I was wondering if there really are no negative long term side effects, could this finally lead to universal healthcare in the US? It seems like a lot of our costs (aside from the obvious medical industrial complex skimming massive profits) comes from health complications related to our obesity epidemic.
> I was wondering if there really are no negative long term side effects
Weight loss via caloric restriction inevitably results in losing lean muscle mass along with body fat.
That's why diet and exercise are paired -- diet loses the weight, and exercise helps to reduce the loss of muscle.
While there's nothing stopping people from pairing Ozempic with exercise to achieve a similar result, I doubt many are. Those ecstatic about the rapid weight loss achieved by these drugs may not be so happy if they were viewing their progress on something that measured their full body composition, rather than just their weight.
These are miracle drugs for people who are morbidly obese and suffering from severe weight-related problems. Those folks can use Ozempic to rapidly lose fat and muscle to get them out of their immediate crisis, and then work to rebuild as much of that lean muscle mass as they can later.
However, people who are just using Ozempic as an easier alternative to diet and exercise are not only taking away supply of this drug from people who really need it to deal with morbid obesity, they're setting themselves up for health problems later in life if enough of their muscle mass has degraded that they start struggling to do everyday activities. Unfortunately, by the time people reach this point, it's unlikely that they'll be able to do anything about other than resort to assistive technology like wheelchairs to regain their mobility.
Yes! GLP-1 agonists came out of nowhere (from a relative timeline perspective), and the positive potential is massive (with some side effects, which may be acceptable in the aggregate compared to the aggregate benefit). What is more likely to occur, based on all available evidence? Humans are going to change their behaviors at scale? Or we're going to use bioengineering to help folks achieve their goals? Don't be mad at the human, they are only human; help the human be a better human via path of least resistance. The human didn't elect to be here, nor exist with the genetic makeup they were given.
If you can build a system to stick to strength training, excellent, but many cannot. I struggle myself sticking to my strength training routine.
> If you can build a system to stick to strength training, excellent, but many cannot. I struggle myself sticking to my strength training routine.
I struggle to just make myself take a daily 1 mile walk. It's not that I can't, it's just that my brain keeps telling me there are better things that I can be doing with my time. Bring on the bioengineering!
I don't know why you're saying that like it's a bad thing.
Clearly, the self-discipline approach just doesn't work. Not on a soceital scale.
Less people dying and people feeling healthier is a good thing. For everyone, you and I included. It also helps that Ozempic also reduce addiction to nicotine, alcohol, and potentially other drugs.
The human condition is complex and it's becoming obvious, to me, the human body and brain were never meant to exist in the kind of society we have. A society of food surplus, sedentary work, and high stressors. Yes, we will adapt - but tools to aid our survival along the way I think could be good.
Not sure on leading to universal healthcare, but it will absolutely impact healthcare. The obvious ones like less heart disease are huge. Then others like fewer knee replacements, and fewer CPAP machines required, the list goes on.
GLP1s have also shown to help with drug and alcohol cravings so there's an entire other area to explore.
I could see where the government simply makes them available to most people.
Buying the stuff from the drug manufacturers is crazy expensive. Over $1000 a month. Going through a compounding phramacy is much cheaper, I pay around $249/month for my script.
You can go even cheaper and buy the peptide yourself from places like peptide sciences and compound it yourself, less than $100 for a 3 months supply, but you increase your risk profile pretty significantly going that route. My partner is a pharmacist and that type of mixing (assuming you do everything correctly) is considered acceptable for "immediate emergency use", not mix up and use for a month or three and keep it in the fridge in the meantime. It's a small risk to be sure, but non-sterile compounding at home is riskier than having a compounding pharmacy do it the right way.
Only one way to know for sure on the long term effects.. However, we do know the long term side effects of obesity - and it is quite costly, by some estimates $200B+/year in the US alone. Not as bad as smoking ($300B+/yr), but entirely preventable regardless.
Most of the data defending the economic harms of obesity are deeply flawed for various reasons, such as:
- Generally low-quality data
- Data that ignores external factors
- Data that doesn't account for behavioral issues like doctors ignoring or minimizing medical complaints made by obese people simply because they're obese
- Data that overemphasizes BMI, an extremely flawed health metric, etc.)
- The criteria for "obesity" itself having changed over the years (based on BMI, of course),
- and others.
There are definitely issues that obesity exacerbates in many people (mobility and cardiovascular), but the overarching purpose behind stats like the ones that you pointed out is to shame people who are (a) naturally hungrier than the average person with a "socially acceptable" frame, while (b) living in car-centric suburbs that discourage things like walking because (c) these suburbs are cheaper than living in cities that have somewhat-functional public transportation because they were created before the car was invented.
No, actually it will make it worse since obesity generally lowers lifetime healthcare spending. This is counterintuitive but we barely spend anything on anyone who’s not a senior, so anything that helps people live longer generally results in higher costs. Dying of heart failure at 50 is comparably cheap to lingering for 10 years in assisted living and bouncing in and out of a hospital for 3 years before the end.
What’s even worse is that from a financial sense, private insurance generally covers the deaths earlier in life, while ozempic (or any other anti-obesity drug) will push a lot more of that spending onto the federal Medicare budget in the long term.
Ozempic is apocalyptic for the Medicare and social security budgets, even if it were free (and Medicare doesn’t cover anyone who’s not a senior anyway). Any drug that broadly extents life would be - we would be equally affected by a free pill that gave everyone another 2 years of life, too. We budgeted based on X number of fat people paying in, but never receiving benefits (via life-expectancy actuarial tables), if you extend life then the payout increases.
If there are no long-term side effects to taking GLP1 agonists (remains to be seen), then I think the following will happen:
- In the short term, the fitness industry (a multi-billion dollar market) and its dependents will crater,
- Smaller, European-like, serving sizes will become the norm, and
- You'll see more and much larger investments in de-alcoholifying beers, wines and spirits.
I do not think this class of drugs will accelerate the adoption of universal healthcare in the US.
For one, the healthcare industry employs a ton of people in towns like Bowling Green. (HCA, the biggest healthcare network in the US, is headquarted in Nashville, TN. Nashville is definitely bigger than Bowling Green, but people that lie in Murfreesboro and other small towns around Nashville work at HCA. Also, many insurance companies are headquartered in the Midwest, where jobs are relatively scant compared to the big coastal cities.) Any policy that ends with "and tens of thousands of jobs will be lost" is political suicide.
Also, the modern healthcare industry in the US was built and designed around private, employer-provided health insurance. Reverse-engineering decades-old business logic and institutional process to fit a government-provided system would be a gigantic and extremely expensive underatking that we would pay for (through taxes).
Fractyl Healthcare is working on a gene therapy targeting this pathway. Chronic maintenance is a temporary hack imho. Long term fix is patching the genetic bug around a miswired reward center.
Magical thinking. Universal healthcare will not happen in the US because for-profit hospital owners and big pharma would lobby against it. US healthcare costs 2x as much per person than other countries but outcomes are worse. Outcomes are not a concern, profits are.
1) There are very serious long term side effects, people are just either unaware or value weight loss enough to tolerate/accept the risks and harms.
2) Your "aside" there is the whole thing though. Obesity drives a lot of costs sure, but Obamacare legislation enshrined health insurance companies and pharmacy benefit managers as essentially government-backed money printing machines, so it's going to take tremendous effort to change any legislation, because they can and will spend literally billions of dollars to keep their monopolistic position.
Severe obesity can take off 10+ years off your life. I would say thats a pretty serious side effect.
Heart disease, diabetes, liver diseases, kidney diseases, gallbladder diseases, pancreas diseases, cancer, sleep issues, fertility issues, sexual health disfunction, mental health problems, to name a few obesity related side effects
>“Either obesity or big pharma’s newest cash cow”?
Pharma is obviously not the only solution to obesity, but the alternatives don't look like they are working very well so might as well give it a shot.
Also whats with the bias against pharma companies? They made/make some very important drugs that save millions of lives. I am not saying they are the good guys, but they certainly have a financial incentive to make stuff that works - and the markets have spoken that a drug that can effectively "cure" obesity is something very very valuable to people.
These seem like criticisms of the US healthcare system and not against pharma companies in general. The wikipedia article you linked even says so:
> The epidemic has been described as a "uniquely American problem". The structure of the US healthcare system, in which people not qualifying for government programs are required to obtain private insurance, favors prescribing drugs over more expensive therapies.
Also, not all pharma companies are criminals like Purdue pharma.
It's pretty awkward to talk about making people form a lifelong addiction to one drug (semaglutide) to counteract the effects of making people form a lifelong addiction to a poison (sugar).
If we spent half the money involved in this scam in removing added sugar from the grocery store shelves we'd beat that epidemic (don't believe me? Look at pictures of people living before the low-fat high carb poisoning in the 80s and 90s)
We already know that people on semaglutides buy less junk food because to them it is less addictive. Less demand, less supply. If anything, this seems like a useful way to smooth the transition to less unhealthy food supply.
People are effectively on these medications permanently or they regain whatever weight they lost on them. So unfortunately the transition isn't so much to healthier diets, but to taking weight-loss drugs forever.
Is this true? Is the rebound effect as high as you think? Because I know 2 people who took it for like 3 years, and while they took some weight back, they're not obese anymore.
The same trend was seen after the 2021 trial, known as Step 1. After 68 weeks of semaglutide injections, the average patient lost more than 15% of their body weight, but within 12 months of treatment ending, patients regained two thirds of their prior weight loss on average. This was associated with a similar level of reversion to the patients' original baselines in some markers of their cardiometabolic health – a category which includes conditions such as diabetes and heart attacks.
Both Rubino and other experts around the world have seen similar patterns when administering GLP-1 drugs in their clinics. "There will be a small proportion of people, 10% maximum, that are able to maintain [all] the weight they've lost," says Alex Miras, a clinical professor of medicine at Ulster University.
To be fair, semaglutide also lowers addiction to nicotine and alcohol, and maybe other drugs.
It seems to me some people have a broken reward system and some... don't. Some people can live life without ever seeking out a vice, and some people are unable to live without a vice.
Probably, from an evolutionary perspective, this made sense. But when you have a surplus of addictive things like sugar, nicotine, and alcohol, combined with mass society-wide manipulation to indulge via advertisement... well this functionality of the human brain makes less sense.
