And it's under-commented upon because it's counterintuitive, but most people stop taking it. Like, two year continuation of use is about 25%.

That's kinda wild, because it seems like holy shit if you're taking a drug that lets you drop 10-20% of your body weight from obese down to normal why would you stop taking it, but people do.

Because the pharmacy will refuse to sell it to you.

Source: UK based friend who says the pharmacy will refuse to sell them once they fall under BMI 25 (still overweight). They'd prefer to be on the tiny maintenance dose but it seems to be very hard to achieve (unless you're going off the market completely).

I'll dispute that, I work for one of the online pharmacies and we won't stop selling it to you once you've reached BMI 25. We do have criteria to guard against sudden or extreme weight loss, but I think the BMI criterion for that is something like < 20 BMI (don't quote me on that, as I'm not sure, but it's not 25).

We'll also keep you on a small maintenance dose if you want, that's a conversation you'll have with your clinician and they'll judge whether it's medically appropriate. As far as I know, there's usually no reason to prevent you, though.

My friend orders from Medexpress - could you maybe share at least the first letter of your pharmacy or a hint so we can try to guess the name of the helpful one?

I don't think it's possible to send dms here....

Oh, it's Numan. If your friend has a different experience with us than what I describe, please email me and I'll look into it (email in profile or just username at Numan.com).

As far as I know, though, you can move to us from another pharmacy even with a BMI of < 25, as maintenance has different criteria than new prescription.

I'm not a clinician, though, so I may be wrong. If you want to email me, I can ask the clinicians and tell you for sure.

Thank you so much. Well try to reach out the normal way. Thank you, you've been so helpful already.

Cost is a big factor. When it becomes generic then I suspect people will stay on it for a lot longer.

Side effects? Also many might not be able to afford it long term as it's quite expensive.

Because they're now "normal", so why would they continue paying for it, taking unpleasant injections, and enduring the side effects?

In this sense it's like any diet: they "work", but if you don't permanently modify your food intake, the weight comes back as soon as you go off the diet.

Another way of putting it is that people achieve their goals and wind down the usage of the drug that got them there.

I think that in a few more years the number may stay at 25% (or whatever) but that the makeup of the 25% may be different. That is, people will go off it and back on it if they see their progress reverse but that will happen to different people at different times.

Because it costs $1000/mo and insurance wants to make it as hard as possible to get that covered because they cannot afford to pay $1000/mo * 45% of Americans without doing things to their rates that are forbidden by the ACA and, for that matter, any approximation of good sense. If people cannot afford an additional $450/mo each on average for their health care, how do you cover a critical long-term $1000/mo drug that 45% of the population needs?

Gating it behind mandatory expensive, difficult-to-schedule appointments with a specialist who is in abruptly short supply where the insurance company is doing their damndest to kick as many of them off their network as they can without getting caught to keep the shortage going is certainly part of that strategy. And the result is “people do not stay on the drug”, which is their goal, and if they don’t meet that goal they have an even bigger problem and can’t continue to exist as a functioning company.

Is that the cost in the U.S.??

Yup. Without insurance, GLP-1s can be up to $1,200/month.

The simple fact is, when it comes to drugs, the development is basically paid for by Americans.

You can also think about it the other way - if a drug caused you to lose 10-20% of your body weight, and you're now at a good body weight after 2 years, why would you want to lose another 10-20% body weight?

I understand that's not really how it works, but people often go very much by feel more than anything else.

> if people stop taking it, they return to the same problems they had without it

Source? Everyone I know who stopped taking it rebounded a bit, but not to where they were. And no literature shows 100% rebound to my knowledge.

I mean roughly in reference to the underlying mechanism it directly addresses, not all the downstream effects. And even that was, admittedly, sloppy, because there's some complex feedback loops involved. I guess it would be more accurate to say it is a maintenance medicine and not a complete cure, and so stopping taking it unmasks the continuing condition that is treating.

> stopping taking it unmasks the continuing condition that is treating

Some of the prediabetics I knew who stopped taking it (N = 2) stopped being prediabetic (N = 1).

I mean, yeah. You could always just lose weight and probably get out of being prediabetic.

> just lose weight

This might be the left-wing analog of climate denialism.

What does the left-wing or more broadly, political philosophy have to do with that statement?

It's not like it's impossible unmedicated. Plenty of people have and will do it. Obviously most people are unable to. I was always surprised just how few prediabetics did though.