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  #1   ^
Old Mon, Jul-18-22, 07:36
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JLx JLx is offline
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Default A new ‘miracle’ weight-loss drug really works — raising huge questions

Novo Nordisk’s Wegovy uses a hormone to regulate hunger. It’s wildly effective, but is it misguided?- Financial Times https://www.ft.com/content/96a61dc0...a2-2b6a382b7a3b

This is a more thoughtful article than many others I've noticed about the new semaglutide drugs.

Quote:
When a patient stops taking Wegovy, their appetite returns within weeks and they pack on weight. In the study run by Robillard’s doctor, Domenica Rubino, the patients who came off the drug regained 7 per cent of their body weight. “We used to think that behaviour causes the weight state, but now we think the weight state actually causes the behaviour,” Rubino says. There may be even worse side effects of coming off the drug. Less than a week after Robillard stopped taking it at the end of the trial in November 2019, she started having panic attacks. “Every circuit started thinking about the cravings,” she says. She regained 20 pounds.

Novo Nordisk’s long-term ambition is to cure obesity by discovering how to stop the body bouncing back. Until then, Kurtzhals believes people should think of treating obesity as they do other chronic diseases. “For some reason, many people have an easier time understanding that your blood pressure medication is for life than understanding that your treatment of obesity is also for life,” he says. Part of that reason may be the price tag. Unlike generic blood pressure drugs that now cost $10 a month, Wegovy’s monthly list price in the US is about $1,350....

Even if Novo Nordisk and its competitors succeed in getting their drug accepted by the people who hold the purse strings, they will still face opponents who reject the whole premise that obesity should be treated with medicine. Advocates of “body positivity” and some weight management experts believe health metrics such as blood pressure or blood sugar are far more useful than body mass index. The company is hoping to sway doubters with a trial, which reports later this year, that will show whether Wegovy reduces the risk of cardiac problems.

Marquisele Mercedes, a doctoral student in public health at Brown University, is fed up hearing that Wegovy is a “miracle”....

Varady worries that it will be easier to medicate a world that she describes as “obesogenic” — tending to cause obesity. Wegovy could become a societal sticking plaster, allowing food companies to continue selling junk and pharma companies to profit from slimming people down. She believes it would be more “humane” if governments found ways “to teach people or tax them”, such as the UK levy on sugary drinks.

Mercedes believes Novo Nordisk’s efforts to counter stigma — the Queen Latifah campaign — could actually end up embedding existing bias. “They’re selling you a solution to the discrimination and stigma you face by giving you a way to be smaller,” she says. It is “literally just advertising. We’re transitioning from the personal failure, lacking willpower, lacking self-control narrative, to this narrative that says ‘Obesity is a disease, you need a prescribed cure’ . . . so we can sell weight-loss medication,” she says. “They are going to make a killing.”


What's clear is that this drug does something real.

Quote:
When we eat, cells in the small intestine secrete GLP-1....The hormone’s effect on the brain, they discovered, is to reduce appetite and create a feeling of fullness.


One patient described feeling as if her mind was "freed from its obsession with eating".
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  #2   ^
Old Mon, Jul-18-22, 07:50
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JEY100 JEY100 is online now
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JL thanks for posting this! I had suggested a friend who wants WL surgery to look into it. The link you posted was behind a paywall for me, but this one opened: https://www.ft.com/content/96a61dc0...U6EF-LmswZHiEJ8
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  #3   ^
Old Mon, Jul-18-22, 08:43
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JLx JLx is offline
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Oh, sorry. I'm not a subscriber and I was able to read it so I thought it was a good link.
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  #4   ^
Old Mon, Jul-18-22, 11:07
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deirdra deirdra is offline
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Quote:
Originally Posted by JLx
What's clear is that this drug does something real.

One patient described feeling as if her mind was "freed from its obsession with eating".
Curiously, this is exactly the feeling I get from eating only real foods, plenty of nutrients, high protein, low net carbs and moderate fat. Do they make my small intestines secrete GLP-1? For free?
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  #5   ^
Old Mon, Jul-18-22, 11:57
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JLx JLx is offline
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I have that feeling getting 130+gms of protein and lowering fat. I did not have that feeling eating the same approx amount of calories - 1500 - and the same approx amount of carbs, 100-120. So for me, it took lowering fat and increasing protein.

I fully understand people wanting to take this drug, though. Unlike the surgery where people can still manage to gain all their weight back through emotional eating or whatever reason, this sounds like as long as you take it, you have a reduced appetite. Or could emotional eaters overcome the drug too? Now that would be an interesting study.

At the end, the woman introduced in the beginning says,
Quote:
"she resents people who think it is a quick fix. She says she has to continue
watching what she eats and exercising. “It’s not like you take the drug, and then you can eat pie and cookies all day.”


implying there has to be some kind of intent to lose weight even with the drug. But otherwise, medically, once the price comes down and as long as serious side effects don't emerge, I can see the medical establishment jumping on this for this reason:

Quote:
Almost half of Americans are expected to be obese by 2030, a Harvard study found, and that could account for up to 18 per cent of healthcare spending on related conditions, ranging from heart disease and stroke to osteoarthritis. Worldwide obesity rates have tripled since 1975, with 650 million adults obese in 2016, according to the World Health Organization. In 2019, the OECD declared that developed countries’ plans to tackle the problem were largely failing.


Well, the countries with national health insurance will be interested but perhaps not the U.S. as Big Food and the weight loss industry may lobby against it. And then there's the puritanical attitude that fat people deserve their fate.
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  #6   ^
Old Tue, Jul-19-22, 12:15
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Nancy LC Nancy LC is offline
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I get that feeling when my blood sugar is lowish.
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  #7   ^
Old Tue, Jul-19-22, 21:07
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But does the drug fix insulin resistance which drives obesity? Does the drug fix other medical issues that are caused by eating higher carb? It’s fixing an external issue, appearances of being obese, but it doesn’t fix the health of the person.
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  #8   ^
Old Wed, Jul-20-22, 06:24
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JLx JLx is offline
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It sounds like the person taking the drug has a newfound ability to resist overeating, which includes carbs presumably. They lose weight, so that alone will address insulin resistance.

That article said they've yet to study other health effects, such as cardiac outcome, but how can major weight loss such as 70 lbs not be of benefit? Just dragging around less body mass relieves some strain on the heart.
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  #9   ^
Old Wed, Jul-20-22, 07:49
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WereBear WereBear is offline
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Quote:
Originally Posted by deirdra
Curiously, this is exactly the feeling I get from eating only real foods, plenty of nutrients, high protein, low net carbs and moderate fat. Do they make my small intestines secrete GLP-1? For free?


The drug price tag would buy a lot of real food.

Quote:
Varady worries that it will be easier to medicate a world that she describes as “obesogenic” — tending to cause obesity. Wegovy could become a societal sticking plaster, allowing food companies to continue selling junk and pharma companies to profit from slimming people down.


She's right to worry. Because they will.
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  #10   ^
Old Wed, Jul-20-22, 13:34
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Calianna Calianna is offline
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Gypsybird said:
Quote:
But does the drug fix insulin resistance which drives obesity? Does the drug fix other medical issues that are caused by eating higher carb? It’s fixing an external issue, appearances of being obese, but it doesn’t fix the health of the person.


JLx said:
Quote:
It sounds like the person taking the drug has a newfound ability to resist overeating, which includes carbs presumably. They lose weight, so that alone will address insulin resistance.


WB said:
Quote:
Wegovy could become a societal sticking plaster, allowing food companies to continue selling junk and pharma companies to profit from slimming people down.



All very good points. I tried both links to read the actual article, both came up with a paywall.

Therefore I also have no idea if it addressed the issues of what kinds of food they're being directed to eat.

Is it just eat whatever you want (candy, cake, and potato chips), and stop when you feel full?

And what of underlying emotional/compulsive eating issues? There are people who will feel full or even excessively full, but will continue to eat just because the food is there.
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  #11   ^
Old Wed, Jul-20-22, 15:17
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JLx JLx is offline
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https://mobile.twitter.com/Financia...090248046641152

Sometimes you can get past a paywall through a social media link, so try that. I did already quote the woman at the beginning of the article saying

Quote:
"she resents people who think it is a quick fix. She says she has to continue watching what she eats and exercising. “It’s not like you take the drug, and then you can eat pie and cookies all day.”


Anyone taking this drug is going to be obese and presumably doesn't want to be, so they're prepared to "watch what they eat" but find it easier to do so because of the what the drug does for them:


Quote:
Unpaid celebrity endorsements include venture capitalist Marc Andreessen, who says the drug completely changed his relationship with food,



Quote:
While experimenting with how to create a new GLP-1-based drug in the 1990s, Novo Nordisk lab scientists noticed their mice and rats began to lose weight. The hormone’s effect on the brain, they discovered, is to reduce appetite and create a feeling of fullness. This is exactly how it worked for Robillard in 2018; she felt her mind freed from its obsession with eating.


And interestingly, as soon as the drug is withdrawn, the appetite and weight returns. With a vengeance, it sounds like.

Quote:
When a patient stops taking Wegovy, their appetite returns within weeks and they pack on weight. ... There may be even worse side effects of coming off the drug. Less than a week after Robillard stopped taking it at the end of the trial in November 2019, she started having panic attacks. “Every circuit started thinking about the cravings,” she says. She regained 20 pounds.


So it sounds like this plan, would not work - well, depending on the diet and exercise plan, I suppose:

Quote:
In February, the UK’s National Institute for Health and Care Excellence issued preliminary guidance advising that Wegovy can be given to the most overweight patients, with at least one obesity-related condition, alongside a diet and exercise plan, but only for two years.
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  #12   ^
Old Wed, Jul-20-22, 17:27
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Calianna Calianna is offline
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Quote:
"she resents people who think it is a quick fix. She says she has to continue watching what she eats and exercising. “It’s not like you take the drug, and then you can eat pie and cookies all day.”


Sorry, I had completely missed that line (I'm not feeling particularly well at the moment.... a bit of brain fog)

But the combination of these 2 factors is really disturbing:

Quote:
When a patient stops taking Wegovy, their appetite returns within weeks and they pack on weight. ... There may be even worse side effects of coming off the drug. Less than a week after Robillard stopped taking it at the end of the trial in November 2019, she started having panic attacks. “Every circuit started thinking about the cravings,” she says. She regained 20 pounds.


Quote:
In February, the UK’s National Institute for Health and Care Excellence issued preliminary guidance advising that Wegovy can be given to the most overweight patients, with at least one obesity-related condition, alongside a diet and exercise plan, but only for two years.


That means that if you happen to have a spare $32,400 sitting around ($1,350/month for 24 months), you can take it for 2 years, lose a whole pile of weight, then gain it all back (with interest? Most likely...) after you've reached the 2 year limit on using it.

Medically approved yo-yo dieting.


Which brings us back to this again:

Quote:
Varady worries that it will be easier to medicate a world that she describes as “obesogenic” — tending to cause obesity. Wegovy could become a societal sticking plaster, allowing food companies to continue selling junk and pharma companies to profit from slimming people down.

...Which in the end isn't really going to help at all.
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  #13   ^
Old Thu, Jul-21-22, 05:32
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WereBear WereBear is offline
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Quote:
Unpaid celebrity endorsements include venture capitalist Marc Andreessen, who says the drug completely changed his relationship with food,


How interesting, because that's exactly how I felt when I went low-carb. It only increased as I went VLC.

Now, that's what works for me. I've become more and more aware that people vary rather widely. Perhaps the most important thing for them to know is how food and weight interact, and how everyone has to figure out the details themselves after that.

Perhaps, if the 2 years with the drug is less expensive and dangerous than WLS, it's even a good thing... as always, if used judiciously for the patient's sake, not wildly in the water supply in the fever dreams of Wall Street.

What if they took the two years in a REAL data-driven program using a glucose meter. Then, taper them off the drug? The article makes it sound like none of THAT is happening.
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  #14   ^
Old Thu, Jul-21-22, 06:46
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JLx JLx is offline
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But look at how many people don't stick to low carb. Are the many, many people who are no longer posting here all out there enjoying their low-carb diets and keeping weight off? Somehow I doubt it. And speaking of enjoyment, VLC is not an enjoyable diet for me at all. I asked one of my doctors once, why low carb wasn't talked about more for diabetics, and he said, "Because people don't stick to it".

I wonder if this drug is similar to how I felt on Metform when I first went on it. It was clearly an appetite suppressant in the beginning. So much so that when I had to go off it for two days to have a CT scan, I noticed the difference! Then that effect faded over time. I asked my pharmacist about that when we were chatting one day and he said that is a common experience.

Rather than surgery, I could see trying this drug at times in my past, times of utter despair over my inability to simply eat as I intended. But if it means being on a drug for life - well, that's questionable. Someone in that article compared it to high blood pressure medication which is actually a good comparison because some people can often get off them with other lifestyle changes - which should be the goal.

If this drug enabled people to lose a lot of weight and feel better as a result, that alone may be motivating. But I also see that it might not. But saying it encouraged yo-yo dieting seems misguided as that is what people are doing now.

Krista Varady, for those who may not recognize her name, is the Intermittent Fasting Researcher who influenced the 5:2 Diet book. When it was so successful, she rushed out her own book which did not impress me, iirc, beyond the basic concept of IF. Food plans that included Pop-tarts, for instance.
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  #15   ^
Old Thu, Jul-21-22, 10:36
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WereBear WereBear is offline
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I see myself as one of those people for whom VLC works. But there's some moderate carb programs that work quite well for other people. I think the important thing the drug could do is give someone a space where they could figure out lifestyle changes. Which would let them taper off the drug.

To me, the biggest problem is people who would rather take a pill than change their lifestyle. Even though these don't work the same way.
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