The Next Blockbuster Drugs are for Weight Loss
August 12, 2022 6:45 PM Subscribe
A New Weight-Loss Drug Really Works - Raising Huge Questions. "Wegovy, made by Danish drugmaker Novo Nordisk, is the first in what is shaping up to be a new generation of obesity treatments, which use a hormone to regulate appetite....The average patient in the study in which Robillard participated lost 15 per cent of their body weight, about three times more than on previous drugs. Nearly a third of them lost almost as much as they would after weight-loss surgery. Robillard lost 57 pounds. The US Food and Drug Administration approved Wegovy for general use in June 2021." This is big and it's coming fast. Other pharma companies have taken notice and a stream of incretin drugs will soon hit the market.
Also: At Long Last Weight-Loss Drugs that Really Work - the next Blockbusters -- which covers drugs offered by Eli Lilly.
The obvious issues are cost and access. So far these drugs only control obesity, they do not cure it. They cost thousands of dollars and they need to be taken for the rest of the patient's life.
Also: At Long Last Weight-Loss Drugs that Really Work - the next Blockbusters -- which covers drugs offered by Eli Lilly.
The obvious issues are cost and access. So far these drugs only control obesity, they do not cure it. They cost thousands of dollars and they need to be taken for the rest of the patient's life.
New Scientist had an article about semaglutide (Wegovy) a couple of months ago which mentions some further downsides: "With semaglutide, by far the most common issues have been gastrointestinal. Forty-five per cent of trial participants reported nausea and 30 per cent experienced diarrhoea or constipation. Vomiting affected 24 per cent. [...] Another 5 per cent developed gallstones due to the rapid nature of the weight loss, requiring surgery in some cases."
posted by offog at 6:58 PM on August 12, 2022 [9 favorites]
posted by offog at 6:58 PM on August 12, 2022 [9 favorites]
My first question was whether the weight loss is sustained any longer than any other weight loss treatment. It isn't clear from the article how long patients have sustained. Can anyone else find that?
It's heinously expensive. Also, "When a patient stops taking Wegovy, their appetite returns within weeks and they pack on weight. . . . There may be even worse side effects of coming off the drug. Less than a week after Robillard stopped taking it at the end of the trial in November 2019, she started having panic attacks. “Every circuit started thinking about the cravings,” she says. She regained 20 pounds."
Also, nausea: "she threw up every week after taking the injection. Now she suffers constipation. Similar side effects were reported in the trial and on drugs.com, where patients universally praise the resulting weight loss but frequently complain of a constant “morning sickness”. The drug also comes with a warning it could increase the risk of thyroid cancer."
posted by Peach at 7:00 PM on August 12, 2022 [7 favorites]
It's heinously expensive. Also, "When a patient stops taking Wegovy, their appetite returns within weeks and they pack on weight. . . . There may be even worse side effects of coming off the drug. Less than a week after Robillard stopped taking it at the end of the trial in November 2019, she started having panic attacks. “Every circuit started thinking about the cravings,” she says. She regained 20 pounds."
Also, nausea: "she threw up every week after taking the injection. Now she suffers constipation. Similar side effects were reported in the trial and on drugs.com, where patients universally praise the resulting weight loss but frequently complain of a constant “morning sickness”. The drug also comes with a warning it could increase the risk of thyroid cancer."
posted by Peach at 7:00 PM on August 12, 2022 [7 favorites]
My first question is, If the FDA approved it 13 months ago, how come I've never heard of it? Taking more than a year to start to spread seems more implausible than the drug itself.
posted by dobbs at 7:10 PM on August 12, 2022 [5 favorites]
posted by dobbs at 7:10 PM on August 12, 2022 [5 favorites]
I know someone who has taken off-label injected Semaglutide (on the advice of an endo, given her genetic diabetes risk), and in her case the side-effects lasted about three days, so they are not ruinous for everyone (not saying they're not ruinous for some). She started during lockdown, so the occasional need to hurry to a bathroom wasn't a dealbreaker.
...and in her case, anyway, gain after stopping was negligible. The drug was borderline miraculous, for her, driving A1c straight into the normal range, and it's stayed there.
Nothing is a silver bullet, but some things do work for some people, and keeping your A1c in-range is pretty valuable. Anecdata, and all that, but if we're gonna point to ruinous side-effects in one person then let's just stop pretending and go with the anecdotes, shall we?
posted by aramaic at 7:18 PM on August 12, 2022 [39 favorites]
...and in her case, anyway, gain after stopping was negligible. The drug was borderline miraculous, for her, driving A1c straight into the normal range, and it's stayed there.
Nothing is a silver bullet, but some things do work for some people, and keeping your A1c in-range is pretty valuable. Anecdata, and all that, but if we're gonna point to ruinous side-effects in one person then let's just stop pretending and go with the anecdotes, shall we?
posted by aramaic at 7:18 PM on August 12, 2022 [39 favorites]
how come I've never heard of it?
Good point. It seems to have flown under the radar. Maybe because of the insane news cycle? I saw a science article about incretins last year, but then it got quiet. At any rate, it's now limelight time. Next up a 60 Minutes episode and full NYT coverage, etc.
posted by storybored at 7:21 PM on August 12, 2022
Good point. It seems to have flown under the radar. Maybe because of the insane news cycle? I saw a science article about incretins last year, but then it got quiet. At any rate, it's now limelight time. Next up a 60 Minutes episode and full NYT coverage, etc.
posted by storybored at 7:21 PM on August 12, 2022
It was hard to get, and hard to get insurance approval for at first. The profit being extracted out of it is obscene. One less discussed aspect is that it seems to have good effect on patients with non-alcoholic steatohepatitis. Even more so that you would expect just from weight loss.
To be meaningful, I think that it needs to be paired with programs to develop good eating habits while the drug makes it easier (by getting rid of so many cravings). Hopefully, once good habits are formed and the rest of the endocrine system and brain is just used to eating less, weight will stay off without the drug. We really do not know how to come off of it without rebound weight gain, but maybe lower doses or cheaper oral drugs that aren't nearly as effective for loss can be used for maintenance.
posted by a robot made out of meat at 7:32 PM on August 12, 2022 [10 favorites]
To be meaningful, I think that it needs to be paired with programs to develop good eating habits while the drug makes it easier (by getting rid of so many cravings). Hopefully, once good habits are formed and the rest of the endocrine system and brain is just used to eating less, weight will stay off without the drug. We really do not know how to come off of it without rebound weight gain, but maybe lower doses or cheaper oral drugs that aren't nearly as effective for loss can be used for maintenance.
posted by a robot made out of meat at 7:32 PM on August 12, 2022 [10 favorites]
I remember fen-phen and the problems it had when it was heavily marketed. I specifically remember people talking about how it was a godsend for people who couldn't lose weight otherwise and then all the negative side effects came in. I'd be extremely wary of Wegovy for that alone. I seem to remember Wegovy commercials as I kind of remember the ads in my head which is kind of scary as I have no conscious memory of actually viewing the ads. They aren't marketing it as a casual weight loss drug, but they are marketing it.
It'd be curious to see how this compares to amphetamines in terms of weight loss. Amphetamines are fairly well tolerated and their side effects are known. I feel as if drugs with recreational uses tend to get a really bad wrap even if the pharmacological profiles are incredibly well known and studies. I also think the abuse factor is overblown. See my recent AskMe on cocaine use for surgery on an effective drug that is artificially scarce and expensive being stigmatized while incredibly dangerous drugs or less effective have taken its place. See marijuana for cancer patients as something similar. I don't know why we're reaching for even more exotic drugs with unknown health risks when we have known drugs that are beneficial.
posted by geoff. at 8:14 PM on August 12, 2022 [16 favorites]
It'd be curious to see how this compares to amphetamines in terms of weight loss. Amphetamines are fairly well tolerated and their side effects are known. I feel as if drugs with recreational uses tend to get a really bad wrap even if the pharmacological profiles are incredibly well known and studies. I also think the abuse factor is overblown. See my recent AskMe on cocaine use for surgery on an effective drug that is artificially scarce and expensive being stigmatized while incredibly dangerous drugs or less effective have taken its place. See marijuana for cancer patients as something similar. I don't know why we're reaching for even more exotic drugs with unknown health risks when we have known drugs that are beneficial.
posted by geoff. at 8:14 PM on August 12, 2022 [16 favorites]
Considering how many different "miracle weight loss drugs" are advertised all over the place, I think "If this works so well, why haven't I heard of it?" is actually a completely reasonable question. A weight loss that truly works would be a truly HUGE deal in our messed up diet-culture obsessed society. If this is for real it's going to become a big thing, and I too wonder why it hasn't already become one.
I really kinda hate the idea that bigger bodies are a thing we have to "fix," though. I've read some stuff here on MeFi that made me question the idea that weight has anything to do with willpower or character. I've learned a little bit about the connection between fat phobia and racism. And I've been listening to Maintenance Phase and I just finished Jenette McCurdy's book about the eating disorders she developed as a child actor, and have started listening to her podcast "Empty Inside.".
I'm landing on: being fat may be kinda bad for you, but not really worse than being unmarried or having only a high school education, statistically. And definitely not as bad for you as being subject to stigma and shaming all the time, avoiding or being refused medical care, and self-starvation (with likely intermittent periods of binging) AKA "dieting."
Now we're gonna make so rich people can be thin, as long as they take a medication for the rest of their lives that messes with their ability to eat intuitively and trust their own hunger signals... Which poor people will never be able to afford.
Is that gonna help fix the problems with weight stigma and thin privilege in our society? Because it doesn't seem like it's gonna help.
posted by OnceUponATime at 8:24 PM on August 12, 2022 [60 favorites]
I really kinda hate the idea that bigger bodies are a thing we have to "fix," though. I've read some stuff here on MeFi that made me question the idea that weight has anything to do with willpower or character. I've learned a little bit about the connection between fat phobia and racism. And I've been listening to Maintenance Phase and I just finished Jenette McCurdy's book about the eating disorders she developed as a child actor, and have started listening to her podcast "Empty Inside.".
I'm landing on: being fat may be kinda bad for you, but not really worse than being unmarried or having only a high school education, statistically. And definitely not as bad for you as being subject to stigma and shaming all the time, avoiding or being refused medical care, and self-starvation (with likely intermittent periods of binging) AKA "dieting."
Now we're gonna make so rich people can be thin, as long as they take a medication for the rest of their lives that messes with their ability to eat intuitively and trust their own hunger signals... Which poor people will never be able to afford.
Is that gonna help fix the problems with weight stigma and thin privilege in our society? Because it doesn't seem like it's gonna help.
posted by OnceUponATime at 8:24 PM on August 12, 2022 [60 favorites]
One reason why word may have spread more slowly is that these drugs were originally created to help with diabetes... until some people on TikTok spread the word about their use by non-diabetics. Because, of course, TikTok ruins everything.
posted by Halloween Jack at 8:28 PM on August 12, 2022 [7 favorites]
posted by Halloween Jack at 8:28 PM on August 12, 2022 [7 favorites]
I’ve been hearing about this drug for quite a while and I’m not remotely in the field. I’ve heard it mostly from people who are very interested in trying it but can’t get access.
messes with their ability to eat intuitively and trust their own hunger signals
Many people don’t have this. I have never understood my hunger signals and probably never will. As a child and young adult I was medically underweight because of not registering those signals. I learned to eat a certain amount because that’s what I was supposed to do to gain weight. I eventually got to a stable “healthy” weight for about eight years. Then at some point it switched the other way and everything in my body became a hunger signal. I’m not sure which came first—becoming overweight or my hunger signals changing. I do often wonder if the weight gain was because of stress and that changed my eating patterns, rather than the other way around.
I would not take this drug and don’t think there’s much particularly wrong with my weight now (other than the difficulty of clothes shopping). But I am on a different med that happens to have appetite suppression as a side effect and… idk, I really do appreciate that it keeps me from just eating constantly. Because that is what happens if I forget to take my med. Basically every half hour I’m eating another meal because if anything happens in my body my brain interprets it as hunger. It’s exhausting and upsets my stomach and irritates my TMJ and destroys my wallet and it… doesn’t happen when I take my med (except for about 2 hours at night after it wears off, which is preferable to it happening all day). I don’t know why. But appetite suppression stops that associate of every little body signal with hunger.
So I can see why people might want some way to modify their hunger signals. Because for lots of people they don’t work right and there is no such thing as intuitive eating for them. But I do very much worry about the pressure to take a drug like this. If you don’t want to, are you then labeled as non-compliant? Is it your “fault” if you get a disease associated with obesity? It is so telling to me that this is marketed as an obesity drug and not simply an appetite suppressant. The fact that those are interchangeable, that it is the weight loss that is the goal rather than the appetite control (with weight loss sequelae rather than the target itself), is a problem.
posted by brook horse at 8:50 PM on August 12, 2022 [34 favorites]
messes with their ability to eat intuitively and trust their own hunger signals
Many people don’t have this. I have never understood my hunger signals and probably never will. As a child and young adult I was medically underweight because of not registering those signals. I learned to eat a certain amount because that’s what I was supposed to do to gain weight. I eventually got to a stable “healthy” weight for about eight years. Then at some point it switched the other way and everything in my body became a hunger signal. I’m not sure which came first—becoming overweight or my hunger signals changing. I do often wonder if the weight gain was because of stress and that changed my eating patterns, rather than the other way around.
I would not take this drug and don’t think there’s much particularly wrong with my weight now (other than the difficulty of clothes shopping). But I am on a different med that happens to have appetite suppression as a side effect and… idk, I really do appreciate that it keeps me from just eating constantly. Because that is what happens if I forget to take my med. Basically every half hour I’m eating another meal because if anything happens in my body my brain interprets it as hunger. It’s exhausting and upsets my stomach and irritates my TMJ and destroys my wallet and it… doesn’t happen when I take my med (except for about 2 hours at night after it wears off, which is preferable to it happening all day). I don’t know why. But appetite suppression stops that associate of every little body signal with hunger.
So I can see why people might want some way to modify their hunger signals. Because for lots of people they don’t work right and there is no such thing as intuitive eating for them. But I do very much worry about the pressure to take a drug like this. If you don’t want to, are you then labeled as non-compliant? Is it your “fault” if you get a disease associated with obesity? It is so telling to me that this is marketed as an obesity drug and not simply an appetite suppressant. The fact that those are interchangeable, that it is the weight loss that is the goal rather than the appetite control (with weight loss sequelae rather than the target itself), is a problem.
posted by brook horse at 8:50 PM on August 12, 2022 [34 favorites]
Jenette McCurdy's book about the eating disorders she developed as a child actor
So...are "eating disorders" (which is a shorthand for anorexia nervosa and bulimia nervosa) bad because they cause you to eat "too little" and/or become "underweight," thus increasing your risk of developing certain physical health problems linked to "not weighing enough," or are the harms they inflict overwhelmingly of a psychological nature, more in the way of conditions like OCD?
posted by cinchona at 8:51 PM on August 12, 2022
So...are "eating disorders" (which is a shorthand for anorexia nervosa and bulimia nervosa) bad because they cause you to eat "too little" and/or become "underweight," thus increasing your risk of developing certain physical health problems linked to "not weighing enough," or are the harms they inflict overwhelmingly of a psychological nature, more in the way of conditions like OCD?
posted by cinchona at 8:51 PM on August 12, 2022
It’s both. Anorexia has the highest mortality rate of any psychiatric disorder. Cardiovascular collapse is one risk, among many others. It is also psychologically devastating, but the physical dangers are quite real. There are also significant physical risks for bulimia, ARFID, and binge eating disorder.
posted by brook horse at 8:58 PM on August 12, 2022 [33 favorites]
posted by brook horse at 8:58 PM on August 12, 2022 [33 favorites]
One reason why word may have spread more slowly is that these drugs were originally created to help with diabetes... until some people on TikTok spread the word about their use by non-diabetics. Because, of course, TikTok ruins everything.
It makes sense that drugs created for diabetes would be effective in weight loss though Wegovy is marketed directly for weight loss and not diabetes. Some quick search of sites where people try to get drugs no matter what, Wegovy has an actual shortage due to the facility it being made in having issues. Mounjaro, even newer so good luck with adverse effects on that one, is just as effective apparently and easier to get with just filling out an online form and not needing bloodwork.
posted by geoff. at 9:15 PM on August 12, 2022
It makes sense that drugs created for diabetes would be effective in weight loss though Wegovy is marketed directly for weight loss and not diabetes. Some quick search of sites where people try to get drugs no matter what, Wegovy has an actual shortage due to the facility it being made in having issues. Mounjaro, even newer so good luck with adverse effects on that one, is just as effective apparently and easier to get with just filling out an online form and not needing bloodwork.
posted by geoff. at 9:15 PM on August 12, 2022
Aubrey Gordon, one of the hosts of "Maintenance Phase," has also suffered from eating disorders. She talks about how you can't even get a diagnosis of "anorexia nervosa" unless your BMI is under a certain number. If you're still fat or "healthy weight" you may be diagnosed as "atypical anorexia nervosa" but that's a recent (2013) category.
Until it was invented, a person could go days without eating, suffer from malnutrition, lose huge amounts of weight, feel weak and fatigued, have unstable vital signs, stop menstruating, and have psychological symptoms including suicidal ideation, and cognitive problems and faintness and dizziness... all without officially having an eating disorder until their weight dropped far ENOUGH.
And they would never ever be told to regain the weight they needed to in order to stop those symptoms, because their weight still "too high."
posted by OnceUponATime at 9:23 PM on August 12, 2022 [27 favorites]
Until it was invented, a person could go days without eating, suffer from malnutrition, lose huge amounts of weight, feel weak and fatigued, have unstable vital signs, stop menstruating, and have psychological symptoms including suicidal ideation, and cognitive problems and faintness and dizziness... all without officially having an eating disorder until their weight dropped far ENOUGH.
And they would never ever be told to regain the weight they needed to in order to stop those symptoms, because their weight still "too high."
posted by OnceUponATime at 9:23 PM on August 12, 2022 [27 favorites]
Per their FDA approvals and labeling, Mounjaro is indicated only for people with diabetes to help with glycemic control; Wegovy is indicated for weight loss in people with or without diabetes but has different criteria depending on whether the patient has diabetes. Of course either can be prescribed off label, so with some disregard for the indications.
Package inserts for more details on things like this:
Mounjaro
Wegovy
posted by Tandem Affinity at 9:30 PM on August 12, 2022 [1 favorite]
Package inserts for more details on things like this:
Mounjaro
Wegovy
posted by Tandem Affinity at 9:30 PM on August 12, 2022 [1 favorite]
Some stuff in the FT article doesn't seem to be true. For instance:
I feel it's a bit like someone who walks to and from work every day through a red light district where a variety of attractive sex workers try to tempt them into having paid sex. That person feels they can't resist the temptations all around them. One solution might be for them to take a drug which changes the levels of their sex hormones so they're no longer tempted. This might work as an effective solution for that person. But it would be a better solution on social level to change the environment, than to tinker with their hormones so they can handle a messed-up environment.
posted by TheophileEscargot at 9:44 PM on August 12, 2022
Once it becomes obese, the human body tends to push itself to rebound to its previous highest weight.That's not supported by anything the article. In fact, the body has mechanisms to keep itself in a healthy weight range, but they often seem to be overwhelmed by the modern environment.
Taken collectively, these data provide evidence for the idea that there is biological (active) control of body weight and also weight stability (and thus a set point at a healthy steady state) in response to eating healthy chow diets. By contrast, this regulation is lost or camouflaged by Western diets, suggesting that the failure of biological control is due mainly to external factors. In this situation, the set point is replaced by various settling points that are influenced by energy and macronutrient intake in order for the body to reach a zero balance of energy and macronutrients and thus a new and possibly unhealthy steady state.The article also says
She warns the drug could actually encourage “weight cycling”, which is “incredibly dangerous”.The science says:
There is some evidence showing that weight cycling has no effect on risk of type 2 diabetes and inconclusive evidence that a history or presence of weight cycling influences body composition, or predisposes to future obesity. The available evidence so far suggests that there is little detrimental effect of weight cycling on current and future obesity and metabolic risk, and therefore weight loss efforts in individuals with overweight/obesity should continue to be encouraged.However I'm worried about these drugs. People sometimes talk about "hunger hormones" as if they're a purely external influence making us their puppets. But they are part of a complicated mechanism. If you put tempting foods around someone who has recently had a full meal, the level of "hunger hormones" like ghrelin rises. Hunger hormones respond to our environment.
I feel it's a bit like someone who walks to and from work every day through a red light district where a variety of attractive sex workers try to tempt them into having paid sex. That person feels they can't resist the temptations all around them. One solution might be for them to take a drug which changes the levels of their sex hormones so they're no longer tempted. This might work as an effective solution for that person. But it would be a better solution on social level to change the environment, than to tinker with their hormones so they can handle a messed-up environment.
posted by TheophileEscargot at 9:44 PM on August 12, 2022
Nobody was madder than my sister when they made fen-phen illegal because for her it "actually worked." Of course it might eventually have killed her but hey.
She later got weight loss surgery....and like a surprising number of people, went on to develop a drinking problem afterwards. Her weight did stay lower than it was before. Maybe the net result was positive? I guess it depends on how tough her liver is.
With that in mind, I'm ok letting rich people be the early adopters if they want. I remain very not convinced that weight loss in itself is a valid medical goal.
posted by emjaybee at 9:49 PM on August 12, 2022 [9 favorites]
She later got weight loss surgery....and like a surprising number of people, went on to develop a drinking problem afterwards. Her weight did stay lower than it was before. Maybe the net result was positive? I guess it depends on how tough her liver is.
With that in mind, I'm ok letting rich people be the early adopters if they want. I remain very not convinced that weight loss in itself is a valid medical goal.
posted by emjaybee at 9:49 PM on August 12, 2022 [9 favorites]
I know someone who's on one of these. She had some lively GI times for a couple of weeks, but is now back to normal.
There's going to be an inherent (but foolish) moral resistance for many people to the idea that you can lose weight with a pill. That needs to be teased out from reasonable concerns about long-term effects. Fen-phen remains a cautionary tale.
posted by praemunire at 9:55 PM on August 12, 2022 [7 favorites]
There's going to be an inherent (but foolish) moral resistance for many people to the idea that you can lose weight with a pill. That needs to be teased out from reasonable concerns about long-term effects. Fen-phen remains a cautionary tale.
posted by praemunire at 9:55 PM on August 12, 2022 [7 favorites]
People still regularly prescribe phentermine for weight loss, and I was told that the inclusion of fenfluramine was what caused so many issues.
Weight loss surgery alone seems like a monkey’s paw if I ever saw one. Agree strongly with the person above who commented on changing habits. I try to remember that breaking a fifty year habit of eating is like, really fuckin hard. Imagine how reinforced that pathway is.
I also feel as though it’s not just the rich who will be early adopters, I tried to get people with Medicaid on what I could to try to get A1cs down.
posted by sibboleth at 9:59 PM on August 12, 2022 [5 favorites]
Weight loss surgery alone seems like a monkey’s paw if I ever saw one. Agree strongly with the person above who commented on changing habits. I try to remember that breaking a fifty year habit of eating is like, really fuckin hard. Imagine how reinforced that pathway is.
I also feel as though it’s not just the rich who will be early adopters, I tried to get people with Medicaid on what I could to try to get A1cs down.
posted by sibboleth at 9:59 PM on August 12, 2022 [5 favorites]
FDA label on semaglutide has the following precautions listed
• Thyroid C-cell Tumors: In rodents, semaglutide causes thyroid C-cell tumors at clinically relevant exposures. It is unknown whether WEGOVY causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as the human relevance of semaglutide-induced rodent thyroid C-cell tumors has not been determined (5.1, 13.1).
• WEGOVY is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk of MTC and symptoms of thyroid tumors (4, 5.1).
• Acute Pancreatitis: Has occurred in clinical trials. Discontinue promptly if pancreatitis is suspected. Do not restart if pancreatitis is confirmed (5.2).
• Acute Gallbladder Disease: Has occurred in clinical trials. If cholelithiasis is suspected, gallbladder studies and clinical follow-up are indicated (5.3).
• Hypoglycemia: Concomitant use with an insulin secretagogue or insulin may increase the risk of hypoglycemia, including severe hypoglycemia. Reducing the dose of insulin secretagogue or insulin may be necessary. Inform all patients of the risk of hypoglycemia and educate them on the signs and symptoms of hypoglycemia (5.4, 7.1).
• Acute Kidney Injury: Has occurred. Monitor renal function when initiating or escalating doses of WEGOVY in patients reporting severe adverse gastrointestinal reactions or in those with renal impairment reporting severe adverse gastrointestinal reactions (5.5).
• Hypersensitivity: Anaphylactic reactions and angioedema have been reported postmarketing. Discontinue WEGOVY if suspected and promptly seek medical advice (5.6).
• Diabetic Retinopathy Complications in Patients with Type 2 Diabetes: Has been reported in trials with semaglutide. Patients with a history of diabetic retinopathy should be monitored (5.7).
• Heart Rate Increase: Monitor heart rate at regular intervals (5.8).
• Suicidal Behavior and Ideation: Monitor for depression or suicidal thoughts. Discontinue WEGOVY if symptoms develop (5.9)
A medical provider with UpToDate access credentials should be able to login and view this page, which will have a good summary of the existing research. Quick scan of the Phase 4 shows a fairly small percentage of people had serious adverse events, with the vast majority of adverse effects being gastrointestinal though the effect size looks small compared to placebo, which also had high reports of new events though nausea and vomiting look much more prevalent with semaglutide.
Much longer study (about a third of a year) also showed some of the same though the difference in renal failure look worrisome though I'm not sure if it's significant.
Someone with much more medical knowledge than me can and should weigh-in but it doesn't seem like we really have any information on long term side effects/adverse events (ie 5+ years), which would make me cautious about seeking a prescription unless there was a dire need for it - I'm a fairly risk-averse person, however, and other folks might have a different take on it.
posted by paimapi at 10:14 PM on August 12, 2022 [4 favorites]
• Thyroid C-cell Tumors: In rodents, semaglutide causes thyroid C-cell tumors at clinically relevant exposures. It is unknown whether WEGOVY causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as the human relevance of semaglutide-induced rodent thyroid C-cell tumors has not been determined (5.1, 13.1).
• WEGOVY is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk of MTC and symptoms of thyroid tumors (4, 5.1).
• Acute Pancreatitis: Has occurred in clinical trials. Discontinue promptly if pancreatitis is suspected. Do not restart if pancreatitis is confirmed (5.2).
• Acute Gallbladder Disease: Has occurred in clinical trials. If cholelithiasis is suspected, gallbladder studies and clinical follow-up are indicated (5.3).
• Hypoglycemia: Concomitant use with an insulin secretagogue or insulin may increase the risk of hypoglycemia, including severe hypoglycemia. Reducing the dose of insulin secretagogue or insulin may be necessary. Inform all patients of the risk of hypoglycemia and educate them on the signs and symptoms of hypoglycemia (5.4, 7.1).
• Acute Kidney Injury: Has occurred. Monitor renal function when initiating or escalating doses of WEGOVY in patients reporting severe adverse gastrointestinal reactions or in those with renal impairment reporting severe adverse gastrointestinal reactions (5.5).
• Hypersensitivity: Anaphylactic reactions and angioedema have been reported postmarketing. Discontinue WEGOVY if suspected and promptly seek medical advice (5.6).
• Diabetic Retinopathy Complications in Patients with Type 2 Diabetes: Has been reported in trials with semaglutide. Patients with a history of diabetic retinopathy should be monitored (5.7).
• Heart Rate Increase: Monitor heart rate at regular intervals (5.8).
• Suicidal Behavior and Ideation: Monitor for depression or suicidal thoughts. Discontinue WEGOVY if symptoms develop (5.9)
A medical provider with UpToDate access credentials should be able to login and view this page, which will have a good summary of the existing research. Quick scan of the Phase 4 shows a fairly small percentage of people had serious adverse events, with the vast majority of adverse effects being gastrointestinal though the effect size looks small compared to placebo, which also had high reports of new events though nausea and vomiting look much more prevalent with semaglutide.
Much longer study (about a third of a year) also showed some of the same though the difference in renal failure look worrisome though I'm not sure if it's significant.
Someone with much more medical knowledge than me can and should weigh-in but it doesn't seem like we really have any information on long term side effects/adverse events (ie 5+ years), which would make me cautious about seeking a prescription unless there was a dire need for it - I'm a fairly risk-averse person, however, and other folks might have a different take on it.
posted by paimapi at 10:14 PM on August 12, 2022 [4 favorites]
paimapi, while I don't know if it is the case here but from my understanding the mechanism of action is usually well understood even if the long-term effects of actually being on the drug are not known. So it isn't as dire as it seems. Plus those warnings are basically if anyone in the study shows those symptoms. Some of those seem to be just symptoms of rapid weight loss.
There's going to be an inherent (but foolish) moral resistance for many people to the idea that you can lose weight with a pill.
Frustratingly I hear this with a lot of things people perceive as something to do with willpower or a moral failing. I had a friend who took a pill for alcohol addiction and I had never seen him not drink, sure enough he stopped drinking. He'd go out still and have zero alcohol beer and the shame he encountered was baffling. People would chastise him for not going to AA or doing 12 steps, and how he'd just go back to drinking after he stopped taking the pill. I now know what overweight people mean when they are eating in public and people judge them if they're not eating incredibly healthy or having a piece of cake at a party.
posted by geoff. at 10:24 PM on August 12, 2022 [21 favorites]
There's going to be an inherent (but foolish) moral resistance for many people to the idea that you can lose weight with a pill.
Frustratingly I hear this with a lot of things people perceive as something to do with willpower or a moral failing. I had a friend who took a pill for alcohol addiction and I had never seen him not drink, sure enough he stopped drinking. He'd go out still and have zero alcohol beer and the shame he encountered was baffling. People would chastise him for not going to AA or doing 12 steps, and how he'd just go back to drinking after he stopped taking the pill. I now know what overweight people mean when they are eating in public and people judge them if they're not eating incredibly healthy or having a piece of cake at a party.
posted by geoff. at 10:24 PM on August 12, 2022 [21 favorites]
Praemunire has it right. Science will have more and better ameliorations for obesity sooner or later and there shouldn’t be any more unease about them than anything else that makes easier to live longer and more comfortably. Obesity from overeating isn’t a moral failing, it’s a health condition not much more amenable to cure by will power than a broken arm.
posted by MattD at 10:35 PM on August 12, 2022 [11 favorites]
posted by MattD at 10:35 PM on August 12, 2022 [11 favorites]
Glad to see one more weapon added to the arsenal.
posted by AdamCSnider at 11:39 PM on August 12, 2022 [2 favorites]
posted by AdamCSnider at 11:39 PM on August 12, 2022 [2 favorites]
Mod note: One deleted. Let's stick to discussing the new treatments, and trust that the "eat less / exercise more" advice is not a thing that people haven't heard before.
posted by taz (staff) at 11:54 PM on August 12, 2022 [38 favorites]
posted by taz (staff) at 11:54 PM on August 12, 2022 [38 favorites]
I know someone who has taken off-label injected Semaglutide
And now you all do. I take off-label Semaglutide for weight loss. It's been a game changer. In Australia, 1mg Semaglutide is used on-label for diabetes and has shown very valuable results. I take it off-label (on prescription but not nationally subsidised) under the direction of my primary care doctor.
A total hysterectomy and steroid use for cancer treatment saw me gain 70lbs. I've been on 'Ozempic' since April and I hope to remain on it until the end of next year. Losing this added weight is important to reduce the likelihood of the cancer reappearing plus it will allow me to move my body more fluidly again.
My surgery and steroid use had resulted in me losing the signal system that told me I was full, or not hungry. Semaglutide has helped me get in contact with those impulses and make choices for my nutrition-seeking body rather than my taste/texture seeking mouth. Plus it has had an outstanding and unexpected effect on inflammation; my post-chemo psoriasis is almost gone and my joints feel less puffed and creaky.
BUT, according to the folk on my national semaglutide facebook page, my results are not universal. Some people have the opposite - an increase in inflammation and autoimmune responses. Constipation, diarrhea, nausea, 'sulpher-gas' burps, the continual feeling of a food bolus in the oesophagus are all common symptoms of Semaglutide and are too much for some people. You have to titrate yourself up to a full dose over weeks. It slows the emptying of the gut and some folk suffer badly from that.
The weight-loss dose tops out at 2.4mg for Wegovey. The top prescribed dose of Ozempic (in Australia) is 1mg. I imagine there are better weight-loss effects on the higher dose, but stronger side effects too.
The drug works on a number of gut/brain connections that are not fully understood. Not only do I eat less on the drug, I drink less alcohol too. A particular low-level gut-level anxiety has dissipated and I feel emotionally more robust. I love this drug, not just for the weight loss which has given me hope of returning to my pre-cancer weight and reducing my risk of recurrence, but for the positive side-effects too.
However, Novo Nordisk are unable/unwilling to keep up with demand and type 2 diabetics are finding it hard to source the drug in Australia for their risky condition. Popularisation of Wegovey* could limit access to the drug even further.
*Wegovey is the brand name for the 2.4mg dose of semaglutide for weight loss. Ozempic is the brand name for the 1mg dose for T2 diabetes. Wegovey is not yet available in Australia.
posted by Thella at 2:28 AM on August 13, 2022 [42 favorites]
And now you all do. I take off-label Semaglutide for weight loss. It's been a game changer. In Australia, 1mg Semaglutide is used on-label for diabetes and has shown very valuable results. I take it off-label (on prescription but not nationally subsidised) under the direction of my primary care doctor.
A total hysterectomy and steroid use for cancer treatment saw me gain 70lbs. I've been on 'Ozempic' since April and I hope to remain on it until the end of next year. Losing this added weight is important to reduce the likelihood of the cancer reappearing plus it will allow me to move my body more fluidly again.
My surgery and steroid use had resulted in me losing the signal system that told me I was full, or not hungry. Semaglutide has helped me get in contact with those impulses and make choices for my nutrition-seeking body rather than my taste/texture seeking mouth. Plus it has had an outstanding and unexpected effect on inflammation; my post-chemo psoriasis is almost gone and my joints feel less puffed and creaky.
BUT, according to the folk on my national semaglutide facebook page, my results are not universal. Some people have the opposite - an increase in inflammation and autoimmune responses. Constipation, diarrhea, nausea, 'sulpher-gas' burps, the continual feeling of a food bolus in the oesophagus are all common symptoms of Semaglutide and are too much for some people. You have to titrate yourself up to a full dose over weeks. It slows the emptying of the gut and some folk suffer badly from that.
The weight-loss dose tops out at 2.4mg for Wegovey. The top prescribed dose of Ozempic (in Australia) is 1mg. I imagine there are better weight-loss effects on the higher dose, but stronger side effects too.
The drug works on a number of gut/brain connections that are not fully understood. Not only do I eat less on the drug, I drink less alcohol too. A particular low-level gut-level anxiety has dissipated and I feel emotionally more robust. I love this drug, not just for the weight loss which has given me hope of returning to my pre-cancer weight and reducing my risk of recurrence, but for the positive side-effects too.
However, Novo Nordisk are unable/unwilling to keep up with demand and type 2 diabetics are finding it hard to source the drug in Australia for their risky condition. Popularisation of Wegovey* could limit access to the drug even further.
*Wegovey is the brand name for the 2.4mg dose of semaglutide for weight loss. Ozempic is the brand name for the 1mg dose for T2 diabetes. Wegovey is not yet available in Australia.
posted by Thella at 2:28 AM on August 13, 2022 [42 favorites]
The supply problems are world-wide. Despite the high prices ($80 for a 1mg dose) in Poland, there was a moment in May when it disappeared from pharmacies completely and I saw many diabetics furious with the weight-loss patients for their off-label use of Ozempic. Right now supply seems to have recovered, with half of all pharmacies showing stocks of Ozempic.
(I don't take it, but some of my meds have intermittent supply problems so Google feeds me various articles on med supply issues. The synthroid shortage was so much fun, especially driving to the next region to get some.)
posted by I claim sanctuary at 2:42 AM on August 13, 2022 [3 favorites]
(I don't take it, but some of my meds have intermittent supply problems so Google feeds me various articles on med supply issues. The synthroid shortage was so much fun, especially driving to the next region to get some.)
posted by I claim sanctuary at 2:42 AM on August 13, 2022 [3 favorites]
($80 for a 1mg dose) in Poland
I've paid up to $170 for the same in Australia, but people who take it for T2 diabetes only pay @$35. I get some money back on insurance so it ends up costing me around $20-$25 per week. I calculate that I make the same value in savings by buying less fast food, coffee, wine, etc., so I consider it a cost-neutral expense.
posted by Thella at 2:52 AM on August 13, 2022 [3 favorites]
I've paid up to $170 for the same in Australia, but people who take it for T2 diabetes only pay @$35. I get some money back on insurance so it ends up costing me around $20-$25 per week. I calculate that I make the same value in savings by buying less fast food, coffee, wine, etc., so I consider it a cost-neutral expense.
posted by Thella at 2:52 AM on August 13, 2022 [3 favorites]
Wegovy has been approved by NICE (the cost / benefit assessment body for the NHS) for use by anyone with BMI 35+ and at least one weight related co-morbidity which TBH will be trivial to find in that patient population if you go looking for it. It's not yet actually available in the UK but I imagine that within a relatively short period it will be widely prescribed.
posted by atrazine at 3:20 AM on August 13, 2022 [2 favorites]
posted by atrazine at 3:20 AM on August 13, 2022 [2 favorites]
There's going to be an inherent (but foolish) moral resistance for many people to the idea that you can lose weight with a pill.
...and this is just a drug that affects appetite. Imagine if/when they can mimic the biochemical stuff that's going on in those people who eat a lot and don't particularly exercise but stay thin.
posted by GCU Sweet and Full of Grace at 3:56 AM on August 13, 2022 [3 favorites]
...and this is just a drug that affects appetite. Imagine if/when they can mimic the biochemical stuff that's going on in those people who eat a lot and don't particularly exercise but stay thin.
posted by GCU Sweet and Full of Grace at 3:56 AM on August 13, 2022 [3 favorites]
...and this is just a drug that affects appetite. Imagine if/when they can mimic the biochemical stuff that's going on in those people who eat a lot and don't particularly exercise but stay thin.
Has there ever been a case of someone closely monitored who didn't gain weight and significantly took in more calories than they burned? I would assume that means they were not uptaking nutrients or had some digestive or other dangerous unhealthy digestive issues. I'm really curious if such a condition exists and what is might be called. I've never heard of it.
posted by geoff. at 4:19 AM on August 13, 2022 [1 favorite]
Has there ever been a case of someone closely monitored who didn't gain weight and significantly took in more calories than they burned? I would assume that means they were not uptaking nutrients or had some digestive or other dangerous unhealthy digestive issues. I'm really curious if such a condition exists and what is might be called. I've never heard of it.
posted by geoff. at 4:19 AM on August 13, 2022 [1 favorite]
Metabolic rates do vary but within a fairly limited range.
One study noted that one standard deviation of variance for resting metabolic rate (how many calories are burnt by living) was 5-8%; meaning 1 standard deviation of the population (68%) was within 6-8% of the average metabolic rate. Extending this, 2 standard deviations of the population (96%) was within 10-16% of the population average...posted by TheophileEscargot at 4:27 AM on August 13, 2022 [2 favorites]
Metabolic rate does vary, and technically there could be large variance. However, statistically speaking it is unlikely the variance would apply to you. The majority of the population exists in a range of 200-300kcal from each other and do not possess hugely different metabolic rates.
I might have to make my first actual post be an update on the science of human metabolism. The long of and short of it weight is highly regulated in the brain/gut axis and is dependent on a lot of things(stress, processed food intake, genetics, activity level+muscle mass). The reason we have epidemic of chronic diseae is not because of a collective loss of will power to eat right and exercise, but the food environment, working conditions, and other social factor are set up to promote unintentional weight gain, diabetes, higher rates of cancer, heart disease, and whole other slue of metabolic diseases.
As for the medications, GLP-1 agonist and other incretin analogs are nothing new. The first one on market was exantide in 2005 and it was noted to be one of the few diabetes drugs that didn't cause weight gain and helped with weight loss. In 2010 liraglutide(Victoza branded for diabetes and Saxenda for obesity, same drug same manufacturer. same strategy as Ozempic and Wegoovy) was released for the same purpose. These were all daily injections and then once they switch to weekly injections they started seeing increasing weight loss probably for multiple reason(easier to adhere to, different pharmacokinetics possibly affecting the brain in addition to gut, etc). The most recent popularity of this has been advertising of the data from this trial. There are some head to head trials comparing semaglutide to others and it seems a bit better, but clinically all the once a week injections seem pretty similar in affect for patients. It's one of the few drugs I can use to help people get off or preventing going on insulin, which for type 2 diabetics can a few draw backs long term. Weight loss I am neutral on, but if I could use it people who have metabolic syndrome and prevent them from developing diabetes it would be a god send. It would be cheaper to fix our food supply and give people living wages to help people loose weight ,but I don't think that is happening anytime soon.
posted by roguewraith at 4:30 AM on August 13, 2022 [36 favorites]
As for the medications, GLP-1 agonist and other incretin analogs are nothing new. The first one on market was exantide in 2005 and it was noted to be one of the few diabetes drugs that didn't cause weight gain and helped with weight loss. In 2010 liraglutide(Victoza branded for diabetes and Saxenda for obesity, same drug same manufacturer. same strategy as Ozempic and Wegoovy) was released for the same purpose. These were all daily injections and then once they switch to weekly injections they started seeing increasing weight loss probably for multiple reason(easier to adhere to, different pharmacokinetics possibly affecting the brain in addition to gut, etc). The most recent popularity of this has been advertising of the data from this trial. There are some head to head trials comparing semaglutide to others and it seems a bit better, but clinically all the once a week injections seem pretty similar in affect for patients. It's one of the few drugs I can use to help people get off or preventing going on insulin, which for type 2 diabetics can a few draw backs long term. Weight loss I am neutral on, but if I could use it people who have metabolic syndrome and prevent them from developing diabetes it would be a god send. It would be cheaper to fix our food supply and give people living wages to help people loose weight ,but I don't think that is happening anytime soon.
posted by roguewraith at 4:30 AM on August 13, 2022 [36 favorites]
I had a pretty negative experience with Wegovy, and not for the typical reasons of nausea or gastro distress. As an obese non-diabetic, my doctor prescribed Ozempic (the very same medication as Wegovy, Semaglutide, but intended for diabetes) off-label for me before Wegovy had been released. I found it only had a mild effect at Ozempic's maximum dose of 1.0mg, but hoped Wegovy's maximum dose of 2.4mg would do the trick when it got released.
When Wegovy was released, we switched over, navigated the difficulties of insurance pre-authorization, but he wanted me to go off the Ozempic and ramp up the Wegovy starting with the lowest dosages, which resulted that small effect of the Ozempic going away for a while with some small degree of weight rebound. A couple of months after I had finally ramped up to the full 2.4 dosage of Wegovy, and had some success with it triggering early satiety during meals, supply chain issues then forced Wegovy off the market, and I was forced to go back to a 1.0mg dose of Ozempic, which again resulted in a great decrease in any benefit from the medication. When the supply chains opened up and I finally was able to get back to 2.4mg of Wegovy, I found that it no longer had any effect on appetite or satiety other than cause a small amount of nausea and gastro discomfort. I was not losing weight.
I decided to go off of it - which resulted in nothing but a small decrease in nausea as it had truly seemed to stop working at all after the roller-coaster ride of ramping it up and down. I have some hope regarding GLP-1 drugs given that there were intermittent positive benefits, but I'm going to wait until tirzepatide/Mounjaro, the latest GLP-1 where the tests have shown even more dramatic benefits than semaglutide/Wegovy, is totally on the market and there are no supply issues.
posted by I EAT TAPAS at 5:43 AM on August 13, 2022 [5 favorites]
When Wegovy was released, we switched over, navigated the difficulties of insurance pre-authorization, but he wanted me to go off the Ozempic and ramp up the Wegovy starting with the lowest dosages, which resulted that small effect of the Ozempic going away for a while with some small degree of weight rebound. A couple of months after I had finally ramped up to the full 2.4 dosage of Wegovy, and had some success with it triggering early satiety during meals, supply chain issues then forced Wegovy off the market, and I was forced to go back to a 1.0mg dose of Ozempic, which again resulted in a great decrease in any benefit from the medication. When the supply chains opened up and I finally was able to get back to 2.4mg of Wegovy, I found that it no longer had any effect on appetite or satiety other than cause a small amount of nausea and gastro discomfort. I was not losing weight.
I decided to go off of it - which resulted in nothing but a small decrease in nausea as it had truly seemed to stop working at all after the roller-coaster ride of ramping it up and down. I have some hope regarding GLP-1 drugs given that there were intermittent positive benefits, but I'm going to wait until tirzepatide/Mounjaro, the latest GLP-1 where the tests have shown even more dramatic benefits than semaglutide/Wegovy, is totally on the market and there are no supply issues.
posted by I EAT TAPAS at 5:43 AM on August 13, 2022 [5 favorites]
Extending this, 2 standard deviations of the population (96%) was within 10-16% of the population average...
[...]
The majority of the population exists in a range of 200-300kcal from each other and do not possess hugely different metabolic rates.
That's a lot. I mean 500 kcal a day results in a pound of weight loss per week for me. Otherwise identical people with a 250 kcal difference would mean one gaining 20 lbs a year verses the other with the same intake. At the extremes of the two standard deviation range the higher metabolic person can eat 30% more than the low metabolic person and maintain the same weight.
posted by Mitheral at 6:08 AM on August 13, 2022 [18 favorites]
[...]
The majority of the population exists in a range of 200-300kcal from each other and do not possess hugely different metabolic rates.
That's a lot. I mean 500 kcal a day results in a pound of weight loss per week for me. Otherwise identical people with a 250 kcal difference would mean one gaining 20 lbs a year verses the other with the same intake. At the extremes of the two standard deviation range the higher metabolic person can eat 30% more than the low metabolic person and maintain the same weight.
posted by Mitheral at 6:08 AM on August 13, 2022 [18 favorites]
I scanned an article on the tweet machine last week exploring the claim that increased hunger is caused by weight gain (not the other way around). It seemed well rationalized to me. Basically, the idea was that our idea of causality of eating and weight is inverted.
Apologies for not linking it. I'm on mobile and traveling, and searching Twitter for those terms is as unbearable as you'd think. I'll post it later I hope.
posted by Dashy at 8:15 AM on August 13, 2022
Apologies for not linking it. I'm on mobile and traveling, and searching Twitter for those terms is as unbearable as you'd think. I'll post it later I hope.
posted by Dashy at 8:15 AM on August 13, 2022
Coincidentally I'm on Semaglutide (in a once-daily tablet formulation, trademarked as Rybelsus here in the UK) right now, recently ramped up to the maintenance dose. That's 14mg/day, presumably because 90% of it doesn't make it into the circulation when it's taken orally.
I can confirm that the gastric distress is bad. I'm on Omeprazole 20mg long term because some of my other meds (for metabolic syndrome—hypertension and type II diabetes) irritate my stomach, and I'm probably going to ask my GP to double my dosage or switch me to a different PPI if I have to stay on Semaglutide.
("Lose weight, exercise more" isn't an option for a 58 year old with bad knees and no sense of balance sheltering in a pandemic. Also, my weight's been stable on +/- 5% for the past 20 years, whatever I do ... "Don't take so many meds' isn't an option either—back in 2006 my unmedicated blood pressure was 250/150—this is a one-way street I'm on. I just hope this turns out to be an off-ramp.)
posted by cstross at 9:24 AM on August 13, 2022 [8 favorites]
I can confirm that the gastric distress is bad. I'm on Omeprazole 20mg long term because some of my other meds (for metabolic syndrome—hypertension and type II diabetes) irritate my stomach, and I'm probably going to ask my GP to double my dosage or switch me to a different PPI if I have to stay on Semaglutide.
("Lose weight, exercise more" isn't an option for a 58 year old with bad knees and no sense of balance sheltering in a pandemic. Also, my weight's been stable on +/- 5% for the past 20 years, whatever I do ... "Don't take so many meds' isn't an option either—back in 2006 my unmedicated blood pressure was 250/150—this is a one-way street I'm on. I just hope this turns out to be an off-ramp.)
posted by cstross at 9:24 AM on August 13, 2022 [8 favorites]
Now we're gonna make so rich people can be thin, as long as they take a medication for the rest of their lives that messes with their ability to eat intuitively and trust their own hunger signals
I'm currently using liraglutide, which has a similar mode of action to semaglutide (supplies of which are currently quite iffy in Australia, as noted above) on advice from my GP, and I cannot emphasize strongly enough that what this drug does for me is let me eat intuitively and trust the satiety signals that I simply do not have when unmedicated.
It's like my appetite has had its wheels aligned and is now running true instead of constantly pulling to the right.
The only times in my entire life that I've ever experienced anything like a possibility of eating both healthily and intuitively is with the aid of drugs.
I was having similarly good results some years back with sibutramine, but about three months in the manufacturer withdrew it from the Australian market on the basis that it had been found to bust foofer valves, albeit at rather lower rates than any of the amphetamine-adjacent alternatives.
I've been getting slightly more nausea with liraglutide than I had with sibutramine, but it's still very mild and the appetite suppressant action is also way stronger so I don't mind a bit.
I can understand why people feel compelled to Have Opinions on these substances, but if you've not been suffering from extensively reduced mobility and disabling joint and muscle pain for decades due to a BMI > 50, and have not as a result of that level of chronic obesity become desperate enough to embark upon a sustainably structured starvation regimen to correct it, then may I gently suggest that the most helpful thing you can do with those opinions is jam them straight up your clacker.
This shit works. And once that fact is well established enough to get more widespread recognition then both liraglutide and semaglutide will undoubtedly end up listed on our Pharmaceutical Benefits Scheme when used for obesity control just like they already are for diabetes, and then I and any other Australian who needs them will be paying under ten bucks a month for them instead of ~AU$400, and it will end up saving us money because the food we'd otherwise have literally no sustainable choice but to eat costs more than that.
If you're determined to play the Rich People concern trolling card then you'd be better advised to bemoan the ongoing existence of shit-grade health systems than the advent of excellent new drugs.
posted by flabdablet at 11:45 AM on August 13, 2022 [35 favorites]
I'm currently using liraglutide, which has a similar mode of action to semaglutide (supplies of which are currently quite iffy in Australia, as noted above) on advice from my GP, and I cannot emphasize strongly enough that what this drug does for me is let me eat intuitively and trust the satiety signals that I simply do not have when unmedicated.
It's like my appetite has had its wheels aligned and is now running true instead of constantly pulling to the right.
The only times in my entire life that I've ever experienced anything like a possibility of eating both healthily and intuitively is with the aid of drugs.
I was having similarly good results some years back with sibutramine, but about three months in the manufacturer withdrew it from the Australian market on the basis that it had been found to bust foofer valves, albeit at rather lower rates than any of the amphetamine-adjacent alternatives.
I've been getting slightly more nausea with liraglutide than I had with sibutramine, but it's still very mild and the appetite suppressant action is also way stronger so I don't mind a bit.
I can understand why people feel compelled to Have Opinions on these substances, but if you've not been suffering from extensively reduced mobility and disabling joint and muscle pain for decades due to a BMI > 50, and have not as a result of that level of chronic obesity become desperate enough to embark upon a sustainably structured starvation regimen to correct it, then may I gently suggest that the most helpful thing you can do with those opinions is jam them straight up your clacker.
This shit works. And once that fact is well established enough to get more widespread recognition then both liraglutide and semaglutide will undoubtedly end up listed on our Pharmaceutical Benefits Scheme when used for obesity control just like they already are for diabetes, and then I and any other Australian who needs them will be paying under ten bucks a month for them instead of ~AU$400, and it will end up saving us money because the food we'd otherwise have literally no sustainable choice but to eat costs more than that.
If you're determined to play the Rich People concern trolling card then you'd be better advised to bemoan the ongoing existence of shit-grade health systems than the advent of excellent new drugs.
posted by flabdablet at 11:45 AM on August 13, 2022 [35 favorites]
Considering how many different "miracle weight loss drugs" are advertised all over the place, I think "If this works so well, why haven't I heard of it?" is actually a completely reasonable question.
If you are selling a "miracle drug" you are in practice unregulated. If you're drug is not miraculous--which is to say, it's FDA approved and actually works--TV ads are heavily regulated.
So the choice of whether to flood the space with direct to consumer advertisements for a prescription medication is complicated and counterintuitive. And right now it's seems just the one drug approved for weight loss; so you have one decision maker.
Wegolvy is it has a "black box" warning, reserved for the most serious side effects, which seems to mean additional restrictions on types of ads (basically, they always need to list side effects and can't do some of the wink-wink marketing that Cialis does to avoid a laundry list of unpleasant risks.)
Another is just staying on good terms with the regulatory bodies and even more traditionally minded employees who very much don't want to feel like they are working for a late night informercial type of company. I think a lot of people would be surprised by some of the discussions within traditional pharma research companies and the pushback on some profit maximization moves.
All that being said I'd assume within 5 years we'll have a flood of very visible ads, as it's more than one company making the decision and it becomes more important for companies to distinguish their drugs in consumers' minds. Once one drug gets TV ads I'd expect the dam to break.
posted by mark k at 11:46 AM on August 13, 2022
If you are selling a "miracle drug" you are in practice unregulated. If you're drug is not miraculous--which is to say, it's FDA approved and actually works--TV ads are heavily regulated.
So the choice of whether to flood the space with direct to consumer advertisements for a prescription medication is complicated and counterintuitive. And right now it's seems just the one drug approved for weight loss; so you have one decision maker.
Wegolvy is it has a "black box" warning, reserved for the most serious side effects, which seems to mean additional restrictions on types of ads (basically, they always need to list side effects and can't do some of the wink-wink marketing that Cialis does to avoid a laundry list of unpleasant risks.)
Another is just staying on good terms with the regulatory bodies and even more traditionally minded employees who very much don't want to feel like they are working for a late night informercial type of company. I think a lot of people would be surprised by some of the discussions within traditional pharma research companies and the pushback on some profit maximization moves.
All that being said I'd assume within 5 years we'll have a flood of very visible ads, as it's more than one company making the decision and it becomes more important for companies to distinguish their drugs in consumers' minds. Once one drug gets TV ads I'd expect the dam to break.
posted by mark k at 11:46 AM on August 13, 2022
Direct to consumer ads right now would be pointless; they can’t make as much as they have demand. Last I looked the asking price was $1300 a month and they can’t stock it. They advertise in the clinical space, but they barely have to. It is 2-3x as effective as prior drugs; it sells itself.
My family’s personal experience mimics what others said. An unmistakable change in hunger signals so that you don’t feel like you need servings that are large, snacks, etc. also nausea the first day after using it. Pretty strong interactions with other causes of nausea like migraines and a gi bug.
posted by a robot made out of meat at 12:56 PM on August 13, 2022 [5 favorites]
My family’s personal experience mimics what others said. An unmistakable change in hunger signals so that you don’t feel like you need servings that are large, snacks, etc. also nausea the first day after using it. Pretty strong interactions with other causes of nausea like migraines and a gi bug.
posted by a robot made out of meat at 12:56 PM on August 13, 2022 [5 favorites]
Concern trolling about side effects if you aren't taking the drug seems shitty.
I take medication that gives me headaches and makes me sweat so much I bring a change of shirt with me any time I have to do any physical labor. On paper that sounds crappy but the benefits it gives me far far far outweighs those side effects.
posted by Ferreous at 1:24 PM on August 13, 2022 [6 favorites]
I take medication that gives me headaches and makes me sweat so much I bring a change of shirt with me any time I have to do any physical labor. On paper that sounds crappy but the benefits it gives me far far far outweighs those side effects.
posted by Ferreous at 1:24 PM on August 13, 2022 [6 favorites]
I'm starting this as well, to prevent the onset of diabetes that hasn't responded to diet and exercise. It's challenging to level up since i need to do it very gradually, and manufacturing delays have made the lower doses hard to get, and it's an autoinjector, so you can't control the dose.
Nausea and constipation are definitely an issue, but going gradually seems to help, as does adding fiber and eating smaller, regular meals, and raising the fat and calories when increasing the dose.
posted by answergrape at 1:45 PM on August 13, 2022 [1 favorite]
Nausea and constipation are definitely an issue, but going gradually seems to help, as does adding fiber and eating smaller, regular meals, and raising the fat and calories when increasing the dose.
posted by answergrape at 1:45 PM on August 13, 2022 [1 favorite]
I saw many diabetics furious with the weight-loss patients for their off-label use of Ozempic. Right now supply seems to have recovered, with half of all pharmacies showing stocks of Ozempic.
I'm diabetic and on Ozempic. Literally three days ago my pharmacy called to say they're unable to get more and Novo Nordisk says it may be available again in September. I'm told that TikTok influencers pushing Ozempic for weight loss are to blame. This is the first time I've been unable to get it.
I had to call my doctor and get switched (temporarily?) to Rybelsus, which is an oral form of semaglutide but not generally as good.
US price for either Ozempic or Rybelsus is $1000 for a 4 week supply, off insurance. I don't know about Wegovy prices. Since I'm also obese I was going to ask my doctor about Wegovy, but I've been hearing about supply problems and insurance being reluctant to cover it.
posted by Foosnark at 4:50 PM on August 13, 2022 [1 favorite]
I'm diabetic and on Ozempic. Literally three days ago my pharmacy called to say they're unable to get more and Novo Nordisk says it may be available again in September. I'm told that TikTok influencers pushing Ozempic for weight loss are to blame. This is the first time I've been unable to get it.
I had to call my doctor and get switched (temporarily?) to Rybelsus, which is an oral form of semaglutide but not generally as good.
US price for either Ozempic or Rybelsus is $1000 for a 4 week supply, off insurance. I don't know about Wegovy prices. Since I'm also obese I was going to ask my doctor about Wegovy, but I've been hearing about supply problems and insurance being reluctant to cover it.
posted by Foosnark at 4:50 PM on August 13, 2022 [1 favorite]
I saw many diabetics furious with the weight-loss patients for their off-label use of Ozempic.
Probably type 2 diabetics should have the common sense not to be looking for other groups to stigmatize as less worthy of treatment.
posted by praemunire at 5:52 PM on August 13, 2022 [2 favorites]
Probably type 2 diabetics should have the common sense not to be looking for other groups to stigmatize as less worthy of treatment.
posted by praemunire at 5:52 PM on August 13, 2022 [2 favorites]
Probably type 2 diabetics should have the common sense not to...
All us should have that common sense, but we don't.
It's like my appetite has had its wheels aligned and is now running true instead of constantly pulling to the right.
Yes, this is my experience with semaglutide. I had lost the ability to know when I was full yet I had also not felt hunger in almost half a decade. I'd felt ravenous many times, but not that kind of hunger you can sit with and observe. When I did eat, one serve never seemed enough and there was always a mumbling anxious commentary going on in my head about what I was going to eat next.
Semaglutide has taken away that ravenous urgency and I'm in touch with my natural hunger mechanism again. I can spoon a much smaller sized serve onto my plate and not feel like I am dieting or restricting or denying myself. I can leave food on the plate and not feel compelled to finish it. I can make social plans and not be worried if they don't include options to eat. I am able to have a direct conversation with healthy feelings of hunger and satiety, and my whole relationship with food no longer comes with a side of shame.
posted by Thella at 6:45 PM on August 13, 2022 [4 favorites]
All us should have that common sense, but we don't.
It's like my appetite has had its wheels aligned and is now running true instead of constantly pulling to the right.
Yes, this is my experience with semaglutide. I had lost the ability to know when I was full yet I had also not felt hunger in almost half a decade. I'd felt ravenous many times, but not that kind of hunger you can sit with and observe. When I did eat, one serve never seemed enough and there was always a mumbling anxious commentary going on in my head about what I was going to eat next.
Semaglutide has taken away that ravenous urgency and I'm in touch with my natural hunger mechanism again. I can spoon a much smaller sized serve onto my plate and not feel like I am dieting or restricting or denying myself. I can leave food on the plate and not feel compelled to finish it. I can make social plans and not be worried if they don't include options to eat. I am able to have a direct conversation with healthy feelings of hunger and satiety, and my whole relationship with food no longer comes with a side of shame.
posted by Thella at 6:45 PM on August 13, 2022 [4 favorites]
This article is pissing me off.
Robillard went on her first diet when she was 10. That’s when her grandmother took the grade-schooler to a Weight Watchers meeting. Nothing helped
You know what would have helped? Not taking a ten year old to weight watchers.
She says that when she returned to the office, slimmed down, people treated her so differently that it actually made her angry. She sought counseling to deal with this unexpected result of her weight loss.
Also terrible.
posted by bq at 8:33 PM on August 13, 2022 [8 favorites]
Robillard went on her first diet when she was 10. That’s when her grandmother took the grade-schooler to a Weight Watchers meeting. Nothing helped
You know what would have helped? Not taking a ten year old to weight watchers.
She says that when she returned to the office, slimmed down, people treated her so differently that it actually made her angry. She sought counseling to deal with this unexpected result of her weight loss.
Also terrible.
posted by bq at 8:33 PM on August 13, 2022 [8 favorites]
My first question is, If the FDA approved it 13 months ago, how come I've never heard of it? Taking more than a year to start to spread seems more implausible than the drug itself.
posted by dobbs at 7:10 PM on August 12
I consume a lot of health and nutrition content and I have seen these drugs discussed.
posted by bq at 8:44 PM on August 13, 2022 [3 favorites]
posted by dobbs at 7:10 PM on August 12
I consume a lot of health and nutrition content and I have seen these drugs discussed.
posted by bq at 8:44 PM on August 13, 2022 [3 favorites]
I started it this past year, being rx'd it for diabetes.
I think there were other mental factors (stress) that added to it, but...
I also was a heavy alcoholic and finally quit drinking in 2021 it's been almost 2 years.
At some point I was put on Rybelsus (the pill form).
Until November last year I was holding a steady 420-ish. Then I dropped to 398 in November. Then in March I'm at 351. I feel like I may have gained a little back.
I also had a lot of stress and issues for the first part of this year that I thought was the trigger for my lack of appetite. I was also trying to eat healthier and not eat sugar all the time (which also I am sure contributes) to weight loss. But I'm sure this semaglutide probably contributes too.
But fuck the whole "weight loss industry" for exploiting a drug for people with diabetes/syndrome x. I mean, fuck the drug industry for exploiting us too, but especially the fucking people who turn our bodies into image factories for their projections and ideals. On the other hand a larger market means (in theory a cheaper price, you know if you didn't have a goddamned monopoly)
posted by symbioid at 9:18 PM on August 13, 2022 [4 favorites]
I think there were other mental factors (stress) that added to it, but...
I also was a heavy alcoholic and finally quit drinking in 2021 it's been almost 2 years.
At some point I was put on Rybelsus (the pill form).
Until November last year I was holding a steady 420-ish. Then I dropped to 398 in November. Then in March I'm at 351. I feel like I may have gained a little back.
I also had a lot of stress and issues for the first part of this year that I thought was the trigger for my lack of appetite. I was also trying to eat healthier and not eat sugar all the time (which also I am sure contributes) to weight loss. But I'm sure this semaglutide probably contributes too.
But fuck the whole "weight loss industry" for exploiting a drug for people with diabetes/syndrome x. I mean, fuck the drug industry for exploiting us too, but especially the fucking people who turn our bodies into image factories for their projections and ideals. On the other hand a larger market means (in theory a cheaper price, you know if you didn't have a goddamned monopoly)
posted by symbioid at 9:18 PM on August 13, 2022 [4 favorites]
That's 14mg/day, presumably because 90% of it doesn't make it into the circulation when it's taken orally.
I can confirm that the gastric distress is bad.
Would you consider trying one of the injectable forms? That 90% might be raising a ruckus in your gut wall that you could sidestep by going subcutaneous instead.
it's an autoinjector, so you can't control the dose.
Is it not an injector pen that lets you dial up whatever dose you want before injecting? Those should definitely be available, so if that's not what you've been supplied with, find out why not.
posted by flabdablet at 6:14 AM on August 14, 2022
I can confirm that the gastric distress is bad.
Would you consider trying one of the injectable forms? That 90% might be raising a ruckus in your gut wall that you could sidestep by going subcutaneous instead.
it's an autoinjector, so you can't control the dose.
Is it not an injector pen that lets you dial up whatever dose you want before injecting? Those should definitely be available, so if that's not what you've been supplied with, find out why not.
posted by flabdablet at 6:14 AM on August 14, 2022
I had lost the ability to know when I was full
For as long as I can remember until the first time I took sibutramine, the only way I'd ever been able to extract any meaning at all from the phrase "feeling full" was if I used it to label the sensation of my stomach being physically incapable of holding anything more.
For years, as a kid, I was completely convinced that I had a stomach at least three times as capacious as any of my peers'. It took me a long time to work out that other people "felt full" way before getting to the point of being literally stuffed full, because that simply never happened to me; I'd always assumed that people were just being polite and/or lying when they said they'd "had enough" to eat for now.
Taking sibutramine was an absolute revelation because it actually let me experience that satiety thing that I'd heard other people talk about for all those years. So does liraglutide, even more clearly. It feels as if I'd been color-blind all my life but finally got to take off the monochromatic red lenses I never realized I'd been wearing: holy shit, these people have never been speaking metaphorically, there really is something to be sensed right there that I've never sensed before, and no fucking wonder my appetite's been all fucked up for all this time and no fucking wonder regulating my bodyweight has always been such a Sisyphean struggle.
I actually wept when it occurred to me just how much emotional energy I'd been wasting on beating myself up for lacking the "willpower" that everybody around me had been endlessly suggesting to me that I was deficient in. No, dickhead, none of them are any better at this than you, they just assume they are because their fucking bodies work properly, and all that finger-wagging If Only You'd Just Eat Less And Move More shit they've been piously preaching at you for all these years is exactly as unhelpful and dismissive as it's always sounded because they have no fucking clue.
If I'm taking appetite regulation medication then I experience what I am forced to conclude is a healthy and even "normal" relationship with food. If I'm not, I don't. It really is that simple and it really is that fucked up.
I am incredibly grateful to the pharma researchers and manufacturers who have now made that relationship accessible to me.
posted by flabdablet at 6:43 AM on August 14, 2022 [37 favorites]
For as long as I can remember until the first time I took sibutramine, the only way I'd ever been able to extract any meaning at all from the phrase "feeling full" was if I used it to label the sensation of my stomach being physically incapable of holding anything more.
For years, as a kid, I was completely convinced that I had a stomach at least three times as capacious as any of my peers'. It took me a long time to work out that other people "felt full" way before getting to the point of being literally stuffed full, because that simply never happened to me; I'd always assumed that people were just being polite and/or lying when they said they'd "had enough" to eat for now.
Taking sibutramine was an absolute revelation because it actually let me experience that satiety thing that I'd heard other people talk about for all those years. So does liraglutide, even more clearly. It feels as if I'd been color-blind all my life but finally got to take off the monochromatic red lenses I never realized I'd been wearing: holy shit, these people have never been speaking metaphorically, there really is something to be sensed right there that I've never sensed before, and no fucking wonder my appetite's been all fucked up for all this time and no fucking wonder regulating my bodyweight has always been such a Sisyphean struggle.
I actually wept when it occurred to me just how much emotional energy I'd been wasting on beating myself up for lacking the "willpower" that everybody around me had been endlessly suggesting to me that I was deficient in. No, dickhead, none of them are any better at this than you, they just assume they are because their fucking bodies work properly, and all that finger-wagging If Only You'd Just Eat Less And Move More shit they've been piously preaching at you for all these years is exactly as unhelpful and dismissive as it's always sounded because they have no fucking clue.
If I'm taking appetite regulation medication then I experience what I am forced to conclude is a healthy and even "normal" relationship with food. If I'm not, I don't. It really is that simple and it really is that fucked up.
I am incredibly grateful to the pharma researchers and manufacturers who have now made that relationship accessible to me.
posted by flabdablet at 6:43 AM on August 14, 2022 [37 favorites]
Obesity from overeating isn’t a moral failing, it’s a health condition not much more amenable to cure by will power than a broken arm.
Plastering broken arms is clearly just pandering to weakness of character. These pathetic social parasites just need to stop flapping and flailing their weird and disgusting limbs about and learn to move more intuitively. I am so sick of having to sit next to them on planes and hear complaints about the armrests for the whole fucking flight. If they need two seats they should fucking buy two seats. Losers.
And they should just do more push-ups for upper body strength. That's what I do and it's always worked for me.
posted by flabdablet at 7:00 AM on August 14, 2022 [5 favorites]
Plastering broken arms is clearly just pandering to weakness of character. These pathetic social parasites just need to stop flapping and flailing their weird and disgusting limbs about and learn to move more intuitively. I am so sick of having to sit next to them on planes and hear complaints about the armrests for the whole fucking flight. If they need two seats they should fucking buy two seats. Losers.
And they should just do more push-ups for upper body strength. That's what I do and it's always worked for me.
posted by flabdablet at 7:00 AM on August 14, 2022 [5 favorites]
For as long as I can remember …. the only way I'd ever been able to extract any meaning at all from the phrase "feeling full" was if I used it to label the sensation of my stomach being physically incapable of holding anything more
This is also my experience. For some of us the signalling system is misaligned, the same way that some of us have other biochemical misalignments. You still have to make sensible food choices and move. But semaglutides even the playing field and allow those of us in that category to actually make those better choices.
I’ve been on off label Ozempic for just over two years now. When I hit a plateau on 1mg after a year and a half, we simply had me inject two doses. My doctor explained that approval for 2mg was pending in my country and delayed due to different regulatory priorities during the pandemic. Now losing again.
I had very limited, occasional digestive side effects on 1mg. On 2mg they are a bit more frequent but I find them easy to manage. In particular, nausea seems to be the direct result of not stopping to eat when I first feel full so…I stop eating and I don’t eat again until I am actually hungry again…not some vague notion of appetite but actually hungry. If that happens when I’m about to go to bed I just go to bed and eat again in the morning.
posted by koahiatamadl at 8:13 AM on August 14, 2022 [2 favorites]
This is also my experience. For some of us the signalling system is misaligned, the same way that some of us have other biochemical misalignments. You still have to make sensible food choices and move. But semaglutides even the playing field and allow those of us in that category to actually make those better choices.
I’ve been on off label Ozempic for just over two years now. When I hit a plateau on 1mg after a year and a half, we simply had me inject two doses. My doctor explained that approval for 2mg was pending in my country and delayed due to different regulatory priorities during the pandemic. Now losing again.
I had very limited, occasional digestive side effects on 1mg. On 2mg they are a bit more frequent but I find them easy to manage. In particular, nausea seems to be the direct result of not stopping to eat when I first feel full so…I stop eating and I don’t eat again until I am actually hungry again…not some vague notion of appetite but actually hungry. If that happens when I’m about to go to bed I just go to bed and eat again in the morning.
posted by koahiatamadl at 8:13 AM on August 14, 2022 [2 favorites]
My guess for why this isn't all over advertising in the US is that most US insurance companies won't approve it, and without insurance it costs a f*ckton of money. That, plus the supply chain issues, make wide-spread advertising a waste of time right now.
Hopefully that will change as more pharma companies jump into the space and more insurance companies remember healthier members cost them less money.
posted by invincible summer at 5:04 PM on August 14, 2022 [1 favorite]
Hopefully that will change as more pharma companies jump into the space and more insurance companies remember healthier members cost them less money.
posted by invincible summer at 5:04 PM on August 14, 2022 [1 favorite]
My guess for why this isn't all over advertising in the US is that most US insurance companies won't approve it, and without insurance it costs a f*ckton of money. That, plus the supply chain issues, make wide-spread advertising a waste of time right now.
It's only approved for treatment of Type 2 diabetes in the US, and in that space it is being advertised to hell and back. (I watch the official "Old People's Hour" of TV every weeknight, "Wheel of Fortune" followed by "Jeopardy", and every ad that isn't for personal injury attorneys or hurricane impact windows is for Ozempic or Rybelsus.)
posted by Daily Alice at 7:02 PM on August 14, 2022 [6 favorites]
It's only approved for treatment of Type 2 diabetes in the US, and in that space it is being advertised to hell and back. (I watch the official "Old People's Hour" of TV every weeknight, "Wheel of Fortune" followed by "Jeopardy", and every ad that isn't for personal injury attorneys or hurricane impact windows is for Ozempic or Rybelsus.)
posted by Daily Alice at 7:02 PM on August 14, 2022 [6 favorites]
I guess I won't have to go on Alone to lose these extra 60 pounds after all!
posted by schyler523 at 6:26 AM on August 15, 2022 [1 favorite]
posted by schyler523 at 6:26 AM on August 15, 2022 [1 favorite]
and every ad that isn't for personal injury attorneys or hurricane impact windows is for Ozempic or Rybelsus.
Throw in drugs to treat plaque psoriasis (Otezla, COSENTYX, etc.) are frequent things I see during national news casts. Up until now I didn't know what Ozempic or Rybelsus actually treated.
posted by mmascolino at 1:16 PM on August 15, 2022 [1 favorite]
Throw in drugs to treat plaque psoriasis (Otezla, COSENTYX, etc.) are frequent things I see during national news casts. Up until now I didn't know what Ozempic or Rybelsus actually treated.
posted by mmascolino at 1:16 PM on August 15, 2022 [1 favorite]
My husband's A1C got a little higher than the doctor liked, so she put him on Ozempic. He's lost some weight, but more importantly his A1C fell a lot. The side effects were NOT GREAT* for a few months, but seem to have steadied out a bit - just in time for him to hit the supply issues and not be able to get this month's dose until today.
*They included something he liked to call "fart burps."
posted by PussKillian at 1:50 PM on August 15, 2022 [2 favorites]
*They included something he liked to call "fart burps."
posted by PussKillian at 1:50 PM on August 15, 2022 [2 favorites]
Fart burps are a thing with liraglutide as well.
First time it happened I thought I was in for another fifteen rounds with giardia because that's what caused them the only other time in my life that I've had them, but it seems it's just a side effect. They're nowhere near as voluminous as the giardia versions were and, unlike those, have not prompted vociferous complaints from people riding in the same car as me.
posted by flabdablet at 4:01 AM on August 16, 2022 [1 favorite]
First time it happened I thought I was in for another fifteen rounds with giardia because that's what caused them the only other time in my life that I've had them, but it seems it's just a side effect. They're nowhere near as voluminous as the giardia versions were and, unlike those, have not prompted vociferous complaints from people riding in the same car as me.
posted by flabdablet at 4:01 AM on August 16, 2022 [1 favorite]
invincible summer: My guess for why this isn't all over advertising in the US is that most US insurance companies won't approve it
Or our multi-billion-dollar weight-lossscam industry's lobbying efforts will keep it out of reach, economically, for most Americans.
posted by tzikeh at 1:45 PM on August 16, 2022
Or our multi-billion-dollar weight-loss
posted by tzikeh at 1:45 PM on August 16, 2022
Medical providers may benefit from listening to this episode of The Curbsiders.
posted by neuron at 10:49 AM on August 17, 2022
posted by neuron at 10:49 AM on August 17, 2022
Now you know yet another person on one of these drugs. My weight has been up and down through adulthood. In May I asked my doctor for a sample of one of the new GLP-1 drugs. She gave me a box of Saxenda. I didn't expect it to work.
But on this drug, I was delighted to find that, like another poster above, I discovered what apparently most other people already experience: "Intuitive eating." That is, I can physically feel when I'm full, and I can recognize approaching fullness even before it happens. I've lost weight at a rate comparable to what I've previously lost on calories-in-calories-out regimens such as Weight Watchers, but when I followed those plans, my hunger was extreme. So far on Saxenda, I have lost 20lbs in 14 weeks.
But the biggest win of this drug hasn't been the weight loss. It's been the reduction in my blood pressure. I started with mild hypertension years ago when my BMI was lower than it is now. I've taken a low dose of a BP drug for about 15 years. But since starting Saxenda, and going through a period of extraordinary personal stress that would normally have raised my blood pressure on a daily basis, my BP is sustaining at the low end of the normal range and I no longer need meds to control it. Not only is this reducing my risk of stroke and cardiovascular disease, but my life insurance premium has also reduced. I sleep much better. We are saving money on food and alcohol because my appetite for either is much lower than it once was. I've also regained a sense of self-worth that comes with the feeling of remaining in control when I'm near a bunch of food that I love.
Here's what sucks about it: It's expensive. Even with every discount available, it would cost me $1500 a month. So I buy it from Canada. It's less than that but still expensive, and I'm privileged to be able to invest in my health this way. Planning for shipping drugs from Canada that must be kept cold (until they're opened the first time) is annoying. The nausea the first two weeks was bad enough that it woke me up from a dead sleep a few times. Waking up running to the bathroom to vomit is super unpleasant. The nausea dissipated and the other GI issues have mostly settled; fiber helps and is good for me anyway. I don't mind injecting myself every day, but some people might. I don't tell many people that I'm on it, because judgment.
posted by ImproviseOrDie at 7:14 AM on August 30, 2022 [5 favorites]
But on this drug, I was delighted to find that, like another poster above, I discovered what apparently most other people already experience: "Intuitive eating." That is, I can physically feel when I'm full, and I can recognize approaching fullness even before it happens. I've lost weight at a rate comparable to what I've previously lost on calories-in-calories-out regimens such as Weight Watchers, but when I followed those plans, my hunger was extreme. So far on Saxenda, I have lost 20lbs in 14 weeks.
But the biggest win of this drug hasn't been the weight loss. It's been the reduction in my blood pressure. I started with mild hypertension years ago when my BMI was lower than it is now. I've taken a low dose of a BP drug for about 15 years. But since starting Saxenda, and going through a period of extraordinary personal stress that would normally have raised my blood pressure on a daily basis, my BP is sustaining at the low end of the normal range and I no longer need meds to control it. Not only is this reducing my risk of stroke and cardiovascular disease, but my life insurance premium has also reduced. I sleep much better. We are saving money on food and alcohol because my appetite for either is much lower than it once was. I've also regained a sense of self-worth that comes with the feeling of remaining in control when I'm near a bunch of food that I love.
Here's what sucks about it: It's expensive. Even with every discount available, it would cost me $1500 a month. So I buy it from Canada. It's less than that but still expensive, and I'm privileged to be able to invest in my health this way. Planning for shipping drugs from Canada that must be kept cold (until they're opened the first time) is annoying. The nausea the first two weeks was bad enough that it woke me up from a dead sleep a few times. Waking up running to the bathroom to vomit is super unpleasant. The nausea dissipated and the other GI issues have mostly settled; fiber helps and is good for me anyway. I don't mind injecting myself every day, but some people might. I don't tell many people that I'm on it, because judgment.
posted by ImproviseOrDie at 7:14 AM on August 30, 2022 [5 favorites]
Having now finished the five week ramp-up phase and a couple of weeks at full dose, followed by another week backed off from 3mg/day to 2.4, I've had enough of liraglutide (Saxenda).
The appetite suppression and satiety enabling effects were absolutely real; the drug does what it claims to do, no question about it. But once I got over 1.8mg/day the side effects were steadily building rather than fading away, and as it turns out, endless fart-burps, constant low-grade nausea, and explosive and shockingly voluminous diarrhoea make me more miserable than constant hunger and no satiety. I have no intention of living as if I had giardia for the rest of my life.
Sigh. Back to discipline I go. Best of luck to those for whom the balance of effects is more useful.
posted by flabdablet at 12:42 PM on September 2, 2022 [2 favorites]
The appetite suppression and satiety enabling effects were absolutely real; the drug does what it claims to do, no question about it. But once I got over 1.8mg/day the side effects were steadily building rather than fading away, and as it turns out, endless fart-burps, constant low-grade nausea, and explosive and shockingly voluminous diarrhoea make me more miserable than constant hunger and no satiety. I have no intention of living as if I had giardia for the rest of my life.
Sigh. Back to discipline I go. Best of luck to those for whom the balance of effects is more useful.
posted by flabdablet at 12:42 PM on September 2, 2022 [2 favorites]
I don't tell many people that I'm on it, because judgment.
Yeah, that part was a bit weird for me too. Several of the same people who have expressed nothing but admiration for the fasting I've been doing were visibly trying not to raise an eyebrow at the mention of using an appetite suppressant drug, especially an injectable, to make the process easier.
I'm the kind of person who really enjoys watching unexamined bigotry squirm as it tries to pretend it can't be seen so this wasn't a negative for me, but I can easily see how it could act as a disincentive to openness for others.
posted by flabdablet at 12:51 PM on September 2, 2022 [4 favorites]
Yeah, that part was a bit weird for me too. Several of the same people who have expressed nothing but admiration for the fasting I've been doing were visibly trying not to raise an eyebrow at the mention of using an appetite suppressant drug, especially an injectable, to make the process easier.
I'm the kind of person who really enjoys watching unexamined bigotry squirm as it tries to pretend it can't be seen so this wasn't a negative for me, but I can easily see how it could act as a disincentive to openness for others.
posted by flabdablet at 12:51 PM on September 2, 2022 [4 favorites]
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posted by emelenjr at 6:48 PM on August 12, 2022 [9 favorites]