[rzmmm]

I'm glad we have GLP-1, and I don't think there are really major side effects. But they are ineffective outside clinical trial setting for treating obesity.

It seems to be like treating alcoholism with disulfiram: it's a miracle in clinical trials but in the real world the patients just lower the doses or discontinue treatment after 1-2 years and go back to their old habits.

[cthalupa]

> But they are ineffective outside clinical trial setting for treating obesity.

This is one of the wildest claims I have ever seen on this website.

Would you claim insulin is ineffective outside of clinical trials for treating type 1 diabetes because people have to keep injecting it?

[rzmmm]

I hope it sounds less wild if you think obesity as disease of addiction. Reducing GLP1 dose can increase the enjoyment in eating, so it makes sense why treating obesity with GLP1 is like treating alcoholism with disulfiram: Effective in theory but hard to adhere outside trials.

Type 1 diabetes (or majority of diseases) doesn't involve addiction.

[XorNot]

It is not ineffective outside of clinical trials. All the evidence says that people gain some weight back after they discontinue treatment - which is not a lack of efficacy. But they also usually gain back less then they lost.

https://pmc.ncbi.nlm.nih.gov/articles/PMC12361690/

[rzmmm]

It's kind of two separate topics: 1. Whether patients can adhere to GLP1. 2. Whether discontinuation leads to weight regain.

[JumpCrisscross]

> they are ineffective outside clinical trial setting for treating obesity

This is totally false. I know a number of people who took GLP-1 to treat their obesity and then stopped and have stayed not obese.

[rzmmm]

I can't reply elsewhere so I will reply to this again.

> In my friends, all of them stopped taking GLP-1 drugs within 2 years because all of them lost the weight they wanted to. Out of curiosity, what sources lead you to believe this?

Anecdotes like this are interesting but in medicine they are not sufficient to make factual statements about drugs. In meta-analyses there is weight regain which is steeper as more weight is lost during treatment [1].

The weight regain seems to be rather slow, it can take years until the baseline weight is reached.

[1] https://www.bmj.com/content/392/bmj-2025-085304

[JumpCrisscross]

> In meta-analyses there is weight regain which is steeper as more weight is lost during treatment

What does "steeper" mean? The studies I've seen show a net weight loss, even after regain, for the median patient.

> The weight regain seems to be rather slow, it can take years until the baseline weight is reached

Maybe. Right now, however, the evidence shows solid effects outside clinical settings. Your original statement was wrong–your sources own refute the claim.

If you're arguing the effects in the real world haven't consistently been as ridiculous as they were in clinical trials, sure, you get a brownie point. But broadly speaking, these drugs are terrifically effective, both when taken for life and when taken intermittently.

[stouset]

If only there were a federal administration whose responsibility it was to collect data about food and drugs so we could rely on something more than anecdotes from random strangers on the Internet.

[JumpCrisscross]

Do you have a link to those data showing GLP-1 agonists are ineffective?

[rzmmm]

I emphasize it's like the drug disulfiram: Very effective as long as patients take the full dose, but the lack of real-world efficacy stems from the difficulty in adhering to the treatment.

This study found that 84.4% non-diabetic patients stop taking GLP-1 drugs within two years. https://jamanetwork.com/journals/jamanetworkopen/fullarticle...

[JumpCrisscross]

> the lack of real-world efficacy stems from the difficulty in adhering to the treatment

Do you have a source for this "lack of real-world efficacy"?

> This study found that 84.4% non-diabetic patients stop taking GLP-1 drugs within two years

"With a with a median on-treatment weight change of −2.9%" [1]. Of those who discontinued and experienced "weight gain since discontinuation," they were "associated with an increased likelihood of GLP-1 RA reinitiation."

I'm genuinely struggling to see how this source shows real world inefficacy. In my friends, all of them stopped taking GLP-1 drugs within 2 years because all of them lost the weight they wanted to.

Out of curiosity, what sources lead you to believe this?

> it's like the drug disulfiram

Have clinicians made this connection?

[1] https://jamanetwork.com/journals/jamanetworkopen/fullarticle...

[stouset]

You didn’t come here with data. You came here with anecdotes and asserted that they were conclusive.