Wegovy = Magic

[sirspamalot]

In some instances, its hard NOT to see it. Bruh.

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[thecarbonionangle]

That was a great watch.
Fun to watch him try the drugs, too

The only thing i didnt quite follow was the sort of “woke” conclusion that peyote should only be a native american thing. With modern agriculture we can allow them to have as much holy cactus as they want while allowing others to also benefit from the medication as well. There is enough for everyone.

 

[communitydoc13]

Not sure why this is triggering.

Because....
You like big butts
but you try to deny
That you're another lover of the thick thigh
and when phlebotomy leans to go to extremes

You get sprung.

 

[RickyScott]

I've tried it. So while I don't have the insight of a PCP, I do have the insight of a patient. Here's my perspective.

I'm 50, no medical comorbidities and don't qualify for a statin. BP is borderline.

I work out regularly, can do 40 pushups in a row and am fat. (BMI qualifies for Wegovy).

I've fluctuated +/- 30 pounds several times in the last decade. Parents are also fat (and still alive with good PS).

Talked to my wife (who is a pcp but not mine) and my PCP, who was kind enough to get samples. I have very good health insurance.

Started samples (had about 8 weeks worth). You taper up dose, but I noticed a change in appetite quickly. By 4 weeks in, I was eating much less. Ran though my 8 weeks of samples with about a 15 lb weight loss. No desire to eat in my normal way.

Some downside for me. I felt a little flat. I take a lot of joy in eating (and other things) and I think this impacted me. Also, nausea was real. I had to stop a workout early due to nausea (so while I was lighter, my exercise tolerance was not improved during this short interval).

Have not gotten insurance pre-auth for my script yet. Have been informed by pharmacy that even with pre-auth, I'm looking at a 6 week wait (weight) due to shortages.

BTW. My ass is gorgeous.

Right now the drugs are pricey, but Lilly’s oral pill is even more effective and will be on the market soon. I think these agents are peptides that can be made quite cheaply. In London, Boots was advertising virtual consultations and had it for 1-200$

 

[sirspamalot]

 

[thecarbonionangle]

Because....
You like big butts
but you try to deny
That you're another lover of the thick thigh
and when phlebotomy leans to go to extremes

You get sprung.

He is clearly into massive derrières and thicc thighs. No judgement there brotha.

 

[communitydoc13]

Right now the drugs are pricey, but Lilly’s oral pill is even more effective and will be on the market soon. I think these agents are peptides that can be made quite cheaply. In London, Boots was advertising virtual consultations and had it for 1-200$

I think it's pretty remarkable. The impact on bariatric surgery is going to be crazy.

I'm aware of some endocrine types who have sworn by metformin (different mechanism entirely) even for non-diabetics for glycemic and weight control (maybe even cancer risk reduction).

I think figuring out the proper use is going to be interesting. I opted to try it because I knew it was effective and was hoping that the weight loss would help me stay off of other meds as I moved from 50-65. (I also just wanted to lose weight).

 

[RickyScott]

I think it's pretty remarkable. The impact on bariatric surgery is going to be crazy.

I'm aware of some endocrine types who have sworn by metformin (different mechanism entirely) even for non-diabetics for glycemic and weight control (maybe even cancer risk reduction).

I think figuring out the proper use is going to be interesting. I opted to try it because I knew it was effective and was hoping that the weight loss would help me stay off of other meds as I moved from 50-65. (I also just wanted to lose weight).

Hyperinsulinemia (blood sugar can still be normal) is probably the underlying cause of many of the diseases of aging.

 

[medgator]

Hyperinsulinemia (blood sugar can still be normal) is probably the underlying cause of many of the diseases of aging.

Metformin improves longevity as well iirc

 

[RickyScott]

Metformin improves longevity as well iirc

The most promising drug in the longevity space is rapamycin. It has improved lifespan in every model organism tested. Being trialed right now in the Dog Aging Project and if positive, will seriously think abt it.

BTW: with these kind of breakthroughs , radoncs are going to be working well into their 80- 90s?

 

[evilbooyaa]

Drugs in this class (Saxenda/Victoza, Trulicity) have been around for over a decade. It's not like we have no idea how the drugs behave in large population samples.



Except the drug doesn't let you. Most patients on it have to remind themselves to eat because the urge to eat decreases significantly. Plus the nausea is a real side effect, particularly if you overeat. That's just how these drugs work.







1) All rapid weight loss results in a large amount of muscle loss. This is true whether that loss occurs with severe calorie restriction, fasting, liquid-shake diets, or Wegovy. Care has to be taken to preserve muscle mass, although that also means a slower rate of weight loss.

How many of you heard, or even suggested, 800-1200 calorie diets to patients? Any patient that adheres to one of those severe diets will have saggy skin (and slowed metabolism) because they're losing muscle mass, but I don't see anyone in this forum saying, "Oh yeah, those diets were terrible ideas and why did doctors ever recommend them?"

And, FFS, it's not melting faces. You know better than that.

2) I find it extremely hard to believe that "lots of our office staff are on it" or "all the ladies at the country club are on it." My DIABETIC patients can't even get it because it's been on back order for so long. Many patients are calling 2-3 different pharmacies just to find it.

I have seen exactly two insurance plans pay for it for non-diabetics, and that's even if you try getting it covered under "metabolic syndrome" or "PCOS" or "insulin resistance." Out of pocket, it's $900. How much are you paying your MAs that they can pay for it in cash? What kind of insurance plans are you offering your staff?

Always love when a bunch of Rad Oncs try to discuss super positive things happening in PCP world in a negative light (mehrlicht and spams) and then get shut down by like someone actually living and experiencing it every day.

@mehrlicht and @sirspamalot, your dunning-kruger and biases are showing.

I have no idea but from a bystander's point I have watched them go from rather large derriere to melted-butt in a couple of months. Just nuts. It can't be just fat, the gluteal muscle (large muscle), i mean it's like there's nothing there and skin covering bone. Perhaps this is just a matter of not dosing correctly during self-administration? I don't know enough to know what's going on. If this isn't happening during physician-directed weight loss with it, then I believe you but this is what I have seen.
Agree with you completely on all the other points.

Bruh - most overweight people carry a LOT of fat in their rear end in hips. In women it is traditionally 'coveted'. You're the one who hates 200+ pound women in a swimsuit. Care to guess where a lot of their extra weight is? Could it be that they are losing fat from their butt when they are on Ozempic because that's where they have the most to lose? And those who AREN'T losing it there, may have had plastic surgery to enhance the booty (much more common now than 10+ years ago)? I'm sure @smq123 can regale us with a fair number of horror stories of the BBL...

I was like kinda tempted to just close this thread but letting strong opinions that disagree with one another is one of the penchants of SDN.... so idk, ya just sound kinda silly to me.

mehrlicht - 'Just do a 96 hour fast and eat nothing but protein, GOD, ya ****ing pissants!'

 

[deleted1168505]

Always love when a bunch of Rad Oncs try to discuss super positive things happening in PCP world in a negative light (mehrlicht and spams) and then get shut down by like someone actually living and experiencing it every day.

@mehrlicht and @sirspamalot, your dunning-kruger and biases are showing.



Bruh - most overweight people carry a LOT of fat in their rear end in hips. In women it is traditionally 'coveted'. You're the one who hates 200+ pound women in a swimsuit. Care to guess where a lot of their extra weight is? Could it be that they are losing fat from their butt when they are on Ozempic because that's where they have the most to lose? And those who AREN'T losing it there, may have had plastic surgery to enhance the booty (much more common now than 10+ years ago)? I'm sure @smq123 can regale us with a fair number of horror stories of the BBL...

I was like kinda tempted to just close this thread but letting strong opinions that disagree with one another is one of the penchants of SDN.... so idk, ya just sound kinda silly to me.

mehrlicht - 'Just do a 96 hour fast and eat nothing but protein, GOD, ya ****ing pissants!'

This is really something else. I mean we were obviously just joking around.

Spam is absolutely correct about weight loss being a caloric math problem. But I have to have primary care residency training to have an opinion on Ozempic? It absolutely reduces lean body mass. Look it up. The gluteus maximus is a very large muscle. It is literally in its name (4 years of Latin in high school was worth something after all!), In fact it is the largest muscle in the human body.

If you take Ozempic, even once, your butt will literally melt. Raiders of the lost Ark style. Falling off in gooey chunks. I promise it.

Never would I have thought an anecdotal observation about Ozempic turning people into pancake-butts and hyperboles about melting faces would have triggered so many this way.

I "hate" morbidly obese women in swimsuits? Hate, as in morally despise? Is that what I said? Come on. Like I said, I draw the line at telling outright lies. Morbid obesity is not attractive. You can be large and attractive, of course. Obesity with rolls of fat and a panus is a different situation. This is a product of evolution. Human beings innately recognize this a sign of poor health and therefore poor quality in a mate to produce future offspring with. We literally all know this whether we admit it or not. I went back through this to see if I wrote something that could have been construed as personally offensive to your primary care friend. I did not. Don't shoot the messenger.

I guess I'm being attacked because I'm pushing back on the whole fat-is-natural-and-beautiful lie the same way I did for questioning the virtues of polyamory. Nope, not going along with it.

By the way, yes do a 96 hour fast. Then do some cold plunges. Then lift some heavy weights. Then meditate. It will make you a better person. Doing things that are hard, both physically and mentally always make you better. You would think that people that went into medicine of all things would inherently understand this. The theres-a-pill-for-that route is certainly a lot easier. Protein, yes, if you're going to be on these drugs you need to eat a lot of protein. Otherwise you risk becoming "skinny fat" with weak bones.

 

[deleted1111261]

I did the cold plunge recently
It was rather refreshing !

 

[sirspamalot]

Put that coffee (and donut) down.

Donuts are for closers.

 

[deleted1168505]

I thought some more about this and realized I was wrong. The bizarre reaction to face melting comments is not about the big-is-beautiful body positivity stuff (which would be ironic because of the vociferous defense of a drug people take with a desire to become slim -- why do you want to be slim if there are beautiful morbidly obese models?). No, the triggering part was "it's obvious" which I hate to break it to you, but it is (because you are rapidly losing an unusual amount of muscle and connective tissue in proportion to body fat (I have seen reports as high as 1:1) than you would by other methods of weight loss). I realized this as it's the same reaction when you try to suggest that breast augmentation or anabolic steroid use is obvious. No guy, I got like this by eating tuna and hard work in the gym, wanna fight huh? </flame_suit_on>

 

[sirspamalot]

Bruh. Chill a bit yo. Not the hill to die on lol.

You know who else doesn't like hills?

 

[evilbooyaa]

I thought some more about this and realized I was wrong. The bizarre reaction to face melting comments is not about the big-is-beautiful body positivity stuff (which would be ironic because of the vociferous defense of a drug people take with a desire to become slim -- why do you want to be slim if there are beautiful morbidly obese models?). No, the triggering part was "it's obvious" which I hate to break it to you, but it is (because you are rapidly losing an unusual amount of muscle and connective tissue in proportion to body fat (I have seen reports as high as 1:1) than you would by other methods of weight loss). I realized this as it's the same reaction when you try to suggest that breast augmentation or anabolic steroid use is obvious. No guy, I got like this by eating tuna and hard work in the gym, wanna fight huh? </flame_suit_on>

It's obvious! There is data! You just have to look it up! I won't link you anything that explains my minority (in this thread) opinion about the immense dangers of this that you all are otherwise positive about! You just have to do your own research! I've done mine (but won't link to it) and clearly it's just SO negative that all of you are all being fooled by pharma! Ozempic melts butt muscles, not butt fat, there's all sorts of data to prove that it's true! But you have to search for it yourself, I am incapable of providing any literature defending my position! You have to do the research!

That's how you sound like to me. Do you know what that sounds like? A COVID anti-vaxxer. So you sound like a COVID anti-vaxxer to me. I'll leave it up to you to determine whether that is a good thing or not.

 

[deleted1168505]

It's obvious! There is data! You just have to look it up! I won't link you anything that explains my minority (in this thread) opinion about the immense dangers of this that you all are otherwise positive about! You just have to do your own research! I've done mine (but won't link to it) and clearly it's just SO negative that all of you are all being fooled by pharma! Ozempic melts butt muscles, not butt fat, there's all sorts of data to prove that it's true! But you have to search for it yourself, I am incapable of providing any literature defending my position! You have to do the research!

That's how you sound like to me. Do you know what that sounds like? A COVID anti-vaxxer. So you sound like a COVID anti-vaxxer to me. I'll leave it up to you to determine whether that is a good thing or not.

And you sound unhinged.

Since you brought it up, we can talk about the shortcomings of the covid vaccine if you like (I bet you will not like).

It is not hard to search pubmed: Effects of Antidiabetic Drugs on Muscle Mass in Type 2 Diabetes Mellitus - PubMed

Conclusion: Although semaglutide, dapaglifrozin, and canagliflozin have a large weight loss effect, it is important to pay attention to muscle loss because a decrease in FFM was observed.

I have no idea why the fact that these drugs cause significant very-noticeable muscle loss and efforts need to be taken to try and mitigate that (high protein diet and weight training, DEXA scan) bothers you so much.

 

[deleted1168505]

I'm sure Peter Attia is FOS too. He's done a few very good podcasts on this topic:

Lean mass loss on GLP-1 receptor agonists: a downside of the “miracle drugs”

Clinical trials have generated impressive data on the effects of GLP-1 agonists on body weight and BMI, but how do these drugs perform in terms of body composition?

peterattiamd.com

In 2021’s STEP 1 trial – the first trial demonstrating the efficacy of semaglutide as a treatment for adult obesity – a subset of 140 patients underwent DEXA scans for body composition analysis. Among these patients, lean mass accounted for approximately 39% of total weight loss – substantially higher than ideal. In a substudy of 178 patients from the SUSTAIN 8 trial on semaglutide as a diabetes treatment, the average proportion of lean mass loss was nearly identical at 40%, despite lower doses and less total weight loss than in the STEP 1 trial.

 

[sirspamalot]

Dude, lets give it a rest. And to say the COVID vaccines have shortcomings, well EVERYTHING has shortcomings. But please don't say they weren't valuable. Or contradict the fact that fewer people, without a doubt, would have died had they not chosen to be anti-vaxx.

 

[evilbooyaa]

And you sound unhinged.

Since you brought it up, we can talk about the shortcomings of the covid vaccine if you like (I bet you will not like).

It is not hard to search pubmed: Effects of Antidiabetic Drugs on Muscle Mass in Type 2 Diabetes Mellitus - PubMed

Conclusion: Although semaglutide, dapaglifrozin, and canagliflozin have a large weight loss effect, it is important to pay attention to muscle loss because a decrease in FFM was observed.

I have no idea why the fact that these drugs cause significant very-noticeable muscle loss and efforts need to be taken to try and mitigate that (high protein diet and weight training) bothers you so much.

Yes, and as a PCP, who probably prescribes Ozempic on a daily basis, has alreayd informed you and us, any strategy leading to rapid weight loss will result in muscle loss, so the same measures tha tshould be taken otherwise should be taken with Ozempic.

So what you've posted does not change hearts and minds.

Speaking of unhinged - You're the one talking about butt and face melting, man.

But, let's reach a compromise - Ozempic (and other meds in that class) cause loss of muscle mass and this should be prevented by a higher protein diet and strength training. I agree with that.
Do you agree that other forms of rapid weight loss cause similar loss of muscle mass?
Do you agree that we have no data suggesting that Ozempic induced rapid weight loss results in more significant muscle mass loss compared to alternative forms of rapid weight loss?
Do you agree that your method of regular bouts of intermittent fasting, occasional 72-96 hour fasts, cold plunges, while it works for you as the means to limit caloric intake, may not work for others in the population?
Do you agree that Ozempic decreases hunger and thus can be a method to decrease caloric intake for those who don't have the discipline that you do?
Is Ozempic good or bad? Guess that's in the eye of the beholder - I think it's good for the right patient, although certainly capable of being abused by those who are not overweight by BMI.

And yeah, not gonna get into the negatives of COVID vaccination on this thread, or in any thread in RO forum. Even this one I'm tempted to close b/c it has nothing to do with RO.

 

[Mandelin Rain]

We should save the debating of vaccines, a person's "T" status, and unfortunate loss of butts to Joe Rogan.

 

[sirspamalot]

Ozempic Face Melting.. yeah, it can happen but.. don't worry, after $ for ozempic, you'll spend $ on fillers.

Muscle wasting is real, no matter how you achieve rapid weight loss. That fat be gone, the muscle needed to support it be gone too. Skin can't delete itself, thus the sag.

Ozempic Face: Facial Changes After Rapid Weight Loss

Facial plastic surgeon Dr. Ponsky explains the phenomenon of Ozempic face. Learn how rapid weight loss changes the face and treatment options.

www.drdianaponsky.com

 

[sirspamalot]

Are we there yet?

 

[deleted1168505]

Data requested and presented
Ozempic perfect
C*vid vaccines perfect
Sorry for criticizing pharma, my fault.

I agree that Ozempic has, well I wouldn't say nothing since obseity is a major cause of cancer but lets go with little, to do with RO.
But that was literally the title of the thread.
I don't understand if we are aruguing that melted faces was or was not a joke or whether it is ok to joke about Ozempic for weight loss. Either way wtf.

At least there are no Ozempic mandates... yet. Think of how many lives and obesity-related healthcare dollars would be saved if it were, though.

 

[sirspamalot]

I for one, will be happy to accept slightly melted faces, corrected by filler, if we can cut obesity and its related illnesses down significantly.

But as with many things, those who need it most, will likely get it the least.

'Murica.

ps. dude, I'm starting to worry about you. whats next, screaming 'wokism' is ruining america? Say it ain't so!

 

[deleted1168505]

Do you agree that other forms of rapid weight loss cause similar loss of muscle mass?
Do you agree that we have no data suggesting that Ozempic induced rapid weight loss results in more significant muscle mass loss compared to alternative forms of rapid weight loss?

No, this is what we absolutely do not agree on, and I provided you data to support this increased rates of fat-free mass loss from these drugs as compared to something like a low carb calorie-restricted diet and daily exercise (ie, lifestyle changes) that will preferentially lower body fat levels and minimize lean mass loss if not actually improve it.

 

[deleted1168505]

ps. dude, I'm starting to worry about you. whats next, screaming 'wokism' is ruining america? Say it ain't so!

Oh, that's just a difference in political opinion. Something that used to be no biggie in this country. Seems one side is given more leeway than the other if "negatives" of a certain non-RO topic will immediately be shut down but the positives presumably wouldn't. Maybe our common hatred of ASTRO can unite us all?

 

[sirspamalot]

Yes on ASTRO. But anyone who believes wokism is a problem for this country (or supports a pigclucker like Trump) isn't someone I can get with. Its disgusting and it usually doesn't require much digging to find the underlying racism, anti-semitism, greed "F you got mine" attitude, etc. which doesn't sit well.

 

[deleted1168505]

I'd reply, but somehow I suspect that engaging in debate about whether "wokism" exists and is a good or bad thing will result in another strike...
Just for the record I didn't bring up "wokism" or C*vid vaccines...

 

[sirspamalot]

Yeah, I'd say if you're looking for folks of that type, SDN isn't the place. Maybe the SPF thread, there are a couple fringe right folks there. Try Truth Social, or Patriot Front, or whatever... Low IQ and the 1% wealthy who use them for profit lol.

 

[deleted1168505]

You will say lifestyle changes are not methods of rapid weight loss. Alright, so even if you want to look at extreme methods of weight loss like bariatric surgery, you still lose more lean mass with Ozempic. And just diet and exercise can be "extreme" too if you cut your calories way down, you just have to survive being hungry all the time.

The magnitude and progress of lean body mass, fat‐free mass, and skeletal muscle mass loss following bariatric surgery: A systematic review and meta‐analysis

Postbariatric loss of muscle tissue could negatively affect long‐term health due to its role in various bodily processes, such as metabolism and functional capacity. This meta‐analysis aimed to unravel time‐dependent changes in ...

www.ncbi.nlm.nih.gov

Our meta‐analysis demonstrated over 8‐kg FFM and LBM loss within 1‐year postbariatric surgery, which reflected 21% and 22% of total body weight loss, respectively.

So fat-free mass loss of 21% and lean body mass loss of 22% with bariatric surgery

vs. numbers near 40% reported for the drugs in question.

So, ahh, double?

 

[communitydoc13]

So, ahh, double?

https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

The original semaglutide trial. Check it out. Also this:

Another semaglutide side effect: Loss of muscle mass?

In recent months, consumers have voiced concerns about potential side effects of semaglutide, a popular weight loss drug. Now, reports of muscle loss in many patients have heightened concern for some — but many experts argue that the "benefits outweigh the risks" for certain patients.

www.advisory.com

A nice little piece of journalism. Some experts give their opinion.

I don't think you have viable comparative numbers here. But more importantly, neither you or I are going to become experts on this in a short period of time. The data on many medical interventions (including things we do) are murky and require clinical judgement. By my assessment, as a consumer and not as an expert on weight loss, the risk profile here is pretty good for many people.

Regarding Peter Attia? Yeah, I'm a little skeptical, as I am of most people who engage directly with the public in the various venues of "popular" medicine or science.

As a doc, I do have some level of expertise and this makes these popular formats not very appealing to me. As a scientist, I am strictly amateur at this point, and I really love a lot of popular science literature (none of which are giving me prescriptions to live longer).

My favorite popular science author: Simon Singh - Wikipedia

Often marginal scientists or practitioners are the best explainers.

 

[smq123]

You will say lifestyle changes are not methods of rapid weight loss. Alright, so even if you want to look at extreme methods of weight loss like bariatric surgery, you still lose more lean mass with Ozempic. And just diet and exercise can be "extreme" too if you cut your calories way down, you just have to survive being hungry all the time.

The magnitude and progress of lean body mass, fat‐free mass, and skeletal muscle mass loss following bariatric surgery: A systematic review and meta‐analysis

Postbariatric loss of muscle tissue could negatively affect long‐term health due to its role in various bodily processes, such as metabolism and functional capacity. This meta‐analysis aimed to unravel time‐dependent changes in ...

www.ncbi.nlm.nih.gov

Our meta‐analysis demonstrated over 8‐kg FFM and LBM loss within 1‐year postbariatric surgery, which reflected 21% and 22% of total body weight loss, respectively.

So fat-free mass loss of 21% and lean body mass loss of 22% with bariatric surgery

vs. numbers near 40% reported for the drugs in question.

So, ahh, double?

So I get that this discussion is, for most of the physicians in this forum, mostly theoretical. You're not treating diabetes, PCOS, insulin resistance, or anything like that. I doubt that many of you will ever write a prescription for this medication. Those that do will probably write less than a dozen in an entire career.

For those of us seeing these patients, these kinds of discussions are not very helpful. Let's say that your gripe about Wegovy is correct and it leads to greater lean muscle mass than bariatric surgery does. And....? So what? Bariatric surgery is a HUGE undertaking, financially, emotionally, physically. Many patients who would benefit from it never do it.

There was literally nothing reasonable to treat obesity with before these drugs came along. Phentermine is a joke. Belviq didn't really work, and it got taken off the market. Orlistat....I think that the downsides are obvious. Contrave has its uses, but I've never seen it work for the majority of patients. Saxenda didn't make a big splash and insurances never paid for it anyway.

Even if Wegovy causes more muscle loss than other weight loss methods, what else do you suggest? That we keep doing the same tired things that didn't work? Or how about we use it, encourage patients to focus on strength training to preserve muscle mass (which they should be doing anyway), and actually help patients lose weight with it?

 

[deleted1168505]

I agree. I am not a GLP-1 expert at the basic science level or really any level. But I was getting chewed out for suggesting that these drugs are not 1:1 comparable to things like bariatric surgery and causing pancake-butts, which I have just false and I have demonstrated that with data as requested.

My suspicion is that they may end up causing a lot of harm when used in certain populations. And I have some concerns about how they are being presented as a magic-bullet quick-fix and gobbled up by mildly overweight middle aged women. I am always immediately suspicious of things that promise to easily solve complicated problems (as is probably obvious from my comments about you know what).

My other concern is that people will use the med as a way to get away with avoiding healthy lifestyle modifications. I don't envy you in having to deal with that and convince people that the drug can be dangerous on its own and it still takes work from the patient to be healthy.

With regards to celebrity youtube doctors, yes, I agree with approaching this carefully too, but it is a logical fallacy to suggest that because a doctor has a youtube channel or a blog then it must be conspiracy theory level quack stuff.

 

[sirspamalot]

Maybe we need to design invisible force fields, or maybe just good old fashioned mouth clamps. I told my wife if someone with a BMI>45 walks up to McDonalds, BY LAW, they should not be allowed to order anything but SALAD and plain chicken. Sales of Soda would be treated the same as beer.

Imagine the black market for nuggets and beer. I know I know.. I'm weird.

 

[communitydoc13]

Maybe we need to design invisible force fields, or maybe just good old fashioned mouth clamps. I told my wife if someone with a BMI>45 walks up to McDonalds, BY LAW, they should not be allowed to order anything but SALAD and plain chicken. Sales of Soda would be treated the same as beer.

Imagine the black market for nuggets and beer. I know I know.. I'm weird.

That donut looks effing delicious!

Maybe not you're response.....but mine.

 

[DoctwoB]

SGlT2 inhibitors- (5 of them) stop kidneys from reabsorbing sugar. They are now standard of care in NON-diabetics with heart failure and kidney disease as they slow progression. (multiple NEJM articles) Also in the NIH's National intervention testing program, SGLT2 inhibitors make mice live longer. So diabetic drugs are affecting overall health (I posted on this before). Wegovy (GLP1R agonist) is also being trialed phase 3 internationalfor alzheimers. Pill formulations are coming soon

SGLT2 inhibitors are the devil.

Sure they may control your sugars and protect your heart. but a shocking number of people end up in my office with recurrent balanitis or UTIs.

I would propose a rule in which you can not be prescribed jardiance if you have a foreskin.

 

[sirspamalot]

Are you joking? I love donuts. I work out because I want to eat more... donuts and chocolate and cheeseburgers.

 

[smq123]

I agree. I am not a GLP-1 expert at the basic science level or really any level. But I was getting chewed out for suggesting that these drugs are not 1:1 comparable to things like bariatric surgery and causing pancake-butts, which I have just false and I have demonstrated that with data as requested.

My suspicion is that they may end up causing a lot of harm when used in certain populations. And I have some concerns about how they are being presented as a magic-bullet quick-fix and gobbled up by mildly overweight middle aged women. I am always immediately suspicious of things that promise to easily solve complicated problems (as is probably obvious from my comments about you know what).

My other concern is that people will use the med as a way to get away with avoiding healthy lifestyle modifications. I don't envy you in having to deal with that and convince people that the drug can be dangerous on its own and it still takes work from the patient to be healthy.

The people irresponsibly prescribing Wegovy were previously irresponsibly prescribing Phentermine. Anything can be turned into a magic bullet if you are greedy enough. Isn't that how we ended up with, what, 900 proton centers in this country?

Most of the patients who ask for it have tried everything. I think you are underestimating the amount of fat shaming (and also, internalized fat shame) that the obese have encountered. Almost all of them have hired a personal trainer or have gone to Orange Theory on a regular basis, have done Weight Watchers, have done keto/paleo, etc. And it wasn't sustainable for most, or they didn't see results, so they stopped - hard to blame them. So they see their doctor to ask about this drug, which is fair. They're very well aware that it takes work to be healthy - they've done that work but they didn't see any significant weight loss from it.

 

[deleted1168505]

Maybe we need to design invisible force fields, or maybe just good old fashioned mouth clamps. I told my wife if someone with a BMI>45 walks up to McDonalds, BY LAW, they should not be allowed to order anything but SALAD and plain chicken. Sales of Soda would be treated the same as beer.

Imagine the black market for nuggets and beer. I know I know.. I'm weird.

Go to Australia and buy a 6 pack of craft beer. It cost me $55. It's a nanny state with a lot of sin taxes. Yet, still very high rates of alcoholism.
Excise taxes on things like soda have been failures in the past too.
These types of taxes unfairly burden the poor, unfortunately since they are regressive by design.
Government always screws it up. Because it has one tool: A big hammer to try and force things. Mouth clamp? Have you never had patients put beer through the PEG tubes before? People always figure out a way to get what they want...

 

[sirspamalot]

I wanna see a twinkie go thru a PEG tube, just so I can cross it off my list of ridiculous medical things I've seen.

 

[deleted1168505]

The people irresponsibly prescribing Wegovy were previously irresponsibly prescribing Phentermine. Anything can be turned into a magic bullet if you are greedy enough. Isn't that how we ended up with, what, 900 proton centers in this country?

Most of the patients who ask for it have tried everything. I think you are underestimating the amount of fat shaming (and also, internalized fat shame) that the obese have encountered. Almost all of them have hired a personal trainer or have gone to Orange Theory on a regular basis, have done Weight Watchers, have done keto/paleo, etc. And it wasn't sustainable for most, or they didn't see results, so they stopped - hard to blame them. So they see their doctor to ask about this drug, which is fair. They're very well aware that it takes work to be healthy - they've done that work but they didn't see any significant weight loss from it.

Listen, I'm on your side. I'm just giving my observational experience from the people I work with that use it. I have no idea how they obtained it as it is none of my business to inquire about the details of their health status. But these people were not very overweight to being with and have had dramatic unnatural body transformations in a very short time. I don't think it should be surprising that people who have NOT tried everything (eating less always works, but some just can't do it for whatever reason and I'm not naive enough to live in a fantasy world that we should refuse to throw in the towel with people who can't deal with hunger or avoid non-fattening foods) are also going to want these drugs, because it is a lot easier and faster than dieting (with permanent nutritional changes) and walking 5 miles every day.

It also sounds like you live in an affluent area. I promise you most of the very obese patients I see are not going to Orange theory or hiring personal trainers (which is not going to do a thing if you are still overeating 1000 calories a day). Obesity is normal as all their friends and family are various levels of overweight to morbidly obese, smoke, etc, and just affording to get here is a challenge. Their minds have a lot of other concerns occupying them besides their BMI, typically.

 

[evilbooyaa]

You will say lifestyle changes are not methods of rapid weight loss. Alright, so even if you want to look at extreme methods of weight loss like bariatric surgery, you still lose more lean mass with Ozempic. And just diet and exercise can be "extreme" too if you cut your calories way down, you just have to survive being hungry all the time.

The magnitude and progress of lean body mass, fat‐free mass, and skeletal muscle mass loss following bariatric surgery: A systematic review and meta‐analysis

Postbariatric loss of muscle tissue could negatively affect long‐term health due to its role in various bodily processes, such as metabolism and functional capacity. This meta‐analysis aimed to unravel time‐dependent changes in ...

www.ncbi.nlm.nih.gov

Our meta‐analysis demonstrated over 8‐kg FFM and LBM loss within 1‐year postbariatric surgery, which reflected 21% and 22% of total body weight loss, respectively.

So fat-free mass loss of 21% and lean body mass loss of 22% with bariatric surgery

vs. numbers near 40% reported for the drugs in question.

So, ahh, double?

This is the second time you are linking a study in this thread. The first one I unfortunately do not have access to the full paper and the abstracts are not inherently useful as the line you linked from the second thread.

Can you (or someone else) copy and paste the 40% line from the previous paper you linked? Or attach a PDF of the paper and I'm happy to take a look myself - Effects of Antidiabetic Drugs on Muscle Mass in Type 2 Diabetes Mellitus - PubMed

I won't move the goalposts and will admit that I need to verify the 40% vs 22% based on your link. Thanks for posting those two links - they are of value together, not necessarily apart.

I wonder about caveats of differences in baseline factors between those obese enough to choose bariatric surgery vs those who would otherwise not be candidates.

Regardless, appreciate you finding receipts to back your argument. Learned something today.

Out of curiosity (no judgment), was this a "I know these numbers because I've studied this previously" or "I had a conclusion in mind and I was able to find studies that supported it"

 

[Lamount]

From my basic understanding (based on reviewing literature/personal experience and reports in the lay-press from weight-loss physicians), the "Ozempic face/butt" are the same phenomenon that happen to anyone who loses a lot of weight quickly, regardless of the mechanism. There is varying amounts of fat in these areas... and, particularly for middle-aged folks, losing fat in one's face can make you look older. When my father lost a lot of weight years ago, he looked gaunt/old at first, but this resolved once his fat redistributed.

It is impossible to lose a lot of weight without losing SOME muscle (unless you are juicing). With semaglutide, this can be mitigated by weight training during weight loss.

In short, it seems like this drug has a similar impact on body composition as any other means of quickly losing weight.

 

[deleted1111261]

Go to Australia and buy a 6 pack of craft beer. It cost me $55. It's a nanny state with a lot of sin taxes. Yet, still very high rates of alcoholism.
Excise taxes on things like soda have been failures in the past too.
These types of taxes unfairly burden the poor, unfortunately since they are regressive by design.
Government always screws it up. Because it has one tool: A big hammer to try and force things. Mouth clamp? Have you never had patients put beer through the PEG tubes before? People always figure out a way to get what they want...

Huh?

6 pack beer in australia ipa - Google Search

 

[deleted1168505]

Out of curiosity (no judgment), was this a "I know these numbers because I've studied this previously" or "I had a conclusion in mind and I was able to find studies that supported it"

I was aware of the data but hadn't independently verified it from the primary literature, rather trusted that the podcasts and blogs I had read about the increased rates of muscle loss were not lying to me (eg, Peter Attia, who is reputable). Looks like they were not and they were consistent with my anecdotal observations. I take it that you also had not done deep dives into the primary literature to support your idea that LBM rates were comparable to bariatric surgery. Regardless, the truth is what it is.

I understand the aversion of medical professionals to sensationalized terms in the lay press like "Ozempic butt" But that doesn't automatically mean there is nothing there.

 

[deleted1168505]

Huh?

6 pack beer in australia ipa - Google Search

Why does nobody believe me about anything!
I promise you I paid $55 for a 6 pack of Hemingway's IPA at a liquor store in Port Douglass. I have no idea if they added extra taxes at the time of sale. It was very good. $55, no not that good. Much cheaper at the brewery for whatever reason.

 

[sirspamalot]

Australia is so expensive I honestly don't know how anyone makes it in any major city there making less than 500k a year if they want their kids to go to private school, live well, and travel. Like major metro in the USA, but even worse.

Our extended family makes 700-1.2m there and lives well, but its not like they feel they are 'rich' any more than any of us.

Private school alone is 50k a year and UP there, taxes on everything are crazy high.

 

[deleted1168505]

This one is in the lay press today under headlines of weight-loss wonder pill, "eat whatever you want", burn belly fat without dieting, etc.

https://www.cell.com/cell-reports/pdf/S2211-1247(23)00166-3.pdf

This amplifies my concern that these will not be marketed to people not who are unable to lose weight through any other means, but as those who want to look good while not giving up unhealthy lifestyles.

Google "CPACC drug" and you will see the headlines I am talking about. "What your patients are reading..."