>This is a diabetes drug.

It was developed as a drug that increases insulin response, but it also appears to have a substantial impact on CNS processes controlling food cravings and other types of desire.

Given that, it’s possible we’ve stumbled upon the mechanism responsible for genetic differences in how we put on weight, whether that’s appetite, metabolic differences or both.

GLP-1 medications have been hypothesized to possibly result in the loss of muscle mass and bone density. There will probably be better data in a few years.

> GLP-1 medications have been hypothesized to possibly result in the loss of muscle mass and bone density.

Yikes. I wonder if there could be long term cardiac or pulmonary health issues as a result of this.

I'm also interested if this creates long-term insulin or pancreatic dysfunction.

What I find weirder is that people chase Ozempic even though they have introduced Wegovy. Which is basically the same drug but without glycemic control and hence more suited for non-diabetics. Both are Semaglutides and Wegovy directly targets weight loss.

No it’s the exact same drug. There’s no “without glycemic control” difference. The largest dose of Ozempic available is a little more than the largest Wegovy but it’s the same drug.

I’m on Ozempic and not Wegovy. Here’s why:

- Wegovy is impossible to get. I had it prescribed a year ago and it still hasn’t been filled. Multiple pharmacies too.

- In the meantime, my new insurance doesn’t cover it or Ozempic. So I’m out of pocket.

- Ozempic 2mg pens are readily available and unlike Wegovy, you dial the dose, so that 2mg pen lasts me 2 months. It’s not officially indicated and they tell you not to, but just google an Ozempic click chart to see. My doctor was the one who suggested this!

- Wegovy pens don’t have variable dosage. Only Ozempic does.

- Theres no price difference in the pen sizes for Ozempic or Wegovy near me. No matter what dose pen you get, and no matter if it’s Ozempic or Wegovy, it’s $1000 for a 4 dose equivalent of the prescribed amount.

So for me it’s a no brainer if I’m paying retail - give me the highest dose Ozempic pen and I’ll dial the smaller dose that I take. It’ll last me twice as long since I take 1mg weekly. And I can actually get it.

The fact that 0.5, 1, and 2mg dose pens all cost the same tells you how badly we’re getting worked here.

They are the exact same active pharmaceutical ingredient (semaglutide), only differ in dosage and the design of the pen used to inject them. Ozempic is a multi use pen while Wegovy comes in fixed dosage single use pens that max out higher than Ozempic's highest dosage.

Glycemic control wouldn't be any different between the two at the same dosage but yes, people should really be seeking out Wegovy or Zepbound (tirzepatide) since those actually have a chance of being approved by their insurance for weight loss based on their FDA indication vs Ozempic or Mounjaro.

> Which is basically the same drug but without glycemic control

No... The effects are the same because they are exactly the same drug (semaglutide), the difference is the dosing schedule and max dose (wegovy is 2.4mg and ozempic is 2mg).

Pretty weird diabetics have a lower dose

They said the same about Viagra.

Ads are all over Instagram. Every TRT company is also offering it.

> This is a diabetes drug. There has to be a biochemical catch here.

What if there isn't a catch? Sometimes technology really does just improve the human condition with no serious downsides. Consider refrigeration or sanitary surgical techniques.

The human body is a massive system of interconnected feedback loops. Tweak one knob, and there are always cascading side effects.

I could entirely see this being a net positive for a lot of people, but I want to know what those side effects are.

Thyroid cancer is one catch.

I was wondering this. How often does it turn out that a drug has no serious downsides? I guess penicillin was, if you're not allergic. (There is microbes evolving antibiotic resistance, but that's probably not a concern for ozempic.)

Try taking strong antibiotics for 2+ weeks. The list of serious downsides will be quite long

Plenty of people have got digestive system paralysis, so that’s a downside. Obviously the big issue is that for people with diabetes this has made the drug unavailable for actual medical problems that don’t have other treatments.

Long term studies are also not super complete - even something known to cause cancer like smoking or asbestos takes decades to show up.

All the usable refrigerants were either flammable, toxic, or highly ozone depleting, or a combination, up until the 90s…

Pretty sure R290 is flammable and I believe being used more and more

Yes, R600 even more so, there are some very expensive exotic refrigerants that are not, but they literally didn’t exist pre 90s.

Ozempic's side effects range from frequent diarrhea to pancreatitis and vision loss. Individuals can consider whether the benefits outweigh the costs. But it isn't free. We might try a Fermi problem to estimate how many of those cheerful Ozempic influencers talk about pancreatitis.

Side effects are real but obesity kills too. Importantly, GLP-1 agonists can also inhibit addictive behaviors (alcohol and substance abuse, gambling) due to a brain chemistry mechanism. Additional harm reduction to consider.

https://ourworldindata.org/obesity

https://www.scientificamerican.com/article/could-new-weight-...

Refrigerants contribute to global warming, no?

The Law of Equivalent Exchange can be dodged, delayed, and ignored for only so long. There may not be a biochemical catch, but we will certainly pay in some other way. Perhaps spiritual, mental, etc.

Except that that’s not an actual natural law. In the same way that sometimes bad things happen to good people for no reason and with no compensation whatsoever, sometimes good things happen to people as well, whether they “deserve” it or not.

Other than that, what’s the problem with a weight loss drug? That it’s “unnatural” or “cheating nature”? The weight gain and the corresponding lifestyle and nutrition that often cause it aren’t exactly nature-given either.

Fullmetal Alchemist isn't real life. You don't have to account for every microgram of material along the way for a drug to be useful and safe.

imagine if you were saying this about vaccines or antibiotics.

this drug has side effects on some people but it’s may make obesity a thing of the past. especially if generics could be made so cheaply

Different people place different weights on different values and outcomes. I'm sure there are many elderly people who miss the culture of sociability with neighbors that was largely a byproduct of material scarcity. Borrowing the sugar, congregating at the neighbor's house who is the only one on the block with a TV, etc. Our loneliness and mental health crisis is largely the price we paid for vanquishing material scarcity.

If you cannot see the dysgenic effects of vaccines, antibiotics, etc I doubt I can convince you in a a single comment. Just take my word for it that the percent of the population that will have permanent defects that require lifelong treatments is continuing to rise. Sperm loads and quality are continuing to drop.

I am not implying that these trade-offs aren't worth making -- just that our collective leadership should be making them with eyes wide open and planning for the inevitable sacrifice each piece of 'progress' requires.

Edit: Just as a simple thought experiment: If these obesity drugs are really the miracles they seem to be, I can see a future in couple generations where any disruption in supply will lead every single person to balloon to the size of the fattest person you have ever seen in your life. What ever gene(s) are regulating satiation will be rendered moot and thus have zero selection pressure. The outsourcing of this function is just that -- the human organism will no longer have any method of regulating hunger, satiation, etc.

To be fair, some people are saying that about vaccines or antibiotics.

Fortunately they don’t regulate access to either for most people in the world.