If you literally cannot stop yourself from being obese any other way, then Ozempic and similar may be a good choice.
But the side effects are large. You can never, ever stop taking it. We don't know what being on it for decades causes. There are anecdotes that it numbs you out emotionally.
There are no shortcuts in life. There is always a tradeoff.
1) Side effects not much more than the most tame of drugs, like aspirin. This one, if it exists, is incredibly rare.
2) You can stop taking it, obviously. Just like any medicine, the effects will wear off, but there's no rebound effect or risky side effect from coming off. You simply return to your previous state.
3) There's more positive anecdotes than negative basically wherever you look. I have a friend who took it and while he lost 20% of weight, he plateau'd - I asked him if he was going to cycle off it and his answer was an emphatic no - I asked why, he said beyond the positive weight effects it: massively curbed his weed addiction, curbed his social media addiction, improved his sleep, and because his compulsive behaviors were down he was doing better at work, reading books for the first time in years, and going to therapy which had helped his dating life. No joke, I was floored at how ridiculous the answer sounded, especially as this was a pretty bro-y friend. Yet I've heard many anecdotes like this from others, one friend stopped a 15-year pack-a-day cigarette addiction they'd had since high school.
4) Some of the other positive trade-offs: reduces addictive behavior, heals heart/bones/brain, dramatically reduces inflammation and can fix inflammatory disorders, positive early studies for Alzheimer's and Parkinson's, etc.
5) There may be no completely free lunches, but there are nearly-free lunches all the time for people with ailments. If I have debilitating GERD, there are antacids that essentially save my life with only mild side-effects. If I have bad eyesight, glasses are a miracle cure. This is all over medicine. If I'm getting surgery, 100/100 people will choose the mild side-effects of anesthetics over the pain.
The most interesting aspect of GLP-1 agonists is indeed the reduction of inflammation.
All the effects on the mind like reduction of addiction, compulsions, craving have a
direct basis in neuroimmunobiology. Neuroimmunopsychiatry.
As I see it, it’s a productive and reasonably accurate view to look at things in the way that inflammation is suffering. Neuroinflammation and suffering being one and the same.
In addiction, in craving, there is neuroinflammation. In getting the fix there is a reduction of inflammation.
Neuroinflammation also makes us angry; it’s behavior-modifying from a social point of view too.
That’s not true. It’s like anything else, it’s about you.
I was on it for 18 months, it allowed me to lose weight and change my habits in a way that has persisted. I lost 90 pounds, and gained back 15, which I attribute to an injury that stopped me from running. I’m back in action now and down 5.
I cannot stress how transformative this drug was for me, at a time of my life that was particularly difficult.
Civilization is built on long term sustainable practice, shortcuts in response to the lack of such practices is how civilizations burn down.
Obviously T1 diabetics need to take medication because there's not much else they can do whatever side effects that has, but the topic is obviously relevant and posted here because these drugs are currently being used/abused for weight loss. Given that sustainable, side effect free ways to lose weight exist (with many additional benefits) that is what a healthy human civilization would do, instead of opting for drugs with utterly unknown side effects, potentially really bad ones, like in this case.
> Given that sustainable, side effect free ways to lose weight exist (with many additional benefits)
Just because it exists doesn't mean it's statistically applicable to a population of people. I've yet to see real evidence that on a population scale, sustainable and side effect free ways to lose weight exists at a statistically significant level. If you're 100+ lbs overweight and you lose it all without any medical intervention for over 5 yrs you're basically a statistical freak.
Not to mention that the human body is completely opposed to losing weight, and will do anything it can to convince you that what you really need to do is to gain it back.
This was something that astounded me about my weight. It is static. Has been static since I gained it all (when my thyroid quit working at 18 - over 4 months I gained 100 pounds). Since that date more than half my life ago, I have been the exact same 220lb +/- 5lb depending on time of day. Through caloric deficits, through hiking and jogging (run many 5ks, and just recently hiked 125mi through the mountains). I'm fit, I eat well, but I'm BMI of 34, and my weight never fluctuates.
My wife has wanted me to get on ozempic, but I'm actually scare of side effects, and the cost is atrocious in the US.
> I've yet to see real evidence that on a population scale,
I mean visit Japan if you want to see a large nation manage its populations weight, but the entire reasoning is completely backwards. Statistics doesn't have a will of its own or causal powers, it's a description of aggregate behavior. Change the behavior and you get some new statistics. 100 years ago you didn't have a single statistic showing that obesity was an issue. What evidence do you need that making people move more and eat less will make them lose weight, there's no law of nature operating against you.
The obvious reason to even think like this is indicative of the problem, that in a lot of places we're so unused to simply enforcing sane cultural norms and incentivizing healthy behaviors and discourage crappy ones that people think it breaks some kind of ironclad law.
> What evidence do you need that making people move more and eat less will make them lose weight, there's no law of nature operating against you.
IDK, any evidence? We've been telling people to move more and eat less for literally decades and it doesn't work to make them lose weight on a broad population level.
Perhaps a better phrasing would be, "There is no free lunch." If you prefer to take Ozempic rather than monitoring caloric intake and exercising, then there are consequences. But if the consequences are worth it, is up to the individual.
Someone reading this might assume its zero sum to you - as if people on Ozempic have not already been exercising and monitoring caloric intake without the associated weight loss/health results they desire - and have only chosen it because they don't want to try something else.
I'm sure you aren't trying to come across as fat shaming, but the reality is of course not zero sum. Diet and exercise doesn't magically work for the entire population.
Diet and exercise definitely worked for me but im not willing to be a sample size of 1 in the face of so many others with legitimate stories.
Diet alone is 100% guaranteed to cause you to lose weight. It really is as easy as counting calories. It is a scientific fact. It is physically impossible to gain, or maintain weight, if you cut caloric intake sufficiently.
Yes, and abstaining from alcohol is guaranteed to stop alcoholism! It is a scientific fact. It is physically impossible to be an alcoholic if you cut alcohol intake sufficiently.
No one here is stating that physics stops working for fat people. Obviously, your body needs an energy source to function and when you deprive it of that energy source it will go to your energy reserves. There might be some woefully ignorant people that claim otherwise elsewhere, but that's not the position of the person you are referring to.
But you're saying "it is as easy as doing activity x" without concern for the difficulty of that activity. There are a wide variety of reasons some people might get fat, but once you are fat, it is far more difficult to get not-fat than it was to get there in the first place. There are a wide variety of feedback loops within the body, including epigenetic ones, that make it much harder to lose weight and keep it off.
Once upon a time, it was trivial for me to not eat garbage food, or too much of any sort of food. I had more trouble trying to eat enough to be in a large enough caloric surplus to get enough protein in and stay in a large enough caloric surplus to build muscle. I never had "food noise" or anything of that nature. Then life happened, my circumstances changed, and I had less time to worry about food. I spent more time going out with co-workers and friends eating and drinking. Other nights, I was too busy to cook, and ordered in more. My weight went up, and before I really realized it, I had put on significant weight. And I realized that something I had found trivial before, something that had taken zero willpower, that I had never struggled with... was something that was incredibly mentally taxing.
Could I count calories and lose weight? Of course. Could I add exercise back in to my routine? Yep. But it was difficult in a way that I never had understood back when I was fit, in a way that I never would have believed could happen to me. And as soon as I got busy again, or had other things occur in my life that took priority, the mental effort to keep "just counting calories" and push down my food cravings and hunger no longer seemed worth it.
I could exert a huge portion of my willpower on this, struggle with it, remove my capacity to spend more time having care and empathy for others, forcefully deprioritize other things in life... or I could use a GLP-1.
I know which path made sense for me, and it's been a hugely beneficial thing in my life.
Agreed. And if you want to stop smoking or gambling it really is as easy as not doing it.
Except reality is it's hard. Addiction is a real issue, people have underlying compulsions and habits as difficult to break as with physical pressure. For some people monitoring caloric intake isn't the option it is for others.
You are not wrong. Starving yourself works, obviously. What doesn't work is maintaining people in a state of starvation. It becomes extremely hard if there are other tasks stealing focus (for example, work), or if you have a high basal metabolic rate, or if you have diabetes, etc.
I am the guy with an appointment with Ozempic prescribing doctor. I will seriously think about it twice. “Normal” starving does not have any very rare and very bad consequences. It’s just very very difficult.
It's true, it isn't a free lunch. You, or your insurer, has to pay for it. It needs to be injected. It won't work as well if you insist on eating a pint of ice cream three times a day. And so on.
>It won't work as well if you insist on eating a pint of ice cream three times a day.
Yeah, good luck with that.
GLP-1 agonists reduce your desire for, and for many people, your ability to consume things like “a pint of ice cream three times a day.” That’s kinda the point.
Clinical trials started in 2008. Thats decades for something major to appear. There are minor things, but people can simply stop taking it. Given the weight lost causes years of healthy lifespan to be gained, it would take a monumental problem that would have been seen by now to make it not worth it for a lot of people who can't lose weight on their own.
You can't stop taking it without gaining the weight back (unless the lifestyle change sticks), but everybody stops taking it in the medium term. The side effects are horrible and stack up over time.
We'll start seeing the miserable condition of very long-term users (or maybe, hopefully, their bodies will reach an equilibrium!), and we will be able to use the sacrifice of their health in order to understand how better to counteract the long-term side effects, or to get hints on how to design the next class of miracle weight loss drugs.
I'm never going to take them. There are better ways to lose weight, with no side effects, and they slowly and stably got me from a 28 BMI to a 22 BMI. I will push the people I love towards those rather than to a set of powerful, expensive drugs with wild side effects that somebody invented a week ago. But I am not hostile to the concept in any way.
> There are no shortcuts in life. There is always a tradeoff.
There are an enormous number of shortcuts in life. This is just the Law of Averages as Protestant superstition stated as a pithy self-help maxim. Taking shortcuts rather than going the long way is almost the definition of intelligence. If you see a bunch of points laid out in a rectangle, you can count them one by one, or you can count the ones on the sides and multiply. There's no tradeoff.
> You can't stop taking it without gaining the weight back (unless the lifestyle change sticks), but everybody stops taking it in the medium term. The side effects are horrible and stack up over time.
Some people experience significant side effects. Many people do not. Tirzepatide seems to induce even fewer side effects in general than semaglutide.
> We'll start seeing the miserable condition of very long-term users (or maybe, hopefully, their bodies will reach an equilibrium!), and we will be able to use the sacrifice of their health in order to understand how better to counteract the long-term side effects, or to get hints on how to design the next class of miracle weight loss drugs.
I'm active on several GLP-1 related forums. On those, people near-universally report side effects lessening over time, from those that have significant side effects to begin with.
The next generation of drugs is arriving now. Eli Lilly is finishing up their initial phase 3 trials for retatrutide at EOY, and in a matter of months I've seen it reduce my ALT levels from edging towards an indication of NAFLD to right in the middle of optimal. Preliminary results from the trials in general seem very positive, so I imagine FDA approval will come later '25/early '26, though the glucagon receptor activity does seem to increase resting heart rate in many people (including myself, though tirzepatide did as well, to a lesser degree.)
> I'm never going to take them. There are better ways to lose weight, with no side effects, and they slowly and stably got me from a 28 BMI to a 22 BMI. I will push the people I love towards those rather than to a set of powerful, expensive drugs with wild side effects
I would agree if you have success in losing weight with other methods, there's not a strong reason to go on the GLP-1s. We do have some evidence that they have other positive health benefits even without the weight loss, but there are some side effects, yes, and we of course do not strongly know what happens if you take these for decades on end. On the other hand, we know that improving diet and increasing exercise are basically all net positives, outside the minimal injury risk that comes with exercise.
I do think you are overstating the side effects, though. There seems to be some small risk of sight issues, though I would like more data here - we know that diabetes is significant risk factor for eye disease, and I'm curious how well these results will be replicated in general, and how well they translate to non-diabetics taking them purely for weight loss. We've also seen thyroid cancer in rodent studies, and while so far no human studies have found an increase, I wouldn't be surprised if there is some risk increase for humans.
> somebody invented a week ago.
We're actually about two decades in on the GLP-1 class of drugs being in-use by humans, but obviously semaglutide and tirzepatide have really ratcheted up adoption.
Can you point to some forums? I'm considering a GLP-1 agonist because I have an impaired ability to feel fullness, and as a consequence I eat all the time (mostly healthy stuff, plants). Want to hear more about others experiences and maybe make some connections with people who aren't going to moralize over "you are wired differently and are therefore a bad person"
But the side effects are large. You can never, ever stop taking it. We don't know what being on it for decades causes. There are anecdotes that it numbs you out emotionally.
There are no shortcuts in life. There is always a tradeoff.