[gnicholas]

I guess this is why it’s so hard to cancel gym memberships. I wonder how these places will be affected by ozempic/etc. On the one hand, people won’t have to exercise to lose weight at much as before. On the other hand, perhaps there will be a cultural change that emphasizes muscle mass/tone more than now. That is, being not-overweight will be the default, and the way people will stand out will be muscle tone, perfect skin/hair/etc. What franchises will pop up to serve these needs?

[nradov]

Gold's Gym and CrossFit already exist to target consumers who want a more toned, muscular appearance. They have been around for a while and should be sustainable as long as they don't do something stupid like take on huge debts to fuel rapid expansion. Any new market entrants will have to come up with a unique angle to compete against those established players. Tonal also appears to be getting some traction in the home strength training market but it's not clear whether they can survive.

GLP-1 drugs like Ozempic can be very effective for rapid weight loss but I think (hope?) that consumers will eventually become disillusioned with them. There are significant side effects in many patients, the weight tends to come back when the drug is stopped, and much of the weight lost is lean muscle rather than adipose tissue. There is a growing body of evidence that having a large amount of skeletal muscle is crucial for maintaining metabolic health (glucose sink) and preventing disabling falls later in life (sarcopenia).

[0xcde4c3db]

A couple more things to consider:

1) I'm having trouble finding a good citation, but I remember it being a minor scandal at some point that statistically, the real-world weight loss from semaglutide was found to be roughly half what it was in the trials, probably because the trial populations were unrepresentative (younger and fewer comorbidities than the real-world population, IIRC).

2) In the face of shortages of the standard branded Ozempic/Wegovy products, a lot of people are turning to compounding pharmacies. But according to Novo Nordisk, there is no legitimate supply chain of semaglutide for them to use, so these pharmacies are apparently selling people a semaglutide salt that is manufactured as a research chemical rather than a licensed drug [1]. The FDA has also warned of outright counterfeit Ozempic getting into the supply chain, complete with fake serial and lot numbers [2].

[1] https://www.nbcnews.com/health/health-news/ozempic-wegovy-we...

[2] https://www.fda.gov/drugs/drug-safety-and-availability/fda-w...

[nradov]

Regardless of the exact effect magnitude, the GLP-1 agonists are very effective relative to other bariatric treatments across all patient populations. Tirzepatide appears to be even more effective than semaglutide in that regard. The concern is not so much over the magnitude of weight loss but over unfavorable changes in body composition and serious side effects such as gastroparesis.

https://peterattiamd.com/ama45/

Novo Nordisk appears to be spreading FUD to some extent. While there are scammers selling fake or adulterated semaglutide (same as with any popular prescription drug), legitimate compounding pharmacies are producing the real thing that is medically equivalent to the branded Ozempic/Wegovy products.

https://time.com/6301552/weight-loss-drugs-compounding-pharm...

[gnicholas]

Yeah, I think Golds and CrossFit could benefit, at the expense of places like 24 Hour Fitness, which are more about losing weight (IMO).

I agree there appear to be non-trivial side effects to these drugs, and I certainly won't be first in line to try them out. But I expect that they will be refined substantially, and that elimination of side effects will be a key goal. For example, if the drug can be administered via pill instead of injection, it would be easier to do a lower, steadier dose, which presumably would mellow out some of the side effects. Pharma companies undoubtedly see the huge pot of gold at the end of the rainbow and will do whatever it takes to get there. The best drugs will likely always be more expensive than the earlier generations, which will be used by larger portions of the population.

But to the extent that tastemakers are the elite, I think we'll see a cultural change regarding desirable traits even if mere mortals like me aren't on the medications. The change will accelerate as the drugs become cheaper and more available to the masses.