Ozempic and Wegovy are selected for Medicare's price negotiations
(apnews.com)188 points by geox 6 months ago
188 points by geox 6 months ago
100% agree.
Insurance companies shouldn't get to pick and choose what drugs are in or out.
I was at a company, and Wegovy was covered.
Then randomly I got an email from HR, "Your medication is no longer covered."
The fuck is my insurance company doing telling my HR what medication I'm on? Even if they didn't say it outright, it wouldn't be hard to figure out giving the drugs that came off the list that were paid for that quarter. =P
Going cold turkey on these drugs is hard... like the doctors tell you that once you start taking them, you really aren't supposed to stop taking them. Or if you do, you have to do so gradually.
The drugs mimic the feeling of being satisfied from being full, by overloading your system with a synthetic version of that hormone that makes you feel that way.
Now... imagine going from "my parents used food to control my behavior growing up, and 40 years of bad behavior cemented that conditioning in place, so now it takes a lot of food to make me feel full / content," to "Oh this is nice, thank you drugs! Now I don't have to eat so much!" to "You're on your own, kid! And by the way, now that your body was used to the drugs, virtually no amount of food will make you feel full / content now. Let's see what happens!"
Fucking insurance companies. People are nothing but pre-existing conditions and behavioral patterns. It shouldn't be up to the insurance companies which ones they elect to cover. "Oh, did you think smoking was cool as a kid? Too bad, hope you die from lung cancer!" It just shouldn't be on them to choose.
I know it's a worn-out stereotype to point out, but from an European, I just hope you realize how jarring it sounds that there is a medication that a doctor determined you need, and TWO companies - entities driven by and existing exclusively for profit - are involved in deciding and communicating with each other on whether you will get it or not.
I do think that this should still actively be regarded as scary and abnormal, even if it's the norm for so many people in the US.
Crazy right? Here in europe they just tell me that my medication isn't covered and I have to pay the whole price for it - if I don't like it, I can switch the government and move somewhere else.
IT IS a worn out stereotype. I'm also European and here the doctors are also limited by the national health insurance company on what medication and treatments they can prescribe you due to cost reduction pressure. Their hands are also tied except not by a private corporation but by the government.
Often you'll encounter the infamous "these tests or procedures aren't covered by the national insurance anymore so you'll have to pay out of pocket", or they're covered, but the nearest appointment on the national insurance is 15 months away, at which point you'll either get better or you'll be dead.
My boss recently moved from Germany to the US and was pleasantly surprised how much better the diagnostic, treatment and medication options are for his child who suffers from some rare mental disorder that's basically ignored in Germany by comparison. US seems to always be on the cutting edge of medical research and treatment which of course comes at a cost since research is very expressive.
Ozempic in Europe seems to be cheap, under $100 in many cases. In the US it costs 10x or more that. So as much as I hate to defend insurance companies, it's not just them.
I get this sounds crazy.
But what’s more crazy is the prospect your doctor is motivated by profit.
Does that mean it’s less likely to be true?
I’ve had some interactions with doctors that would chill your soul.
“Here’s some long acting opiates. Take three a day for a month.”
I’ve had doctors offer me antibiotics for the flu.
I’ve been offered surgeries for conditions that don’t require them.
I’ve seen doctors offer a week in the psych hospital over mild distress.
Doctor's office won't make money from prescriptions for a drug, and the pharmaceutical company will sell their drug to whoever will buy it. Both those entities also exist in non-US medication transactions as well, so I'm not sure it's relevant. The point is that the insurer and the employer are two extra middlemen.
You do realize that Euroean countris also decide what drugs and procedures they will cover on their national health plans too? Because you have a more limited set of options, your doctors will know what is covered and only recomend tose options, but it doesn't mean there aren't things that aren't covered.
> Then randomly I got an email from HR, "Your medication is no longer covered."
> The fuck is my insurance company doing telling my HR what medication I'm on?
Isn't this a straightforward HIPAA violation?
No. HIPAA is rarely straightforward, and in any event it’s not uncommon for employers to have some degree of access to claims data. In a case like this I assume the company self-funds the plan.
That's wild; HIPAA mainly exists to protect medical data from employers (among other threat actors) in the first place
I'm 99% sure HIPAA just applies to medical personnel (i.e. nurses, doctors) so they can't outright share private information. Third parties (i.e. your mom or insurance companies) can share it all day without violating HIPAA.
It does not protect your medical data whatsoever.
The insurance company is the face, the villain is your company. Most bigger companies are self insured. These drugs are expensive and blow up plan costs when everyone is on them.
A relative has a self-insured Cigna plan that randomly fucks with you. The company hired another company to argue with them on your behalf. End of the day, Cigna is administering the plan they established.
There are these weight loss companies producing the stuff you should buy it from them cost about $350 a month.
I had some really bad side effects on those meds... was on for over three years when I realized that was causing my gastroparesis and other issues. I felt like I was starving 24/7 for 8 months coming off. I wouldn't ever go back. Throwing up fermented crap nearly daily isn't fun, let alone the pain and nausea.
I partly agree with Kennedy. Ozempic will not make America healthy again. You will have to look into lifestyle choices.
This being said, if you want to go the medication route, there are not patents for medications in India. You could try to obtain it from India: https://dir.indiamart.com/impcat/semaglutide-tablet.html
I am not an MD and this is not medical advise.
QUESTION: If I live in the US in state XZ, what is the best, easiest way (zoom?) to get a valid prescription to order drugs from Mark Cuban? https://www.costplusdrugs.com
> Ozempic will not make America healthy again
Will it help a significant net number of Americans be healthier? If so, then it should be made available to those people.
> You will have to look into lifestyle choices
That's not being questioned, is it? Who doesn't understand that exercise and eating well is better than not exercising and eating garbage all day?
You were obviously not able to understand my argument.
Ozempic treats a problems (overweight) and might prevent problems further down the road (diabetes, high blood pressure, heart problems etc.) with trade offs like higher risk for specific cancers.
It does not treat the underlying cause ob obesity. One that might be highly processed food and Kennedy, whatever you think of him, stated this correctly.
Where in my post do you see that I said that Ozempic should not be made available? Please work on your reading abilities.
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.
Check out local weight-loss and hormone clinics, which often have connections to reliable compounding pharmacies.
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…
Drugs cost what they cost because of R&D, not manufacturing.
Look at how cheap generics are, that's what it costs to actually make and distribute a drug.
The pharma business model is that you spend incredible amounts of money on doing research, identifying promising drugs, doing trials, and overcoming all the regulatory hurdles you need to overcome to get the drugs to market. You then get a 20-year[1] exclusivity deal on your newly-introduced drug through patents, which you use to recoup your costs.
You don't just recoup the costs of inventing this particular drug, but also all the other drugs that seemed promising, had all that money spend on trials, but ended up just a bit too ineffective to ever be sold.
We could abolish the patent system and genericize everything, and that would instantly bring drug prices down massively, but then we wouldn't ever see any new drugs being researched.
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.
Compounded drugs are only legally available when the fda declares there is a shortage. Once novo nordisk shows that they can make enough of it buying compounded versions will be illegal.
Tirzepatide is out of FDA-declared shortage but somehow Semaglutide isn't: https://www.fda.gov/drugs/drug-safety-and-availability/fda-c... But expect it to be soon.
Now Mounjaro is out, Ozempic can only really compete on price, which has to be adding downward pressure
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.
> It would be easier to squeeze Novo
Didn't Novo pretty much tell congress that the only reason why the high price for Ozempic and Wegovy is the US system of middlemen and that lowering it's prices won't necessarily benefit the patients? The CNN reporting from the hearing is pretty interesting[1]. According to Novo Nordisk when they tried lowering the prices of their insulin product, pharmacy benefit managers dropped their products out of coverage, resulting in fewer people having access to the medication overall.
It's not entirely clear that Novo Nordisk is the company that needs to be squeezed.
1) https://edition.cnn.com/2024/09/24/health/ozempic-novo-nordi...
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.
This will just make it impossible for poor countries to get drugs.
Not 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.
That’s because Medicare only covers drugs for approved FDA usage. It’s covered for diabetes but not weight loss. In general this is good policy. It is possible to challenge for some cases but generally that is the rule. It’s a perfectly reasonable way to both control costs and prevent harm.
If the drug manufacturers wanted it to be covered for weight loss there IS a process. File the correct paperwork with the FDA and do the rigorous studies that were don’t for the approved usage.
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/
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.
A little more complicated because in some settings drugs are covered by Medicare part B but generally not if administered yourself at home. Then yes it’s part D and the most out of pocket in Part D from 2025 going forward is $2K.
Also, they do negotiate for a very few drugs and the number is climbing. This was part of the IRA. However only drugs that are FDA approved for your issues are covered.
Before the IRA the government was not allowed to negotiate any drug prices by law which was/is crazy.
What, specifically, wasn’t HHS allowed to do? They weren’t purchasing the drugs.
Certainly the VA can and does negotiate prices for the drugs it buys (that’s one input to the HHS Medicare price-fixing formula), but it has a formulary and is buying drugs for its patients directly.
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.
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.
It wouldn't surprise me if they picked who would be included based on which drugs should be relatively price flexible yet cost a lot. I've noticed that ozempic/wegovy prices have dropped in many markets recently, even price controlled ones, especially compared to Mounjaro, as the latter is seen as more effective and in short supply and has fewer generics available still.
In fact, by introducing new multi-dose versions to different regions, I'm starting to see Mounjaro prices reportedly double for some. The real kicker is that for some brands/doses the price doesn't vary whether you get more or less of the drug - so people end up asking to for a prescription to the highest dose off-label and then split the dose themselves.
For example, you can click the auto-injector pen a fewer number of clicks to measure out a smaller dose than what is normally injected by the pen, then relatively safely save it in the fridge for longer than recommended even without preservatives (some pens have and some don't).
It's frustrating when pricing decisions are made assuming insurance benefits and yet insurance isn't always available, e.g. unemployment. This thinking even applies in places that do regulate drug prices. But hey, you can always sign up for the manufacturer's discount program to get it cheaper, so, win-win right?
As others have pointed out, the drugs on this list go into effect in 2027, which is after the EU semaglutide patents expire (2026), so that might be a pretty compelling reason for semaglutide pricing to be more flexible than tirzepatide.
> The real kicker is that for some brands/doses the price doesn't vary whether you get more or less of the drug - so people end up asking to for a prescription to the highest dose off-label and then split the dose themselves.
FWIW, I'm paying cash buying it directly from Lily, and they charge $400/mo for the 2.5mg dose and $550/mo for the 5mg dose. So, some price differentiation between dose sizes, but not linear.
Yeah. I've seen some split between low vs high doses, where the first two doses cost less than the rest - a cynical take is that they want to make it cheaper to get started knowing they will get you hooked possibly for life, or at least the duration of their patent.
But yes, non-linear by design - a 15mg dose provides 6x the medication but cannot be sold for 6x the price or people will stay on lower doses (or discontinue) rather than going to a higher dose.
Meanwhile it provides 6x the medication. One multi-use 4-week pen has enough to provide 12 weeks of doses at 4-week titration if used off-label. Obviously this is only helpful on low doses.
Important note: I am not a doctor, I don't recommend doing this - in fact, I have not done it myself and will probably not do it in future. I have seen YouTube videos of medical professionals explaining how to dose split weight loss drugs though.
I would highly recommend dose splitting the brand name drug over picking some compounding pharmacy's version of the drug, or worse, buying it off the street. It's crazy though, there are even counterfeit medications in the supply chain sometimes, for example: https://www.fda.gov/drugs/drug-safety-and-availability/fda-w...
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.
The patent on the manufacturing process, not the peptide itself.
Or do both, and let them compete with each other for Medicare's business.
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.
Maybe we should start asking very single tribe/minority across the world if they want to be independent. We would very quickly find that current states are rather fragile conglomerates sometimes holding together by surprisingly weak forces.
I can see few parts in US for example wanting independence under certain conditions. Or US could have given kurds Kurdistan in the middle east with all that crap it caused in past 2 decades, largely stabilizing (big part of) the region. Clearly not policy US cares about much, so lets stop pretending actual wants or needs of Greenland population are anybody's concern here.
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.
If you were a drug company how much money would you spend on developing an Ozempic/Wegovy follow on drug?
Price controls like this are popular because the benefits are easy to see and the costs are distributed and nebulous. Excepting things like the fires in LA which are distributed and obvious.
https://www.vox.com/22553793/gila-monster-lizard-venom-inspired-obesity-drug-semaglutideThe fact that it's up to the insurance provider to choose what medication they cover is so absurd. Your doctor can prescribe medication, and the insurance company can say, "Nah, we choose not to cover that. And we don't cover the generic versions either!"
It's so shitty when you have to change insurance plans, and then get stuck holding the bill for medication that you were taking, but is no longer covered under your new plan -- especially for weight loss drugs that don't seem to be even like 80% covered under any plan you can get on your own.
Insurance should cover everything. Period. Full stop. Just because you change jobs doesn't mean you should ever have to change medications.
Anyway, Free Luigi! =P
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 :-)
So the debate of the flatness of earth is also not settled based on your measurements of internet sentiment?
I mean, it's certainly settled for me. At the same time, I think it would dishonest to insinuate that there are NOT people claiming the Earth is flat on the internet (Honestly, I don't believe that flat-earthers actually believe that--I think they're all trolling).
So, I don't know. I guess I just wanted to chime in to note that I have seen people repeat this crap about calories.
> 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.
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.
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.
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 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.
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 .
All of them are essential as an objective to implement or improve the how.
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.
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
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.
> 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.
Just coming here to say that most of the world (outside the USA) does not need Ozempic at all to be healthy. So maybe this medication is really a luxury.
This isn't true at all.
The obesity epidemic is international.
https://en.wikipedia.org/wiki/List_of_countries_by_obesity_r...
In France it's reimbursed but only if you are diabetic. I'm not sure people talking about it here are diabetic.
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.
I think it's just a case of our ape bodies not being prepared for a modern world where calories are abundant - which is a good thing! It means people don't starve in developed countries.
We wear clothes because we evolved to not have hair. We wear glasses because we spend more time focusing on nearby objects. Some people need GLP-1 agonists because their body makes them consume food it doesn't need, and there's no scarcity to stop them. It's okay to use technology to adapt our bodies to a different world.
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.
It's unclear what the exact cause of the obesity epidemic is. Ultra processed foods are one theory, but not the only one. The US has been down the path before of making public policy from unsettled science, and it led to probably worse food.
Anecdotally, I can say that you absolutely can get quite fat on a diet of abundant "quality", minimally-processed food. It's just a little more expensive. I don't know how the food supply arguments about obesity can land anywhere other than "we should make calories more expensive" or "we should make it illegal to make food taste good", neither of which are remotely politically viable or morally justifiable.
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.
You believe in a lie, most of the insane margins go towards sharholders of private laboratories or insurance companies and other parasites. Very little of it goes toward actual R&D, and the foundational part of it is done by public labs anyway, that are payed for by taxes.
Developing an approved drug costs 1-2 billion dollars.
If you can't recoup that by selling the drug, developing drugs is not sustainable and will not happen. And the US is really the only country where you can sell for substantially more than manufacturing cost.
Ozempic manufacturers do make huge profits now, but that's quite rare. This is a tough industry to make money in.
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.