[Alupis]

The problem with this (and all diet plans/drugs) is the lifestyle that led to problem in the first place.

If you do not change your lifestyle, for real and not just superficially, then you will relapse with a vengeance.

That is to say, be careful with using a drug as a crutch. Sure, it can artificially make you much more interested in not consuming so many calories and/or perhaps being more active than before - but you have to continue that lifestyle after stopping the drug.

Will Ozempic users have developed the personal discipline to prevent themselves from relapse without the drug - or will they forever be on a the yo-yo of weight gain/loss?

[Someone1234]

> Will Ozempic users have developed the personal discipline to prevent themselves from relapse without the drug - or will they forever be on a the yo-yo of weight gain/loss?

Have alcoholics using Naltrexone? Or opioid addicts using Methadone, or smokers using nicotine gum/patches?

See I'm bringing this up to point out the obvious double standard, people suffering from food addiction (i.e. literally the high from food) or binge-eating disorder, who finally have an effective treatment, are treated like it isn't addiction or illness, but a "lifestyle," but if you said this stuff about any other addiction people would call you out and be horrified.

For people mildy overweight or accidentally obese, it is a wildly different illness for people with lifetime problems who have lost/regained weight tens of times and likely know more about nutrition than most healthy-weight people ever will.

[seadan83]

The concern regarding a drug as a crutch is stil valid. Smokers/drinkers may deal with stress by smoking/drinking. After cessation, ways to deal with stress need to be learned from a new.

"Addiction" is ambiguous and a term almost better not used. "Addiction" may constitute chemical dependency but can also be largely a set of habits. A set of habits and lifestyle are pretty much the same thing.

[CydeWeys]

The problem is that calling it a "crutch" is already presupposing a negative judgment of it. Use a neutral word; e.g. it is a weight loss aid.

[tomrod]

Some things simply are negative, and masking behind a neutral word makes the neutral word perceived as negative over time.

Masking reality is not a good way to work within it nor modify it.

[CydeWeys]

Some things simply are negative, sure. I think we can all agree that murder is negative on the whole, for example.

But you are making a HUGE leap here in assuming that GLP1 agonists "simply are negative". You have not remotely supported this logical leap. All studies in fact have shown that GLP1 agonists are significantly positive: That they improve health, reduce obesity, reduce all-cause mortality, etc. You are denying observed reality across a large number of double blinded, objective clinical trials.

[collingreen]

I just keep following your comments down the page and giving you upvotes.

I think folks using drugs (or meditation or habits or diet or any other thing) to intentionally make their life better is amazing and should be celebrated.

If some things are easy for you but not others try to be grateful for yourself without having to be petty or wanting others to be worse off.

[tomrod]

To be clear, I don't think GLP1 agonists are "negative." I think the blend of environmental, food supply, and other factors that led many adults, in the US and elsewhere, to need obesity intervention is the negative. GLP1 agonists are an inherent crutch.

Much like if we geoengineered cloud seeding or similar light blocking and fail to reduce CO2, the treatment masks the cause and can lead to worse outcomes globally (even if some folks are better off - and I hope they are!).

[cthalupa]

What's the explanation for why GLP1 medications are negative things? There are a very minor subset of people that have some medically significant adverse reactions, but it is VERY small. We don't have any evidence to my knowledge of any long term risks with being on it.

[blackeyeblitzar]

GI issues are fairly common and sometimes linger after stopping too. Loss of muscle mass is also common.

[Alupis]

> We don't have any evidence to my knowledge of any long term risks with being on it.

Nobody has yet been on these drugs for an entire lifetime - which is what is being advocated in this thread.

[unethical_ban]

If someone has a broken leg, the word "crutch" isn't derogatory in the first place.

Cessation tools are not negative. Yes, root causes of abuse should be addressed, but aids are aids.

[CydeWeys]

    Crutch (n)
    a : a support typically fitting under the armpit for use by the disabled in walking
    b : a source or means of support or assistance that is relied on heavily or excessively

Use a is a neutral, non-judgmental, literal use of the word. Use b is clearly a pejorative, judgmental, metaphorical use of the word. The two are not the same.

[borski]

The negative connotation of a crutch implies that you are past the point of needing it and should be standing on your own two feet. If a thing is not meant to be temporary, or if you'll never be able to perform a task as well without it as you could with it, then it's a tool rather than a crutch.

Thus, calling GLP-1 meds a “crutch” implies that they are unnecessary, and that the patient should be able to do it without medication, which then creates guilt and shame where there shouldn’t be any.

[fknorangesite]

> If someone has a broken leg, the word "crutch" isn't derogatory in the first place.

It is so profoundly disingenuous to pretend not to know what the word "crutch" means or what connotations it has in this context. Like, come on.

[ab5tract]

Is using glasses to see a crutch? Asking as someone who needs them as much as I need the prescribed-for-life medications I’ve been prescribed.

[seadan83]

Reflecting on this, I think that 'for-life' aspect is very key. A 'seeing aid' vs 'seeing crutch'. Crutches are usually meant to be temporary. A walking stick is the walking aid equivalent. Hence, for weight loss, is medication meant to be the life long solution? As a facilitator to move the needle for people - very helpful. The underlying question about lifestyle and habits never changing is where the life long crutch concern comes in.

[nswest23]

All these people are calling it a crutch are moralizing tongue clicking, holier than thou Calvinists who think you shouldn’t be able to be thin unless you bootstrapped yourself to thinness with your own blood sweat and tears, as though this viewpoint represents some abstract understanding of the world instead of merely a smug sense of self righteousness.

[seadan83]

Crutches allow broken legs to heal properly. It could be that some simply don't have that same strong negative connotation.

What is more, getting hung up on the wording is missing the larger point.

[buzzerbetrayed]

Crutch and “weight loss aid” aren’t synonymous at all. You can’t ask someone to use a word that has a less negative connotation if they mean completely different things. They intentionally said crutch because they’re specifically talking about people who use it as a crutch. Not people who just use it as a weight loss aid.

[golol]

What's wrong eith a medicine as a crutch? If you break your leg you use a damn crutch and that's good. If you suffer from an illness and we have a medicine that's worse than the illness and affordable - go for it. Phrasing it as a crutch suggests it is somehow only a temporary that prevents you from finding a "real" solution by changing your "lifestyle". It doesn't matter, only outcomes matter.

[names_are_hard]

Agreed. After I broke leg the physical therapist saw me walking without aids and said I should go back to using a cane and explained that I'll heal better and faster if I use help than if I don't. Made me realize that the expression "using x as a crutch" doesn't make sense if it's supposed to imply that x is an impediment to progress.

[cbsmith]

> The concern regarding a drug as a crutch is stil valid.

People with pacemakers can't get off of them either, but it doesn't have the same stigma. Diabetics often need regular insulin injections, but it doesn't have the same stigma. People with high-blood pressure often need regular medication, but it doesn't have the same stigma. It's mostly antidepressants and now Ozempic which have this stigma.

> A set of habits and lifestyle are pretty much the same thing.

I believe the DSM does not consider them "pretty much the same thing".

[namaria]

'Anew' is an adverb: learn anew.

'Learn from a new' is missing an object.

[goosedragons]

I think the difference is with food you have to eat it. You don't need alcohol, opioids or nicotine to live. With food it's much easier to fall back into similar or the same pattern as before because you can't avoid it.

[dazc]

The other problem being the availability of healthy food. Those without the time or facility to cook are dependent upon stores selling convenience foods which are anything but healthy, those foods labelled as such being some of the worst examples.

Despite not being overweight and taking regular exercise, I have recently been diagnosed as diabetic and now see the world in a different light. It really is quite shocking how many aisles in. a typical supermarket are stocked with complete junk food.

[tonyedgecombe]

>The other problem being the availability of healthy food. Those without the time or facility to cook are dependent upon stores selling convenience foods which are anything but healthy, those foods labelled as such being some of the worst examples.

Is it impossible to buy healthy food in your region? The average American spends six hours a day watching TV, do they really not have enough time to cook a meal? Just how many people do not have a cooker in their home? Is it cheaper to buy preprocessed food rather than the raw ingredients in that meal?

It seems to me the real problem is the supply of food is abundant and corporations have gone to extraordinary lengths to make it very palatable. Add in peoples tendency to chose the easy option (ready meals, eating out) and you get an obesity epidemic.

[collingreen]

Everyone has 24 hours a day. We could all move to the cheapest CoL areas, grow our own food, and run marathons all day every day. Everyone, including you, could sneak one more rep in instead of some activity in the day. This holier-than-thou attitude of dismissing people is lame.

Empathy can go a long way and the more we can have for each other the better we will collectively be.

[tonyedgecombe]

>This holier-than-thou attitude of dismissing people is lame.

If you want to solve the problem you have to understand it. I see lots of dubious suggestions like lack of time when working hours have reduced massively in recent history[1].

>Empathy can go a long way and the more we can have for each other the better we will collectively be.

If our read my second paragraph then you will see I'm not laying the blame at individuals.

[1] https://ourworldindata.org/working-hours

[seadan83]

Chemical dependency I believe can confuse the brain, where it actually does think you need the drug to live.

It can be very hard to avoid booze or cigarettes. They are everywhere. Potentially throughout all of a person's social group. Maybe at home if spouse or parents smoke.

As a former smoker, changing diet was easier for me than to change a smoking habit

[tsimionescu]

While you're chemically addicted to a substance, yes, the body thinks you literally need it to survive. The point is what happens after you break the chemical addiction, you go through withdrawal, and can function again. The brain stops feeling you need it in that same way after this process. But it's almost impossible for someone who went through alchohol or nicotine or opioid withdrawal to ever consume that again and not relapse into addiction.

If the same logic applies to a "food addiction", then discontinuing the drug that helped you go over the initial addiction is going to be almost impossible, since you can't abstain from food.

[seadan83]

Withdrawal can often be both a mental and chemical process. The desire to do something and constantly thinking about it can be just as much habit as it is chemical.

We are mostly on the same page I think. To the point though, re: food - it is not all equal. Fast food, ice cream, fried food, candy, chips- it is quite different from cooking your own meals and snacking on things like fruit, veggies and hummus (etc..)

Similar to your first point, I can't buy ice cream because I have no self control over it. (I would not say I have a food problem, it would therefore be a lot harder for others I believe)

While I agree "you can't abstain from food", it might be a bit overly reductive. Not all food is responsible for 'problem' eating. Similar to near absolutely (or absolutely) avoiding booze/nicotine, there might be similar foods that must be avoided. Which comes back to habits, changes to how a person snacks, when they eat, how long is spent in food prep,more grocery store trips, how they shop in the grocery store (etc)

[seec]

I think smoking is particularly hard because most of the really bad effects come much further down the line. You can smoke for years (even tens of) without much problem and if you do some sports even the cardio/breathing effects are largely mitigated (I know, this is what I do).

So, it's easy to only think about how good it makes you feel at the moment.

But alcohol will show nasty side effects rather sooner than later, it will show on your face, you will feel liver problems very fast and since you are in a secondary state when inebriated you will seem out of place when not in that state.

Both of those substances have the particular effect that if you use them repeatedly over a short (1-2 week) period of time in moderate but sustained quantities, you will get chemically addicted. This is nasty and the reason why every parent tries to make this fact known to their children (more or less successfully depending on method).

Food addiction in my opinion is very different, it comes purely from psychological factors and should be very easy to correct on time. It's not something that comes around in 1 week or 2. Even if you overeat 1000 kcal (1/3 more than the average of 2000) over the course of 2 weeks, you would only gain 2kg of body fat at worse. It's really a very long sustained process to really become obese, it's not like chemicals that can get you in 2 weeks max.

While it's hard to lose what you gained (you basically need to starve a little bit) it's not that hard to make adjustment to life choice to avoid making the situation much worse.

[bitnasty]

Actually not true. All addicts develop lifestyles around their addictions. Alcoholics often have many social connections that involve alcohol, what they do for fun involves alcohol, etc. A successful recovery typically involves changing this lifestyle to make the problem behaviors easier to avoid.

[nox101]

People that move out of the USA generally lose weight. Especially if they move to a country with snaller portions and more walking. People that move to the USA generally gain weight. Evidence that it's lifestyle.

[NilMostChill]

That's evidence of environmental factors.

[maigret]

https://usa.streetsblog.org/2023/04/14/exactly-how-much-less...

[ta_1138]

An environment that physically makes you more sedentary as, outside of a couple of cities, many things that would be sensibly done through walking in other countries involve driving.

You can easily tell this is the case by seeing where the obesity is less prevalent

[hnburnsy]

Maybe peer and societal influences too?

[pclmulqdq]

I would suggest that you look at food labels of "equivalent" products on both sides of the Atlantic. US packaged foods have a lot more sugar (and general calories) than those in Europe, even when they are the "same."

[amarcheschi]

I visited us in summer, from Italy. Bread was so sugary. Cakes were sugary. Everything was much more sugary than here

[grepfru_it]

Just needs to be a walking friendly city. You will lose weight in eg NYC or Seattle

[lazyasciiart]

I'm in Seattle, and I can tell you that foreigners don't move here and lose weight.

[gooosle]

Most of the obese people I know are completely clueless about nutrition and exercise (even though they think they know a lot).

[Alupis]

This is bunk. An actual chemical addiction is not the same as feeling an urge to drink 8 cans of coke a day, or being unable to not buy a bag of chips at the gas station.

[ben_w]

Is it, though?

Your entire body and brain is a complex and messy chemical reaction.

The opening sentence of the wikipedia article on addiction currently reads: "Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behavior that produces natural reward, despite substantial harm and other negative consequences."

The page then lists "eating or food addiction" as examples, with food addiction being its own entire page.

[croes]

That doesn't prove it's an addiction.

More likely it's listed as one so insurance company pay for the drugs.

Addiction treatment gets payed, low self control not.

Half Bake- Thur good goes to rehab NSFW

https://youtu.be/uUPHlAbAf2I?si=TVVxffFprAtdJyAk

[manacit]

Gambling? Porn? Sex?

These are all things that we acknowledge are possible to be addicted to to that are not substances. Not to mention that coke has caffeine which is a chemical substance just as much as anything.

You can pin addiction to anything as a personal weakness, including drugs. Why are some people able to smoke a few cigarettes or do a little bit of cocaine without ever getting addicted, when others are hooked on day one?

If there's one thing that's been fun to see as the outcome of GLP-1 drugs, it's that a lot of people seem to have a real problem seeing people better themselves the "easy way".

[mathgeek]

A good way to frame addiction is via perceived rewards. You can be addicted to many things if you look at it as “the person expects a reward for an activity, often errantly”. The worse addictions get into “the reward isn’t even expected with a moment’s clarity, but you do it anyway” territory.

[naijaboiler]

It doesn’t matter what the actual addiction is, the reward circuitry in the brain is pretty much similar.

Addiction is basically highjacking our brain wiring that’s meant to help us expend energy chasing things that we need for survival (food, reproduction), and using it to chase other things

[tharkun__]

But you are addicted to a substance in those cases.

Sure, you don't take the substance directly. But the things you do have your body produce/release the substance.

A dopamine high is a dopamine high. Even though you didn't buy a dopamine pill from a shady dude in the parking lot.

[jdhendrickson]

I find this attitude strange. I am a very physically fit man, I do not know what it is like to walk in the shoes of someone who has an addiction to food, but I do know people eat themselves to death. People deal with debilitating diseases that are directly linked to the amount they are eating. People literally destroy their body and live in the wreckage, and you think that it's not an addiction? If not an addiction what exactly is going on?

[fragmede]

Addiction is this really scary thing I saw on tv about downtown Philadelphia and fentanyl killing people buy that's far away and couldn't happen here. Sure, I have friends who are fat and are unable to stop themselves from drinking 8 cans of coke a day but they're not shooting up with needles and I know them so they can't be this scary kind of person called an addict. Also I know this one girl who's glued to her phone all day and can't do anything else and she's also definitely not an addict.

Addiction hits the same part of the brain, no matter if it's chemical, physical, or digital. Just because our culture sees them differently doesn't make it the same underlying problem.

[wtetzner]

Seed oils (used in almost everything these days) contain a lot of linoleic acid, which is a precursor to endocannabinoids, potentially giving you the munchies. If eating gives you the munchies, making you want to eat more, I'd call that a chemical addiction.

I think avoiding bad foods is a better solution than reaching for drugs, but if the drugs help break the cycle, it could be beneficial.

[zero-sharp]

>Seed oils (used in almost everything these days) contain a lot of linoleic acid, which is a precursor to endocannabinoids, potentially giving you the munchies. If eating gives you the munchies, making you want to eat more, I'd call that a chemical addiction.

If you listen to nutrition gurus, you'll hear claims like "food X contains chemical Y and chemical Y is either itself toxic or metabolizes to something toxic, therefore you shouldn't eat X". I promise you I can find videos where somebody has found something bad about spinach and will try to convince you not to eat it. It's a bad way to reason.

Identifying individual biological pathways isn't enough to make (dietary) prescriptions. Often, the metabolites of the food aren't produced in high enough quantities to make a measurable effect (on health, or this case behavior). This kind of thing has to be studied at the level of behavior.

[mort96]

The fact that people have this idea that "obese == unable to resist drinking 8 cans of coke per day" is honestly part of the problem.

[elzbardico]

As much as we pretend otherwise and rationalize stuff because the greatest sin for our generation is being judgemental, I am pretty sure this is the case in a lot of instances.

[rixed]

Maybe, but shame has never been a very good cure overall.

[vkou]

Shaming people is fantastic at making me feel self-righteous, though, which is the best metric by which I can evaluate treatments and interventions for other people.

(When I feel charitable, I can instead wring my hands and hemm and haww about the unknown consequences of people using medication to solve their health problems. I can't outline what exactly those consequences are, but I can certainly hemm and haww.)

[stirfish]

People get addicted to gambling, and you don't put that in your body at all.

[spondylosaurus]

This is the example I'm shocked more people don't invoke in these discussions. Gambling addiction is indisputably real, and slot machines (or craps tables or the ponies down at the track) don't even have stick a needle in you to get you hooked. Actions and reactions are more than enough.

Compulsive overeating relies on the same behavioral/reward mechanisms, with the added bonus of food being something you do physically ingest in the process.

[FabHK]

Gambling addiction also has the highest suicide rate among addictions, so definitely serious. The Atlantic had an article recently arguing that allowing sport gambling in the USA was a mistake, imposing huge costs on the most vulnerable.

[coffeebeqn]

It’s also popular in other forms these days. Wallstreetbets options gambling, most of crypto, the way many people are “trading” these is purely gambling with some bro-astrology.

When I was a poor teenager I was gambling online and it is an incredible way to lose money unlike anything. With the click of a button you can throw $100 or $1000 into the void- and you often follow it up until your account is empty. Hard to do with many other substances.

[__blockcipher__]

It’s the same thing. Obviously withdrawals and such are different but the core mechanism of disregulated reward processing leading to compulsive behavior engagement is exactly the same.

[JamesBarney]

>If you do not change your lifestyle, for real and not just superficially, then you will relapse with a vengeance.

Longterm glp-1 agonist research doesn't agree with this.

> but you have to continue that lifestyle after stopping the drug.

Why stop the drug?

>Will Ozempic users have developed the personal discipline to prevent themselves from relapse without the drug - or will they forever be on a the yo-yo of weight gain/loss?

A small % of people are able to achieve significant weight loss with diet and exercise. And an even smaller % of that group are able to maintain it for the long term. We've been trying to solve obesity this way for a 50 years and have bubkis to show for it. If someone has high cholesterol we give them a statin, if they have high blood sugar we give them diabetes. Now if they're overweight we give them ozempic.

[data_spy]

The research says you gain the weight back:

"For the two in every five patients who discontinue the treatments within a year, according to a 2024 JAMA study, this means that they are likely to rebound to their original weight with less muscle and a higher body fat percentage." The other issue is the muscle loss on being on these drugs as "Clinical data shows that 25 per cent of weight loss from Eli Lilly’s shot resulted from a reduction in lean body mass, including muscle, while 40 per cent of Novo Nordisk’s jab was due to a drop in lean body mass." Via https://www.ft.com/content/094cbf1f-c5a8-4bb3-a43c-988bd8e2d...

[JamesBarney]

Sorry I meant with continued use of the treatment you don't regain the weight. I agree if you stop taking the medication your weight will rebound.

[Alupis]

Right, so we doom some portion of the population to forever take a pill from big pharma? How is that acceptable with anyone?

The goal should be to use Ozempic until you are in a better place to manage things yourself. The goal should not be to get people hooked on Ozempic for their entire lives.

Perhaps Ozempic prescriptions should come with prescribed exercise with check-in and monitoring, or something.

[BurningFrog]

I guess young people don't always know this, but there are plenty of medications a lot of people take for the rest of their lives. Blood pressure and cholesterol pills are maybe the most common.

This gives a vast number of people 5-10 years longer lives, and I think this is great thing, even if some pharma executives end up getting rich.

[ido]

Or insulin. I’ve been shortsighted since childhood and will need to wear glasses for the rest of my life (unless I get laser corrective surgery, I guess).

Many people in my wife’s family have thyroid gland dysfunction and have to take thyroid hormones their whole lives.

[Karrot_Kream]

Not just young people. High blood pressure runs in our family. A cousin, despite being healthy in most indicators, developed high blood pressure at 23. She's still going in her 50s just fine but has had to take blood pressure meds for the last 27 years.

[JamesBarney]

> Right, so we doom some portion of the population to forever take a pill from big pharma? How is that acceptable with anyone

This is literally how almost all medicine works that treats a chronic condition.

> Perhaps Ozempic prescriptions should come with prescribed exercise with check-in and monitoring, or something.

Why?

[rootusrootus]

> doom some portion of the population to forever take a pill from big pharma

That is temporary. The effects are real. The fact that you don't think big pharma should profit handsomely for making it happen is not the only alternative. Before too long semaglutide, as one example, will be out of patent and available as a generic. It won't cost a thousand bucks a month to big pharma, it'll be practically free. Cheap enough that most insurance plans will likely subsidize it all the way to zero out-of-pocket cost just because the ROI is so good.

[fragmede]

How my decisions will affect some company's bottom line is way behind "will this help me live a better, longer life" in my list of priorities, but I'm already on other medications that are generic for the rest of my life for other genetic defects I've been blessed with, though I'm not on Ozempic.

[golol]

Why not? What would you rather be: Fat to your death, or healthy and dependent on modern technological society in yet another way? How is it any different to diabetes treatment?

[Tagbert]

I take a statin as something in my body produces high levels of cholesterol even on a low fat diet. I will always take a statin. It works well and there are few side effects.

My spouse must take a thyroid medicine every day for life.

Not taking these pills is life threatening. How is taking them not acceptable?

[lazyasciiart]

Wait til you learn about hormonal birth control.

[s1artibartfast]

Some regain, some don't. Some people have multiple heart attacks.

It is really that simple.

[Alupis]

> Why stop the drug?

Why would you want to continue using a drug for the rest of your life?

> Longterm glp-1 agonist research doesn't agree with this.

Please explain. If you stop using the drug, because you've achieved your goals, what stops you from relapsing other than your own personal habits and lifestyle?

> A small % of people are able to achieve significant weight loss with diet and exercise. And an even smaller % of that group are able to maintain it for the long term. We've been trying to solve obesity this way for a 50 years and have bubkis to show for it. If someone has high cholesterol we give them a statin, if they have high blood sugar we give them diabetes. Now if they're overweight we give them ozempic.

Yes, a pill for this, a pill for that... and there's no chance we'll discover these drugs have negative effects when used by a person for 50 years.

[JamesBarney]

> Why would you want to continue using a drug for the rest of your life?

It's better than being obese. This is true of most drugs for chronic conditions. very few of them are curative, almost all of them treat the condition.

> Longterm glp-1 agonist research doesn't agree with this.

Sorry I wasn't clear, I meant with continued treatment you don't rebound.

> Yes, a pill for this, a pill for that... and there's no chance we'll discover these drugs have negative effects when used by a person for 50 years.

They might have negative side effects but obesity has very large negative side effects. I would be incredibly surprised if any of these drugs that have been used in diabetes treatment for a long time have anywhere close to the negative side effects of obesity.

[tikhonj]

> Why would you want to continue using a drug for the rest of your life?

Because it is a substantial net benefit to your life?

Same reason I might want to continue with, say, a regular exercise routine or meditation practice.

[justinclift]

> ... if they have high blood sugar we give them diabetes.

That sounds like a hell of a treatment plan. o_O

[bregma]

It doesn't work. I keep trying to get off the diabetes and I just relapse after a few weeks. It doesn't help that my body tries to hide the glucose everywhere, like attached to hemoglobin or in my liver in the form of glycogen so it can share a hit with me first thing every morning.

Nope, not going back to the doctor that gave me diabetes. That was a mistake.

[lizardlena]

> A small % of people are able to achieve significant weight loss with diet and exercise. And an even smaller % of that group are able to maintain it for the long term.

Ozempic is only fighting symptoms of that, not the root of the problem which is the stigma around weightgain, being a big person, just fatphobia being extremly generalized and a lot of shame surrounding weight. While it's amazing for people who have medical conditions making them gain a lot of weight, just saying that they should take ozempic will not change people gaining too much weight. It's not anything like high cholesterol or high blood sugar in most cases.

[JamesBarney]

Fighting the symptoms of what?

Taking ozempic will definitely keep people from gaining weight and will help them lose weight.

[Eisenstein]

A few questions:

Can you qualify what you consider to be a 'symptom' vs a 'condition'?

Is high cholesterol a symptom of something, or a condition itself? What about high blood sugar?

Would you say that acid reflux is a symptom or a condition?

Is a person that takes Prilosec daily to treat bad reflux treating the symptoms and not the underlying condition?

What about people using asthma inhalers, or epipens: symptom or condition?

Are people allowed to use the medicines if their underlying conditions are not being treated?

[fortran77]

> While it's amazing for people who have medical conditions making them gain a lot of weight,

You mean matter is created out of thin air because of a "medical condition" and not by eating too much food?

[cthalupa]

I'm someone that has spent many years of my life eating well and exercising regularly, including weightlifting. I'm also someone who has spent the past decade doing neither of those things, with one attempt in the middle to correct my behavior interrupted by a knee injury.

I'm currently on tirzepatide and have also started to resume exercise, and I'm enjoying it like I did when I was younger - I expect I'll be able to go off of it when I get to my goal weight.

But at the same time, there's not any real reason that people would need to go off the drugs, outside of cost. So far we don't see any adverse reactions in the vast majority of people. Some people have reactions from rapid weight loss - gallstones, hair loss, etc. but these are also risks in crash diets, etc.

We accept that people will need lifelong medication (often with worse side effects) for other illnesses that have less risk to all cause mortality, etc., than obesity. Why would we be unwilling to do it for obesity?

The fact of the matter is that despite the risks and downsides of obesity being well known in America, 42% of American adults are obese. No amount of education or knowledge that has gotten us on the whole to eat better or exercise more. Plainly, being on these GLP1 medications is preferable to being obese based on all current knowledge.

[CydeWeys]

> The fact of the matter is that despite the risks and downsides of obesity being well known in America, 42% of American adults are obese.

It's down to 40% and dropping now, thanks essentially solely to GLP1 agonists! This will, no lie, save our country trillions of dollars in increased years of quality of life (and thus productivity) and reduced healthcare costs.

[metabagel]

> The problem with this (and all diet plans/drugs) is the lifestyle that led to problem in the first place.

I don't think we fully know what led to the problem in the first place.

I think it's a complex interaction between the types of foods we eat, and which are more affordable, our gut microbiome, and the amount and frequency of exercise which we are able to fit into our day.

We have some pretty good ideas that reducing intake of high glycemic foods, safely reducing overall calorie intake, and getting regular exercise will help.

However, it's the bad food which many families can most afford. Many people find it difficult to make time for exercise, since they are pretty exhausted from making a living. The foods which are bad for us tend to make us feel good in the short term.

When a person has become obese, it is harder to start exercising, and it's harder to find exercises which don't hurt their feet, joints, back, or other parts of their body.

Ideally, we would all have copious time to exercise, and healthy food would be abundant and affordable. But, that's generally not the case for most people.

And some people seem to be genetically predisposed to gain weight.

[sirsinsalot]

If you compare the typical American diet and ingredients to the rest of the world, the answer is clear.

The problem is most Americans (where the obesity crisis is worst) don't know their country's businesses are selling them rubbish and their government is subsidising it.

[jrockway]

I don't think you expect to stop taking the drug. It's a for-life kind of thing.

If a prescription for "lifestyle changes" were a drug, it would be one of the least effective drugs ever made. I read something directed at medical professionals that are skeptical of the GLP-1 receptor agonists and it asks, if you prescribe a drug and your patient refuses to take it, why would you keep prescribing that drug? Of course not. That's what lifestyle changes are, and the landscape has changed so that there are alternatives.

(My employer is heavy on the "lifestyle changes" angle. They will not pay for GLP-1s, but they will send you a newsletter about losing weight if you want. Guess who's losing the weight.)

[nwienert]

> you will relapse with a vengeance

You say this - but not from experience (correct me if I'm wrong and you have taken a GLP-1 agonist).

I say this because as someone who has taken it, I found one of the craziest parts is how they do seem to help you set better habits, and those habits do stick, and it's not like some fake thing.

For example MJ helped me do the following: entirely stopped late night snacking, stopped craving sweets, stop smoking weed. And it doesn't come back when I go off, even after months.

I wasn't especially overweight when I went on (maybe 20lbs), I did it for the incredible immune system benefit which seem to heal my immune disorder, but I was stunned at the results outside of it.

I get that people hate the idea of something that helps you be better without having to "put in work", but in the weirdest and best way possible, it seems to do that, at least in part.

[coffeebeqn]

> people hate the idea of something that helps you be better without having to "put in work"

This is kind of an incredible reaction many people seem to have. Isn’t this just a net positive? Even if someone feels like gatekeeping good health, ozempic is only giving you maybe 60% of the benefits of a healthy diet and regular exercise. It’s not taking anything away from people who put in the effort

[golol]

"Everything comes at a cost" as a meme is really deeply integrated in our culture. Since thousands of years probably.

[monkeycantype]

The genetics of hunger are fascinating, people literally feel very different levels of hunger. My family are mostly all quite fit and healthy, but this is because exercise and dieting are a cultural obsession in my family to an un-mentally healthy extent, because as I understand through conversation with others We feel an unusually high level of hunger, I can be full to bursting and hunger does not stop. I tried semaglutide, it was the first time I can recall ever feeling the absence of hunger. To think that my family and I are likely nowhere near the top of the hunger spectrum astonishes and horrified me

[slothtrop]

Yes, what's true and often understated about weight-loss is that people usually do lose weight when they decide to, but gain it back. Aside from lifestyle, metabolic adaptation is one factor. Since metabolism is lower, increasing calorie intake too quickly leads to weight-gain, and metabolism remains worse than it was before.

[perching_aix]

Sounds like it directly affects their lifestyle though? Being less drawn to addictions, and thus less engaged in related activities, is a pretty big lifestyle change.

[Alupis]

> Being less drawn to addictions, and thus less engaged in related activities, is a pretty big lifestyle change

While on the drug. Will those changes remain if the user stops using the drug?

[CuriousCosmic]

It really depends. If you break the addiction and it could very well remain.

An example is tobacco/nicotine. If you stop smoking while you are on the drug and you break the addiction and the habit, you aren't going to reform that habit unless you start smoking again. And that's unlikely to occur because you no longer have the habit, you no longer have the chemical compulsion, and you aren't consuming any of it. Maybe stress could force a relapse due to weakness of mind but all things considered that's minor relative to the chemical addiction and the habit forming behavior.

An example where you may see relapse is alcohol or marijuana where the substance comes almost more from a social environment than it does from the chemical draw. Like once the habit is broken, it's still easy to be put into situations where recreational use is common and more or less expected on rare or semiregular occasions. That of course could lead to new habits forming and leading to relapse or it may not depending on what other (hopefully healthy) habits the user is now taking part in, their stress level, and other aspects of their life.

So the answer is of course that it depends but if the drug can reliably help people break habits then it can maybe also be useful in helping them avoid forming new bad habits or relapsing when the urge becomes too strong to resist.

[Someone1234]

What is the core of your point? That these drugs, that extend life, and reduce associated illnesses should be ignored or not used, because instead people can die sooner in some attempt to cure themselves the "correct" way?

A corpse cannot learn healthy lifestyle habits. A living person who lost weight the immoral way or whatever you're trying to say, can of course.

[BurningFrog]

A lot of people take blood pressure, cholesterol, and other medications daily for their entire lives.

If Ozempic ends up being another such drug, I don't think that's a bad thing.

[knifie_spoonie]

I'm not so sure about that.

All the people I know who are on those for-life medications absolutely hate the fact that they have to keep taking those pills every day until they die.

[eichin]

eh, my inner "prepper" is annoyed by the dependency, the rest of me is pleased that I've already lived longer than any of my male ancestors. (Kind of hard to sneer at advanced technology given what I do for a living :-)

[Alupis]

The point is you still need to develop a lifestyle that is healthy. The drug isn't a miracle, it's a band aid. If you do not change your lifestyle, and you discontinue using this drug, you will relapse. This is the same issue many people face when they diet as well, so it is nothing new.

The point of my saying this is to point that out, because a lot of people in this thread seem to think it is totally ok to be on an Ozempic prescription for your entire life. That's horrifying for so many reasons. Others seem to think you take Ozempic until you're "cured" then you just live happily ever after. That's hardly going to be the case for many people who have struggled with weight for their entire lives.

[Wytwwww]

> That's horrifying for so many reasons

Why? AFAIK Ozempic seems to work by "modifying" behaviour and reducing the appeal of overeating and possibly engaging in other addictive behaviours.

It's not some magic pill that you take and then don't actually have to change anything about your lifestyles. It seems similar to antidepressants, ADHD drugs etc. in that way and a lot of people take those for extended periods or even their entire lives.

Besides potential side-effects etc. what's to horrifying about it?

[rixed]

I think we hear you, we should all take more care about bad lifestyle, everybody should exercise regularly and eat healthy food. But to be fair nobody has promoted a bad lifestyle, or said that, given there is this new drug let's care even less.

At the contrary, given the testimonies it sounds like the drug helps people to adopt better habits, no?

[Alupis]

> given the testimonies it sounds like the drug helps people to adopt better habits, no?

No, it helps people live a better lifestyle so long as they remain on this drug. The feeling/impulses are artificially suppressed.

Maybe they come right back if you stop taking the drug. One would hope you can take the drug until in a good place to take over on your own. Time will see - a great experiment is about to take place.

[perching_aix]

They said that this specific effect was largely sustained after stopping with the drug, so... ¯\_(ツ)_/¯

[homebrewer]

Yeah, no. Speaking of "personal discipline" makes it obvious you have never seriously dealt with addicts. Solving it long term is basically impossible for some of us; pretty sure because of how our brains are wired at the physical level. I know all the (popular) science, I discussed it with a good doctor whom I personally know, I know you're supposed to change your habits long-term (and how you're supposed to do it), and I recently lost 15 kgs of weight for the fourth time in my life. The longest time I managed to maintain healthy weight was maybe 3-4 years. If Ozempic (or whatever) actually solves this, I'm ready to go on it for the rest of my life.

I also live in a "vodka belt" and know several alcoholics who tried very hard to maintain their "personal discipline". It's impossible for most of them -- almost all relapse in a few years' time.

[zero-sharp]

I'm one of those people who has repeatedly lost weight by managing food intake. I'm talking about losing over 30 pounds, more than once. It might have been three times. Oh yea and I've kept it off for close to a decade now. I didn't use drugs. At times I used a food scale to manage portions. At times I literally just microwaved broccoli for a snack/meal. I still do it periodically if I'm feeling self-conscious. Does it suck? Yep. Have you guys ever tried those things?

I mention this because I feel like you need somebody who has gone through the experience to actually have credibility in the conversation, to tell you that personal discipline is a real thing that can achieve results. I think it's ridiculous how quickly you dismissed the parent post.

[phil21]

I've gone through that experience multiple times as well. Also over 30lbs each time. Also having kept it off for years, although not quite a decade for my longest period. COVID was my last regression, as it was for many who lost it and maintained it the way we both did.

The GLP-1's are a game changer. I will never lose weight the "white knuckle" way again. I can, and I have proven it to myself and others. It's not complicated as you say - it's quite simple.

It's simply such a giant imposition on your life and mental well being that I am thankful others won't have to go through it as their only option in the future. The sheer chunk it takes out of my executive function means I can't perform nearly as well at other tasks in life. The GLP-1 class of drugs make it trivial in comparison. Like a performance enhancer for a diet.

I also have worked out a hell of a lot more taking Tirzepatide than I ever did counting calories on a food scale. This is because I feel so much better it's not even a comparison - primarily mentally, but also physically due to the other positive side effects the drug has associated with it. Plus I don't feel guilty when I go out with friends to a burger joint - I eat half and feel perfectly satiated, no guilt or "cheat day" required. My energy levels are not comparable. I have much more time in my day available for other activities, such as keeping appointments with my personal trainer at the gym or taking 6 miles of walks per day.

Losing weight and maintaining an active healthy lifestyle doesn't have to "suck" any more.

I feel like you need someone who has gone through both experiences to actually have credibility in this conversation. Willpower isn't a special trait, it's not something to lord over other people.

[zero-sharp]

>Willpower isn't a special trait, it's not something to lord over other people.

I'm not special. Look at his post. He quickly dismisses the idea of personal discipline and asserts that keeping weight off is "basically impossible" in the first two lines. What kind of bullshit is that? Because we don't know what it's like? Well I do.

[phil21]

I worded that poorly and deleted a paragraph below it since it maybe was wandering into places I didn’t want it to.

Reading on the topic of self control and personal discipline, and talking with friends with phds on the subject of addiction medicine changed my mind and perspective on it. I can white knuckle pretty much anything - so can most people if properly motivated. I no longer find that interesting or a point of pride.

When you look into addiction at a deeper level you find people who are sober from their drug of choice, but utterly miserable. This is similar to your description of having to lose and maintain weight through self control. The “it sucks” part. I no longer feel it needs to suck, just like a former alcoholic will tell you how it’s relatively easy to be sober but miserable. The hard part is figuring out how to do it while being happy and not constantly in a battle with yourself. I see what you describe as someone who avoids alcohol by not visiting establishments that serve it and keeping it out of the house.

What I realized is that I don’t need to do that with food - there is help available. I’m now like the former alcoholic that can be around booze without a single thought of taking a sip. It’s an entirely different life experience and I’m not miserable or using a portion of my brain to remain in control.

I have done it both ways and the GLP-1s effectively saved my life. Not literally - but it’s now a life worth living vs just surviving.

I firmly believe these drugs will be as society changing as antibiotics were.

[zero-sharp]

Sure, I'm proud of being able to do it. But it's not an ego/pride thing this in this conversation. I don't know how to say this politely, but I think it's dangerous when our own failures warp our world view with regards to possibilities and truth. "I couldn't do it, so it's impossible" Well maybe? But maybe not.

And you're right. I've had to make lifestyle changes where I avoid certain venues. I don't have fast food. I've had chips maybe a handful of times in the past several years. You can call it a battle, but I wouldn't say I'm miserable on a daily basis. I just got used to it.

Using drugs to improve your quality of life is incredibly valuable. At the same time, I still believe that lifelong dependence to drugs should be avoided. I anticipate negative societal and psychological outcomes in the future. But I have to run.

[theshackleford]

You only know what it’s like for you

You know nothing of anyone else’s experience and pretending otherwise is comical at best.

[zero-sharp]

>You only know what it’s like for you You know nothing of anyone else’s experience and pretending otherwise is comical at best.

Well we're all technically different, so nobody knows what it's like to be you. So literally no advice or data can actually apply to you. Those scientific studies studied other people, right? Cool world we've created.

[mrcrumb1]

At what point are you willing to concede that it might not be feasible for someone that isn't you? If it were 10% harder do you think you would have stuck through it? 50% harder? The numbers say the proportion of people who are successful is very small and there are sure a lot of people who are trying

Edit: I'll add that I've successfully shed 100lbs through discipline before. With the life I currently as caretaker for my son I don't nearly as much room in my life for the mental overhead that sort of change in diet required me in the past.

[zero-sharp]

I can imagine it being a lot harder. There are all sorts of arrangements that either enable or reinforce the types/volume of food that you eat. Still, I think people should try to be aware of their own situation and try to identify those factors that promote weight gain. Even if it was harder, I still think it's inappropriate to say it's "basically impossible" and to deny common sense.

[mrcrumb1]

You talk about common sense and see a sea of people who are trying to lose weight (cdc says about half of adults in the US[1]) at very low success rates (<1% according to this study [2]) and think: they must be ignorant or not trying hard enough. I just don't really see how you could reasonably make that case.

1. https://www.cdc.gov/nchs/products/databriefs/db313.htm#:~:te....

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539812/

[zero-sharp]

I don't really know what to tell you. Again, I understand weight loss can be extremely difficult. What's the conclusion you're trying to get me to accept?

Telling somebody that they're ignorant or not trying hard enough isn't exactly constructive. But neither is digging up studies trying to convince people that they can't achieve some level of fitness. It's science, but somebody else's failure doesn't determine yours. Again, common sense.

You need to examine your life and figure out what factors contribute to your weight gain. Is that already unreasonable?

[nunez]

So I was, also, a firm believer of the "gotta fix your lifestyle" school of thought regarding weight management until I was introduced to the Maintenance Phase podcast (hosted by Aubrey Gordon and Michael Hobbes).

This podcast, and Aubrey's book "What We Don't Talk About When We Talk About Fat," opened my eyes to the fact that many people are just _born_ hungrier than others.

The body will weigh what the body wants to weigh, no matter how many fad diets or drugs you throw at it.

Unfortunately, those whose bodies that don't conform to our modern, eugenicized definition of "healthy" and don't particularly care for working out at all times are dealt a lifelong sentence of social ostracizing, "have you tried this diet" and "calories in, calories out," mostly against their will.

To wit: I can easily scarf down 3000+ calories per day. EASILY. I also know people who struggle to eat 2000 calories per day. I've seen this dynamic with kids in the same family as well.

I'm not saying that it's impossible to make healthier choices. Everyone can benefit from a balanced diet and more exercise. I'm saying that some people will naturally be heavier than others, and that should be okay.

[cam_l]

I figure for some people it will work as a crutch and for some it will work as a prosthetic. I guess that depends on whether you need to take some weight off and allow yourself to heal, or if you are actually missing that appendage. Metaphorically.

[mitjam]

It seems to be more like an orthosis than a crutch as it helps the body to get back into a healthy state instead of replacing it‘s functionality.

[legacynl]

Well that's the whole point of the novelty of this drug.

This drug somehow effects our emotional resilience and/or the strength of our response to emotional decisions and/or the way our brain weighs different options regarding to long-term planing.

Basically instead of your suggestion of not treating drugs as a crutch, and trying hard to restructure your life; this drug basically does exactly that. It gives you the decision making of a person that already did fight the addiction and restructured his life. The only thing then is for the person to actually restructure his life by living his newly well-decisioned life for a while.

That's why it is sometimes bad advice to tell people not to use medicine as a 'crutch'. Just like actual crutches, they actually are meant to be able to temporarily support a person. If somebody needs a 'crutch' they should fully use it, especially if it can help them ultimately solve the need for the crutch.

I get what you're trying to say with the crutch thing, but personally this kind of attitude prevented me from considering medication much earlier. Even though we all feel deep in our hearts that standing by yourself is better than relying on some crutch, nobody cares, and nobody is going to give you any bonuspoints if you make it to your death without any help. If any type of medication or treatment can help you, for the love of all that is good, use it.

[skywhopper]

Did you even read the top level comment here where the person addresses this? Anyway, this sort of moralizing is incredibly inhelpful. Very few people are obese because they lack “discipline”. Certainly they are no less disciplined than most non-obese folks in the world. All sorts of factors play into obesity that have nothing to do with “discipline”: genetics, gut microbiome, local environment, food availability, mental health, physical disease.

There’s some small percentage of people for whom “discipline” is enough, but when people talk like you are with the implicit assumption that all fat people are lazy and immoral due to lack of “discipline”, you only reinforce the misinformation about the causes of obesity and make it harder to address novel causes with novel treatments.

[sheepscreek]

As someone very close to an Ozempic user, I can tell that you have no idea what you’re talking about.

Would we consider insulin a crutch? Think of this as something in the same league. At least that is the case for a good chunk of the target audience.