If this makes it better and easier for companies to actually pay out for this I am 100% for it, there should not be a constant jerking about for what is or isn't paid. Also - this wasn't for weightloss (which I assume would have been Wegovy approved), this was for diabetes, and it was under control with Rybelsus, and I assume Ozempic, though we were still in the process of building up to it (I was on max dose of Rybelsus and I'm pretty sure I needed the max Ozempic as well). If they had given a reason for the denial it'd be one thing but it was just a blanket denial.
I just hope this makes it easier for folks who need it to be able to obtain it.
Insurance companies shouldn't get to pick and choose what drugs are in or out.
I was at a company, and Wegovy was covered.
Then randomly I got an email from HR, "Your medication is no longer covered."
The fuck is my insurance company doing telling my HR what medication I'm on? Even if they didn't say it outright, it wouldn't be hard to figure out giving the drugs that came off the list that were paid for that quarter. =P
Going cold turkey on these drugs is hard... like the doctors tell you that once you start taking them, you really aren't supposed to stop taking them. Or if you do, you have to do so gradually.
The drugs mimic the feeling of being satisfied from being full, by overloading your system with a synthetic version of that hormone that makes you feel that way.
Now... imagine going from "my parents used food to control my behavior growing up, and 40 years of bad behavior cemented that conditioning in place, so now it takes a lot of food to make me feel full / content," to "Oh this is nice, thank you drugs! Now I don't have to eat so much!" to "You're on your own, kid! And by the way, now that your body was used to the drugs, virtually no amount of food will make you feel full / content now. Let's see what happens!"
Fucking insurance companies. People are nothing but pre-existing conditions and behavioral patterns. It shouldn't be up to the insurance companies which ones they elect to cover. "Oh, did you think smoking was cool as a kid? Too bad, hope you die from lung cancer!" It just shouldn't be on them to choose.
I do think that this should still actively be regarded as scary and abnormal, even if it's the norm for so many people in the US.
Yes you can't change from a cheap high-deductible plan to a platinum gold super plan the second you feel an expensive emergency coming on, that is an important note. But it wasn't the context here. For chronic disease management you do benefit from completely freedom to find your way to a plan you like eventually.
It is still a horribly overpriced system though.
It's true that there is a list of qualifying life events that let you change or acquire insurance outside of open enrollment, but none of them look like "because I don't like my insurer" to me.
Having to wait between zero to 12 months to change insurance plans is a barrier, but a small one compared to the inability to change plans at all, as in a nationalized health scheme.
"Almost all European countries have healthcare available for all citizens. '''Most European countries have systems of competing private health insurance companies''', along with government regulation and subsidies for citizens who cannot afford health insurance premiums."
They are probably more expensive than the government plans, but same is true in reverse in the US. One helps the poor more, and makes sure those who can afford still have an option, the other makes those with good jobs, and get paid well having good care, and costing the poor who can least afford it, far more in terms of their capacity to pay. You're just wrong on this, and trying to be cute with boolean logic is ... "cute".
Americans get more drugs covered on average is my impression.
I would take the default of "some" coverage over "no" coverage any day.
That said it’s still a good deal and you can switch Part D policies year to year in case there are formulary issues. Plus with the IRA changes the max out of pocket is 2K which before you had no cap on—some new drugs are so crazy expensive that without this even the co-pay would wipe people out. That’s only recent fixed.
In our own case, my wife who 3 years ago our out of pocket for some daily cancer pills went from 15k in 2023, to 8K in 2024, to 2K this year as the IRA fully kicked in.
Some provinces such as Quebec have a public drug insurance plan as well which you pay into via income tax if you haven't got a private plan.
Over 90 percent of people on ACA plans get subsidies too. Also emergency treatment is guaranteed.
It's certainly a mess of a system, but every time the government does something to "fit" it, the price goes up faster and it becomes a bigger mess.
If anything getting it for diabetes got harder now.
Canadian employers sunlife insurance.
If you were prescribed it before the influx(not specific date) it was covered for diabetic purposes and still covered.
Now if you want to apply sunlife says NO, but you can get your doctor to send us these forms with additional info about the diabetes diagnosis and need and may be covered.
On the flip side theres a local diabetic that has been getting multiple high dosage units covered, but doesn't actually need them or take them
Flips them for $200 cad each to people looki g for weightloss.... (230-280cad in a pharmacy with prescription no insurance)
The US does allow for "off-label" prescriptions. The question then is : will your insurance pay for it. In my case, even though I am diabetic, they wouldn't cover Ozempic, or, apparently even Trulicity, which is just absurd (or Rybelsus which is the oral form of Semaglutide which they DID cover for a full year before putting me on Ozempic for like 2 months, and then denying (after the "new formularies" are approved and I get to be forced and switch to a med they still claimed to cover but not, apparently - I'm assuming they want me to appeal and give a whole run around on that.
But yeah... Technically it's for Diabetes only, but if you have good insurance, they'll probably hand out for any reason (see: "Hottest Celebrity Weight Loss Drug" for example; maybe that's changed now that Wegovy is released/authorized for weight loss)
Often you'll encounter the infamous "these tests or procedures aren't covered by the national insurance anymore so you'll have to pay out of pocket", or they're covered, but the nearest appointment on the national insurance is 15 months away, at which point you'll either get better or you'll be dead.
My boss recently moved from Germany to the US and was pleasantly surprised how much better the diagnostic, treatment and medication options are for his child who suffers from some rare mental disorder that's basically ignored in Germany by comparison. US seems to always be on the cutting edge of medical research and treatment which of course comes at a cost since research is very expressive.
When I worked for Facebook in the US, it was conspicuous how doctors would run extra tests on me because the health insurance was paying for everything and anything. That’s not balanced either because less fortunate people pay for that in their insurance premiums.
What do you consider the norm? 90%+ of Americans have some form of health insurance. I don’t have a bad one, but it’s not as great as some public sector employees do. Am I in the norm? If so, that’s ok
The company he worked at in Germany was even more prosperous yet had worse healthcare there. What's the deal?
First, the middle-men who negotiate and develop the formularies for insurance companies, called pharmacy benefit managers, get a cut of the reduced cost. So they make more money from a drug being $1000 and rebated to $100 than they would from the drug just being $100 all along. The pharma company makes the same amount per unit, $100, but they are much more likely to get onto an insurance plan if they go through the sham of marking it up to $1000 and then cutting it down.
Secondly, extremely inflated list prices that get rebated down simply mean that it becomes that much more critical for patients to pay for an insurance plan, because it is increasingly untenable to be without one.
These "negotiations" that PBMs do have been closely guarded "trade-secrets" but pharma companies have in recent congressional hearings have essentially said this is the situation. This seems to be supported by the fact that in their financial reports for products like insulin, the actual profit per unit has largely kept pace with inflation over the last few decades, despite the listed price of insulin skyrocketing during the same timeframe.
This is pretty much entirely the result of there not being a non-profit seeking government provided insurance option available to all in the US. If there is a reasonable alternative to private insurance that isn't engaging in the insurance cartel, no one is forced to use private insurance and the private insurers are actually forced to compete in a market. Completely socialized medicine isn't required, we simply need a Medicare-for-all option available to destroy the anti-competitive behavior that currently exists in the US insurance market.
If it was truly a free market, the federal government wouldn't be involved at all and I could buy insurance from any company in any state. It's because of the government's involvement that I can't buy insurance of my choice and preferred pricing from any insurer in any state.
But what’s more crazy is the prospect your doctor is motivated by profit.
Does that mean it’s less likely to be true?
I’ve had some interactions with doctors that would chill your soul.
“Here’s some long acting opiates. Take three a day for a month.”
I’ve had doctors offer me antibiotics for the flu.
I’ve been offered surgeries for conditions that don’t require them.
I’ve seen doctors offer a week in the psych hospital over mild distress.
I never had the problem of doctors pushing treatments I didn’t need in UK, Canada, Italy, or any of the other places I’ve lived.
Seems to be an American thing, but maybe I’m missing something.
> The fuck is my insurance company doing telling my HR what medication I'm on?
Isn't this a straightforward HIPAA violation?
It does not protect your medical data whatsoever.
https://www.hhs.gov/hipaa/for-professionals/covered-entities...
A relative has a self-insured Cigna plan that randomly fucks with you. The company hired another company to argue with them on your behalf. End of the day, Cigna is administering the plan they established.
This being said, if you want to go the medication route, there are not patents for medications in India. You could try to obtain it from India: https://dir.indiamart.com/impcat/semaglutide-tablet.html
I am not an MD and this is not medical advise.
QUESTION: If I live in the US in state XZ, what is the best, easiest way (zoom?) to get a valid prescription to order drugs from Mark Cuban? https://www.costplusdrugs.com
Will it help a significant net number of Americans be healthier? If so, then it should be made available to those people.
> You will have to look into lifestyle choices
That's not being questioned, is it? Who doesn't understand that exercise and eating well is better than not exercising and eating garbage all day?
Ozempic treats a problems (overweight) and might prevent problems further down the road (diabetes, high blood pressure, heart problems etc.) with trade offs like higher risk for specific cancers.
It does not treat the underlying cause ob obesity. One that might be highly processed food and Kennedy, whatever you think of him, stated this correctly.
Where in my post do you see that I said that Ozempic should not be made available? Please work on your reading abilities.
Obesity is caused by compulsive excess calorie intake. That’s precisely what Ozempic treats.
Kennedy is a grifter who profits from quack medicine. Ozempic, because of its effectiveness, threatens the supplements industry which is rife with quack cures for obesity. This is the reason he’s against it.
OMG. Please don't try to lecture a STEM PhD in Science.
Obesity is caused by many things. Genetics, epigenetics, psychology, bad food (highly processed, addictive taste), social interactions, gut microbiome, hormone balance disruptions (plastics?) possibly even viral infections.
Kennedy may be many things. Maybe even an idiot. With the statement that "Ozempic will not make America healthy again" he is right. If you have a smoking epidemic, better lung cancer treatment is not the right answer. What again does not include that better lung cancer treatments should not be available.
You’re correct, but Ozempic isn’t a lung cancer treatment, it’s a supremely successful smoking cessation aid. I don’t understand how you’re struggling with this metaphor as a Science STEM PhD in Science.
Obesity is a physics problem: you can gain weight on the healthiest food imaginable, and you can lose weight on a diet of marshmallows. Ozempic attacks the lack of control over the calorie input, the only thing that ultimately matters in this equation.
But in fairness, there's a complex etiology behind the lack of control of the calorie input, and attacking causes a bit earlier in the chain could make even more sense, no?
I'm not saying Ozempic is bad-- it's quite a good thing. But to the extent that it lowers our desire to really figure out these causes and deal with them, that's unfortunate.
And yeah, it is not a cure, but in the absence of a cure, harm reduction is a worthy goal.
Ozempic is nothing like cancer treatment. It’s surprising you don’t understand this. Ozempic would be better compared to medicine that magically removes nicotine cravings, allowing people to quit smoking.
Some people cant have it all in life. You gotta sacrifice. The carbs in our case.
Source: I do it for other reasons.
That is, if you follow it, I'm sure it works.
But the vast majority of people drop out of keto diets very quickly. So it's lousy advice and an unsuccessful intervention.
It's a bit like saying to a patient "you gotta sacrifice -- you should doing 3 hours a day of cardio". If they do follow through with it, it will work. But the vast majority of people won't be able to maintain doing that.
I feel like even with keeping my calories to about 1500/day I'm just fine, and the cravings for sweets and over indulging just aren't in my head.
Responded to with
> anecdote
I'm happy you have found something that works for you but the diet tribalism on this site is getting old. At least it's good to see the initial Keto comment getting downvoted to oblivion.
The epilepsy version is indeed hard to maintain, but can be life changing (increase life quality in epilepsy, bipolar, schizophrenia etc)
The T2D version is way easier. If you studdy it or get a coach, you will know all the pitfalls. But its like therapy, you need to want it yourself. Cant be forced into it.
The US just has no mechanism to control prices. There isn't really competition for specific drugs.
Most other markets with state insurance have purchasing controls. That is to say, if the price is too high, the government doesn't buy it.
Very few places have price controls e.g. "products cant be sold for more than X".
The US government is the outlier in that it situationally states it will pay the price no matter the cost.
Reasonable government policy needs to start with putting a price on human life (QALY), and purchasing goods and services that come in under that price. This is how it works in other state insurance systems.
Instead, we have a divided and fractured jigsaw and heavy lobbying to keep it that way.
The point is that governments won't pay any price, they usually negotiate a (good) price given their buying power. As you say they may not buy it, but countries that dictate a price (generally) cannot force a company to supply it.
Ultimately it comes down to market forces, even if the market looks very strange, with essentially one buyer and one seller.
That isn't really a market.
Suppose you have a government that requires everyone to pay for public health insurance, effectively eliminating the market for private insurance because hardly anybody buys private insurance when they both already have public insurance and have paid the money they'd have used to buy it in taxes. Then the government insurance declares the maximum price they'll pay. Is there any meaningful way to distinguish this from price controls? The vast majority of customers can't afford the drug without insurance and the government is the insurance company and is setting the price through regulation.
In particular, notice that this has all of the problems of price controls. There is no real market to enable price discovery, no effective way for customers to switch insurers and thereby punish insurers who pay too much and have high premiums or pay too little and have poor coverage, it's just regulators making up a number and saying take it or leave it.
And even at that, you shouldn't have a problem for generic drugs because then the insurance can just put it out for bids and still have price discovery (i.e. a lowest bidder). But here we're talking about brand new drugs that are still under patent, which have one supplier because they're supposed to be expensive because that's the incentive for the drug companies to fund the R&D and cause them to exist to begin with.
Note also that this is a feature, not a bug. You don’t want drug companies figuring out what price makes them the most money, because the market for patented drugs is not a competitive market (or a transparent one for the consumer). The price that makes the company the most money is not the same as the one that maximizes welfare.
It's not supposed to be competitive, that's the entire point of a patent. They're supposed to be able to extract nearly the full value of the drug during the patent term, because that's the value of the drug existing, so that's how much incentive you want there to be to create it. After that the patent expires and it becomes a cheap generic, which is what the public gets out of the deal.
It’s far far more efficient to have an expert guess the price that maximizes public welfare. They won’t get it 100% correct, but they’ll do better than monopoly pricing
There is though, because it gives you the price that it's worth to the buyers, which is the amount of benefit the buyers derive from it existing, which is the amount of incentive we want to provide to create it.
For something that wouldn't otherwise exist, the monopoly price for a temporary period of time is a close approximation to what would maximize welfare -- it's proportional to the value of having it exist without being the whole thing, because it becomes a competitive commodity when the patent expires.
It does not. It gives you what it’s worth to the last buyer, sure. All of the buyers before that value it higher than that price, and all of the people that don’t buy it value it lower than that price. In the end, all you’ve really found is the price the company expects will maximize profit.
This may tell you a little bit about what the company believes the demand function is, but it doesn’t confirm or deny their correctness.
But, in Romania, Ozempic was negotiated/price controlled by the government to be for around ~100$/month. First year or two supply was enough, so we got it, this year demand in places with more cash is high, so Romanians don't get any more Ozempic (but we still have Rybelsus)
Where this happens it's basically because the public wants more insurance than the government is providing, e.g. you're required to pay $3000 for $3000 worth of insurance but there are people who want $5000 worth of insurance so they buy another $2000 in private insurance.
But that doesn't really change the problem because the extra insurance covers different stuff. If your coverage from the government covers the drug and your coverage from a private insurer covers longer inpatient stays or hospice care, the latter is unrelated to the former. Meanwhile there are still a lot of people who only have the government insurance and can't switch to a different provider for that coverage because the government plan is required by law. And even if you could get drug coverage from a private insurer, the patient would then be paying for the whole cost of the drug out of the private insurance premiums even though they're still paying for the public insurance, which will deter people from doing that unless the government coverage is not just bad but catastrophically bad.
The way you could make it work is that instead of the government setting the retail price of the drug, they set how much they pay for the drug and the patient pays the rest, which the patient could then have covered by private insurance at their option. Then you actually have price discovery because if the drug is worth more to people than the government is paying, they'll buy the amount of private insurance needed to pay the rest.
> But, in Romania, Ozempic was negotiated/price controlled by the government to be for around ~100$/month. First year or two supply was enough, so we got it, this year demand in places with more cash is high, so Romanians don't get any more Ozempic (but we still have Rybelsus)
Production capacity isn't normally the issue for drugs under patent. The issue is that you need somebody to pay enough to cover the R&D or otherwise you don't get the drug, and drug R&D is crazy expensive because the price has to cover the R&D cost for all the drugs that don't work out.
https://www.fiercepharma.com/pharma/ozempic-shortages-contin...
https://www.tga.gov.au/safety/shortages/medicine-shortage-al...
For one of the most popular drugs in recent years, yeah, production might take some time to ramp up.
The issue definitely isn't R&D cost recuperation: in the US Ozempic is much more expensive, but in Romania nobody would pay that much (government or private).
Which is why it's an outlier.
> The issue definitely isn't R&D cost recuperation: in the US Ozempic is much more expensive, but in Romania nobody would pay that much (government or private).
This has nothing to do with whether the government sets the price. If people in the US would pay $1000 and people in Romania would pay $200 but the government sets the price at $100 in Romania then there is $100 less incentive for R&D.
Can you do it? Sure. Are you going to get an infection from it? Probably not. Is it riskier than having a compounding pharmacy doing it the right way? Absolutely, and in a meaningful amount of risk. The type of infections you get from contaminated injections are not something you want to deal with
What you're describing is a adequate for immediate use. Not use and storage.
Wiping the bottle before use is just standard practice to prevent contamination after compounding.
Doesn't mean it's safe. Lots of people trade off a small risk of harm for immediate benefits. Hell, look at alcohol.
From a quick look earlier this week that's not easy, and I've dealt with research peptide sites before. I was hoping to try one of the ones that's newer than Semaglutide for my IBS - that worked really well the later half of the week but not the first few days where it made things worse. I don't need to lose weight but I'd love to get that under control better.
i.e. The price difference could be reflecting a real qualitative difference such as being produced in different facilities, slightly less pure ingredients, less stringent QC, etc…
Look at how cheap generics are, that's what it costs to actually make and distribute a drug.
The pharma business model is that you spend incredible amounts of money on doing research, identifying promising drugs, doing trials, and overcoming all the regulatory hurdles you need to overcome to get the drugs to market. You then get a 20-year[1] exclusivity deal on your newly-introduced drug through patents, which you use to recoup your costs.
You don't just recoup the costs of inventing this particular drug, but also all the other drugs that seemed promising, had all that money spend on trials, but ended up just a bit too ineffective to ever be sold.
We could abolish the patent system and genericize everything, and that would instantly bring drug prices down massively, but then we wouldn't ever see any new drugs being researched.
We know that these drugs cost roughly $10/dose to produce, and most of that is the auto-injector pens. Hardly seems worth ruining their reputation and getting punished be regulators to save a few dollars on something with a 600-6000% markup.
Can you link the source?
If it really is a 600% to 6000% markup then it does seem unlikely they would try to save a few dollars.
The marginal cost of an additional batch is relatively small in comparison.
It is like estimating the cost of a rocket based on the price of metal.
The person above was claiming they were using substandard versions of their medication in non-US markets where the retail cost is lower. I was pointing out that the manufacturing cost is so low, that doesn't make sense.
Your point now has nothing to do with the discussion being had.
However, bad data is bad data. If I said the moon creates waves because it is made of cheese, I think it is completely legitimate to point out out that it is in fact not made of cheese.
It can only lower your credibility and the credibility of the associated arguments…
One concept is a single firm selling a branded product in multiple markets. Novo Nordisk sells at different prices in different markets, but the product is all of equal quality, and usually comes off of the same manufacturing line globally, or one of a few.
The other is usually generics made by entirely different companies. These can vary greatly in quality, from identical to deadly. It is a bit of a stereotype, but you usually see higher quality control and less fraud in US and western European manufacturing than say India, China, or SEA.
Having worked for US drug manufacturers, they deeply desire to move manufacturing to Asia where they can, but dont because of frequent quality issues when they do.
> less pure ingredients, less stringent QC
Why don't you link to a paper or source showing that to be true? If you want to discuss credibility.
You selectively quoted a chunk leaving out “could be reflecting”, implying a probability above 0.
So at most it can be said to imply there will always be a true probability greater than 0.
e.g. Someone could perish from a meteorite hitting them tomorrow. There will always be some non zero probability of that.
Didn't Novo pretty much tell congress that the only reason why the high price for Ozempic and Wegovy is the US system of middlemen and that lowering it's prices won't necessarily benefit the patients? The CNN reporting from the hearing is pretty interesting[1]. According to Novo Nordisk when they tried lowering the prices of their insulin product, pharmacy benefit managers dropped their products out of coverage, resulting in fewer people having access to the medication overall.
It's not entirely clear that Novo Nordisk is the company that needs to be squeezed.
1) https://edition.cnn.com/2024/09/24/health/ozempic-novo-nordi...
That would put the drug out of reach of most of the people in those poor countries.
It just sounds like it's sourced from somewhere else like any generic would be.
IMO the state should be able to take away monopolies just as easily as it passes them out in the first place.
It's commonly used to signify sarcasm or a tongue-in-cheek comment.
/woosh
> Medicare enrollees, however, still won’t be able to access the drugs for obesity under a federal law that prohibits the program from paying for weight loss treatments
Also, you have to be severely ill or elderly to get Medicare. This is for their diabetic treatment.
If the drug manufacturers wanted it to be covered for weight loss there IS a process. File the correct paperwork with the FDA and do the rigorous studies that were don’t for the approved usage.
The pharmacies are also in on it https://pmc.ncbi.nlm.nih.gov/articles/PMC11147645/
It’s a price-setting exercise. Yes, the drug-maker can walk away, but at the cost of massive punitive excise taxes on selling their drug to anyone in the US, not just Medicare Part D plans.
It's like saying taxes are a "negotiation for a contribution to the state government".
Also, they do negotiate for a very few drugs and the number is climbing. This was part of the IRA. However only drugs that are FDA approved for your issues are covered.
Before the IRA the government was not allowed to negotiate any drug prices by law which was/is crazy.
Certainly the VA can and does negotiate prices for the drugs it buys (that’s one input to the HHS Medicare price-fixing formula), but it has a formulary and is buying drugs for its patients directly.
Of course, Big Pharma will fight to slam it shut again.
It's not a negotiation between two parties with equal power, it's just the government saying "either pay this price or you'll be penalized".
The better solution is to allow parallel trade of pharmaceutical across borders.
It will force countries paying far less to pay more and conversely the US paying less.
No, no it's only a global economy when companies want to manufacture products using slaves in third world countries or they want to outsource programmers and call center employees, but not when consumers want to buy medications or DVDs at the prices they sell for in those same countries or even just want to get higher quality products they refuse to sell you here (https://www.cbsnews.com/news/hershey-sues-shops-importing-br...)
You end up with a circular reference that spirals prices down.
At some point that price is lower than the net positive profit point.
Don't give in!
In fact, by introducing new multi-dose versions to different regions, I'm starting to see Mounjaro prices reportedly double for some. The real kicker is that for some brands/doses the price doesn't vary whether you get more or less of the drug - so people end up asking to for a prescription to the highest dose off-label and then split the dose themselves.
For example, you can click the auto-injector pen a fewer number of clicks to measure out a smaller dose than what is normally injected by the pen, then relatively safely save it in the fridge for longer than recommended even without preservatives (some pens have and some don't).
It's frustrating when pricing decisions are made assuming insurance benefits and yet insurance isn't always available, e.g. unemployment. This thinking even applies in places that do regulate drug prices. But hey, you can always sign up for the manufacturer's discount program to get it cheaper, so, win-win right?
> The real kicker is that for some brands/doses the price doesn't vary whether you get more or less of the drug - so people end up asking to for a prescription to the highest dose off-label and then split the dose themselves.
FWIW, I'm paying cash buying it directly from Lily, and they charge $400/mo for the 2.5mg dose and $550/mo for the 5mg dose. So, some price differentiation between dose sizes, but not linear.
But yes, non-linear by design - a 15mg dose provides 6x the medication but cannot be sold for 6x the price or people will stay on lower doses (or discontinue) rather than going to a higher dose.
Meanwhile it provides 6x the medication. One multi-use 4-week pen has enough to provide 12 weeks of doses at 4-week titration if used off-label. Obviously this is only helpful on low doses.
Important note: I am not a doctor, I don't recommend doing this - in fact, I have not done it myself and will probably not do it in future. I have seen YouTube videos of medical professionals explaining how to dose split weight loss drugs though.
I would highly recommend dose splitting the brand name drug over picking some compounding pharmacy's version of the drug, or worse, buying it off the street. It's crazy though, there are even counterfeit medications in the supply chain sometimes, for example: https://www.fda.gov/drugs/drug-safety-and-availability/fda-w...
Technically this is done by the Biden admin but obviously coordinated with the incoming Trump admin who has made their attention of using trade to squeeze Denmark in order to get full control of Greenland very clear.
But I guess politicians are much cheaper than that.
All of these trillions are imaginary numbers buried in ice
Why would the Biden administration coordinate with Trump in an attempt to control Greenland? That makes no sense.
The Danes agreed that Greenland can become independent if supported by a national referendum. Apparently there is a decent amount of interest in that idea.
So the US can come in and say "hey, instead of independent, you could be in a union with the US". There is enough interest in that that it's a serious concern for the Danes.
To be fair we learned it from watching Dad (England).
> unstable authoritarian regime
How is it unstable?
> apparently just because
Territorial waters and exclusive economic zone claims grant amazing access to the arctic.
> something the US wants
It's really just the moneyed interests inside of it. China and Russia seem to have the same bent for the same reasons. It was recently unusual in Iraq since the federal corruption had risen to such a level, enabled by 9/11, that lackies for these interests somehow found themselves directly employed by government.
I prefer nuance over hyperbole.
I'll bite - the guy taking office soon recently attempted a coup and his party backs him no matter what action he takes despite his rampant criminality.
There have been at least 2 assassination attempts on this individual recently (by folks who ostensibly supported him previously) and had one been successful who knows what his remaining supporters would have done in response.
The USA is teetering.
This is just more hyperbole and relies on a highly subjective interpretation of a single tweet and blithe expansion of the accepted definition of coup. The least generous but realistic interpretation of those actions is that through poor word choices he incited a riot. You can credibly debate that this was criminal and intentional but to call it an example of a "coup" is flatly absurd.
> his party backs him no matter what
There is astounding and readily available evidence to the contrary. I'm not sure why you think there hasn't been or isn't currently Republican Party members that despise him and openly attempt to undermine him. They're not particularly difficult to find.
> despite his rampant criminality.
It seems like the majority of his actions are within the law. I understand you disagree with his administrative prerogatives but this lens is extremely distorted.
> at least 2 assassination attempts on this individual recently
How that implicates "stability" of a nation is beyond me. Are you prepared to label all prior presidents with successful or unsuccessful assassination attempts as being "unstable?" Is that your bar? Do you not see any connection between your widely held extreme points of view and these extreme actions?
Finally.. what is the source of this instability? That he won an election? That's an odd understanding of politics. One that I think is projected by lazy "news" channels that find it easier to market outrage than they do facts.
> and had one been successful who knows what his remaining supporters would have done in response.
From hyperbole into historically detached flights of fancy.
> The USA is teetering.
All actual available evidence is to the contrary. The economy is strong and the social order isn't. Qui bono? Perhaps you shouldn't focus so much on domestic politics.
The Jan 6 committee laid it out in detail but if not for Mike Pence having a shred of integrity trump's plan would have led to the state delegations in the House selecting the "winner" of the 2020 election. That's a coup attempt. It was well documented.
I can see few parts in US for example wanting independence under certain conditions. Or US could have given kurds Kurdistan in the middle east with all that crap it caused in past 2 decades, largely stabilizing (big part of) the region. Clearly not policy US cares about much, so lets stop pretending actual wants or needs of Greenland population are anybody's concern here.
When we recently made agreements with the US to allow them to store some of their weapons here in case of a crisis we did this, the mutual concern was Russia. The weapons stored are presumably also of types useful for dealing with Russia.
We Europeans have nuclear weapons as well, so there's no possibility of the US preventing any uncivilized violence-- we do in fact have very real autonomy.
The US probably did blow up Nordstream; but this is very simply that it's easy to make the right choice when you're not paying for it, so this isn't some example of better American morality. Poland has a formal alliance with us and we would have to defend them by all means at our disposal.
But, taking into account the sale of oil fund assets by Azerbaijan and the corresponding increase in military spending I assume more pipelines will soon have to be blown up, only this time it'll be the UK who adds its complaints to those of Germany and the other gas dependent countries. The Armenians might even have to do it themselves, rather than relying on help from others.
https://www.washingtonpost.com/national-security/2023/06/06/...
However, I mostly think you did it because you said you would, and I kind of trust you when you do things like that. When your leaders try to communicate their intentions, they usually mean what they say and it's not terribly complicated.
The US talk about agreement with the EU view that this is somehow a brazen and dangerous sabotage is pretty funny though, because this kind of thing is absolutely legal-- completely, not like 'Oh, this is disputable', but completely. The useless German arrest warrant that was issued was funny too. Neither of these two mean anything, but I get the impression that everybody knows it's legal and wish it weren't. They know that the Armenians can blow up Turkstream and the Georgian pipelines, even with the slightest provocation, since there's no ceasefire agreement and all their big investments can be destroyed in an instant with unhappy Brits as a likely result.
You don't even need an order. If your country is occupied by another country or at war, and you can damage infrastructure useful for the enemy war effort, whether in export of energy or the electrical grid or anything like that, you don't need an order, you should just do it. Attacks on things in international waters is obviously permitted. If it belongs the enemy and you can attack it, you probably should. It's more complicated if it's in a neutral country, and then it might actually be illegal, but otherwise-- do the work and put on some distinctive marking for the attack itself, and there's nothing to complain about.
It's something that anyone who has lived in a smaller country with a neighbour that could possibly make war upon them drills into their own heads when they first read their grandparent's old 1950s military manuals.
Of course, if the US really did warn, then it may be as you say-- after all, why warn of what one would oneself plan to do, but people can be tricky, so there isn't a guarantee there either, especially if the explosives are pre-planted.
I'm reminded of the weird US accusations against Russia right after the event though, now that I read the article again, and that's another reason to suspect the US. Imagine that you're in an Agatha Christie novel and somebody says stupid things to you. There's only one conclusion-- he wants you to think stupid things. The article also contains some of this kind of stupid about 1/3 in and it's right when it starts discussing this kind of thing, so, no it's 100% the US. You don't talk like this, or reason like this, unless you did it. It even has one of those 'how did you know the parts you weren't there for' problems.
Price controls like this are popular because the benefits are easy to see and the costs are distributed and nebulous. Excepting things like the fires in LA which are distributed and obvious.
https://www.vox.com/22553793/gila-monster-lizard-venom-inspired-obesity-drug-semaglutideIt's so shitty when you have to change insurance plans, and then get stuck holding the bill for medication that you were taking, but is no longer covered under your new plan -- especially for weight loss drugs that don't seem to be even like 80% covered under any plan you can get on your own.
Insurance should cover everything. Period. Full stop. Just because you change jobs doesn't mean you should ever have to change medications.
Anyway, Free Luigi! =P
The latter was settled in a 2023 cohort study that showed doing is completely ineffective. [1]
There's been tons of data on this. The scientific consensus has been pretty clear for a hundred years, but nobody wanted to listen. Probably in part because there was no good solution before.
Maybe the debate amongst actual doctors and researchers. But, the debate amongst dummies on the internet (social media) CERTAINLY had people arguing that it was somehow about more than the number of calories in and out.
Edit: to be clear, this also applies to comment sections on HN :-)
So, I don't know. I guess I just wanted to chime in to note that I have seen people repeat this crap about calories.
If you missed the whole "calories in, calories out" debate, consider yourself lucky. The comment above isn't helpful, but there really was a period of time where the topic du jour among health influencers was debating that calories didn't explain weight gain or loss. It played into the popular idea that blame for the obesity epidemic rested squarely on the food industry and "chemicals" in our food.
At one point, I had a podcast-obsessed coworker who tried to tell us all that even when he ate 1000 calories per day he couldn't lose weight. He had a long list of influencers and podcasters who supported this claim.
The CICO debate was especially popular among influencers pushing their own diet. Debating CICO was a convenient gateway to selling people your special diet that supposedly avoids the "bad" calories and replaces them with "good" calories, making you lose weight.
For what it's worth CICO sucks because (1) nobody can stick to it, ever (2) humans are awful at estimating their calories in, studies show only 1/5 of people can properly estimate the calorie content of their food [1] and (3) your metabolism slows down in response to, specifically, caloric restriction diets and your hunger rises which makes it difficult to estimate your calories out without indirect calorimetry.
Yes, CICO works in a lab, and for some weird people. It's a matter of thermodynamics. However you are a far more complex system than a coal powered furnace. And yes certain types of food will be more or less satiating and may influence the amount of total calories you consume. It's really really hard to overeat if you just eat lean protein, for instance.
CICO is, in practice, a tool that is roughly impossible for most people to leverage to lose a meaningful amount of weight and keep it off.
Which brings us back to the difference between maintaining a persistent caloric deficit -- and instructing people to do so.
This is the critical one that leads people to correctly argue CICO is largely useless for attempting to lose weight: the "CO" part of that is highly variable and is not merely a matter of being active. The body has all sorts of mechanisms that it can adjust to achieve the amount of storage vs burning that it wants to do, regardless of the amount of food consumed or the activity level.
Put simply: starvation mode is a myth for everything but outliers that are uninteresting to discuss.
Full stop.
Even if your metabolism slows down in response to caloric restriction, it does not move the needle to any appreciable degree.
Because it takes energy to do. It just does, you cannot fool physics.
However, measuring calories is incredibly difficult. Both in and out. Also, if you put 5000 calories worth of food inside of you, but then immediately vomit out 4500 of those calories, you've only really consumed 500 calories. You can overwhelm the system.
If you can restrict yourself to consuming at a caloric deficit, you will lose weight.
That's difficult however. Because if you pick a target calorie amount, you will see less progress as you lose weight. Because of math. 1500 is half of 3000, but only a quarter of 2000. People get fixated on 2000, as if we operate based on 2000 calories a day. But if you were previously consuming 3000 calories a day, your weight requires 3000 calories a day. So when you drop to 1500, you are going to lose about a pound every two days for a while. When you get to about 2500 maintenance calories/day, you're going to slow down to a about pound every three days. This is not your metabolism "adjusting". You weigh less, it takes fewer calories to maintain that weight.
And you will be hungry. It will suck. And you have to be meticulous in your record keeping. There are no "free" calories.
And we're not even getting into the mental component of all of this. What's been termed as "food noise". And it's one of the things that people on Ozempic and the like notice the most, they stop thinking about food. And food addiction is one of the absolute worst addictions to have. Hands down. With just about every other addiction, abstinence is an option. Alcohol, gambling, heroin, cocaine, meth, etc, none of that is necessary to live. We need food. We need to eat. You cannot avoid food. You have to actually develop discipline. Teetotalers do not have discipline. They avoid the issue altogether.
So CICO works, but it's incredibly difficult to do for lots of reasons that are not related to the biology or physics of it.
It CICO is physics, not a complete instruction set for life. I dont understand why it makes people so angry.
This is like saying most people barely use 5lb dumbbells when told to work out, so working out must not work. Like, of course major lifestyle changes take willpower!
https://www.thecanadianencyclopedia.ca/en/article/rabbit-sta....
>At one point, I had a podcast-obsessed coworker who tried to tell us all that even when he ate 1000 calories per day he couldn't lose weight. He had a long list of influencers and podcasters who supported this claim.
The week after Thanksgiving, I had a heart attack (age 50). I was in the CICU for nearly a week before they let me go home. On the day I was released, they sent a nutritionist in to tell me that I shouldn't try to eat one meal a day, that I really needed to be eating 3 meals a day, and to eat bread at least for two of those (or other carbs). Don't eat butter, eat margarine though. Yadda yadda. This was what, 8 weeks ago? Not 1962 in any event.
Do you know what 1000 calories looks like spread across 3 meals? Or how long you have to run on a treadmill to make up 300 calories if you bump that up to 1300? Or that, even sitting in an office chair every day, I can't lose weight (of any significance) at caloric intake much above that? I'm willing to concede that any problems I'm having here are in my own head, that I can't change my behavior or habits or whatever (to literally save my own life), but this isn't the sort of problem that can be handled by any but the most godlike of willpowers (which I do not have, if that doesn't go without saying). Right now, I probably need to be eating just one meal every other day, as I'm not really gaining any weight back but I'm not losing much either. My meal, such as it is, is a salad that fits in a small bowl (less than 2 cups of lettuce and uncooked vegetables). None of this is helped by knowing that people who are so-called medical professionals are giving me is absolute horseshit.
The truth of the matter is that we are adapted to eat only once every few days, and for even that meal to be meager and less than appetizing. But we live in a world that has mastered abundance and flavor, and uses marketing science to constantly try to get us to to buy all that. When you tell people "just eat less", really you're just doing the r/fatpeoplehate but in a covert way where you don't have to feel like an asshole. We (all of us, sympathizers, haters, acceptance activists) turn this into a morality tale, and can't think about this rationally. For anyone that cares, I wear 33" jeans, but I probably need to drop another 20-25lbs realistically.
PS Just giggled thinking about what it would mean to the US economy if suddenly every adult over the age of 28 started eating one small meal every 2-3 days... even our stock market is arrayed against us.
Yup welcome to the bad genetics club. Those calculators of TDEE vs weight/height are only an approximation. Many such cases of people who fall well-below those estimates. Many people need far less food than commonly assumed.
PS Just giggled thinking about what it would mean to the US economy if suddenly every adult over the age of 28 started eating one small meal every 2-3 days... even our stock market is arrayed against us.
Not just from less consumption, but also reduced productivity--people being tired all the time, irritable, unable to work as effectively or unable to concentrate. This is why tech companies put so much emphasis on food and having cafeterias stocked with snacks or catering.
The whole debate seems like people violently agreeing with each other aside from some fringe idiots that dont believe in thermodynamics.
They're not.
If you account for that, a lot of the calculators make more sense, and a lot of people would be shocked at how little they should be eating.
"Reduce calories" is about as useful as "exercise more", "sit less", "drink less", etc, etc. All are obviously good, but for various reasons it can be hard for people to achieve them.
GLP-1's basically take the "how" out of the equation. Take this drug, eat less without fighting your own desires.
this is a case where more personal / colloquial / folk evidence was needed to convince people.
The amount of woo-woo “science” in laymen communities on the subject is utterly astounding considering the evidence directly in front of them. Check out the various subreddits for a casual glimpse - anyone saying stuff like “the primary method of action is eating less” is downvoted and the woo woo “metabolism” or “hormones” stuff is upvoted and celebrated.
In the end I think there is a lot of weird guilt around overeating I never really understood existed before. I lost 100lbs using Mounjaro but never once thought it was anything other than me eating too much and moving too little while I was obese. It’s just a lot of damn work and willpower for me to change that. Tirzepatide was simply a performance enhancing drug for my diet that finally put me over escape velocity to make lifestyle changes that so far have stuck for a couple years now.
Calories in / calories used is NOT a complete model because different foods can have different caloric retention. The most extreme example being corn that comes out entirely undigested. Further, shittier foods that the body craves most are also the least satiating over the longer term.
Reducing calories is three or four steps removed from the actual problem. Like arguing the problem is organ failure when in the first order problem is that you got shot. You have to deal with the wound; and you have to deal with the blood loss. That will, in turn, address the organ failure.
Really? Because GLP1s reduce hunger and food cravings, less of those means less eating, less eating means less calories. The drug just makes people involuntarily fast, it has no thermogenic of lipolysis abilities.
The obesity epidemic is international.
https://en.wikipedia.org/wiki/List_of_countries_by_obesity_r...
Telling people to eat less or move more doesn't work and hasn't worked.
Sorry if it seems not empathic enough, that was not my intention. I know that the use of such drugs may be medically necessary.
Edit: To serious answers: I was wrong, I stay corrected.
https://en.wikipedia.org/wiki/List_of_common_misconceptions
"Wealthy Ancient Romans did not use rooms called vomitoria to purge food during meals so they could continue eating and vomiting was not a regular part of Roman dining customs. A vomitorium of an amphitheatre or stadium was a passageway allowing quick exit at the end of an event."
~ Ancient Hunger, Modern World by Solia Valentine
Via: https://escholarship.org/content/qt2594j40t/qt2594j40t_noSpl...
[1]: https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext... [2]: https://www.perseus.tufts.edu/hopper/text?doc=Perseus:abo:ph...
https://blog.oup.com/2014/11/roman-emperor-tiberius-capri-su...
> Stories of this kind were part of the common currency of Roman political discourse. Suetonius devotes similar space to the sexual transgressions of Caligula, Nero, and Domitian – such behaviour is to be expected of a tyrant. The remoteness of the emperor’s residence itself must have fuelled the most lurid imaginations back in Rome.
Suetonius was born in 69 AD; Vitellius was emperor in 69 AD and Claudius was emperor from 41-54. They weren't contemporaries.
The Romans were no stranger to just making shit up.
Heavily overweight. She is already partially immobile. Pre-diabetic. She may have other conditions, further complicated by her weight. She's on a fixed income.
Which is more probable -
1) A dietary intervention that she attends once a week that revamps her entire daily consumption (but remember, she's on a fixed income) along with some intense exercise?
or
2) put her on a single medication that changes her tastes for sugary and starchy foods, reduces her cravings, reduces inflammation, and in turn, will make her lighter and more mobile.
It is a no-brainer for Medicare. This will save so many downstream costs.
If they eat a lot of foods (some even good), their gastro issues are significant. So not only has it had substantial mental shifts around what they desire, but a bunch of foods are just not edible even if they wanted them anyway.
They went from ADHD driven boredom eaters to not even thinking about food.
The semaglutide really helps, I'm on a lower dose of it 0.5mg/week and have been on it for over a year. I've lost a fair bit of weight but that has stabilized. It costs me ~$30 per month and I save much more than that on eating less food.
For me it really helps with chronic fatigue which was destroying my life. I think it really is a wonder drug for people with auto-immune issues. I was insanely sensitive to it when I started which I think is common with people with ADHD so I started really low and only very slowly worked my way up.
You should apologize for making it obvious that you don’t know how the drugs work (as illustrated by sibling comments). If your analogy is “gas-guzzling cars”, I would suggest you revisit your reading on the topic.
We wear clothes because we evolved to not have hair. We wear glasses because we spend more time focusing on nearby objects. Some people need GLP-1 agonists because their body makes them consume food it doesn't need, and there's no scarcity to stop them. It's okay to use technology to adapt our bodies to a different world.
At least it takes a load off one problem (obesity related diseases). Could it actually exacerbate unethical farming even more or lead to even worse outcomes? Hope not.
I've read that obesity and smoking are net positives for the cost of state-supplied medical care because it causes people to die younger and quicker.
My real concern is what you stated: the by treating some of the symptoms of a toxic food system we will avoid treating the causes (in the USA, we would do well to take soft drinks out of schools and treat adding sugar to foods as an sin to be taxed)
The obesity crisis (specifically in the US, but elsewhere too) has been caused by bad food essentially - food that is not only nutrient deficient, but also engineered to be as cheap as possible and addictive as possible to get you to buy more of it.
As ever, the US is attempting to fix the symptoms, as opposed to the underlying cause, following the general idea of 'if everyone does what they like, things will turn out ok (somehow)'.
Probably negative health implications of these drugs will surface as people become habituated, and we can continue to shake our heads and wonder how it all went so wrong over there.
Taking a step back, obesity actually is an adaptation. When food is scarce, you want your body to extract and store every gram of nutrition it can get. And that would provide a distinct advantage when you're trying to reproduce.
The thing is, GLPs don't only suppress eating. There are plenty of substances out there that can do that...and there are plenty of people who can't lose weight by starving themselves, because your body will try to maintain its weight.
The question should be "why isn't everyone obese, given the huge amount of calories available to humans?"
We're close.
According to the CDC, approximately 73.6% of American adults are considered overweight, including those who are obese
Obesity is not an adaptation. It's a total aberration. Storing energy in the form of fat is an adaptation. Becoming obese is overloading your entire system.
> why isn't everyone obese
Well... they sure are trying...
It's rare to see this mentioned, so I'm trying to build awareness.
If you can't recoup that by selling the drug, developing drugs is not sustainable and will not happen. And the US is really the only country where you can sell for substantially more than manufacturing cost.
Ozempic manufacturers do make huge profits now, but that's quite rare. This is a tough industry to make money in.
Willpower is not a muscle, it's a well that fill doing what you enjoy, and clear when used. During my diet, my work ethic was at the bottom, and I couldn't force myself to go out meet new people.
Now that I have a healthier weight and stopped dieting hard (I'm still constantly hungry, but now it's my life), I'm a great coworker, I met a lot of people, made life-changing decisions and I have a lot of willpower left to do all the little things right. If I had a drug that helped me control my appetite at the time, i would have taken it.
I won't negate your experience, since this is such a personal thing, and it's not like we have a rigorous scientific understanding of these things. But to me, willpower does feel like a trainable thing. Doing hard things seems to make me better at doing other hard things. Limiting my TV makes me less likely to compulsively eat later. Working out hard makes me less likely to lie in bed scrolling on my phone. Doing hard coursework makes me more focused at work.
The caveat is that these changes seem to happen pretty gradually, and the gains can be lost pretty easily, just like with muscle.
But being in a perpetual caloric deficit can be pretty rough and can definitely sap your energy. Glad you found your way to a healthier weight.
I can definitely relate with the GP, even though your comment is relatable too. They're just different mechanisms, or they apply differently to different people.
For example, personally I find lifting in the gym or running on the treadmill to be quite boring. I like biking and running outside, especially on trails. A lot of people enjoy group classes like crossfit or yoga, since the social reinforcement can make it psychologically a lot easier.
Καλή τύχη.
Thanks!
Mostly, they haven't. You and I are outliers.
The population-level data tells us that overweight people are mostly unable to control their weight in the face of modern food. That being the case, it doesn't seem unreasonable to look for alternative solutions to the failed option of just telling people to eat less.
edit: regarding strength of addiction - I mean, of course, isn't it profoundly obvious that different people will have different strengths of addiction? I can drink without the slightest inclination to excess, while others are broken alcoholics. My grandfather didn't have the slightest interest in food beyond the calories needed to survive, while I have to fight every day to eat well.
It's profoundly obvious you're missing the point, and conflating somehow having a low degree of addiction to something with not being addicted at all to it. Your example about alcohol clumsily compares people addicted to it with people who obviously don't have a problem with it. We were talking, instead, about people, like myself, who had some degree of addiction to food, and still found it in themselves to overcome that shit. So it's two groups of people: addicts who beat their addiction, and addicts that didn't; not addicts and non-addicts, like you explained. Your examples, as you can see, are totally irrelevant and miss the point completely.
You also seem to imply that the degree to which you're addicted to something is the sole factor determining whether you will overcome your addiction or not, leaving your own will out of the equation. It should be logically self-evident that the fact that somebody beat their addiction says close to nothing about its "strength". One could have many physiological and psychological predispositions to food adiction and still beat it, while somebody with just a fraction of such problems could live a miserable life and never do away with it.
You> It's profoundly obvious you're missing the point, and conflating somehow having a low degree of addiction to something with not being addicted at all to it
Suggest applying some of that willpower towards paying attention to what you're reading.
> You also seem to imply that the degree to which you're addicted to something is the sole factor determining whether you will overcome your addiction or not
I don't imply anything of the sort. Willpower is one variable, level of addiction is another. What I do imply is that without deeper observation of a person's life, and the other areas in which they might demonstrate willpower, you can't make strong conclusions about their lacking willpower based simply on their weight.
Based on all I know about you (or you about me), we could each be people of tremendous willpower who overcame titanic odds to beat our food addiction, or we could simply be people who really quite like food who tried hard and overcame our mild predisposition.
Would you concede that some foods are more addictive than others? Doesn't this suggest other remedies like food regulations, at the very least, should be deployed in concert with seeming "miracle drugs" like GLP-1 agonists?
Mine is linked to grahlin, I'm just always hungry. Painfully so too (at least it used to be). Do you have a friend who doesn't like to eat, sometimes forget to, and only do so to avoid hypoglycemia? I'm the opposite, I produce too much grahlin, too fast. The weird part is that the more you eat/fatten, the more your hormone production increase.
My solution was regular, multiple days fast. Not calorie reduction (which was slightly painful, and very hard to follow), but full on fast, where the first two days are impossibly painful, but then your body start to ignore grahlin, and the last 3-5 are pretty much OK (hypoglycemia is an issue though, I did it with a doctor). And of course, more fibers in the diet (reducing milk-based products and meat helped).
I was obese twenty years ago, and lost the weight via diet and exercise. Keeping that weight off is the single hardest thing I have ever done, and a battle I still have to consciously fight every single day. Doing so causes me a great deal of pain and frustration, and I know that I'm someone who is right on the edge of not being able to control my weight. Why should it be that difficult? So that I can pass some kind of purity test?
The fact is that the food we eat has evolved over time, and is too hard to resist overconsuming for a large fraction of our population. If we can create more addictive food, why not create antidotes? If we could easily treat alcohol addiction with a pill, would we tell alcoholics to just apply willpower instead? Why would we want people to suffer like that?
It wasn’t short term at all like you say. Something was seriously wrong.
It’s everything though - if it was that easy to just start doing it then people would.
I needed a jolt and impetus to get better. I was depressed, worryful, everything.
I have lost 40 lb. I went from 255 to 229 with the assistance of Mounjaro. I stopped taking it but kept up with the regimen. I am now down to 214.
Some people who take it don’t do it right, they still eat crap and so those are the people who rebound or think they need to go up to 15. I was taking 2.5 then 5 when I stopped.
Yea it is willpower and discipline. Being on the medicine as an assistant along with a lot of research spurred by the community such as maximizing protein, fiber and water intake to become satiated was all that did it with exercise.
Just like you can't will yourself to be healthy if you are sick with the Flu. Some people can't just will themselves to be skinny. This is why we have drugs and treatments, because our bodies are not perfect machines that work the way we want them to.
Yes that would be Prednisone. People call it the devils tic-tac. Its a wonder drug with terrible long term costs to your body especially at higher doses.
Our biology hasn't changed much in recent years. Our environment has. So has our obesity levels. I mean, it's an "environment" that has "super size," as a default option.
Edit: In addition, anti-depressant prescription has sky rocketed.
* habits. often times, obese people use food as a stress response, as a reward, etc. this then makes them relapse.
* "target weight" of the body. there is a memory effect where once you have built up fat tissue, your body wants you to return to that weight. In other words, it's not just the first step that's hard, but all the steps thereafter. Relapse is easy.
* fat tissue makes you more hungry.
* environmental issues, like unwalkable cities, an entire industry putting chemicals into foods that make you addicted to them, its excessive marketing, missing availability of non-processed foods (large percentage of US population lives in food deserts), etc.
It's not just discipline of the individual holding them back.
These weight loss drugs are conditioning people to feel satisfied with less food in their stomachs, but only while they take the medication. If you don't put the same serious effort into improving your lifestyle, you're going to end up overeating again, gaining all that weight back, and probably going back on weight loss pills. Instead of solving the unhealthy dependency on food that most seriously overweight people struggle with, you're adding a dependency on medication.
Where I live, these drugs haven't even passed medical review for weight loss yet, they're purely prescribed for diabetics. That doesn't stop the illegal second hand market (taking drugs out of the hands of diabetics that are much better served with them) unfortunately.
In general, I do think weight loss drugs are better for society as a whole, as they save people from the ticking time bomb that is obesity, but I wish we could come up with a better solution.
And this talk of "dependency on medication" is ridiculous. Lots of people take medication every day to live a better life, or they use medical devices like eyeglasses and hearing aids, etc. That's one of the blessings of modern society.
Truth be told, my body can't effectively lose and maintain weight unless I'm eating a strict 1500 calories and replacing the walking with an hour long run each day. I know this because I've tried it and managed to maintain it for 6-months. It was a herculean effort and despite the results I paid a toll both physically and mentally. This isn't to say that the laws of thermodynamics don't apply to me; but my body will fight against them harder than most.
(I believe I would be a good candidate for these drugs. The only thing stopping me is the thought of having to be on them indefinitely.)