Unfortunately different people can need really different takes on diet.

"5 smaller regular portions during the day" is part of how I went from 100 to over 110kg and struggled to walk longer than 20 minutes. Getting back to walking fit required 10 days being fed minimal amounts to prevent collapse of digestive system with a tube through the nose. I still gained weight ultimately, but combined with exercise it allowed me to walk and even run for short distances.

Spent years just trying to figure out what's wrong with endocrine system - still don't really know. One of the things led to being prescribed ozempic, not just for weight loss, but because of its function of lowering insulin levels.

> When you stop using this drug, and you have not adjusted the way you eat/live... don't you just yoyo back up? I'd think so.

Why does it matter? Do we worry that asthmatics will start havin asthma attacks again if they stop their medications? Do we worry that diabetics will struggle with insulin problems if they stop theirs? Do we worry that people with vision problems will suffer again if they stop using their eyewear? If someone has to take ozempic every day for the rest of their lives in order to maintain a healthy weight, why the heck do we think that’s worse than being obese every day for the rest of their lives? Why is it more noble that you “nearly a decade in” struggle every single day of your life to maintain a healthy weight? Wouldn’t it be better if you could both maintain a healthy weight and also stop struggling so much?

It matters.

Keeping people on this medication for life seems like a really bad thing - atleast until we clearly know what the long term effects are. Those are unknown.

The other medication you mention is known, studied, affordable. Comparing insulin to Ozempic is .. well, a non-comparison in my book.

Generally speaking - definitely for something that you can treat with a life style change and some inconvenience in the beginning - a life where you can live without a drug is better than one where you keep being dependent on it.

Unless you're the pharma industry, that is.

There are scores of medications necessary for chronic conditions that we give to patients without intention of stopping that have not been around for a lifetime of testing for “long-term safety.” If your cardiologist prescribes you an SGLT2-i for heart failure because we have studies that show it has significant mortality benefit, you probably won't bat an eye before taking it---yet they have only been FDA approved since 2013. (As an aside, people also don't generally rag on heart/kidney/liver failure patients for poor lifestyle habits that may have contributed or continue to contribute to their disease, as they do for patients with obesity.) GLP-1 receptor agonists like Ozempic have been on the market since 2005. Obesity is among the most prevalent, morbid diseases that itself accounts for 20% of US health expenditure; it will lead to diabetes, hypertension, OSA, heart failure, arthritis, depression, cirrhosis, even cancer and then some. Our scientific and clinical understanding of obesity is evolving beyond it being a self-imposed and self-treatable lifestyle choice, but as a complex neurohormonal disease; one that is chronic like hypertension, and that must be treated chronically (like hypertension) as well. As doctors, counseling patients to diet and exercise (even offering nutritionist referrals) is the equivalent of sitting idly by as patient after patient rotates through our clinic having tried diet/exercise for years all the while developing obesity-related comorbidities.

>The other medication you mention is known, studied, affordable. Comparing insulin to Ozempic is .. well, a non-comparison in my book.

Ozempic is literally a drug for diabetes. We're already prescribing this to people with the expectation they will be on it for life.

>something that you can treat with a life style change and some inconvenience in the beginning

We have people in this very discussion who are also morally opposed to Ozempic describing how keeping their weight is a decades long daily struggle. That doesn't sound like "some inconvenience in the beginning". We also have decades of research (and the reality of the world we live in) suggesting to us that "lifestyle change and some inconvenience" is not working as a treatment.