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.
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.
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.
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.
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
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.
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
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?
> 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.
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.
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.
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.
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.
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.
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.
> 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.
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.
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.
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
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.
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).
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.
> 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.
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.
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
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.
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.
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.
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.
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'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.
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!
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.
"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.
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. .
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.
Readit News
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.
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?
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.
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.
N=1, I'm on ZepBound and in general my brain is less likely to give in to things that give instant satisfaction.
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.
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.
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
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?
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.
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.
Are there any alternatives coming out soon or generics?
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)
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...
There are group chats with tens of thousands of people and I havent seen any issues with the drug
Minimal, but minimal progress in the US was/is still progress.
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
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?
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.
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.
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.
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.
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.
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.
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.
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
That the NHS is getting to a place where it’ll provide it, I’d say yes.
Dead Comment
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!
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.
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 controlling what you put into your mouth is easier than controlling your anxiety.
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
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.
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).
Considering it took you a miracle drug to learn the lesson, that seems like a humorously arrogant take.
Deleted Comment
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.
Deleted Comment
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
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.
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
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!
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."
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.
Dead Comment
The biggest part of that equation is regain part. Most people quit GLP-1s because of costs. Let's fix that.
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.
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.
Also it should be mostly used as an adjunct to strict diet and exercise.
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.
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.
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.
Deleted Comment
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.
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.
It has the same effect as starving yourself. Go look up pictures of "ozempic face"
"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.
Will you be one of them? Click here to find out!
Pretty easy to predict if you're willing to make it happen.
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.