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I was wondering if there really are no negative long term side effects, could this finally lead to universal healthcare in the US? It seems like a lot of our costs (aside from the obvious medical industrial complex skimming massive profits) comes from health complications related to our obesity epidemic.
> I was wondering if there really are no negative long term side effects
Weight loss via caloric restriction inevitably results in losing lean muscle mass along with body fat.
That's why diet and exercise are paired -- diet loses the weight, and exercise helps to reduce the loss of muscle.
While there's nothing stopping people from pairing Ozempic with exercise to achieve a similar result, I doubt many are. Those ecstatic about the rapid weight loss achieved by these drugs may not be so happy if they were viewing their progress on something that measured their full body composition, rather than just their weight.
These are miracle drugs for people who are morbidly obese and suffering from severe weight-related problems. Those folks can use Ozempic to rapidly lose fat and muscle to get them out of their immediate crisis, and then work to rebuild as much of that lean muscle mass as they can later.
However, people who are just using Ozempic as an easier alternative to diet and exercise are not only taking away supply of this drug from people who really need it to deal with morbid obesity, they're setting themselves up for health problems later in life if enough of their muscle mass has degraded that they start struggling to do everyday activities. Unfortunately, by the time people reach this point, it's unlikely that they'll be able to do anything about other than resort to assistive technology like wheelchairs to regain their mobility.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4383600/ ("Pharmacology of manipulating lean body mass")
https://newatlas.com/medical/drug-mimics-exercise-weight-los... ("Drug that mimics exercise triggers weight loss and builds lean muscle")
Not sure on leading to universal healthcare, but it will absolutely impact healthcare. The obvious ones like less heart disease are huge. Then others like fewer knee replacements, and fewer CPAP machines required, the list goes on.
GLP1s have also shown to help with drug and alcohol cravings so there's an entire other area to explore.
I could see where the government simply makes them available to most people.
Buying the stuff from the drug manufacturers is crazy expensive. Over $1000 a month. Going through a compounding phramacy is much cheaper, I pay around $249/month for my script.
You can go even cheaper and buy the peptide yourself from places like peptide sciences and compound it yourself, less than $100 for a 3 months supply, but you increase your risk profile pretty significantly going that route. My partner is a pharmacist and that type of mixing (assuming you do everything correctly) is considered acceptable for "immediate emergency use", not mix up and use for a month or three and keep it in the fridge in the meantime. It's a small risk to be sure, but non-sterile compounding at home is riskier than having a compounding pharmacy do it the right way.
Only one way to know for sure on the long term effects.. However, we do know the long term side effects of obesity - and it is quite costly, by some estimates $200B+/year in the US alone. Not as bad as smoking ($300B+/yr), but entirely preventable regardless.
This is not entirely true.
Most of the data defending the economic harms of obesity are deeply flawed for various reasons, such as:
- Generally low-quality data
- Data that ignores external factors
- Data that doesn't account for behavioral issues like doctors ignoring or minimizing medical complaints made by obese people simply because they're obese
- Data that overemphasizes BMI, an extremely flawed health metric, etc.)
- The criteria for "obesity" itself having changed over the years (based on BMI, of course),
- and others.
There are definitely issues that obesity exacerbates in many people (mobility and cardiovascular), but the overarching purpose behind stats like the ones that you pointed out is to shame people who are (a) naturally hungrier than the average person with a "socially acceptable" frame, while (b) living in car-centric suburbs that discourage things like walking because (c) these suburbs are cheaper than living in cities that have somewhat-functional public transportation because they were created before the car was invented.
- Why BMI is flawed, from Nature: https://www.nature.com/articles/d41586-023-03143-x
- Everything You Know About Obesity is Wrong, from Huffington Post (the author co-runs a podcast on the topic): https://highline.huffingtonpost.com/articles/en/everything-y...
- Obesity was long considered a personal failing. Science shows it's not, from USA Today: https://www.usatoday.com/in-depth/news/health/2022/07/26/ame...
No, actually it will make it worse since obesity generally lowers lifetime healthcare spending. This is counterintuitive but we barely spend anything on anyone who’s not a senior, so anything that helps people live longer generally results in higher costs. Dying of heart failure at 50 is comparably cheap to lingering for 10 years in assisted living and bouncing in and out of a hospital for 3 years before the end.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225430/
This is broadly confirmed across a number of studies, a study of European healthcare found lifetime spending increases too.
https://pubmed.ncbi.nlm.nih.gov/37222003/
What’s even worse is that from a financial sense, private insurance generally covers the deaths earlier in life, while ozempic (or any other anti-obesity drug) will push a lot more of that spending onto the federal Medicare budget in the long term.
Ozempic is apocalyptic for the Medicare and social security budgets, even if it were free (and Medicare doesn’t cover anyone who’s not a senior anyway). Any drug that broadly extents life would be - we would be equally affected by a free pill that gave everyone another 2 years of life, too. We budgeted based on X number of fat people paying in, but never receiving benefits (via life-expectancy actuarial tables), if you extend life then the payout increases.
If there are no long-term side effects to taking GLP1 agonists (remains to be seen), then I think the following will happen:
- In the short term, the fitness industry (a multi-billion dollar market) and its dependents will crater,
- Smaller, European-like, serving sizes will become the norm, and
- You'll see more and much larger investments in de-alcoholifying beers, wines and spirits.
I do not think this class of drugs will accelerate the adoption of universal healthcare in the US.
For one, the healthcare industry employs a ton of people in towns like Bowling Green. (HCA, the biggest healthcare network in the US, is headquarted in Nashville, TN. Nashville is definitely bigger than Bowling Green, but people that lie in Murfreesboro and other small towns around Nashville work at HCA. Also, many insurance companies are headquartered in the Midwest, where jobs are relatively scant compared to the big coastal cities.) Any policy that ends with "and tens of thousands of jobs will be lost" is political suicide.
Also, the modern healthcare industry in the US was built and designed around private, employer-provided health insurance. Reverse-engineering decades-old business logic and institutional process to fit a government-provided system would be a gigantic and extremely expensive underatking that we would pay for (through taxes).
IIRC the GLP-1 drugs have a black box warning for thyroid cancer, as well as some other potential side effects.
Still, I think NNT < NNH all things considered.
Fractyl Healthcare is working on a gene therapy targeting this pathway. Chronic maintenance is a temporary hack imho. Long term fix is patching the genetic bug around a miswired reward center.
Magical thinking. Universal healthcare will not happen in the US because for-profit hospital owners and big pharma would lobby against it. US healthcare costs 2x as much per person than other countries but outcomes are worse. Outcomes are not a concern, profits are.
1) There are very serious long term side effects, people are just either unaware or value weight loss enough to tolerate/accept the risks and harms.
2) Your "aside" there is the whole thing though. Obesity drives a lot of costs sure, but Obamacare legislation enshrined health insurance companies and pharmacy benefit managers as essentially government-backed money printing machines, so it's going to take tremendous effort to change any legislation, because they can and will spend literally billions of dollars to keep their monopolistic position.
What, in your view, are the "very serious long term side effects" of semaglutide/GLP-1 agonists?
It's pretty awkward to talk about making people form a lifelong addiction to one drug (semaglutide) to counteract the effects of making people form a lifelong addiction to a poison (sugar).
If we spent half the money involved in this scam in removing added sugar from the grocery store shelves we'd beat that epidemic (don't believe me? Look at pictures of people living before the low-fat high carb poisoning in the 80s and 90s)
Why is this an "instead"?
We already know that people on semaglutides buy less junk food because to them it is less addictive. Less demand, less supply. If anything, this seems like a useful way to smooth the transition to less unhealthy food supply.
To be fair, semaglutide also lowers addiction to nicotine and alcohol, and maybe other drugs.
It seems to me some people have a broken reward system and some... don't. Some people can live life without ever seeking out a vice, and some people are unable to live without a vice.
Probably, from an evolutionary perspective, this made sense. But when you have a surplus of addictive things like sugar, nicotine, and alcohol, combined with mass society-wide manipulation to indulge via advertisement... well this functionality of the human brain makes less sense.
I would add ultra-processed foods to this as well.
I firmly believe that, decades from now, we will look back in horror at what food manufacturers have done to us.
Neither is sugar a poison nor the general driver of the obesity epidemic.
"South Park" did a special on this, "The End of Obesity", which is available on Paramount+. It's hilarious, and, as is often the case with South Park, also quite accurate in the underlying themes.
> “We’re redneck enough to be fat, but smart enough to do something about it,” says Mary Sansom
Quite the quote
With the advent of Ozympic, it would be cool if at some point being slim became so commonplace and boring that we flipped back to being attracted to fat people like the middle ages.
That won't happen because it never happened in the first place. The people of the middle ages were like us -- they broadly liked slender people, women with perky breasts, and men with broad shoulders.
This should not be surprising. Attraction is pretty hard-wired into humans by evolution, and for most of our existence, food has been scarce. There is absolutely no reason why a time of more plentiful food due to agriculture (relative to most of human history) would have resulted in changing the body types we generally prefer. To say nothing of evolution's timescales, which are measured in tens of thousands of generations for significant changes like that.
https://www.reddit.com/r/AskHistorians/comments/8044k7/is_it...
Gotta love using reddit as a source. Redditors unite!
Nah, it will either lead to:
- more trendiness of muscles/fitness
- plastic surgery (like the russian/housewives-of inflated lips)
People are lazy, I get it, but ozempic should provide the enabler for big people to get fit: it gets rid of a whole lot of fat that increases stresses on their joints. So you lose weight with ozempic, and then you could ... ideally ... start a good fitness program.
But we all know it will be used just for the pill popping convenience.
Yes, Ozempic removes the fat (and obesity related health problems) but doesn't remove the need for exercise. Exercise has a whole host of positive effects beyond weight management.
I believe Ozempic will probably lead to a lot of thin, but sarcopenic people.
> People are lazy, I get it
No I don't think you do.
We are dealing with a global crisis of obesity. We have a disease more prolific than ever before. There is something about the human brain that is wrong or imcompatible with the modern surplus of food. Something about our reward centers doesn't work. Not with modern society.
Addiction of this scale cannot be solved with individual actions. "Just stop" doesn't save an alcoholic, nor does it save a smoker. Fundamentally we need to rewrite how we view obesity.
We need solutions. Not more of this "try harder" fluff. Because it just doesn't work. If what you're saying is true, we wouldn't be in this mess. Obesity is more complex than we give it credit. It goes back to the food industry, health industry, advertisement. We can't just ignore everything and continue our "do nothing" approach.
This is not a discipline problem, this is a human problem. The solution MUST then target humans, not their actions. If that's a drug, for now, that's fine.
Most of weight loss actually happens in the kitchen, not the gym. A candy bar is roughly equivalent to a 20 minute run, in terms of Calories. Weight loss drugs surpress appetite urges. Even if you got super fit on the drug, without long term habit changes, most people are likely to put back on the weight quickly. Somewhat counter intuitively, fat people tend to have strong muscles to move all their mass around. My understanding with these drugs is that they artificially inhibit cravings, reducing the urge to eat, thus effectively stimulating weight loss. As soon as the drug stops being administered, the cravings return (and thus the weight) regardless of how fit you are.
Just as an anecdote, I used to not understand how people got so fat. Just eat less lol? I’ve been a little light for my size pretty much my whole life, so I didn’t quite understand. In fact, if it were up to me I probably wouldn’t eat at all. So the concept of being overweight was foreign to me and I assumed that fat people must be lazy/weak/whatever. As I got older and a little more in tune with my body, I noticed what sugar cravings are really like. And my god, when that part of the brain complains, it gets front and center stage. I specifically remember trying hard to resist reaching for a soda for like an hour. I conceded and drank one. I couldn’t focus otherwise. Then I realized that there are people (typically easily spotted) that live every day of their life like this. And I get that the brain is hardwired for gluttony- I will literally never eat enough food in my life- so it’s a rather natural thing to want Calories. I’m lucky that I’ve got a passable relationship with food. I feel for those who struggle with it. I’m also glad that there is a stop-gap in drugs like ozempic that help effectively curtail eating, today. I’m also hopeful that the drugs of tomorrow will be even safer and more effective than we have now and that the systemic sources of obesity in society erode away. I think the future is only getting brighter (and lighter) for the millions struggling with their weight.
I highly doubt your thesis. People losing weight with no effort is not going to enable them to put in effort to actually get fit. Especially later in life for folks that have spent most of their adult years not moving a lot. Coupled with that is the potential muscle loss from losing weight this way; trying to regain that lost muscle could be discouraging at first, especially without the right diet.
> But we all know it will be used just for the pill popping convenience.
Hell yeah sounds good to me.
"Fat" back then was roughly a BMI of 23-27. Average American BMI is around 30 today.
That's because there was no processed food and high fructose corn syrup back then so 27 is probably the max BMI they can reach.
Nowadays the sky's the limit for how beautiful one can be.
A town full of people with stinky burps
I thought this article was never going to end. It’s essentially the same point repeated three times.
these medications are pulling the same metabolic levers as the ketogenic/carnivore diet. the exact same thing happens on each: everybody gets pregnant after not being able to, everybody loses fat, everybody is cured or nearly cured of alcohol addiction and various mental health ailments (keep an eye out for the impact of ozempic-like medications on PTSD), heart disease and many other kinds of diseases are massively improved. ozempic doesnt do this for everyone and there are way more and more serious side-effects with ozempic but the overlap is absolutely unmistakable. keto and these medications arent making people lose weight, they are making people fundamentally healthier (ignoring side effects). they are doing something that addresses the pathological nature of an agriculture-based diet. some day very soon, we will discover the exact pathways and levers that are being modulated by these therapies and we will create a solution that wipes out most modern diseases in one fell swoop with essentially no side effects. that is coming very soon because with ozempic, there is now a north star for researchers to follow. very exciting times. savor and appreciate this insane, backwards and brutal time before the great health revolution while you still can!
Is this comment AI generated? It reads like nonsense.
no. it might seem strange for someone who is not aware of whats going on. reality is often strange
No such thing as free lunch. Up to the individual to decide whats worse but the "miracle cure" positioning these drugs are enjoying in popular media is troubling.
https://www.masseyeandear.org/news/press-releases/2024/07/pr...
Human technology is nothing but free lunch after free lunch after free lunch for centuries. And the rate of free lunches is only increasing.
Your study you linked compares the diabetic population taking GLP-1s against a healthy population. Of course they're going to find more eye problems in the diabetic population, diabetes damages the eye.
Correlation does not imply causation. Especially this one.
Ozempic is a dosage for type-2 diabetes, Wegovy is a dosage for weight loss due to obesity. It's the same medication, but FUD scapegoating or conflating one with the other leads to misinformation.
Industrial made problems need pharmaceutical made solutions.
Second week on Mounjaro and it's crazy how all my overeating triggers, hunger pangs and sugar cravings are just gone.
Yep, but Mounjaro is not approved for weight loss. It's for type-2 diabetes.
After a month of Wegovy, I was barely eating and not hungry. Have lost 35 lbs. so far after going just on the side of obesity due to complications of the only antidepressant I've ever found to pull me mostly out of otherwise treatment-resistant depression. Too often, people will casually blame others for not having "stronger self-control" when the motivations, opportunities, and compounding factors make it extremely difficult or impractical to resist. Even so, Medicare doesn't cover Wegovy or Zepbound, but will cover Ozempic and Mounjaro because it's all about discriminating against obesity.