GLP-1 medications for weight loss?
October 11, 2021 7:08 AM Subscribe
I’m a little overweight, with a family history of type 2 diabetes. I spoke a weight loss doctor who I’m inclined to trust a lot and he enthusiastically recommended that I try a GLP-1 medication like Wegovy / Ozempic / semaglutide in conjunction with dietician-supported lifestyle changes. I spoke to my GP who thought it was a not unreasonable idea. It sounds almost too good to be true: Take a pill, lose weight. If it works, why isn’t everyone doing this? I’m curious about the pros and cons, and looking for thoughts/ideas.
** About me:
I am a 53 year old man. I’ve had a couple of cycles in my life gaining and losing lots of weight (over the past 15 years I’ve weighed as much as 245 pounds and as little as 175) and now am at a plateau at around 210 pounds at 6-feet tall. I eat a healthy diet, use food journals, and exercise a lot. When I’ve lost weight, I’ve done it the “right” way - very very gradually, no fad diets, etc.
Apart from being overweight, I’m in generally good health, all my blood test levels are okay, etc. I have a family history of type 2 diabetes, and had a small scare a couple months ago when blood sugar was high but it seems to be normal again.
I’d like to lose weight if I can. If I can’t, I’m okay with that. But I’m interested in exploring whether it is possible, in ways that are healthy, sustainable, and don’t interfere with my ability to enjoy life. At lower weights, I find I feel physically better and more energetic and believe there may be some health benefit to losing weight if I can. I also like how I look at lower weight. I’m newly single and dating. I’d be happier to weigh less, though I’m also okay with my body as it is. I also think I may have better sexual response at lower weight, which would be great.
** Thoughts/questions about this decision
It seems very exciting to imagine that meds, in conjunction with sustainable diet and exercise, could help me lose a few pounds. I recently had some very successful experiences with antidepressants, and am feeling optimistic in general about meds.
Here are my thoughts on pros, cons, and others.
* Pro
- I am in general a fan of learning and experimentation. This seems like a thing to try and see if it works.
- The known risks of side effects seem low to me and not too worrisome. There is a risk of thyroid cancer which seems miniscule and does not worry me, a risk of pancreatitis that I can live with, and a risk of nausea and digestive problems that seems unworrisome.
- If this works, it would be great, for all the reasons listed above.
- The doctor who recommended this is a weight loss expert I’m generally very inlined to trust (Yoni Freedhoff)
- It seems not unreasonable at this stage in my life to be on meds for health-related issues. The doctor described it this way “Obesity is a chronic condition. You are someone in remission for this chronic condition. This medication may be helpful to you.”
* Con
- It seems a little too good to be true. Given how many people want to lose weight, if there is a drug that can substantially help with this, why is that not front-page news? Why isn’t everyone on it? This is maybe my biggest question.
- I have lost a lot of weight twice in my life. My impression is that each time, it has made it a bit harder to maintain weight loss, by messing with my metabolism/appetite. Right now it takes a fair amount of effort to maintain my somewhat-heavy weight. I worry if I lose any weight again, it will worsen that problem.
- I guess there may be unknown risks with a fairly new drug. (But I’m inclined to think there are also risks with being overweight…)
* Other
It seems possible that to maintain this loss, I’d need to stay on the meds permanently. I think I am okay with that. The financial costs are not insubstantial, but I think they would be worth it (I’d pay a lot per year to be ten or fifteen pounds lighter).
*Overall
I am strongly leaning toward trying out this drug. But it also seems like a decision to put some thought into (since it might mean being on an expensive medication more or less permanently).
* Questions
I’m really curious on any thoughts on the above: Do the pros and cons make sense? Are there considerations I am overlooking? Do you or someone you know have experience with GLP-1 meds and weight loss? Any ideas, thoughts are welcome!!
** About me:
I am a 53 year old man. I’ve had a couple of cycles in my life gaining and losing lots of weight (over the past 15 years I’ve weighed as much as 245 pounds and as little as 175) and now am at a plateau at around 210 pounds at 6-feet tall. I eat a healthy diet, use food journals, and exercise a lot. When I’ve lost weight, I’ve done it the “right” way - very very gradually, no fad diets, etc.
Apart from being overweight, I’m in generally good health, all my blood test levels are okay, etc. I have a family history of type 2 diabetes, and had a small scare a couple months ago when blood sugar was high but it seems to be normal again.
I’d like to lose weight if I can. If I can’t, I’m okay with that. But I’m interested in exploring whether it is possible, in ways that are healthy, sustainable, and don’t interfere with my ability to enjoy life. At lower weights, I find I feel physically better and more energetic and believe there may be some health benefit to losing weight if I can. I also like how I look at lower weight. I’m newly single and dating. I’d be happier to weigh less, though I’m also okay with my body as it is. I also think I may have better sexual response at lower weight, which would be great.
** Thoughts/questions about this decision
It seems very exciting to imagine that meds, in conjunction with sustainable diet and exercise, could help me lose a few pounds. I recently had some very successful experiences with antidepressants, and am feeling optimistic in general about meds.
Here are my thoughts on pros, cons, and others.
* Pro
- I am in general a fan of learning and experimentation. This seems like a thing to try and see if it works.
- The known risks of side effects seem low to me and not too worrisome. There is a risk of thyroid cancer which seems miniscule and does not worry me, a risk of pancreatitis that I can live with, and a risk of nausea and digestive problems that seems unworrisome.
- If this works, it would be great, for all the reasons listed above.
- The doctor who recommended this is a weight loss expert I’m generally very inlined to trust (Yoni Freedhoff)
- It seems not unreasonable at this stage in my life to be on meds for health-related issues. The doctor described it this way “Obesity is a chronic condition. You are someone in remission for this chronic condition. This medication may be helpful to you.”
* Con
- It seems a little too good to be true. Given how many people want to lose weight, if there is a drug that can substantially help with this, why is that not front-page news? Why isn’t everyone on it? This is maybe my biggest question.
- I have lost a lot of weight twice in my life. My impression is that each time, it has made it a bit harder to maintain weight loss, by messing with my metabolism/appetite. Right now it takes a fair amount of effort to maintain my somewhat-heavy weight. I worry if I lose any weight again, it will worsen that problem.
- I guess there may be unknown risks with a fairly new drug. (But I’m inclined to think there are also risks with being overweight…)
* Other
It seems possible that to maintain this loss, I’d need to stay on the meds permanently. I think I am okay with that. The financial costs are not insubstantial, but I think they would be worth it (I’d pay a lot per year to be ten or fifteen pounds lighter).
*Overall
I am strongly leaning toward trying out this drug. But it also seems like a decision to put some thought into (since it might mean being on an expensive medication more or less permanently).
* Questions
I’m really curious on any thoughts on the above: Do the pros and cons make sense? Are there considerations I am overlooking? Do you or someone you know have experience with GLP-1 meds and weight loss? Any ideas, thoughts are welcome!!
Response by poster: wpofibh: Thanks!! A couple things.
Wegovy was recently approved for weight loss.
"[wegovy] demonstrated an average of 14.9% body weight reduction after 68 weeks of therapy in those assigned to the medication group, versus only 2.4% weight loss in those assigned to the placebo group. The average weight loss seen with existing anti-obesity medications is typically about 5% to 9%, while those engaged in lifestyle and behavioral therapy alone are expected to lose only 3% to 5% of their body weight." (NEJM via health.harvard.edu)
For me, even a 5% to 10% reduction in body weight would be a pretty desirable thing.
I hear you about the idea that a weight-loss doctor might be biased. The guy I talked to is a strong proponent of the idea that many people need to make peace with the weight they are at rather than lose more. But he is still a weight loss doctor. I talked to my GP who thought the idea was okay. I can talk to her some more. I'm using MeFi as a supplement to advice from a doctor, not as a replacement for it.
posted by LambSock at 7:32 AM on October 11, 2021 [3 favorites]
Wegovy was recently approved for weight loss.
"[wegovy] demonstrated an average of 14.9% body weight reduction after 68 weeks of therapy in those assigned to the medication group, versus only 2.4% weight loss in those assigned to the placebo group. The average weight loss seen with existing anti-obesity medications is typically about 5% to 9%, while those engaged in lifestyle and behavioral therapy alone are expected to lose only 3% to 5% of their body weight." (NEJM via health.harvard.edu)
For me, even a 5% to 10% reduction in body weight would be a pretty desirable thing.
I hear you about the idea that a weight-loss doctor might be biased. The guy I talked to is a strong proponent of the idea that many people need to make peace with the weight they are at rather than lose more. But he is still a weight loss doctor. I talked to my GP who thought the idea was okay. I can talk to her some more. I'm using MeFi as a supplement to advice from a doctor, not as a replacement for it.
posted by LambSock at 7:32 AM on October 11, 2021 [3 favorites]
Without expressing an opinion as to its effectiveness (you seem very much as up to date/more on the medical literature on this as me and I've never tried it and don't know anyone who has tried it) I really do think this isn't widely attempted just because it's new new. If it's as effective a treatment as it looks, I would still expect about a decade before people widely employed it, reasoning from what I've experienced with other effective but novel treatments.
posted by peppercorn at 7:43 AM on October 11, 2021
posted by peppercorn at 7:43 AM on October 11, 2021
Hello LambSock!
We're in the same age band, but I'm a shorter and heavier. Like you, I've been through a couple of cycles of gain and loss, and really wasn't looking forward to riding back up keto mountain again, so I reached out to my doc and asked about this. He and I seem to get along pretty well when it comes to question/detailed data/discussion, so we talked and thought it'd be a pretty good idea save for the cost not being covered by most insurance programs for weight loss use. So, if you want to go down this path, be prepared.
I will be starting my 8th week with this idea today, still ramping up the dosage. I've never had to do self injections before and I was expecting something a little more scary, but turns out it's not at all an issue.
Now, to the heart of the matter: does it work? At the lower doses I've done so far it is very impressive in that it shuts hunger off like a switch. There are points in the day where I have to remind myself that it'd probably be a good thing to eat something. This effect does seem to lessen a bit as you get to the end of the week and/or as you continue to adjust to the medication.
This has made clear to me the distinction between eating because you're hungry vs eating because you're bored or you've hit some other behavioral trigger that says "mmm, you need to stuff your face."
I've also noticed that as I don't want to eat more over time, obviously my total ability to take in food has been reduced. I used to clean my generously loaded plate and maybe go back for more - now I know that I'm not going to be able to eat a bunch and adjust accordingly. I also think about the quality of the food that I'm going to be eating and if it's worth the calories, knowing that eating too much will leave you uncomfortably full.
I've been known to enjoy a beer or three, and that's had to get reduced. In the product literature it specifically warns against "gassy" drinks like beer, telling you that it could leave you "bloated and uncomfortably full". That's a wonderful way to describe the belchingly miserable state you'll be in if you don't exercise some control and throttle your intake accordingly.
I'm down about 6 pounds so far, and I haven't really changed my level of physical activity. I've been waiting to get a little weight loss going before getting back on the treadmill and now I guess i've reached that point.
So - PROs:
- Hunger is greatly reduced, at least for me
- Ability to eat larger amounts reduced.
- Awareness of eating as a habit, not eating for nutrition
CONs:
- Cost.
Obviously for long-term effects and potential impacts you get to make that decision for yourself - seems like you've considered everything there. Good luck!
-HF
posted by HannoverFist at 8:08 AM on October 11, 2021 [12 favorites]
We're in the same age band, but I'm a shorter and heavier. Like you, I've been through a couple of cycles of gain and loss, and really wasn't looking forward to riding back up keto mountain again, so I reached out to my doc and asked about this. He and I seem to get along pretty well when it comes to question/detailed data/discussion, so we talked and thought it'd be a pretty good idea save for the cost not being covered by most insurance programs for weight loss use. So, if you want to go down this path, be prepared.
I will be starting my 8th week with this idea today, still ramping up the dosage. I've never had to do self injections before and I was expecting something a little more scary, but turns out it's not at all an issue.
Now, to the heart of the matter: does it work? At the lower doses I've done so far it is very impressive in that it shuts hunger off like a switch. There are points in the day where I have to remind myself that it'd probably be a good thing to eat something. This effect does seem to lessen a bit as you get to the end of the week and/or as you continue to adjust to the medication.
This has made clear to me the distinction between eating because you're hungry vs eating because you're bored or you've hit some other behavioral trigger that says "mmm, you need to stuff your face."
I've also noticed that as I don't want to eat more over time, obviously my total ability to take in food has been reduced. I used to clean my generously loaded plate and maybe go back for more - now I know that I'm not going to be able to eat a bunch and adjust accordingly. I also think about the quality of the food that I'm going to be eating and if it's worth the calories, knowing that eating too much will leave you uncomfortably full.
I've been known to enjoy a beer or three, and that's had to get reduced. In the product literature it specifically warns against "gassy" drinks like beer, telling you that it could leave you "bloated and uncomfortably full". That's a wonderful way to describe the belchingly miserable state you'll be in if you don't exercise some control and throttle your intake accordingly.
I'm down about 6 pounds so far, and I haven't really changed my level of physical activity. I've been waiting to get a little weight loss going before getting back on the treadmill and now I guess i've reached that point.
So - PROs:
- Hunger is greatly reduced, at least for me
- Ability to eat larger amounts reduced.
- Awareness of eating as a habit, not eating for nutrition
CONs:
- Cost.
Obviously for long-term effects and potential impacts you get to make that decision for yourself - seems like you've considered everything there. Good luck!
-HF
posted by HannoverFist at 8:08 AM on October 11, 2021 [12 favorites]
Ozempic's side effect of nausea, vomiting and diarrhea was terrible.
So to try and avoid type 2 diabetes, you are going to take a type 2 diabetes drug?
If he's such a strong proponent of accepting your body, why is he even recommending this when there isn't much to be changed about you. You are already doing the right things. You'd still have to do all those things.
posted by Ftsqg at 8:13 AM on October 11, 2021 [2 favorites]
So to try and avoid type 2 diabetes, you are going to take a type 2 diabetes drug?
If he's such a strong proponent of accepting your body, why is he even recommending this when there isn't much to be changed about you. You are already doing the right things. You'd still have to do all those things.
posted by Ftsqg at 8:13 AM on October 11, 2021 [2 favorites]
So one thing to think about is that it's important to look at actual studies rather than articles directed toward the general public. As a cancer patient, I find that articles about treatments can make something sound like the new miracle drug when the results are not that great (a drug that extends survival by an average of less than six months can be touted as a game changer). Often, these articles come from institutions where the authors are employed and people who write these articles interview the authors, who stand to make a lot of money from the drug. The FDA can seem like it's going to be a trustworthy source of information, but that's not always true. They just approved an Alzheimer's drug that has almost no efficacy, and the story of how Fen-Phen, which killed people, was approved (by a close vote) is terrifying. So if I were you, I would go to PubMed and look at the studies. One, linked to in the second article you presented, is here.
From my quick glance through the paper, the one thing I'd note is that this was a 68-week-long study. As you no doubt know, losing weight and keeping weight off are two different things. What is the end game for this drug? Are you thinking you'll lose weight and then stop taking it? Is there any research showing people who do that will keep the weight off? (there might be in other studies - I don't know). Is there any research on long-term side effects? Are you expected to stay on it the rest of your life? I don't know the answers to these questions, but they are all things to consider.
posted by FencingGal at 8:16 AM on October 11, 2021 [4 favorites]
From my quick glance through the paper, the one thing I'd note is that this was a 68-week-long study. As you no doubt know, losing weight and keeping weight off are two different things. What is the end game for this drug? Are you thinking you'll lose weight and then stop taking it? Is there any research showing people who do that will keep the weight off? (there might be in other studies - I don't know). Is there any research on long-term side effects? Are you expected to stay on it the rest of your life? I don't know the answers to these questions, but they are all things to consider.
posted by FencingGal at 8:16 AM on October 11, 2021 [4 favorites]
Given how many people want to lose weight, if there is a drug that can substantially help with this, why is that not front-page news? Why isn’t everyone on it? This is maybe my biggest question.
I received a prescription for Wegovy, which has had radically better results in clinical trials than the other semaglutide medications, not long after it was approved in June - and there's a pretty clear answer to this question. Because of insurance, market availability and a four-month titration period before receiving a full 2.4mg weekly dose of the medication, virtually nobody other than those involved in the early clinical studies are actually on the full dose of the medication right now.
Wegovy is an expensive medication, and your drugstore and insurance will almost certainly require an official pre-approval process before the prescription can be processed. In my case, it took several weeks to get pre-approval. I was very lucky to be approved to get the medication with a reasonable co-pay, so it was worth the wait.
When you start Wegovy, you do .25mg injections for four weeks, .5mg for four more, 1mg for four more, 1.7mg for four more and then finally you can start on the 2.4mg dose. This is because increases in dosage are very commonly accompanied by nausea and gastrointestinal side effects - more severe the larger the increase - that taper off after a couple of weeks. So, it's only in week 17 that you get a full dose. Many who have prescriptions have found that, because this medication has just gotten to market, the various interim dosages are out of stock, slowing down their progress to the full dose.
Wegovy was only approved by the FDA ~19 weeks ago, so even those of us who sought prescriptions at the very earliest and found the medication in stock likely still aren't at 2.4mg unless their doctor has recommended an alternate dosing schedule.
Because of this long ramp-up period, it's too early for me to give you a personal anecdote about how this is working. The early doses (.25 and .5mg) seemed to have absolutely no effect on me whatsoever. The later doses (1mg and 1.7mg) have resulted both in mild nausea and also lowered appetite, especially in the context of feeling full after eating less in any given meal. Other people, on the forum, have had strong reactions to the lower doses, others seem to need higher doses to get the effect. I have not lost much weight yet, but I am eating less, I haven't had a bad experience, and it's honestly too early in the process to tell.
One thing I want to mention is that for weight loss, semaglutide is not a "take a pill" medication. Both semaglutide preparations approved for weight loss are injections. Wegovy, which has shown the greatest success in studies, is a once-weekly injection using a single-use pen. It's reasonably easy and painless to self-inject. Semaglutide is available in pill form (Rybelsus) to manage type 2 diabetes but is not approved for or shown to be as effective as Wegovy for weight loss.
I think we'll be truly seeing if semaglutide is the solution to weight loss and maintenance those early studies imply that it is sometime next year. I generally agree with your list of pros and cons; having had major struggles with my weight and appetite all my life, I was ready to take the risk. We'll see how it goes.
posted by I EAT TAPAS at 8:31 AM on October 11, 2021 [2 favorites]
I received a prescription for Wegovy, which has had radically better results in clinical trials than the other semaglutide medications, not long after it was approved in June - and there's a pretty clear answer to this question. Because of insurance, market availability and a four-month titration period before receiving a full 2.4mg weekly dose of the medication, virtually nobody other than those involved in the early clinical studies are actually on the full dose of the medication right now.
Wegovy is an expensive medication, and your drugstore and insurance will almost certainly require an official pre-approval process before the prescription can be processed. In my case, it took several weeks to get pre-approval. I was very lucky to be approved to get the medication with a reasonable co-pay, so it was worth the wait.
When you start Wegovy, you do .25mg injections for four weeks, .5mg for four more, 1mg for four more, 1.7mg for four more and then finally you can start on the 2.4mg dose. This is because increases in dosage are very commonly accompanied by nausea and gastrointestinal side effects - more severe the larger the increase - that taper off after a couple of weeks. So, it's only in week 17 that you get a full dose. Many who have prescriptions have found that, because this medication has just gotten to market, the various interim dosages are out of stock, slowing down their progress to the full dose.
Wegovy was only approved by the FDA ~19 weeks ago, so even those of us who sought prescriptions at the very earliest and found the medication in stock likely still aren't at 2.4mg unless their doctor has recommended an alternate dosing schedule.
Because of this long ramp-up period, it's too early for me to give you a personal anecdote about how this is working. The early doses (.25 and .5mg) seemed to have absolutely no effect on me whatsoever. The later doses (1mg and 1.7mg) have resulted both in mild nausea and also lowered appetite, especially in the context of feeling full after eating less in any given meal. Other people, on the forum, have had strong reactions to the lower doses, others seem to need higher doses to get the effect. I have not lost much weight yet, but I am eating less, I haven't had a bad experience, and it's honestly too early in the process to tell.
One thing I want to mention is that for weight loss, semaglutide is not a "take a pill" medication. Both semaglutide preparations approved for weight loss are injections. Wegovy, which has shown the greatest success in studies, is a once-weekly injection using a single-use pen. It's reasonably easy and painless to self-inject. Semaglutide is available in pill form (Rybelsus) to manage type 2 diabetes but is not approved for or shown to be as effective as Wegovy for weight loss.
I think we'll be truly seeing if semaglutide is the solution to weight loss and maintenance those early studies imply that it is sometime next year. I generally agree with your list of pros and cons; having had major struggles with my weight and appetite all my life, I was ready to take the risk. We'll see how it goes.
posted by I EAT TAPAS at 8:31 AM on October 11, 2021 [2 favorites]
I know someone who was on Saxenda (injectable form) for a few months, she lost 35 pounds and has thus far kept it off. YMMV, but she's a huge fan. Her A1c (et al) all dropped back into the normal range, so she's gone from being pre-diabetic to average, and the weight loss was remarkable (and sustained).
I will note she (with her endo's approval) ramped up the dosage more slowly than usual; Saxenda has a specific ramp-up that they recommend, but she stayed at each level until the weight loss plateaued, then went up to the next step, rinse-and-repeat. As a consequence she wasn't at the final dose level for very long before quitting.
posted by aramaic at 8:35 AM on October 11, 2021 [3 favorites]
I will note she (with her endo's approval) ramped up the dosage more slowly than usual; Saxenda has a specific ramp-up that they recommend, but she stayed at each level until the weight loss plateaued, then went up to the next step, rinse-and-repeat. As a consequence she wasn't at the final dose level for very long before quitting.
posted by aramaic at 8:35 AM on October 11, 2021 [3 favorites]
(Yes, I realize it's clear that weight loss is statistically associated with these drugs -- but you had asked why "everyone" doesn't use them and whether they're too good to be true. The answer is that for any INDIVIDUAL person, they may well be too good to be true. The average weight loss is 14.9% of body mass but that average includes individual users who lost no weight, or even gained weight. And if the weight loss use has only just been approved for just one formulation, then as folks have noted above, this just hasn't been an option for most people yet.)
posted by We put our faith in Blast Hardcheese at 9:30 AM on October 11, 2021 [1 favorite]
posted by We put our faith in Blast Hardcheese at 9:30 AM on October 11, 2021 [1 favorite]
(1) Self-injection, which no one enjoys
(2) Some people have pretty darned unpleasant GI side effects. Remember Olestra?
(3) Patients and doctors both (rightfully) remember fen-phen
(4) People will not believe that weight loss might be a problem fixable with "just a pill"--it's an affront to their moral universes, because Fatness is a Just Punishment for Weakness and Laziness
That said, I've literally seen these drugs discussed on the "front page" of the NYT website.
I have a friend considering it, and I get why, but, man, based on the way the fen-phen debacle showed how doctors overweight the benefit of weight loss as opposed to all other risks, I'd wait a couple of years, at least.
posted by praemunire at 9:43 AM on October 11, 2021 [3 favorites]
(2) Some people have pretty darned unpleasant GI side effects. Remember Olestra?
(3) Patients and doctors both (rightfully) remember fen-phen
(4) People will not believe that weight loss might be a problem fixable with "just a pill"--it's an affront to their moral universes, because Fatness is a Just Punishment for Weakness and Laziness
That said, I've literally seen these drugs discussed on the "front page" of the NYT website.
I have a friend considering it, and I get why, but, man, based on the way the fen-phen debacle showed how doctors overweight the benefit of weight loss as opposed to all other risks, I'd wait a couple of years, at least.
posted by praemunire at 9:43 AM on October 11, 2021 [3 favorites]
I have friends in a similar situation (some extra weight, diabetes in the family, etc.) who have had MDs suggesting the same meds for them as a weight loss assist. I assume it's becoming more of a norm.
I take a semaglutide for prediabetes, which suppressed my appetite and slowed my absorption. It was the reason I was able to lose 50 lbs. I'm a huge fan (even with the lousy side effects which were indeed lousy but which faded in time). That said, yes, when I went a while between doses, my large appetite came roaring back, so it might have to be a long-term fix.
posted by Ink-stained wretch at 10:54 AM on October 11, 2021 [2 favorites]
I take a semaglutide for prediabetes, which suppressed my appetite and slowed my absorption. It was the reason I was able to lose 50 lbs. I'm a huge fan (even with the lousy side effects which were indeed lousy but which faded in time). That said, yes, when I went a while between doses, my large appetite came roaring back, so it might have to be a long-term fix.
posted by Ink-stained wretch at 10:54 AM on October 11, 2021 [2 favorites]
I tried a few of these. I didn't mind the shots so much, but the gastro side effects were terrible. I was sick the whole time I was on them except Saxenda, which my doc gave me free as a trial and it seemed to be working, but my insurance company refused to pay for it without a diabetes diagnosis. So, no more for me.
posted by ceejaytee at 11:09 AM on October 11, 2021
posted by ceejaytee at 11:09 AM on October 11, 2021
I tried liraglutide for similar reasons and it absolutely worked for about two years, I lost about 40 lbs, not effortlessly but effectively (which was a totally new experience for me, having been trying to not be fat since high school.) After about 2-3 years homeostasis kicked back in and I gained it all back. And now my insurance won't pay for it without a diabetes diagnosis.
posted by fingersandtoes at 11:23 AM on October 11, 2021
posted by fingersandtoes at 11:23 AM on October 11, 2021
Response by poster: fingersandroes: Were you on liraglutide when the weight came back? Or did it come back after you stopped?
posted by LambSock at 11:31 AM on October 11, 2021
posted by LambSock at 11:31 AM on October 11, 2021
I'm not sure. TBH, once I was in that post-loss not-fat stage, I wasn't as assiduous as I should have been about taking it every day; I got a bit sloppy about that. So maybe it wouldn't have come back if I'd been assiduous? But I subsequently did try to take it off, being assiduous (I had a bunch stored up, which is how I know I'd been sloppy about taking it) and it no longer seemed to work.
One of the things that it seemed to do in the beginning was make me just not feel like eating much. It wasn't one of those terrible heart-pounding appetite suppressants, it just... I mean the first few weeks were miraculous. I understood, for the first time ever, what it felt like to be one of those people who don't feel compelled to eat much. I was rarely hungry; when I was hungry, it only took a little bit of food to satisfy me; and I just wasn't interested in the sweet tasty stuff that has been my Achilles heel all my life.
(Which, by the way, is one reason I've become militantly hostile about thin people telling fat people how to not be fat: it feels ENTIRELY DIFFERENT when when tempting foods don't have power over you. It's not a question of discipline: it's that you don't HAVE to be disciplined, you don't have to waste mental effort and physical discomfort on being disciplined, because the food is just not compelling like it is for us fat people. It's a completely different experience in the body. It was great while it lasted. )
posted by fingersandtoes at 11:46 AM on October 11, 2021 [9 favorites]
One of the things that it seemed to do in the beginning was make me just not feel like eating much. It wasn't one of those terrible heart-pounding appetite suppressants, it just... I mean the first few weeks were miraculous. I understood, for the first time ever, what it felt like to be one of those people who don't feel compelled to eat much. I was rarely hungry; when I was hungry, it only took a little bit of food to satisfy me; and I just wasn't interested in the sweet tasty stuff that has been my Achilles heel all my life.
(Which, by the way, is one reason I've become militantly hostile about thin people telling fat people how to not be fat: it feels ENTIRELY DIFFERENT when when tempting foods don't have power over you. It's not a question of discipline: it's that you don't HAVE to be disciplined, you don't have to waste mental effort and physical discomfort on being disciplined, because the food is just not compelling like it is for us fat people. It's a completely different experience in the body. It was great while it lasted. )
posted by fingersandtoes at 11:46 AM on October 11, 2021 [9 favorites]
I've been using these since May. I am down 30 lbs. as of now, in "1-derland" (below 200) for the first time in years. Can confirm: game-changer.
I used Saxenda (liraglutide) first, following their recommended dosage schedule. I lost ~15 lbs there, but at about week 10 I ran into severe GI problems and stopped for a pause, also during a vacation.
After the pause, I've been on Ozempic (semaglutide) since. Their recommended dosage schedule is slower, and I'm only at the 1.0 dosage now. After reading on a few groups, I'm planning to stay here unless I plateau.
Long term? My weight was just doing the slow creep upwards, and even if I just reset my baseline and gain 20 lbs in 10 years, it will have been worthwhile. As of now, the word is that docs expect you to stay on a low dose of this lifetime, and if I need to, I will. I had a few GI effects last week (one vomit episode, some days with burps and nausea) but these were minor, and seem to have passed.
The major effect is that it slows digestion, such that your stomach stays fuller longer, and you feel full much, much sooner into any given meal. For diabetics or people with insulin resistance, it changes insulin metabolism/response. It doesn't seem to do anything to insulin-normal people.
The game-changer part for me is the reduction in hunger. I have spent my life negotiating to keep myself somewhere between just-a-little hungry and dysfunctionally hungry; it's always been unpleasant, and a mental load, and sometimes I get it wrong and bonk. I've been some degree of "hangry" for .... decades. It feels entirely different to not have to devote mental energy to how hungry I can keep myself, and when to time eating around that goal. And, obviously my weight crept up over years anyway, despite very careful hunger maintenance and regular activities that are a major part of my life. This medicine has truly showed me that my hunger was not matched in any way to my metabolism, and that for whatever reason, that my hunger is dysregulated.
I suspect this is true for many people. I think we're only beginning to maybe be able to consider that weight is not under voluntary, puritanical control. But maybe not, this is the US public we're talking about. Patriarchal puritanism reigns supreme. But I digress.
It's not unlike birth control pills. With regularly fluctuating hormones, I have 1.5 days a month where I am just ... not sane. I feel it, and I know it, but cannot outrun or out-think it. I use birth control pills continuously, which is a recommended use, and have 1-2 periods a year now. Result: my mental state is predictable and even-keel. I don't lose 2 days a month. I can devote brain space to ... where it should go. These GLP drugs feel the same: I no longer need to devote brain space to negotiating with irrational, outsized, incorrect hunger. Life is entirely different, as fingersandtoes said, when hunger doesn't need to be disciplined.
The injections are via an auto-injector, and only into subcutaneous fat -- totally not a thing.
posted by ashy_sock at 12:33 PM on October 11, 2021 [5 favorites]
I used Saxenda (liraglutide) first, following their recommended dosage schedule. I lost ~15 lbs there, but at about week 10 I ran into severe GI problems and stopped for a pause, also during a vacation.
After the pause, I've been on Ozempic (semaglutide) since. Their recommended dosage schedule is slower, and I'm only at the 1.0 dosage now. After reading on a few groups, I'm planning to stay here unless I plateau.
Long term? My weight was just doing the slow creep upwards, and even if I just reset my baseline and gain 20 lbs in 10 years, it will have been worthwhile. As of now, the word is that docs expect you to stay on a low dose of this lifetime, and if I need to, I will. I had a few GI effects last week (one vomit episode, some days with burps and nausea) but these were minor, and seem to have passed.
The major effect is that it slows digestion, such that your stomach stays fuller longer, and you feel full much, much sooner into any given meal. For diabetics or people with insulin resistance, it changes insulin metabolism/response. It doesn't seem to do anything to insulin-normal people.
The game-changer part for me is the reduction in hunger. I have spent my life negotiating to keep myself somewhere between just-a-little hungry and dysfunctionally hungry; it's always been unpleasant, and a mental load, and sometimes I get it wrong and bonk. I've been some degree of "hangry" for .... decades. It feels entirely different to not have to devote mental energy to how hungry I can keep myself, and when to time eating around that goal. And, obviously my weight crept up over years anyway, despite very careful hunger maintenance and regular activities that are a major part of my life. This medicine has truly showed me that my hunger was not matched in any way to my metabolism, and that for whatever reason, that my hunger is dysregulated.
I suspect this is true for many people. I think we're only beginning to maybe be able to consider that weight is not under voluntary, puritanical control. But maybe not, this is the US public we're talking about. Patriarchal puritanism reigns supreme. But I digress.
It's not unlike birth control pills. With regularly fluctuating hormones, I have 1.5 days a month where I am just ... not sane. I feel it, and I know it, but cannot outrun or out-think it. I use birth control pills continuously, which is a recommended use, and have 1-2 periods a year now. Result: my mental state is predictable and even-keel. I don't lose 2 days a month. I can devote brain space to ... where it should go. These GLP drugs feel the same: I no longer need to devote brain space to negotiating with irrational, outsized, incorrect hunger. Life is entirely different, as fingersandtoes said, when hunger doesn't need to be disciplined.
The injections are via an auto-injector, and only into subcutaneous fat -- totally not a thing.
posted by ashy_sock at 12:33 PM on October 11, 2021 [5 favorites]
Oh, and -- there are supply problems right now with the semaglutide (Wegovy), which almost certainly is contributing to the lack of publicity.
My insurance covered it. From reading groups, many but not all insurers cover it. There's ways to get it semi-cheaply from Canadia or Mexico.
I joined a facebook group after my liraglutide experience, just to convince myself that not everyone experiences the side effects I did (which is true). It's a good idea to get an overview of people's experiences, but also a cautionary note, these are also people who have been immersed in weight-loss culture for years, and it's very apparent, so caveat emptor.
posted by ashy_sock at 12:47 PM on October 11, 2021
My insurance covered it. From reading groups, many but not all insurers cover it. There's ways to get it semi-cheaply from Canadia or Mexico.
I joined a facebook group after my liraglutide experience, just to convince myself that not everyone experiences the side effects I did (which is true). It's a good idea to get an overview of people's experiences, but also a cautionary note, these are also people who have been immersed in weight-loss culture for years, and it's very apparent, so caveat emptor.
posted by ashy_sock at 12:47 PM on October 11, 2021
I’ve been on Ozempic for just over a year now. I only had minor side effects ramping up the dose and no noticeable side effects since then. I was prescribed the drug by a diabetes and obesity specialist in a country where my dr’s appointments are covered by my insurance but the off label use is not meaning I pay for the drug. I’m fine with that. This is not a money spinner for my doctor - my average time in there to get weighed, talk to the doc and the nutritionist is 15 mins and they frequently seem to bill for less time than I spent talking to people.
The drug doesn’t cause miraculous weight loss. But it puts your metabolism on a base line, where it is much more feasible to lose weight due to the effects described by others. However, if I eat a high carb diet or drink alcohol regularly my weight loss stagnates and I can absolutely put on weight. But if I limit myself to one drink a week and aim for a modest carb intake I get great results without feeling like I am missing out on anything because I don’t feel hungry much and regularly leave food on my plate.
As an experiment I skipped a weekly injection last month for the first time since I started using it. And by the end of that week I was able to eat much larger portions again and was hungry again much faster after eating.
posted by koahiatamadl at 12:52 PM on October 11, 2021 [1 favorite]
The drug doesn’t cause miraculous weight loss. But it puts your metabolism on a base line, where it is much more feasible to lose weight due to the effects described by others. However, if I eat a high carb diet or drink alcohol regularly my weight loss stagnates and I can absolutely put on weight. But if I limit myself to one drink a week and aim for a modest carb intake I get great results without feeling like I am missing out on anything because I don’t feel hungry much and regularly leave food on my plate.
As an experiment I skipped a weekly injection last month for the first time since I started using it. And by the end of that week I was able to eat much larger portions again and was hungry again much faster after eating.
posted by koahiatamadl at 12:52 PM on October 11, 2021 [1 favorite]
Forgot to add - I could never relate to those skinny folks who were talking about forgetting to eat. That never used to happen to me…and now it does.
posted by koahiatamadl at 12:59 PM on October 11, 2021 [3 favorites]
posted by koahiatamadl at 12:59 PM on October 11, 2021 [3 favorites]
on top of the budget concerns illustrated above, drugs aren't just prescribed out to everyone because of potential side effects which can significantly decrease your quality of life. I'm not a doctor but I believe the norm in medical practice is that if there are interventions you can prescribe that don't include a reliance on drugs, these are recommended first. so if you're telling your PCP that you are mindfully following a diet and exercising, they'll then look into prescribing the medication following some literature review on their end but not before then
fwiw, the most recent systematic review I could find (from January of this year) shows low certainty regarding bodyweight reduction with an effect size of about a kilogram. this is half that of regular exercise, which also has a higher certainty, comes with a lot of other benefits, and also has very minimal side effects. until most people are being mindful of their diets and exercising regularly, it's not likely that an ethical practitioner will start writing scripts for these pills since part of patient care is keeping in mind the cost
posted by paimapi at 1:48 PM on October 11, 2021
fwiw, the most recent systematic review I could find (from January of this year) shows low certainty regarding bodyweight reduction with an effect size of about a kilogram. this is half that of regular exercise, which also has a higher certainty, comes with a lot of other benefits, and also has very minimal side effects. until most people are being mindful of their diets and exercising regularly, it's not likely that an ethical practitioner will start writing scripts for these pills since part of patient care is keeping in mind the cost
posted by paimapi at 1:48 PM on October 11, 2021
My endo enthusiastically recommended it to me, and after doing a little bit of research online I declined to try it. My reasons:
1. Lots of people (posting in FB groups and elsewhere) reported gastro side effects from it, such as nausea, vomiting, diarrhea, constipation, abdominal pain and "eggy burps". My digestive system tends to be a pain in the ass anyway, and I have no interest in "working through" gastro side effects which could potentially be temporary or potentially not. I've mostly got my gastro issues under control but spent years being miserably uncomfortable, and worry about whether I could regain control if I did something that triggered symptoms again. I just hate being digestively uncomfortable SO MUCH.
YMMV as far as symptoms... other people reported no such effects and loved the weight loss.
2. From what I can tell, the drug works at least in part by delaying the emptying of your stomach after you eat, meaning you feel full longer and for a lot of people that automatically means eating less. However, feeling "not hungry" or even rather full has never deterred me from eating. I'm a person who eats for emotional reasons, and will eat even if I'm not hungry. If I'm feeling stressed or bored I'll eat a small amount of junky food every time I have the tiniest amount of room in my stomach to fit it in. I suspect this tendency would make the drug less effective for me for weight loss.
So there's one answer to your question of why everyone who needs to lose weight isn't on it.
posted by Serene Empress Dork at 2:17 PM on October 11, 2021 [1 favorite]
1. Lots of people (posting in FB groups and elsewhere) reported gastro side effects from it, such as nausea, vomiting, diarrhea, constipation, abdominal pain and "eggy burps". My digestive system tends to be a pain in the ass anyway, and I have no interest in "working through" gastro side effects which could potentially be temporary or potentially not. I've mostly got my gastro issues under control but spent years being miserably uncomfortable, and worry about whether I could regain control if I did something that triggered symptoms again. I just hate being digestively uncomfortable SO MUCH.
YMMV as far as symptoms... other people reported no such effects and loved the weight loss.
2. From what I can tell, the drug works at least in part by delaying the emptying of your stomach after you eat, meaning you feel full longer and for a lot of people that automatically means eating less. However, feeling "not hungry" or even rather full has never deterred me from eating. I'm a person who eats for emotional reasons, and will eat even if I'm not hungry. If I'm feeling stressed or bored I'll eat a small amount of junky food every time I have the tiniest amount of room in my stomach to fit it in. I suspect this tendency would make the drug less effective for me for weight loss.
So there's one answer to your question of why everyone who needs to lose weight isn't on it.
posted by Serene Empress Dork at 2:17 PM on October 11, 2021 [1 favorite]
I am currently taking Wegovy, after taking Saxenda. It has been working for me. I think the lack of wide spread buzz about it is because there is a shortage, and most insurance companies aren't covering Wegovy currently. Novo Nordisk offers a coupon that covers the high cost of the drug- you pay $25, but even with that my regular CVS isn't even trying to fill it. I have had to go to Walgreens and make a lot of phone calls to get it filled.
I had so many more awful side affects with Saxenda, which was a daily inject-able, I did not have a large amount of success with it compared to other folks, and because of that my endocrinologist switched me to Wegovy- which I have no of the bad side affects of Saxenda. It does cut off feeling hungry. The way I describe it to others is I can go to a grocery store and just shop for what I need, I never feel like I need to "treat" myself when I see a yummy cake or other high calorie food.
If you are significantly overweight, with the exception of weight loss surgery (which is the #1 weight loss option based on the research), these new types of drugs are working in the short term. In the long term, who knows. But if you have struggled with your weight in a significant way, have lost weight only to regain it, and also have health side affects from weight- this medication is a good option. We know from Covid that obesity does cause issues for people than people who weigh less do not have. Please do your research from people who have struggled with their wight and tried lots of options- I feel like a lot of people in this thread do not have first hand experience with this medication nor with being significantly overweight.
posted by momochan at 4:44 PM on October 11, 2021 [3 favorites]
I had so many more awful side affects with Saxenda, which was a daily inject-able, I did not have a large amount of success with it compared to other folks, and because of that my endocrinologist switched me to Wegovy- which I have no of the bad side affects of Saxenda. It does cut off feeling hungry. The way I describe it to others is I can go to a grocery store and just shop for what I need, I never feel like I need to "treat" myself when I see a yummy cake or other high calorie food.
If you are significantly overweight, with the exception of weight loss surgery (which is the #1 weight loss option based on the research), these new types of drugs are working in the short term. In the long term, who knows. But if you have struggled with your weight in a significant way, have lost weight only to regain it, and also have health side affects from weight- this medication is a good option. We know from Covid that obesity does cause issues for people than people who weigh less do not have. Please do your research from people who have struggled with their wight and tried lots of options- I feel like a lot of people in this thread do not have first hand experience with this medication nor with being significantly overweight.
posted by momochan at 4:44 PM on October 11, 2021 [3 favorites]
I am a T2D who has taken 0.5 mg of Ozempic weekly since March. It was my idea, and my doctor was okay with trying it out. I was able to stop taking long-acting insulin after about a month on Ozempic, and my glucose numbers have been consistently good ever since. Secondarily to me, my BMI has gone from about 40 to 33, so far. (I am very aware that BMI is a poor assessment tool, but would prefer not to give my height/weight stats in a public forum.)
Agree with all who say it can be a game changer -- I feel like, for perhaps the first time ever, I don't have an overclocked appetite. I feel full when I am actually full, not quite a while after I am full. Also agree that it can be a challenge digestively -- for me, the benefits outweighed the detriments, but I can definitely understand mileage varying. Eating higher carb foods absolutely aggravates the negatives. And sometimes, on the morning of Injection Day, I can feel the overclock creeping back in.
Something to consider, especially since you're concerned about T2D: You might want to try wearing a continuous glucose monitor for a while and learn more about how your body processes foods, exercise, sleep, and stress. You don't say whether your scare was the result of an A1c or a fasting glucose test -- but, especially if it was the latter, watching your patterns and tendencies might give you good insight without risking digestive misadventures. Starting to wear a CGM was, for me, also a game changer.
posted by gnomeloaf at 6:39 PM on October 11, 2021 [4 favorites]
Agree with all who say it can be a game changer -- I feel like, for perhaps the first time ever, I don't have an overclocked appetite. I feel full when I am actually full, not quite a while after I am full. Also agree that it can be a challenge digestively -- for me, the benefits outweighed the detriments, but I can definitely understand mileage varying. Eating higher carb foods absolutely aggravates the negatives. And sometimes, on the morning of Injection Day, I can feel the overclock creeping back in.
Something to consider, especially since you're concerned about T2D: You might want to try wearing a continuous glucose monitor for a while and learn more about how your body processes foods, exercise, sleep, and stress. You don't say whether your scare was the result of an A1c or a fasting glucose test -- but, especially if it was the latter, watching your patterns and tendencies might give you good insight without risking digestive misadventures. Starting to wear a CGM was, for me, also a game changer.
posted by gnomeloaf at 6:39 PM on October 11, 2021 [4 favorites]
I understood, for the first time ever, what it felt like to be one of those people who don't feel compelled to eat much.
And isn't that just the most miraculous thing? I got it from Reductil (sibutramine) and kept on getting it until Abbott withdrew the drug from the Australian market because of studies showing an increased risk of heart attack and stroke in patients who already had high blood pressure.
Sibutramine had already been available for a couple of years before my doctor put me onto it, and my short but sweet romance with it lasted only a few months, but in that time I'd lost 15kg without really having to think about it. It was fantastic. No side effects for me either - not even hip-pocket-wise; the drug was pretty close to paying for itself in reduced spending on food.
I will certainly be taking Wegovy for a spin once it becomes available in Australia at less than stratospheric prices.
posted by flabdablet at 8:10 PM on October 11, 2021 [3 favorites]
And isn't that just the most miraculous thing? I got it from Reductil (sibutramine) and kept on getting it until Abbott withdrew the drug from the Australian market because of studies showing an increased risk of heart attack and stroke in patients who already had high blood pressure.
Sibutramine had already been available for a couple of years before my doctor put me onto it, and my short but sweet romance with it lasted only a few months, but in that time I'd lost 15kg without really having to think about it. It was fantastic. No side effects for me either - not even hip-pocket-wise; the drug was pretty close to paying for itself in reduced spending on food.
I will certainly be taking Wegovy for a spin once it becomes available in Australia at less than stratospheric prices.
posted by flabdablet at 8:10 PM on October 11, 2021 [3 favorites]
Given the long history of weight loss miracle drugs that turn out to cause significant morbidity and mortality once longer-term studies come out, I'd be very scared to start one of these new drugs. I'm not aware of any weight loss drug that has proven both safe and effective in the long term.
posted by decathecting at 1:37 PM on October 13, 2021
posted by decathecting at 1:37 PM on October 13, 2021
The question, as always, comes down to a risk vs benefit analysis. If a drug that does control my morbid obesity has a 1% chance of killing me ten years early, and my morbid obesity has a 10% chance of killing me ten years early, then staying on the drug is a no-brainer.
That said, good solid numbers are always hard to come by. My own judgement is likely to be informed by proven risks associated with related classes of drugs, as well as comparison of demonstrated risk levels for new drugs against the risk levels of things I do every day without worrying much, like getting behind the wheel of a car.
posted by flabdablet at 8:42 PM on October 13, 2021 [1 favorite]
That said, good solid numbers are always hard to come by. My own judgement is likely to be informed by proven risks associated with related classes of drugs, as well as comparison of demonstrated risk levels for new drugs against the risk levels of things I do every day without worrying much, like getting behind the wheel of a car.
posted by flabdablet at 8:42 PM on October 13, 2021 [1 favorite]
For me the reasons were cost: with the ramp up, it would cost me about £2k just to find out if it would work for me.
Not convinced it would work for me: In the studies I read, the control group were eating around 3k calories a day, the ozempic group were eating less, but if you looked at the difference in calories, those on the drug still only lost about half as much weight as you'd expect. (based on the 3500 calories per lb of fat measure - which I appreciate isn't perfect but even so). I'm already eating about the same number of calories as those in the study on the drug. I have PCOS so my metabolism doesn't work like it should.
Also my friend with PCOS actually tried it - she got it through some dodgy place that skipped the ramp up so she had horrible side effects but even with the nausea, she lost about a quarter of the weight that other people in her group did so she decided lb for £ it wasn't worth it.
posted by missmagenta at 5:47 AM on October 14, 2021
Not convinced it would work for me: In the studies I read, the control group were eating around 3k calories a day, the ozempic group were eating less, but if you looked at the difference in calories, those on the drug still only lost about half as much weight as you'd expect. (based on the 3500 calories per lb of fat measure - which I appreciate isn't perfect but even so). I'm already eating about the same number of calories as those in the study on the drug. I have PCOS so my metabolism doesn't work like it should.
Also my friend with PCOS actually tried it - she got it through some dodgy place that skipped the ramp up so she had horrible side effects but even with the nausea, she lost about a quarter of the weight that other people in her group did so she decided lb for £ it wasn't worth it.
posted by missmagenta at 5:47 AM on October 14, 2021
This thread is closed to new comments.
My understanding about drugs like the ones your doctor is recommending is that they aren't "weight-loss drugs." They are drugs that help with blood sugar control, and sometimes as an effect of increased blood sugar control, a patient will also lose weight. The average weight loss is NOT substantial.
I am concerned that you say your blood levels are fine and you do not have diabetes but your doctor thinks you should still take these drugs. If I were you I would be consulting your GP and possibly getting a second opinion, NOT from a weight-loss doctor.
posted by We put our faith in Blast Hardcheese at 7:20 AM on October 11, 2021 [3 favorites]