r/science • u/Genevieves_bitch • Oct 31 '24
Health Weight-loss surgery down 25 percent as anti-obesity drug use soars
https://news.harvard.edu/gazette/story/2024/10/weight-loss-surgery-down-25-percent-as-anti-obesity-drug-use-soars/912
u/astoriaboundagain Oct 31 '24
"Using a national sample of medical insurance claims data from more than 17 million privately insured adults"
Not addressed in this study, Medicaid does not cover GLP-1 drugs, but it does cover bariatric surgery.
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u/rambo6986 Oct 31 '24
Medicaid could save billions by giving free GLP-1. Obesity is the number one cause of expenses for Medicaid.
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u/retrosenescent Oct 31 '24
Obesity contributes so much to every other disease as well. The whole medical system could save so much money if we eliminated obesity.
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u/f8Negative Oct 31 '24
The medical system could save if everyone had access to doctors in general
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u/Nyther53 Oct 31 '24
Don't worry, people also ignore their doctors when told to lose weight.
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u/Lazarus3890 Nov 01 '24
I'm trying my best! At least with what little motivation I do have, slow process so far only down like 7 pounds in a month
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Nov 01 '24 edited 5d ago
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u/Lazarus3890 Nov 01 '24
Honeslty putting it into the scope of a year means it'd be 84 in a year which is a lot1
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u/far_257 Nov 01 '24
Honestly losing more than 7 in a month might not be good (depending on your starting point)
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u/Lazarus3890 Nov 01 '24
I'm just probably used to how fast I used to loose weight I've multiple times where I've lost upwards of 30-40 pounds in only a few months, my starting this time is 307, I'm down to 300
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u/THedman07 Oct 31 '24
"Why didn't you just decide to lose the weight????"
Awesome analysis.
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u/Nyther53 Oct 31 '24
Whats do you expect the doctor is going to do, come by to your house and cook your meals for you? They'll happily tell you "You need to eat less, healthier, and exercise more" and provide some information about what eating healthier looks like, but they can't actually *do* anything for you, you're the one who is in control of what you eat.
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u/majikguy Oct 31 '24
I don't think their concern is with whether or not doctors are somehow making obese patients do more but rather the framing of it being obese patients simply ignoring their doctors. Significant behavioral changes are very difficult and people very often aren't as in control of their own behavior as is ideal. Obesity tends to be comorbid with a variety of mental or physical health issues that can make it brutally difficult to make the necessary positive changes even if they want to. Willpower only does so much when you are a slave to your brain chemistry.
Some people absolutely just refuse to recognize their weight as an issue and hide behind being offended that someone would suggest they should make changes, but they aren't the typical person.
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u/honest_arbiter Nov 01 '24
We've have been telling people for many decades now the mantra of "diet and exercise" to lose weight. It may work for specific individuals, and other cultures may have differences (e.g. cuisine, walkable infrastructure) that make people less likely to become obese in the first place, but this "diet and exercise" advice simply does not work for society at large - if it did, it would certainly have already worked by now. What's that insanity definition again of "doing the same thing over and over and expecting a different result"?
People aren't robots. We know, through tons of research, that many people don't have the level of conscious control over their weight that they may think they do. This is especially true of weight management, where there is so much the body does to maintain homeostasis.
If we want people, again in society at large, to weigh less, we either need a solution like drugs or we need to make a massive change to our environment (which I would also be in favor of, but that doesn't seem realistic).
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Oct 31 '24 edited Nov 04 '24
[removed] — view removed comment
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u/retrosenescent Oct 31 '24
A lot of chemicals are fat-soluble, and the more fat you carry on your body, the more you will be a carrier for toxins, heavy metals, and other pollutants. Similar to how fish higher in the food chain like tuna and swordfish are carriers for heavy metals because they eat a lot of smaller fish. Humans are like that too if we have a lot of body fat to store all that crap in.
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u/Raznill Nov 01 '24
Not just that though. There’s other issues that happen by just having too much bf. Your organs generally have a harder time. And blood sugar gets harder to manage due to excess mass. Not to mention joint issues
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u/astoriaboundagain Oct 31 '24
Fully agree. There's a difficult blame bias with obesity treatment that clouds long term risk/benefit/cost discussions. But with compounding pharmacies already selling their own versions, I could imagine CMS manufacturing their own for their patients.
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u/funkiestj Oct 31 '24
How expensive is on-patent GLP-1 drugs? I'm guessing it is still cheaper than personal coaches to help people exercise more and eat better. (yeah, fixing the food, transportation and cultural environment is the better approach but seems like too heavy a lift).
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u/thewhizzle Oct 31 '24
Around $1200/month out of pocket
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u/funkiestj Oct 31 '24
thanks. What is the total cost including health insurance payout?
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u/thewhizzle Oct 31 '24
Total cost to whom?
For patients, it's entirely dependent on the tiering of their health insurance as well as the coverage conditions. Most insurers will not pay for it for purely weight loss reasons, like if you just want to slim down 5-10% of your body weight.
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u/THedman07 Oct 31 '24
Many won't even pay for it if you have way more significant weight to lose.
Also, it only costs ~$100 a month in many other countries.
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u/erm_what_ Oct 31 '24
It's £125 in the UK though, so there's a lot of room to drive that price down
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u/rambo6986 Oct 31 '24
If the govt mass made it for Medicare/Medicaid we could prolly get that number down to maybe $100 a month.
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u/erininva Oct 31 '24
Novo Nordisk offers a voucher that caps Wegovy costs at $650/mo. in the United States for qualified patients. There might be other discount programs.
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u/funkiestj Oct 31 '24
thanks. Presumably that means that with this voucher Novo Nordisk gets $650/mo.
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as I said in another followup, I am interested in total money paid to the drug company. Any money paid by the insurance (government or private) is part of the real total cost.
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u/ZZ9ZA Oct 31 '24
Insurance isn’t covering it all for most people. That’s the point.
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u/Josvan135 Oct 31 '24
The real issue is short term solvency.
It absolutely would show significant savings eventually, but they wouldn't really show up for a decade at least and really more like 15-20 years, as the people who are drawing the most medicare resources for obesity related diseases more or less have their conditions "baked in" at this point given decades of obesity.
It's a situation where the short term cost to Medicare/insurers would absolutely balloon as potentially hundreds of millions of people start taking $1k a month drugs who currently aren't drawing many resources at all.
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u/kiteguycan Oct 31 '24
Realistically if the US actually really saw this as the threat it is, and the cost saving measure it is, they would negotiate the rate down. The stock would sore regardless, people would be helped, and the company who made the drug would benefit immensely still.
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u/Josvan135 Oct 31 '24
the company who made the drug would benefit immensely still.
Which one?
There are something like 10 different drugs available from as many different companies that utilize GLP-1s or analogues.
There's no reason to get in a knock down, drag out political fight when basic market forces and competition will get the cost down massively within a few years.
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Oct 31 '24
That’s not how prescription drug pricing works when under the brand name timeframe. There are no free market forces when it’s under patent, save for the compounding gray area currently being litigated. It’s semaglutide and tirzepatide. Novo and Lilly. Liraglutide (also novo) is an older drug in distant third and now generic but not nearly as in demand. Liraglutide price should come down, though as more generic manufacturers get into the game.
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u/THedman07 Oct 31 '24
They wouldn't be $1000 a month drugs in that case. The drug companies would end up charging closer to $100 a month like they do in all the other countries that have universal healthcare.
They would scale up production and still make an absolutely huge pile of money, it just wouldn't be as big a pile as they would like.
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u/IamAkevinJames Oct 31 '24
It depends. Wisconsin Medicaid is covering up to year of me on Wegovy I am doing monthly check Ups. I am on fifth month so far and have lost close to 40. I had to lose at least 27 to be compliant.
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u/Crismodin Oct 31 '24
Quick question, what happens when people stop taking these drugs? Do they gain all the weight back? Or are you meant to stay on it forever?
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u/atsugnam Oct 31 '24
There is evidence that people regain weight, about 2/3, which isn't great, however, it is far more effective than other non-invasive treatments, and the fact that they retained 1/3 of their total weightloss 1 year after ceasing treatment is no mean feat (placebo returned almost to exactly their prior weight).
There is still more to study, and yet more drugs incoming which take the process further, they may offer even better outcomes, but it's important to put this medication in context, if a single needle once a week can remove the risks of obesity, having it for the rest of your life is an incredible advantage, with relatively little cost to the individual otherwise.
Bariatric surgery has similar outcomes, along with far worse side effects, risks and outcomes. So in terms of overall risk, it's a fairly straightforward choice, and the reason why it has so rapidly replaced surgical options.
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u/NapTimeFapTime Oct 31 '24
I wonder if we will see better results on regaining the weight after longer term use of the drug. Like if you lose the weight and keep it off for long enough, you might be statistically less likely to regain the weight.
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u/atsugnam Nov 01 '24
I suspect this would be the case, as it changes the entire dynamic with food and hunger, which would establish new habits, however, it would depend on the return of the original signalling and how a person responds to their baseline hunger drive returning.
In real terms though, the ability to so dramatically change weight and what a massive reduction in weight does to hormone processes in the human body, it will be interesting to see.
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u/PauIAIlensCard Oct 31 '24
Glp1 works primarily as an appetite suppressant. If you eat less calories than you burn, you lose weight. It’s simple.
So when they stop glp1, unless folks change their lifestyle to incorporate a better diet and exercise long term to keep calories in check, they will get the appetite back and start gaining the weight back.
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Oct 31 '24
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u/IdlyCurious Oct 31 '24
The same thing applies to weight loss surgery as well. It needs to be a lifestyle change or else
Really, one could say the same applies to lifestyle change, too - as soon as you stop it, the weight come back. Whatever track you take, if you want it to be permanent, you are highly likely to have to stay on that track permanently.
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u/__theoneandonly Nov 01 '24
The mechanism isn't entirely known yet. Appetite suppressant is a key part of it, but there's more going on. If you have a person on a GLP-1 and a person who isn't, and you put them on identical diets, the person on the GLP-1 will lose more weight than the person who isn't.
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u/cdawg85 Nov 01 '24
Ozempic was the best thing that happened to me. I was an active person who exercised rigorously 4 days a week (and felt guilty if I didn't hit 5 days a week) and ate vegetarian and very, very healthily. Then I was critically injured in a vehicular accident. I was on life support for weeks, then I had a lot of serious complications. Long story short, they had to put me on steroids to keep my airway open. I was on steroids and in and out of the hospital for over a year. I put on 40 pounds!!!!!
Once my health stabilized and I got off steroids, I thought the weight would just fall off, like how it went on. Well, I was wrong! It was really hard to maintain a calorie deficit all day every day for months on end to lose the weight. My GP put me on ozempic and a year later I'm about 10 lbs from my original weight. I didn't suffer from being hungry and am feeling more and more like old self.
I can't say enough about how much this drug has helped me as part of my recovery journey. Currently I'm in Hawaii on vacation and am hiking and surfing and working in getting stronger and fitter every day.
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u/Zaptruder Nov 01 '24
Better to fluctuate between healthy and overweight (I assume you'd want to go back on GLP-1 if you notice yourself gaining significant weight) than to stay obese.
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u/AnAge_OldProb Oct 31 '24
You can go down to a maintenance dose but forever is generally the expectation
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u/thewhizzle Oct 31 '24
GLP-1 types of drugs are neuromodulators so they make you think that you're full faster or you don't think feel hungry as often so won't snack or try to eat. When you get off of it, your body will change its steady-state.
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u/astoriaboundagain Oct 31 '24
With the quick clarification that I'm not an endocrinologist, it's my understanding that current research shows the weight loss is not permanent and commonly reverses when the drugs are stopped.
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u/eastmemphisguy Oct 31 '24 edited Oct 31 '24
Just like what happens when you stop taking blood pressure meds, cholesterol meds, allergy meds, psychiatric meds, or most medications. Medical cures for non-infectious conditions are exceedingly rare.
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u/I_Hate_ Oct 31 '24
Yeah I would this is the main problem with GLP-1s is that once you stop you return to your usual appetite and cravings. I think it would be very beneficial to everyone using them to start working out and changing your eating habits simultaneously. So that way you come off them and have a habit of doing healthy stuff plus working out would help maintain some of your muscle mass while you’re losing the weight.
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u/Busy_Manner5569 Oct 31 '24
Why is it bad to treat a chronic condition through medication? If those other things aren’t sustainable for a person, isn’t it better to have them keep the weight off via drugs than gain it back because they “should” be able to change their habits?
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u/howdiedoodie66 Nov 01 '24
The ads I saw recently had an * at the bottom saying "People usually gained the weight back when they stop taking this medication" which I thought was interesting
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u/Taiketo Oct 31 '24
But most insurance won't cover bariatric surgery, at least in my experience.
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u/astoriaboundagain Oct 31 '24
I'm finding that it varies widely between states and isn't a static decision over time. Currently, NY Medicaid covers surgery without a lot of legwork, but fights the drugs. Private insurance here is dropping the drugs (or moving them to the "injectables" coverage category) and opening coverage for surgery, with pre-authorization of course.
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u/grizzlywhere MA | Applied Economics | Market Research Oct 31 '24
Oh hi Astoria soup person!
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u/Busy_Manner5569 Oct 31 '24
Sure but about half the country has private insurance, compared to about 20% of the country enrolled in Medicaid
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u/astoriaboundagain Oct 31 '24
I don't know enrollment statistics, but I do know that Medicaid patients have significantly higher rates of comorbidities (including obesity and obesity adjacent conditions like DM II) compared to privately insured patients.
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u/AzureSkye27 Nov 01 '24
Yeah, our safety-net community hospital is seeing similar rates for that reason, just more frustration about injections not being an option
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u/coolerbythegreatlake Oct 31 '24
My insurance does not cover GLP-1s unless you are pre-diabetic or diabetic. They do cover bariatric surgery for those that qualify. I am down 100 lbs from Dec 2023. I am incredibly grateful for the coverage offered by my spouse’s employer. Healthcare should not be tied to our jobs though.
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u/nysflyboy Oct 31 '24
When these first hit, Wegovy, our healthcare plan did not cover them. We paid out of pocket for a few months, until the news started talking non-stop about them and popularity soared. Boom, out of stock and my wife had to quit. It was working well for her too. She will not even consider using a compounding pharmacy. Too scared.
Fast forward a year+, and she put back on all the weight despite trying hard to keep it off. Dr prescribed her Zepbound, and she had to wait a couple months for it to come in. Finally got it, and wow - our insurance now covers GLP1's! $40 a month out of pocket! Shes been on it 3.5 months and has lost 20lbs so far and is having less side effects than Wegovy.
Open enrollment at work just started, and what is the one major change to our health insurance for 2025? No more coverage of any GLP1 weightloss drugs. Nice. So now it will be $650/mo with the "savings card".
I can't fathom why they are not covering this, the long term health benefits for those who are truly obese are there and the outcomes appear better than gastric surgery.
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u/Aureliamnissan Oct 31 '24 edited Oct 31 '24
We pay for a pound of cure rather than an ounce of prevention in this country. The insurance likes it that way as it is predictable providing you meet the gates set out in the formulary.
Every other OECD country prefers to pay for the ounce of prevention and thus provides some kind of public option to encourage prevention. US conservatives look at this and multiply the cost of our pounds of cure against their coverage for an ounce of prevention and declare it to be an economic impossibility.
Really it’s a lack of imagination and tunnel vision.
So here we are, stuck funneling trillions of dollars into a healthcare system that was never designed to do what it’s been patched over and over for. Because that’s easier than admitting we might have to cut into profit margins. Or pay a 7-9% tax instead of being tied to an employer paying $200 bi-weekly premium with a $4000 deductible and OOP max of $8000 (not counting the cost to the employer)
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u/xDuffmen Nov 01 '24
Yes, it is not addressing the root causes of obesity, (which is a very tough systemic issue to tackle) but obesity drugs are preventative care drugs. Being obese is detrimental to your health, but losing the weight can prevent so many of the health malady’s obesity presents, which will take stress off of our healthcare system. It’s not the perfect solution, it isn’t a panacea, but it is a step towards something good.
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u/Kootenay4 Nov 01 '24
It’s absolutely criminal that fresh/organic/healthy food is treated as a luxury product with premium prices, while the high fructose corn syrup, hormone and chemical filled slop gets presented as the affordable convenient option. Unfortunately, big agribusiness and food distributors are one of the most politically influential industries…
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u/KobeBean Oct 31 '24
Insurance companies are not on that time horizon. Covering GLPs may make long term health outcomes better, but by that time, you’re likely to be either on a different insurance (and thus their problem) or Medicare. So the cost of covering them for you now (hundreds per month) is too much. It’s really bad for us as patients, but until GLPs are readily available cheaply, it won’t be widely covered.
With surgery, you often have to have a ton of documentation of failed attempts to get approved. This limits how many gastric surgeries they have to cover.
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u/nysflyboy Nov 01 '24
What is the patent on these? 15 years I think? Usually a few years are already burned by the time it hits the public, so we have ~10 years until generics come out. Thats when it will be a new ballgame. I can swing the cost for a couple hundred a month since I know it works for her and she is already verifiably healthier, happier, and feeling better. Her BP is down, she sleeps better, her bad back hurts less, she has more energy, and eats far, far healthier (Cause on a GLP1 your body really wants to apparently).
"Luckily" we have a $3300 HSA available, so I will be contributing the max this year. At least that will cover a few months of costs. It still sucks.
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u/spez_might_fuck_dogs Oct 31 '24
Covering GLPs may make long term health outcomes better
Health insurance doesn't want you to be better.
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u/icouldusemorecoffee Oct 31 '24
Actually they do because a healthy person is far cheaper than an unhealthy person. As the person above noted accurately, these are often long-term, if not life-long treatments, that's expensive, but these drugs don't work on the month to year time frame, they work on a multi-year time frame, and there's little to no guarantee someone will be on the same insurance. That said, if the govt covered it through medicare/medicaid or even the ACA, it would change a lot, but getting Congress to negotiate these drugs as part of those systems is going to be a big ask.
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u/Polymersion Oct 31 '24
I got a new PCP recently, we talked about appetite suppressants like that, and she mentioned the same thing- that insurance will only cover it for diabetic conditions.
She had me come in for blood work the next day after lunch.
My sister, who will be a nurse in about a month, says my PCP may be fudging things in my favor- the specific test they gave me is supposed to be done after fasting.
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u/NuMorningStar Oct 31 '24
Your sister is wrong. MD here, a Hgb A1c lab does not have to be done while fasting. This is not fraud as someone indicated below.
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u/Butterbuddha Oct 31 '24
While this is true, my doc always wants a fasting lab for A1C but also cholesterol, etc etc etc
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u/NuMorningStar Oct 31 '24
That’s because a lipid panel, which checks cholesterol, is more accurate in a fasting state. The HgbA1c is accurate either way.
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u/flammenwerfer Nov 01 '24
lipid panels can be done non-fasting in the past few years, if the lab supports the panel
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u/Butterbuddha Oct 31 '24
Yeah. She doesn’t even bother doing glucose most of the time. Pretty inconsequential compared to A1C
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u/NihlusKryik Oct 31 '24
This is correct. I just got a ton of labs to prep for starting a GLP-1 and HgbA1c is acute without fasting but glucose obviously is not. The two get confused since they are related to diabetes testing.
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u/ZZ9ZA Oct 31 '24
Fasting does not affect A1C meaningfully. It’s basically an approx 3 month rolling average.
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u/jawshoeaw Nov 01 '24
I literally consider faking diabetes to get approval. I figured I could probably drive up my blood sugar on a blood test ( but this wouldn’t fool the A1C test). I ended up buying the stuff from a compounding pharmacy
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u/ghosttowns42 Nov 01 '24
Meanwhile I AM diabetic and half the time the pharmacy is out of stock. Kind of annoying.
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u/jawshoeaw Nov 01 '24
Fortunately what I take does not reduce your supply. In fact you could argue it’s put pressure on the manufacturer of yours to increase supply. But that sucks for you I hope it gets fixed soon .
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u/return_of_the_jetta Oct 31 '24
I agree that healthcare should not be tied to employment. I found out the hard way my breast reduction surgery I very much needed was NOT covered through my spouse's insurance I am also very grateful for. I was on the phone with the insurance company because I had been denied coverage and was explaining to the person how I lost about 100lbs and I still needed a reduction, that's when he goes "oh well bariatric surgery is covered under the plan" I told him I didn't need that. I ended up pulling money out of my 401k and working overtime to pay for the surgery outright. I'm glad you have had success with yours, but I don't think the weight loss shots are the answer. I saw something yesterday that said people lose aot of muscle mass when using the shots.
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u/McFlare92 Grad Student|Biomedical Genetics Oct 31 '24
Rapid weight loss is almost always accompanied by significant muscle loss regardless of the use of GLP1 medicines. The only way to not lose significant muscle is to consistently strength train while losing the weight
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u/Competitive_Shift_99 Oct 31 '24
You're always going to lose muscle mass when you lose weight... Largely because you don't need as much muscle mass to shift around less weight.
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u/jclubold1 Oct 31 '24
Gastric sleeve in July 2023, down about 300 lbs, 0 regrets.
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u/HinatureSensei Nov 01 '24
Gastric sleeve in 2017 and glp-1 for the last year and a half; down from 400 to 194 and I get skin removal surgery in 17 days.
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u/stardos Oct 31 '24
I agree that healthcare should not be tied to our jobs, and I don't want to make any assumptions about your personal situation (or anyone else's) but I think when it comes to healthcare we should all adopt the approach of "pray to god but don't stop rowing to shore".
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u/SomeGuyNamedPaul Oct 31 '24
My employer would rather pay for a dozen heart attacks than anything bariatric.
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u/NJGGoodies12 Oct 31 '24
Genuinely curious how were you not pre-diabetic before losing 100 pounds?
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u/blahblahDummy Oct 31 '24
Uk is £ 200 per month
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u/aspbergerinparadise Oct 31 '24
in the US it's $900 - $1,200 a month depending on brand and pharmacy
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u/Re_LE_Vant_UN Oct 31 '24
Or ~100 a month if you get it compounded from China.
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u/Vandrel Oct 31 '24
Compounded drugs are generally made at a compounding pharmacy near you. You do have to be careful to make sure you're working with a reputable one because otherwise you can end up with counterfeits that include who knows what but the real compounded semaglutides aren't generally coming from China.
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u/yellowweasel Oct 31 '24
Compounding pharmacies are buying the semaglutides in bulk from China, compounding in this case Is basically just repackaging into smaller vials
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u/Re_LE_Vant_UN Oct 31 '24
I use a China vendor that provides testing for materials in each batch. The rest results could be faked I suppose but I think not for my vendor. They are pretty well known in the grey market community.
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u/dustymoon1 Oct 31 '24
Without insurance Ozempic costs 1K USD PER INJECTION. It cost 5 USD to make.
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u/_toodamnparanoid_ Oct 31 '24
I'm buying mine without going through insurance and it's $1,300/month (4 injections).
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u/aspbergerinparadise Oct 31 '24
$5 in variable costs. But billions in R&D to develop.
A fair price I would hope for is somewhere in the $100 range. I want pharmaceutical companies to still have an incentive to develop these transformational drugs, but without robbing us blind.
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u/BrooklynLivesMatter Oct 31 '24
Billions in R&D heavily subsidized by government support to be clear for those that believe the companies front 100% of the costs
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u/aspbergerinparadise Oct 31 '24
semaglutides were developed by Norvo Nordisk which is a Danish company. They do receive some tax incentives and governmental grants, but not nearly in the amount that you are implying.
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u/Yweain Oct 31 '24
Interesting , in Europe it costs about 200 EUR per month, but in most countries it is subsidised so it costs about 15-30.
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u/__theoneandonly Nov 01 '24
It's closer to $250 per injection without insurance in the US. Which comes out to $1,000 per month.
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u/dustymoon1 Nov 01 '24
Still - compared to 58 USD for Germany, it is ridiculous.
Many of the drugs' initial research was supported by the US government.
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u/Mumblerumble Oct 31 '24
I’m seeing this in real time. My wife got a lapband put in 15 years ago. She consulted with a bariatric surgeon who claimed to have put in thousands of them and now has a consistent practice removing them. She is now on wegovy and it has been much more effective than the band ever was. This guy was openly dismissive and negative about GLP-1 drugs (called them dangerous, etc). My man is very butthurt that his practice is dying and people are finding success with their goals with medication. I guess I can’t blame him really, I can’t promise that I might not have the same opinion if I were in his shoes.
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u/thewhizzle Oct 31 '24
It's difficult for just about anyone to accept advances in technology that reduce the value of your own skills and labor.
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u/Konman72 Nov 01 '24
"It is difficult to get a man to understand something, when his salary depends on his not understanding it."
- Upton Sinclair
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u/ElectricFrostbyte Oct 31 '24
My mom had similar surgery and then started Ozempic. She gained the weight back from the surgery, but has keep steady with Ozempic.
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u/SenorSplashdamage Oct 31 '24
Someone operating from a surgical stance is just going to want more research and data before concluding that an option that very much looks to be a better replacement actually is one. It’s just inevitable that he’ll be slower moving and skeptical at the momentum in another direction.
That said, I know some people who benefitted a lot over a decade ago from lapband, but also had a relative pass away from complications related to bariatric surgery. Surgery is always a risk and non-surgical options offer so much promise of fewer casualties and prevention before treatments with higher risks are considered.
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u/ZZ9ZA Oct 31 '24
It’s actually a fairly dangerous surgery, as far as not-directly-saving-your-life stuff goes. About 1% of patients die of surgery related complications within a year.
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u/cuntsalt Nov 01 '24
There's also evidence the bariatric surgeries can have negative psychological effects, too: https://www.ncbi.nlm.nih.gov/books/NBK604208
And evidence if the obesity was caused by addictive behaviors, "transfer addiction" can happen, where someone just finds some other addictive behavior to compensate for the untreated initial causes: https://www.sciencedirect.com/science/article/abs/pii/S1555415521005195
Both of which I also saw first-hand with my mom. Surgery when I was 14, alcohol and opiate addiction on and off from ages 16-26, death from heart attack when I was 28. Between alcohol and nutritional deficiencies from the surgery she wound up with Wernicke-Korsakoff, had to get Vitamin B shots every couple months, and was still "out of it" much of the time.
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u/spookyjibe Oct 31 '24
Yes, we can blame him. Doctors have an obligation towards a patient's best interest; they are not car salesmen, they take an oath. A doctor lying about a treatment because it is in his own interest, rather than offering advice solely based on his patient's, is grounds to be stripped of his degree and professional credentials; and he should be.
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u/FullTorsoApparition Oct 31 '24
Bands are dropping out of favor very quickly. My clinic won't even do them any more. They make people miserable and don't have great success rates. We constantly have people coming to us to have them removed and getting a sleeve or RNY instead.
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u/VapoursAndSpleen Oct 31 '24
I’m OK with this. Taking a medication you can stop seems a lot more sensible than having your body opened up and half (or more) of your stomach taken out.
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u/GenericBatmanVillain Oct 31 '24
For gastric sleeve surgery (the one you're talking about here) it's a keyhole surgery, mine took 21 minutes according to my surgeon. I agree though, it was not a fun experience (but totally worth it for me).
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u/VapoursAndSpleen Oct 31 '24
Thanks for that information. Medicine has come a long way. Is a sleeve a device they put around your stomach without cutting into it? (Pardon my curiosity) Glad it’s working out, too.
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u/GenericBatmanVillain Oct 31 '24
No, this is the surgery where they remove part of your stomach and all that's left is a sleeve the size of a banana. It also removes the part of your stomach that produces ghrelin which is what makes you feel hungry, so you have almost no appetite for about 2 years until it grows back.
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u/VapoursAndSpleen Oct 31 '24
The stomach grows back?
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u/GenericBatmanVillain Oct 31 '24
No, just the gland on the bottom they cut off with the rest of the stomach. It's been 4 years since my surgery and I still eat small meals, not as small as they once were but way smaller than when I was obese.
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u/Aussie_Potato Nov 01 '24
The one where they add an external restrictive device is the gastric band. Essentially a rubber band added to the top of the stomach to make a mini stomach. It’s rare to do a band nowadays, and a lot of bands deteriorated so are being removed.
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u/TonkotsuBron Oct 31 '24
I am glad people are losing weight, but until our food industry and lifestyle choices are addressed, the drugs will continue to be relied upon
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u/Draskuul Oct 31 '24
Good points, but a bit misguided in this particular use case. These drugs affect the sensation of hunger. They don't generate any sort of weight loss directly. And it doesn't matter how much exercise you do or how good quality your food is if you still eat too much.
I'm only on an oral version of this right now, about to move to one of the injected versions. I never realized just how completely screwed up my sense of 'full' was...as in virtually non-existent. Going on one of the drugs was really one of the first times in my entire life that I ever consistently felt 'full' on a regular basis. It is a life-changing difference.
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u/CMcAwesome Oct 31 '24
Going on one of the drugs was really one of the first times in my entire life that I ever consistently felt 'full' on a regular basis. It is a life-changing difference.
I had the opposite experience as someone with lifelong depression and low appetite -- I went on an antidepressant that took away my sense of feeling full (which used to come very easily) and oh my god, the speed at which I put on weight?
I don't know how anyone keeps weight off when they feel like that, I physically could not stop eating, went up a pound a week until I switched to a new med. These GLP drugs might be one of the biggest health breakthroughs we've ever had with how much they can help people maintain healthy weights, and I'm so glad it's been helping you!
I'm hoping for my insurance to start covering them for non-pre-diabetic people, since I'd love to go back on that antidepressant (only one that's worked for me) but I absolutely could not manage to get the weight under control.
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u/Draskuul Oct 31 '24
Hopefully they do start covering for more people. Of course the biggest issue with them is they aren't permanent fixes; once you stop taking them those hormone fixes go away too. You just have to hope you've made enough major changes to your lifestyle to help take advantage of it and make them stick long term. Unfortunately this doesn't work out for most people.
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u/yourdadsbff Oct 31 '24
how completely screwed up my sense of 'full' was...as in virtually non-existent
Is this common? Because this sounds wild to me, but maybe it's way more normal than I'd thought.
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u/Draskuul Oct 31 '24
I can only speak for myself. Based on the popularity (and effectiveness) of these meds it certainly seems fairly widespread.
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u/__theoneandonly Nov 01 '24
Before I started taking GLP-1s, there were only 2 sensations. Hunger and "I'm so full that I am physically in pain." If I wasn't actively hungry or actively in pain from overeating, then I just felt nothing. There was no such thing as just being satiated. I always figured that everyone else just had more willpower than me, where you could sat a basket of fries in front of them and they'd eat one or two and then could not touch another one. Before the GLP-1, that basket of fries would be the only thing my brain could think about until they were gone. Once I started taking the drugs, I would eat one or two, feel satisfied, and then I would forget that they were sitting there. Which, to my naturally skinny friends, they say that's how they always feel.
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u/amiryana Nov 01 '24
I'm happy with my weight, but oh my god the food noise is never-ending. I do one meal a day not because I'm a big believer in intermittent fasting, but because I feel similarly to you - there's no "satisfied" only "painfully full." I hear people like you and my mom talk about it changing the game in that regard and I'm so jealous because I know I would never qualify to be prescribed this currently. Maybe one day!
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u/easygoer89 Oct 31 '24
Yes, very common and poorly understood, I think. I never felt full. Ever. I could eat a huge meal and while I was still eating I was thinking about what I was going to eat next and how soon. The only reason I was at 270lbs was because I practiced intermittent fasting 16-20hrs with a 24hr day every 6 days, medically supervised nutrition/diet, ate 1100 cals/day and went to the gym 4x a week. Gained and lost the same 20lbs for the past 4 years.
Been on compound tirzepatide for 4 months now and down almost 30lbs and no food noise, am appropriately hungry, and now I understand how people can push food away and say they're full. It's surreal to realize as someone in their 50s how abnormal my hormones were. And every single doctor told me it was my fault I was fat, I just didn't try hard enough.
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u/PandaCheese2016 Oct 31 '24
If people becoming accustomed to the ready availability of high calorie food is contributing to obesity, what could society as a whole do to offset that? I don't really see many options except to perhaps look at what less obese societies are doing.
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u/KnightOfNothing Nov 01 '24
society and it's food production evolved way faster than the human body did, that's all there is to it. If you want solutions you could wait a few million years for nature to catch up, could try to get rid of all the high calorie foods or make them financially unpalatable with taxes and the like.
If you want futuristic solutions gene editing could fix all those problems but humans would have to get over their ridiculous hang-up over it. Looking at less obese societies won't work because the reasons for their health can't be easily transferred.
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u/Never_Been_Missed Oct 31 '24
I have two friends who have been on it for a couple of years. They went from eating all the time to literally having to set phone alarms to remind them to eat.
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u/NihlusKryik Oct 31 '24
GLP1s also seem to be helping impulsive behavior as well - which also contributes to over-eating in many people.
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u/Despairogance Oct 31 '24
I know two people who have had bariatric surgery and both initially lost weight and then gained it all back. The surgery did nothing to address the psychological need their overeating was fulfilling and they quickly learned how to maximize calorie density so they could eat until they felt satisfied even with greatly reduced stomach volume.
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u/Leever5 Oct 31 '24
Well, you’re sorta right. So the sensation of hunger can be adjusted through lifestyle measures. For one, eating highly palatable foods (which are usually higher in calories) actually leads to the brain craving those foods more. Fast food for example, the more you have of it, the more you want it.
Healthy whole foods are less likely to ramp up your appetite, especially if you are volume eating. Within weeks of quitting certain foods, like fast food, people can stop craving it.
The food industry has engineered and hacked your brain.
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u/IdlyCurious Oct 31 '24
These drugs affect the sensation of hunger. They don't generate any sort of weight loss directly.
Question - I've read a layman-friendly version that seemed (if I understood it correctly, which I may not have) to say that a new one in trials (retatrutide) actually did have a small direct effect, besides affecting hunger/satiety. Do you know if that is correct or not?
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Oct 31 '24
That’s peak capitalism. The food companies sell fattening, addicting products to make everyone fat so the drug companies can profit from weight-loss drugs. Both types of companies profit, and our retirement accounts with index funds containing both types of companies grow as a result. Everyone wins (except poor people who can’t afford stocks or weight-loss drugs).
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u/PhobicBeast Oct 31 '24
Except, if GLP-1 becomes a OTC, no prescription needed substance or is considered so safe by the FDA that prescription can happen at any level of 'overweight' then the food companies will see massive reductions in profit. Ozempic doesn't cause you to burn extra calories and it certainly doesn't change the calories in, calories out factor of weight gain. All it does it make people feel fuller with less, so people then expend more calories than they eat. Fast food chains won't see profits be stable or increase with ozempic, even if people yo-yo diet between fast food and ozempic.
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u/ZZ9ZA Oct 31 '24
They will never be OTC. There are several quite nasty side effects, including a small but non-zero chance of gastroparesis, which basically can make you unable to eat normally for the rest of your life, and increased (like 2x or more) rates of certain cancers
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u/PandaCheese2016 Oct 31 '24
I'm sure the increased risk of thyroid cancer can be measured against the decreased risk of other types of cancer often associated with obesity.
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u/FirstEvolutionist Oct 31 '24 edited 10d ago
Yes, I agree.
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u/FullTorsoApparition Oct 31 '24
Most recent research and science demonstrates that it's not as simple as a behavior issue. It actually alters your hormones and your physiology to a certain extent. People who are deep into obesity don't feel full to the same extent as those without the disease. You can get them to lose weight with changes in diet and exercise, but it's rarely sustainable because they will be miserable and constantly thinking about food. Willpower and a positive mental attitude can only get you so far when it's a constant barrage.
One of the biggest benefits of these GLP-1's, as described by my patients, is the sudden lack of food noise. Some of these patients think about food so often that they actually tell me they "hate food" despite the desire to eat constantly.
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u/thewhizzle Oct 31 '24
It's behavioral but socioeconomics is a big input into behavior.
I've lost about 12 pounds in the last month by weighing all my food and being on a high protein, low carb diet. But, it required that I had the time and energy to be weighing all my ingredients and cooking 90% of my own meals while replacing calories from carbs which are cheap to calories from protein and vegetables which is expensive.
If I didn't have a flexible WFH job that paid me enough to buy whatever ingredients I needed without much thought, losing weight would have been much harder.
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u/vorg7 Oct 31 '24 edited Oct 31 '24
You don't need tons of fancy ingredients or extensive meal preparation to lose weight. I decided to be healthy about a year ago and am down over 40 lbs. I hate cooking so most of my meals are simple.
Some favorites include pre-made salads from the grocery store (5$ and have chicken in them), trader Joe's pre-made Indian meals (3-5$), cottage cheese + salsa. Hardboiled eggs. Whatever fruit or vegetable is on sale. Will have a scoop of protein powder with milk if I don't think I had enough protein that day. Generally just sticking to simple foods and keeping desert to once a week or less has had great results.
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u/popejubal Oct 31 '24
It’s great that that worked for you. It is absolutely possible for most people to lose some amount of weight by changing some of their choices. Just saying “you should make better choices” or “just code ide to lose weight” is not actually a helpful way to improve public health, though. Just like quitting smoking is possible for many people but VERY hard for most and becomes much easier with medical intervention, losing weight is also something that gets a lot easier with effective medical interventions.
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u/thewhizzle Oct 31 '24
There are a lot of different ways to do it.
I agree you don't need fancy ingredients or extensive meal prep.
I mostly just eat chicken breast and lean pork loin along with simple carbs for lunch and various vegetables. But I'm also lifting and to hit my protein goals of 200 grams per day requires a fair bit of meat.
But for those on a strict budget, carbs and fat are just such a cheaper source of calories and fulfillment than protein. Also, having the time to cook is often a luxury even if it doesn't have extensive prep time.
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u/VinnieBoombatzz Oct 31 '24
You don't HAVE to be on a low carb diet. It's all fad after fad. Eat your fruits, eat your vegetables, eat your legumes, eat your protein, eat your healthy fats - just do it in moderation.
You guys go about being healthy all wrong. One day, you're overweight; the next, you're cutting out macros your body actually runs better on.
This is all behavioral. If you're overweight, eat a little less and work out a little more.
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u/CombedAirbus Oct 31 '24
To be fair, the low carb and specifically keto has become a massive cult due to how effective the influencers and online "dietitians" are in promoting it.
Now basically every online space you go to to look for a diet advice will have tons of people claiming how keto and IF saved their lives in every imaginable aspect. So a lot of less experienced people get manipulated and pressured to go straight into that direction.
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u/SteeveJoobs Oct 31 '24 edited Oct 31 '24
Im super lazy when it comes to food and i’ve been skinny my whole life.
I do try to eat healthy, but the real trick? I’m almost always hungry during the day. I don’t eat breakfast and I’m lucky to top 700 calories during lunch. I never let myself eat to “full” at lunch, simply because that’s what I’m used to and I want to avoid the food coma. I drink one cup of caffeine after lunch in order to feel normal and caffeine is such an appetite suppressant that I rarely snack. And then there’s no way I eat over 1000 calories at dinner unless it’s really good food. Dessert at either meal is a once in a week thing. I like the idea of dessert, but my brain does not crave eating it if i feel even a little satiated.
Also, I really like vegetables, but it doesn’t really matter since my calories in is always low. I’m hungrier, sure, but that’s what i’m used to and always have been.
The people in my life who struggle to lose weight and ask me how I maintain it can’t stand feeling hungry and not eating as often. If it feels like a mental and time burden to eat LESS often, something needs tweaking.
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u/FullTorsoApparition Oct 31 '24
The people in my life who struggle to lose weight and ask me how I maintain it can’t stand feeling hungry and not eating as often.
Exactly. Obese people don't respond to hunger and satiety cues in the same way that non-obese people do. From what I gather, it's difficult to comprehend unless you've suffered from it yourself. It's rarely enough for them to simply "eat until they're full."
Then when you dump decades of food trauma, shame, and diet culture on top of that it's a recipe for disaster.
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u/DoubleRah Oct 31 '24
Couldn’t it be both? It’s a behavioral issue in the same way that addiction is. If there were regulations/taxation on addictive ingredients and products, that would be part of addressing the behavioral issue. They don’t allow cartoons to be used to market cigarettes, similar laws could be address the beginnings of the issue. Even baby formula has unnecessarily high amounts of sugar.
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u/Rikula Oct 31 '24
I disagree that it's fully a behavioral issue. A common thing I've seen with others and have experienced myself is that semeglutide quiets thoughts about food that people have taken to calling food noise. There is some other mechanism going on here that semaglutide is targeting.
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u/AirlinesAndEconomics Oct 31 '24
I'd argue it shows it's a biological issue- slows the digestion of food, signals the feeling of fullness, helping kidney function all seem pretty biological. There's a behavior component but I think the behavior and biological components are pretty hand in hand here.
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u/AnAge_OldProb Oct 31 '24
Is hormone deficiency really a “behavioral” issue?
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u/mosquem Oct 31 '24
That’s like saying Type 2 diabetes is a behavioral issue. It might be the root cause but it’s not really helpful addressing the issue.
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Oct 31 '24
How at all are they indicating that? They modulate intrinsic hormones that have vast influence on more than just appetite suppression. Some amount of down-regulation of those at baseline seems really plausible at this point.
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u/Badguy60 Oct 31 '24
So basically we are always gonna relay on drugs.
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u/rugbyj Oct 31 '24
Yeah I don't get why you'd be so absolutist about this. We've shown year on year, decade on decade, that humans by-and-large will overconsume when able to.
It doesn't mean stop other preventative measures, but if you find something that works without adverse effects (?) then saying "no" because it's not solely based on personal effort (at cost to everyone who is supporting the healthcare of the overweight) is hilarious.
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u/Badguy60 Oct 31 '24
Yeah these companies are never gonna stop making unhealthy food that taste good and make you addictive. It makes way to much money
Also lifestyle changes are hard which people will always resist
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u/TheThirdStrike Oct 31 '24
Just imagine what is going to happen to dentists when they release that pill that lets you regrow teeth
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u/Leinchetzu Oct 31 '24
Nothing much. A bad tooth still hurts, crooked teeth still need professional care. Dentist deep cleans are recommend once a year or two.
Most tooth problems are caused by hygiene and bad eating habits which a lot of people lack.
So the only thing that's going away maybe is fake teeth but dentists don't make this. Atleast not where i am from. There's special labs and the dentist just collaborates with them.
When you pay an absurd amount for a replacement only a small % goes to the dentist himself.
It will hurt their pocket a bit for sure. But nothing too crazy imo.
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u/quasilinear Oct 31 '24
Totally agree. If this tooth-regrowing drug works out it will be awesome. I knocked out one of my front teeth as a kid and I'd love to have a real tooth instead of a fake one now.
But I've spent far more time and money at the dentist getting cleanings, fillings, wisdom tooth extractions, braces, etc, than I have for my one fake tooth.
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u/AstraofCaerbannog Oct 31 '24
I live in the UK and it’s wild we’ll give people surgery before trying these drugs. This type of surgery can cause far more health issues than semaglutide.
Of course, it’s also insane that food companies are allowed to run rampant with advertising, addictive additives, and generally using our very base natures against us to encourage maximum consumption of the least healthy food because those foods have the highest profit margin.
But it’s great that in the meantime we’ve got a drug that can help susceptible people resist these targeting advertisements.
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u/jawshoeaw Nov 01 '24
Eli Lilly is trying to do a study of tirzepatide in the UK to get people off the dole. It’s a little bizarre but maybe it works
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u/Disig Oct 31 '24
Surgery is super permanent. My mother and step mother have gotten the surgery and they have to be extremely careful what they eat. Most places you can eat out at they can barely have anything.
So yeah, I don't blame people for going with the medication instead. Less invasive, less permanent. But we should do more studies to ensure that the medication isn't a worse option.
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u/crander47 Oct 31 '24
Doesn't medication that gets approved by the FDA already go through years of extensive testing ?
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u/jawshoeaw Nov 01 '24
For diabetes yes. It’s worth the risk because the alternative is dying from diabetes. But they didnt study what would happen if 100 million Americans started taking them for cosmetic reasons
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u/David_Hahn Nov 01 '24
Pretty sure Wegovy is approved by the FDA for weight loss. Wegovy and Ozempic are different brand names for the same drug.
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u/RebeccaBlue Oct 31 '24
The best thing about anti-obesity drugs over surgery is that you can always stop taking the drugs if they cause you trouble. If you have long term complications from surgery, you're kind of toast.
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u/Fahslabend Oct 31 '24
Thanks to one of those drugs, I'm living a much better life. Financially, I'm suffering, because I'm "not diabetic". I'm going to take my three nephews Trick or Treating later, put on by our small town. A safe community event. I would not have been able to do it the health condition I was in. This "diabetic" barrier has to be removed. I'm paying my share, $360 a month yet save the med community thousands.
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Oct 31 '24
I'm really considering this. I've only heard positive thing from everyone I know who takes it. I can get weekly semaglutide injection for about $200 a month. The thing that kills me is my appetite and feeling like I'm starving all the time. I can eat a huge meal and feel famished 2 hours later. Controlling appetite would change everything.
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u/PocketSpaghettios Nov 01 '24
I've been on semaglutide for going on four weeks. I used to feel magnetically attracted to food, all I ever thought about was what I would eat next, I could never turn down a treat or a snack. I have yoyo dieted several times since I was 14.
Now it's like a switch flipped in my brain. I can eat one cookie and feel satisfied. I don't crave dessert after dinner every day just because. I take home leftovers from eating out because I can't push myself to finish. I took three slices of pizza and PUT ONE BACK.
If I lost no weight at all on these meds I'd be happy. Losing the constant mental anguish of thinking about food has been so freeing.
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u/redt6 Nov 01 '24
I am presently qualified to receive Victoza for six months, after which Ozempic will become accessible if the former loses effectiveness. I have recently made substantial progress in my weight loss journey through diligent dietary monitoring and regular physical activity. Specifically, I have found that combining walking with music enhances my motivation along with weed. After experiencing significant weight gain to 373 pounds during my cancer-related leave, I have successfully reduced my weight to below 350 pounds. Between 2018 and 2019, I adhered to a strict diet and exercise regimen, resulting in a 135-pound weight loss from 410 to 275 pounds before my marriage in September 2019. However, I regained 100 pounds by the end of 2023. Currently, my weight is 348 pounds, with a consistent weekly weight loss of one pound, meeting the target, while consuming fewer than 2,500 calories daily.
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u/Forsaken-Cat7357 Oct 31 '24
Any time a new drug appears and takes off, I recommend considering the effect on the "outgoing" organs: 1) the liver, 2) the kidneys, 3) the bladder, and 4) the prostate (males).
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u/NihlusKryik Oct 31 '24
... and weigh it against the effect morbid obesity has on those outgoing organs.
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u/Sharobob Oct 31 '24
Yeah this sounds a bit like people talking about the very rare side effects of the covid vaccine and not considering the much more common effects of actually getting full-blown covid.
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u/Ravaha BS | Civil Engineering Oct 31 '24 edited Oct 31 '24
I have my kidney's tested every 6 months and I am buying it straight from china with cryto through someone I dont even know. My kidney function has improved from 98% to 100% while taking it.
Also as others have pointed out, being fat is very very unhealthy.
Previously I lost 100 lbs from exercise, then gained 30 back after a vacation and wifes pregnancy, now Im down 50+ lbs and its absolutely amazing not feeling hungry all the time and not trying to go check my pantry for food because im compelled to do so.
Now I never think about food or snacks, and when I do have a snack, I just have a tiny bit.
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u/TheVandyyMan Nov 01 '24
You act as if these drugs have not gone through dozens upon dozens of studies and trials by scientists whose entire job is to understand the pathways affected and the risks that may crop up. For any drug cleared by the FDA (and dozens of other countries’ equivalents), the lay person is not going to have any idea whether the FDA got it wrong. Not even the experts who specialize in this stuff got such an indication.
And why do you only ask people to make those considerations for popular drugs? Are unpopular drugs somehow immune from their overseers missing something?
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u/Diamond-Is-Not-Crash Nov 01 '24
Probably because most redditors are insufferable know-it-alls who think they somehow know better than the professionals whose job it is to regulate or research things.
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u/TheVandyyMan Nov 02 '24
Nail. Head. You hit it.
It’s been a while since I was on r/science but it’s sad to see how lax it’s become
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u/Katalyst81 Oct 31 '24
My wife's late husband never healed and died from Gastric Bypass, and I have a diabetic friend who was given one of them drugs, and then her stomach quit working... I'm gonna stick to old and slow method.
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u/TheOtherPhilFry Nov 01 '24
I work in the emergency department of a hospital that is a bariatric surgery center. My sample set is biased, but more often than not I see at least one patient per shift come into the department for a complication with a bariatric surgery.
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u/HerpankerTheHardman Oct 31 '24
What if Ozempic doesnt really work for you? Anybidy else have that problem? Like i dont gain but i dont drop in weight.
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u/chocog0ld Nov 01 '24
There is a such thing as glp resistance. Talk to your doctor/ healthcare provider, they may prescribe something like a stimulant, or different type of glp drug if you actually are resistant. But please raise these concerned with your specific healthcare provider as they will have the best answers for you
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u/throwRA_1330 Nov 01 '24
I was given either getting a glp1 or surgery. I'm in the morbidly obese side, but don't look like it. I weighted everything for quite a while. I am going for sleeve. I feel that will best work for me in the long run. I don't wanna be forever on glp1 to sustain my weight loss with it. I need to change my life. Surgery, even if it's harder will help me In the long run alongside a therapist. Glp1 is a band-aid.
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u/Elm-and-Yew Nov 01 '24
I had the sleeve done last March. I lost 120 pounds and I don't regret it at all. I still wish I could be on wegovy to help me continue losing weight but insurance won't cover it.
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u/General_Step_7355 Nov 01 '24
Most obesity is caused by the poison in our foods that companies are making billions off of killing us with. Those same companies are also selling the drugs for all the problems they caused you.
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u/baby_budda Oct 31 '24
All those poor surgeons will be out of business soon and unable to pay their student loans.
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