re: On Mounjaro for two months, my take - 7 month update

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Cmon man Do you really need data showing you this? If someone goes from a BMI of 45 to 18, it’s clear as day their chance of having comorbidities will plummet. There’s literally nothing more detrimental to the human body than obesity.

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Just ignore, he will slither back into his hole when he does not get the attention he craves to justify his existence on this planet.

No it’s exactly what you’re talking about. Cost. Dialysis patients are costing Americans billions, with a B, each year. And a lot of these patients could’ve possibly been saved by these drugs.

Anyways, I’m going light da pit and we’ll never convince each other so have a good one baw. .

Lsu4444 is right about a lot of these things. If insurance (i.e. us) is paying for it, the cost to treat obesity is astronomical and multiple cost effectiveness studies show it is not cost effective. A recent study in patients with a preexisting history of heart disease, a population at a much higher risk for a future event than a population of obese nondiabetic patients, showed that GLP-1’s reduced events by 0.75% a year. So, it would require treating over 130 high risk patients for a year to prevent one event at a cost of $1.6 million. For obese patients that price would be much higher. There are better ways to spend that money. However, If a person wants to pay cash for it, I have no problem with that.

Also, LSU777’s claim that obesity is caused by low GLP-1 levels is not true. Some studies show a correlation, but that absolutely does not show causation. Obesity itself likely causes low GLP-1 levels not vice versa given the fact that the prevalence of obesity has exploded, which you would not expect if it was caused by a chemical imbalance (you would expect the rate to be fairly constant). Also, there is a study in obese kids that show increased glp-1 levels in obese kids compared to non-obese.

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Dude, honestly prob jr. high or even before. You’ve know me 35 years now, so you know I was always a big baw! Feeling fricking incredible now though. Hitting the big 4-0 in 2 months and plan on being in my best shape in my adult life.

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I love it! Three days before I hit the big 4-0! You old SOB!

Keep up the hard work, you’ll be a frikkin unit! You needa come pick me up in LC and show me how to catch some specks!

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I fully support individuals rights and decisions to buy diabetic meds for weight loss, just not at the expense of others.

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So you are ok with treating diabetes, but not obesity? Same medication treats both diseases. Why is it at the expense of another? Why do you feel a diabetic is entitled to the medication but someone with the disease obesity is not entitled to it?

Treating obesity IS TREATING diabetes preemptively. Pretty simple concept. Everyone should have access to the medications they need. And they should be held accountable to following their care plan, which should include but not be limited to diet and exercise modification.

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So you are ok with treating diabetes, but not obesity?

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No, both should be treated.

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Same medication treats both diseases.

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It's certainly one method that can be used to treat both.

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Why is it at the expense of another?

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Huh?

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Why do you feel a diabetic is entitled to the medication but someone with the disease obesity is not entitled to it?

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Not all patients who are obese have diabetes and there are more cost effective methods to treat tthe majority.

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Pretty simple concept.

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Agreed. Roughly 30% of obese people have diabetes. Using the same costly methods to treat the other 70% is wasteful and is not proving to prove overall lwoer healthcare costs.

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Everyone should have access to the medications they need.

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I am all for access and NEED is an interesting word here. An obese person doesnt need a GLP 1- meds but if they want it, I don't care if they take it. Just do so at your own cost.

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You are biased by the fact that your livelihood relies on prescribing GLP1s and viewing obesity as a disease that people are powerless over due to “food noise” or GLP1 deficiency. Frankly, you are not objective

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100% wrong. Those in the absolute upper echelon of the scientific and research community disagree with you. I’m doing no more than telling you what they know at this point. I’m sorry you don’t like it. You are entitled to your opinion, no matter how wrong it is.

My livelihood does not depend on any of this. You only go there as an attempt to discredit me and what I am saying. And why?

I am not biased. I used to think what you think. I was wrong.

The studies you seek are underway, but you have been given a look. They take many years with critically large sample sizes to ensure data validity.

You cannot show me studies proving causation of obesity being anything other than a lack of GLP-1 deficiency, but that in and of itself doesn’t make your argument wrong. I’m telling you that your argument is wrong, based on what the top researchers and doctors in the world have learned. You can disagree all you want, and that is ok. There are still flat earthers running around.

I most certainly am not reducing obesity to anything. Quite the contrary. I am simply trying to get it through your head that WE KNOW factually that when the body does not naturally produce enough GLP-1, the brain does not properly regulate sensations of hunger. To the extent that this deficiency, for the vast majority, cannot be overcome without intervention. This is what causes the consumption of excess calories that will be stored as fat tissue. Surgical intervention is actually the less costly long term solution. The success rate is lower, as a patient compliance with diet, exercise, and nutritional supplementation has proven more difficult than compliance of giving oneself an ejection once a week.

Why is it so hard to accept that using medication to treat the second leading cause of preventable death in the US is ok? Really dwell on why you are so against it. The cost argument is false. And quite ridiculous. You gave one example of coronary event in ONE YEAR. Using your math, that is 6% increased probability over 5 years. 12% over 10 years. 24% over 20 years. And that is just one preventable consequence of not treating obesity. Now go fetch the math on diabetes. And then all the pain treatment and surgeries for bad knees, hips, backs, necks, etc. Renal disease. And on and on. Anyone with half a brain can quickly and easily understand how ridiculous the argument is that the cost of GLP-1 treatment is too high. It’s truly laughable.

If you were right about all this, why hasn’t “move more eat less” solved the obesity pandemic? It’s been pushed for decades and simply does not work for the vast majority.

If there were a better more cost effective way to treat the disease, I would be shouting it from the mountain tops. But there currently is not. So, this is where we are.

Maybe take a look at this thread. Maybe ask our resident estate sale plundering man about his journey. Ask him if he was able to sustain “move more eat less.” He’s one person that has probably added many quality years to his life and improved quality of all years remaining in his life by using a medication. Why are you so mad about that? It’s amazing and I’m so happy for him and the millions of others.

The real cost argument is that the cost of not covering these meds for individuals that need them is what will continue to drive up our healthcare costs. There is a cost to doing nothing.

Also, consider this. These medications are so incredibly successful in treating this disease. If there was no causal relationship between GLP-1 deficiency and obesity, would there be this level of success from these medications?

To be clear, again, there are plenty of other compounding issues at play with this disease that have exasperated the level and severity of the symptoms of it. Food supply, marketing, workplace habits, and so on are all compounding issues that play into this. BUT, when you fix the GLP-1 deficiency, all of those other issues don’t prevent weight loss. Please challenge yourself to really consider why that is.

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It's amazing how humanity has all of a sudden developed this GLP-1 deficiency within the past 40 years. That's a remarkable time for an evolutionary change. That it coincides with an abundance of shitty food, shitty nutritional advice and more sedentary lifestyles is even more curious.

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100% agree our food is a huge problem. But, it should be as easy as just not eating it right? Will power should be more than adequate, right? It’s not. I’ve never claimed that it’s only GLP-1 deficiency. And I’ve never claimed that GLP-1 deficiencies are not compounded by other mitigating factors. I’m sure they are. There 100% is a genetic component(nature) to it, but nurture is absolutely in play as well.

I’m not saying there aren’t other problems involved. I’ve always made it clear there are.

I just don’t understand why there is such vitriol about this. We know for a fact that a GLP-1 deficiency is the main driver of obesity today. The food that is consumed is a mitigating factor that has pushed the average delta further from the baseline. 100% accepted. The food is no longer an issue once GLP-1 levels are brought up to normal ranges. You have to see that.

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My hunch is that latter thought. People get fat because we live in an obesogenic environment and then there's a negative feedback loop that is difficult to break.

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Let’s pretend we will never know if the chicken or egg came first(we will know but some of these studies are multi decade long and we can’t wait). We know these meds successfully break the cycle. There has become an obsession with causation. It does not matter. We know that at the point of a patient walking in with a BMI of 60, that patient needs some type of intervention to reroute from the current poor trajectory. If that person has never attempted to exercise and eat less, then sure that should be attempted first before anything else.
Intake practically always shows a long history of failed attempts at multiple forms of eat less move more diets and frequently other approaches. By the time a patient with the disease of obesity seeks medical treatment, they have tried everything else they can think of many times without success. The vast majority of these patients carry incredible amounts of shame, depression, and guilt with them due to how they are treated by society. That is a big compounding issue as well, but I would argue not as big as the food problem.

The argument of causation is only relevant as much as understanding it can help treat the disease. We know from an avalanche of anecdotal data that GLP-1 deficiency drives obesity. The studies will support this from a scientific evidentiary approach as well, but it honestly doesn’t matter. We already know that if you fix the GLP-1 the deficiency, you successfully treat the disease.

Sure, there are plenty of people abusing these meds. That’s an entire separate argument, and the rabbit hole we are in is sufficiently deep as is. This is why anyone that has struggled with weight should seek help from a qualified specialist. MD with DABOM and ASMBS is ideal. Meds alone is not the answer and never will be.

Editing to add that if a maintenance care plan can be reached that requires no meds at all, I would completely support that. Early indications are that GLP-1 levels go back down once patients stop taking the meds, even when their BMI and behaviors have changed. Even being in normal BMI range with healthy diet and exercise, sadly.

I’m aware of at least one study that has targeted broader long term maintenance options. The use of Leptin is definitely one of them. I could be wrong, but I believe it is a main target of the study.

Our understanding of all this will continue to evolve, and I do hope we find better and more cost effective options. I choose to be loud because I have a vantage point and access to information and data that very few others do. And I believe everyone should know.