Regime Change: the weight loss drugs

“Imagine if there were a pill you could take to be able to eat whatever you wanted and not gain weight!”

Throughout my life, this was The Impossible Dream!

For a long time, obesity, or just…noticeable chubbiness was a rural vs. urban thing in our country. Where I grew up, everybody filled out as they got older. Only some little kids were skinny. We used to joke that with the adults, you could figger out their age by counting the rings (Y’know, like with trees…..:joy::joy::joy:) I suffered terribly when I went away to school and found out that female adolescents weren’t s’posed to look like that, in fact it was risible. And ugly.

Maybe what, 5-6 years ago?— as we’ve discussed here before, we reached the exact opposite of that situation: “ body positivity”, which in practice meant the girls (and lotsa the young men) all got huge. In wedding photos the bride looked like the Pillsbury dough boy! In beach photos the bathing beauties looked like a buncha manatees. And they were told it was great, they were beautiful, healthy, Oh and woe to anybody who commented about it: this was now “body-shaming” and it was every bit as despicable as racism!

(I’ll leave aside for the moment the absolutely unprecedented situation we live in, where our biggest worry is accidentally ingesting too many calories rather than not getting enough. What other society ever experienced that, at ALL economic classes?)

About a year ago I began noticing, with relief, that the girls were slimming down again. Thank God! Because, no: fat is not healthy: I looked at these maidens in their ponderous pulchritude and saw knee and hip replacements and obesity-onset diabetes in their futures.

I think the unchecked obesity craze started with concerns about anorexia, and morphed into an all-in endorsement of gluttony! Oh yes. You don’t get THAT fat without a LOT of binge eating. I have been there. (As for the “fat is beautiful!” aspect of it, I admit I kinda envied that, feeling like I was born too early.)

I’ve struggled all my life with this. I have been 20 lbs thinner, and I’ve been 35 pounds fatter, than I am now. I’ve lost lotsa weight and gained it back, even though I was SOOOO much happier when I was thinner, I reveled in the secondary sexual gratification. I loved looking good in anything I wore. So why didn’t I GET thin and STAY thin? Well, eventually I kinda did, due to the pressure of life on the Philadelphia Main Line. It was a constant worry, though, a constant self-criticism. When I got pregnant, I immediately gained 12 lbs which I needn’t have gained, it was just such a relief to know that for awhile, being big would be a positive thing, people would admire it! I paid for that post-partum, my pregnancy 65 lbs gain was quickly sucked away by breastfeeding, EXCEPT for that last 12. That required work and discipline, but I was good at that, having done it dozens of times.

Eternal vigilance was the price of freedom (from the discomforts of obesity and the social opprobrium.) So now, when it appears that we HAVE that magical nostrum, I am BITTER! These people are getting slenderness for FREE! something I have always had to work at, pleased with me when I succeeded, absolutely despising myself when I lapsed!

It’s too good to be true, it hasta be! I asked my BMD, surely there must be long-term effects of these new drugs that we just don’t know about yet? These lazy young fools are like the Geishas who whitened their faces with lead-based powders and ended up with big lumpy tumors on their once-perfect cheeks, right? RIGHT???) Also, as of right now ( I think Trump is trying to change this) the drugs are expensive; I looked it up and one ad says Ozempic could be “as low as” $349 a month! And covered by Medicare/Medicaid only if prescribed for diabetes.

Also, they make you nauseated and give you diarrhea, AND, it’s “recommended” that you avoid sugar and fatty foods and alcohol.
Um ,yeah..who wants to eat a lot, with those symptoms, and with the prices of the ‘recommended” foods, like fresh fish, fresh fruits and vegetables ( it’s like an ad for Whole Foods.) And additionally, if you made those changes in diet, wouldncha likely lose weight anyway?

Anyway, it now seems pretty clear that all those celebrities who gained a ton and celebrated “body positivity” were just kidding. Or lying. Or making the best of a bad situation they’d gotten themselves into.

Now that it isn’t hard ( REALLY hard, requiring long-term self- discipline) to be slim, they’re ALL going for it! They’re expunging pictures of themselves in their former Reubensesque incarnations.

John Updike in his later years referred to himself so a “time traveler”. He meant that when you live long enough, you see metamorphoses in culture that you could never have imagined you’d see.

Tru dat, and so many of them, like the present resurgence of old-fashioned anti-semitism, are sad and terrifying.

THIS culture change is primarily…amusing. So far. Mos’ly. But I think I’ll stick to my “yo-yo” diet pattern.
It’s better than going straight up! And it may yet prove to be better, safer, SANER, than artificial pharmaceutical intervention.

(I can’t help hoping I’ll live to see that :squinting_face_with_tongue:!)

5 Likes

You will almost certainly see the users having to continue with these meds for LIFE - since it is already clear that stopping results in weighing even MORE than before starting!

8 Likes

Is it? I was wondering about that…it seems to be the sequel to ANY very substantial weight loss, even the eminently sensible Weight Watchers. People gain it all back and then some.To actually change your “set point” takes years not weeks or months.

2 Likes

It is very, very doubtful that these drugs have negligible negative impact on healthspan.

It seems fairly little changed in terms of healthspan science since John Walker added these to his reading list:

The only exception may be an excellent review book by Michael Rose with the results of some interesting recent experiments. These mostly confirm what Michael Rose was prescribing 15 years ago:

3 Likes

It’s worse than that. Some people regain the weight even while still on these drugs. The same goes for individuals who’ve had bariatric surgery. In both cases, the treatment does not change the way calories are absorbed or metabolized. It is still possible to consume excessive calories while on the medication or after having the stomach size reduced. Lifestyle change is required; these interventions only facilitate this but do not guarantee it.

Anecdotally, I can report that I know someone who had the surgery and is now as big as ever. Imagine someone on Ozempic who has to keep taking forever even after having regained most of the weight.

7 Likes

Oh God, the gastric band tragedy is another thing! I thought when people endured a lot of discomfort and effort to get something, that usually makes them happier with the result. Dissonance theory. People who got stomach surgery DID endure a major operation, there must’ve been pain and disability. And yet: yes! I’ve known people who got the op, lost weight—and then gained it all back by sipping milkshakes all day long.

Do they really WANt to do it? I mentioned that at various points I engaged in binge eating. WHY? i don’t know! It was not fun, it was not a matter of eating all I wanted of cake, ice cream, cookies. It was just, shoveling down a LOT of whatever was around. I hated me as I did it. And I KNEW how to eat “correctly”. And I knew I wouldn’t like the result. Looking back it was a compulsion. So I reckon I should, and upon reflection do, have a lot of fellow feeling for those milkshake sippers.
There is one aspect I can totes relate to: when you’re fat you’re…substantial. You’re takin’ up a lotta space in the world. It’s just a fact. Also, you keep warmer in winter. So maybe your body just …craves those things, even as your mind wants to look like a Vogue model (before body positivity).

I can’t see the logic in any of it. I had a friend who was really, really big. Definitely fat-lady size. And she lost a —well seemed like a ton. Just by controlling what she ate, maybe a slim-fast or 2, no drugs or anything. She looked great and everybody complimented her. But…well, you can guess. She told me, when she was on her way back up, that her son had asked: “ Mom—what are you DOING?” I figured this was my only chance to ask someone the same question, what was going through their minds as they ate themselves back to obesity?. I said, why do you think this is happening?

She said, “ Well, so many people were complimenting me, and they’d ask me how I lost so much weight, and they’d ask me to speak to their groups about it, and….that was a lot of PRESSURE!”

Well, yes, or a lot attention, which I always thought was the most effective behavioral reinforcement.

Idk maybe it’s just scary to change yourself that much. It’s a different thing from just gaining and losing 8 or so pounds.

5 Likes

Reminds me of that old joke.

How many psychiatrists does it take to change a light bulb?

One, but the lightbulb has to really want to change.

Weight control requires a person to acquire or recover a taste for healthier foods and to eschew unhealthy foods. Exercise helps a little but most people have neither the time nor the inclination to do enough to make much difference.

What are healthier foods? The evidence points in the direction of minimally-processed foods. Ultraprocessed foods are calorie-dense and engineered to make you want to eat more.

I lost weight during the Plague Year ((2020), without intending to, by skipping an evening glass of wine & dessert during the week and by cycling more than before. My motives were

  1. to not be drinking every day
  2. to reduce junk-food consumption
  3. to spend more time outdoors

While many people reported gaining weight during 2020, I lost 25 lbs. Now, I’m back to my fighting weight, i.e., what I weighed in my 20s: another 10 lbs lower.

6 Likes

I consider bariatric surgery for obesity, the equivalent of ligating the veins of IV drug addicts.

4 Likes

I have known people like that too. Is the desire for slimness just fashion? Think of the ladies shown in many medieval & renaissance paintings. The BBC once did a rather funny sketch with fat lady Dawn French stuffing herself before her session posing for a famous renaissance painter while commiserating with a slim lady (Helena Bonham-Carter) who was bemoaning the limited demand for models for paintings of plagues & famines.

There is a view that we are fighting nature in seeking year-round slimness. For most of human evolution, the breeding survivors where those who could pack on the pounds during the summer in order to survive inevitable starvation during the winter. Fructose in autumn fruits seems to have played a role in this large annual weight cycle – something which wild bears undergo even today.

Put that former evolutionary advantage together with the modern year-round access to food and fatness is inevitable – unless an individual practices severe self-discipline.

5 Likes

Well, congrats! I didn’t gain weight during Covid either. For one thing, the cancelation of Thanksgiving and Christmas meant a lot less feasting opportunity. And I’m lucky, I live remotely in the country, and really, my routine didn’t change much.

Your comment reminded me of an article I read somewhere, aimed at “preppers”. It pointed out the most important thing is being physically fit, not stockpiling canned goods. Tru dat. We’ll have to defend whatever stores we have. We’ll have to be prepared to move from place to place, probably on foot. And, if this weight loss drug trend continues, we’ll have to dodge hordes of “Ozempic-face” and “Ozempic feet” zombies! What is going to happen with those people if they have to stop,cold, can’t get their drug? Will their appetites return to a monstrous degree, so that we actually do have to worry about them eating us? No, @drlorentz , you’re doing the right thing: you’ll be in shape to outrun them (or at least to outrun many of your fellow citizens who never took the drugs, which amounts to the same thing) . Kudos!

5 Likes

What is the evidence for this? If the out-of-Africa model is correct, most of human evolution took place in warm, sometimes arid climates, e.g., tropical savanna. Diaspora into Mediterranean climates still does not imply especially harsh winters. Same goes for the Fertile Crescent. I don’t know enough about other models aside from out-of-Africa to comment but I’d guess hominin evolution relied upon easy ecologies. Perhaps resident anthropologist @Hypatia can shed more light on this.

2 Likes

It won’t be pretty. Word is that they gain more weight back than they lost.

Psychiatrist Hannah Spier had an informative interview with a physician who specializes in this area:

1 Like

“…early humans (referring to prehistoric Homo sapiens and earlier hominins during the Paleolithic era, roughly 2.6 million to about 12,000 years ago) were generally not fat or obese in the modern sense. Most evidence points to them being lean and muscular, adapted to a demanding hunter-gatherer lifestyle with high physical activity, inconsistent food availability, and diets that prevented widespread excess body fat.”

https://grok.com/c/481c4c40-ba9c-42c8-bd95-9d79e7d3367f

1 Like

Okay, after all I’ve learned today, I don’t even think these drugs should be legal, except for diabetes patients. It’s awful! Oh my God, our poor young people, SO pharmaceutically corrupted. And no end in sight. I do not take pill One, and I hope to get through the rest of my life that way.

1 Like

Because I couldn’t name every medical issue that is linked to obesity, I let the AI summarize.

Below is a comprehensive list of well-established medical conditions strongly linked to obesity, supported by major health organizations (WHO, CDC, NIH, American Heart Association, etc.) and large-scale meta-analyses.Cardiovascular Diseases

  • Coronary heart disease / ischemic heart disease

  • Heart failure

  • Hypertension (high blood pressure)

  • Stroke (both ischemic and hemorrhagic)

  • Atrial fibrillation

  • Peripheral artery disease

  • Venous thromboembolism (deep vein thrombosis and pulmonary embolism)

  • Aortic stenosis

Metabolic and Endocrine Disorders

  • Type 2 diabetes mellitus (strongest single association)

  • Prediabetes and insulin resistance

  • Metabolic syndrome

  • Dyslipidemia (high triglycerides, low HDL cholesterol)

  • Polycystic ovary syndrome (PCOS)

  • Hypogonadism in men (low testosterone)

Cancers (obesity is linked to increased risk of at least 13 cancers)

  • Endometrial (uterine) cancer

  • Post-menopausal breast cancer

  • Colorectal cancer

  • Kidney (renal cell) cancer

  • Liver cancer (hepatocellular carcinoma)

  • Pancreatic cancer

  • Ovarian cancer

  • Esophageal adenocarcinoma

  • Gastric cardia cancer

  • Gallbladder cancer

  • Thyroid cancer

  • Multiple myeloma

  • Meningioma

Gastrointestinal and Liver Diseases

  • Gallbladder disease / gallstones

  • Non-alcoholic fatty liver disease (NAFLD) → non-alcoholic steatohepatitis (NASH) → cirrhosis

  • Gastroesophageal reflux disease (GERD) and Barrett’s esophagus

  • Hiatal hernia

Respiratory Conditions

  • Obstructive sleep apnea (OSA) – extremely common

  • Obesity hypoventilation syndrome (Pickwickian syndrome)

  • Asthma (worsened severity)

  • Increased risk of respiratory failure and ARDS

Musculoskeletal and Joint Issues

  • Osteoarthritis (especially knee and hip)

  • Lower back pain

  • Gout

  • Reduced mobility and disability

Mental Health and Neurological

  • Depression (bidirectional relationship)

  • Anxiety disorders

  • Reduced quality of life

  • Stigma and body image issues

  • Dementia and cognitive decline (long-term studies show increased Alzheimer’s risk)

Reproductive and Hormonal

  • Infertility (both men and women)

  • Erectile dysfunction

  • Irregular menstruation and anovulation

  • Complications in pregnancy: gestational diabetes, pre-eclampsia, macrosomia, stillbirth, cesarean delivery

Kidney Disease

  • Chronic kidney disease (obesity-related glomerulopathy)

  • Kidney stones

Other Conditions

  • Increased severity of infections (e.g., worse outcomes in COVID-19, influenza, sepsis)

  • Higher surgical and anesthesia risks

  • Skin conditions: acanthosis nigricans, intertrigo, cellulitis

  • Cataracts

Overall Impact

  • All-cause mortality: Obesity shortens life expectancy by 5–20 years depending on severity.

  • Severe (class III) obesity (BMI ≥ 40) carries the highest risks.

The more excess weight and the longer it is carried, the higher the risk. Many of these conditions improve or resolve with sustained weight loss (especially ≥10% body weight).Sources: WHO 2024 report on obesity, CDC 2023–2025 data, The Lancet 2022–2024 series on obesity, American College of Cardiology, International Agency for Research on Cancer (IARC), and large cohort studies (e.g., Nurses’ Health Study, Framingham Heart Study, UK Biobank).

Explain mechanisms linking obesity to type 2 diabetes

Effective strategies for sustainable weight loss

I compare Ozempic to Statins. Statins have side effects. Once prescribed Statins will be taken for the rest of your life. The need for Statins would not be as prevalent if people ate a healthy diet and followed a regular exercise and weight training program.

The success rate of weight loss programs is dismal. Less than 20% of people that try to lose excess weight are successful in the long term. These weight loss programs often have side effects.

If a drug could be used that significantly increased the percentage of people that could recover from a drug or alcohol addiction, would you want it outlawed because it would be required for life or because it has some potential side effects?

Every drug has potential side effects and the risk versus benefit should be considered, but it appears to me obvious that the side effects and risks for GLP1 inhibitors are relatively minor compared to the impact of obesity.

3 Likes

Good for you. My wife and I also take no pills (vitamins excepted). Over the years, physicians and nurses often seemed disappointed when told that.

1 Like

This is a video that perfectly reflects my opinion. He touches on things I didn’t including the high percentage of steroid and testosterone

2 Likes

I congratulate you; it’s been easy for me cuz I’ve always lived with a medical doctor. Lotsa people for example get put on statins pretty much as a matter of course. They cause muscle pain. But if you consult a physician who looks not at you but at treatment protocols, you’ll soon end up every morning facing one of those li’l plastic pill holders marked with days of the week

Dear @Metellus, I am not pro-obesity, as I’d think would be obvious from my post. Yes it’s bad, it hurts and then kills! And yes I know, in fact I know from personal experience, that weight loss programs don’t have much long-term success (but: side effects?) But from what I read, these weight loss drugs don’t either.

Obesity IS a condition that CAN be alleviated without these drugs, is all I’m saying. I’ve read that the factor which most successfully motivates people to lose weight is vanity. Great so let’s start culturally criticizing again, pointing out that after all, it’s their own fault . Obesity CAUSES sickness, but it is not itself a sickness.

By all means prescribe these drugs for the 600 pound guy who hasn’t been outta his house in years cuz he can’t get through the door. (I’m not exaggerating.) But let’s NOT just routinely give it to the kids, is all I’m saying.

1 Like

Good old Grok, repeating what ladies with credentials from the local J-School have said. But even Grok has to regurgitate “diets that prevented widespread excess body fat” – or, to put that in normal human language ‘diets that were at least seasonally inadequate’.

Who survived when food availability was inconsistent? Obviously, the individuals with the genetic variations which allowed them to accumulate fat during the seasonal times of plenty, keeping them alive during the hard times.

Well, that explains why our ancestors spent hundreds, maybe thousands, of evolving generations migrating to the harsh climates of the Far North where they followed the reindeer herds or consumed beached whales in the brief summers! An obvious major reason for leaving easy Edens was the desperate search for food, where only the successful survived the winters and bred. Until the Green Revolution of the mid-20th Century, food around much of the world was generally in short supply, certainly seasonally – maybe Grok missed that?

Doctor Richard Johnson tried to popularize the relevant scientific literature in his 2022 book “Nature Wants Us To Be Fat”. Maybe Grok can read that and provide a summary? To help Grok out, the ISBN is 978-16377-40347

2 Likes