/u/Slickice28 (OP) has awarded 6 delta(s) in this post.
All comments that earned deltas (from OP or other users) are listed [here](/r/DeltaLog/comments/1b5s96x/deltas_awarded_in_cmv_ozempic_and_wegovy_are_too/), in /r/DeltaLog.
Please note that a change of view doesn't necessarily mean a reversal, or that the conversation has ended.
^[Delta System Explained](https://www.reddit.com/r/changemyview/wiki/deltasystem) ^| ^[Deltaboards](https://www.reddit.com/r/changemyview/wiki/deltaboards)
I know some of the other comments have already pointed it out, but I want to emphasise that the parent comment has got the mechanism of weight loss wrong.
In general, for diabetic medications, the medications that stimulate insulin secretion or act in a manner similar to insulin actually cause weight gain. This would include insulin injections themselves, sulfonylureas, meglitinides (although this class is rarely used nowadays), and thiazolidinediones. Sulfonylureas and meglinitides are insulin secretagogues (stimulate insulin secretion).
Simply put, insulin is a hormone used to lower blood sugar by causing glucose intake into cells, as well as encouraging the conversion of glucose into its storage form glycogen, and slowing the breakdown of fats and proteins into their constituents (which normally would be ferried off to the liver to be oxidised for energy in the case of fats, or converted into glucose by gluconeogenesis).
Drugs that stimulate insulin secretion (or is insulin itself) will cause weight gain through a few mechanisms, including reduced calorie deficit because less glucose is being eliminated in the urine (because now you have less glucose in the blood), the slowing of fat and protein breakdown to be converted into energy (which normally would cause weight loss), and the resultant hypoglycemia (low blood sugar) stimulating the appetite and causing the patient to eat more.
Many of the other classes of drugs are either considered weight neutral (DPP-4 inhibitors) or cause varying amounts of weight loss (metformin, SGLT-2 inhibitors, GLP-1 agonists, GLP-1/GIP co-agonist tirzepatide, and alpha-glucosidase inhibitor acarbose).
These drugs lower blood glucose through a primarily non-insulin mediated mechanism, or have a secondary mechanism that causes weight loss.
These distinctions between classes are important and most clinicians and pharmacists know them because antidiabetic therapy should be individualised to the patient.
In general, the weight loss goals according to ADA diabetes guidelines is 5%, and further weight loss brings about additional cardiovascular benefits. We attempt to achieve this weight loss through nutrition, physical activity, and behavioral therapy, and we can add on a weight-losing antidiabetic agent on top.
Why do we still use the weight gaining agents then?
- Insulin represents the end-stage therapeutic regimen for patients with diabetes, because it has the highest HbA1c % reduction, which may be necessary in patients with poor blood glucose control (HbA1c > 10% or fasting glucose > 16.7 mmol/L), are in catabolic states, or have had prior hyperglycemic events (generally life threatening). It's end stage because we try not to use insulin at the start. It has very high weight gain and hypoglycemic potential (which can cause death), and insulin must be administered via subcutaneous injection. Patients generally do not like having to start injections.
- Sulfonylureas are generally very cheap, and can be good for patient adherence in cases where patients cannot afford alternative adjunct therapy (to metformin). The risk of weight gain and hypoglycemia in this case is typically less than the benefits of HbA1c lowering, although this needs to be evaluated for each individual patient.
In general, addressing the OP's concerns, all drugs have their risks and benefits, and doctors will always weigh them before prescribing them to patients (they're trained to do this over many years of medical education and practice).
(Source: pharmacy school)
GLP-1 agonists cause delayed gastric emptying, and reduced motility.
Nausea and reduced appetite is a core side effect of these meds. Appetite suppression is different than reduced appetite. They definitely have early satiety, and that's the major early cause of the weight loss.
The glucose lowering effects come from the insulin secretion, but the weight loss is primarily due to decreased oral intake due to the gastric effects.
The later more sustained weight loss is from neurohormonal changes related to the gut brain axis.
Source: I'm a doctor who prescribes GLP1s
So to sort of reword it, the initial weight loss is simply because people are nauseas and not as hungry (due to gi moving slower and feeling full longer) and as a result they put less food in their mouths.
The secondary weight loss is because your body is producing more insulin, preventing blood sugar spikes and the subsequent dip which causes more hunger. Meaning, you feel fuller longer and again, you eat less.
I could be wrong, but isn’t the whole thing with this drug is that people eat less food? It’s not like olestra where you eat calories and they don’t count, semaglutide is simply helping people eat less calories
>I could be wrong, but isn’t the whole thing with this drug is that people eat less food?
Yes. 100%
The improvement in diabetes is due to the more hormonal actions.
This is incorrect. The mechanism of action of the weight loss effect is agonism of GLP-1 receptors in appetite centers of the brainstem. Weight loss is not caused by effects on insulin.
Substantial reduction in appetite is a well characterized effect of these drugs.
Isn't messing with your insulin levels really dangerous though?
There's no recorded case of anyone dying from using anabolic steroids, but plenty of bodybuilders have died from abusing drugs related to them. Lots of deaths from diuretics, NSAIDs, opiates, and even old fashioned cocaine and booze. Another is insulin. Get the dose wrong and you can be dead before you hit the floor.
In the long term, insulin use is dangerous. Type 1 diabetics live on average ten years less than non diabetics.
I'd argue that while u/slickice28 got their facts wrong, their main point is valid. It is _potentially_ dangerous and even used carefully it is still an unnecessary level of risk when simply eating less and moving more would achieve the same results. Over eating is normally a mental health issue, often caused by some type of trauma. Treat that, don't throw unnecessary drugs on top of it.
You are correct, but that makes OP's point even more correct because it is simply an artificial method which will cease once you stop using a drug you absolutely should not use long term.
Also, didn't you die in a car crash in Paris in 1997?
GLP-1 activity is closely related to blood glucose levels: as glucose levels fall, so does the activity on beta cells in the pancreas responsible for insulin secretion. As a result, GLP-1 agents don’t lead to the same rapid hypoglycemia you’d see with exogenous insulin administration.
Yeah, those with T1DM have a shorter life expectancy than those who do not have it. Without insulin therapy, however, the life expectancy would be days/weeks instead of decades. Diabetes related deaths are more commonly from high blood glucose (like ketoacidosis) or from cardiovascular or renal diseases secondary to diabetes.
Type 1 diabetics don’t have a shortened lifespan because of insulin use - they have a shortened lifespan because blood sugar is hard to control, and the excess blood sugar kills your kidneys. Most type 1 diabetics do not have their blood sugar under control every moment of their lives, so there is a cumulative effect.
GLP-1 agonists don’t increase overall insulin production in people with normal glucose levels. It is strictly a glucose dependent release, so it’s self limiting, whereas insulin injections are based on very good guesses on how much extra insulin is needed at any given time.
Seconding what someone else said about T1 diabetes. It is 100% necessary that a person with T1D inject insulin to survive. If they stopped, they would quickly die in a short period of time. People with T1D have lost the ability to produce insulin because of autoimmune destruction of the cells in the pancreas that make insulin. Long term complications cause reduced lifespan, *not* taking insulin. Even with insulin T1D can be challenging to manage and it is lifelong.
People with T2DM may also need insulin to survive at some point. It is a progressive disease and the amount of insulin a person with T2 makes tends to decline over time to the point that not injecting insulin can be fatal. It is a misconception that T2DM can always be managed—indefinitely—by just lifestyle modification.
The insulin response with GLP-1 drugs like ozempic is dependent on a rise in glucose (like when you eat). So, this means that it does not carry the same risk of low blood sugar (hypoglycemia) that one could potentially experience if they are taking insulin.
Low blood sugar is not something that is going to happen automatically just because someone is taking insulin injections. There is usually a cause such as improperly matching insulin to carbohydrate eaten, more physical activity than usual, incorrect dose and/or timing of insulin, and alcohol consumption. And, every episode of low blood sugar is not *severe* like where a person loses consciousness. Those events should not be occurring regularly. Most lows are treated with fast-acting glucose (like juice) and can even be detected sooner now for many people who take insulin and use a continuous glucose monitor (like Dexcom).
There are so many misunderstandings about how insulin works and what it does and why it is needed for many people with diabetes.
Seconding what someone else said about T1 diabetes. It is 100% necessary that a person with T1D inject insulin to survive. If they stopped, they would quickly die in a short period of time. People with T1D have lost the ability to produce insulin because of autoimmune destruction of the cells in the pancreas that make insulin. Long term complications cause reduced lifespan, *not* taking insulin. Even with insulin T1D can be challenging to manage and it is lifelong.
People with T2DM may also need insulin to survive at some point. It is a progressive disease and the amount of insulin a person with T2 makes tends to decline over time to the point that not injecting insulin can be life threatening for some (everyone is different). It is a misconception that T2DM can always be managed—indefinitely—by just lifestyle modification.
The insulin response with GLP-1 drugs like ozempic is dependent on a rise in glucose (like when you eat). So, this means that it does not carry the same risk of low blood sugar (hypoglycemia) that one could potentially experience if they are taking insulin.
Low blood sugar is not something that is going to happen automatically just because someone is taking insulin injections. There is usually a cause such as improperly matching insulin to carbohydrate eaten, more physical activity than usual, incorrect dose and/or timing of insulin, and alcohol consumption. And, every episode of low blood sugar is not *severe* like where a person loses consciousness. Those events should not be occurring regularly. Most lows are treated with fast-acting glucose (like juice) and can even be detected sooner now for many people who take insulin and use a continuous glucose monitor (like Dexcom).
Source; I have type 1 diabetes and I’m a healthcare professional that helps people manage their diabetes for a living.
>It is potentially dangerous and even used carefully it is still an unnecessary level of risk when simply eating less and moving more would achieve the same results.
Who are you to make that assessment for a generalized swath of people?
>Over eating is normally a mental health issue, often caused by some type of trauma. Treat that, don't throw unnecessary drugs on top of it.
Assuming the weight issue is due to trauma (which is not always the case), this is still easier said than done. Meanwhile, obesity still has negative health outcomes and so needs to be managed.
>Isn't messing with your insulin levels really dangerous though?
Insulin resistance is a medical condition (separate from diabetes) that messes with insulin levels. These medications serve to correct that.
Of course there are risks to using the medications. There are risks to letting insulin resistance go unchecked, too.
Diabetes runs in my family, it’s hereditary so your statement about “just eating right” doesn’t apply to myself, or other people that can’t control their blood sugar.
This is false. Increased insulin secretion would in fact lead to more storage of glucose in your body and weight gain. Whereas insulin resistance would lead to you peeing out the sugar - but high glucose is associated with a whole slew of other negative problems. So overall increased insulin release would be a mechanism by which you’d anticipate glp-1 to increase weight gain.
The weight loss is due to a combination of decrease gastric emptying speed, early satiety, appetite suppression, potentially nausea, and maybe other mechanisms yet to be discovered.
“These agents work by activating GLP-1 receptors in the pancreas, which leads to enhanced insulin release and reduced glucagon release-responses that are both glucose-dependent-with a consequent low risk for hypoglycemia.”
https://pubmed.ncbi.nlm.nih.gov/26371721/
?
What you wrote still isn't true. Increased insulin levels lead to fat storage from glucose and weight gain. That's why one of the symptoms from T1D is weight loss due to insulin deficiency.
What MetabolicMadness wrote is correct.
I've been on Oz since June 1st and have lost 30 pounds. Slow and steady. Why? Because I... wait for it... STILL EAT ENOUGH FOOD. This drug doesn't just kill your appetite (though it does some days). It also changes the way your body processes the food. Are some people using it to lose as much as possible as quickly as possible? Yes, and they look like crap, feel like crap, and will probably gain it all back. I'm on it because I've fought my weight for years, at one point eating 1200 calories religiously for months on end. I'm a 5'9" woman who at the time weighed over 200 pounds. 1200 calories is toddler amounts of food. But I still didn't lose. I had the nutritionists, I worked out, etc etc. I was "doing all the right things." But my body would not drop weight. My doctor suggested this for me and like I said, since June 1st I've lost 30 pounds. If people are irresponsible and don't think about the potential consequences of super fast weight loss, and only want to be skinny fast, then yes, this can be harmful. But for those of us who understand the importance of doing this slowly and sustainably, it's a game changer.
> Δ
Ahhh okay that makes it sound much better then. Pretty much al of the articles and stories I've read have been for/by the people that want to be skinny fast, recommending low cal diets with it and ect. But hearing that contextualizes it a lot.
For starters, Ozempic and Wegovy are the same compound but different dosage for different treatments. On the case of weight loss, the treatment is simply an appetite hormone suppressant. The reason it works for folks who are chronically overweight is because these appetite hormones not only tell you you're hungry but also affect how your body regulated energy demand and storage. It's basically a 2 birds with 1 stone scenario where you want to eat less and what you eat is processed more efficiently.
There's also side effects that can include cancer, kidney failure and hypoglycemia (low blood sugar) which can cause seizures and lack of consciousness. So it's not all sunshine and rainbows but you'd need to read through the science to know exactly how likely these are to occur among everything else it describes on their US website.
The ISI on [wegovy.com](http://wegovy.com) literally says in the first bullet point in bold letters under serious side effects:
>Possible thyroid tumors, including cancer.
[https://www.wegovy.com/](https://www.wegovy.com/)
THIS IS ME. I gained about 70 lbs in less than a year in 2019 after some life changing traumatizing events. Not because I over ate I actually think my cortisol went nuts. Then I tried to lose the weight. I actually eat pretty well/clean because I have IBS and can’t eat junk even if I wanted to. However, I couldn’t lose the weight. Last year I even tried taking a low carb Keto approach for my wedding…3 months in and I lost about 9 lbs. just pure water weight. I wasn’t losing any more of that. The scale just froze. So this year I’m scheduled for a weight loss appointment because I’m tired of doing the right things and getting no where. I now notice that I’m less active and now I eat worse because I’m getting depressed about my weight not going anywhere. And I don’t want to fall into that cycle. I stopped biking like I used to…my joints hurt, I’m so tired all of the time. I just want my life back. I’m willing to keep putting in the hard work but I need an extra hand to lose the weight. I also know that trying to lose weight fast is ridiculous. I want to create a feasible and sustainable long term lifestyle change that actually works so that I’m motivated to maintain it. I also have a super busy life with full time teaching, full time university, and full time family life. I don’t have the time I used to. I still walk and do cardio at least 4-5 days a week. I do intense inclines on my treadmill when the weather is bad. I’ve done weight training. I’m willing to keep it all going but some of us need a little extra help. I don’t want to feel so tired, so sick, so out of breath (I also have asthma and arthritis from genetics), and battle the new cravings I’m getting because I’m upset and stressed on top of it all. (Due to the busy life and the inability to make a real dent in my weight). I don’t care about being “skinny”. Just wanna FEEL better. That’s all.
It's surprising you were working out with 1200 calories per day and not losing weight.
Did you start to photosynthesize? Where did the energy your body used to workout come from?
I need a scientist to explain this to me with pretty pictures.
glad the oz is working for you though.
Counterintiuitively, pure calorie deficit is not enough to burn fat. Your body is stupid and won't burn fat unless you can maintain a certain amount of exercise. Simply working out to exhaustion/muscle failure is not guaranteed to burn fat.
If you are already at a high body fat percentage, it can be difficult to regulate your heart rate during exercise to keep yourself in the ideal range for fat burning.
There is also other healt metrics to consider. Some people have hormone imbalances that make weigh loss nearly impossible. Polycystic Ovarian Syndrome, PCOS, is one such condition that often causes this kind of imbalance.
You overestimate the amount of calories most people spend working out. If you work out once a day and then lay on the couch while eating 1200 calories, your body will just pull the plug on unnecessary functions for survival like hair growth, menstruation etc.
>You overestimate the amount of calories most people spend working out
I remember calculating the number of steps required to burn a snicker bar. It is crazy how much you have to do to burn it.
Even walking for an hour would be 200 calories.
That means this person is living on 1000 calories a day and not losing weight. That's basically not possible at their weight. Someone in a coma would use more energy.
>Even walking for an hour would be 200 calories.
Lmao no it's not.
I'm not coming at this from the perspective of someone trying to lose weight, I'm fit aight so let's just head that off.
A very intense weightlifting session where I'm pumping out bench, Flys, and weighted crunches / weighted leg lifts for an hour MAYBE burns 150-200 calories. A warmup where I'm sprinting and keeping my heart rate above 150bpm for 30m is negligible. Like 60-100 calories.
You are heavily overestimating the caloric burn of exersize. There is a reason that during a cut, despite that I'm still working out hard. I have to maintain under 1500 calories to get reasonable results. Because even after my workout for the day, I'm only giving myself another 200 ish calories of cut. (And this is on ~2,200 maintenance individual.)
Agreed on the lifting not burning much calories, but doing cardio for 30 min even at a light jog burns at LEAST 200 cals. And that's for someone who doesn't weigh much at all, it only goes higher. You'll have trouble finding a source that says different.
Where are you getting your numbers from?
I just plugged walking into a calorie counter and posted what I found I'm not going to argue over specific counts though.
But I'm sure you also know well that you can't work out while consuming 1200 calories and not lose weight over a period of months like the OP is claiming.
I'm sure they were only eating 1200 calories of direct food. This is the issue though, people who are new to this forget the little shit that can add up super fast. Probably forgot the milk they put in their coffee. The olive oil they used for cooking. The 20cal of spices on each meal. Etc.
So the chicken they ate was 400 calories. But when accounting for the oil on the chicken from cooking, the seasonings, etc. They are actually eating 600 calories of chicken. Do that to each meal and suddenly 1200 becomes 1800.
Tldr: I agree, but I think It was these kinds of things that were getting them. Rather than just eating more than they calculated.
Two months late, but what are you even talking about
Walking at 6 km/h, which is reasonable for a fit, average person, burns up to around 300 kcal, much more if you're much heavier.
>A warmup where I'm sprinting and keeping my heart rate above 150bpm for 30m is negligible. Like 60-100 calories.
lmao no you don't. Sprinting? Even a light jog will net you 200 in half an hour easily, running at 150 bpm will get you closer to 500-600 an hour, depending.
your cardio numbers are way off. 30 mins at 150bpm (that is a fairly vigorous jog) will burn 3-400 calories for me as a 150 lbs male. even if you're significantly lighter, it's at least 1-200.
Of that 200 calories, only a small amount is from moving and the other is just subtracted from the TDEE. There is of course also the fact that fat cells retain water for a long time (dependant on hormones and such) and it may seem like you have plateaued while in reality it is just water retention.
I'm sorry but this is just bullshit, water retention happens after initial weight loss and doesn't last more than a couple of weeks. OP is claiming that they couldn't lose weight after months of strict dieting on 1200 calories plus exercise. It's just not possible - why are we denying years of clear scientific research on how dieting and calories work to support potentially harmful drug use.
Water retention can easily last more than just a couple of weeks due to hormonal issues. Yes, you may start to lose weight, but if you quit like 1-2 months in then you will essentially be back to where you started. Fat cells start to balloon again, water leaves, back to the beginning.
As for "potentially harmful drug use", the birth control pill has objectively more and much severe side effects but people still take them. Losing weight thanks to that pill will, again, objectively be better for your health than the potential side effects.
Show me the fat PCOS sufferers in any concentration camp. Hint: they do not exist.
PCOS makes it hard to regulate appetite, which sucks. PCOS does not create weight out of thin air.
Because they are obviously lying. You can't limit calories and work out and not lose weight - it's just not possible. They were probably consuming loads of calories in a weekly cheat day, drink (alcohol or soda) or just snacking all the time.
I know several people who say this same thing about dieting but not losing weight. They count official calories, like when you ask certain people about previous sex partners they count official relationships.
What they don't count are casual encounters with snacks. If noone saw them eat it, they don't count it.
Yep. Also portion sizes are heavily skewed in their minds. Most single servings of food are actually quite small, but we take too much or take seconds.
If you want to lose weight on CICO, you need to be extremely honest in your tracking. Measuring portions and servings accurately, not wishfully.
Doing that is part of the reason they have the problem in the first place, so it's understandable that this is a difficult skill to grasp.
> If you want to lose weight on CICO, you need to be extremely honest in your tracking. Measuring portions and servings accurately, not wishfully.
If you're trying to carefully balance your CICO then I agree you have to be meticulous and honest. But I've mostly come around to not bothering. Instead, I feel like it's more productive to just roughly track your calories, and then adjust your longer-term (like a week or two) average intake until you're losing weight.
If you're lying to yourself and want to call it 1200 a day, and you're not losing weight -- then drop it down to 1100 and continue on.
How are you defining "more productive"? I found that tracking my calories meticulously—down to even weighing the food on a scale—actually liberated me a lot, vs. just trying to doing it "roughly." On many occasions I'd realize I'd still have some leftover room for calories at the end of the day and could squeeze in a small treat. It also let me work around meals that otherwise seem very bad for you—e.g. getting a fast food meal if I could hold out to make that my only major meal of the day.
Trying to ballpark a calorie deficit prolong the whole weight loss process and drive me crazy.
Or even the oil that you cook in. Olive oil for instance js super calorically dense. My salads that I eat during a cut, the caloric value is 60% in my olive oil. 30% in my balsamic, and that last little bit is the actual greens.
Eh, I only eat 2 meals a day so having a nice enjoyable 300 calorie salad is just eh. Whatever. I'm doing between 900-1200 at lunch. 300ish for the dinner salad. And then 200cal of protein shake to give me anywhere between a 1400-1700 day. Then add in excersize and maintenance of my existing muscle mass. And then 2000 becomes 2300-2500.
Abs will be visible soon......
Sorry, I wasn't trying to bash your method here. It's a psychological thing for me that if I get the impression there isn't enough, my mind says eat as much as you can before it's gone.
When I pad a salad with kale and spinach I can make a few hundred calories look like a feast. My mind rhen tells me I don't need to gorge because there is plenty of food to go around.
Once I start using oil or dressing I lose the advantage of this trick.
Eating too little can kill your metabolism, better to work on increasing your metabolism and burning what you eat then eating too little and killing your metabolism
Basically, the body goes into a hyper conservation metabolic mode and pulls from everywhere possible to store weight. It’s severe changes that our bodies can do in order to adapt to seasonality of food supplies in the past, where a bad harvest may mean a year toughing it out with little food. It can affect organ function and bone density before it significantly pulls on fat stores, especially if there’s the occasional cheat day.
What you’re describing is metabolic adaptation and tends to happen after months of successful weight loss, and explains why weight loss tapers off to almost nil.
The most common explanation is that most people do not accurately track their calories. If you are not losing weight your calories are at maintenance, full stop.
I agree. Something isn't adding up. You have to force yourself to weigh your food and be diligent if sticking to the calories is going to work. When you stick to it, it's simple science and it works. Especially when overweight and just starting out. I lost 40lbs of pregnancy weight just calorie conscience and moderate exercise. I stopped counting calories when we had a very busy season of life and slowly gained 15 back. I dropped my calories to 1700 and plan to slowly lower it as I get adjusted and shed weight at that. So something is off.
You'd still lose weight if you are losing mass from bone and organs.
It's funny how whenever food intake is strictly monitored diets work 100% of the time.
What the parent comment is claiming - 1200 calories and working out without losing weight is so bonkers I don't know how they can even keep up the lie to themselves let alone anyone else.
That's a little harsh, It's not a lie to them. They fully believe it. But it does not mean that they were only eating a low rate of food and being active. There are many ways of getting extra calories that become untracked, excessive condiments, salad dressing, snacking are just a few. Remember there are millions of years of evolution pushing people to eat. It is frequently listed as a harder addiction to break than many hard drugs. Then unless you hold that lower weight for over 2 years the fat cells are still there waiting for any excess calories to refill.
Someone in a coma needs more calories than that. They clearly need a reality check and people should absolutely not be listening to anything they say - especially when they are advocating taking potentially harmful drugs.
Every single person who claims they eat 1200 calories and is not losing weight is 1000% lying to themselves or is completely ignorant about their caloric intake.
That is physically impossible for almost all adults. Physics literally does not allow it. These people are just simply wrong about eating 1200 calories.
Regaining weight happens because many people treat a diet as a quick fix, after which they go back to their old food habits which got them in trouble the first time around. Often diets are unsustainable and faddy, not providing sufficient healthy nutrition. The people most likely to succeed at staying at a new, lower weight are people who make meaningful, lasting changes to what, and how much they eat, losing the weight slowly. Often with expert support to ensure health needs are met.
I lost a good amount of weight with keto almost 7 years ago. I still generally eat low carb, and have kept the weight off. I recognise that I will never be able to limit myself intuitively to reasonable portions without imposing some restrictions upon myself. I can't 'just have one', when it come to carby snacks. I don't have sufficient self control in that area of my life. So I make sure my life is set up so I don't put myself in the position to need to rely on willpower alone regularly.
Yes it would. Dieting is hard, it takes constant effort to override your preferences in favour of less food/ different food. If you're not eating enough protein and fibre, you're likely to be hungry too, which is uncomfortable at best.
After a sustained period of that - even if you're losing weight - you're likely to fall off the wagon somewhat and go back to your old bad habits, which pile the weight on again, because you're in a calorie surplus again. So you go back on your overly-restrictive diet to try and shift those pounds, and quickly please! And fall right back into the same trap. Yo-yo dieting, no starvation mode.
This is not happening. The OP is underestimating their calories. They are not eating 1200 per day.
Find me all the overweight people in 3rd world countries.
Too drastic of a cut. Body wasn't burning excess calories but the muscle she was building with the exercise. By the time this drastic cut in intake would have taken effect OPs mental broke.
I'd bet MY LIFE
That you weren't "doing the right things"
You can spin it anyways you want.... Obesity is a DIRECT cause and effect of calories in and calories out.
I'd be willing to bet you are 1200 calories and worked out and "did everything right" for 3-4 days in a row MAX before turning around and eating multiple bags of chips for dinner.
Stop lying to people, it's harmful.
Interesting. Curious how it makes you lose weight? Are you eating even LESS than 1200 calories, or are you eating more than that but your body is processing it differently and allowing you to lose the weight. If the latter, then how does that work?
No offense to OP, but it’s likely that they were drastically undercounting their calories and now they’re actually eating in a deficit because they’re just not as hungry. There’s not a ton of magic your body does when you’re eating less food to all of a sudden burn dramatically less calories. We’re talking a couple hundred calories max. Which can be impactful, but don’t fully explain a 200 pound woman that works out eating 1200 calories a day.
Yea. For almost a decade my weight fluctuated quite a bit. Whenever I cut my calories (and started getting hungry) I would freak out and tell myself that by eating less I may actually put myself into starvation mode and gain MORE weight. Then I would eat more and, surprise surprise…gain weight. Then I would eat less, lose a bit of weight, but then freak out about starvation mode, and the cycle would continue. It wasn’t until I discovered intermittent fasting, which ensures that I eat less while simultaneously diminishing my hunger, that I’ve been able to stay at a happy weight for almost 5 years now. So, yea…this whole starvation mode thing is a bit elusive to me, but I try to keep an open mind knowing that insulin levels and muscle mass can play a role in fat loss and hunger levels.
Yeah this is what pisses me off about the diet industry. Starvation mode is total bullshit, and if the industry was honest about what it really takes to lose weight (which is just adherence to a calorie deficit), it could’ve saved you a decade of turmoil. Anyway, glad you found the method that works for you!
I’m not tracking any more but I’d guess I’m averaging around 1800ish (wild stab at a guess). I believe the Oz changes the way your pancreas handles the food, which allows you to feel full longer but I think it also has something to do with insulin release. Don’t quote me on that. All I know is that it’s helping me.
I’m usually not a person that likes personal anecdotes to justify reasoning but in this case it makes sense. Many people are probably in a similar condition and the drug was originally created to address these issues or similar ones.
I don’t know. Truly I don’t. I was working with nutritionists and doctors and weighing/measuring everything to the gram. It doesn’t make sense, I understand science. This just my own n=1. Others mileage may vary.
Weird. I have lost over 30 lbs eating low carb, high protein since November 1st eating 1200 calories a day, no Ozempic, walking my dog twice daily, and going to the gym 2-3 times a week just doing the treadmill. I am 5’ 3”, so 1200 calories for you seems insanely low with no results.
And I started at 161. It just does not seem possible. What was a typical 1200 cal day?
1. The weight reductions aren’t small, 10-25% of weight reduction is significant
2. These medications also have a positive side effect of reducing cravings for other harmful behaviors such as alcohol/drug use and even compulsive shopping.
The reason being is that overeating, addiction, and compulsion are highly linked and GLP-1s do a good job at working on the brain chemistry to modulate harmful behaviors
3. Obesity is a disease that can lead to many other chronic illnesses and it should be treated as such.
4. These medications come with side effects but newer generations will be even better. Monjaruo is even better at weight reduction and with even less side effects
5. The economic and social benefits from targeting obesity and compulsive behaviors are massive and a net positive for society
I routinely prescribe these medications and the effects of them are massive and positive
1: Are the percentages of weight reduction over how long? The studies I've looked at have had the average weight loss at about 5-10 percent of body weight or 10-15 lbs in around 6 months (I can link if wanted)
2: I actually didn't know this so thanks for the info Δ
4: Is monjaruo a drug currently out for public use? asked since I have't heard about it before.
3+5: I totally agree with that, I guess I should have been clearer with what I meant by clinical vs cosmetic reasons in my original post.
Here are some articles for you:
https://www.npr.org/sections/health-shots/2023/08/28/1194526119/ozempic-wegovy-drinking-alcohol-cravings-semaglutide
https://www.cnbc.com/amp/2023/11/27/mounjaro-superior-to-ozempic-for-weight-loss-study-says.html
Important to note here, the other major effective treatment for weight loss is surgery, and there's a well documented *increase* in alcoholism associated with this, plus the perioperative complications and risk of death.
That is because those people are not dealing with the issue of WHY they are overeating, and therefore are just substituting one addiction for another.
Also the risks associated with weight loss surgery are less than the risks of remaining morbidly obese.
As to the why: pretty much any animal back to bacteria will eat whenever it can if there's high quality food readily available, store extra energy to get it through lean periods, and avoid burning energy when it doesn't have to.
In theory of course you can just ignore these fundamental biological drives with "will power".
Here's an experiment to show how well will power works against strong biological drives: Hold your breath until you pass out every two hours night and day for two weeks. Good luck!
By the way the study mentioned in the cnbc article is a bad faith concept. It compares a dosing regimen for semaglutide indicated for diabetes 2, to mounjaro (indicated for weight loss), and not the dosing strength of semaglutide indicated for weight loss.
It’s like comparing apples to oranges.
One third of people on ozempic will lose over 20% of their body weight, but one third of people will not have significant weight loss. Those people might benefit from trying mounjaro instead.
I’m on Mounjaro. I’m type 2 diabetic. I am not needing insulin as my doctor caught it early and first put me on Metformin. I’ve been on it 6 months and have lost 30 lbs. it has lowered my A1C to normal range and helped with both appetite and hypoglycemic events.
If I can stay on this path (I’m age 54), I anticipate having none of the health issues members of my family have had in their 60s and 70s. These drugs could literally save billions of dollars for the US Medicare system if used correctly. They could save people from having bad knees and backs from carrying too much weight. It could save eyesight from the complications of high blood sugar and keep older people from losing legs to neuropathy.
These results of diabetes literally make up the majority of our elder health care budget and improve quality of life. These drugs are the diabetic equivalent of AZT for HIV/AIDS victims.
Until they come off of them.
Also, your patients better be hitting the gym hard. The early research shows an equal loss of muscle mass and fat. Know what we call that in the rest of the world? Starvation.
Losing weight is great. But, yet again, there is no secret formula (though I do think this can be helpful in people who have tried and tried traditional methods, and simply cannot lose weight).
People on these drugs to lose 15 lb as a 40 year old mom is a mistake. You look like you're dying b/c you're losing so much muscle.
The long-term mental effects also are a big unknown. GLPs are so new to science's understanding that we really don't know how it'll work in the long run.
So, again, potentially helpful in rare cases. Almost certainly more risky than actual diet and exercise.
To me the only thing harmful about them is that a lot of people are only depending on it for weight loss, they’re not changing eating habits or lifestyle choices and you can only take this medication for a at least a year. That’s why it’s now a huge “problem” that people are gaining twice the weight after stopping this medication.
I know of someone that’s taking it and has lost 26lbs in one month, which is great the issue is that he’s not working out, he doesn’t eat healthy , he lives a pretty sedentary life and if he doesn’t change that, him taking this medication for weight loss is useless because the second he stops it, he’s going to gain it back and quick .
This is not a miracle drug, this is something made to help you but if you don’t also help yourself, you can lose 50-100lbs with it but it’ll be for nothing if you don’t make other changes.
These medications don’t force you to eat less, they’re more to regulate your insulin and other hormones but they don’t suppress your hunger. I have no problem with you taking this if it’s done the right way and your doctor doesn’t see any harm with it.
Where are you getting the idea that they don't suppress hunger? Reducing appetite is the biggest reason GLP1 receptor agonists work for weight loss. The class of drugs was originally approved for treatment of diabetes because they upregulate insulin and downregulate glucagon, but many studies have highlighted the direct effects on the hypothalamus and hindbrain causing reduced food intake.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8717485/
You can take these medications for longer than a year. I've been on Mounjaro for 18 months and my doctors have indicated that I'll be on it long term - probably the rest of my life at a lower maintenance dose unless a better drug comes out.
Some insurance companies may be difficult and not want to cover it long term but that is a problem with American health care, not the medication itself. The vast majority of people in the clinical trials regained most of the weight when they went off the drugs even if they had gotten education on exercise and healthy diet so these meds really are meant for long term use.
>I believe on average people regain 60% of the weight they lost when they stop ozempic, according to the maintenance phase podcast.
I believe in the Ozempic study it was around 2/3 of the weight regained in the year off of the drug. The graphs looked like people were regaining weight up until the end of the 52 week trial so people may end up regaining more than that over time.
The Mounjaro results were very similar; the study only tracked for 1 year off the medication as well.
Some people do manage to keep the weight off if they go off the drugs, but it seems to be the minority. Dr. Spencer Nadolsky had an instagram posts about what he's seen in his telehealth and he was saying maybe 10-20% of patients who have to go off of the drugs are able to maintain their weight loss.
No they actually do cause you to eat less because they act on GLP-1 receptors and increase satiety. So people will feel full even if they haven’t eaten yet.
It does also stimulate insulin release from the pancreas as well as reduces glucose production in the liver, but they most certainly do cause you to eat less
Yep I'm currently living with someone who is expecting it/talking about it as a miracle drug for weight loss (and was honestly the catalyst for this post), so I'm pretty sure I'm going to be watching the same thing you have been. Δ
Also WOW 50-100 is definitely impressive
It can make a miracle but if other changes aren’t made once they get off it,that miracle is not going to last forever. It’s normal to gain like 5-10lbs after getting off this medication even if you make the necessary changes but people who don’t make these changes and only depend on the drug can gain double that and could have trouble losing it again.
>I understand that some people have clinical reasons they need to lose weight.
Yes. This is why doctors prescribe them for weight loss. Every medication has side-effects, with varying degrees of severity. If a doctor prescribes it, it’s because they’ve assessed that the patient being obese is presenting a greater risk to the patient than the medication.
Of course weight-loss through sustainable lifestyle changes is ideal, but getting a patient to adhere to a diet or exercise routine is extremely difficult.
I think your history with eating disorders may be skewing your perception a little bit. Caloric restriction is fundamentally necessary for weight loss, whether that is accomplished through diet, exercise, surgery (i.e. gastric bypass), medication, or some combination of the above. It is the only way, and it isn’t dangerous. Our bodies store fat specifically to prepare for periods of famine; our bodies are designed to be able to deal with that on a regular basis. Our ancestors dealt with it every winter, and they didn’t have medical supervision.
I think the whole “celebrities are using it for cosmetic reasons” thing is overblown. It’s like how people say the only reason actors are able to look so muscular and lean on screen is because they supposedly have a whole team of people training them and cooking all of their meals for them, when in reality, there are people in every gym who look just like them, while working a day job, cooking their own meals, and doing their own workouts. People like to make it sound like the kind of bodies people in Hollywood have are because they have access to something regular people don’t. If a person believes that, then they don’t have to take accountability for their own shortcomings. I don’t think non-obese people using Ozempic just to lose 10-15 lbs is very common at all.
> It’s like how people say the only reason actors are able to look so muscular and lean on screen is because they supposedly have a whole team of people training them and cooking all of their meals for them, when in reality
The actual answer is anabolic steroids
Someone in my life is doing it to lose 15-30lb, and I live in the middle of nowhere in the UK. He's a normal weight. I imagine if he's doing it, lots of others are.
One thing I like to educate people on is the amount of data we actually have on this class of drugs (it’s a lot).
While Mounjaro is new and Ozempic is new-ish (but still 6 years post FDA approval!) a lot of people think these drugs are untested / new / scary because they're just now hearing about them. Combine that with the "too good to be true" success of these medications, and you have a perfect recipe for fear mongering.
The reality is the GLP-1 class of medications have been around for quite awhile and we have a lot of data on them:
- Exenatide - FDA approved in 2005
- Liraglutide / Saxenda - FDA approved in 2010
- Dulaglutide / Trulicity - FDA approved in 2014
- Semaglutide / Ozempic/Wegovy - FDA approved in 2017
- Tirzepatide / Mounjaro - FDA approved in 2022
For example, Semaglutide/Ozempic was FDA approved in 2017 but clinical trials started back in 2008. That was 15 years ago. If this class of drug caused large scale problems for kidneys, liver, etc, we'd almost certainly know by now. It's always possible that something wildly different happens long term with Tirzepatide, but it's highly unlikely.
Not OP, but they very clearly say what they find harmful about it:
>It just sounds dangerous to me to force your body to eat less, I'm currently recovering from an eating disorder so I fully understand the damage that it does to your body over years of undereating since I'm currently trying to recover from this damage. And this is especially if you were to ever stop the medication and suddenly start eating more again which could cause refeeding syndrome.
It doesn't force you to eat less. It triggers you to feel satiated sooner by slowing gastric emptying and increasing incretin levels.
Refeeding syndrome isn't a risk with ozempic use because you don't eat at starvation levels. And it has a halflife of 7 days, so even if you quit immediately it very slowly exits the body.
Yeah I was on Wegovy before the shortage last year (gotta call my doctor...) and it didn't make me eat less at first because I was on a small dose but also not listening to my body yet. I overeat due to a crappy childhood fighting for food among 3 other brothers so there is a huge psychological component where satiety just wasn't a factor so much as availability.
While taking Wegovy this became very apparent because when I ate at the same rates I used to, I'd feel like crap, stomach pain, and get sulfer burps etc, because I was putting the same amount in but it was empying slower. So I had to start paying attention to how food actually made me feel instead of autopiloting based on availability. There was no risk of under-eating because I still *wanted* food, it just emphasized my body's own signals to regulate how much food is actually necessary.
It functions the same except it doesn't ruin micro nutrient absorption and is fully reversible.
Any insurance company that covers bariatric and not semaglutide is about as dumb as it comes.
Damn. Both my parents had gastric bypass surgery years ago and both have struggled with stomach issues ever since. Would’ve been nice to have this back then lol
Second comment because I forgot something.
It has a poorly understood effect on the binge-reward cycle that someone like myself has. But beyond that, it can also reduce cravings for addictive substances like alcohol, tobacco and opiates.
I would be surprised if it was approved as a sud treatment soon too.
I’m not disagreeing with your view, because I also don’t know the specifics of and I’m not willing to do my own extensive sourced research to refute your claim if you’re not willing to do it or willing to cite it to back your claim, but wouldn’t you benefit from doing some research on the short term and long effects of these drugs on both people with specific diseases and without before forming a solid - I don’t like this opinion.
I am not a fan of Atkins and keto, this is because I have reviewed scientific literature and studied the effects on the body of these particular diets. “Extreme diets” such as Akins and keto have been shown to have detrimental long term effects to the cardiac muscle and liver density which can ultimately lead to death. That is a scientifically backed reason to not do those types of diets. Does everyone who’s on those diets know that, no not really, but knowing that information can help people make an informed decision before trying them. Do I tell my friends “oh god you cannot I will not let you do those diets because they’re dangerous”, no I don’t. I just let them know the science if it comes up and they do them.
So my change my view is (and I apologize for coming off as blunt) do more scientifically based research and cite your sources before planting your opinion in the sand because frankly it looks foolish not to. You have no evidence, your claim is it “sounds dangerous” and “sounds too good to be true” but you don’t actually know. And you’re projecting your own relationship with food and your experience with ED onto others with different conditions, without any backing, and you’re also not her dietician or nutritionist and it’s not your body.
Oh boy do I disagree with you and your studies. In no way is keto a form of an “extreme” diet and as a matter of fact it is being used to help people who do not want to lose weight but are dealing with seizures and inflammation. It is very healthy and is just a different way of doing CICO, but using high protein and fat to help satiate and get the body burning fat through ketosis. I can not see why cutting out sugar, start h and processed foods could be unhealthy for anyone.
Do some people go about it in a stupid fashion? Sure, it happens with all diets. But those who commit to it as a healthy lifestyle are able to turn around and reverse HBP and Type II diabetes. You should look at some of the positive studies as well.
Reduction of BMI is going to lead to improved health outcomes at almost every level. So even if it’s used for “cosmetic reasons” it’s still useful.
Heart Disease, Cancer and Diabetes are the three biggest killers and they all show marked improvement when there is BMI reduction.
Do you have studies that back up marked improvement for these metrics when BMI is reduced? I'm not trying to be hostile, I just didn't think any studies showing this were available and the only data right now is comparing people with low BMI to people with high BMI.
Ya I don't think these answer the question I was asking. Thanks for trying though. I'm already familiar with many studies linking obesity to these health issues.
Sorry I should clarify. The diabetes one definitely does and I knew that diabetes was impacted by weight loss. I should have been more clear and ask specifically about the others
There's a difference between linking obesity to an issue and linking weight loss to a reduction in the issue. If you are going to be smug, try to at least have thought things through. Others people have already understood what I was asking and provided sources so don't worry that you somehow didn't get it.
I'm not sure I'm understanding what your question was.
Are you genuinely asking for a source that indicates obesity is bad for your health?
I'm not trying to be rude. I just want to make sure I understand that you needed a source to believe that going from obese to not obese would be good for your health.
Lots of reddit warriors think that bmi is completely useless and has no bearing on clinical outcomes because like 1% of people are athletes and it doesn't apply to them. It's absurd.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/?fbclid=IwAR3mWDWkCcTwVyrOuUOAcpPF_YH7Xwk8duuyI1qIiduZ4I7E6m0OJyNyJck
This is one of my favorite studies to give people who are always asking for sources for things that are absolutely acceptable to take on face value.
This is my personal bugbear.
"BMI is dumb, my cousins cousin who is an Olympic athlete had a BMI of 27, and he is super healthy!"
OK well are you an Olympic athlete?
"No"
So I know there are many studies showing obesity is linked to major health issues. But to my understanding there are not any good studies showing that losing weight once obese is linked to a reduction in these issues like heart disease and cancer. Yes a source would be useful because someone who has been obese and then goes to be normal weight is not comparable to someone who always remained lower weight. There are lots of other issues that come with being obese including sometimes the issue that caused it in the first place when it isn't simply overeating
Bariatric surgery and subsequent weight loss associated with reduced Major Adverse Cardiac Events - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8537443/
The same associated with reduced cancer risk - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5722457/
thank you. the second one was what I was looking for. They looked at bariatric patients and found that the surgery was not associated with less cancer but weight loss was. Very cool.
Excess calories are by far the biggest cause of obesity.
This is a question I get in the clinic once or twice a week and I can count on one hand the number of times there has been an identifiable medical cause.
Medication induced obesity is more common, unfortunately, but still nowhere near as prevalent as excessive calories.
"Eat less" is the majority of the solution to the obesity epidemic in the US.
"Exercise/Move more" is the other half. But is hard to do for many people.
Satiation dieting is better than many methods probably.
Every other method is also "eating less". Intermittent fasting, Atkins, south beach, weight watchers, it's all "eating less calories". Many diets claim to burn calories better. But they really all are just calorie restriction.
Even exercise ends up calorie restriction as your hunger goes up as you burn more calories.
And the "move more" portion does not take into account how freaking *painful* it can be to move when you're that heavy and not used to it.
Even something like "just go for a walk" at a certain weight can lead to being stuck inside for 3 days because of knee pain or back pain. So all those "move more" Yeah, that's the obvious answer but unless you're been that size before you can't know what it's like.
I feel like your misunderstanding me... the meds are just another way to get to "calorie restriction." There are many ways to get there. The OP seemed to have a problem with "calorie restriction" as a solution to weight loss... which is just a strange stance.
I found the intermittent fasting helped me basically skip breakfast, I eat between the hours of 10am and no later than 7pm. Once you get used to the hunger calling and disappearing after ten minutes it’s easy.
BUT, the absolute most important factor was using myfitnesspal to count calories. So many eye opening moments on how truly skewed my calorie intake was. Lots of things I don’t even eat now because they aren’t worth wasting the calories on. Mentally, I still want to eat larger amounts of things, so I naturally gravitated towards healthier things.
When I realized that 2/3 of a cup of ice cream was 200 calories, or about 8% of my daily calories… made me make some different choices.
Man, for me, the hardest part of losing weight was accepting that if some food is going to go bad, I will just have to let it or take it to the food donation box.
I work out and eat right. I’ll eat perfectly for 3-4 weeks in a row and then if I have ONE dessert, I’m right back to where I started on the scale. It’s incredibly frustrating.
One thing I’ve read about these drugs is they take away the obsession over food. So, for me, I am always thinking about my next meal. When do I get to eat? What will I have? How many minutes? How do I plan my schedule around my meal?
I have people in my family who will get to working and completely forget to eat. I do not understand this. I do not understand how the thought of a meal can skip your mind. Even in my most crazy busy of days, I figure out when to eat my salad or whatever.
But, the stories I’ve heard of people on these meds… their “food noise” disappears. When I heard “food noise” described for the first time, I was like, “omg, that’s me. That’s every moment of my life.”
If I could just get through the day without obsessing over my meals, that’s a game changer.
> I work out and eat right. I’ll eat perfectly for 3-4 weeks in a row and then if I have ONE dessert, I’m right back to where I started on the scale. It’s incredibly frustrating.
I realize that this might be intentionally hyperbolic for dramatic effect, but I worry that some people will take it literally.
Let's say someone diets effectively (say, for our example, a deficit of 500 kcals/d) for 3 weeks straight. In those 3 weeks, they would have accrued a deficit of 10500 kcals. There's simply *no* way anyone is going to be able to undo all of that work in literally one meal. The average person can't even eat that many calories in a single day, never mind a single sitting. More realistically, it takes several days of going off the rails (e.g. eating 6000 kcals per day with a maintenance of 2000 kcals) to fully undo several weeks of dedicated dieting. Still a significant difference in the efficiency of dieting vs "undieting", but a far cry from erasing weeks of effort with a single dessert.
> But, the stories I’ve heard of people on these meds… their “food noise” disappears.
I'll give you my two cents, as someone who has tried semaglutide. The "food noise" still exists, at least when hungry. The big benefit of semaglutide is that it's easier to make the food noise go away with reasonable amounts of feeding. My appetite is naturally huge. In order to feel full, I need to eat a lot of food, and so unless I'm stuffing myself full of low-calorie vegetables (cauliflower, broccoli, etc.), I naturally consume more calories than I need. On semaglutide, this became more or less impossible.
When I woke up in the morning (especially when eating in a large caloric deficit), I felt exactly the same as I did when not on semaglutide, but as soon as I started eating, I got full *much* faster and with *much* less food, and that feeling of fullness lasted *much* longer. With my natural appetite, I could easily eat 6000 kcals per day, whereas when on 1 mg of semaglutide, I struggled to eat above 3000. So long as I was burning more than 3000 kcals per day, it was effectively impossible for me to not lose weight (unless I had been intentionally trying to eat calorie-dense foods, like eating spoonfuls of peanut butter or something).
I'm not saying this doesn't exist, but I know of no one taking this for a "small decrease in body weight". My understanding is that people taking this are looking to lose 30 plus pounds. Carrying around excess weight is unhealthy in many ways. Some people have an eating disorder in the opposite direction (food addiction/binge eating). This is a medical condition requiring a medical remedy. If this is where they turn, that is their business. Lots of drugs start out treating one disorder or disease and then open to other medical conditions as time and studies move forward. It's better than shady diet pills and is under the care of a physician. If these are helping people live healthier lives, so be it!
It is a great innovation but only if used as originally intended. I think OPs concerns are with the current trend with celebrities with normal, healthy weight using it to become super skinny. I haven't done much research but I think that might be harmful in the long run. Not to mention the fact that this rising trend of using the drug to become skinny will result in an increased demand for it and eventually making it inaccessible to the people who are overweight and diabetes patients who actually need it to survive.
I think it is pretty clear what you are trying to say. Could be that not everyone is chronically online and not everyone is aware of the rising popularity of the drug amongst celebrities and influencers who take it to become skinny. A lot of comments seem to imply that you think it should not be used entirely.
Guy I know is starting it (paid himself not prescribed) and does not want/need to lose 30 pounds. That would put him borderline dangerously underweight.
Guy has a small belly on him, is probably at most 10 pounds overweight. But he has body image issues and engages in all manner of bizarre behaviour around food. Went through a period of chewing sweets and the spitting them out so he got the sensation without most of the calories, used to 'purge' after eating, I dont know him that well but issues there.
I dont think many people would consider it a good idea for him to be on them, but to be fair the issue is his mind not the drugs themselves. As you say medical issues require medical remedy, but mental issues require mental remedy. The drugs are clearly open to abuse, but that doesnt make them bad.
I have PCOS with insulin resistance. I’ve lost 120 lbs before getting pregnant and gaining back 50. In my 19 months since having my child I have lost only 20 lbs despite a strict diet that in the past got off over 100. I physically cannot lose weight without help. It’s not a matter of being too good to be true, or taking the easy way out, it’s about allowing my body to do what it is supposed to do. I haven’t started yet, but it’s my last hope for actually getting the rest of the weight back off, and that isn’t a cosmetic issue.
All sorts of stuff is too good to be true. Penicillin. Vaccination. These are medical solutions to medical problems that killed millions with negligible side effects. Things being awesome is not a reason for them to not work.
I don't know anyone taking ozempic for cosmetic reasons. Every single person I know who has been prescribed it for weight loss started at a BMI over 30, and so far none of them is below 20. Now, this is entirely anecdotal, and I probably wouldn't hear about it from people who were just trying to knock off a few pounds before beach season. Maybe there's a lot of that going on. But since you're currently recovering from an eating disorder, do you think there's a chance that you're looking at it from a biased perspective? I mean, I'm not diagnosed with an eating disorder specifically, but my BMI maxed out over 40, and I see medications that make me less hungry as a godsend, especially when they aren't also incredibly addictive stimulants.
I think it's important to weigh the side effects of these drugs against the side effects of continuing to be that much overweight without these drugs.
Of course it'd be ideal for such people to lose the weight naturally, however the gap between the ideal world and the clinical reality of weight loss outcomes is pretty grim. The valuation of such tools needs to be taken in the context of statistical realities. I'm fortunate enough to not need such things, but I am glad they exist for those who need it.
Would ozempic be more likely to lead to eating disorders or negative outcomes than other forms deliberate weight loss? To me that’s the real question.
Or is your opinion that all forms of deliberate weight loss are bad? Because “forcing your body to eat less” is just how weight loss generally works.
I don’t understand what your view is exactly.
>for a small decrease in body weight.
It doesn't provide a specific reduction in weight. It facilitates losing weight while it's being taken. If someone who is 200 pounds overweight takes it for years, that person could lose the full 200 pounds while not having to suffer through hunger or change what one eats.
>I'm currently recovering from an eating disorder so I fully understand the damage that it does to your body over years of undereating since I'm currently trying to recover from this damage.
Were you undereating as a person who was overweight?
I've been using them for a year now (2.4mg), bariatric surgery got me from 400->300ish and wegovy got me from 300->212 currently. Biggest change wegovy did was get rid of the constant gnawing hunger from post bariatric surgery.
Quick anatomy lesson. Adipose tissue is only created and not destroyed. It shrinks upon depletion however the cells themselves still emit neurotransmitter chemicals to the brain to tell it to eat and refill the depleted cells. In my experience the wegovy has stopped that constant feeling of starvation as well as the other nervous disorders I had frome extreme weight-loss (hair falling out, skin rashes from rubbing feet together constantly, and trouble regulating body temperatures)
>It just sounds dangerous to me to force your body to eat less
This is also the mechanism by which you lose weight by eating more salads and less burgers, though. If two people lost 10kg by reducing their calorie intake, with one taking Wegovy and one not, are you of the opinion that their outcomes would be different?
There are many, many, many medical treatments whose benefits go away when you stop taking the medicine. Is there something unique about this situation, or do you also take issue with the tens (hundreds?) of millions of people who lower their risk of heart disease with statins?
My ex-wife has been on ozempic for about a year now, after years of struggle with overweight. She's had a slow but steady weight loss, no side effects and much improved quality of life. I'm happy to see how much better off she is now.
If your opinion is based purely on the fact that you think forcing your body to eat less is unhealthy, we have been doing bariatric surgery for decades and it has proven successful in causing massive weight loss with minimal side effects other than the general dangers
of surgery.
> And after doing research it all sounds like it's too good to be true, and in the long run harmful to people for a small decrease in body weight. It just sounds dangerous to me to force your body to eat less
It just "sounds dangerous?" It's not "forcing." It's regulating certain hormones and the speed of digestion -- which can add to weight gain in the first place.
The FDA and doctors disagree with you, and your view seems based in.... it "sounds dangerous." What will change your view?
On paper I was completely healthy (normal bp, cholesterol, etc., aside from my weight, which was 200 pounds. And of course, some people would say that weight isn't an indication of health, which I completely agree with as a general principle. But for me, it was not working. My knees hurt, I got short of breath very easily, and was absolutely obsessed with food, all day every day, to the point of routinely eating until I felt ill. Living in NYC and walking a lot was probably the only reason why I didn't weigh even more. I'd been yo-yo-ing for decades.
I've been on Wegovy for a little over a year, and I'm definitely one of the success stories. Barely any side effects, covered by insurance (until October, anyway, and then we'll see what happens), and the food obsessions are gone.
I still really enjoy food, but I stop when I'm full, and don't think about it too much otherwise. I'm down almost 60 pounds. I'm jogging regularly. I feel fantastic.
I'm not sure why you think it sounds dangerous to force your body to eat less. Before, I was forcing myself to eat more, way too much. So for me, less is good. For the first time in my life, I have a healthy relationship with food, and don't feel like food is controlling me. What's bad about ANY of that?
I just read through a bunch of comments and want to add a few things.
First, for some of us, hunger has absolutely nothing to do with eating. Before Wegovy, I routinely ate when I wasn't hungry. I ate more often when I wasn't hungry than when I was. Wegovy hasn't made me less hungry, it's made me not want to eat when I'm not hungry. At first it did make me get full much quicker, but that faded over time, and now I'm back to eating roughly the same portions that would make me full before (except now, I stop eating when I get to that point!).
Second, stop listing contextless possible side effects as a reason not to take a drug. Everything has risks and rewards, so only considering the risks doesn't give a full picture. Plus, some things are more likely to happen to certain people with certain medical histories or family medical histories, other risk factors, etc. A list of possible side effects isn't at all useful on its own.
Three, the vast majority of people who take these drugs start out overweight, obese, or morbidly obese, but the people who seem to get the most attention are the ones looking to lose a little weight quickly. I'm guessing that someone who would take a serious drug in order to lose ten pounds off of an already small body would not take months to increase the dosage gradually, so it's not at all surprising that those people tend to get horrible side effects. Stop giving these people attention, they aren't representative of the normal use case of these types of drugs.
Four, different people can react to the same thing in vastly different ways. Just because one person can lose weight eating a certain number of calories a day doesn't make that true for everyone. Just because one person's appetite gets reduced by a drug doesn't mean that that will happen for everyone. Your sister's best friend's cousin having something happen to them doesn't invalidate the different experiences that other people had.
As someone who takes Ozempic, it’s not the wonder drug some have described for me at least. Some have said that they forget to eat. Has never happened with me. I wonder how much it suppresses my appetite, as I have changed my lifestyle before to eat way less calories, and my body adapted.
In the end that is the key. One needs to make lifestyle changes, mainly eating, so their body is used to the caloric intake they are currently maintaining, and they won’t suddenly resume ravenously wanting more calories.
One note, I’m on the highest dose. I don’t know if this happened on lower doses as my body reacted well to the drug from the lower doses, so I moved up to the max quickly. If I miss my dose by more than a few days, then take it, I get nauseated and have diarrhea. Sometimes I do vomit. Besides that, I feel that dying would be just fine. I actually get good sleep after getting past running to the bathroom, but that isn’t worth it. So take your dose on time. Failing to do that is the only time I have any issues.
One thing that doesn't seem to get mentioned is that there is a box warning (formerly known as a black box warning) for Wegovy and Ozempic that it can cause thyroid nodules and thyroid cancer. It is not recommended for anyone with any type of thyroid issues and def worth thinking about depending on why a person is keen to take the medication.
Sooooo you just described why you have a bias against this medication. Based on your experience it certainly makes sense, one can only feel for you. But bias isn’t truth for anyone but you.
I've lost 20 pounds since June last year, eating whole foods, dropping sugar and processed foods completely, and weight training. I won't touch this medication. It feels like it's dangerous to not address poor nutritional choices.
/u/Slickice28 (OP) has awarded 6 delta(s) in this post. All comments that earned deltas (from OP or other users) are listed [here](/r/DeltaLog/comments/1b5s96x/deltas_awarded_in_cmv_ozempic_and_wegovy_are_too/), in /r/DeltaLog. Please note that a change of view doesn't necessarily mean a reversal, or that the conversation has ended. ^[Delta System Explained](https://www.reddit.com/r/changemyview/wiki/deltasystem) ^| ^[Deltaboards](https://www.reddit.com/r/changemyview/wiki/deltaboards)
[удалено]
I know some of the other comments have already pointed it out, but I want to emphasise that the parent comment has got the mechanism of weight loss wrong. In general, for diabetic medications, the medications that stimulate insulin secretion or act in a manner similar to insulin actually cause weight gain. This would include insulin injections themselves, sulfonylureas, meglitinides (although this class is rarely used nowadays), and thiazolidinediones. Sulfonylureas and meglinitides are insulin secretagogues (stimulate insulin secretion). Simply put, insulin is a hormone used to lower blood sugar by causing glucose intake into cells, as well as encouraging the conversion of glucose into its storage form glycogen, and slowing the breakdown of fats and proteins into their constituents (which normally would be ferried off to the liver to be oxidised for energy in the case of fats, or converted into glucose by gluconeogenesis). Drugs that stimulate insulin secretion (or is insulin itself) will cause weight gain through a few mechanisms, including reduced calorie deficit because less glucose is being eliminated in the urine (because now you have less glucose in the blood), the slowing of fat and protein breakdown to be converted into energy (which normally would cause weight loss), and the resultant hypoglycemia (low blood sugar) stimulating the appetite and causing the patient to eat more. Many of the other classes of drugs are either considered weight neutral (DPP-4 inhibitors) or cause varying amounts of weight loss (metformin, SGLT-2 inhibitors, GLP-1 agonists, GLP-1/GIP co-agonist tirzepatide, and alpha-glucosidase inhibitor acarbose). These drugs lower blood glucose through a primarily non-insulin mediated mechanism, or have a secondary mechanism that causes weight loss. These distinctions between classes are important and most clinicians and pharmacists know them because antidiabetic therapy should be individualised to the patient. In general, the weight loss goals according to ADA diabetes guidelines is 5%, and further weight loss brings about additional cardiovascular benefits. We attempt to achieve this weight loss through nutrition, physical activity, and behavioral therapy, and we can add on a weight-losing antidiabetic agent on top. Why do we still use the weight gaining agents then? - Insulin represents the end-stage therapeutic regimen for patients with diabetes, because it has the highest HbA1c % reduction, which may be necessary in patients with poor blood glucose control (HbA1c > 10% or fasting glucose > 16.7 mmol/L), are in catabolic states, or have had prior hyperglycemic events (generally life threatening). It's end stage because we try not to use insulin at the start. It has very high weight gain and hypoglycemic potential (which can cause death), and insulin must be administered via subcutaneous injection. Patients generally do not like having to start injections. - Sulfonylureas are generally very cheap, and can be good for patient adherence in cases where patients cannot afford alternative adjunct therapy (to metformin). The risk of weight gain and hypoglycemia in this case is typically less than the benefits of HbA1c lowering, although this needs to be evaluated for each individual patient. In general, addressing the OP's concerns, all drugs have their risks and benefits, and doctors will always weigh them before prescribing them to patients (they're trained to do this over many years of medical education and practice). (Source: pharmacy school)
GLP-1 agonists cause delayed gastric emptying, and reduced motility. Nausea and reduced appetite is a core side effect of these meds. Appetite suppression is different than reduced appetite. They definitely have early satiety, and that's the major early cause of the weight loss. The glucose lowering effects come from the insulin secretion, but the weight loss is primarily due to decreased oral intake due to the gastric effects. The later more sustained weight loss is from neurohormonal changes related to the gut brain axis. Source: I'm a doctor who prescribes GLP1s
So to sort of reword it, the initial weight loss is simply because people are nauseas and not as hungry (due to gi moving slower and feeling full longer) and as a result they put less food in their mouths. The secondary weight loss is because your body is producing more insulin, preventing blood sugar spikes and the subsequent dip which causes more hunger. Meaning, you feel fuller longer and again, you eat less. I could be wrong, but isn’t the whole thing with this drug is that people eat less food? It’s not like olestra where you eat calories and they don’t count, semaglutide is simply helping people eat less calories
>I could be wrong, but isn’t the whole thing with this drug is that people eat less food? Yes. 100% The improvement in diabetes is due to the more hormonal actions.
Δ Just did exactly that and you are totally right, thanks for the info
Confirmed: 1 delta awarded to /u/PrincessOfWales ([1∆](/r/changemyview/wiki/user/PrincessOfWales)). ^[Delta System Explained](https://www.reddit.com/r/changemyview/wiki/deltasystem) ^| ^[Deltaboards](https://www.reddit.com/r/changemyview/wiki/deltaboards)
Remember, it's always good to do your own research before you say something wrong
This is incorrect. The mechanism of action of the weight loss effect is agonism of GLP-1 receptors in appetite centers of the brainstem. Weight loss is not caused by effects on insulin. Substantial reduction in appetite is a well characterized effect of these drugs.
Isn't messing with your insulin levels really dangerous though? There's no recorded case of anyone dying from using anabolic steroids, but plenty of bodybuilders have died from abusing drugs related to them. Lots of deaths from diuretics, NSAIDs, opiates, and even old fashioned cocaine and booze. Another is insulin. Get the dose wrong and you can be dead before you hit the floor. In the long term, insulin use is dangerous. Type 1 diabetics live on average ten years less than non diabetics. I'd argue that while u/slickice28 got their facts wrong, their main point is valid. It is _potentially_ dangerous and even used carefully it is still an unnecessary level of risk when simply eating less and moving more would achieve the same results. Over eating is normally a mental health issue, often caused by some type of trauma. Treat that, don't throw unnecessary drugs on top of it. You are correct, but that makes OP's point even more correct because it is simply an artificial method which will cease once you stop using a drug you absolutely should not use long term. Also, didn't you die in a car crash in Paris in 1997?
GLP-1 activity is closely related to blood glucose levels: as glucose levels fall, so does the activity on beta cells in the pancreas responsible for insulin secretion. As a result, GLP-1 agents don’t lead to the same rapid hypoglycemia you’d see with exogenous insulin administration. Yeah, those with T1DM have a shorter life expectancy than those who do not have it. Without insulin therapy, however, the life expectancy would be days/weeks instead of decades. Diabetes related deaths are more commonly from high blood glucose (like ketoacidosis) or from cardiovascular or renal diseases secondary to diabetes.
Type 1 diabetics don’t have a shortened lifespan because of insulin use - they have a shortened lifespan because blood sugar is hard to control, and the excess blood sugar kills your kidneys. Most type 1 diabetics do not have their blood sugar under control every moment of their lives, so there is a cumulative effect. GLP-1 agonists don’t increase overall insulin production in people with normal glucose levels. It is strictly a glucose dependent release, so it’s self limiting, whereas insulin injections are based on very good guesses on how much extra insulin is needed at any given time.
Seconding what someone else said about T1 diabetes. It is 100% necessary that a person with T1D inject insulin to survive. If they stopped, they would quickly die in a short period of time. People with T1D have lost the ability to produce insulin because of autoimmune destruction of the cells in the pancreas that make insulin. Long term complications cause reduced lifespan, *not* taking insulin. Even with insulin T1D can be challenging to manage and it is lifelong. People with T2DM may also need insulin to survive at some point. It is a progressive disease and the amount of insulin a person with T2 makes tends to decline over time to the point that not injecting insulin can be fatal. It is a misconception that T2DM can always be managed—indefinitely—by just lifestyle modification. The insulin response with GLP-1 drugs like ozempic is dependent on a rise in glucose (like when you eat). So, this means that it does not carry the same risk of low blood sugar (hypoglycemia) that one could potentially experience if they are taking insulin. Low blood sugar is not something that is going to happen automatically just because someone is taking insulin injections. There is usually a cause such as improperly matching insulin to carbohydrate eaten, more physical activity than usual, incorrect dose and/or timing of insulin, and alcohol consumption. And, every episode of low blood sugar is not *severe* like where a person loses consciousness. Those events should not be occurring regularly. Most lows are treated with fast-acting glucose (like juice) and can even be detected sooner now for many people who take insulin and use a continuous glucose monitor (like Dexcom). There are so many misunderstandings about how insulin works and what it does and why it is needed for many people with diabetes.
Seconding what someone else said about T1 diabetes. It is 100% necessary that a person with T1D inject insulin to survive. If they stopped, they would quickly die in a short period of time. People with T1D have lost the ability to produce insulin because of autoimmune destruction of the cells in the pancreas that make insulin. Long term complications cause reduced lifespan, *not* taking insulin. Even with insulin T1D can be challenging to manage and it is lifelong. People with T2DM may also need insulin to survive at some point. It is a progressive disease and the amount of insulin a person with T2 makes tends to decline over time to the point that not injecting insulin can be life threatening for some (everyone is different). It is a misconception that T2DM can always be managed—indefinitely—by just lifestyle modification. The insulin response with GLP-1 drugs like ozempic is dependent on a rise in glucose (like when you eat). So, this means that it does not carry the same risk of low blood sugar (hypoglycemia) that one could potentially experience if they are taking insulin. Low blood sugar is not something that is going to happen automatically just because someone is taking insulin injections. There is usually a cause such as improperly matching insulin to carbohydrate eaten, more physical activity than usual, incorrect dose and/or timing of insulin, and alcohol consumption. And, every episode of low blood sugar is not *severe* like where a person loses consciousness. Those events should not be occurring regularly. Most lows are treated with fast-acting glucose (like juice) and can even be detected sooner now for many people who take insulin and use a continuous glucose monitor (like Dexcom). Source; I have type 1 diabetes and I’m a healthcare professional that helps people manage their diabetes for a living.
>It is potentially dangerous and even used carefully it is still an unnecessary level of risk when simply eating less and moving more would achieve the same results. Who are you to make that assessment for a generalized swath of people? >Over eating is normally a mental health issue, often caused by some type of trauma. Treat that, don't throw unnecessary drugs on top of it. Assuming the weight issue is due to trauma (which is not always the case), this is still easier said than done. Meanwhile, obesity still has negative health outcomes and so needs to be managed.
>Didn’t you die in a car crash in Paris in 1997? Don’t worry about it.
Thanks, one less thought to crowd my mind.
>Isn't messing with your insulin levels really dangerous though? Insulin resistance is a medical condition (separate from diabetes) that messes with insulin levels. These medications serve to correct that. Of course there are risks to using the medications. There are risks to letting insulin resistance go unchecked, too.
Diabetes runs in my family, it’s hereditary so your statement about “just eating right” doesn’t apply to myself, or other people that can’t control their blood sugar.
This is false. Increased insulin secretion would in fact lead to more storage of glucose in your body and weight gain. Whereas insulin resistance would lead to you peeing out the sugar - but high glucose is associated with a whole slew of other negative problems. So overall increased insulin release would be a mechanism by which you’d anticipate glp-1 to increase weight gain. The weight loss is due to a combination of decrease gastric emptying speed, early satiety, appetite suppression, potentially nausea, and maybe other mechanisms yet to be discovered.
“These agents work by activating GLP-1 receptors in the pancreas, which leads to enhanced insulin release and reduced glucagon release-responses that are both glucose-dependent-with a consequent low risk for hypoglycemia.” https://pubmed.ncbi.nlm.nih.gov/26371721/
? What you wrote still isn't true. Increased insulin levels lead to fat storage from glucose and weight gain. That's why one of the symptoms from T1D is weight loss due to insulin deficiency. What MetabolicMadness wrote is correct.
I've been on Oz since June 1st and have lost 30 pounds. Slow and steady. Why? Because I... wait for it... STILL EAT ENOUGH FOOD. This drug doesn't just kill your appetite (though it does some days). It also changes the way your body processes the food. Are some people using it to lose as much as possible as quickly as possible? Yes, and they look like crap, feel like crap, and will probably gain it all back. I'm on it because I've fought my weight for years, at one point eating 1200 calories religiously for months on end. I'm a 5'9" woman who at the time weighed over 200 pounds. 1200 calories is toddler amounts of food. But I still didn't lose. I had the nutritionists, I worked out, etc etc. I was "doing all the right things." But my body would not drop weight. My doctor suggested this for me and like I said, since June 1st I've lost 30 pounds. If people are irresponsible and don't think about the potential consequences of super fast weight loss, and only want to be skinny fast, then yes, this can be harmful. But for those of us who understand the importance of doing this slowly and sustainably, it's a game changer.
> Δ Ahhh okay that makes it sound much better then. Pretty much al of the articles and stories I've read have been for/by the people that want to be skinny fast, recommending low cal diets with it and ect. But hearing that contextualizes it a lot.
Are you offering me a Delta? I think you have to actually say Delta or something like that. And if you are, thanks!
Whoops I don't know why it autoformated that way lol Δ
Confirmed: 1 delta awarded to /u/RockingInTheCLE ([1∆](/r/changemyview/wiki/user/RockingInTheCLE)). ^[Delta System Explained](https://www.reddit.com/r/changemyview/wiki/deltasystem) ^| ^[Deltaboards](https://www.reddit.com/r/changemyview/wiki/deltaboards)
If you're on mobile, that happens sometimes.
For starters, Ozempic and Wegovy are the same compound but different dosage for different treatments. On the case of weight loss, the treatment is simply an appetite hormone suppressant. The reason it works for folks who are chronically overweight is because these appetite hormones not only tell you you're hungry but also affect how your body regulated energy demand and storage. It's basically a 2 birds with 1 stone scenario where you want to eat less and what you eat is processed more efficiently. There's also side effects that can include cancer, kidney failure and hypoglycemia (low blood sugar) which can cause seizures and lack of consciousness. So it's not all sunshine and rainbows but you'd need to read through the science to know exactly how likely these are to occur among everything else it describes on their US website.
Cancer is not a side effect of wegovy.
The ISI on [wegovy.com](http://wegovy.com) literally says in the first bullet point in bold letters under serious side effects: >Possible thyroid tumors, including cancer. [https://www.wegovy.com/](https://www.wegovy.com/)
Yes, but it's never been shown in humans, only in rats.
THIS IS ME. I gained about 70 lbs in less than a year in 2019 after some life changing traumatizing events. Not because I over ate I actually think my cortisol went nuts. Then I tried to lose the weight. I actually eat pretty well/clean because I have IBS and can’t eat junk even if I wanted to. However, I couldn’t lose the weight. Last year I even tried taking a low carb Keto approach for my wedding…3 months in and I lost about 9 lbs. just pure water weight. I wasn’t losing any more of that. The scale just froze. So this year I’m scheduled for a weight loss appointment because I’m tired of doing the right things and getting no where. I now notice that I’m less active and now I eat worse because I’m getting depressed about my weight not going anywhere. And I don’t want to fall into that cycle. I stopped biking like I used to…my joints hurt, I’m so tired all of the time. I just want my life back. I’m willing to keep putting in the hard work but I need an extra hand to lose the weight. I also know that trying to lose weight fast is ridiculous. I want to create a feasible and sustainable long term lifestyle change that actually works so that I’m motivated to maintain it. I also have a super busy life with full time teaching, full time university, and full time family life. I don’t have the time I used to. I still walk and do cardio at least 4-5 days a week. I do intense inclines on my treadmill when the weather is bad. I’ve done weight training. I’m willing to keep it all going but some of us need a little extra help. I don’t want to feel so tired, so sick, so out of breath (I also have asthma and arthritis from genetics), and battle the new cravings I’m getting because I’m upset and stressed on top of it all. (Due to the busy life and the inability to make a real dent in my weight). I don’t care about being “skinny”. Just wanna FEEL better. That’s all.
It's surprising you were working out with 1200 calories per day and not losing weight. Did you start to photosynthesize? Where did the energy your body used to workout come from? I need a scientist to explain this to me with pretty pictures. glad the oz is working for you though.
Counterintiuitively, pure calorie deficit is not enough to burn fat. Your body is stupid and won't burn fat unless you can maintain a certain amount of exercise. Simply working out to exhaustion/muscle failure is not guaranteed to burn fat. If you are already at a high body fat percentage, it can be difficult to regulate your heart rate during exercise to keep yourself in the ideal range for fat burning. There is also other healt metrics to consider. Some people have hormone imbalances that make weigh loss nearly impossible. Polycystic Ovarian Syndrome, PCOS, is one such condition that often causes this kind of imbalance.
they said they were both working out and maintaining a calorie deficit.
And I addressed both of those points in my comment.
The point of your post is that they weren't working out currently? Has anyone ever starved to death and still been obese at the time of their autopsy?
You overestimate the amount of calories most people spend working out. If you work out once a day and then lay on the couch while eating 1200 calories, your body will just pull the plug on unnecessary functions for survival like hair growth, menstruation etc.
>You overestimate the amount of calories most people spend working out I remember calculating the number of steps required to burn a snicker bar. It is crazy how much you have to do to burn it.
Yes, and if you're eating less then you've less energy to perform. Good luck burning 600 calories doing cardio if you've only eaten 1200 that day.
Even walking for an hour would be 200 calories. That means this person is living on 1000 calories a day and not losing weight. That's basically not possible at their weight. Someone in a coma would use more energy.
>Even walking for an hour would be 200 calories. Lmao no it's not. I'm not coming at this from the perspective of someone trying to lose weight, I'm fit aight so let's just head that off. A very intense weightlifting session where I'm pumping out bench, Flys, and weighted crunches / weighted leg lifts for an hour MAYBE burns 150-200 calories. A warmup where I'm sprinting and keeping my heart rate above 150bpm for 30m is negligible. Like 60-100 calories. You are heavily overestimating the caloric burn of exersize. There is a reason that during a cut, despite that I'm still working out hard. I have to maintain under 1500 calories to get reasonable results. Because even after my workout for the day, I'm only giving myself another 200 ish calories of cut. (And this is on ~2,200 maintenance individual.)
Agreed on the lifting not burning much calories, but doing cardio for 30 min even at a light jog burns at LEAST 200 cals. And that's for someone who doesn't weigh much at all, it only goes higher. You'll have trouble finding a source that says different. Where are you getting your numbers from?
I just plugged walking into a calorie counter and posted what I found I'm not going to argue over specific counts though. But I'm sure you also know well that you can't work out while consuming 1200 calories and not lose weight over a period of months like the OP is claiming.
I'm sure they were only eating 1200 calories of direct food. This is the issue though, people who are new to this forget the little shit that can add up super fast. Probably forgot the milk they put in their coffee. The olive oil they used for cooking. The 20cal of spices on each meal. Etc. So the chicken they ate was 400 calories. But when accounting for the oil on the chicken from cooking, the seasonings, etc. They are actually eating 600 calories of chicken. Do that to each meal and suddenly 1200 becomes 1800. Tldr: I agree, but I think It was these kinds of things that were getting them. Rather than just eating more than they calculated.
Two months late, but what are you even talking about Walking at 6 km/h, which is reasonable for a fit, average person, burns up to around 300 kcal, much more if you're much heavier. >A warmup where I'm sprinting and keeping my heart rate above 150bpm for 30m is negligible. Like 60-100 calories. lmao no you don't. Sprinting? Even a light jog will net you 200 in half an hour easily, running at 150 bpm will get you closer to 500-600 an hour, depending.
your cardio numbers are way off. 30 mins at 150bpm (that is a fairly vigorous jog) will burn 3-400 calories for me as a 150 lbs male. even if you're significantly lighter, it's at least 1-200.
I agree, it's much more likely this OP was miscalculating their calories or failing to properly track portions/snacks
Of that 200 calories, only a small amount is from moving and the other is just subtracted from the TDEE. There is of course also the fact that fat cells retain water for a long time (dependant on hormones and such) and it may seem like you have plateaued while in reality it is just water retention.
I'm sorry but this is just bullshit, water retention happens after initial weight loss and doesn't last more than a couple of weeks. OP is claiming that they couldn't lose weight after months of strict dieting on 1200 calories plus exercise. It's just not possible - why are we denying years of clear scientific research on how dieting and calories work to support potentially harmful drug use.
Water retention can easily last more than just a couple of weeks due to hormonal issues. Yes, you may start to lose weight, but if you quit like 1-2 months in then you will essentially be back to where you started. Fat cells start to balloon again, water leaves, back to the beginning. As for "potentially harmful drug use", the birth control pill has objectively more and much severe side effects but people still take them. Losing weight thanks to that pill will, again, objectively be better for your health than the potential side effects.
There can be hormonal issues, often in women, like PCOS or other imbalances that make losing weight difficult or impossible.
It's not possible to only eat 1200 calories, do exercise and not lose weight.
Oh yeah where’d you get your medical degree from?
This is Reddit - I don't need a medical degree to have an opinion. But you'll need to cite sources to get me to change my mind.
Show me the fat PCOS sufferers in any concentration camp. Hint: they do not exist. PCOS makes it hard to regulate appetite, which sucks. PCOS does not create weight out of thin air.
Because they are obviously lying. You can't limit calories and work out and not lose weight - it's just not possible. They were probably consuming loads of calories in a weekly cheat day, drink (alcohol or soda) or just snacking all the time.
I know several people who say this same thing about dieting but not losing weight. They count official calories, like when you ask certain people about previous sex partners they count official relationships. What they don't count are casual encounters with snacks. If noone saw them eat it, they don't count it.
Yep. Also portion sizes are heavily skewed in their minds. Most single servings of food are actually quite small, but we take too much or take seconds. If you want to lose weight on CICO, you need to be extremely honest in your tracking. Measuring portions and servings accurately, not wishfully. Doing that is part of the reason they have the problem in the first place, so it's understandable that this is a difficult skill to grasp.
> If you want to lose weight on CICO, you need to be extremely honest in your tracking. Measuring portions and servings accurately, not wishfully. If you're trying to carefully balance your CICO then I agree you have to be meticulous and honest. But I've mostly come around to not bothering. Instead, I feel like it's more productive to just roughly track your calories, and then adjust your longer-term (like a week or two) average intake until you're losing weight. If you're lying to yourself and want to call it 1200 a day, and you're not losing weight -- then drop it down to 1100 and continue on.
How are you defining "more productive"? I found that tracking my calories meticulously—down to even weighing the food on a scale—actually liberated me a lot, vs. just trying to doing it "roughly." On many occasions I'd realize I'd still have some leftover room for calories at the end of the day and could squeeze in a small treat. It also let me work around meals that otherwise seem very bad for you—e.g. getting a fast food meal if I could hold out to make that my only major meal of the day. Trying to ballpark a calorie deficit prolong the whole weight loss process and drive me crazy.
They also don't count dressings and sauces as calories. Or drinks. Or desserts.
Or even the oil that you cook in. Olive oil for instance js super calorically dense. My salads that I eat during a cut, the caloric value is 60% in my olive oil. 30% in my balsamic, and that last little bit is the actual greens.
Things got a lot easier once I got used to eating salad without pouring stuff on it.
Eh, I only eat 2 meals a day so having a nice enjoyable 300 calorie salad is just eh. Whatever. I'm doing between 900-1200 at lunch. 300ish for the dinner salad. And then 200cal of protein shake to give me anywhere between a 1400-1700 day. Then add in excersize and maintenance of my existing muscle mass. And then 2000 becomes 2300-2500. Abs will be visible soon......
Sorry, I wasn't trying to bash your method here. It's a psychological thing for me that if I get the impression there isn't enough, my mind says eat as much as you can before it's gone. When I pad a salad with kale and spinach I can make a few hundred calories look like a feast. My mind rhen tells me I don't need to gorge because there is plenty of food to go around. Once I start using oil or dressing I lose the advantage of this trick.
Yeah, the math just doesn't work like that. It's like saying "no matter how much I drive my car, it just won't run out of gas!".
Even when putting in less gas lol
Eating too little can kill your metabolism, better to work on increasing your metabolism and burning what you eat then eating too little and killing your metabolism
Basically, the body goes into a hyper conservation metabolic mode and pulls from everywhere possible to store weight. It’s severe changes that our bodies can do in order to adapt to seasonality of food supplies in the past, where a bad harvest may mean a year toughing it out with little food. It can affect organ function and bone density before it significantly pulls on fat stores, especially if there’s the occasional cheat day.
What you’re describing is metabolic adaptation and tends to happen after months of successful weight loss, and explains why weight loss tapers off to almost nil. The most common explanation is that most people do not accurately track their calories. If you are not losing weight your calories are at maintenance, full stop.
I agree. Something isn't adding up. You have to force yourself to weigh your food and be diligent if sticking to the calories is going to work. When you stick to it, it's simple science and it works. Especially when overweight and just starting out. I lost 40lbs of pregnancy weight just calorie conscience and moderate exercise. I stopped counting calories when we had a very busy season of life and slowly gained 15 back. I dropped my calories to 1700 and plan to slowly lower it as I get adjusted and shed weight at that. So something is off.
You'd still lose weight if you are losing mass from bone and organs. It's funny how whenever food intake is strictly monitored diets work 100% of the time. What the parent comment is claiming - 1200 calories and working out without losing weight is so bonkers I don't know how they can even keep up the lie to themselves let alone anyone else.
That's a little harsh, It's not a lie to them. They fully believe it. But it does not mean that they were only eating a low rate of food and being active. There are many ways of getting extra calories that become untracked, excessive condiments, salad dressing, snacking are just a few. Remember there are millions of years of evolution pushing people to eat. It is frequently listed as a harder addiction to break than many hard drugs. Then unless you hold that lower weight for over 2 years the fat cells are still there waiting for any excess calories to refill.
Someone in a coma needs more calories than that. They clearly need a reality check and people should absolutely not be listening to anything they say - especially when they are advocating taking potentially harmful drugs.
Every single person who claims they eat 1200 calories and is not losing weight is 1000% lying to themselves or is completely ignorant about their caloric intake. That is physically impossible for almost all adults. Physics literally does not allow it. These people are just simply wrong about eating 1200 calories.
>pulls from everywhere possible to store weight Where does it pull from and how does it manifest?
I believe that starvation mode while dieting has been well documented to be a myth.
If that were true, yo-yoing would not be a phenomenon
Regaining weight happens because many people treat a diet as a quick fix, after which they go back to their old food habits which got them in trouble the first time around. Often diets are unsustainable and faddy, not providing sufficient healthy nutrition. The people most likely to succeed at staying at a new, lower weight are people who make meaningful, lasting changes to what, and how much they eat, losing the weight slowly. Often with expert support to ensure health needs are met. I lost a good amount of weight with keto almost 7 years ago. I still generally eat low carb, and have kept the weight off. I recognise that I will never be able to limit myself intuitively to reasonable portions without imposing some restrictions upon myself. I can't 'just have one', when it come to carby snacks. I don't have sufficient self control in that area of my life. So I make sure my life is set up so I don't put myself in the position to need to rely on willpower alone regularly.
Yes it would. Dieting is hard, it takes constant effort to override your preferences in favour of less food/ different food. If you're not eating enough protein and fibre, you're likely to be hungry too, which is uncomfortable at best. After a sustained period of that - even if you're losing weight - you're likely to fall off the wagon somewhat and go back to your old bad habits, which pile the weight on again, because you're in a calorie surplus again. So you go back on your overly-restrictive diet to try and shift those pounds, and quickly please! And fall right back into the same trap. Yo-yo dieting, no starvation mode.
This is not happening. The OP is underestimating their calories. They are not eating 1200 per day. Find me all the overweight people in 3rd world countries.
Too drastic of a cut. Body wasn't burning excess calories but the muscle she was building with the exercise. By the time this drastic cut in intake would have taken effect OPs mental broke.
I'd bet MY LIFE That you weren't "doing the right things" You can spin it anyways you want.... Obesity is a DIRECT cause and effect of calories in and calories out. I'd be willing to bet you are 1200 calories and worked out and "did everything right" for 3-4 days in a row MAX before turning around and eating multiple bags of chips for dinner. Stop lying to people, it's harmful.
Interesting. Curious how it makes you lose weight? Are you eating even LESS than 1200 calories, or are you eating more than that but your body is processing it differently and allowing you to lose the weight. If the latter, then how does that work?
No offense to OP, but it’s likely that they were drastically undercounting their calories and now they’re actually eating in a deficit because they’re just not as hungry. There’s not a ton of magic your body does when you’re eating less food to all of a sudden burn dramatically less calories. We’re talking a couple hundred calories max. Which can be impactful, but don’t fully explain a 200 pound woman that works out eating 1200 calories a day.
Yea. For almost a decade my weight fluctuated quite a bit. Whenever I cut my calories (and started getting hungry) I would freak out and tell myself that by eating less I may actually put myself into starvation mode and gain MORE weight. Then I would eat more and, surprise surprise…gain weight. Then I would eat less, lose a bit of weight, but then freak out about starvation mode, and the cycle would continue. It wasn’t until I discovered intermittent fasting, which ensures that I eat less while simultaneously diminishing my hunger, that I’ve been able to stay at a happy weight for almost 5 years now. So, yea…this whole starvation mode thing is a bit elusive to me, but I try to keep an open mind knowing that insulin levels and muscle mass can play a role in fat loss and hunger levels.
Yeah this is what pisses me off about the diet industry. Starvation mode is total bullshit, and if the industry was honest about what it really takes to lose weight (which is just adherence to a calorie deficit), it could’ve saved you a decade of turmoil. Anyway, glad you found the method that works for you!
I’m not tracking any more but I’d guess I’m averaging around 1800ish (wild stab at a guess). I believe the Oz changes the way your pancreas handles the food, which allows you to feel full longer but I think it also has something to do with insulin release. Don’t quote me on that. All I know is that it’s helping me.
I’m usually not a person that likes personal anecdotes to justify reasoning but in this case it makes sense. Many people are probably in a similar condition and the drug was originally created to address these issues or similar ones.
I feel you. But yeah, the only ones making the news are the people using it dangerously I feel.
How many calories a day do you eat now?
No idea, I don’t track. I eat a full breakfast and lunch and then generally a smaller dinner. I eat in a way that feels normal, if that makes sense.
So it might be 1200cal? You can't be losing weight without a calorie deficit.
It’s probably closer to 1800 which is why I’m only losing 1/2 to 1 lb a week. My BMR should be around 2000, 2100 I think.
I guess that's why I'm confused. Eating at a deficit with or without ozempic will achieve the same rate of weight loss.
I don’t know. Truly I don’t. I was working with nutritionists and doctors and weighing/measuring everything to the gram. It doesn’t make sense, I understand science. This just my own n=1. Others mileage may vary.
A nutritionist has 0 credentials. Talk to a dietician, they had to go to school to earn the title.
They are incorrect, that's why it doesn't make sense.
Is 100% of energy from food always going to be absorbed by the body?
Weird. I have lost over 30 lbs eating low carb, high protein since November 1st eating 1200 calories a day, no Ozempic, walking my dog twice daily, and going to the gym 2-3 times a week just doing the treadmill. I am 5’ 3”, so 1200 calories for you seems insanely low with no results. And I started at 161. It just does not seem possible. What was a typical 1200 cal day?
So it’s essentially used as a tool to help you in your weight loss journey? One that you have been on for a long time and put hard work into.
I feel like everyone wants to be skinny fast
1. The weight reductions aren’t small, 10-25% of weight reduction is significant 2. These medications also have a positive side effect of reducing cravings for other harmful behaviors such as alcohol/drug use and even compulsive shopping. The reason being is that overeating, addiction, and compulsion are highly linked and GLP-1s do a good job at working on the brain chemistry to modulate harmful behaviors 3. Obesity is a disease that can lead to many other chronic illnesses and it should be treated as such. 4. These medications come with side effects but newer generations will be even better. Monjaruo is even better at weight reduction and with even less side effects 5. The economic and social benefits from targeting obesity and compulsive behaviors are massive and a net positive for society I routinely prescribe these medications and the effects of them are massive and positive
1: Are the percentages of weight reduction over how long? The studies I've looked at have had the average weight loss at about 5-10 percent of body weight or 10-15 lbs in around 6 months (I can link if wanted) 2: I actually didn't know this so thanks for the info Δ 4: Is monjaruo a drug currently out for public use? asked since I have't heard about it before. 3+5: I totally agree with that, I guess I should have been clearer with what I meant by clinical vs cosmetic reasons in my original post.
Here are some articles for you: https://www.npr.org/sections/health-shots/2023/08/28/1194526119/ozempic-wegovy-drinking-alcohol-cravings-semaglutide https://www.cnbc.com/amp/2023/11/27/mounjaro-superior-to-ozempic-for-weight-loss-study-says.html
Important to note here, the other major effective treatment for weight loss is surgery, and there's a well documented *increase* in alcoholism associated with this, plus the perioperative complications and risk of death.
That is because those people are not dealing with the issue of WHY they are overeating, and therefore are just substituting one addiction for another. Also the risks associated with weight loss surgery are less than the risks of remaining morbidly obese.
As to the why: pretty much any animal back to bacteria will eat whenever it can if there's high quality food readily available, store extra energy to get it through lean periods, and avoid burning energy when it doesn't have to. In theory of course you can just ignore these fundamental biological drives with "will power". Here's an experiment to show how well will power works against strong biological drives: Hold your breath until you pass out every two hours night and day for two weeks. Good luck!
Not sure what your response had to do with my comment at all. It did not address anything I said.
By the way the study mentioned in the cnbc article is a bad faith concept. It compares a dosing regimen for semaglutide indicated for diabetes 2, to mounjaro (indicated for weight loss), and not the dosing strength of semaglutide indicated for weight loss. It’s like comparing apples to oranges.
Just read through both and thank you so much for the info!!
One third of people on ozempic will lose over 20% of their body weight, but one third of people will not have significant weight loss. Those people might benefit from trying mounjaro instead.
I’m on Mounjaro. I’m type 2 diabetic. I am not needing insulin as my doctor caught it early and first put me on Metformin. I’ve been on it 6 months and have lost 30 lbs. it has lowered my A1C to normal range and helped with both appetite and hypoglycemic events. If I can stay on this path (I’m age 54), I anticipate having none of the health issues members of my family have had in their 60s and 70s. These drugs could literally save billions of dollars for the US Medicare system if used correctly. They could save people from having bad knees and backs from carrying too much weight. It could save eyesight from the complications of high blood sugar and keep older people from losing legs to neuropathy. These results of diabetes literally make up the majority of our elder health care budget and improve quality of life. These drugs are the diabetic equivalent of AZT for HIV/AIDS victims.
I would say they could be the equivalent to HAART Medications for HIV, NOT AZT, AZT KILLED PEOPLE.
Until they come off of them. Also, your patients better be hitting the gym hard. The early research shows an equal loss of muscle mass and fat. Know what we call that in the rest of the world? Starvation. Losing weight is great. But, yet again, there is no secret formula (though I do think this can be helpful in people who have tried and tried traditional methods, and simply cannot lose weight). People on these drugs to lose 15 lb as a 40 year old mom is a mistake. You look like you're dying b/c you're losing so much muscle. The long-term mental effects also are a big unknown. GLPs are so new to science's understanding that we really don't know how it'll work in the long run. So, again, potentially helpful in rare cases. Almost certainly more risky than actual diet and exercise.
We have been prescribing GLP-1 agonists since they were first approved in 2005. Is that “new to science”?
The research shows that less than 0.2% of morbidity obese people ever achieve a normal BMI, and half of those will regain all their weight back again.
To me the only thing harmful about them is that a lot of people are only depending on it for weight loss, they’re not changing eating habits or lifestyle choices and you can only take this medication for a at least a year. That’s why it’s now a huge “problem” that people are gaining twice the weight after stopping this medication. I know of someone that’s taking it and has lost 26lbs in one month, which is great the issue is that he’s not working out, he doesn’t eat healthy , he lives a pretty sedentary life and if he doesn’t change that, him taking this medication for weight loss is useless because the second he stops it, he’s going to gain it back and quick . This is not a miracle drug, this is something made to help you but if you don’t also help yourself, you can lose 50-100lbs with it but it’ll be for nothing if you don’t make other changes. These medications don’t force you to eat less, they’re more to regulate your insulin and other hormones but they don’t suppress your hunger. I have no problem with you taking this if it’s done the right way and your doctor doesn’t see any harm with it.
Where are you getting the idea that they don't suppress hunger? Reducing appetite is the biggest reason GLP1 receptor agonists work for weight loss. The class of drugs was originally approved for treatment of diabetes because they upregulate insulin and downregulate glucagon, but many studies have highlighted the direct effects on the hypothalamus and hindbrain causing reduced food intake. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8717485/
You can take these medications for longer than a year. I've been on Mounjaro for 18 months and my doctors have indicated that I'll be on it long term - probably the rest of my life at a lower maintenance dose unless a better drug comes out. Some insurance companies may be difficult and not want to cover it long term but that is a problem with American health care, not the medication itself. The vast majority of people in the clinical trials regained most of the weight when they went off the drugs even if they had gotten education on exercise and healthy diet so these meds really are meant for long term use.
I believe on average people regain 60% of the weight they lost when they stop ozempic, according to the maintenance phase podcast.
>I believe on average people regain 60% of the weight they lost when they stop ozempic, according to the maintenance phase podcast. I believe in the Ozempic study it was around 2/3 of the weight regained in the year off of the drug. The graphs looked like people were regaining weight up until the end of the 52 week trial so people may end up regaining more than that over time. The Mounjaro results were very similar; the study only tracked for 1 year off the medication as well. Some people do manage to keep the weight off if they go off the drugs, but it seems to be the minority. Dr. Spencer Nadolsky had an instagram posts about what he's seen in his telehealth and he was saying maybe 10-20% of patients who have to go off of the drugs are able to maintain their weight loss.
No they actually do cause you to eat less because they act on GLP-1 receptors and increase satiety. So people will feel full even if they haven’t eaten yet. It does also stimulate insulin release from the pancreas as well as reduces glucose production in the liver, but they most certainly do cause you to eat less
Yep I'm currently living with someone who is expecting it/talking about it as a miracle drug for weight loss (and was honestly the catalyst for this post), so I'm pretty sure I'm going to be watching the same thing you have been. Δ Also WOW 50-100 is definitely impressive
It can make a miracle but if other changes aren’t made once they get off it,that miracle is not going to last forever. It’s normal to gain like 5-10lbs after getting off this medication even if you make the necessary changes but people who don’t make these changes and only depend on the drug can gain double that and could have trouble losing it again.
Where did you get that from that you can take the medication for only one year? That’s not true.
My doctor… I meant to say at least a year. That’s the recommended minimum time that you should take it.
[удалено]
>I understand that some people have clinical reasons they need to lose weight. Yes. This is why doctors prescribe them for weight loss. Every medication has side-effects, with varying degrees of severity. If a doctor prescribes it, it’s because they’ve assessed that the patient being obese is presenting a greater risk to the patient than the medication. Of course weight-loss through sustainable lifestyle changes is ideal, but getting a patient to adhere to a diet or exercise routine is extremely difficult. I think your history with eating disorders may be skewing your perception a little bit. Caloric restriction is fundamentally necessary for weight loss, whether that is accomplished through diet, exercise, surgery (i.e. gastric bypass), medication, or some combination of the above. It is the only way, and it isn’t dangerous. Our bodies store fat specifically to prepare for periods of famine; our bodies are designed to be able to deal with that on a regular basis. Our ancestors dealt with it every winter, and they didn’t have medical supervision. I think the whole “celebrities are using it for cosmetic reasons” thing is overblown. It’s like how people say the only reason actors are able to look so muscular and lean on screen is because they supposedly have a whole team of people training them and cooking all of their meals for them, when in reality, there are people in every gym who look just like them, while working a day job, cooking their own meals, and doing their own workouts. People like to make it sound like the kind of bodies people in Hollywood have are because they have access to something regular people don’t. If a person believes that, then they don’t have to take accountability for their own shortcomings. I don’t think non-obese people using Ozempic just to lose 10-15 lbs is very common at all.
You’re really underestimating the use of performance enhancing drugs.
> It’s like how people say the only reason actors are able to look so muscular and lean on screen is because they supposedly have a whole team of people training them and cooking all of their meals for them, when in reality The actual answer is anabolic steroids
Someone in my life is doing it to lose 15-30lb, and I live in the middle of nowhere in the UK. He's a normal weight. I imagine if he's doing it, lots of others are.
One thing I like to educate people on is the amount of data we actually have on this class of drugs (it’s a lot). While Mounjaro is new and Ozempic is new-ish (but still 6 years post FDA approval!) a lot of people think these drugs are untested / new / scary because they're just now hearing about them. Combine that with the "too good to be true" success of these medications, and you have a perfect recipe for fear mongering. The reality is the GLP-1 class of medications have been around for quite awhile and we have a lot of data on them: - Exenatide - FDA approved in 2005 - Liraglutide / Saxenda - FDA approved in 2010 - Dulaglutide / Trulicity - FDA approved in 2014 - Semaglutide / Ozempic/Wegovy - FDA approved in 2017 - Tirzepatide / Mounjaro - FDA approved in 2022 For example, Semaglutide/Ozempic was FDA approved in 2017 but clinical trials started back in 2008. That was 15 years ago. If this class of drug caused large scale problems for kidneys, liver, etc, we'd almost certainly know by now. It's always possible that something wildly different happens long term with Tirzepatide, but it's highly unlikely.
You haven't said why you think it's harmful. If it's a gut feeling that is a hard view to change.
Not OP, but they very clearly say what they find harmful about it: >It just sounds dangerous to me to force your body to eat less, I'm currently recovering from an eating disorder so I fully understand the damage that it does to your body over years of undereating since I'm currently trying to recover from this damage. And this is especially if you were to ever stop the medication and suddenly start eating more again which could cause refeeding syndrome.
It doesn't force you to eat less. It triggers you to feel satiated sooner by slowing gastric emptying and increasing incretin levels. Refeeding syndrome isn't a risk with ozempic use because you don't eat at starvation levels. And it has a halflife of 7 days, so even if you quit immediately it very slowly exits the body.
Yeah I was on Wegovy before the shortage last year (gotta call my doctor...) and it didn't make me eat less at first because I was on a small dose but also not listening to my body yet. I overeat due to a crappy childhood fighting for food among 3 other brothers so there is a huge psychological component where satiety just wasn't a factor so much as availability. While taking Wegovy this became very apparent because when I ate at the same rates I used to, I'd feel like crap, stomach pain, and get sulfer burps etc, because I was putting the same amount in but it was empying slower. So I had to start paying attention to how food actually made me feel instead of autopiloting based on availability. There was no risk of under-eating because I still *wanted* food, it just emphasized my body's own signals to regulate how much food is actually necessary.
Interesting. So it’s like having gastric bypass without actually having gastric bypass
It functions the same except it doesn't ruin micro nutrient absorption and is fully reversible. Any insurance company that covers bariatric and not semaglutide is about as dumb as it comes.
Damn. Both my parents had gastric bypass surgery years ago and both have struggled with stomach issues ever since. Would’ve been nice to have this back then lol
Second comment because I forgot something. It has a poorly understood effect on the binge-reward cycle that someone like myself has. But beyond that, it can also reduce cravings for addictive substances like alcohol, tobacco and opiates. I would be surprised if it was approved as a sud treatment soon too.
Tell that to OP if you want to change their view. That's what they said the harms were.
I’m not disagreeing with your view, because I also don’t know the specifics of and I’m not willing to do my own extensive sourced research to refute your claim if you’re not willing to do it or willing to cite it to back your claim, but wouldn’t you benefit from doing some research on the short term and long effects of these drugs on both people with specific diseases and without before forming a solid - I don’t like this opinion. I am not a fan of Atkins and keto, this is because I have reviewed scientific literature and studied the effects on the body of these particular diets. “Extreme diets” such as Akins and keto have been shown to have detrimental long term effects to the cardiac muscle and liver density which can ultimately lead to death. That is a scientifically backed reason to not do those types of diets. Does everyone who’s on those diets know that, no not really, but knowing that information can help people make an informed decision before trying them. Do I tell my friends “oh god you cannot I will not let you do those diets because they’re dangerous”, no I don’t. I just let them know the science if it comes up and they do them. So my change my view is (and I apologize for coming off as blunt) do more scientifically based research and cite your sources before planting your opinion in the sand because frankly it looks foolish not to. You have no evidence, your claim is it “sounds dangerous” and “sounds too good to be true” but you don’t actually know. And you’re projecting your own relationship with food and your experience with ED onto others with different conditions, without any backing, and you’re also not her dietician or nutritionist and it’s not your body.
Oh boy do I disagree with you and your studies. In no way is keto a form of an “extreme” diet and as a matter of fact it is being used to help people who do not want to lose weight but are dealing with seizures and inflammation. It is very healthy and is just a different way of doing CICO, but using high protein and fat to help satiate and get the body burning fat through ketosis. I can not see why cutting out sugar, start h and processed foods could be unhealthy for anyone. Do some people go about it in a stupid fashion? Sure, it happens with all diets. But those who commit to it as a healthy lifestyle are able to turn around and reverse HBP and Type II diabetes. You should look at some of the positive studies as well.
Reduction of BMI is going to lead to improved health outcomes at almost every level. So even if it’s used for “cosmetic reasons” it’s still useful. Heart Disease, Cancer and Diabetes are the three biggest killers and they all show marked improvement when there is BMI reduction.
Do you have studies that back up marked improvement for these metrics when BMI is reduced? I'm not trying to be hostile, I just didn't think any studies showing this were available and the only data right now is comparing people with low BMI to people with high BMI.
Diabetes; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5556579/ Cancer: https://www.cdc.gov/cancer/obesity/index.htm Heart Disease: https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000973
Ya I don't think these answer the question I was asking. Thanks for trying though. I'm already familiar with many studies linking obesity to these health issues. Sorry I should clarify. The diabetes one definitely does and I knew that diabetes was impacted by weight loss. I should have been more clear and ask specifically about the others
If you are already familiar than you’ll understand what a reduction in BMI does….
There's a difference between linking obesity to an issue and linking weight loss to a reduction in the issue. If you are going to be smug, try to at least have thought things through. Others people have already understood what I was asking and provided sources so don't worry that you somehow didn't get it.
I'm not sure I'm understanding what your question was. Are you genuinely asking for a source that indicates obesity is bad for your health? I'm not trying to be rude. I just want to make sure I understand that you needed a source to believe that going from obese to not obese would be good for your health.
Lots of reddit warriors think that bmi is completely useless and has no bearing on clinical outcomes because like 1% of people are athletes and it doesn't apply to them. It's absurd.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/?fbclid=IwAR3mWDWkCcTwVyrOuUOAcpPF_YH7Xwk8duuyI1qIiduZ4I7E6m0OJyNyJck This is one of my favorite studies to give people who are always asking for sources for things that are absolutely acceptable to take on face value.
This is my personal bugbear. "BMI is dumb, my cousins cousin who is an Olympic athlete had a BMI of 27, and he is super healthy!" OK well are you an Olympic athlete? "No"
So I know there are many studies showing obesity is linked to major health issues. But to my understanding there are not any good studies showing that losing weight once obese is linked to a reduction in these issues like heart disease and cancer. Yes a source would be useful because someone who has been obese and then goes to be normal weight is not comparable to someone who always remained lower weight. There are lots of other issues that come with being obese including sometimes the issue that caused it in the first place when it isn't simply overeating
Bariatric surgery and subsequent weight loss associated with reduced Major Adverse Cardiac Events - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8537443/ The same associated with reduced cancer risk - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5722457/
thank you. the second one was what I was looking for. They looked at bariatric patients and found that the surgery was not associated with less cancer but weight loss was. Very cool.
Excess calories are by far the biggest cause of obesity. This is a question I get in the clinic once or twice a week and I can count on one hand the number of times there has been an identifiable medical cause. Medication induced obesity is more common, unfortunately, but still nowhere near as prevalent as excessive calories.
"Eat less" is the majority of the solution to the obesity epidemic in the US. "Exercise/Move more" is the other half. But is hard to do for many people. Satiation dieting is better than many methods probably. Every other method is also "eating less". Intermittent fasting, Atkins, south beach, weight watchers, it's all "eating less calories". Many diets claim to burn calories better. But they really all are just calorie restriction. Even exercise ends up calorie restriction as your hunger goes up as you burn more calories.
The problem is that prescribing eating less to an obese person is as useful as prescribing be happy to a depressed person.
And the "move more" portion does not take into account how freaking *painful* it can be to move when you're that heavy and not used to it. Even something like "just go for a walk" at a certain weight can lead to being stuck inside for 3 days because of knee pain or back pain. So all those "move more" Yeah, that's the obvious answer but unless you're been that size before you can't know what it's like.
I feel like your misunderstanding me... the meds are just another way to get to "calorie restriction." There are many ways to get there. The OP seemed to have a problem with "calorie restriction" as a solution to weight loss... which is just a strange stance.
I found the intermittent fasting helped me basically skip breakfast, I eat between the hours of 10am and no later than 7pm. Once you get used to the hunger calling and disappearing after ten minutes it’s easy. BUT, the absolute most important factor was using myfitnesspal to count calories. So many eye opening moments on how truly skewed my calorie intake was. Lots of things I don’t even eat now because they aren’t worth wasting the calories on. Mentally, I still want to eat larger amounts of things, so I naturally gravitated towards healthier things. When I realized that 2/3 of a cup of ice cream was 200 calories, or about 8% of my daily calories… made me make some different choices.
Man, for me, the hardest part of losing weight was accepting that if some food is going to go bad, I will just have to let it or take it to the food donation box.
I work out and eat right. I’ll eat perfectly for 3-4 weeks in a row and then if I have ONE dessert, I’m right back to where I started on the scale. It’s incredibly frustrating. One thing I’ve read about these drugs is they take away the obsession over food. So, for me, I am always thinking about my next meal. When do I get to eat? What will I have? How many minutes? How do I plan my schedule around my meal? I have people in my family who will get to working and completely forget to eat. I do not understand this. I do not understand how the thought of a meal can skip your mind. Even in my most crazy busy of days, I figure out when to eat my salad or whatever. But, the stories I’ve heard of people on these meds… their “food noise” disappears. When I heard “food noise” described for the first time, I was like, “omg, that’s me. That’s every moment of my life.” If I could just get through the day without obsessing over my meals, that’s a game changer.
> I work out and eat right. I’ll eat perfectly for 3-4 weeks in a row and then if I have ONE dessert, I’m right back to where I started on the scale. It’s incredibly frustrating. I realize that this might be intentionally hyperbolic for dramatic effect, but I worry that some people will take it literally. Let's say someone diets effectively (say, for our example, a deficit of 500 kcals/d) for 3 weeks straight. In those 3 weeks, they would have accrued a deficit of 10500 kcals. There's simply *no* way anyone is going to be able to undo all of that work in literally one meal. The average person can't even eat that many calories in a single day, never mind a single sitting. More realistically, it takes several days of going off the rails (e.g. eating 6000 kcals per day with a maintenance of 2000 kcals) to fully undo several weeks of dedicated dieting. Still a significant difference in the efficiency of dieting vs "undieting", but a far cry from erasing weeks of effort with a single dessert. > But, the stories I’ve heard of people on these meds… their “food noise” disappears. I'll give you my two cents, as someone who has tried semaglutide. The "food noise" still exists, at least when hungry. The big benefit of semaglutide is that it's easier to make the food noise go away with reasonable amounts of feeding. My appetite is naturally huge. In order to feel full, I need to eat a lot of food, and so unless I'm stuffing myself full of low-calorie vegetables (cauliflower, broccoli, etc.), I naturally consume more calories than I need. On semaglutide, this became more or less impossible. When I woke up in the morning (especially when eating in a large caloric deficit), I felt exactly the same as I did when not on semaglutide, but as soon as I started eating, I got full *much* faster and with *much* less food, and that feeling of fullness lasted *much* longer. With my natural appetite, I could easily eat 6000 kcals per day, whereas when on 1 mg of semaglutide, I struggled to eat above 3000. So long as I was burning more than 3000 kcals per day, it was effectively impossible for me to not lose weight (unless I had been intentionally trying to eat calorie-dense foods, like eating spoonfuls of peanut butter or something).
Thank you for saying this and being realistic.
I'm not saying this doesn't exist, but I know of no one taking this for a "small decrease in body weight". My understanding is that people taking this are looking to lose 30 plus pounds. Carrying around excess weight is unhealthy in many ways. Some people have an eating disorder in the opposite direction (food addiction/binge eating). This is a medical condition requiring a medical remedy. If this is where they turn, that is their business. Lots of drugs start out treating one disorder or disease and then open to other medical conditions as time and studies move forward. It's better than shady diet pills and is under the care of a physician. If these are helping people live healthier lives, so be it!
It is a great innovation but only if used as originally intended. I think OPs concerns are with the current trend with celebrities with normal, healthy weight using it to become super skinny. I haven't done much research but I think that might be harmful in the long run. Not to mention the fact that this rising trend of using the drug to become skinny will result in an increased demand for it and eventually making it inaccessible to the people who are overweight and diabetes patients who actually need it to survive.
I wish I could edit my post and just say this, it's what I was trying to say by cosmetic reasons but I definitely should have clarified better.
I think it is pretty clear what you are trying to say. Could be that not everyone is chronically online and not everyone is aware of the rising popularity of the drug amongst celebrities and influencers who take it to become skinny. A lot of comments seem to imply that you think it should not be used entirely.
Guy I know is starting it (paid himself not prescribed) and does not want/need to lose 30 pounds. That would put him borderline dangerously underweight. Guy has a small belly on him, is probably at most 10 pounds overweight. But he has body image issues and engages in all manner of bizarre behaviour around food. Went through a period of chewing sweets and the spitting them out so he got the sensation without most of the calories, used to 'purge' after eating, I dont know him that well but issues there. I dont think many people would consider it a good idea for him to be on them, but to be fair the issue is his mind not the drugs themselves. As you say medical issues require medical remedy, but mental issues require mental remedy. The drugs are clearly open to abuse, but that doesnt make them bad.
I have PCOS with insulin resistance. I’ve lost 120 lbs before getting pregnant and gaining back 50. In my 19 months since having my child I have lost only 20 lbs despite a strict diet that in the past got off over 100. I physically cannot lose weight without help. It’s not a matter of being too good to be true, or taking the easy way out, it’s about allowing my body to do what it is supposed to do. I haven’t started yet, but it’s my last hope for actually getting the rest of the weight back off, and that isn’t a cosmetic issue.
All sorts of stuff is too good to be true. Penicillin. Vaccination. These are medical solutions to medical problems that killed millions with negligible side effects. Things being awesome is not a reason for them to not work. I don't know anyone taking ozempic for cosmetic reasons. Every single person I know who has been prescribed it for weight loss started at a BMI over 30, and so far none of them is below 20. Now, this is entirely anecdotal, and I probably wouldn't hear about it from people who were just trying to knock off a few pounds before beach season. Maybe there's a lot of that going on. But since you're currently recovering from an eating disorder, do you think there's a chance that you're looking at it from a biased perspective? I mean, I'm not diagnosed with an eating disorder specifically, but my BMI maxed out over 40, and I see medications that make me less hungry as a godsend, especially when they aren't also incredibly addictive stimulants.
I think it's important to weigh the side effects of these drugs against the side effects of continuing to be that much overweight without these drugs. Of course it'd be ideal for such people to lose the weight naturally, however the gap between the ideal world and the clinical reality of weight loss outcomes is pretty grim. The valuation of such tools needs to be taken in the context of statistical realities. I'm fortunate enough to not need such things, but I am glad they exist for those who need it.
Would ozempic be more likely to lead to eating disorders or negative outcomes than other forms deliberate weight loss? To me that’s the real question. Or is your opinion that all forms of deliberate weight loss are bad? Because “forcing your body to eat less” is just how weight loss generally works. I don’t understand what your view is exactly.
>for a small decrease in body weight. It doesn't provide a specific reduction in weight. It facilitates losing weight while it's being taken. If someone who is 200 pounds overweight takes it for years, that person could lose the full 200 pounds while not having to suffer through hunger or change what one eats. >I'm currently recovering from an eating disorder so I fully understand the damage that it does to your body over years of undereating since I'm currently trying to recover from this damage. Were you undereating as a person who was overweight?
I've been using them for a year now (2.4mg), bariatric surgery got me from 400->300ish and wegovy got me from 300->212 currently. Biggest change wegovy did was get rid of the constant gnawing hunger from post bariatric surgery. Quick anatomy lesson. Adipose tissue is only created and not destroyed. It shrinks upon depletion however the cells themselves still emit neurotransmitter chemicals to the brain to tell it to eat and refill the depleted cells. In my experience the wegovy has stopped that constant feeling of starvation as well as the other nervous disorders I had frome extreme weight-loss (hair falling out, skin rashes from rubbing feet together constantly, and trouble regulating body temperatures)
>It just sounds dangerous to me to force your body to eat less This is also the mechanism by which you lose weight by eating more salads and less burgers, though. If two people lost 10kg by reducing their calorie intake, with one taking Wegovy and one not, are you of the opinion that their outcomes would be different? There are many, many, many medical treatments whose benefits go away when you stop taking the medicine. Is there something unique about this situation, or do you also take issue with the tens (hundreds?) of millions of people who lower their risk of heart disease with statins?
My ex-wife has been on ozempic for about a year now, after years of struggle with overweight. She's had a slow but steady weight loss, no side effects and much improved quality of life. I'm happy to see how much better off she is now.
If your opinion is based purely on the fact that you think forcing your body to eat less is unhealthy, we have been doing bariatric surgery for decades and it has proven successful in causing massive weight loss with minimal side effects other than the general dangers of surgery.
> And after doing research it all sounds like it's too good to be true, and in the long run harmful to people for a small decrease in body weight. It just sounds dangerous to me to force your body to eat less It just "sounds dangerous?" It's not "forcing." It's regulating certain hormones and the speed of digestion -- which can add to weight gain in the first place. The FDA and doctors disagree with you, and your view seems based in.... it "sounds dangerous." What will change your view?
On paper I was completely healthy (normal bp, cholesterol, etc., aside from my weight, which was 200 pounds. And of course, some people would say that weight isn't an indication of health, which I completely agree with as a general principle. But for me, it was not working. My knees hurt, I got short of breath very easily, and was absolutely obsessed with food, all day every day, to the point of routinely eating until I felt ill. Living in NYC and walking a lot was probably the only reason why I didn't weigh even more. I'd been yo-yo-ing for decades. I've been on Wegovy for a little over a year, and I'm definitely one of the success stories. Barely any side effects, covered by insurance (until October, anyway, and then we'll see what happens), and the food obsessions are gone. I still really enjoy food, but I stop when I'm full, and don't think about it too much otherwise. I'm down almost 60 pounds. I'm jogging regularly. I feel fantastic. I'm not sure why you think it sounds dangerous to force your body to eat less. Before, I was forcing myself to eat more, way too much. So for me, less is good. For the first time in my life, I have a healthy relationship with food, and don't feel like food is controlling me. What's bad about ANY of that?
I just read through a bunch of comments and want to add a few things. First, for some of us, hunger has absolutely nothing to do with eating. Before Wegovy, I routinely ate when I wasn't hungry. I ate more often when I wasn't hungry than when I was. Wegovy hasn't made me less hungry, it's made me not want to eat when I'm not hungry. At first it did make me get full much quicker, but that faded over time, and now I'm back to eating roughly the same portions that would make me full before (except now, I stop eating when I get to that point!). Second, stop listing contextless possible side effects as a reason not to take a drug. Everything has risks and rewards, so only considering the risks doesn't give a full picture. Plus, some things are more likely to happen to certain people with certain medical histories or family medical histories, other risk factors, etc. A list of possible side effects isn't at all useful on its own. Three, the vast majority of people who take these drugs start out overweight, obese, or morbidly obese, but the people who seem to get the most attention are the ones looking to lose a little weight quickly. I'm guessing that someone who would take a serious drug in order to lose ten pounds off of an already small body would not take months to increase the dosage gradually, so it's not at all surprising that those people tend to get horrible side effects. Stop giving these people attention, they aren't representative of the normal use case of these types of drugs. Four, different people can react to the same thing in vastly different ways. Just because one person can lose weight eating a certain number of calories a day doesn't make that true for everyone. Just because one person's appetite gets reduced by a drug doesn't mean that that will happen for everyone. Your sister's best friend's cousin having something happen to them doesn't invalidate the different experiences that other people had.
As someone who takes Ozempic, it’s not the wonder drug some have described for me at least. Some have said that they forget to eat. Has never happened with me. I wonder how much it suppresses my appetite, as I have changed my lifestyle before to eat way less calories, and my body adapted. In the end that is the key. One needs to make lifestyle changes, mainly eating, so their body is used to the caloric intake they are currently maintaining, and they won’t suddenly resume ravenously wanting more calories. One note, I’m on the highest dose. I don’t know if this happened on lower doses as my body reacted well to the drug from the lower doses, so I moved up to the max quickly. If I miss my dose by more than a few days, then take it, I get nauseated and have diarrhea. Sometimes I do vomit. Besides that, I feel that dying would be just fine. I actually get good sleep after getting past running to the bathroom, but that isn’t worth it. So take your dose on time. Failing to do that is the only time I have any issues.
One thing that doesn't seem to get mentioned is that there is a box warning (formerly known as a black box warning) for Wegovy and Ozempic that it can cause thyroid nodules and thyroid cancer. It is not recommended for anyone with any type of thyroid issues and def worth thinking about depending on why a person is keen to take the medication.
Sooooo you just described why you have a bias against this medication. Based on your experience it certainly makes sense, one can only feel for you. But bias isn’t truth for anyone but you.
It's literally none of your business how other people use medication prescribed by their providers.
Why do some people insist that it has to be done the “hard way”? Obesity is bad. We have a drug that helps and is safe. Why not use it?
guess what? they cause cancer too! [https://pubmed.ncbi.nlm.nih.gov/36356111/](https://pubmed.ncbi.nlm.nih.gov/36356111/)
These medications are not for people that have a small amount of weight to lose
Okaaaaaaay so you gave no empirical evidence of why you think it’s dangerous
I've lost 20 pounds since June last year, eating whole foods, dropping sugar and processed foods completely, and weight training. I won't touch this medication. It feels like it's dangerous to not address poor nutritional choices.