The Global Obesity Epidemic

[Ron Obvious]

I'm a dye-in-the-wool skeptic and thus a Marxist.

Dear oh dear.

 

[Puppycow]

The other bit of good news is that people who quit semiglutide - 50% keep the weight off.

I was wondering about this. I found maybe some mixed results.

I don't know if this is the study you are referring to:

Many Patients Maintain Weight Loss a Year After Stopping Semaglutide and Liraglutide

Key Findings

• More than half of patients are able to maintain weight loss achieved while on semaglutide or liraglutide even a year after discontinuing the medication.
• However, a portion of patients who stop taking either medication experience weight regain, with 18.7% of liraglutide users and 17.7% of semaglutide users regaining all the weight they had lost or more.

But also I found this:
Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension

Conclusions: One year after withdrawal of once-weekly subcutaneous semaglutide 2.4 mg and lifestyle intervention, participants regained two-thirds of their prior weight loss, with similar changes in cardiometabolic variables. Findings confirm the chronicity of obesity and suggest ongoing treatment is required to maintain improvements in weight and health.

Neither of the studies is really long term. It's about one year after people stop taking it. Two years, 3 years, 5 years later, who knows?

 

[macdoc]

More positive effects

PEOPLE ON OZEMPIC FIND THAT THEY'RE DRINKING AND SMOKING LESS TOO
"IT WAS TOTALLY OPPOSITE OF WHEN I TRIED TO QUIT IN MY PREVIOUS YEARS."

https://futurism.com/neoscope/ozempic-drinking-smoking-less

snip

Case in point, in a new survey from the investment firm Morgan Stanley, which was shared with CNBC and Quartz, respondents on those drugs — collectively known as glucagon-like peptide-1 (GLP-1) agonists — also reported lower rates of smoking and alcohol consumption, suggesting that these drugs' craving control mechanisms extend beyond food.

That's the heart of it. The drug costs peanuts to make so there is no reason not to stay on it long term.
On the Australian PBS an Ozempic Pen costs $6.70

 

[Puppycow]

‘Enormous potential’: weight-loss drugs cut cancer risk by a fifth, research shows

Blockbuster injections such as Wegovy have revolutionised the treatment of obesity, and recently been approved for use in other areas of medicine, including reducing the risk of heart attacks, strokes and cardiovascular-related deaths.

Now experts say they increasingly believe weight-loss drugs could play a big role in preventing and treating cancer, the second leading cause of deaths globally.

A study presented at the world’s largest cancer conference found patients taking the drugs were 19% less likely to develop 13 obesity-related cancers, including ovarian, liver, colorectal, pancreatic, bowel and breast cancer.

The research involving 34,000 people, led by the Case Western Reserve University in Ohio, also found patients were half as likely to die over 15 years compared with patients not taking the jabs, also known as GLP-1 receptor agonists (RA).

 

[bigred]

The simplest explanation for obesity — too many calories in and too few calories spent — isn’t as exciting or exotic as some of the unproven ideas out there, which may explain in part why it’s so doggedly ignored. But there’s another reason for its relative unpopularity: Researchers want to avoid blaming and shaming

Yeah, God forbid we ask or expect personal accountability from people...that's so yesterday. Instead, pat them on the head and give them new drugs that they can use a super-sized pepsi to wash down (along with a Big Mac and "biggie" fries)

 

[macdoc]

new drugs that they can use a super-sized pepsi to wash down (along with a Big Mac and "biggie" fries)

That's NOT how it works .....last time I checked this was a science forum

 

[Puppycow]

That's NOT how it works .....last time I checked this was a science forum

Apparently big red doesn't really believe that "all lives matter"

 

[The Atheist]

Apparently big red doesn't really believe that "all lives matter"

They clearly don't or we wouldn't have a world where millions die of malnutrition at the same time as millions dying of obesity-related illness.

 

[angrysoba]

They clearly don't or we wouldn't have a world where millions die of malnutrition at the same time as millions dying of obesity-related illness.

Obesity is a form of malnutrition.

But let me guess, you think that obese people are actually hoarding the food that could be given to Bob Geldof in the 1980s and are upset about them being very fat and grotesque.

Here's the thing. We now have a far more reliable method of stopping the thing you hate so much, but apparently it doesn't sufficiently lean into the right morality that you insist on, so you and Big Red are somehow against it.

This, to me, is a pretty grotesque form of moralizing.

 

[Darat]

New research from the Raffan Lab has found that a genetic mutation in a quarter of all Labrador retriever dogs makes them more prone to obesity. This mutation, in a gene called POMC, plays a major role in hunger and energy use, and means that dog owners must be particularly strict with feeding and exercising their Labradors to keep them slim.

 

[bigred]

That's NOT how it works .....last time I checked this was a science forum

No idea what you're talking about, but I'm betting you get that a lot

Apparently big red doesn't really believe that "all lives matter"

And again...

Apparently your reading comprehension is lacking

 

[dann]

Ultraprocessed Foods (Science-Based Medicine, June 12, 2024)

The problem with the concept when used in studies.

 

[macdoc]

swwwisssh...

No one on Ozempic would binge on anything let alone fast food.....they would not be interested....something you just don't get.
You get a third of the way through eg a big mac and you just toss the rest. You know that so you don't bother.

The people surveyed said they cut back the most on foods that are high in sugar and fat, reducing their consumption of sweets, sugary drinks and baked goods by up to two-thirds. The survey found 77% of people on weight loss drugs went to fast food restaurants less often, while 74% reduced their visits to pizza shops.7 Oct 2023

 

[Skeptical Greg]

Ultraprocessed Foods (Science-Based Medicine, June 12, 2024)

The problem with the concept when used in studies.

From your link:

In this data set consumption of upf was associated with lower income, lower educational level, living alone, higher BMI and lower physical activity. These are all features that increase the risk of all-cause mortality.

How did they get to higher BMI? Ultraprocessed foods?

Correlation or causation? It's a vicious circle.

We need a study with people who maintain an acceptable BMI.

One group heavy on the ultraprocessed. The other group not so much.

Not going to happen though..

 

[dann]

This, to me, is a pretty grotesque form of moralizing.

Indeed!
I've never been obese or even overweight. I stop eating when I'm no longer hungry. If I wanted to moralize, I could look down on people whose appetite regulation doesn't work the way mine does (for whatever reason), but the point of obesity for most of them appears to be that they don't stop feeling hungry (again: for whatever reason).

I don't do anything (deliberately) to not feel hungry when I have had enough to eat. I don't have to deny myself anything food-wise to stay slim. (And I don't live in a food desert.) I am pretty sure that if it didn't work that way for me, I would be overweight or obese. And in that case, I would appreciate medication that made me stop feeling hungry when I had 'had my fill', which appears to be what Wegovy or Ozempic does.

Would I become obese if I stopped exercising, which seems to be connected to appetite regulation? It's possible. I don't know. The reason why I don't stop exercising isn't that I fear what might happen if I didn't. I enjoy taking long walks in the park and/or nature, riding a bike, dancing salsa, and I have plenty of opportunities to do so. (Even though the pandemic put a stop to my doing the latter indoors, but it's summer now, and there are more than enough opportunities outdoors.)
Not everybody has those or similar opportunities. They should.

As it is, I appreciate both my natural (?) appetite regulation and the opportunity for people who don't have it, whether due to nature or nurture, to get medication that works for them. For their sake (and for the sake of people who can't afford it), I wish it were cheaper and available to everybody who needs it.

For their sake, I also wish the moralizers would stop moralizing, but moralizers gonna moralize, and I don't think there'll be a pill for their attitude problem anytime soon.

 

[dann]

From your link:


How did they get to higher BMI? Ultraprocessed foods?
Correlation or causation? It's a vicious circle.
We need a study with people who maintain an acceptable BMI.
One group heavy on the ultraprocessed. The other group not so much.
Not going to happen though..

Studies have been made. However, the problem with any such study is the definition of, in this case, upf. I agree with Steven Novella that the list of ingredients and additives is what's important and a much more unambiguous concept than upf.

Not surprising, but 'removing' (i.e. limiting access to) one ingredient appears to have an impact:

Findings In this cohort study of 6313 children living in Seattle or a nearby comparison area, a statistically significant reduction in BMI was observed for children in Seattle after the implementation of a sweetened beverage tax compared with well-matched children living in nontaxed comparison areas.

Meaning These results suggest that the sweetened beverage tax in Seattle may be associated with a small but reasonable reduction in BMI among children living within the Seattle city limits.
Sweetened Beverage Tax Implementation and Change in Body Mass Index Among Children in Seattle (JAMA, May 29, 2024)

 

[dann]

New research from the Raffan Lab has found that a genetic mutation in a quarter of all Labrador retriever dogs makes them more prone to obesity. This mutation, in a gene called POMC, plays a major role in hunger and energy use, and means that dog owners must be particularly strict with feeding and exercising their Labradors to keep them slim.

In the case of dogs, the genetic problem could be solved by breeders: Eliminate the mutation from the gene pool.

 

[The Atheist]

Obesity is a form of malnutrition.

Disingenuous to say the least.

Fat ***** aren't starving to death, they're eating themselves to death - quite an important difference from kids screaming in pain from hunger.

But let me guess, you think that obese people are actually hoarding the food that could be given to Bob Geldof in the 1980s and are upset about them being very fat and grotesque.

That's truly pathetic and 100% stupid. I said nothing about redistribution of food and I don't give a rat's arse what people look like. One of my favourite singers is the fattest, ugliest chick I ever saw: Beth Ditto.

The only time I bitch about fat ***** is when, like the late and unlamented Cat Pause, they try to sell fat as a viable life choice.

Here's the thing. We now have a far more reliable method of stopping the thing you hate so much, but apparently it doesn't sufficiently lean into the right morality that you insist on, so you and Big Red are somehow against it.

Sheesh, if you had any more straw you could feed a couple of farms. I made no comment about morality and you assuming I hate fat people is knee-jerk bollocks.

This, to me, is a pretty grotesque form of moralizing.

I made an observation which is 100% correct. We live in a world where some people starve to death. If people cared, it wouldn't happen.

The question was if "all lives matter" and they clearly don't.

You can hop down off that horse now before the lack of oxygen kicks in.

 

[dann]

I guess "fat *****" is supposed to be a term of endearment.

 

[The Atheist]

I guess "fat *****" is supposed to be a term of endearment.

I do realise that your ESL English skill is exacerbated by a total lack of knowledge of Kiwi English.

 

[angrysoba]

Disingenuous to say the least.

Fat ***** aren't starving to death, they're eating themselves to death - quite an important difference from kids screaming in pain from hunger.



That's truly pathetic and 100% stupid. I said nothing about redistribution of food and I don't give a rat's arse what people look like. One of my favourite singers is the fattest, ugliest chick I ever saw: Beth Ditto.

The only time I bitch about fat ***** is when, like the late and unlamented Cat Pause, they try to sell fat as a viable life choice.



Sheesh, if you had any more straw you could feed a couple of farms. I made no comment about morality and you assuming I hate fat people is knee-jerk bollocks.



I made an observation which is 100% correct. We live in a world where some people starve to death. If people cared, it wouldn't happen.

The question was if "all lives matter" and they clearly don't.

You can hop down off that horse now before the lack of oxygen kicks in.

Why do I assume you hate fat *****? You have called for them to be euthanized in the past.

But if you are not talking about food redistribution, then what has one issue (obesity) to do with the other you raised (starvation)? If nothing, then why do you post off-topic rantings?

 

[The Atheist]

Why do I assume you hate fat *****? You have called for them to be euthanized in the past.

I think you're confusing them with old people, who I'd definitely cull.

If you think you have evidence to the contrary, be my guest.

But if you are not talking about food redistribution, then what has one issue (obesity) to do with the other you raised (starvation)?

I like the irony.

 

[Skeptical Greg]

Obesity is a form of malnutrition.

Disingenuous to say the least.

I think angrysoba may be referring to this:

Malnutrition in Obesity: Is It Possible?

Malnutrition is a state of the body in which due to insufficient supply or incorrect absorption of essential nutrients, the body composition changes and the body's functions are impaired. Malnutrition is associated not only with reduced body mass index but also with obesity.

and...

Obesity is defined as a paradoxical state of malnutrition, which despite excessive energy consumption is associated with a shortage of individual microelements. Deficiency or lack of homeostasis of essential micronutrients can significantly affect daily performance, intellectual and emotional state, but also the physical state of the body.

Ultra processed foods raise their ugly head again.

Here is another article I found interesting/informative:
A lot to slug through, but an informative look at the economic angle.

Obesity as Malnutrition: The Role of Capitalism in the Obesity Global Epidemic



Obesity in Ethiopia? No way!

 

[Orphia Nay]

From Stephen Barrett’s newsletter:

Patients commonly discontinue semaglutide weight-loss treatment

An analysis of nationally representative, commercial insurance data has found while prescriptions of semaglutide drugs for weight management have increased exponentially, many patients discontinued the drugs before achieving clinically meaningful weight loss. [Real-world trends in GLP-1 treatment persistence and prescribing for weight management. Blue Health Intelligencer Issue Brief, May 2024 https://www.bcbs.com/sites/default/files/BHI_Issue_Brief_GLP1_Trends.pdf ] Key findings include:

about half the patients who received prescriptions stayed on treatment for a minimum of 12 weeks, enough time to achieve clinically meaningful weight loss
30% of patients discontinued treatment within four weeks, before reaching the targeted dose
patients aged 35 and older were more likely to stay on GLP-1 treatment for at least 12 weeks
patients who regularly visited their healthcare providers were more likely to stay on the drugs
The report notes that almost all new users of the drugs suffer some gastrointestinal side effects. Patients often stop treatment due to difficulty coping with vomiting, nausea, and diarrhea.

===

 

[angrysoba]

Do we know if the ‘benefits of Ozempic’ are because of the drug, rather than because of the weight loss?

This podcast is a little (too) long, but they do go into a paper on kidney disease in which they find that it is likely the drug is protective of kidney health even in cases where there is little weight loss (such as for treating diabetes).

They also cover a lot of other questions about the drugs essentially arguing that in many cases these should be available to more people. The price of the drugs is exorbitant in places like the US and inexcusably so, in their opinion, given that it produced for a far lower price.

Link

 

[angrysoba]

From Stephen Barrett’s newsletter:

Patients commonly discontinue semaglutide weight-loss treatment

An analysis of nationally representative, commercial insurance data has found while prescriptions of semaglutide drugs for weight management have increased exponentially, many patients discontinued the drugs before achieving clinically meaningful weight loss. [Real-world trends in GLP-1 treatment persistence and prescribing for weight management. Blue Health Intelligencer Issue Brief, May 2024 https://www.bcbs.com/sites/default/files/BHI_Issue_Brief_GLP1_Trends.pdf ] Key findings include:

about half the patients who received prescriptions stayed on treatment for a minimum of 12 weeks, enough time to achieve clinically meaningful weight loss
30% of patients discontinued treatment within four weeks, before reaching the targeted dose
patients aged 35 and older were more likely to stay on GLP-1 treatment for at least 12 weeks
patients who regularly visited their healthcare providers were more likely to stay on the drugs
The report notes that almost all new users of the drugs suffer some gastrointestinal side effects. Patients often stop treatment due to difficulty coping with vomiting, nausea, and diarrhea.

===

How did you get the newsletter? I looked around to see what I could find regarding this study. The way it's presented here sounds very negative. People get on the medication, feel sick and mostly give up.

But looking at the report, it seems to confirm that the drugs are very effective, but that there are certain barriers to getting it, including the side effects that make people give up before the benefits are apparent.

However, some of the benefits are mentioned in the report...

GLP-1s are game changers. The first licensed GLP-1 for weight loss, a daily formulation, liraglutide (Saxenda®),
resulted in a 5% weight loss for most people who used it during clinical trials. This level of weight loss is clinically
significant and has measurable effects on conditions associated with obesity.6,7 Some of the GLP-1-type drugs
that are now in the late phases of development can help people lose in excess of 25% of their starting body
weight, rivaling the amount of weight loss achieved after most bariatric surgeries.
Even at modest levels of sustained weight loss (5% or more for people that meet threshold GLP-1 therapy-eligible
body mass index (BMI) numbers), there are significant benefits to their health and well-being. Health conditions
related to obesity, such as diabetes, hypertension, heart disease, stroke, liver disease, sleep apnea, and increased
wear and tear on joints are improved. For example, in a trial of 529 people with obesity and heart failure, people
who were on the GLP-1 semaglutide (Wegovy®) had nearly double the improvement in symptoms as measured on
a standard heart failure questionnaire after one year when compared to people that were treated in the standard
way.11 In another large study, the Semaglutide Effects on Cardiovascular Outcomes in People with Overweight
or Obesity (SELECT) trial, people with both excess weight and cardiovascular disease who took semaglutide
(Wegovy®) had a 20% lower risk of heart attacks and strokes than those on placebo.12

Link

 

[Orphia Nay]

I’m subscribed to the newsletter.

I think Ozempic etc is a great invention, but I don’t think it’s perfect. The cut and paste I did from the newsletter was just presenting facts from both sides of the debate.

I think the fact that “about half the patients who received prescriptions stayed on treatment for a minimum of 12 weeks, enough time to achieve clinically meaningful weight loss” says a lot.

I don’t think it’s a perfect drug, but it’s a really great tool in the weight loss drawer, if you’re not affected by the side effects.

 

[dann]

Scary story about Ozempic!
Patients on Ozempic are developing a new form of sudden blindness, say doctors (BusinessInsider/MSN.com, July 3, 2024)

As in many such stories, the title makes it sound more dramatic than it actually is, but still ...
A more informative title would have been: Some patients, not very many but more than you would expect in a similar group of people, have lost their eyesight, according to doctors

* A new study suggests people on Ozempic or Wegovy may be more likely to suddenly go blind.
* The condition, called NAION, is still exceedingly rare. It's also painless and untreatable.
* Blood-sugar issues can affect our vision.
(...)
Out of more than 16,000 eye patients in Massachusetts included in this six-year retrospective investigation, only 37 people on semaglutide developed NAION [nonarteritic anterior ischemic optic neuropathy]. But that was still more than four times as many eye problems as those experienced by similar patients who were not on the drugs over the same time period.

I doubt that it feels like only if you happen to be one of the 37 and Ozempic turns out to actually have been the cause.

Key Points
Question Are prescriptions for semaglutide associated with an increased risk of nonarteritic anterior ischemic optic neuropathy (NAION) in patients with type 2 diabetes or patients who are overweight or obese?
Findings This matched cohort study of 16 827 patients revealed higher risk of NAION in patients prescribed semaglutide compared with patients prescribed non–glucagon-like peptide receptor agonist medications for diabetes or obesity.
Meaning The findings suggest a potential risk of NAION associated with prescriptions for semaglutide, but future study is required to assess causality.
Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide (JAMA Network, July 3, 2024)

 

[The Atheist]

Someone in Alabama has out-Onioned The Onion, with a massive troll about fat chicks.

Clever person with unknown "Miss Alabama" brand goes for a contest set up so a chick who could only be described as morbidly obese would win it.

https://www.eonline.com/news/1403246/miss-alabama-sara-milliken-claps-back-at-body-shamers

Snopes already has the true story, but a large portion of the internet has lost its marbles - and lunch, apparently - over the winner. Some very funny posts here and there.

 

[Skeptical Greg]

This bit has been making the rounds lately.

Millennials and Gen Xers face higher risk of 17 cancers than previous generations, study suggests

In about the middle of the article we see:

The researchers found that 10 of the 17 cancers with increasing incidence in younger birth cohorts are related to obesity.

And

As cancer requires time to develop, an obesity-related cancer in a young adult could be associated with their childhood health.

Just more affirmation of what we know is a serious problem.

 

[dann]

Apropos:

Conclusions and Relevance In this cohort study, SSB excise taxes were associated with lower BMI percentile among youth. Policymakers should consider implementing SSB excise taxes to prevent or reduce youth overweight and obesity and, ultimately, chronic disease, particularly among children younger than 12 years.
City-Level Sugar-Sweetened Beverage Taxes and Youth Body Mass Index Percentile (JAMA Network, Juli 31, 2024)

 

[Puppycow]

Couldn't hurt. Looks like they only looked at children younger than 12, but I wonder if the benefits might be even broader and include older children and adults. It doesn't make a huge difference, but I wouldn't have expected it to.

 

[dann]

Exclusive: Most patients stop using Wegovy, Ozempic for weight loss within two years (Reuters, July 10, 2024)

Not in itself a bad thing, particularly if it's because they've slimmed down and have started exercising. If it's because of side effects or lack of insurance coverage, it's not so good, especially not if the the increased risk of strokes and heart attacks in the obese returns.

 

[dann]

Jim Gaffigan on Jimmy Kimmel Live:

0:44--> I have lost some weight, and I've done it the old-fashioned way, which is sticking a shot in my stomach. There has been no effort, no self-control, no sweating. It's the most American thing you could do: Stick some of that Big Farmer--> Big Pharma right in and look better in the morning. (...)
I love how people are, like, uh, like all secretive about it. Like, they don't, it's like, what's the big deal? It's like, 'Oh, I'm I freely, oh, I'm embarrassed to admit I'm taking something that's going to allow me to live longer'. What's the big deal? It's like, 'Now my knees don't hurt and I'm, you know, I don't have diabetes'. What's the negative?!
Jim Gaffigan on Playing Tim Walz on SNL, Getting Skinny & Meeting the Pope with a Bunch of Comedians (YouTube, Nov 22, 2024)

It sounds almost like a commercial for the new weight-loss drugs, but I think it's great that he stresses how will power has nothing to do with it. The drugs don't strengthen people's will power, they. just give them (back?) the kind of appetite regulation that some of us have the natural way, without drugs.
Self-control has nothing to do with it, and this should shut up fat-shamers like Bill Maher, but it obviously won't.

 

[Skeptical Greg]

Why eat healthy when all you have to do is take a pill?

Great, if you can afford the pill.

( I suspect most of the victims of the Global Obesity Epidemic cant afford or have access to the pill.. )

 

[dann]

There are other reasons in addition to weight loss why avoiding things like trans fats and sugar is better for you.
At least in Denmark, doctors recommend both exercise and healthy diets to obese patients. I think they do in most countries.
Novo Nordisk recommends that exercise and a healthy diet should accompany the use of their drugs, whether used to lose weight or for diabetes.
As for the affordability of weight-loss drugs, help may be on the way:
Biden proposes Medicare and Medicaid cover costly weight-loss drugs for millions of obese Americans (AP, Nov 26, 2024)

RFK Jr Gets Hit by Massive Surprise Announcement with Biden's Ozempic Plans (The Damage Report on YouTube, Nov 28, 2024)
Biden announces proposal to have certain weight loss drugs, such as Ozempic, be covered by Medicaid and Medicare, which is likely to trigger fight from RFK Jr who has openly condemned Ozempic in favor of eating healthier. Yasmin Kahn and Sharon Reed break it down on The Damage Report.

 

[The Don]

Why eat healthy when all you have to do is take a pill?

Great, if you can afford the pill.

( I suspect most of the victims of the Global Obesity Epidemic cant afford or have access to the pill.. )

A friend has lost well over 60kg this year thanks to weight loss drugs. His appetite has been successfully suppressed for several months.

My fear is that once he's off the drugs, his appetite will return to its previous level and the weight will pile back on.

 

[angrysoba]

A friend has lost well over 60kg this year thanks to weight loss drugs. His appetite has been successfully suppressed for several months.

My fear is that once he's off the drugs, his appetite will return to its previous level and the weight will pile back on.

The Don, Sure, but my guess is that he would not have lost 60 kgs otherwise.

This is what is, to my mind, infuriating about the anti-Ozempic argument which emphasizes strategies which have proven not to work.

Now, for me, if I want to lose some weight and get fit, it might be a matter of just cutting back on booze and running a bit more each week. I can do that no problem.

But there is a reason why some people end up overweight by 60kgs and it is not simply a matter of lacking in moral fibre. Someone like that clearly has a much greater desire and compulsion to eat more than I can ever imagine wanting to eat.

This next bit is NOT aimed at the Don,

As for the idea that the poor won't be able to afford such pills, the problem is that in rich countries it is often the poor who need them most. And frankly, it is likely that the poor will save health services money by not being chronically ill with obesity-related illnesses.

Why oh why is it that when someone says, "We must do something to fix this!" and someone comes up with an absolute proven solution, the same person will then say, "No, I want it to be harder to solve than that, and based on things that are not working right now, anyway."

Look, fer Chrisssakes! Forget the crap that RFK and crunchy granola hippies like to spout about seed oils and artificial colours being the big problem.

The problem is this: highly palatable calorie-dense food that is so cheap that anyone can afford it in large quantities. In some way, this is a good thing. We used to all be dying of starvation and famines. Now, no problem with that in rich countries. But the trade-off is very fat people. You don't like to see fat people, so give them this stuff that will stop them needing that food.

 

[The Don]

He absolutely wouldn't have lost weight without the drugs.

In the case of my friend, he readily admits that the excess weight has been acquired over 20+ years due to an over-fondness for food and a lack of exercise (initially because he didn't like it, later because his knees and back hurt too much).

Unless he takes the drugs forever, there is a real risk that the weight loss will be temporary.

 

[dann]

The Don, Sure, but my guess is that he would not have lost 60 kgs otherwise.

This is what is, to my mind, infuriating about the anti-Ozempic argument which emphasizes strategies which have proven not to work.
Now, for me, if I want to lose some weight and get fit, it might be a matter of just cutting back on booze and running a bit more each week. I can do that no problem.
But there is a reason why some people end up overweight by 60kgs and it is not simply a matter of lacking in moral fibre. Someone like that clearly has a much greater desire and compulsion to eat more than I can ever imagine wanting to eat.
This next bit is NOT aimed at the Don,

As for the idea that the poor won't be able to afford such pills, the problem is that in rich countries it is often the poor who need them most. And frankly, it is likely that the poor will save health services money by not being chronically ill with obesity-related illnesses.

Why oh why is it that when someone says, "We must do something to fix this!" and someone comes up with an absolute proven solution, the same person will then say, "No, I want it to be harder to solve than that, and based on things that are not working right now, anyway."

Look, fer Chrisssakes! Forget the crap that RFK and crunchy granola hippies like to spout about seed oils and artificial colours being the big problem.

The problem is this: highly palatable calorie-dense food that is so cheap that anyone can afford it in large quantities. In some way, this is a good thing. We used to all be dying of starvation and famines. Now, no problem with that in rich countries. But the trade-off is very fat people. You don't like to see fat people, so give them this stuff that will stop them needing that food.

I don't think you see the contradiction! The accessibility of highly palatable calorie-dense food is actually good in every way. The problem is that the highly palatable calorie-dense food that poor people can afford without having to spend too much of their spare time shopping and cooking it is the ultra-processed kind of inferior quality. That's why rich people are usually in much better shape than poor people even though they would be able to buy much more of the ultra-processed highly palatable calorie dense food of inferior quality than poor people. They don't because they can afford the healthy alternative. (Trump is an outlier in this respect.)

Apart from the cheap food of inferior quality, the major problem is the appetite regulation of (some) people. That's why Ozempic works. Some of us don't have the problem. Our appetite regulation works, so we don't need weight-loss drugs to stay slim - in spite of the abundance and accessibility of calorie-dense food.
The big question is why the appetite regulation of some people doesn't work the way nature intended. Exercise seems to plays an important role even though it's often insufficient once people have become obese. I have mentioned several times that infrastructure is a problem in this respect. In countries that encourage people to exercise more by means of nudging, people tend to be slimmer than in countries that don't do this. The point seems to be that exercise helps regulate appetite. The point isn't that exercise burns calories because it's not particularly good at that, recent studies show:

Exercising to lose weight? Science says it rarely works. (WaPo, Nov 27, 2024)
When Herman Pontzer began studying the metabolisms of the Hadza, a tribe of modern hunter-gatherers in Tanzania, for a 2012 study, he assumed they’d be incinerating calories like a furnace. They were in almost constant motion — walking, jogging, tugging and lifting all day long.
But when he and his colleagues compared the Hadza’s typical daily energy expenditure, controlled for body size, with that of your average couch potato office worker back in the United States, the totals were nearly identical.

Apparently, exercise doesn't work as well for slimming down as it does for staying slim and not get fat. It remains to be seen if exercise will help people stay slim, i.e. get it back to 'default mode' (if there is such a thing), once they have slimmed down by means of weight-loss drugs.
As for the price of those drugs, they will probably get cheaper when more companies begin to supply them. There are several products based on the principle of appetite regulation on the way. Eli Lilly claims that its new drug is even better than Novo Nordisk's Wegovy.