I don't know, I tend to notice the effect wears off over time. Not sure it's a good idea to consume it permanently. Perhaps a better use would be for short periods to course correct.
Anecdotally, the dose required to maintain a stable weight seems to be lower than the dose required to lose weight. Most people tend to regain some weight when going cold turkey.
The safety profile of the drugs with diabetics, and the health benefits that come from the associated weight loss may make permanent use a net benefit for most people. There appears to be little, if any, "course correction" effect from taking it for short periods of time.
It depends how you define "short period of time". When I started, I lost 40kg in a matter of 5 months. Is that short? If you develop a tolerance to the product, then it doesn't protect you long term from gaining back weight, combined with you losing the option to do a rapid descent.
I am not saying that those variations are great from a health point of view, but they are certainly not as bad as staying obese.
Yeah that's quite short. Healthy weight loss is typically in the ~.5-1 kg/week, while this is an extended period at 2-4x that rate. The effect that will have will largely depend on what your starting weight is, but unless you're starting significantly north of 140kg, it seems like the amount of muscle (and maybe bone density?) loss would be pretty severe.
I have found the same thing, but my experience (YMMV; not recommended that you take my advice!) is that a one week break almost entirely resets it.
I now take a one week break every few months and have not noticed any decline in effects over time.
My suggestion would be to find an endocrinologist that specialises in obesity and these weight loss drugs. They will have dealt with patients who have experienced tolerance and have developed ways to work around it from real life experience. Obviously well-studied protocols with evidence would be preferable, but with how new these drugs are there hasn't been long enough to collect it yet.
I’ve been on it for years, at a lower dose though, the counter action by the body is probably dose dependent so my theory is lower for longer is more sustainable. I think people get attached to the rapid weight loss, coupled with the high expensive, incentivizes higher doses. I take gray market supply and it’s rather cheap.
Also it should be mostly used as an adjunct to strict diet and exercise.
People find they need to increase to higher tolerable doses to ensure their hunger is satiated. But also, you need to increase your protein and fiber intake to maintain that satiation. I tried going up to 10mg and I had such a sick feeling. 5mg I could tolerate. Some people are up 15mg.
According to all the studies, this is absolutely the worst thing that you can do. GLP-1s are revolutionary, but when you go on them, you should intend to stay on them for life. When patients first go on them, they lose both muscle and fat, and when they go off them, they regain just fat, and in many cases they're in a worse situation than they would be if they hadn't gone on them in the first place.
Letting your weight fluctuate up and down in giant swings is, in many ways, harder on the body than just staying at a steady weight, even if it's overweight.
There’s nothing in these drugs that makes you lose more muscle than fat, you don’t lose any more muscle than if you do a regular diet, not even slightly.
Second, the drugs don’t do anything to cause you to gain back mostly fat, and people going off them have more success, not less, than your average person who loses weight rapidly whether through diet or other means.
The average person who is 50lbs overweight because they gained 5lbs a year for a decade will lose all of that weight within 6 months with nearly entirely positive side effects, and if they stop taking it, will regain a bit less than they did before, meaning it would take another decade to get back to where they were. That is unequivocally a huge net positive.
It’s not like Testosterone which does have dramatic negative effects when taken long term and can cause dependency.
It also happens to be extremely effective at reducing bad habits, and yes those habit changes persist after quitting - not perfectly, but surprisingly so. This even works for smoking, drinking, and gambling.
GLP-1 definitely doesn’t prevent you increasing your percentage of total calories from protein, and doing regular resistance exercise. That was the advice from my doctor, and while I’m only 2 months in, weekly scans have not yet shown any significant decrease in lean mass. I don’t see any reason why they would, as long as I continue eating protein and lifting heavy things.
Are the long-term (>20 years) effects of taking GLP-1s really all that well understood? Because that's kind of what you're suggesting here.
Making millions of people dependent on a drug to maintain basic health does not strike me as the best of ideas regardless. I understand why it's a good idea for many from an individual perspective and I'm not judging anyone, but from a societal perspective it does not seem like a reasonable solution.
Why not? We have an overweight and obesity epidemic that has persisted through everything else we've gotten enough political capital to try thus far. The "miracle" drug is the most promising direction we've had in a long time. Whatever possible adverse long term effects have to be (plausibility they actually happen) x (harm they cause) > known harms of being overweight.
The scale of the solution is allowed to match the scale of the problem which is on the order of 2/3 of adults or 200,000,000 people.
Well, don't say you weren't warned when it turns out the miracle is not such a miracle after all and it all massively backfires in a few decades, at which point you're still going to have to actually fix the real underlying causes.
The class of drugs having a 2+ decade negative health effect greater than the negative health effect of obesity over the same period, without any obvious short-to-medium health effect, is likely to be small.
For obese people: probably. The overall health benefits for overweight people are a lot less clear. Being merely overweight (rather than obese) is not that strongly associated with negative health effects.
Look, I hope you're right. If in 20 years time we look back at these comments and no negative effects have manifested then I'll happily buy you a beer to celebrate. Hell, I'll buy you an entire crate of beer. But I think this is one hell of a risk to take.
The obesity trend has happened almost in lockstep with the proliferation of highly processed foods. Butter and animal fats being replaced with low quality, hydrogenated vegetable oils. Cane sugar being replaced with high fructose corn syrup and other highly processed sweeteners. Sodas and sugary juices replacing water. Food like substances with little to no nutritional value designed solely for taste and texture.
These things are calorically dense while containing nothing the body needs to thrive (though the calories will allow it to survive). They are easy to eat in large amounts and leave you feeling hungry. And unfortunately, these are the most affordable and readily available foods in the United States.
I don't think this is a conspiracy. It's just capitalism. These low quality ingredients are cheap and extremely shelf stable. In addition, the government subsidizes the production of this garbage.
So to say obesity has persisted through everything we've tried is a bit backwards. It would be more accurate to say "a percentage of the population has managed to avoid obesity despite all of the things we've tried."
- Make healthier food options more affordable and readily available
- Better nutrition education
- And if you really want to get the government involved, ban the use of some additives, oils, sweeteners, and dyes that allow the creation of many of these highly processed foods
I agree with every word of your analysis and I agree that we've tried basically nothing. But this is why I talked about political capital—every one of your suggestions has been available for the last twenty years and nothing has come of it and the problem continues to get worse. When you say something like, "healthy food should be more affordable and readily available" you'll get a lot of nods of agreement but when it comes time to turn that idea into actual policy everyone gets cold feet. Proposals like price caps for whole foods, subsidies for meals that meet some threshold of healthy, sin taxes for unhealthy foods, outright bans of certain ingredients the votes dry right up.
But people want Ozempic, they will actively seek it out, and in numbers that can actually make a dent in the problem. In a way that people don't seek out healthy alternatives or exercise. Because people don't want to be healthy, they want to be skinny. You can't control people, you can only respond to them and, ya know, whatever works man.
> healthy food should be more affordable and readily available
I think there's more than one way to achieve that. It doesn't have to be bans or subsidies. A lot of it has to do with education and competition. Unfortunately, they are kind of a circular dependency.
- There's so much cheap, highly processed food out there. The companies pay for prime real estate on the shelves and expensive marketing. It is chemically engineered to exploit your pleasure senses when you eat it. That is a hard beast to fight without proper education. And not just the food pyramid, but in depth explanations on why you should avoid it and what to eat instead. There are large groups of the population that have no idea that pop tart or cereal are not a healthy breakfast option.
- If there were more companies creating and promoting healthy, less-processed food options, the price would naturally comedown due to competition. But without the education, these products just do not sell as well. If I gave you some natural peanut butter or almond butter (just almonds or peanuts - 1 ingredient) and I gave you a jar of a more common peanut butter like JIF (sugar + hydrogenated oil for better consistency) and you had no other information at all, you're choosing JIF 10 out of 10 times. It's cheaper, it taste better, and you don't have to stir it. These megacorps prey on that lack of knowledge.
More education -> make better choices when buying -> more companies selling those choices -> cheaper prices on those choices.
Of the measures you suggested, the one I've seen has worked was taxing soda and a direct correlation on less consumption.
The thing with healthy food is not that they are expensive, because they aren't, raw veggies, whole grains, raw chicken, raw pork are not that expensive, especially if you buy in bulk. The problem is that it takes time to cook them, which people may not have, and in general (at least the USA), I feel like people suck at cooking, and don't really have a good food culture of enjoying cooking, like italians do for example.
I believe something similar happened to cigarettes, they are super taxed as well as all the health campaigning around them.
Funnily enough, GLP1 might fix this food production issue as well.
Since urges for junk food and stuff are lowered as well, it would be interesting to map how GLP1 spreads through the population vs junk food consumption.
Matt Levine in his column actually addressed that GLP1 could cause the junk food/alcohol/other addictive stuff industries to lose a lot of money due to less consumption.
It's possible that junk food becomes a niche thing given enough time and GLP1.
The biggest part of that equation is regain part. Most people quit GLP-1s because of costs. Let's fix that.