How long til we're all on Ozempic?

I've been on tirzepatide (Mounjaro) for 4 months now. I'm down 13% of my body weight. I realized that frequent cannabis consumption interferes with the weight loss, so I've kicked the habit from daily to occasionally on weekends. I've started walking 2-3 miles a day, 2-3 days a week regularly, in addition to eating less and being more motivated to calorie count.

All this to say, this drug has been life changing for me. I spend more time doing things I want to do, depression and anxiety have less of a hold on me now. I feel that this drug has allowed me to be the best version of myself I have been in a long time. The only side effects so far have been positive. I do worry about what I will do once it's time to titrate off the weekly dose and the best I can think of is that the habits I'm forming in the time on the drug I will have the resolve to continue after cessation.

I say this because I have battled depression, anxiety and obesity issues my entire life. I've had many failed attempts at getting back to a healthy, productive and non-obese lifestyle. I don't know what is so different about having the drug help me, but I can tell you that it has been different.

As someone who struggled with their weight his whole life, this medication is a god send.

My wife and I cook every evening. We never eat food made in a factory. We buy raw products and spend a good amount of time every day cooking them.

Every morning I wake up and go on a 5 mile hike.

And still weight kept on coming on. Worse yet, I am on ADHD medication, which are amphetamines and actually make you lose weight. Yet... the number on the scale kept on creeping up.

And you know what it is? It's volume. I eat too much. And I have no cookies at home. I have no chips at home. No soda, no alcohol. I drink black coffee with a splash of milk. I don't eat any sweeteners.

I have had weight loss surgery (lap band) which was later reversed as it hurt 24/7.

Now, on ZepBound I lost 20lbs in 2 months. I am not hungry. My brain can actually focus on the things that matter.

Why do we find it acceptable to help people who struggle with alcohol abuse, or nicotine addiction, or opioid addiction, but not to help people who struggle with food abuse?

Instead of a system that makes these drug available for purchase, I'd rather live in a system that promotes healthy food and active behavior. Unfortunately, I have to drive everywhere, work too many hours to have free time for recreation and have no idea which government subsidy is going to help big ag likely at the expense of my health.

All things being equal, I'd prefer to spend less money on prescriptions and have fewer trips to the doctor.

This compares Ozempic with past drugs, but sales of past drugs are almost always limited by demand. I'm not sure there's much to learn here for a drug that is limited by supply. Also, this part is silly:

"The announced investments across both companies total $32 billion. GLP-1s were 71% of Novo’s revenue in 2023, 16% of Lilly’s in 2023, and 26% of Lilly’s in 2024Q1. If these sales are proportional to the manufacturing capacity used to create those drugs, then about 40% of Novo and Lilly’s combined estimate of $45 billion in gross PP&E is for GLP-1s, for a total of $18 billion; $25 billion would then mean a 140% increase in GLP-1-relevant PP&E."

Manufacturing investment is not proportional to sales, because there's a fixed cost to making a certain drug regardless of how much you sell. If a rare-disease drug will have a few thousand patients ever - not uncommon! - you still need to figure out a synthesis path for that particular drug, run QC tests on the production line, get regulatory approval, etc. Economies of scale matter a lot (https://en.wikipedia.org/wiki/Experience_curve_effects).

I'd think it more likely that it'll be one of the next generation drugs, but I do agree with the premise that it will be really common.

A few weeks ago I started a low dose of tirzepatide (aka Mounjaro, aka Zepbound) and the side effects are interesting.

The biggest negative, which just takes adjustment, is drastically lower stomach capacity. Used to be that two eggs and two pieces of toast was breakfast. Now I better skip at least one of those pieces of toast or I'm going to feel overfull and might get reflux as punishment.

But there are some unexpected positives.

Obviously I am eating less. I have to log food not to keep it in check, but to make sure I'm eating enough and with the right nutrients. There's another possible negative here -- you get a lot of hydration from food, so if you start eating less you should carefully monitor your fluid intake to allow for that.

But I'm also more focused. Not nearly as distracted. I'm getting a lot of things done which I used to just procrastinate on until years had passed in some cases. Man, the garage is going to be clean and superbly organized in a few weeks.

And my emotions are quieter. Not just the food noise, that was expected, but I feel more relaxed. That's not what I expected, and I'm pleasantly surprised.

As an aside, what makes this all really noticeable is that it's a once-a-week injection, and the peaks and valleys are very obvious. Saturday is injection day, but Sunday is where it really becomes quite noticeable that I took it. Monday-Wednesday is cruising altitude and the effects are good but not over the top. Thursday I can feel it tapering, and today ... well, I'm looking forward to tomorrow's injection. I might switch to a twice-a-week split dose at some point to ease the peaks and valleys.

Edit: Before someone asks, yes I have considered there may be long term effects. This is a risk, which I've decided I'm okay with at my age. Nobody gets to live forever anyway, and I was going to end up in an early grave via another route if I didn't do this. "Just eat less and exercise more" is trite. If it were that easy, we'd all be in fantastic shape.

I do hope to taper off at some point if I can figure out an alternate strategy for staying lighter. Though I'll miss some of the positive side-effects.

My biggest fear is either there will be long term negative consequences to Ozempic et al, and a huge swath of the population will be dealing with issues 30 years form now - OR - there will be some long term positive consequence to using Ozempic et al, and I'm not getting any of the benefits because I'm not overweight.

> How long til we're all on Ozempic?

It's genuinely quite depressing that so many people in the United States have a weight problem that the overwhelming majority of the population would benefit from this and headlines including "we are all" are not inaccurate.

I don't think other countries are necessarily perfect here, but 74% of Americans don't have a healthy weight when you look at their BMI. That's a staggering statistic. Something is seriously wrong societally, and the priority should absolutely be non-pharmaceutical interventions.

I think Ozempic is a treatment of a symptom but not the underlying condition, but unlike many of the posters here, I do not think the underlying condition is "obesity". The below is mostly speculation.

Research especially into people with healthy body weight seems to indicate that there is something going on that is causing widespread obesity. That is, there's some sort of environmental "GLP-1 Turbocharger".

Maybe it relates to processed food, maybe it relates to microplastic contamination, maybe it's in the cheese, maybe it's an innocuous viral agent, maybe it's gut biome, maybe it's ADHD drugs, maybe it's SSRIs.

I suspect that Ozempic is helping us get back to a baseline level of exposure by counteracting this. And in the future if we're lucky we'll figure out what it is and try to correct it at the source.

Seven years, December 2031. That's when the patent expires, the kinks and side effects will have been found/ironed out and it becomes a cheap plentiful generic. I'm healthy enough to wait.

I think we desperately need to answer the question of why GLP-1 agonists are so effective, and particularly whether it's counteracting something in the environment that has been acting to reduce GLP-1 (or other glucagon-related pathway) activity without us realizing it. The obesity data practically screams that something happened in North America ca. 1980 that messed up our metabolisms, and it may have spread to Europe after a delay. Unfortunately, it seems like one of those things where there are various people with pet theories and little substantial effort to get to the ground truth. Perhaps the inevitable search for "me-too drugs" will uncover something.

Novo Nordisk just settled with Viatris, a company which was trying to have the Ozempic patent cancelled.[1] That would have killed their monopoly. "Terms of the settlement are confidential".

They just did the same thing with Mylan.[2]

And may have done something similar with Rio Pharmaceuticals.[3]

The Federal Trade Commission is also fighting that.[4]

[1] https://www.reuters.com/legal/litigation/novo-nordisk-settle...

[2] https://iplaw.allard.ubc.ca/2024/10/08/settlement-of-patent-...

[3] https://www.pacermonitor.com/public/case/52064967/NOVO_NORDI...

[4] https://www.cnbc.com/2024/04/30/ftc-challenges-patents-held-...

I’m pretty sure all the Shortages of Ozempic and mounjaro are due to injector mechanism production factors and the fact that when the drug is transported in a reconstituted fashion in the injector, it needs to be kept in cold chain storage the whole way which makes logistics much much harder

My friends and I all live outside of the USA and we can get basically unlimited ampoules of powdered Mounjaro from China. It is very simple to reconstitute with Sterile water in a no touch way and works great. We have all had significant weight loss and improvement in blood pressure and glucose levels etc.

Waiting for these companies to get their act together, especially when mounjaro is a copycat drug is not acceptable. these drugs are biochemically very simple peptides with a couple of cross linkages and very easy to make in high quantities so there is no excuse for everyone who needs them to not be on them. a large portion of the world not having access to these drugs for the patent period and continuing to suffer all the effect of obesity is not morally acceptable.

How long til we're all on Ozempic?

Just my own preference but I stopped doing tinker drugs some time ago and focus on things that make semi-permanent changes even if they are much smaller incremental changes. I call any drug that tinkers with feedback loops a tinker drug. An example for me personal was hypertension. I focused on finding the root cause which took a long time but now if I can't get a hold of the things I used to make changes I don't have to worry about a hard rebound swing back to and beyond where I was, something that BP drugs did when I could not get a hold of the drugs because of doctors screwing with me.

For weight I went with Berberine, prolonged fasting and paleo. It's slow but steady and for me personally slow and steady has been winning the race without side effects. That's just my methodological preference and not meant to be any form or fashion of advice for anyone else. I support people doing whatever they find works for them. This was just my long way of answering the question.

A lot of people fail to realize that eating healthy and exercising is not enough for a lot of people who fight with their weight their entire lives.

Ozempic and Wegovy are game changes and have real, tangible health benefits.

One person told me, "No matter how much I eat or exercise, I have been 'hungry' my entire life. That ended when I started taking these drugs."

For the longest time people argued if overweight people ate too much or not. I’ve heard plausible sounding arguments on both sides.

It seems Ozempic has answered that question decisively, no? The solution to being overweight is eating less in almost all cases it seems. And feeling less hungry with Ozempic can help get you there.

Living a healthy lifestyle, so that you won't need Ozempic, is possible - even surrounded by all the drugs and booze and carbs.

I do it. Lots of people do it. The information is freely available, now more than ever.

From all I've read, Ozempic isn't a silver bullet, and has many side effects. It just helps people stave off the inevitable for a while.

I find it fascinating how many things like this just completely gloss over the fact that some people have side-effects to these drugs that make them completely non-useable, and often it's some of the people who could most benefit.

I have ADHD, and have tried all the current generation of these drugs and absolutely CANNOT take them, they basically prevent my ADHD medication from working and I end up depressed and wanting to kill myself.

This idea of these drugs being a "cure-all" that we'll all just be taking one day proactively scares the shit out of me, because I worry it will mean that medical science will stall (as far as it relates to these types of conditions) for those of us who simply can't take these drugs.

Statins are regularly given to people with high cholesterol. I would bet that most older people take or qualify to take a statin. If it happens with statins, therefore, it's not out of the realm to think that most people will eventually be prescribed GLP-1 to reduce weight which will improve overall health. It makes sense.

As far as I can tell, the intended meaning of the question in the title is "how long until everyone who wants Ozempic can have it?".

But at first I read it in a more cynical and sinister way, the more literal interpretation - how long until everyone is on weight loss drugs?

In a world where such medications are normalized, fast-food/processed-food companies might just work harder to make their products more addictive and pervasive, and then we're all back to square one.

One lurking concern I've had around this space is that junk food makers simply find a way to make their food even more addicting.

Arguably though, ozempic'd customers and shrinkflation'd products would be a recipe for amazing margin improvement. And they can dress it up as doing good because its better for people, (like the 100 calorie snack packaging).

One trend I noticed, whenever this topic is discussed in public forums, it attracts a lot of negativity from "just exercise and eat less" crowd (generalizing here). I wonder why it caused so much negative reaction? On the surface it shouldn't matter much, since it does not appear to harm ones who found a way to maintain healthy body without drugs. Yet it reliably causes a quite noticable number of folks to be quite aggressive towards either people using these drugs or companies making these. (Similar trend can be seen in other drugs like THC for example)?

As every conversation with weigth management/obesity treatment, there are still people thinking that just more willing power / better habits is what's needed.

To those people I suggest you run an experiment : what ever your current body weigth is right now. Try loosing and keeping off 20%.

One thing that it seems we are just starting to talk about with these drugs is the associated muscle and bone density loss. I'm concerned that this generation of GLP-1 early adopters will wind up more frail and suffer a lower quality of life in old age as a result.

There's some evidence that Ozempic improves general impulse control, e.g decreasing alcohol consumption [0], which the article mentions.

Also, as Tyler Cowen writes [1], this is probably going to translate into big improvements for animal welfare:

> People lose weight on these drugs because they eat less, and eating less usually means eating less meat. And less meat consumption results in less factory farming. This should count as a major victory for animal welfare advocates, even though it did not come about through their efforts. No one had to be converted to vegetarianism, and since these drugs offer other benefits, this change in the equilibrium is self-sustaining and likely to grow considerably.

So overall, widespread Ozempic adoption seems like progress to me.

[0] https://www.npr.org/sections/health-shots/2023/08/28/1194526...

[1] https://www.bloomberg.com/opinion/articles/2024-07-20/animal...

Obesity rates are on the rise in all modern countries, and although the rate of growth is different, in no country does it show any signs of slowing down.

https://ourworldindata.org/grapher/share-of-adults-defined-a...

Are these drugs good? I'm not sure, but I think a lot of these drugs seem to be reducing how much people eat -- helping people break from the life time of bad habits they've learned since childhood from their parents/friend/media/fast food industry. I don't know if eating habits in childhood can embed themselves as permanent alterations to the person's biology, like myopia in eye sight. But if it does, then these drugs might be the "glasses" equivalent for metabolism/eating. Citation needed. But if so, then let's see if we can learn from our mistake with how glasses are perscribed, and instead of leaving children in the same environment that results in the development of the same diagnosis which will then require them to also take ozempic/use glasses/etc, and instead raise them so that they never develop the problem in the first place.

Note: even the myopia link is still being researched I believe, but more papers seem to be showing this potential relationship.

Variables:

- unhappiness increasing (citation needed)

- low income people buy cheap, processed food

- middle class people eat out at restaurants more since they can afford it

- upper class people likely the healthiest?

- unhealthy processed foods have become regular standard snacks (eg chips, cola) taking the place of healthy snacks like fruits/veg

- portion size increases in the home and at restaurants

- the fast food industries incentive to get people to eat more

- people developing bad eating habits at young ages, which are significantly harder to break later in life and could potentially result in permanent changes to metabolism (similar to how myopia has been linked to children spending a lot of time inside/books/screens)

- low availability of healthy fresh food -- when was the last time you got fruit as a snack in the middle of the day? Or for dessert?

- reduced mobility; sitting jobs, order to your door, work from home

One other note: the current peptide-based GLP-1 drugs are not likely to be the permanent solution. Injectables are just too problematic for that.

Several companies are now working on more classic small-molecule drugs targeting the same receptors. So it's likely that in several years we'll get a pill with the same effects.

Yes, there's technically a pill version of Ozempic already (Rybelsus), but it works by making the stomach wall to be slightly permeable to peptides. You can guess that it has pretty unpleasant side effects, and an awesome bioavailability of 0.7%

I don't share the American enthusiasm for pharmaceuticals. Exercise and healthy eating. I also don't have the other issues mentioned. Maybe the title is a bit clickbaity and I shouldn't be taking it so literally.

Ozempic is just scratching the surface, the pipeline is bursting...

>...combinations of GLP-1 with other entero-pancreatic hormones with complementary actions and/or synergistic potential (such as glucose-dependent insulinotropic polypeptide (GIP), glucagon, and amylin) are under investigation to enhance the WL and cardiometabolic benefits of GLP-1 RA.

I count 18 or so here...

>https://www.nature.com/articles/s41366-024-01473-y

The headline here seems like an extremely baity one.

A ton of people don’t have this issue at all. I hesitate to say “most” because both in the US and UK it seems the majority do.

But it still feels like a hack to me. The issue seems like it’s that most people are now basically sedentary. So we can solve the excess hunger via drugs, but is that really what we should be doing?

It feels to me that if we must have a wonder drug - it’d be one that gets people up and about and enjoying exercise. It seems really sad to me that so many feel that their physical form and embodiment is an annoyance rather than the gift it truly is.

I don’t want this to come out insensitive or from under the rock, but why is taking a drug a novel & cool idea (all of a sudden/recently) as opposed to good old fashioned working out and not eating more than what you need? okay, this drug is all kinds of great and it’s the next best thing since green grapes, still not eating more and workout is better than taking drugs that effect your brain right? Are doctors required to explain this before prescribing this in US?

I hope that these drugs pull people back from nasty habits such that they eventually build the strength to do without them. As of yet, I do not see why it has to be a win-lose situation one way or the other. Crutches aren't evil - they are expedient while they are expedient.

Sometimes when you have a really strong habit, it becomes really hard to imagine yourself being otherwise. I welcome anything that helps people see beyond a prison they've put themselves in, as long as it doesn't put them in a worse prison.

Does Ozempic or whatever put one in a worse prison? This seems personal, and not a categorical matter.

Those who take it have a choice of how to develop their sense of identity in relationship to their treatment. It is here where the rubber hits the road - these abstract extremes of "you're suppressing your ability to grow" and "you're hopeless without it" are short-sighted and serve no good purpose.

My pet crackpot theory is that within the next 100 years semaglutide is going to be in the drinking water (much like fluoride) because the benefit to society is going to be too hard to pass up on. However, it seems that it's delivered via injection so maybe putting it in the water supply wouldn't even be effective.

To anyone thinking that exercise will fix anything: I've owned a Concept 2 rowing machine since 2005. In that time I've done an average of 100 workouts per year, for a total of over 35 days of rowing. Some workouts were relatively easy 120bpm heart rate; some were at a relatively brutal 160bpm. Concept 2 estimates I've burned just over 600,000 calories, or about 1,000 Big Macs. Could I have eaten 1,000 Big Macs in 19 years? I think so.

It's pretty crazy to me that that we aren't already all on Ozempic. The cost to the country for all chronic conditions obesity causes will bankrupt the country. Insurers should basically be forced to cover all the downstream costs their policies create or they'll continue to kick the can.

Ideally we didn't addict our country to cheap junk food but that ship has sailed. If it were up to me I'd tax the shit out of any company selling a product with more than five grams of sugar and use that to buy the patent to tirzepatide and make generic medications available asap.

This article seems to frame things in such a strange way. Maybe instead of trying to get everyone obesity medication, we can instead educate society so we all understand nutrition and diet and can combat the ever-persistent forces of corporations pushing unhealthy food on us?

FWIW, junk food makers are thinking up new ways to stay relevant and still sell a modified version of their junk foods adapted to people on GLP-1 medicine… Nestle, Mondelez, etc are all scrambling to do so. Here is an article (in French) on the matter: https://www.letemps.ch/economie/ozempic-wegovy-mounjaro-nest...

If you are on a weight loss drug like Ozempic, make sure you are doing resistance training. Ozempic reduces your appetite and help you go into a calorie deficit. Bone mass, muscle mass, ligament and tendon mass can all suffer on a calorie deficit unless your body is get regular stimulus that 'muscle, bone, and connective tissue strength are still important.'

Also, changing your diet while on Ozempic to (1) cut down carbohydrate intake and (2) include more healthy protein (meat, eggs, fish, etc.), fats (nuts, olive oil, etc.) and fruits/veggie will supercharge your weight loss and your overall health gains.

Many in the thread have asked “why get off the drug?”

Regeneron is pursuing its own version of a magic weight loss drug and is arguing that the current batch of GLP1 drugs reduce muscle mass, which is one of the most important things to maintain as one passes middle age (comorbidity etc.)

https://www.ft.com/content/094cbf1f-c5a8-4bb3-a43c-988bd8e2d...

The co-founder of Regeneron has warned that blockbuster weight-loss drugs could cause “more harm than good” unless the rapid muscle loss associated with the treatments is solved...

Clinical studies suggest that patients treated with the new class of weight- loss drugs, known as GLP-1s, lose muscle at far faster rates than people losing weight from diet or exercise, exposing them to health problems, said George Yancopoulos, who also serves as Regeneron’s chief scientific officer.

I hate that we are obsessed with treating the symptoms of our issues instead of the cause.

It will be interesting to see how health insurance companies deal with Ozempic. A few days ago a top article on HN posed the question: Millions of Americans could benefit from drugs like Ozempic; will they bankrupt the healthcare system?

Of course there are many health benefits to losing weight. Given there are clear, healthy, non-drug assisted ways to lose weight, should drug-assisted weight loss be considered an 'elective' procedure, so to speak (similar to liposuction). With so many people qualifying for this drug, would it be fair to increase insurance premiums for overweight individuals? (I say this as someone who could lose a few lbs). Should healthy active folks who keep their weight in-check naturally be required to foot some of the insurance premium bill for those who use this drug to lose weight? If someone rebounds multiple times after going off Ozempic do we continue to collectively pay? Will we be required to collectively pay for people to stay on Ozempic indefinitely to maintain a healthy weight?

https://www.latimes.com/science/story/2024-05-29/will-ozempi...

My wife was interested in taking the Ozempic route, and I am not fond of drugs.

We then started intermittent fasting together as a lifestyle, and it's been great. Losing weight while not restricting what we eat and feeling great as our body adapts and doesn't let us overeat. I just wonder about the long-term effects, but I'd rather take this risk than a drug like Ozempic.

Stupid question but I wonder if the side-effects are a partial contributor to its success: feeling nauseous, upset stomachs, bloating, acid reflux etc? And are there similar, cheaper supplements/drugs that can induce nausea etc?

I know my appetite falls off a cliff if I'm nauseous/have an upset stomach/suffering from reflux.

The absurdity of creating a drug to curb obesity instead of forcing industrials to make food healthier. The ravage of corruption, sorry lobbying, still killing us all for greed.

Don't think the hype will last long at all, since this ridiculous drug has extremely bad side effects, and works by enriching the body with millions of small fat cells that are all ready to blow up the moment you stop taking the drug. Or in orher words, it's a trap. If you take it, you have to take it forever and suffer extreme side effects, if you stop taking it, you will turn into a fat pig, worse than before, and you gained nothing.

It absolutely boggles my mind to always see Americans swallow everything and anything that big pharma serves them. It's insane behaviour.

Up until the point where our modern food environment changes radically - the more people who need it and can take it, the better.

WFH & being sedentary

Since WFH, it’s scary to me how sedentary I have become.

It wouldn’t surprise me if I now walk < 1,000 steps per day.

I can easily go a couple of days and never even leave the house.

My waistline shows it. And I’m actually eating less than I did when I went into office.

I guess its basic thermodynamics.

Most of us should probably be on appetite suppressors due to the industrial revolution making food more than abundant while pumping it full of empty calories.

Eternity, unless it's pumped into the water supply

Obesity rate in the US has started to decline and it sounds like they're largely attributing it to ozempic et al.