Speaking of Fat People: The National Association to Advance FAT Acceptance(NAAFA).

[Cisco Kid]

IMO, a healthy weight is less than you are now if you are labeled obese. I kidded a lean, fit Swiss mountain guide after he got back from a 10 day trek that his wife needed to fatten him up now that he's back. "I'm one skin layer from being obese now" he said with a smile. I ate meat potatoes pasta and junk food like a pig my whole life and couldn't gain a pound. OK, 40 lbs in 60 years but I lost 15lbs in the past 10 years. I got A G E.

The Gov't proposed making weigh loss drugs covered my Medicare/Medicade yesterday. JFKjr has not happy.

[MagnificentUnicorn]

You seem to have adopted a persecuted stance.

Where is the controversy on here you’re speaking of?

Saying “this medication doesn’t help in 100% of cases and also has side effects - some of which can be serious” is the most universal and least controversial statement in medicine.

And why the comment about “you’d be nuts to prescribe these meds without discussing the side effects”? Did someone advocate for that? Is that supposed to be something special/specific about these medications in particular?

Your take on his response adopting a persecuted stance might be your bias. I don’t see that at all. It sounds like an opinion based on experience.


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[The AD]

I've got to think--in lieu of any new data suggesting adverse long-term effects from these weight loss drugs--that on the balance they are doing a lot more good than harm. They help most obese people lose weight without serious side effects. Are they a crutch? Sure, but a lot of people need that crutch. I think at this point it's pretty clear we're not going to solve the obesity epidemic with only a "diet and exercise" approach.

[XXX-er]

I see quite a few patients that are taking Ozempic and or metformin are getting quite sick from it. Gastroparesis doesn't sound fun, but hey, lots of scans (here eat some radioactive eggs) can be done to confirm this and keep the healthcare economy going.

thats interesting ^^ as a type II my younger GP ( you have diabeties while an older consulting anesthetist said you have high blood sugar) was trying to get me on the stuff but I resisted metformin for a long time

I was about to cave and then somehow my last fasting a1C looked OK to my GP so she never brought it up on the last medical she did ask what changes I made ?

I said something about changing from pale ales to IPA

[californiagrown]

I've got to think--in lieu of any new data suggesting adverse long-term effects from these weight loss drugs--that on the balance they are doing a lot more good than harm. They help most obese people lose weight without serious side effects. Are they a crutch? Sure, but a lot of people need that crutch. I think at this point it's pretty clear we're not going to solve the obesity epidemic with only a "diet and exercise" approach.

Yep, dont let perfection be the enemy of good/better. The peptides are cheap to produce, and appear to be overwhelmingly safe, and effective. As with any new medicine/supplement, some caution should be exercised to monitor for side effects and longer term issues that have yet to be identified... but these peptides could dramatically increase the overall health of our population.

[MagnificentUnicorn]

I've got to think--in lieu of any new data suggesting adverse long-term effects from these weight loss drugs--that on the balance they are doing a lot more good than harm. They help most obese people lose weight without serious side effects. Are they a crutch? Sure, but a lot of people need that crutch. I think at this point it's pretty clear we're not going to solve the obesity epidemic with only a "diet and exercise" approach.

Some of the issue is that the people taking these drugs will need to be on them for the rest of their lives. That’s expensive but so is obesity, but we don’t know the long term effects of taking these drugs. We’re a really unhealthy society, that’s what really needs to change but unfortunately I don’t see that happening.


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[mtnjam]

thats interesting ^^ as a type II my younger GP ( you have diabeties while an older consulting anesthetist said you have high blood sugar) was trying to get me on the stuff but I resisted metformin for a long time

I was about to cave and then somehow my last fasting a1C looked OK to my GP so she never brought it up on the last medical she did ask what changes I made ?

I said something about changing from pale ales to IPA

We usually only see the patients that are already deep into the, either poorly managed blood glucoses or that have insulin resistance and no matter what they do, can't get those values to go down. But yeah, metformin kind of sucks and makes people feel kind of shitty (literally). I'm not clear on the exact mechanism of Ozempic, but based on Trackheads info I'll have to do some googling to find out the physiology versus metformin.
Sounds like your BG's are managed well? Don't give the GP's too much info or they're gonna label you an alcoholic.

[XXX-er]

I will probably need to be on IPa's for life, fortunatly there are 2 craft brew and both the brewers are pretty good

[fomofo]

Some of the issue is that the people taking these drugs will need to be on them for the rest of their lives. That’s expensive but so is obesity, but we don’t know the long term effects of taking these drugs. We’re a really unhealthy society, that’s what really needs to change but unfortunately I don’t see that happening.

Crux of the biscuit, right there. And begs the question - why not?

Sure, I know why not, but ... why the fuck not?

[The AD]

And, in a sense, having drugs like this is an enabler for unhealthy lifestyles. That's the part I dislike for sure.

[mtnjam]

^^^this

Although intended to be a useful medication for management of blood glucose, like most things, people just want an easy fix to their poor lifestyle choices. Pop a pill culture.

Not saying that IDDM-1 or IDDM-2 is poor lifestyle at all as I have family members that are and were one or the other. My grandfather was T2, but that was under his own accordance and kept eating like a hard working midwestern farmer, but in the end his vascular problems, probably due to chronically elevated blood glucose, that did him in.

[fomofo]

I'm just finishing up reading an interesting book about the history of humankind, Sapiens. Coincidentally I just got to this passage last night (page 348 in the hardcover)...

The flowering of the consumerist ethic is manifested most clearly in the food market. Traditional agricultural societies lived in the awful shade of starvation. In the affluent world of today one of the leading health problems is obesity, which strikes the poor (who stuff themselves with hamburgers and pizzas) even more severely than the rich (who eat organic salads and fruit smoothies). Each year the US population spends more money on diets than the amount needed to feed all the hungry people in the rest of the world. Obesity is a double victory for consumerism. Instead of eating little, which will lead to economic contraction, people eat too much and then buy diet products - contributing to economic growth twice over.

Factor in Sapiens was published almost 10 years ago, before the widespread use of these new weight loss drugs, so the conclusion might now need to be amended along these lines...

Obesity is a triple victory for consumerism. Instead of eating little, which will lead to economic contraction, people eat too much and then buy diet products, until they reach the point where they need to go on medication for the rest of their lives - contributing to economic growth thrice over, and guaranteeing an endless harvest of new consumers for all these market segments.

Pretty fucking sad, eh? We could do better.

[mtnjam]

Pretty fucking sad, eh? We could do better.

we could, but that would take far too much work and self-accountability....sad indeed

I sometimes think back to what it might have been like in 1924 and really wonder if people were really this stupid then, we have so much potential as a species, but *this* is what we do with it. Don't get me started on handheld technology either, all this technology...and *this* is what we do with it?

I should go yell at the non-existent clouds in Boise today...i'll just shake my fist at the chemtrails

[XXX-er]

We usually only see the patients that are already deep into the, either poorly managed blood glucoses or that have insulin resistance and no matter what they do, can't get those values to go down. But yeah, metformin kind of sucks and makes people feel kind of shitty (literally). I'm not clear on the exact mechanism of Ozempic, but based on Trackheads info I'll have to do some googling to find out the physiology versus metformin.
Sounds like your BG's are managed well? Don't give the GP's too much info or they're gonna label you an alcoholic.

yeah I had been up around 9 then at 50 I cut food intake/ cut all added sugar/ checked the white label to pick the food choice on a supermarket shelf with the lower sugar that i was still going to eat which got me down to 7ish on the a1C, also lose 10-15lbs in 6 months so IME just doing the right thing made a big difference, so that was 18yrs ago but I am predisposed to a higher blood sugar and so did my father so its hereditary

SO I'm not going on metformin, not on any meds at 68 ( except the IPA) and there is nothing you can do about my sense of humor, BTW stopping booze for 6 months ( as opposed to quiting ) did not make a big difference on a1C

Small town so my MD knows me/ sees me skiing or biking and I think she is more worried about the rest of the town than me

[bennymac]

Your take on his response adopting a persecuted stance might be your bias. I don’t see that at all. It sounds like an opinion based on experience.


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Stating “this medication doesn’t work in 100% of people and can have side effects - some of which can be serious - and those side effects need to be discussed prior to starting the medication ” is neither an opinion nor is it controversial.

He said bringing up the side effects and efficacy of these medications is “controversial in this thread” - that’s an opinion but I’m not sure where it’s coming from.

[Trackhead]

Benny, let it go man. It doesn't matter.

-GLP1's work great for diabetics, and they have very low risk of hypoglycemia.
-They are expensive and almost NEVER covered by insurance for weight loss in the absence of diabetes.
-I prescribe them every day. I think they are great for diabetics, and good for "some" people for weight loss.
-They can have nasty side effects, but most do fine.
-We don't know about long term efficacy for weight loss.
-"lifestyle measures" almost never work, I'm glad pharma created GLP1s because it's a non-surgical, less invasive approach to effective weight loss.

Good bye. My mistake, again, for commenting on anything other than skiing.

[pfluffenmeister]

I'm just finishing up reading an interesting book about the history of humankind, Sapiens. Coincidentally I just got to this passage last night (page 348 in the hardcover)...

The flowering of the consumerist ethic is manifested most clearly in the food market. Traditional agricultural societies lived in the awful shade of starvation. In the affluent world of today one of the leading health problems is obesity, which strikes the poor (who stuff themselves with hamburgers and pizzas) even more severely than the rich (who eat organic salads and fruit smoothies). Each year the US population spends more money on diets than the amount needed to feed all the hungry people in the rest of the world. Obesity is a double victory for consumerism. Instead of eating little, which will lead to economic contraction, people eat too much and then buy diet products - contributing to economic growth twice over.

Factor in Sapiens was published almost 10 years ago, before the widespread use of these new weight loss drugs, so the conclusion might now need to be amended along these lines...

Obesity is a triple victory for consumerism. Instead of eating little, which will lead to economic contraction, people eat too much and then buy diet products, until they reach the point where they need to go on medication for the rest of their lives - contributing to economic growth thrice over, and guaranteeing an endless harvest of new consumers for all these market segments.

Pretty fucking sad, eh? We could do better.

Add on the fact that many of these weight loss drugs manufacturers have quit producing insulin (perhaps a more needed drug?)and moved those lines over to produce more ozempic(s).
More money in the prozemic(s).
Also driving insulin costs through the roof.

Win-win-win for GDP?

[XXX-er]

Wasn't insulin already thru the roof down there, I heard stories of Americans coming narth or buying it on-line from syrup land??

In Federal politics the NDP party ( fuckign commies eh) has been propping up the minority Liberal ( less commie eh ) government so if the Libs wanted to stay in power they had to play ball with the NDP which meant give Diabetic's free insulin and dental care for people with no plans

[bennymac]

Benny, let it go man. It doesn't matter.

-GLP1's work great for diabetics, and they have very low risk of hypoglycemia.
-They are expensive and almost NEVER covered by insurance for weight loss in the absence of diabetes.
-I prescribe them every day. I think they are great for diabetics, and good for "some" people for weight loss.
-They can have nasty side effects, but most do fine.
-We don't know about long term efficacy for weight loss.
-"lifestyle measures" almost never work, I'm glad pharma created GLP1s because it's a non-surgical, less invasive approach to effective weight loss.

Good bye. My mistake, again, for commenting on anything other than skiing.

Don’t make up fake controversy just to pretend you have to push back against it. And don’t whine when called on it.

Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes

https://www.nejm.org/doi/full/10.1056/NEJMoa2307563

“Among 17,604 patients with a BMI of 27 or greater and preexisting cardiovascular disease but without diabetes, treatment with once-weekly subcutaneous semaglutide at a dose of 2.4 mg for a mean duration of 33 months reduced the risk of a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke by 20%




——

This is from a year ago.

This of course needs further study in larger groups of people with various degrees of risk - but overweight people who are taking these as “lifestyle” medications for weight loss may potentially also be lowering their risk of heart attacks and strokes - even if the weight they lose isn’t a large amount.

Of note: Adverse events leading to permanent discontinuation of the treatment given occurred in 16.6% in the Ozempic group and 8.2% in the placebo group.

Unnecessary disclaimer: no I don’t work for big pharma. Yes medications have side effects. No they never work 100% of the time. Yes some side effects can be serious. Yes this all needs to be discussed/understood before someone starts any medication. Yes exercise and diet are more important than medications in treating obesity.

[dunfree]

And, in a sense, having drugs like this is an enabler for unhealthy lifestyles. That's the part I dislike for sure.

Hasnt the a bunch of the feedback been that they fix unhealthy lifestyles? Greatly reduce hunger and other things?

[ötzi]

From what I've read they seem to have a positive effect on addictions of all sorts, from food to alcohol and drugs including nicotine. So they're not just helping people lose weight, they're disrupting the addictive process that lead to the weight gain in the first place.

And once the addiction is broken they may not need to be administered further. So the "Big Pharma wants people on these drugs for life" line of argument may not hold together. I'm sure that Big Pharma would be happier if they just toned down addictive behavior a bit rather than fixed it, but that may not be what's happening.

https://www.science.org/content/arti...ion-treatments

[The AD]

Hasnt the a bunch of the feedback been that they fix unhealthy lifestyles? Greatly reduce hunger and other things?

I agree with this, but the people put themselves in the position to need these drugs in the first place. That's the behavior that needs to be addressed. I agree the results with the drugs are overall positive.

[Buzzworthy]

From what I've read they seem to have a positive effect on addictions of all sorts, from food to alcohol and drugs including nicotine. So they're not just helping people lose weight, they're disrupting the addictive process that lead to the weight gain in the first place.

And once the addiction is broken they may not need to be administered further. So the "Big Pharma wants people on these drugs for life" line of argument may not hold together. I'm sure that Big Pharma would be happier if they just toned down addictive behavior a bit rather than fixed it, but that may not be what's happening.

https://www.science.org/content/arti...ion-treatments

Kinda like shrooms.

[Cisco Kid]

Fat Shaming on Thanksgiving is weird. I've been fit all my life because I got genetically lucky. I've never measured me with thee for gifts I got and thought I was somehow superior. Add that I was groomed to have empathy for people. Except assholes, then I have a problem but I'm working on it.

[Buzzworthy]

Judgement is now taught over empathy unfortunately.