A friend of mine who works in primary care has a policy of not prescribing semaglutide unless a patient has tried at least three months of diet/exercise first. She now has a long list of patients who decide to screw that and self-refer to a specialist who'd write them the script. I don't work in primary care myself, but this more or less matches my own experience - 95% of people do not want to put in the effort of changing diet, exercise, and other lifestyle habits. They want a quick fix.

In the words of Ronnie Coleman, "Everybody wants to be a bodybuilder, but nobody wants to lift no heavy-ass weights."

So I really do think the popularity of semaglutide is a bottom up phenomenon. There is has been huge consumer demand for a weight loss drug for decades, and pharma is only now meeting that demand.

> doctors having intimate financial relationships with pharma is already a public secret

A small number of elite doctors have intimate relationships with pharma. The other 99% who are prescribing semaglutide do not profit from it. In fact, it's the other way around. You can't bill for the act of prescribing medications, but there are dedicated billing codes for counseling a patient on diet/lifestyle modification.

I lost a bunch of weight when I moved to Dublin and started walking everywhere. Then I moved to the Netherlands and lost even more, and got stronger. I didn't particularly try, I just lived somewhere where I used my own body to get around and the "normal" portion sizes were actually somewhat sane (a bag of Doritos here is maybe a third the size of one in the US).

I was 280 pounds when I lived in suburban California. I'm 180 pounds now.

Build bike lanes and public transport, put schools where kids can walk to them, and maybe don't sell a thousand calories of chips in a personal-sized and marketed bag, and it should get better.

As an added bonus you get a lot less air pollution (and noise pollution, etc.) and less people being run over!

GLP-1 pharma intervention is breadboarding the human, next step is a permanent fix. Adversarial bioengineering, if you will.

Regarding your proposed gene therapy, would this gene therapy be available to anyone? Could it be refused? Is it reversible? Who would pay for it? The beauty of The Culture is that it is not monolithic, has no border, has godlike AI that takes care of all the problems, and can be abandoned or joined by anyone.

I know what you meant, but according to a comment here once, European city streets actually have worse air pollution than US ones because Europe went hard for diesel engines (to reduce CO2 emissions) for its cars, and diesel produces a lot of very small carbon particles, which turned out to be more harmful than most people suspected back when the diesel decision was made.

[1]: https://www.amsterdam.nl/en/traffic-transport/low-emission-z...

Of course, Volkswagen lying about their diesels and killing people in the aggregate didn’t help.

What we need is car-free or low-car cities, not just different cars.

Popular EV's aren't significantly heavier than ICE vehicles. A Tesla model 3 and a BMW model 3 are both about 3500 pounds. Range is a huge selling feature for EV's and weight has a significant impact on range, so there is strong evolutionary pressure to lighten EV's. Crappy EV's like the Hummer are heavy; but popular EV's like Tesla's and Hyundai's have weight comparable to normal cars so that they can have impressive ranges without too many expensive and heavy batteries.

EV's increased tire wire is due to their massive torque at low range. If you want your tires to last, just don't drive like a hooligan. We got 70,000 km out of our first set of EV tires.

Tire particulates are an "all cars a bad" issue. EV's are not significantly worse than petrol vehicles vis a vis tire particulates. Their lack of exhaust particulates means that an EV produces about ~half the total number of particulates.

Even so, I still find that the fewer cars there are, the easier it is for me (and my kids) to walk and bike places safely, helping us be healthier (and not reliant on drugs like Ozempic) which was the real point of my comment.

Everyone is directly responsible for their own health and nobody else is. The insanity of this statement is baffling.

If the genetic / hormonal explanation is right, it would mean the "effort" is not the same for everyone. So expecting people on the wrong side of the equation to not go for a solution to right the scales demonstrate a lack of empathy.

Would you call cochlear implants a quick fix for people who have problem hearing?

There's nothing with wanting a quick fix to make it easier and less unpleasant. I'd happily use a provably safe one. The only issue is that currently that fix carries unknown risks.

In absolute, changing diet is not inherently hard : it's pretty easy to eat a balanced diet and get pleasure from it.

But it's not enough to just say "eat better", "do more sports" : people can't change the way the lived their whole life if you don't educate and help them to make the change. The education on this topic is so poor that we are still confusing balanced diet and low-calorie diet.

And then there is the elephant in the room which is the refined sugar : for some dubious reason, most scientists agree that refined sugar acts like a hard drug but nobody officially wants to call it a drug. Recent research are saying that the addictive effects of refined sugar are akin to heroin. That's a serious issue then. What it means is that a doctor asking his patient to eat less sugar / eat a balanced diet without further guidance or help is just like saying to an heroin addict that he should stop.

I'm relatively overweight and pretty self educated on the topic but I still decided to work with a nutritionist to change my diet and we are talking about months if not years of follow-up. Eating habits are largely automated by our biology : willpower and education are nothing against an hypoglycemia induced sugar craving.

Like drugs, most people need help and guidance on the long term to change those habits. But what's even worse is that unlike drugs, unhealthy products are basically everywhere in your supermarket, your TV ads, your billboards, your friends lifestyle, and even worse, profoundly ingrained in the culture. You have to fight the "drug" but also the whole capitalist world around you.

But even a balanced diet can let you put weight if you eat too much.

We know genetics disorder like Prader-Willis can cause insatiable appetite. Even with a "balanced diet" those affected by it will end-up obese.

Now the current research on GLP-1 hint at many people having a harder time feeling satiated, not to the Prader-Willis point but still worse than what is considered normal. For people who don't have the problem it is easy to think they just have more discipline / willpower and that's why they're thin. I'd like them to imagine what would happen if after eating 2 or 3 pizza slices they'd still feel like their stomach is empty. What if it's not a one time occurrence but all day every day from the moment they develop a conscience to their death bed. A little like drug addiction but you need some drug to live so it is legal and you can buy it everywhere. Still think you'd have the discipline to not go for the whole pizza?

Being obese with a balanced diet is absolutely not the same thing than being obese because you eat too much "bad" calories. Obese or not, a balanced diet gives you everything your body needs to function properly, be able to move and for your mind to be clear.

The thing is, obesity is a really, really recent trend in humanity history, so recent that a lot of countries are still not concerned by the phenomena (but it's changing). It's pretty certain that _something_ in the environment changed recently and made the humans obese.

People who blames other people willpower just don't understand that if obesity is in an uptrend, it means that people who were previously healthy are becoming obese for some reason. Something new pressurizes humans to become obese and the only question is not if you are concerned but when will the pressure be high enough.

I think it's refined sugar. Plus a bonus of sedentary lifestyles.

Even that is the generous interpretation. Imagine instead of just their regular (or lack of) hunger signals, people had an alarm constantly ringing in the head telling them to eat all the time, that was only ever silenced if they over ate. The persistence of it pushes it in the direction of mental torture.

Yes, technically it can be overcome, but it is a huge tax on your life.

The truth is we can never really know what someone else's inner experience is.

this is a crisis.

at this point this is like going to a 3rd world country and telling them if you dont want all the problems that come with not having money to just get rich.

like its possible, my brother did it, most my family did it, we all have the capability to do it. it maybe harder for some due to physical limitations or mental ones. so why dont you? dont hate being poor and not getting all the women and luxuries?

74% is sick and its infectious. it curates mental problems that make it even harder to overcome. 74% means there are too many factors that are contributing to this epidemic. if modern technology is able to help get society on the right track i dont know why anyone should be.. for lack of a better word fat shamed haha.

of course we need to be careful and thoughtful. im not even sure though if it will be available for most people anytime soon. i hope so though, iv never been fat per say. maybe a bit more lbs then id like but i do understand how much it helps every part of your life being at a satisfying weight. this could be the greatest cure for depression through medicine ever imo.

i live in one of the fattest cities in america. when i go outside i swear to you sometimes i can go a day without seeing a single person of normal weight. besides the few homeless in my area.

Rephrasing the famous quote, it's easy to lose weight — I've done it four times already, ranging from 95 kg to 60 kg over the course of the last 15 years. It's much more difficult to maintain healthy weight over the long term — the longest period I managed that was only three years. Even if you have all the information and know which problems obesity leads to, it's difficult to keep yourself from getting back into unhealthy territory unless you're willing to spend your entire life counting calories and tracking weight religiously.

It's something with the brain, it's insatiable and won't leave you alone until you stuff yourself to the point that you physically can't eat any longer. The last time I gained weight (from 68 kg to around 88 kg) I did it eating only healthy food in unhealthy amounts.

If I can get magic fix (like semaglutide) that would allow me not to think about food any longer and maintain healthy weight over the rest of my life, that would be great.

It depends on your habits. My habits are generally good enough that I don't need to count calories. Which is mostly luck, not an achievement of mine, btw.

> The last time I gained weight (from 68 kg to around 88 kg) I did it eating only healthy food in unhealthy amounts.

First, there isn't even clear consensus what's healthy and what isn't. But even if there was, I doubt you only ate healthy food. It is very hard to gain much fat eating a lot of vegetables and some fish and eggs.

Of course it's possible your diet is great. My experience with fat people has been that their diet was a whole lot worse than they claimed...

Well yes obviously that is difficult to do. Our society (American society, that is) is about “me” and convenience.

Nobody seems to want to say what is obvious to me: ban junk food. Sugary white bread, Cheez Its, Oreos, candy, ice cream, highly processed frozen burritos, frozen pizza, Little Debbie’s, potato chips , all of it.

It is crazy to me the C levels of poison food companies do not rot in jail for the rest of their lives for knowingly selling poison and lying about it. It is crazy to me how a group of people can conspire to harm the citizens of a nation in the name of profit and not receive any consequences. It’s crazy to me the governments of that nation actually enjoy it and don’t care.

This ozempic study seems to suggest something similar.

Self-discipline is a noble concept, and probably important in the grand scheme of things, but sometimes medicine and technology outpaces what is naturally possible, which inevitably results in a moral backlash.

Many are unlucky to have unforgiving disorders.

This is easily seen in T2D which is mostly diet related and fixable.

The data however shows that diet and exercise fails for most people though. I don't see it as entirely irrational to go strait to the more effective drugs.

> I just don't get the lack of skepticism.

Simple answer is people like to eat, lack discipline, and want to look good. None of these will ever change, and so the economic pressure is immense and unstoppable. Until it's proven that these drugs have serious side effects (and that's a real possibility), people will gamble on the risk/reward.

I wouldn't touch them yet myself, but I can see it's a fait accompli. As for solving the root cause, doctors and policy makers have tried everything, to little or no avail. And so we're back to those 3 variables that won't change.

this is not the answer to the question they asked, just a useless triviality. They are not asking _why_ people would like this, it's obvious, they are asking how is this possible to continue eating garbage and living a bad lifestyle, and keep losing weight, and is it then still a health positive or not?

Easy, you don't. Just like someone on Nicorette isn't as unhealthy as a smoker. These drugs curb addiction, so you eat less.

These people lose weight because they have taken all the steps to lose weight. Less food less weight, it's that simple.

This is indeed a simple answer, and way over simplified. You can walk into any grocery store in the US and most of the floor space is dedicated to packaged poison and chemicals masquerading as food.

In June 2008, a phase II clinical trial began studying semaglutide, a once-weekly diabetes therapy as a longer-acting alternative to liraglutide

Hold up, isn't the same true of exercise? And dieting? Those are approaches most people must also keep doing indefinitely in order for the effects to remain.

You post suggests that there is some kind of superior one-and-done fix which is being bypassed or not-invented, but I'm not sure what that would look like or why we should expect it to be around the corner. (Gastric restriction surgery for all?)

The body wants to maintain whatever weight it usually has, if you can keep that weight lower using drugs, there is absolutely a way to stop using the drug and keep the weight loss. You need lifestyle changes, of course, and that is something these GLP-1 agonists do for you. They make you not want to eat.

Ideally, we could allow everyone enough time off enough exercise, rest, and so on, to emulate what has shaped us for the first however many millennia, but we haven't.

Using a medication to compensate for that seems reasonable, provided we've accurately estimated it's negatives, etc...

First of all this is just blatantly disregarding the first order quality of life benefits, which is beyond inexcusable. These count as a perfectly legitimate rationale in and of themselves. Even a 'season' of improved quality of life needs to matter to those of us who value health and life.

But secondly, as a consequence of the above, it can dramatically shift the odds of maintaining good habits in a positive direction. It's easier to initiate and sustain momentum from a position of strength, of enjoying a benefit that's already in hand, than it is to try and summon the extraordinary willpower necessary to initiate and power through a long-term health journey. I don't see any reason to force people to take path that except for a confused desire to impose pull-yourself-up-by-your-bootstraps moralizing.

Third, it appears to come with the benefit of moderating cravings for alcohol, which in and of itself is such a critical health benefit is that it could compensate for even quite serious side effects, if it had them.

Fourth, it does address root causes. Unlike a bariatric surgery or gastric sleeve, it is an intervention that impacts cravings and metabolic processes at their source. Different people are born with different exposures to the risks given our reward and addiction systems. Whatever our initial state we didn't "earn" that and once again I think it's confused moralizing true require people to essentially rewire their reward systems out of a subjective belief that that's more pure or doesn't itself come with negative consequences.

Fifth, it is a medicine and medicines involve tradeoffs. Being qualified to prescribe medicines involves being trained to think coherently about a trade-offs. If you're not trained, then ignoring benefits and focusing on negatives might feel like it's some form of enlightened skepticism. But it's just as much malpractice to ignore the benefits of medicine as it would be to ignore negative side effects. Even it's necessary to maintain a lifelong relationship with the specific form of medicated intervention, that can be a net positive trade-off for long-term quality of life.

A number of other things you mention are pretty subjective. It's just as hard for me to diet and exercise when I'm BMI 19 or BMI 25. In fact, that's true for 90+% of people, because everyone almost universally rebounds to bad habits, in all studies. This "power through a long-term health journey" is your whole life, always, there is no start or stop to this until we die or give up, even with this pill. The pill may help with the BMI part, but it obscures the fact that there is still very real health damage from bad diet and bad lifestyle no matter what your BMI or even visceral fat is.

For someone who is 100+ pounds overweight, losing a big chunk of that has a whole set of knock on effects (lower appetite, ability to actually exercise without pain, more general energy, fewer depressive episodes, etc.), that help make permanent weight loss a lot more achievable. In addition, semaglutide can be tried before a doctor would normally do a gastric bypass (and probably makes that operation a lot easier even if it doesn't completely work).

And, before you go blaming everyone that their dietary choices are their own fault, do be aware that the total number of fat cells is highly conserved in the human body. In addition, fat cells "remember" the weight when they were created and only turn over at about 20-25% per year. If you were obese in adolescence and teenage years due to the habits your parents taught you, that can be really difficult to correct as an adult.

Sure, these kinds of drugs are wrong for losing those 20 pounds that you should remove via diet, some extra exercise and some lifestyle changes. Yeah, a lot of people are stupidly using these drugs from dumb reasons instead of what they should be using them for.

That doesn't make the drugs useless.

2. Your argument boils down to "if there exists a traditional way to solve a problem then we should keep doing things the old way, even if the old way costs more time, energy, and money; for example it's better to use a sickle instead of combine harvester because combine harvesters are evil because they make people lazy" which is exactly how you avoid civilizational progress.

> Rarely do shortcuts result in long term solutions.

This sentence is so ridiculous it deserves a witty insult but the etiquette of this website stops me.

* the observable weight loss seems real based on reports - that's easy to measure, and harder to fabricate like "blaming fats" conspiracies of the past. Unless there is truly massive numbers falsification in all these studies, which i doubt. So that's kind of exciting.

* stuff like this article about visceral fat might also be true, so that's also easy to get excited about, and might even be true.

Major downsides are transparent and predictable - this is not magic, or willpower replacement for health, because:

* if you keep eating garbage, you will still suffer health damage despite losing weight. If I eat nothing but twinkies for a year, and this pill makes me feel full after two twinkies a day, I will lose weight, I will also kill my liver and suffer severe malnutrition - you are right! A less extreme, average American food will also produce health damage while losing weight on this pill.

* if you live a bad lifestyle while on this pill, you will still lose weight, but will damage your health exposing yourself to things like diabetes, CVD, etc.

* the big unknown for me - curious about that - do people develop tolerance for this pill? and another big one, do they rebound violently (much worse than usual) once they stop taking it after a while? or not. This is easier to cover up and harder to measure.

* other more subtle things like is there a link to higher cancer risks over time, etc, but the first two "cons" points are big enough for me already.

TLDR: this is a way to look better and soften some effects of obesity, but does not help with continuing health damage that still needs to be addressed in a more traditional way unfortunately. Lack of skepticism is not because the massive downsides are unknown or absent, but because apparently they are less of a concern to users+marketers.

No.

Let me paraphrase the conversation I had with the head of obestity at one of Europe's leading research hospitals (top 5 in EU):

Once you get a certain amount of overweight, regardless of the cause, there are so many regulation systems in your body (at least 20 that we know of) which kick in to keep you overweight that it is not possible to diet and exercise your way back to a healthy weight without picking up a new disease (eating disorder, exercise additiction, etc.). The people who manage it spend the rest of their lives obsessively weighing everything they eat, exercizing every day, and even then if they slip up or lose mobility or something, inevitably they will become overweight again.

The only known medical treatment is operating on the stomach. This changes enough of the regulation systems (including the hormonal ones) that it has a reasonable chance of sticking. GLP-1 seems to offer a second option.

It continues to astonish me that eating disorders which result in weight loss are (correctly) accepted by society as diseases with complex causes which can include lifestyle and self-control but also mental health and innumerable other things, but if you're overweight clearly you are a sad sack of shit that just can't open their mouth without shoving food in it.

This is untrue, you can stop taking the drug and the effects will persist, most people keep weight off after coming off the drugs.

I've assembled some stuff on this here:

https://glp1.guide/content/do-people-regain-all-the-weight-l...

There are anecdotal reports of astounding levels of hunger returning (more than before perhaps) but this can be solved by a more gradual wean-off (like the ramp up).

> I just don't get the lack of skepticism.

There has never been such a con-free, researched solution to weight loss (and originally these drugs were meant to treat type 2 diabetes, so it's more like we have a viagra situation on our hands).

Don't read what the media puts out, go back and read the research papers. It's not magic -- it's well researched, and while it's not clear exactly every effect, there is a growing body of evidence.

'No Way to Prevent This,' Says Only Nation Where This Regularly Happens.

The legitimate hormonal imbalance and genetic defect is being human. Our brains and bodies were never intended to operate in a setting with a surplus of extremely nutritious food.

To me, it is clear that food can be extremely addictive, maybe even more so than traditional avenues of addiction like nicotine or alcohol. It's obvious that modern day foods are constructed in such a way to ensure this addiction.

They have appropriate amounts of fat, sodium, and sugar to give an immediate good feeling to people, as well as increase their dopamine for a while.

The reality is that the obesity epidemic is the primary killer in the first world. We have moved past the point where we can close our ears and yell "bootstraps! bootstraps!!!"

Clearly this is bigger, more complex, and more sinister than online armchair doctors will have you believe. Look around you. I see a society of sickness. Did everyone magically, at the same time, become lazy? Is everyone just stupid? I don't think so.