Is stated willingness to engage in lifestyle changes before undergoing treatment a good predictor of actual lifestyle changes later on? This is an empirical question that should be answered empirically. Take the case of your uncle, whether real or fictional, for the sake of the argument. It’s not fun to go jogging at 38 BMI. It’s not easy to have the mental energy to rearrange one’s diet after years of low sleep quality due to sub clinical sleep apnea. Get his BMI to 25 and he might actually start enjoying jogging, perhaps starting to see life differently and taking more action when it comes to setting up his maintenance diet. It’s no use to engage in moral gatekeeping. Ozempic sounds like housing first policy for homelessness: just solve the main problem upfront, let people sort things out afterwards. If your uncle is 50 and ends up regaining weight after getting off the drug getting back to the initial weight in 10 years or so then just give him a second course. That’s still ten years of better quality of life gained.
Are the side effects you mention worse for people than being twenty or thirty pounds overweight for years prior to developing acute illness? I did not see that case being made. And I am not sure why the patient isn’t best positioned to make that choice with their doctor.
1 - if you don't like pharma companies developing drugs that are designed to be taken for life (fair point), why do you present the fact that many people come off GLP1s within a year as negative? How many people quit because the drugs have done the job? With or without lifestyle changes? That's success.
2 - surely this is at least partly a success story for capitalism? Obesity is widely regarded as a significant problem. Private companies came up with potentially the best solution to it, governments have never come close. Should they not be rewarded? At least some of that money will go into developing other drugs. Wouldn't you prefer people with a track record of success to be developing drugs rather than anyone else?
3 - the heart disease/everything else improvements. Does anyone know if this is linked to simply losing weight or is there something else at play? Have these things been studied? We're getting a better understanding of why exercise is so healthy (rather than being effective for weight loss). When you eat too much, your body increases metabolism to burn calories off. A big part of that is ramping up the immune system, causing system wide inflammation. Doing this all the time is really bad for you. Exercise gets rid of the excess calories, so your body doesn't inflame everything. Also why your weight loss can plateau - the calories out bit changes. Do the GLP1s and greatly reduced calorie intake tap into the same mechanism?
Very balanced take and it feels right to be wary of capitalism and commit to lifestyle changes wherever you can rather than sticking to the drug to do 'miracles' for you!
The problem with ozempic is mainly strong reactions from both medical professionals as well as patients. There is no middle ground for discussion. You can’t love certain aspect of this drug or say well let’s fix our broken food system too instead of just taking ozempic
What percentage of people taking Glp1s are not under doctor supervision? Doesn’t seem to be a high number, so what’s the problem?
Thank you for writing this. It has given me a decent idea about how the drug works (I had none before this)
Is stated willingness to engage in lifestyle changes before undergoing treatment a good predictor of actual lifestyle changes later on? This is an empirical question that should be answered empirically. Take the case of your uncle, whether real or fictional, for the sake of the argument. It’s not fun to go jogging at 38 BMI. It’s not easy to have the mental energy to rearrange one’s diet after years of low sleep quality due to sub clinical sleep apnea. Get his BMI to 25 and he might actually start enjoying jogging, perhaps starting to see life differently and taking more action when it comes to setting up his maintenance diet. It’s no use to engage in moral gatekeeping. Ozempic sounds like housing first policy for homelessness: just solve the main problem upfront, let people sort things out afterwards. If your uncle is 50 and ends up regaining weight after getting off the drug getting back to the initial weight in 10 years or so then just give him a second course. That’s still ten years of better quality of life gained.
Are the side effects you mention worse for people than being twenty or thirty pounds overweight for years prior to developing acute illness? I did not see that case being made. And I am not sure why the patient isn’t best positioned to make that choice with their doctor.
That was good, though there are questions.
1 - if you don't like pharma companies developing drugs that are designed to be taken for life (fair point), why do you present the fact that many people come off GLP1s within a year as negative? How many people quit because the drugs have done the job? With or without lifestyle changes? That's success.
2 - surely this is at least partly a success story for capitalism? Obesity is widely regarded as a significant problem. Private companies came up with potentially the best solution to it, governments have never come close. Should they not be rewarded? At least some of that money will go into developing other drugs. Wouldn't you prefer people with a track record of success to be developing drugs rather than anyone else?
3 - the heart disease/everything else improvements. Does anyone know if this is linked to simply losing weight or is there something else at play? Have these things been studied? We're getting a better understanding of why exercise is so healthy (rather than being effective for weight loss). When you eat too much, your body increases metabolism to burn calories off. A big part of that is ramping up the immune system, causing system wide inflammation. Doing this all the time is really bad for you. Exercise gets rid of the excess calories, so your body doesn't inflame everything. Also why your weight loss can plateau - the calories out bit changes. Do the GLP1s and greatly reduced calorie intake tap into the same mechanism?
It’s amazing how well you broke down the science behind the drug. I think I can reexplain how Ozempic works to anyone
Love it. The best 101 on Ozempic I've read.
Indeed, I didn't know much about this before, despite this being in the news so often.
Very very well explained. Always a treat to read your work Samarth! 👏
Love when people explain technical stuff with such simplicity.
Very balanced take and it feels right to be wary of capitalism and commit to lifestyle changes wherever you can rather than sticking to the drug to do 'miracles' for you!
Excellent discussion. Please see my Substack The Constant Dieter's Notebook.
The problem with ozempic is mainly strong reactions from both medical professionals as well as patients. There is no middle ground for discussion. You can’t love certain aspect of this drug or say well let’s fix our broken food system too instead of just taking ozempic
So well written! And gave me so much more clarity that i had before thank you
It's just not right to recommend/ gloat about a drug so casually. Please leave that to the medical professionals.
1. These semaglutide drugs are still in their nascent stages of deployment and there are advances happening frequently.
Ex - Eli Lilly's oral tablets have fewer side effects than Ozempic.
2. There is a major opportunity for Indian generics manufacturers to bring the cost down. Capitalism can amplify both the positives and the negatives.
I do understand the scepticism but let's wait and see.