I recently became aware of the new GLP-1 drugs. This is a relatively new class of drugs (first drug in the class came on the market in 2005) used primarily for the treatment of diabetes 2.
In recent years, they’ve become increasingly trialed and used for weight loss. These drugs, specifically Ozempic and Mounjaro, cause satiety and they are the first real pharmaceutical alternative to bariatric surgery for weight loss. The usual advice (eat better and exercise more) produces sustained long-term results in about 5% of cases. It’s approximately as useful an approach as telling a dialysis patient that he should grow a new kidney.
As I’m living in Manila and with my BMI hovering around 29, I decided to go into the pharmacy and buy some Ozempic. The effect was spectacular. I’ve been on the medication for about a month and I’ve lost 6 kg. Some water weight, of course, but the loss of fat is quite noticeable already. The constant nagging desire to snack on this or that is GONE. I can eat a small portion and be full. There’s no food cravings at all. I’m running a caloric deficit of about 800 calories a day with little effort.
My alcohol consumption (which had increased significantly within the last 3 years) is down by 90%. It wasn’t really a problem…yet…but now it’s definitely not a problem.
I cannot tell you how liberating it is not having to fight against the desire to overeat every day. Side effects are mild (some occasional fatigue in my case) and supposed to diminish over time.
In my opinion, the GLP1 drugs and other, future satiety drugs are the most important pharmaceutical innovation in terms of their benefit in quality of life since the invention of hormonal contraception. Ultimately, half the US population will be taking them; most people will require life-long maintenance.
The end of carb cravings is one of the benefits I found to going low carb. That’s been working for me for over 20 years. Am glad you found something that works for you, but what do you intend to do when you reach your goal weight?
Certainly have all the trappings of a miracle…but not side effect free. I think I posted this analysis…if I didn’t, I should have. Of course, the side effects of excess bodyfat are pretty dire so it’s a question of risk benefit. Great it’s working so well…you were just able to walk into a shop and buy it?
Any diet with dramatic weight loss will also cause significant lean tissue loss. It’s true that it appears that GLP1s cause larger lean mass loss than bariatric surgery; however, it’s unclear to what degree this can be counteracted by exercise and eating sufficient protein. The STEP trial didn’t have any resistance-training component, it just counselled people that they should walk and take the stairs for 150 minutes a week. I can’t say I am particularly surprised that the patients in that study lost a lot of muscle.
Eli Lily claims much lower lean mass loss for Mounjaro:
So, you can just go into a pharmacy and buy it there with no prescription? That’s so fortunate. What is the cost? Here, insurance requests for coverage are often denied and its pretty pricy paying for it OOP.
At the current exchange rate, a 1-month pen with 4 x 1mg costs $129. That said, it can be difficult to get that dose because it tends to be out of stock a lot. The 0.5 mg dose costs about the same. And technically, you need a prescription, though just saying that you have one is often enough, especially as a westerner.
Low carb also helps me with food cravings, though the effect isn’t as powerful as with Ozempic. However, I find maintaining a low carb diet consistently to be quite expensive and annoying, especially in the Philippines, where vegetables and Western-grade food are generally substantially more expensive than in Germany, and where you can’t really eat salad given that fields are often fertilized with non-sterilized pig manure.
I think you can expect that to change. The very overweight/obese are in the majority…and that majority is getting bigger…so that’ll be a powerful lobby to get it added to the various formularies. I expect to see a big increase in my Part D premiums if/when that happens for us Chronologically Enriched.
I think what’s also likely to happen is an apparent increase in the appreciation of BMI as a predictor for disease as I bet that’ll be one cutoff point for coverage. Seems that for the past decades, there’s been something of a cottage industry in overweight/obesity denialism and pretty much every discussion on some of the old TMF boards would roll that way if BMI was mentioned in the context of excess fat. All the usual stuff about it being outdated, not relevant to the individual, doesn’t reflect body composition/muscle mass…all true but irrelevant for the majority of the population. You can bet folk will embrace it now if just a few pounds puts an individual under any cutoff point.
On one of my Peloton cult boards earlier in the week, a poster put up a photo of herself and asked if her BMI was maybe 30 as her workplace was offering a free wellness program for folk with a BMI 30 and above. Obviously something intended as an attempt to rein in the costs of obesity in the workplace.
A flurry of posts with various calculators came up and it turned out she was somewhere around 26…definitely overfat (and looked it) but niwhere near obese. Along with the sort of stuff I posted upstream…insistence that it was overrated as a commentary on health, muscle weighs more than fat etc etc…there were indeed suggestions that, if it requires a weigh in to get on the program for free, she should overeat beforehand, chug gallons of water etc.
Quite possibly…unless the other problem that’s often found with miracle drugs materialises. That they can produce more clinical complications and a greater risk to taking them than the benefits they produce. From BLOCKBUSTER/MIRACLE!! to KILLER … and then, after appropriate post-market surveillance found to be useful to some and not to others.
It’s good to see you back! As the Devil’s Advocate you should badmouth drugs! According to my cardiologist I was condemned to metformin for life. According to another doctor I was condemned to sulfasalazine for life. Both were wrong! The drugs that cured me and keep me healthy are available prescription free in most supermarkets. But one has to be careful, the agroindustrial food complex also uses the same dirt tricks that the healthcare industrial complex uses, addiction!
One does need a bit of self discipline because temptation is powerful and hard to avoid . Over the past four years I gained over seven kilos (16 pounds) and I’m finding it hard to get rid of them. Cheese is back on the banned list.
Ah, but were they wrong at the time they made these utterances? From your own accounts, you were “Lifestyle Choicing” your way to a need for these medications long before any physician had a chance to express an opinion …and long after you needed a doctor to tell you that you were doing something wrong, correct? All without too much assistance from the agroindustrial food complex. You should give yourself more credit.
It’s great that you discovered healthy eating etc and that you were fortunate enough that such an apparently simple remedy worked for you in spite of the investment you made in getting sick. Thing is, not everyone has been gifted with such a favorable genetic hand (which you must have if you’re totally cured) or the ability to snap to it when necessary.
I think it’s a worthwhile experiment for folk to be using this drug “off label” if they’re willing to do it at their own expense and risk…especially at BMIs that’re lower than has currently been tested. It’s probably the fastest way to find out if it’s a good idea or not
The most fascinating thing about Ozempic/Mounjaro is that they appear to have the same effect on alcohol addiction as they have on food addiction.
Tons of stories that go like “Until recently I was an alcoholic , now I’m drinking a beer on occasion”. These alcoholics don’t go dry - they just lose the urge to drink.
The effect is dose-dependent. That said, not everyone stops. One guy was complaining that Ozempic was interfering with his ability to get properly drunk. It had “destroyed his relationship with alcohol”.
Just as it is possible to eat to gain weight it is possible to eat to lose weight. Choosing the latter if done intelligently can become healthy habits. There are two dovetailing things that matter, water in the food like eating grapes and raw foods.
I find myself now shopping for some food every other day. As a single male that is less expensive because I just fill in the gaps which makes for variety. I cook and use better quality frozen foods for ease of preparation. All of that leaves me managing extremely well.
I have lost 46 lb as of now. I am starting to lose more weight. The weight has been off close to two years now.