so worried about this anymore, there are days when I don't take it (either forget or wake up too late in the day) and I don't feel any different. I never felt like I craved it or had any sort of rewarding feeling upon taking it. I never took Adderall so I can't compare, but from what I know the mental effects of Phentermine are much weaker.
Usually it's prescribed for no more than 3 months, but the doc recommended taking it for longer. He mentioned that addiction risk is negligible for most people. Very solid doctor who specializes in those thing, so I took his word for it after a bit of Googling.
Glad its working for you!
Did you lose any muscle mass?
Most likely.
But I had a lot of muscle mass to begin with, due to years of bodybuilding. And I still have significant muscle after the diet, despite of not touching a weight during all this time (I know I should have). People still ask me about my lifting routine even though I didn't lift in like 2+ years.
Knowing myself, it'll come back within a couple of months of lifting weights and getting proper protein, once I get back to it. And I plan on doing exactly that. Being fat kind of made me lose motivation to go to the gym. It's a vicious cycle I imagine many fat people struggle with. So I prioritized losing fat first and foremost.
They most certainly did, these drugs stop you from eating, not magically burn fat and leave muscle mass alone.
It has the same effect as starving yourself. Go look up pictures of "ozempic face"
I wouldn't say "starving yourself", there's no reason to believe it's different from any other diet (except it's easier to stick to). If you get enough calories, prioritize protein, do some resistance training and get proper sleep, you can minimize muscle loss and in some cases even gain muscle while losing fat.
Anyone read the source and find the 98% accuracy stat? The source link has a UTM source of ChatGPT. Could it be a hallucination?
Maybe more of a misinterpretation by AI and/or author than full on hallucination.
"Life insurers can predict when you'll die with about 98% accuracy."
"98%" appears in the citation[1], but as the ratio of actual deaths to expected deaths. (i.e. 98% of the deaths they expected actually occurred.) Some months that figure was ~104%, so it's not a measure of accuracy.
1: https://www.soa.org/4aa060/globalassets/assets/files/resourc...
I saw that too and thought the utm_source=chatgpt was pretty funny, since I only noticed it when I was pasting the link into chatgpt myself to get it to tell me where the "98% accurate" claim was coming from.
Anyway, it's a pretty vague statement. What it sounds like it's saying is for the average person they can predict when they will die, and you have to decide if they mean the day, the year or the decade. But chatgpt gave me an interpretation that seems to make more sense:
> The 98 % figure is about aggregate forecasting, not clairvoyance. It means that when an insurer predicts, say, 10 000 deaths across its book in 2024, the actual count typically falls within roughly ±200. For any single customer, the prediction is still just a probability curve, not a calendar appointment with the Grim Reaper.
It's extremely incorrect. 98% accuracy on when "you'll" die would imply an R^2 of 0.98 for individual-level lifespan predictions. We are nowhere close to that.
It could mean a lot of things. It could mean "We think you'll die at 87+-5 years" and counting it as a success if you die anywhere in that age range for instance which I could believe they can predict the vast majority of the time. I doubt they are referring to the R Squared.
I believe it’s seeing the 98% mortality rate in 2020 vs 2019 for the same month.
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.
I don't think this is addressing the thrust of the article, which is that Life Insurance companies are getting "fooled" by patients who on paper are healthier then they are in reality. Someone on PreP to prevent getting HIV is as healthy on paper as they are in reality as far as I can see.
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.
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.
Huh. I’m at a healthy weight but I’m taking retatrutide for IBS and it’s working wonders. Very low dose, though. I originally tried it with semaglutide before the weight loss craze kicked off and the first few days of the week were worse and the latter half of the week was better, so that didn’t make sense for me to stay on.
Can you say more about retatrutide for IBS? My IBS is debilitating to the point where I usually refuse to eat food on week-long work trips, because the unplanned emergency toilet trips wreak havoc with my schedule and ability to sit in meetings all day. I'd never heard there was a solution to it.
Sure, and I totally get your issues. I was a damned wedding photographer and I'd only eat towards the very end of the night, and still had a few iffy days.
As I stated, I originally tried semaglutide with no luck. I didn't try tirzepatide. I've been taking a very low dose of retatrutide - about .5mg twice a week. It seemed to be waning in effectiveness a bit so I upped the dose to 2mg/week for now. It's a night and day difference. Most days I go to the bathroom maybe two times, as opposed to the maybe 5-10 times I would need to unmedicated.
To be clear, this isn't an approved use of the medications (and retatrutide isn't approved at all yet, though it pretty clearly will be). However, they slow down gut motility - and as a bonus for your refusing to eat during week-long work trips, they'd probably at least help with that too, in terms of hunger.
With all of these long acting GLP's you will get a much smoother experience dosing them 2-3 times/week.
Maybe in the first few weeks, but their half-life is 7 days. You're not doing much besides making a hassle for yourself if your doing that after the first couple of weeks
The amount of "time on" is completely irrelevant. You will reduce peaks and troughs by injecting > once/week, this is a fact.
Yeah, I guess it's worth adding my relatively moderate side effect experience has been dosing 2-3x/week the whole time.
I can tolerate tea quite well. Unseeetened iced tea by the gallon, specifically.
I'm not on any medications, and I've never been able to handle tea in the morning. Green, black, iced, hot, matcha. It always makes me feel nauseated unless I've eaten breakfast first. I always drink black coffee though, without problems.
I am similar. Green tea always makes me feel nauseous on an empty stomach. Tea with milk is normally ok.
That's why the Brits are having it ;-)
This is due to the high concentration of tannin in the tea. It causes stomach problems if you dont have protein in your belly already.
[dead]
Unnoticable meaning doesn't have any effect at all, or just no bad side effects?
I’ve been on 15mg (the highest dose) of Zepbound for the past six months. As of right this second I’ve lost 74 pounds since September 2024 when I switched to Zepbound after having a terrible experience with Ozempic/Wegovy and gaining from 260-308.
I notice no ill effects, I just had my three month checkup with the doctor and he thinks I’m good on maintenance mode at max dose, I’ve still got about 34 pounds as my total weight loss goal. Really an ideal case.
For my wife on the other hand she just has constant diarrhea which she blames on the drug, and is only on 5mg. She also gets headaches from the medicine. She’s lost only 20 pounds, even though she needs to lose another 120 or so to be “healthy weight”.
However, before she started taking Zepbound she was only able to walk a few hundred feet at a time, because her back hurt so terribly. The anti inflammatory “side effects” she’s experiencing have massively improved her quality of life, even without huge amounts of weight loss.
I'm sorry to hear about your wife's issues with it. My experience was completely the opposite. Since glp-1s slow gastric emptying they've completely ameliorated my IBS-D. It's been marvelous
I'm on 2.5mg and I just got sulfur burps, which, to me, is the worst side-effect of the lot. I've also gotten terrible diarrhea previously, even on the lowest dose, I've started and stopped it around five times. Hopefully fifth time's the charm, but yes, side-effects very much depend on the person. I have friends on 10mg and 15mg and they're fine.
I have 2 measurable ones on Zepbound.
My lowest sleeping heart rate is now at least 10 beats higher than before starting (it comes down during the week to about 10 over)
The night after taking the injection my sleep is crap, and the heart rate is 5+ higher again
I have lost 20lbs since mid March with no real effort, and we’re about to do some blood tests for specific cholesterol numbers, which was one of the reasons to try this out.
Below the baseline of individual variance.
Like if your stomach really hated taco bell and you start taking a pill and now you get the same effect from artificial sweeteners you don't care because you're still within what's normal.
That's the level of side effects these things have.
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.)
Why would that be a 'bad' side effect? Isn't that the whole point of the medication?
Parent is not saying hunger supression is a bad side effect, they just clarify that the difference in noticabeality talked about a few comments up refers to the bad ones - but the good one's remain the same.
As in I cannot identify anything wrong with me most of the time while on them.
Pharmaceuticals generally do not drop in price while they are under patent. They will lobby like crazy to get on the approved 3rd party payment schemes though as that makes it "affordable" to more as then everybody pays regardless of wether you use or not. And a treatement that you have to continue forever or fall back? Pure gold!
Insurers certaily don't mind you living longer. More payments, less payouts. They just need to update their predictive models or coverage policies to safeguard their margins. The 'problem' is transitory.
> Insurers certaily don't mind you living longer. More payments, less payouts.
There are times when this is a problem, but even then it isn't the insurance companies that are complaining. There was a big "problem" during the beginning of the AIDS epidemic. For reasons I don't quite understand, the holder of the policy (the insured) can sell their policy to a random third party. The seller sells because they need immediate cash for end of life hospice treatment. The buyer buys because they know this person is about to die and they are going to get a cash payout of more than they paid for. This was a guaranteed payout because there was no treatment. This was a rare example of an investment with zero risk and high return. If you got the virus, you were going to be dead in a few months. This is a win-win for both the deceased and the new buyer, and it is neutral for the life insurance company because either way they have to pay the same amount to someone at the time of death.
The arrival of AZT cocktails threw a monkey wrench into the whole plan because suddenly a guaranteed death is no longer guaranteed and it leads to an ethical quandary because the "investor" doesn't get a return for their "investment" unless that person dies, and now they are literally wishing death on someone. (see also: There is no such thing as a risk free investment.)
https://www.theatlantic.com/health/archive/2018/10/viatical-... "The Gay Men Who Have Lived for Years With Someone Waiting on Their Death"
I think this is US only problem
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
Oh also, the side-effect category is a good place to watch:
https://glp1.guide/tag/category-side-effects/
https://glp1.guide/tag/category-risks/
I try to tag all the new news of negative side effects there
Which of these are issues that diabetic/pre-diabetic/obese people would be likely to suffer from anyway?
And which of them are issues that people massively changing their diet and dropping weight, while also making lifestyle changes like exercising more (due to finding it easier after losing weight) would be likely to experience?
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.
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.
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.
Yeah, both Ozempic and Trulicity have automated systems like this, just press a button and pop. Is there even a way to hit a vein? The needle is not very deep (it's subcutaneous, just barely under the skin). And it's the stomach, which AFAIK, doesn't have a lot of exposed veins?
Either way super simple and quick. Fairly painless. I had a weird rash one time, but apart from that a total of about 15 injections haven't had any issues on either Ozempic or Trulicity in terms of injections. Others may have difficulties, but it's been super easy IMO.
You can get these drugs with a vial and needles and it’s cheaper that way. Not familiar with the autoinjectors, but the instructions when using a vial and insulin needles is definitely to pull back.
Peptides don’t have the same negatives as say insulin, but preferable to not have them in your bloodstream nonetheless.
> And it's the stomach, which AFAIK, doesn't have a lot of exposed veins
And it's mostly for people who have plenty of stomach fat, so even less chance of hitting something else.
Mounjaro uses very different designs across the world. The UK has an included needle; here in Germany you need to get them yourself, and neither is an auto-injector.
This is right. It's all or nothing, and there's no "pull back" functionality.
Only on the autoinjectors. Not true with the vial and insulin needles.
Absolutely do not do this.
I understand if you have an autoinjector, you _can't_ do this, but this is how I was trained to give injections as an EMT-B (and paramedic training provided by the Army, as I was an Army medic).
This is incorrect, always do this. Its called aspiration and it ensures you are not in a vein or artery.
Not sure why you are being downvoted. Some of the people using the brand name medication have some sort of auto-pen style injection but anyone using generics simply injects with an insulin pin. I always just pull back on the plunger (aspirate) before injecting. I currently take 18 shots a week (I'm very pro better living through chemistry) and do this every time. No issues.
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.
I take 18 shots a week - Big fan of better living through chemistry I don't even notice the SubQ shots anymore. The only annoying part is I have to lean forward to find enough belly fat when I shoot there. Still not a huge fan of the IM injections into my legs but we all suffer for our art.
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
https://en.wikipedia.org/wiki/Orforglipron
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.
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.
I was a heavy alcoholic, and the ability to quite drinking was... amazing. Now that I'm off, I just remind myself I never want to get back at that dark place, but I'm so very glad it made quitting just... happen. It's wild how easy it was. A little mental control in terms of "no, don't go to the liquor store" but it was habit more than physical addition at that point. This was with Rybelsus. Sober 4.5 years now. It was definitely not an intended side effect but I'm glad I was rx'd when I was. I was not in a good state.
Crazy to hear all these stories. My wife’s friend was a pack a day smoker for a decade that had transitioned into a heavy vape smoker, normal weight but couldn’t get off vaping despite trying. She tried Tirz to see if it would help and after only about 3 months she quit entirely, now completely smoke free for two months.
I'm on semaglutide for weight loss purposes, while having no other health issues relevant here.
I don't think it's made any difference to any addictive tendencies or my bad habits (and with ADHD, those certainly exist). It certainly helps with the appetite of course.
This is definitely anecdotal evidence, but it's wise to hold on longer for more data to come in before advocating for it on those grounds alone.
Too many miraculous stories so far I’ve heard, numerous people close to me quitting lifelong addictions cold turkey within months of starting.
I’ve never had an addictive personality but I also found I gave up a couple habits while on it.
I wonder if ADHD specifically isn’t as prone to positive effects there.
I’m INVESTING more. I’ve paid off like $15,000 in debts this year. I swear it’s because of the Zepbound.
Strange side effect, but maybe because you are happier? :)
I’ve lost 80 pounds before GLP-1s were a thing and didn’t gain this superpower, and the last time I lost weight (about ten years ago) I went from front line desktop support to teaching myself to code and getting a job as a software engineer, so honestly maybe it’s just “not having sleep apnea”, then when I regained the weight it felt like I lost some IQ points. So you may be on to something. Also it seems to generally reduce inflammation.
My heartburn I suffered from is completely gone but that’s because I just absolutely stuffed my face, I felt like I could never eat enough food.
I had terrible side effects with Ozempic but have had minimal side effects with Zepbound that have disappeared over time. I just wake up on Thursdays and inject it first thing.
The auto pen misfired the other day and I called Eli Lilly and they immediately emailed me a voucher for a free 4 pack of the shots. It’s also eliminated my sleep apnea (via the weight loss).
There's an auto-injector mechanism, at least with my brand; you don't need to needle yourself
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.
Thanks!
These tend to cost more than self-injecting. Maybe your insurance covers it and you don't care.
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.
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.
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’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.
Well that’s pretty clean.
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.
Good for you, that's incredible
wow 120 lbs is amazing.
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
I am aware of the mechanics, thanks.
Ok, my mistake
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 dont think there is any confusion about that. How would "excreting fat" even work?
DNP makes you burn fat, so technically it’s possible. It’s also dangerous as hell.
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 funny to think feeling bad from it is having the highest impact.
I cant think of anything. I take 18 shots a week, including the GLP-1 shot once a week. I don't even notice it. I even give my wife her shot. Gotten to the point where I don't have a lot of belly fat to inject into so I have to lean forward but that's really it. I've never had a side effect from GLP-1. No nausea, nothing. Only side effect is I now have the will power not to kill a pint of ice-cream after 6pm. Its been 100% a willpower increase for me vs a physical change. Started in January at 240lbs. 210.8lbs as of this morning. Every ab is defined. Stuff is great, no idea why anyone would want to come off.
I can still eat whatever I want I just choose not to. For example, had burgers, fries and ice-cream for lunch on Saturday with the family and then just a protein shake for dinner.
I also don't snore anymore. I used to snore terribly, my wife would wake me up at least once a night to tell me to roll over. Not at all now.
Most importantly, even though I am on a ton of test and deca, my blood pressure is normal, and my cholesterol has actually gone down.
> 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)
> 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.
Same with reviews. If sellers don't proactively ask for reviews from happy customers, then you're often only going to see negative reviews.
This must be an existing named bias, but my google foo is failing me.
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.
So, in a way it tortures you so much, that your brain/psyche has no other choice to very quickly adapt to it and stop you from doing the old habits that used to give comfort and joy?
Perhaps like giving a teen a whole carton of cigarettes to smoke.
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.
> 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].
I’m sorry, but as one of the rare (decently) fit & nondiabetic people that have taken these drugs I’m going to call out your comment a bit.
While I have no doubt that obese people have gradually made appetite control harder for themselves, the full feeling you get on GLP meds is in no way the way us normal-weight people feel.
I too, could easy eat a whole bag of doritos after some pizza and then decide I want ice cream. I don’t do that because I know it’s an awful idea and so I maybe just have a pickle after the pizza instead.
On GLP-1 medications at a decent dose I don’t know if I could force myself to eat anything after half of my normal serving of pizza.
That’s not the way the rest of us normally are apart from rare exceptions, I assure you.
Yeah but right now we're just arguing about how strong each person's feeling of "I could eat more" is.
Personally, I really like how, on the medication, it's easy to say "nah, I'd better not". Off the medication, it's impossible, as I have to eat whatever is in front of me, or I won't stop thinking about it.
Sure, obviously there's no real way to compare that. I was just pointing out that the way it makes people feel isn't natural - as in, that's not how most skinny people feel either.
What's with the body shaming mate?
I literally have no feeling of 'full'. I used to. I have no idea when it stopped working, but it definitely stopped working.
You can't know what I feel. I can't know what you feel. I'm fit, I have zero appetite control.
If I stop doing tons of exercise, boom, problems. I got old, I stopped moving as much, boom, problems.
People like you are part of the problem, not the solution.
Honestly, you wouldn't say this shit to someone's face.
It was honestly hard enough posting this here in the first place and then a dick like you comes along.
Cheers thanks for ruining my day you prat.
I apologize for ruining your day, that wasn't my intention. As I stated in my post I don't doubt that obese people have screwed up that signaling over time. Are your cravings off medication worse than mine? Probably. We'd pretty quickly get in to a "Is your green my green?" type discussion talking about that, which obviously has no conclusion. However, I've seen many, many people repeat something along the lines of "Wow, I guess this is what skinny people feel like all the time!" in reference to these medications. I was just pointing out that it absolutely is not how we feel, and I'm one of the fairly rare people out there that can confirm 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.
>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).
> 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.
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.
It's a maintenance medicine, not a cure, so if people stop taking it, they return to the same problems they had without it.
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.
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 drug”, 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.
Is that the cost in the U.S.??
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).
I'll dispute that, I work for one of the online pharmacies and we won't stop selling it to you once you've reached BMI 25. We do have criteria to guard against sudden or extreme weight loss, but I think the BMI criterion for that is something like < 20 BMI (don't quote me on that, as I'm not sure, but it's not 25).
We'll also keep you on a small maintenance dose if you want, that's a conversation you'll have with your clinician and they'll judge whether it's medically appropriate. As far as I know, there's usually no reason to prevent you, though.
Cost is a big factor. When it becomes generic then I suspect people will stay on it for a lot longer.
You can also think about it the other way - if a drug caused you to lose 10-20% of your body weight, and you're now at a good body weight after 2 years, why would you want to lose another 10-20% body weight?
I understand that's not really how it works, but people often go very much by feel more than anything else.
Side effects? Also many might not be able to afford it long term as it's quite expensive.
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.
> 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).
I mean, yeah. You could always just lose weight and probably get out of being prediabetic.
> just lose weight
This might be the left-wing analog of climate denialism.
It's not like it's impossible unmedicated. Plenty of people have and will do it. Obviously most people are unable to. I was always surprised just how few prediabetics did though.
What does the left-wing or more broadly, political philosophy have to do with that statement?
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.
I guess similar to smoking a handful of cigarettes a day? (Not a whole pack. More like five.)
"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
I meant: we don't know the longevity effects of people being on a glp-1 drug for decades.
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.
Ok, sure - but are diabetes patients representative of the whole target market for GLP-1? And there will still be an uncomfortable variable that controls the outcome - patient compliance. That's what makes life insurers woozy.
I didn't have look on the studies but I would not be surprised if a decent amount of participants were completely healthy individuals. And maybe (more from random sampling) some unsuspicious mildly overweight without other problems. Especially in the earlier cohorts of testing.
The slippage part of the article is definitely bogus. The origin of the graph [0] attributes it to Accelerated Underwriting programs.
[0] https://www.swissre.com/reinsurance/life-and-health/l-h-risk...
I've been on GLP-1 for a month and my triglycerides halved, and my cholesterol dropped to the levels it was in my twenties. If that's not a predictor of lower mortality, there's something wrong with our fundamental medical knowledge.
Has your weight dropped?
Yes, I lost around 4kg. Though the triglycerides and cholesterol are mostly because I stopped eating sweets and fatty foods, not because of the weight loss itself.
Insurance companies need to go after processed food companies if they don't like it, not their customers
> 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.
I think this is pretty far off the cusp and seems like a bit of reddit logic "health insurance is scam, internet said so".
Health insurance is one of the rare services where incentives between consumer and business are well aligned. The vast majority of people are healthy. Healthcare is expensive in the US because the uninsured population continues to rise out of "they're not making me pay for it": There are entire tranches (in the US) also don't buy insurance and use the ER and abuse EMTALA for their primary care (most of this is actually unintentional in my opinion, it's less educated populations in the US who are repeatedly taken advantage of and left to ride on government, which is extremely eye-wateringly bad at spending money). Personal experience here working in an ER.
The real pathway in the US to success is getting those populations onto private health insurance. Obama tried a heavy handed "health insurance mandate" that hilariously somehow passed the supreme court, but was so laughable mis-aligned with American ideals even Biden wouldn't enforce it.
What is apparent though is these populations are completely willing to pay bills like their cell service, gasoline, car payments, etc before investing in the most important thing (their health). This gives me hope there is a way forward by riding these perceived essential services somehow. I'm not really sure what the answer is here, but there is at least opportunity for some creative solutions.
I also think the disagreement here between red vs blue isn't the outcome: both want people to be healthy. Red doesn't want single payer, whereas blue does. Red ignores the fact these systems don't exist, blue ignores the fact that no other country in the world has the diversity of America and there are not functional examples.
I thought about it quite a bit and I came to conclusion that it is not 100% alignment between consumer and insurance, like it would appear on the surface. To me it seems insurance in the long term is interested in health services becoming more expensive (bigger pie they can manage), but steadily. I.e. it will affect insurance negatively if costs will suddenly increase by alot in a single year while premiums are locked in. But if it will keep inflating steadily and predictable - it only gives them a larger chunk of cash to manage and profit from. There are of course limits, so it needs to align with income inflation to avoid situation where their pie is shrinking because people/government simply can't afford it anymore.
Universal healthcare is a human right.
Food is even more of a human right, but in most places around the world most people buy their own food. Especially the better run places.
(Food assistance is usually coupled with means testing.)
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These types of arguments are somewhat worthless when they're not made in context to obesity.
What I mean is, you should be comparing the risk of GLP-1s versus the risk of obesity, because realistically this is the vast majority of people's risk analysis criteria here.
Obesity increases your risk of CVD, metabolic syndrome, diabetes, liver disease, kidney disease, joint diseases, and overall mortality. CVD, in particular, is the number 1 cause of death in many developed countries.
Like all drugs, GLP-1s come with risk. This fact, however, is worthless. We must ask if it is less risky than the aggregate sum of the above diseases. I think the answer is overwhelming yes.
Therefore, obese people should probably consider GLP-1 medications. Particularly if they have tried, and failed, weight loss before. Which every obese person has.
In addition, when considering the downside of medication, we MUST compare it to the alternatives. Many obese people are already on multiple life-long medications. Statins, hypertension medication, insulin and other diabetes management drugs, etc.
Not only do these medications require significantly more management than a GLP-1, but they, too, come with their own set of risks, which we must then add to the risk of disease.
I, personally, have taken multiple chemotherapy drugs to cure my cancer. These drugs make GLP-1s look like nothing. They have damaged my body in irreversible ways. They've aged my blood, exposed me to extreme levels of known carcinogens, raised my risk of mortality, and overall lowered my quality of life.
However, I am thankful for them. Yes, my risk of mortality is much higher. But, compared to cancer, which has a 100% chance to kill me, it was a worthy tradeoff.
Your citation measures 15-year mortality in adults 20-49. The P values for BMI's relationship with all-cause mortality and cardiac mortality were 0.071 and 0.030 respectively. It compares BMI against waist circumference and body fat percentage and suggests that the latter measures are better. I think it's misleading to say that "weight is not a primary predictor of health" based on this evidence.
First, the paper is talking about BMI rather than weight.
Second, what most people mean by "weight" in ordinary conversation is closer to body fat percentage than it is to BMI: Arnold Schwarzenegger was famously obese by BMI, but anybody who called him overweight during a conversation at the pub would likely be told he doesn't count.
Thirdly, the paper was close to statistical significance, even looking at young people and even with a cohort of a bit under 5000 people, so it doesn't rule out a correlation with BMI either (although yes, it does suggest BMI is a proxy for body fat, but this isn't a controversial statement).
Fourthly, GLP-1 agonists do reduce body fat[0], and body fat is the measure suggested by the paper you cited as being better than BMI.
[0] https://www.sciencedirect.com/science/article/abs/pii/S00142...
I would appreciate citations. I'm a doctor on GLP-1s,who had previously convinced my mother to commence the same. In her case, it was driven clearly by failure of other methods to control her obesity and worsening liver fibrosis, on top of pre-existing diabetes. On my end, no such issues at present, but I consider it safe enough that it's a first-choice approach to robust weight loss, and I personally use it in conjunction with diet and exercise.
"Relatively high levels of significant side effects" is a vague and unhelpful claim:
High compared to what? What counts as a significant side effect here? What actually are the side effects in question? Are those side effects permanent and irreversible? Can they be avoided by adjusting the dose? Dozens of such considerations come into play.
No drug I'm aware of is perfectly safe, and I know many drugs indeed.
To the best of my knowledge, the combined risk of taking semaglutide utterly pales in comparison to the clear and present harms of obesity. The only clear downside is cost, and while I'm lucky enough to to have access to cheaper sources, they're not even that expensive when you consider the QOL and health benefits.
https://pubmed.ncbi.nlm.nih.gov/38629387/
> Conclusion: Semaglutide displays potential for weight loss primarily through fat mass reduction. However, concerns arise from notable reductions in lean mass, especially in trials with a larger number of patients.
That's a significant long-term damage to health, quite possibly permanent for 40+ patients.
Sounds scary doesn't it? It's a shame that the magnitude of lean-muscle loss is entirely comparable to that of going on a strict diet or fasting:
Intermittent/time-restricted fasting
https://jamanetwork.com/journals/jamainternalmedicine/fullar...?
That's simply how the body reacts to a caloric deficit, without additional exercise. If you combine both IFT and resistance exercise, you find no muscle loss at all:
https://pmc.ncbi.nlm.nih.gov/articles/PMC7468742/
That's an apple to oranges comparison, because there's nothing preventing someone from taking Ozempic from exercising on the side.
And in fact, other trials found that the overall ratio of fat:muscle lost was rather favorable, and that functional strength wasn't compromised:
https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.157...
>Based on contemporary evidence with the addition of magnetic resonance imaging-based studies, skeletal muscle changes with GLP-1RA treatments appear to be adaptive: *reductions in muscle volume seem to be commensurate with what is expected given ageing, disease status, and weight loss achieved, and the improvement in insulin sensitivity and muscle fat infiltration likely contributes to an adaptive process with improved muscle quality, lowering the probability for loss in strength and function*
Interpreting the risks and benefits of medication isn't a trivial exercise, if you're driven by a handful of studies or ignorant of the wider context, then it's easy to be mislead.
> That's an apple to oranges comparison, because there's nothing preventing someone from taking Ozempic from exercising on the side.
Strongly disagree on this. If there was nothing preventing the patient from changing their diet and physical activity / exercise level they could lose the fat through diet and exercise without resorting to taking semaglutides in the first place. Withdrawal studies show that there is a clear tendency for the weight to rebound after withdrawal from semaglutide use, therefore it's very hard to argue that it is the weight / fat mass alone blocking patients from indulging in a healthier lifestyle.
Semaglutide may help manage sustained weight loss by e.g. reducing the effect of reduced leptin baseline, however overall I remain highly skeptical of possibility for semaglutides to be "a first-choice approach to robust weight loss".
That has nothing to do with GLP-1 agonists and everything to do with the fact that rapid weight loss without exercise and sufficient protein intake leads to substantial lean mass reduction.
It's still better unless you were woefully weak, in which case a doctor should have prescribed adequate nutrition and physical activity.
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.
Maybe in some platonic ideal, but in practice a) consumers (and even brokers) aren’t that sophisticated, and b) likelyhood of the company being around in 20 years isn’t baked into the price. When I shopped for insurance there were only 3 options with contract terms that passed muster, and all three companies are large ones that I’d expect to be around in 20 years to a degree that has no relation to the price quotes I got.
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.
Insurance companies only make money, when they insure people..
... and the question was about the aggregate effect. What happens if all life insurers go bankrupt?
Why would they all go bankrupt? Seems silly.
Yes, some life insurance companies can make mistakes or get unlucky. after a few went bankrupt from whatever you are imagining, you'd think that the remaining companies would change their risk models or simply charge higher premiums?
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 think you are misunderstanding the counterfactual.
Right now, it would be hard for an amateur to make a living starting up a new life insurance company, because there's lots of competent competition.
However, _if_ all existing life insurers went bankrupts, then, yes, you could easily make a killing by starting a new slightly less incompetent life insurance company.
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.
Well, at least you stopped arguing about how easy term life insurance is.
Funny enough, Dunning-Kruger's study never showed anything remotely as what's nowadays called the Dunning-Kruger effect on the Internet.
Their study was mostly just a statistical artifact.
That is great, they are by definition a net negative on the economy as a whole? You shouldn't gamble on your own health.
No. Many people have family/kids and want to care for them, and their plan A is to work until retirement. If they die prior to that, the family/kids would be in dire straits. That's plan B, the issue life insurance solves perfectly well.
That, in fact, is the general (and beneficial) function of insurance: You only need to provision for the expected loss (plus some fee for the insurance), not the maximum loss (which many people could not afford).
What do you mean by 'expected' loss? You don't mean the expected value in the statistical sense?
That's what I mean.
Suppose you want to insure your home against fire, which could create damage of say $1m with probability 0.1%.
Without insurance, you'd have to put aside savings of $1m (the maximum loss), that would remain untouched with 99.9% probability, and be used to cover the fire damage otherwise.
With insurance, you'd pay the insurer $1m * 0.1% = $1000, plus a bit on top to cover their cost and profit. In case of fire, they cover your loss. Everyone wins.
So, with insurance you replace provisioning for the maximum loss by provisioning for the expected loss plus a fee.
(That's why one should not get insurance for small items (where one can cover the max), such as baggage or mobile phones or so, but for large items, such as house, life, health).
Oh, that's what you mean. Yes, insurance is there to smooth out risks. And I agree that items you can self-insure, you probably should.
Similarly, I can't really understand insuring against expenditures that are certain. Eg insuring for the cost of routine pregnancy (as opposed to insuring for complications only). Or even worse: yearly allowances like 100 dollars flat for new glasses: just decrease my insurance premiums by that 100 dollars, please. (Unless it's a tax dodge, then it makes sense.)
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.
If you want to gamble on your health then you want a tontine, not life insurance.
Oh come on, you can't be serious.
It's not a gamble, you transfer your risk to a collective.
It doesn't matter whether your counterparty for your insurance is a collective or a single individual like Warren Buffett.
The 'collective' part is a distraction when trying to understand insurance.
Similar for insurance to work you don't need to have a group of people who are in the same situation as you: in principle an insurer can work out the risks, even if you are in a unique situation.
It's just that working these things out costs time and money, so it's cheaper for you, if you are like everyone else.
But eg if you are a famous singer, you can insure your voice just fine. Companies also regularly purchase insurance against customers winning prizes. See https://en.wikipedia.org/wiki/Prize_indemnity_insurance
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.
> (directly contributing to countless murders and other schemes)
Do you have any data on how much of a problem that is?
In the US, a reasonable estimate is dozens of murders per year. I don't know if we can do any better without running a study: There's no good data easily available; the murder clearance rate in the US is now quite low; most insurance killings are, of course, staged to look like accidents.
But it's enough of a problem that there are quite a lot of legal journal articles about it, e.g.: https://scholarship.law.campbell.edu/cgi/viewcontent.cgi?art...
Life insurance has killed a lot of people. People who would otherwise be alive but for the existence of payouts upon their deaths.
Sounds like insurance companies aren't profit maximising enough!
If I sign up for a big life insurance, those guys better give me a body guard and a food sniffer to protect themselves from a big payout.
It's not different time preferences. According to time preference theory the insurers have perfect information about the future so they would have taken the change in lifespan induced by GLP-1 into account before it was even invented. The assumption that mistakes are impossible is one of the core foundations of neoclassical economics. In time preference theory the bias towards the present or future is a moral issue that you get beaten over with to enact a just world fallacy.
In liquidity preference theory insurers do not have perfect information so they must make a tradeoff between collecting information and acting on the information they already have. There will be a bias towards the present and the past, because more information is available about the past and present than the future. What's being "discounted" is uncertainty, not time. Hence there is also a general bias towards stability and conservatism (sticking with existing decisions, even if they are bound to become obsolete).
Now let's apply this to the article:
The insurers don't know if you can stick with your weight loss, so they will conservatively deny coverage until they are certain that they know your health/risk profile. According to time preference theory this would never happen since the insurer already knows whether you will succeed at weightloss or not.
> The assumption that mistakes are impossible is one of the core foundations of neoclassical economics.
[citation needed]
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.
> A relatively low dose of Semaglitide
Can you share what dose?
> my muscle mass has increased slightly
how was this measured?
Day to day I use a home body composition scale (Withings Body Scan), the results of which have been corroborated by two Dexascans I've done at my gym a little less than a year apart.
For me personally, the little bit of help in the form of forward progress on weight loss has given me a reason to be a little more methodical in my strength training, and I'm seeing a slow but consistent payoff. And as far as I can tell, I'm not fighting an uphill battle in terms of adding muscle mass at all because of the GLP-1.
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.
> They switched from 30-day to 90-day refills. Suddenly, patients had to think about their medication four times a year instead of twelve. Adherence rates shot up almost immediately.
When I have a “refill” (here in Australia we call them “repeats”) due, my pharmacy sends me an SMS… I just reply “yes please” and that goes straight to the pharmacist who dispenses, and I get another SMS telling me the dispensed medication is ready to pick up
I’m on tirzepatide and I’m committed but I’m “going a bit slow” because the side effects started to get a bit too much. Still, my base expectation is I’m taking a GLP-1 agonist for the rest of my life, unless my doctor tells me I have to stop for some reason, or I somehow go bankrupt and can’t afford it any more.
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.
The solution is for life insurance companies to pay people to stay on ozempic
The “payment” can come in the form of lower rates, with penalties if you stop.
We already do something similar with smoking cessation. They, essentially, pay you to quit smoking.
The social difference is that we frame smoking as an addiction, and smokers as victims of the Tobacco industry. But we frame obesity as a moral failing. So, the former we're ready to jump in and help. But, the latter, we are much more hesitant.
Theoretically, economic outcomes would override these social and moral effects. But leadership is often stupid, so we'll see.
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.
I think the difference is people generally get Life Insurance when they are younger (I'm guessing frequently when they have kids, that is when I got it at least) but get Annuities when they are a senior. I don't know anyone my age who is purchasing an annuity now, though I suppose there must be someone who would be willing to sell it.
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.
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...
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.
Is there any research on whether GLP-1s are also beneficial for generally healthy and not overweight people?
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).
The last thing I will ever give a rats ass about is insurance companies. They are the scourge of this earth but they have used legislation to embed themselves in our every day lives.
I live in California and have no claims ever. My home insurance has doubled in 4 years to almost $4000 a year. My car insurance is about $2800/yr.
So I hope insurance companies break. Like Danerys said in Gamr of Thrones, I hope someone breaks the wheel.
> I live in California
Car insurance companies in CA actually lose money on the state, if that makes you feel better: https://money.com/car-insurance-policies-problems-california...
There are laws that prevent them from charging enough to even break-even on the policies.
$4000/year might be a lot or a little. If you own a $5m house up against a forest it's probably a bargain. The car price could reflect a bunch of factors.
Pay some broker for a one-off consultation to advise you on how to save money.
Reality is insurance companies are now going though a cycle of "price in the actual risk" rather than "drop prices to gain customers"
So you pay less than 1% of the cost to rebuild your home per year in home insurance, in a state that regularly has fires, floods, and earthquakes? That seems fair to me
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.
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.
You definitely (at least in the US) need income (or an income proxy like zip code). Mississippi has a life expectancy ~10 years less than Massachusettes.
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.
> 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
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.
The link even has the source being ChatGPT - it hallucinated!
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. .
Call me cynical but it wouldn't surprise me if insurers somehow tried to leverage this "crisis" into some sort of "get written into law, guaranteed profits forever" play the way that health, home and auto have.
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.
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
The reason insurers ask about weight loss is that it could be a sign of a (severe) undiagnosed medical condition - e.g. they should be contacting a doctor(!)
Can't they just adjust their model based on whether the patient is on a GLP-1 and account for the likelihood they'll stop taking it?
The article addressed this. The person could have gotten GLP-1 from a D2C provider and insurance has no record of this person ever taking GLP-1.
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?
Pancreas issues and hair loss IIRC?
Hair loss is
1. Exactly the type of "side effect" that people will report because they lost hair (because lots of people experience hair loss whether they are on a GLP1 or not)
2. A fairly minor side effect that wouldn't be a strong reason to not prescribe.
Pancreas issues were worried about, but those worries (so far) appear to be unfounded. https://pmc.ncbi.nlm.nih.gov/articles/PMC6382780/ is a meta-analysis of 12 studies (36k patients) over 2 years that showed no evidence of increased pacreatic issues, and https://pubmed.ncbi.nlm.nih.gov/38175642/ is a 7 year analysis of ~33k patients that also shows no increase in issues.
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.
That's interesting I keep reading about a billion issues glp1 help like addiction, alzheimers and more
Can't the insurance companies just look for stretch marks?
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.
“mortality slippage” coincides with Sars2 circulating within our population so I bet it has a lot to do with it
If GLP-1s are working for people, why do they quit taking them?
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.
[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC10224223/
I know a couple who self identify as foodies and they started taking it for weight loss. They now complain that date night is no fun because they don't enjoy the food. They have not yet dropped the meds but I can see it happening soon.
They are very expensive
Cost.
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.
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 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...
The topic of per-country pricing was mentioned several times.
I was wondering how big the price differences would be so I set up a quick form to collect some data points from several countries and for several products.
It would be cool if you could provide some data - I would then share it back as a reply to this thread within 1-2 days after closing the survey. The latest data entry will be possible on Sunday.
https://forms.cloud.microsoft/e/DjDgH62s21
> 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.
Look at the url source. Ifs ChatGPT generated hallucination
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.
Not really, they can just stop insuring people who take them at all.
Is the rise of GLPs yet another case of Neal Stephenson called it again? I'm rereading Anathem and struck by similarities of Allswell and the psychoactive components of GLPs. In the book, Allswell is a drug that gives people a sense of calm and well being, and is genetically engineered into food in a way that puts water fluoridation to shame. Otoh, the lower-caste slines of Arbre are also overweight so maybe the parallels are limited.
> 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?
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.
The idea is that the insurer doesn't even know the customer is on glp1, and I guess doesn't require a full physical often enough to reprice frequently.
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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.
We’re not evolved to turn down cheap, easy calories by default.
Have you ever met a human before?
hahahaha
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.
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.
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.
You don't have to - all the fast food menus I've seen contain caloric information. Right on the menu. People still eat it.
Somewhat similar to how a carton of cigs contains a big warning that says "THIS WILL KILL YOU DO NOT SMOKE THIS UNDER ANY CIRCUMSTANCES"
Welp...
> 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.
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.
In 2013, my weight was around 48kg, and I increased it to 55kg through fitness and dietary control. In 2016, my body shape reached its peak at 60kg, with a body fat percentage of 12%. In 2022, my weight was 63kg, but my body fat percentage was around 22%. I still managed to regain a weight of around 57kg and a body fat percentage of 18% through fitness and dietary control. I just want to emphasize that controlling diet is very important for shaping the body, and the method of controlling diet is to calculate the calories of food. Only then will you realize what foods you should consume. For example, when you are thirsty but don't want to drink pure water, you want to drink a beverage with a taste like coffee or tea. If you understand the calorie percentage of these foods, you can know that if you choose coffee, it's best to drink an Americano, and if you prefer tea, you can drink almost all types of tea. Even tea is considered beneficial for weight loss. Find tea here,https://teayucafe.com/ The reason why many people fail to achieve their weight change goals by calculating calories is that they cannot persist. Remember, this is a long process.
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.”
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.”
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.
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 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.
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.
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.
> 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.
I don't mean to be overly harsh, but saying "just changing their diet" is quite ignorant. There's been a huge amount of research into the challenges of weight loss, so it should be (more) common knowledge by now that it's not just about deciding to do it and "having discipline" - it takes much more than that, both physically and psychologically.
I understand where you're coming from, though, I used to think the same - I remember a specific situation where an obese person next to me was breathing heavily from doing something easy and me thinking "how do you hear yourself breathing audibly from doing almost nothing and not decide and just change it". Unfortunately, I got into a situation where I now understand the issue and am struggling to lose weight, despite hearing myself breathing audibly after picking up something from the floor and all the rational understanding and knowledge of what I need to do.
IMO, in a lot of cases, the first step should be going to a therapist.
It probably depends if they also change eating habits. If they change nothing regaining the weight is no surprise.
It's linked in the article.
It's variable. some regain all, other regain less. But they basically all regain some.
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).