My hot take on these GLP-1 drugs is that they won't work long term for most people. If the plan is to give the drug to as many obese people as possible and take a victory lap, thats going to fail.
I don't think its resonable for most people to continue taking GLP-1 antagonists all their lives. Its been widely shown that most people rapdily gain back ~2/3 of their weight after stopping semaglutide. This means that the people who lost weight did not build sustainable weight management habits during their time on these drugs.
IMHO a better solution would be to design individualized weight loss programs which would help people build sustainable healthy eating habits, and change their relationship to food while using GLP-1 as a tool to help the process and motivate people. I understand that is much easier said than done, especially at such a large scale.
Maybe the answer lies in a combination of various actions, some ideas include,
- Medicare and Medicaid negotiating to reduce the cost
- Possibly offering lower/higher dosages based on needs to better manage cost
- Offering incentives/discounts when GLP-1 is used in-combination with health coaching.
- Offering GLP-1 drugs with lifetime maximums similar to Orthodontic procedures such as braces or clear aligners, with some exceptions based on medical needs.
- Reduce food deserts, especially in rural and low income areas.
- Penalize companies which sell seriously addictive / unhealthy foods. We did that with Cigarettes! Unhealthy diets filled with addictive sugary processed foods cause similar harm to families, society, and future generations.
> I don't think its resonable for people to continue taking GLP-1 antagonists all their lives.
Why not? People take statins or beta blockers for the rest of their lives. Sure it's not that feasible at current US prices but they won't be that expensive forever.
While I 100% agree that GLP-1 antagonists won’t lead most to making actual changes to their behaviors with food outside of forcing them to not over-eat when actively taking the drug, I am not so sure about your hot take here.
A woman I know has been on this stuff for a couple years now and while she has plateaued for about 6 months, her current weight is now in a healthier spot.
It’s crazy what losing some weight can do to people’s mental health too. Like her home is more organized, she’s more active with walking (doesn’t hurt anymore), she just overall describes not fearing food anymore.
And now for the bad news, her insurance no longer covers it. It’s kind of insane but apparently this stuff has a black market, like she buys it from one of her coworkers like it’s some sort of street drug.
In summary I think we need more time to see but from what I’ve heard this does seem to be a long-term solution similar to insulin shots if you had to compare to something existing.
I agree that obesity can be a chronic condition for many people, especially when combined with societal pressures causing mental harm.
> And now for the bad news, her insurance no longer covers it.
This is one of the reasons why I think these GLP-1 drugs are going to be classified by insurance as a temporary tool to help people improve their health. Rather than a long term medical necessity like insulin.
> I think we need more time to see
I agree with this statement, we definitely need more time. We don't fully understand the long term effects of GLP-1 in large populations.
I'm in the camp of, if its possible to use GLP-1 as a ramp to building sustainable habits and then wean off the drug, then as many people as possible should be weaned off.
There is also a nexus with the reward system of the brain in general, and semaglutide definitely seems to have effects similar to ADHD medication in these respects. It also seems to help alcoholism for the same reasons - it helps reduce the underlying dysregulation in the reward system that keeps people in that loop.
Probably this will be the next patent-ever greening strategy pursued after the weight loss thing.
It’s an absolutely wild drug in medical terms. “The white whale” is an understatement here. It literally is a white whale for multiple whole fields of medical science.
Speaking of the effect in the brain, a rare but real side effect in many people is anxiety to the point where they have to discontinue the med. I wonder why.
I don't think its resonable for most people to continue taking GLP-1 antagonists all their lives. Its been widely shown that most people rapdily gain back ~2/3 of their weight after stopping semaglutide. This means that the people who lost weight did not build sustainable weight management habits during their time on these drugs.
IMHO a better solution would be to design individualized weight loss programs which would help people build sustainable healthy eating habits, and change their relationship to food while using GLP-1 as a tool to help the process and motivate people. I understand that is much easier said than done, especially at such a large scale.
Maybe the answer lies in a combination of various actions, some ideas include,
- Medicare and Medicaid negotiating to reduce the cost
- Possibly offering lower/higher dosages based on needs to better manage cost
- Offering incentives/discounts when GLP-1 is used in-combination with health coaching.
- Offering GLP-1 drugs with lifetime maximums similar to Orthodontic procedures such as braces or clear aligners, with some exceptions based on medical needs.
- Reduce food deserts, especially in rural and low income areas.
- Penalize companies which sell seriously addictive / unhealthy foods. We did that with Cigarettes! Unhealthy diets filled with addictive sugary processed foods cause similar harm to families, society, and future generations.