For folks who are risking health complications due to obesity and yet still struggle to achieve meaningful weight loss, this can be an acceptable tradeoff. Especially considering the increased life expectancy. The health benefits of being in a normal weight range can't be overstated.
But if you're "not overweight", or are fortunate enough to make progress through diet and exercise, you probably don't want to be taking this for the rest of your life. It's not cheap and there can be side effects.
And if you're not planning to take it for the rest of your life, there's no point.
I'm at the age where I'm attending a ton of weddings, and many of the brides and grooms go on Ozempic for a few months before the wedding, fully acknowledging they'll probably gain all the weight back afterward (despite their best efforts to keep it off!)
The weight loss may not be permanent, but it's a day where most people are probably photographed and recorded more than any other day in their lives, and those captured images are indeed pregnant. The added stress and hectic nature of planning a large wedding makes it quite difficult to diet, exercise, and lose weight the natural way as well (I imagine).
Not necessarily. When you get to the target weight, you don't need to go straight from the dose you are on to zero, you can, and probably should, lower the dose little by little, just like you raised the dose at the beginning of the regimen. If you are at 2mg, you first go to 1mg, see if your weight is stable, then if it is, go to 0.5 mg, then 0.25 mg. In the near future there will be oral versions of the GLP-1 antagonists, to you will be able to fine-tune even more precisely the dose, for example, you could figure if you can skip some days.
The body has some "weight memory". But I heard this memory disappears after about 10 years. If you take Ozempic for 2 years, go in very low dose maintenance mode for 8 years, and then stop taking it, but keep an eye to see if you need to start again, what other dieting option offers you this type of choice?
I do think they'll probably be available eventually, but I don't think it's as trivial a problem to solve as you're implying.
How is it that once you stop taking everything reverts?
In response, your body secretes more hormones, so you take more GLP-1 drugs. Increase until you reach a stable balance that adequately controls the hunger.
Now, when you stop taking the GLP-1 drugs, you have a flood of surplus hunger hormones... and the hunger comes back with a vengeance. Plus, you probably haven't learned any effective coping skills for dealing with that hunger while taking the drug - so you're likely to revert to old lifestyle practices.
Or at least that's my understanding. The endocrine system is complicated. However, mechanism aside, the data is clear that people regain the weight once they stop. There's a relevant study here:
https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.147...
If your body is telling you 24/7 that you're hungry, it's very hard to ignore that drive - it's literally one of our most basic hardwired instincts. Even more so if you have a particularly stressful life or get poor sleep, which also feeds into the hormone issues.
So yes, it is always "calories in - calories out"... but unless you're willing to lock people in a lab and have a third-party control the diet, you also have to consider the mental and biological factors that drive how many calories people's bodies are seeking out.
Diet and exercise do work for some people, and is always the best option when it works. But we also know from decades of failed diets that they do not work for many people - lifestyle modification has a terrible success rate.
Trying to ignore being hungry it is a poor strategy. The solution is to to make peace with the sensation of hunger.
I do think most obesity should be treated as a mental health issue rather than a physical health issue.
The issue isn't that the person is obese - that's the symptom. The issue is that they're overheating. "What's driving me to overeat?" is the question they need to be asking themselves, and that answer will be the first piece of the puzzle.
Most obese people became obese in childhood. In obese people, especially those from childhood that were forced to always clean their plate, signaling pathways for satiation tend to stop working, so consuming a "normal" amount of food becomes difficult. Furthermore, mechanisms for hunger in obesity function very similarly to mechanisms for cocaine or alcohol addiction.
Drugs like Ozempic finally allow their biological signals for "you've had enough food" to actually work, so obese people can lose weight because they feel satiated like normal people do.
FWIW I have lost weight both ways - 80lbs through sheer will, and 25lbs through Mounjaro. I vastly prefer the second. The former is the hardest thing I have ever done (or will likely ever do) in my life. It was harder than getting into a top college, harder than anything relating to my career, harder than literally any other endeavor I've taken. It is definitely unreasonable to expect the average person to expend so much extreme mental effort when alternatives exist to become healthy.
I was SO hungry, it was indeed one of my dominant thoughts other than wanting to kill myself (or distract myself with hot hand warmers in between puking). It virtually never truly went away, other than when I was distracted by even worse senations.
What I then struggle to understand is why my obese and well-off father with a LOT of free time can't make the decision to stop eating fast food, can't consistently stick with not buying presumably very immediately gratifying and pleasurable fast food that often makes him feel sick later. Why I could actually have made radical changes to my diet years before I ever had that level of extreme suffering, or consistently rejected taking any opioids or weed even when my tolerances were probably more reset 1 or 2 weeks in and they could've provided substantial short-term escape from that hell.
I ask in this manner not to try to "brag", as if there's some achievement in meaningless and random suffering, but rather to ask about and understand how you might interpet it. I feel like I've experienced severe and truly engulfing hunger + pain. Coming out of that, I don't understand why some people can't escape the "addiction" of overeating unhealthy food, let alone too much of it, and others can escape the throes of drug dependency.
What could be so alien about someone like me compared against my own father, as opposed to his being in an active refusal to try?
Ultimately, it all seems to me like the issue isn't one of avoiding pain so much as refusing not to experience constant cheap pleasure, and yet given the same opportunities of similar constant cheap pleasures I've mostly avoided them in seeing the longer term pain lying in wait behind their facade. I feel as though the only definitive observation I can make there is that most obese people can't seem to see their condition similarly. They can get hyped up selling themselved and those around them a meme "diet plan" while its easy in their mind, but once it comes time to do the hard work of rejecting harmful habits all the cheap fun imagining the future disappears and they quit, simply ignoring all the downsides by trying to embrace even more pleasure.
Well, addiction is a difficult thing. Most people with a serious addiction will never be able to overcome it. A small number of people will have the willpower to get through the withdrawal and engulfing suffering related to it.
> it all seems to me like the issue isn't one of avoiding pain so much as refusing not to experience constant cheap pleasure
People that are addicted to food, cocaine, or alcohol don't want to be addicted to it. They hate their constant urges. When I was at my worst I didn't want to eat the food I was eating. But fighting that urge requires a monumental amount of willpower people often simply don't have. It's not a "willpower deficiency" just as we wouldn't call a normal person willpower-deficient if they couldn't kick a cocaine addiction.
> once it comes time to do the hard work of rejecting harmful habits all the cheap fun imagining the future disappears and they quit, simply ignoring all the downsides by trying to embrace even more pleasure.
Yeah, they give up - which to me is completely unsurprising given how hard losing weight and kicking that addiction is for some people. See, given how addicted you are to food, a diet plan could range from merely "hard work" to "so ridiculously hard that your psychology can't handle it".
This is why I think medicines like Ozempic are critical. They enable you to lose weight without needing to exercise Herculean feats of willpower if you are very addicted to food (especially if you have been since childhood.)
Exercising the willpower to not eat when you're hungry is only a Herculean effort if you've stopped exercising it regularly for a long time.
At any given moment, we might have multiple conflicting desires (e.g. "I want to eat this pizza," and "I want to lose weight"), and it takes a lot of mental practice to be able notice when this is happening, and take a moment to identify which of your wants are base urges and which are real, higher-order desires, then align your actions with the higher-order ones. Meditation helps, and for those that really struggle with exercising executive function, therapy can help as well. But it takes a lot of practice and sustained effort. Habits change quite slowly and most of the work of losing weight is building the right mental frameworks so that you can start changing habits. Trying to brute force weight loss is like trying to swim the English channel with no training - you're going to fail and might hurt or even traumatize yourself in the process, which will make it even harder if you try again later.
Medication does work and it has its place, but because it comes with side effects and does not resolve the underlying mental issues that are driving the addictive behavior, I really do feel it should be a last resort for the most serious cases of addiction, not the first line of attack. It's possible you and I may agree on this point, but many don't, and refusing to acknowledge that obesity is primarily a psychological issue is doing more harm than good.
Addiction mechanics play a role here. It's not just willpower, it's willpower minus addiction. The second variable is absolutely massive, it snowballs over time, and it's why addiction treatments often have more interventions than just willpower.
As such, it's a thousand times more difficult for an obese person to "simply not eat" than it is for a normal person to "simply not eat." To the normal person, not addicted to food, it might seem simple, like the obese person simply lacks willpower, but in the obese person's shoes the normal person would likely end up the same way.
Hence, the obesity epidemic - it sneaks up on you.
I wonder what this is doing to our insurance premiums because it sure isn't cheap, but other than that, I say if you want to take it, then go for it. I probably would if the cost was reasonable.
Others will simply lie about their weight to their primary care, increasing it slightly to match the BMI bar.
Finally, some people will get the drug from compound pharmacies.
TL;DR - yes, it probably impacts premiums, but insurance companies are somewhat evil for attaching so many restrictions around a drug that every overweight person should have free access to.
It is frankly ridiculous that these companies have the power to get between a doctor and patient, and what the doctor deems medically necessary.
It will figure out your TDEE and give you the information you need to hit a particular rate of weight loss or gain.
Strength and endurance training now is still a great idea for the health benefits and for building her body up before the next pregnancy.
She's been very consistent in going to the gym and has seen some good results. But it does require a lot of motivation and effort.
She's tempted to ask our GP about Ozempic, but also afraid of unknown risks that comes with going off-label.
My opinion is that she should continue in the old-fashioned-way because it's been working well, not just for weight-loss, but also as an escape from childcare.
But now seeing people lose weight very much faster than her, I almost see her lose the motivation to do it the old-fashioned way. Some of her gym friends are on it, and so is a daily reminder for her.
So I am a bit mixed on this. We're also planning to have another child soonish, so unsure if this even factors in.
I am worried that collectively, the world has gone a bit too fast in using this for minor weight-loss.