Ozempic and Wegovy are selected for Medicare's price negotiations
(apnews.com)130 points by geox 17 hours ago
130 points by geox 17 hours ago
When I last looked up the literature, Keto diet was one of the least effective interventions.
That is, if you follow it, I'm sure it works.
But the vast majority of people drop out of keto diets very quickly. So it's lousy advice and an unsuccessful intervention.
It's a bit like saying to a patient "you gotta sacrifice -- you should doing 3 hours a day of cardio". If they do follow through with it, it will work. But the vast majority of people won't be able to maintain doing that.
I started keto in June of 24, lost 50lbs and added a compounded version of Ozempic in November to get through the holiday season with a little extra help. I'm on a fairly low dose, 50mg/week, and it's working tremendously. I've lost another 25lbs up to now and it's about 10x times easier to stick with keto, macro logging, and calorie tracking.
I feel like even with keeping my calories to about 1500/day I'm just fine, and the cravings for sweets and over indulging just aren't in my head.
There are different keto diets.
The epilepsy version is indeed hard to maintain, but can be life changing (increase life quality in epilepsy, bipolar, schizophrenia etc)
The T2D version is way easier. If you studdy it or get a coach, you will know all the pitfalls. But its like therapy, you need to want it yourself. Cant be forced into it.
Very glad to see this, it's worth noting that the compounded semiglutide pricing (think generic, although it's more complicated than that) has been plummeting ever since it was introduced onto the market. We've seen some pretty incredible results and I really hope they get cheap enough to be prescribed more widely.
It is worth noting that Compounded Semaglutide sold in the US is still more expensive than branded Semaglutide sold in other markets, where national price negotiations occur. For example, it can be under $100/month in several European nations.
The US just has no mechanism to control prices. There isn't really competition for specific drugs.
I think it is critical to differentiate price controls and purchasing controls.
Most other markets with state insurance have purchasing controls. That is to say, if the price is too high, the government doesn't buy it.
Very few places have price controls e.g. "products cant be sold for more than X".
The US government is the outlier in that it situationally states it will pay the price no matter the cost.
Reasonable government policy needs to start with putting a price on human life (QALY), and purchasing goods and services that come in under that price. This is how it works in other state insurance systems.
Although you're right, it's a little misleading.
The point is that governments won't pay any price, they usually negotiate a (good) price given their buying power. As you say they may not buy it, but countries that dictate a price (generally) cannot force a company to supply it.
Ultimately it comes down to market forces, even if the market looks very strange, with essentially one buyer and one seller.
Why is it worth noting in this context? It seems like an unrelated observation. The original commenter is clearly in the U.S., so you're telling them something that doesn't help them at all.
The research peptide sites are about the only reasonable places to buy this stuff
Nonsetrile compounding, like you'd do from the peptide sites is only safe for immediate use, and semaglutide is not that way. You mix up a vial and use it for a month or so.
Can you do it? Sure. Are you going to get an infection from it? Probably not. Is it riskier than having a compounding pharmacy doing it the right way? Absolutely, and in a meaningful amount of risk. The type of infections you get from contaminated injections are not something you want to deal with
Except you have to figure out who is actually selling legit stuff at the real dosage.
From a quick look earlier this week that's not easy, and I've dealt with research peptide sites before. I was hoping to try one of the ones that's newer than Semaglutide for my IBS - that worked really well the later half of the week but not the first few days where it made things worse. I don't need to lose weight but I'd love to get that under control better.
I’ve seen these comparisons a lot, but how is it determined that the actual quality of a name brand medicine is the same in the two different markets…?
i.e. The price difference could be reflecting a real qualitative difference such as being produced in different facilities, slightly less pure ingredients, less stringent QC, etc…
It feels very conspiratorial to suggest multinational pharmaceutical companies are creating low quality versions of their own branded drugs in Europe.
We know that these drugs cost roughly $10/dose to produce, and most of that is the auto-injector pens. Hardly seems worth ruining their reputation and getting punished be regulators to save a few dollars on something with a 600-6000% markup.
It would be easier to squeeze Novo if they included Zepbound from Eli Lilly in the mix - we could argue that if we're going to spend unfathomable amounts on these medications we might as well buy the more effective medication from an American company.
There's no need to spend unfathomable amounts. We just need to establish and enforce the favored nation status if they want to sell their drugs here. No drug (least of all US developed drug) should cost more in the US than it does elsewhere. That's what Trump was proposing in his last term. Because the Congress is corrupt AF, that went nowhere, but maybe we could give it another try now that his mandate is much stronger? As things currently are, we're getting robbed.
What about poor countries? If a drug company had to sell drugs for the same price in the US and a country like Sudan, the result would almost certainly be raising the price in Sudan up to US prices rather than lowering the price in the US to Sudan prices.
That would put the drug out of reach of most of the people in those poor countries.
Interesting that they're negotiating semaglutide (Ozempic/Wegovy) but not tirzepatide (Zepbound/Mounjaro). Cynically, maybe a ploy to bolster a US pharma (Lily) as opposed to Danish Novo? I don't know anything about how this program selects drugs to negotiate.
Why is there a specific list? Why don't we just let Medicare negotiate.
Because this isn’t really a “negotiation” as configured by the statute: Medicare doesn’t have a formulary, it doesn’t pay for drugs, the Part D plan providers (some quite large and with their own negotiating heft) do.
It’s a price-setting exercise. Yes, the drug-maker can walk away, but at the cost of massive punitive excise taxes on selling their drug to anyone in the US, not just Medicare Part D plans.
At least the door is cracked open and it's a start.
Of course, Big Pharma will fight to slam it shut again.
That's because it's not really a solution.
It's not a negotiation between two parties with equal power, it's just the government saying "either pay this price or you'll be penalized".
The better solution is to allow parallel trade of pharmaceutical across borders.
It will force countries paying far less to pay more and conversely the US paying less.
> The better solution is to allow parallel trade of pharmaceutical across borders.
No, no it's only a global economy when companies want to manufacture products using slaves in third world countries or they want to outsource programmers and call center employees, but not when consumers want to buy medications or DVDs at the prices they sell for in those same countries or even just want to get higher quality products they refuse to sell you here (https://www.cbsnews.com/news/hershey-sues-shops-importing-br...)
Pat and cynical oversimplifications are bad for discourse, because they suggest that a default angry response is correct and, coincidentally, frees you from having to think harder about anything.
Don't give in!
We can debate the merits of various drug pricing schemes but at the end of the day, prices are set by a small group of interested actors who want the prices to be as high as they possibly can without causing a violet revolt. So call it what you will but let's not pretend there's some deeper, more important meaning to be sussed out here.
https://www.vox.com/22553793/gila-monster-lizard-venom-inspired-obesity-drug-semaglutideNot the lifeline for us fatties.
> Medicare enrollees, however, still won’t be able to access the drugs for obesity under a federal law that prohibits the program from paying for weight loss treatments
Also, you have to be severely ill or elderly to get Medicare. This is for their diabetic treatment.
The US is trying to squeeze the Danes to get hold of Greenland.
It is front page news in dk - leaders from major Danish companies have been called in by the government … novo is the biggest exporter to the us and the most obvious squeeze.
Technically this is done by the Biden admin but obviously coordinated with the incoming Trump admin who has made their attention of using trade to squeeze Denmark in order to get full control of Greenland very clear.
It's not really a "squeeze".
The Danes agreed that Greenland can become independent if supported by a national referendum. Apparently there is a decent amount of interest in that idea.
So the US can come in and say "hey, instead of independent, you could be in a union with the US". There is enough interest in that that it's a serious concern for the Danes.
The Danes aren't concerned because there's enough interest, they're concerned because a violent, hegemonic imperialist superpower run by an unstable authoritarian regime has decided Greenland should be theirs, apparently just because, and historically speaking having something the US wants means your cities get liberated into smoking rubble.
> they're concerned because a violent, hegemonic imperialist superpower
To be fair we learned it from watching Dad (England).
> unstable authoritarian regime
How is it unstable?
> apparently just because
Territorial waters and exclusive economic zone claims grant amazing access to the arctic.
> something the US wants
It's really just the moneyed interests inside of it. China and Russia seem to have the same bent for the same reasons. It was recently unusual in Iraq since the federal corruption had risen to such a level, enabled by 9/11, that lackies for these interests somehow found themselves directly employed by government.
I prefer nuance over hyperbole.
This particular thing was always in the works but we should ask the Greenlanders where they’d rather be and pay them if they choose otherwise than us. The land is too strategic and Denmark cannot hold it usefully.
There is no functional difference in likely effectiveness between the present EU, of which Denmark is a member state, or the present US holding Greenland against a Russian attack. The Russian attack would be smashed either way.
That seems unlikely. Peace in Europe exists because the United States threatens its absence with a fist by its heart. America had to save Europe from destroying itself once and now the US has pacified Europe by placing its troops and weapons there lest the nations turn on each other in uncivilized violence again. And then again, when they dragged their feet, the US had to blow up their gas pipelines pour encourager les autres. The continent is incapable of protecting its own shipping lanes without US support and NATO acts as a deterrent solely because the US is in it. Take it out and the Europeans will spend the majority of their time telling everyone how it's not a big deal that Ukraine will fall to Russia, and Poland, and so on.
What you're writing has very little to do with reality.
When we recently made agreements with the US to allow them to store some of their weapons here in case of a crisis we did this, the mutual concern was Russia. The weapons stored are presumably also of types useful for dealing with Russia.
We Europeans have nuclear weapons as well, so there's no possibility of the US preventing any uncivilized violence-- we do in fact have very real autonomy.
The US probably did blow up Nordstream; but this is very simply that it's easy to make the right choice when you're not paying for it, so this isn't some example of better American morality. Poland has a formal alliance with us and we would have to defend them by all means at our disposal.
But, taking into account the sale of oil fund assets by Azerbaijan and the corresponding increase in military spending I assume more pipelines will soon have to be blown up, only this time it'll be the UK who adds its complaints to those of Germany and the other gas dependent countries. The Armenians might even have to do it themselves, rather than relying on help from others.
The cynic in me thinks they are only going for Semaglutide because the patent expires in several places in 2026, tirzepatide has another ten years.
Or do both, and let them compete with each other for Medicare's business.
The USA is a racket cubed. https://www.healthsystemtracker.org/brief/prices-of-drugs-fo...
The pharmacies are also in on it https://pmc.ncbi.nlm.nih.gov/articles/PMC11147645/
my favorite part of ozempic is that it settled the debate on calorie reduction.
The debate has never been "will consuming less calories than you expend make you lose weight" -- the debate has been "will just telling people to consume less calories, patting yourself on the back and calling it a day make them lose weight."
The latter was settled in a 2023 cohort study that showed doing is completely ineffective. [1]
There's been tons of data on this. The scientific consensus has been pretty clear for a hundred years, but nobody wanted to listen. Probably in part because there was no good solution before.
> The debate has never been "will consuming less calories than you expend make you lose weight"
Maybe the debate amongst actual doctors and researchers. But, the debate amongst dummies on the internet (social media) CERTAINLY had people arguing that it was somehow about more than the number of calories in and out.
We should probably stop treating debates among "dummies on the internet" as anything other than noise that muddies up the conversation.
Edit: to be clear, this also applies to comment sections on HN :-)
No, there are definitely lots of people that straight up claim that CICO is a myth, some magic force makes some calories turn into fat or not turn into fat. Totally aside from the "'eat less' is hard advice to take" crowd (which is true). That former group has been proven incorrect.
I dont think anyone has agued that the follow through is the hard part.
The whole debate seems like people violently agreeing with each other aside from some fringe idiots that dont believe in thermodynamics.
> The debate has never been "will consuming less calories than you expend make you lose weight"
If you missed the whole "calories in, calories out" debate, consider yourself lucky. The comment above isn't helpful, but there really was a period of time where the topic du jour among health influencers was debating that calories didn't explain weight gain or loss. It played into the popular idea that blame for the obesity epidemic rested squarely on the food industry and "chemicals" in our food.
At one point, I had a podcast-obsessed coworker who tried to tell us all that even when he ate 1000 calories per day he couldn't lose weight. He had a long list of influencers and podcasters who supported this claim.
The CICO debate was especially popular among influencers pushing their own diet. Debating CICO was a convenient gateway to selling people your special diet that supposedly avoids the "bad" calories and replaces them with "good" calories, making you lose weight.
Ah, gotcha.
For what it's worth CICO sucks because (1) nobody can stick to it, ever (2) humans are awful at estimating their calories in, studies show only 1/5 of people can properly estimate the calorie content of their food [1] and (3) your metabolism slows down in response to, specifically, caloric restriction diets and your hunger rises which makes it difficult to estimate your calories out without indirect calorimetry.
Yes, CICO works in a lab, and for some weird people. It's a matter of thermodynamics. However you are a far more complex system than a coal powered furnace. And yes certain types of food will be more or less satiating and may influence the amount of total calories you consume. It's really really hard to overeat if you just eat lean protein, for instance.
CICO is, in practice, a tool that is roughly impossible for most people to leverage to lose a meaningful amount of weight and keep it off.
Which brings us back to the difference between maintaining a persistent caloric deficit -- and instructing people to do so.
I'm still sympathetic to those arguments. Humans have, for at least the last several million years, been taught in the evolutionary sense to never let a calorie go uneaten. Too many famines. "Just don't do that thing that every gene in your body screams at you to do, and feel miserable for it" isn't really good advice, and isn't all that insightful. One can't even necessarily make judgements about how many calories they themselves can eat based on what they see other people around them eating. "That other person stays skinny, and I'm eating about the same amount as them" is not an on-the-surface unreasonable assumption... but it doesn't work, even if you could eliminate human misperceptions.
>At one point, I had a podcast-obsessed coworker who tried to tell us all that even when he ate 1000 calories per day he couldn't lose weight. He had a long list of influencers and podcasters who supported this claim.
The week after Thanksgiving, I had a heart attack (age 50). I was in the CICU for nearly a week before they let me go home. On the day I was released, they sent a nutritionist in to tell me that I shouldn't try to eat one meal a day, that I really needed to be eating 3 meals a day, and to eat bread at least for two of those (or other carbs). Don't eat butter, eat margarine though. Yadda yadda. This was what, 8 weeks ago? Not 1962 in any event.
Do you know what 1000 calories looks like spread across 3 meals? Or how long you have to run on a treadmill to make up 300 calories if you bump that up to 1300? Or that, even sitting in an office chair every day, I can't lose weight (of any significance) at caloric intake much above that? I'm willing to concede that any problems I'm having here are in my own head, that I can't change my behavior or habits or whatever (to literally save my own life), but this isn't the sort of problem that can be handled by any but the most godlike of willpowers (which I do not have, if that doesn't go without saying). Right now, I probably need to be eating just one meal every other day, as I'm not really gaining any weight back but I'm not losing much either. My meal, such as it is, is a salad that fits in a small bowl (less than 2 cups of lettuce and uncooked vegetables). None of this is helped by knowing that people who are so-called medical professionals are giving me is absolute horseshit.
The truth of the matter is that we are adapted to eat only once every few days, and for even that meal to be meager and less than appetizing. But we live in a world that has mastered abundance and flavor, and uses marketing science to constantly try to get us to to buy all that. When you tell people "just eat less", really you're just doing the r/fatpeoplehate but in a covert way where you don't have to feel like an asshole. We (all of us, sympathizers, haters, acceptance activists) turn this into a morality tale, and can't think about this rationally. For anyone that cares, I wear 33" jeans, but I probably need to drop another 20-25lbs realistically.
PS Just giggled thinking about what it would mean to the US economy if suddenly every adult over the age of 28 started eating one small meal every 2-3 days... even our stock market is arrayed against us.
My meal, such as it is, is a salad that fits in a small bowl (less than 2 cups of lettuce and uncooked vegetables). None of this is helped by knowing that people who are so-called medical professionals are giving me is absolute horseshit.
Yup welcome to the bad genetics club. Those calculators of TDEE vs weight/height are only an approximation. Many such cases of people who fall well-below those estimates. Many people need far less food than commonly assumed.
PS Just giggled thinking about what it would mean to the US economy if suddenly every adult over the age of 28 started eating one small meal every 2-3 days... even our stock market is arrayed against us.
Not just from less consumption, but also reduced productivity--people being tired all the time, irritable, unable to work as effectively or unable to concentrate. This is why tech companies put so much emphasis on food and having cafeterias stocked with snacks or catering.
Some people have such bad metabolism that they have to east tiny amounts of food to not gain weight ,way lower than predicted by calculators and controlling for weight. Ozempic makes this easier. Yeah, you're right that overeating is the problem, but this threshold is low for those with crap genetics.
I don't think it was ever really a debate.
"Reduce calories" is about as useful as "exercise more", "sit less", "drink less", etc, etc. All are obviously good, but for various reasons it can be hard for people to achieve them.
GLP-1's basically take the "how" out of the equation. Take this drug, eat less without fighting your own desires.
All of them are essential as an objective to implement or improve the how.
Yes, "eat less" is the answer, but this is harder to do yeah if your metabolism is slow or always being hungry. this drugs makes it easier to eat less and hence lose weight .
there are plenty of people who claim that no amount of calorie reduction results in weight loss. Often it's people who are claiming to eat starvation amounts of food while gaining weight. Of course researchers have known it was delusional, but the belief persisted in pop culture. Ozempic is putting that to rest.
this is a case where more personal / colloquial / folk evidence was needed to convince people.
I doubt that the people who believe that obese people somehow violate the first law of thermodynamics will be convinced to change their mind now, just because Ozempic became a thing. They will probably just misunderstand how the drug works.
Unfortunately it didn’t. Seems to have actually emboldened the “CICO isn’t a thing” crowd even more.
The amount of woo-woo “science” in laymen communities on the subject is utterly astounding considering the evidence directly in front of them. Check out the various subreddits for a casual glimpse - anyone saying stuff like “the primary method of action is eating less” is downvoted and the woo woo “metabolism” or “hormones” stuff is upvoted and celebrated.
In the end I think there is a lot of weird guilt around overeating I never really understood existed before. I lost 100lbs using Mounjaro but never once thought it was anything other than me eating too much and moving too little while I was obese. It’s just a lot of damn work and willpower for me to change that. Tirzepatide was simply a performance enhancing drug for my diet that finally put me over escape velocity to make lifestyle changes that so far have stuck for a couple years now.
Ozempic tends to change not just the total number of calories but also the timing and the cravings for shitty food.
Calories in / calories used is NOT a complete model because different foods can have different caloric retention. The most extreme example being corn that comes out entirely undigested. Further, shittier foods that the body craves most are also the least satiating over the longer term.
Reducing calories is three or four steps removed from the actual problem. Like arguing the problem is organ failure when in the first order problem is that you got shot. You have to deal with the wound; and you have to deal with the blood loss. That will, in turn, address the organ failure.
Was it ever really a debate? There’s tons of experimental evidence that shows calorie reduction leads to weight loss, even without pharmaceuticals. The Ozempic data can be explained simply by this factor. There doesn’t seem to be enough data fluctuation between the two sets to indicate a significant set of unknown variables impacting the data.
yeah, but do ozempic et al only rely on calorie reduction? i find it hard to believe that hormones only affect one thing in isolation. it may be doing something like a) suppressing appetite to reduce caloric intake AND b) shielding against a lowered metabolism due to calorie restriction.
It's not even appetite per se; GLP-1s regulate blood sugar for more sustained levels, which is upstream of appetite. Safe to say that blood sugar impacts a bunch of other stuff too.
I think it confers some metabolic boost, but more data is needed
> settled the debate on calorie reduction.
Really? Because GLP1s reduce hunger and food cravings, less of those means less eating, less eating means less calories. The drug just makes people involuntarily fast, it has no thermogenic of lipolysis abilities.
I find something really gross and dystopian about the idea of Ozempic. Developing the willpower to resist short-term gratification, and the ability to make long-term decisions about your diet and health are some of the most important ingredients to living a good life. The idea of letting a drug do the thinking for you because you just can't trust yourself really horrifies me.
Respectfully, have you ever had anything in your life that you have struggled desperately with, and needed help? Anything at all that might give you a little empathy on the topic?
I was obese twenty years ago, and lost the weight via diet and exercise. Keeping that weight off is the single hardest thing I have ever done, and a battle I still have to consciously fight every single day. Doing so causes me a great deal of pain and frustration, and I know that I'm someone who is right on the edge of not being able to control my weight. Why should it be that difficult? So that I can pass some kind of purity test?
The fact is that the food we eat has evolved over time, and is too hard to resist overconsuming for a large fraction of our population. If we can create more addictive food, why not create antidotes? If we could easily treat alcohol addiction with a pill, would we tell alcoholics to just apply willpower instead? Why would we want people to suffer like that?
You just don't understand how food addiction works. Going from 34 BMI to 28 (I'm at 26 now) was the hardest thing I ever done, and I had money, great friends, a great family and a doctor that followed me twice a month.
Willpower is not a muscle, it's a well that fill doing what you enjoy, and clear when used. During my diet, my work ethic was at the bottom, and I couldn't force myself to go out meet new people.
Now that I have a healthier weight and stopped dieting hard (I'm still constantly hungry, but now it's my life), I'm a great coworker, I met a lot of people, made life-changing decisions and I have a lot of willpower left to do all the little things right. If I had a drug that helped me control my appetite at the time, i would have taken it.
> Willpower is not a muscle, it's a well that fill doing what you enjoy, and clear when used.
I won't negate your experience, since this is such a personal thing, and it's not like we have a rigorous scientific understanding of these things. But to me, willpower does feel like a trainable thing. Doing hard things seems to make me better at doing other hard things. Limiting my TV makes me less likely to compulsively eat later. Working out hard makes me less likely to lie in bed scrolling on my phone. Doing hard coursework makes me more focused at work.
The caveat is that these changes seem to happen pretty gradually, and the gains can be lost pretty easily, just like with muscle.
But being in a perpetual caloric deficit can be pretty rough and can definitely sap your energy. Glad you found your way to a healthier weight.
How have fat people gotten thinner without those meds up until now, then? Was their addiction not as strong as yours, as you seem to imply? They just didn't "understand"? Look, I went from being an absolute fucking fatass to 8% body fat out of willpower alone when I was 17. It took a lot, namely destroying every bad habit I upheld for years regarding food and exercise, but I wanted to do it bad enough, so I did. It was a really extreme and sudden change of mindset, like a flip of a switch, actually, because I had enough of the bullying and lack of self confidence. One day I just got mad enough and changed my whole life.
> How have fat people gotten thinner without those meds up until now, then?
Mostly, they haven't. You and I are outliers.
The population-level data tells us that overweight people are mostly unable to control their weight in the face of modern food. That being the case, it doesn't seem unreasonable to look for alternative solutions to the failed option of just telling people to eat less.
edit: regarding strength of addiction - I mean, of course, isn't it profoundly obvious that different people will have different strengths of addiction? I can drink without the slightest inclination to excess, while others are broken alcoholics. My grandfather didn't have the slightest interest in food beyond the calories needed to survive, while I have to fight every day to eat well.
Exactly, regarding strengths of addiction. I don't feel morally superior about not being an alcoholic... it's pretty clear that my experience of alcohol is just wildly different from some of my friends. I enjoy alcohol fine, but I never feel like I'm exercising willpower when I choose to stop after 1-2 drinks.
the guy you're replying to also lost weight without the drugs... he says he would have taken them if they'd been available.
> You just don't understand how food addiction works.
Would you concede that some foods are more addictive than others? Doesn't this suggest other remedies like food regulations, at the very least, should be deployed in concert with seeming "miracle drugs" like GLP-1 agonists?
Can't speak for the original commenter, but I would not concede that, because experiencing semaglutide has convinced me it's not true. The feeling I can now clearly recognize as something like "food addiction" disappeared uniformly for everything from Brussels sprouts to donuts.
There is multiple effects fighting against people who want to lose weight:
* habits. often times, obese people use food as a stress response, as a reward, etc. this then makes them relapse.
* "target weight" of the body. there is a memory effect where once you have built up fat tissue, your body wants you to return to that weight. In other words, it's not just the first step that's hard, but all the steps thereafter. Relapse is easy.
* fat tissue makes you more hungry.
* environmental issues, like unwalkable cities, an entire industry putting chemicals into foods that make you addicted to them, its excessive marketing, missing availability of non-processed foods (large percentage of US population lives in food deserts), etc.
It's not just discipline of the individual holding them back.
It's also unlike most addictions, you have to eat few times a day if you don't want to die... alcohol, drugs, gambling are not required to survive, eating is.
I took compounded Mounjaro for two months. It was like a jolt to the system and got me back on track. I learned how to eat better and alter what I eat plus tracking it. Started walking and going to the gym. Started with 7k steps and now easily over 12k a day on average. I don’t drink soda and if I do it js Coke Zero, Pepsi Zero or Diet Coke. We just don’t buy it. I didn’t know about maximizing my protein and fiber.
It wasn’t short term at all like you say. Something was seriously wrong.
It’s everything though - if it was that easy to just start doing it then people would.
I needed a jolt and impetus to get better. I was depressed, worryful, everything.
I have lost 40 lb. I went from 255 to 229 with the assistance of Mounjaro. I stopped taking it but kept up with the regimen. I am now down to 214.
Some people who take it don’t do it right, they still eat crap and so those are the people who rebound or think they need to go up to 15. I was taking 2.5 then 5 when I stopped.
Yea it is willpower and discipline. Being on the medicine as an assistant along with a lot of research spurred by the community such as maximizing protein, fiber and water intake to become satiated was all that did it with exercise.
Consider the fact that, if a drug can make you skinny, perhaps a drug can also make you fat. Or, even your own body can make you fat. Sometimes, what we think are our choices, have more to do with our biology and environment.
Just like you can't will yourself to be healthy if you are sick with the Flu. Some people can't just will themselves to be skinny. This is why we have drugs and treatments, because our bodies are not perfect machines that work the way we want them to.
> with our biology and environment.
Our biology hasn't changed much in recent years. Our environment has. So has our obesity levels. I mean, it's an "environment" that has "super size," as a default option.
Do you object to pencil and paper because people write down reminders because their memory isn't good enough to remember everything?
I do make good decisions and put in 10k steps everyday, which according to my stepcounter puts me in the top 5% for people my age. I've managed to slow my progression into the abyss; but I'm still going there.
Truth be told, my body can't effectively lose and maintain weight unless I'm eating a strict 1500 calories and replacing the walking with an hour long run each day. I know this because I've tried it and managed to maintain it for 6-months. It was a herculean effort and despite the results I paid a toll both physically and mentally. This isn't to say that the laws of thermodynamics don't apply to me; but my body will fight against them harder than most.
(I believe I would be a good candidate for these drugs. The only thing stopping me is the thought of having to be on them indefinitely.)
I don’t understand why the USA doesn’t just ban processed foods? I know USA only cares about profit but come on. Other countries don’t eat like we do.
Just flip it around: what if there were a drug that made people fat? Is it an insufficient willpower issue then? Willpower works for some, but the drugs make it easier.
I understand that those drugs are very useful, but in a way it feels for me like ancient Rome with its orgies and vomit inducing so they can eat more. At least looking at USA from Europe. The problem of sugar content, dietary choices and portion sizes remains. It is similar to gas guzzling cars.
Sorry if it seems not empathic enough, that was not my intention. I know that the use of such drugs may be medically necessary.
Edit: To serious answers: I was wrong, I stay corrected.
> I understand that those drugs are very useful, but in a way it feels for me like ancient Rome with its orgies and vomit inducing so they can eat more.
https://en.wikipedia.org/wiki/List_of_common_misconceptions
"Wealthy Ancient Romans did not use rooms called vomitoria to purge food during meals so they could continue eating and vomiting was not a regular part of Roman dining customs. A vomitorium of an amphitheatre or stadium was a passageway allowing quick exit at the end of an event."
"Two of the most notable examples from Ancient Rome center on the emperors Vitellius and Claudius who were notorious for their binge eating and purging practices. Historian Suetonius writes that “Above all, however, he [Vitellius] was … always having at least three feasts, sometimes four in a day — breakfast, lunch, dinner, and a drinking party — and easily finding capacity for it all through regular vomiting” (Suetonius, Vit, 13) [1]. Similarly, the emperor Claudius was infamous for never leaving a meal until overfed, after which a feather was placed in his throat to stimulate his gag reflex (Suetonius, Claud, 33) [2]. In his writing, Suetonius takes on a disapproving tone when describing the eating habits of Claudius and Vitellius, as highlighted by the use of words such as “luxury,” “cruelty,” and “stuffed”(Crichton, 204). This tone indicates that although binge eating and purging were accepted, albeit uncommon in Roman culture, the practices were negatively associated with gluttony and a lack of self-control. "
~ Ancient Hunger, Modern World by Solia Valentine
Via: https://escholarship.org/content/qt2594j40t/qt2594j40t_noSpl...
[1]: https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext... [2]: https://www.perseus.tufts.edu/hopper/text?doc=Perseus:abo:ph...
Hit pieces aren't a modern invention.
https://blog.oup.com/2014/11/roman-emperor-tiberius-capri-su...
> Stories of this kind were part of the common currency of Roman political discourse. Suetonius devotes similar space to the sexual transgressions of Caligula, Nero, and Domitian – such behaviour is to be expected of a tyrant. The remoteness of the emperor’s residence itself must have fuelled the most lurid imaginations back in Rome.
Suetonius was born in 69 AD; Vitellius was emperor in 69 AD and Claudius was emperor from 41-54. They weren't contemporaries.
If you think that's bad just wait until you hear what Hillary was doing in that pizzeria basement!
The Romans were no stranger to just making shit up.
Purely from a cost perspective - imagine a 79 year old grandma.
Heavily overweight. She is already partially immobile. Pre-diabetic. She may have other conditions, further complicated by her weight. She's on a fixed income.
Which is more probable -
1) A dietary intervention that she attends once a week that revamps her entire daily consumption (but remember, she's on a fixed income) along with some intense exercise?
or
2) put her on a single medication that changes her tastes for sugary and starchy foods, reduces her cravings, reduces inflammation, and in turn, will make her lighter and more mobile.
It is a no-brainer for Medicare. This will save so many downstream costs.
To add, they actually prevent you from eating some bad foods too. At least in the compound versions that i know people on.
If they eat a lot of foods (some even good), their gastro issues are significant. So not only has it had substantial mental shifts around what they desire, but a bunch of foods are just not edible even if they wanted them anyway.
From what I understand these medications make you want to eat less in the first place, so it's not quite the same thing.
Yup. The people i know on this didn't even get it for the weight, but the behavior changes. This isn't letting them eat the same stuff and lose weight, this is changing what they want to eat.
They went from ADHD driven boredom eaters to not even thinking about food.
I have ADHD and the dopamine dysregulation really makes it hard to avoid eating things with sugar in it.
The semaglutide really helps, I'm on a lower dose of it 0.5mg/week and have been on it for over a year. I've lost a fair bit of weight but that has stabilized. It costs me ~$30 per month and I save much more than that on eating less food.
For me it really helps with chronic fatigue which was destroying my life. I think it really is a wonder drug for people with auto-immune issues. I was insanely sensitive to it when I started which I think is common with people with ADHD so I started really low and only very slowly worked my way up.
The ancient Rome vomiting thing is a myth. https://en.m.wikipedia.org/wiki/Vomitorium
My understanding is that the drugs keeps you from wanting to eat as much.
If everyone 30+ bmi can get to 30 for “free” (not sure where the subsidizing stops, for me it’s free if I’m over 30 bmi), that’s just too tantalizing to pass up, even if the moral applies.
At least it takes a load off one problem (obesity related diseases). Could it actually exacerbate unethical farming even more or lead to even worse outcomes? Hope not.
"load off" groan...
I've read that obesity and smoking are net positives for the cost of state-supplied medical care because it causes people to die younger and quicker.
My real concern is what you stated: the by treating some of the symptoms of a toxic food system we will avoid treating the causes (in the USA, we would do well to take soft drinks out of schools and treat adding sugar to foods as an sin to be taxed)
You may be wrong in the specifics of the mechanism of calorie reduction (reducing appetite vs reducing calorific absorption), but not in the general philosophy.
The obesity crisis (specifically in the US, but elsewhere too) has been caused by bad food essentially - food that is not only nutrient deficient, but also engineered to be as cheap as possible and addictive as possible to get you to buy more of it.
As ever, the US is attempting to fix the symptoms, as opposed to the underlying cause, following the general idea of 'if everyone does what they like, things will turn out ok (somehow)'.
Probably negative health implications of these drugs will surface as people become habituated, and we can continue to shake our heads and wonder how it all went so wrong over there.
One of the mechanisms of operation is to reduce your desire to eat.
Taking a step back, obesity actually is an adaptation. When food is scarce, you want your body to extract and store every gram of nutrition it can get. And that would provide a distinct advantage when you're trying to reproduce.
The thing is, GLPs don't only suppress eating. There are plenty of substances out there that can do that...and there are plenty of people who can't lose weight by starving themselves, because your body will try to maintain its weight.
The question should be "why isn't everyone obese, given the huge amount of calories available to humans?"
> obesity actually is an adaptation
Obesity is not an adaptation. It's a total aberration. Storing energy in the form of fat is an adaptation. Becoming obese is overloading your entire system.
> why isn't everyone obese
Well... they sure are trying...
The tradeoff with these price controls is that they make current medications cheaper, but make future medications substantially less profitable, making them less likely to be developed.
It's rare to see this mentioned, so I'm trying to build awareness.
My ACA insurance (because I was unemployed) covered Rybelsus (pill form, which is a much higher dose due to lack of absorption through the stomach), then in like October or November they said "nah" and said "go to Ozempic" I had just completed my first two sets of increases before the final uppage to be on the stable dose, when insurance said "Nah." So my doc RX'd Trulicity to see if they would cover that, which, for some reason they also didn't. I haven't had the time or energy during the holidays to deal with it, so now I'm dealing with increased hunger from going cold turkey off these things all because of bullshit micromanagement from shitty insurance companies on the market place.
If this makes it better and easier for companies to actually pay out for this I am 100% for it, there should not be a constant jerking about for what is or isn't paid. Also - this wasn't for weightloss (which I assume would have been Wegovy approved), this was for diabetes, and it was under control with Rybelsus, and I assume Ozempic, though we were still in the process of building up to it (I was on max dose of Rybelsus and I'm pretty sure I needed the max Ozempic as well). If they had given a reason for the denial it'd be one thing but it was just a blanket denial.
I just hope this makes it easier for folks who need it to be able to obtain it.