It’s very expensive at $10k/year/patient, but I wonder if the long term costs are still cheaper than treating heart attack or stroke. Obesity greatly increases the risk of cardiovascular events so I think this may end up saving Medicare money by shifting to pharmaceuticals from emergency care.
Of course, would be nice if they would negotiate a lower price as it’s really expensive.
But Medicare covers other chronic preventative meds, PReP coming to mind and that’s like $10k/year. But still way cheaper than HIV treatment that it prevents.
It’s around £250 a month in the UK privately, when it falls under the NHS fully it will likely be even cheaper.
There is absolutely no reason for it to cost $10K per year in the US.
I’m more worried about the long term effects of it, we had plenty of “miracle drugs” in the past that resulted in significant damage long term to either those who took them or to their children.
GLP-1 receptor agonists have been pretty widely used for diabetes since 2005.
If there's a major unseen gotcha lurking, it hasn't showed up in the first two decades. (Plus however long prior to that the clinical trials were going on for.)
With the right compounding pharmacy you can get it for less than ~$200/mo USD since Ozempic and Wegovy are the same drug, Semaglutide, just at a different dose.
Is it "off label" use of Ozempic? Yes. Are the FDA and medical patents in the US broken? Yes.
The cost of 10k per year is very likely to drop over time, especially if there's a huge roll out for millions of people. I think statistics calculations will show a net positive effect in terms of long term health care savings, unless Wegovy has serious side-effects that counter the benefits.
Medicare (the government part) wouldn't pay directly for Wegovy since it's an out-patient drug. That would be Medicare Part D, which is managed by private insurers who can negotiate.
> For the first time, the law provides Medicare the ability to directly negotiate the prices of certain high expenditure,
single source drugs without generic or biosimilar competition. Below is the list of 10 drugs covered under Medicare
Part D selected for negotiation for initial price applicability year 2026, based on total gross covered prescription drug
costs under Medicare Part D and other criteria as required by the law.
> For the first time, Medicare will be able to negotiate directly with manufacturers for the price of certain high-spending brand-name Medicare Part B and Part D drugs that don’t have competition.
With substantially less market power than "the Federal government on behalf of all of Medicare", and with the knowledge that the Feds will bail them out when costs are high.
> The Congressional Budget Office has estimated that negotiated prices will reduce Medicare spending on drugs subject to negotiation, translating into nearly $100 billion in federal savings between 2026 and 2031.
First of the GLP-1 receptor agonists was https://en.wikipedia.org/wiki/Exenatide in 2005 (with clinical trials prior to that). Safety profile is reasonably well understood with two decades under our belts.
Ah, but that is the beauty of it you see. You can then also sell a medication to counter the heart damage..
Beyond the sarcasm, it is concerning that most comments read here are raving about how much of a positive effect this cure could have. From a quick scroll, I haven't seen any addressing the fact that a new pill is not helping solve the cause of the problem.
We, as a society, have absolutely no reason to be obese. Yet, we choose to ignore the root of the problem, and cheer on the palliative chemical solutions. These solutions inevitably come we serious health side effects that we accept without blinking, as the most natural thing. And the industry also cheers as they can now also sell a second cure to address the side effects of the fist cure.
It shouldn't be forgotten that the pharmaceutical industry is, fist of all, a business.
The main cause of the problem is probably the widespread availability of cheap processed food in the US and, increasingly, other rich countries. I would support regulating these foods, but that would be very politically difficult and it would probably take many years for regulations to gain enough traction to make a difference.
We know from behavioral genetics that, for people in the same environment, individual differences in obesity are about 70% heritable. And there's loads of evidence that the standard "diet and exercise" approach does not lead to long-term weight loss in the vast majority of people who attempt it. (It does lead to shorter-term weight loss, but then people regain the weight, for biological reasons.)
So, short of massive regulation of modern "food products", the only options are either bariatric surgery (which does produce long-term weight loss) or some new intervention. The GLP drugs are the most promising candidates in that category.
I agree that there's too much triumphalism about these drugs at the moment. We don't really know yet whether they will produce long-term weight loss without serious side effects.
The solution to a problem isn't limited to undoing the cause.
Pros and cons not withstanding, any intervention which reduces obesity is a solution. Think of it like having a flat and thinking that taking the nail out of the tire is the only way to fix it. Replacing the tire also works.
>Because the root cause isn't a sudden increase in appetite.
It seems plausible that the introduction of evolutionarily novel ultraprocessed foods, designed by scientists in labs to be as tasty as possible, could increase a lot of people's appetites.
> It seems plausible that the introduction of evolutionarily novel ultraprocessed foods, designed by scientists in labs to be as tasty as possible, could increase a lot of people's appetites.
Bravo. So we also know what we should go after instead of simply compensating the issue with new pills. Because we also know how well the pill approach worked in the US when handling pain..
This would address future generations, after a lengthy analysis and fights about what actually should be regulated and how. It wouldn't do anything for people right now.
So yeah, we could improve the future, but there's also lots of people who need help today and bringing up "but we failed in that one specific case" while being silent about everything else in medicine is silly.
I agree that they might create a positive feedback loop, see for example the ever-present sugar cravings that take a few days-weeks of no dessert or sugar to subside.
The processed foods however is what we’d want to get rid of. Otherwise all we do is slow down the loop, and add in more side effects.
> We, as a society, have absolutely no reason to be obese. Yet, we choose to ignore the root of the problem
This applies to lots of conditions, right? I mean, society has absolutely no reason to have HIV. Just wear condoms and/or be obstinate. Easy peasy, right?
Fortunately, we have medication to treat and prevent HIV. Quite expensive, but they save lives.
We should rejoice that medications have been developed to cure otherwise incurable diseases. But this does not apply to the current case.
When 50% of your population is obese, and a further 33% is overweight, you have a major health crisis at play. And maybe, instead of trying to find better ways of soaking up the leaking water, we should focus on fixing the leak, not matter how great the cleaning products are that are being sold to us.
We've heavily regulated cigarettes, we've heavily regulated (some) life-threatening chemicals, it's time to focus on the rubbish being sold to us as food, and it's time to educate our populations without being too soft on the sensibilities of some, or too lenient towards the commercial interests of others.
I think you're missing the fact that USA, as a very rich country, tends to subsidize drugs for everyone. Your cost is artificially lower as ours is artificially higher.
The only way to make it cheaper in the US is to make your pay more.
> The only way to make it cheaper in the US is to make your pay more.
I think this is very unimaginative to claim that the developer/manufacturer costs are fixed in stone and THE ONLY WAY is for customers to zero-sum it amongst themselves.
Most of the cost was in development/trials, the marginal cost of manufacture is probably in the single digits per month. With such an enormous market demand the development costs can be recouped faster and there is a possibility to lower the prices in the states as well.
Also 10x difference points to more systematic differences in the healthcare systems not just altruism of the US citizens.
Artificially lower, as in getting lower profit, not as in subsidised. If you're trying to say corps sell ozempic at a loss, that's a big (citation needed).
For comparison, (as far as I know) the drug with the most revenue per year is Humira which costs roughly the same per year and has several million customers globally.
There are several anti-obesity drugs in the pipeline that work through similar mechanisms that should be entering the market which should lower the price through competition.
Heart disease, diabetes, and fatty liver disease are some of the most common killers and the reduction in excess body fat will causally and significantly lower the risks for all of them.
I’m all for it. Initial results seem very promising, especially for those struggling to get to their target weights. I was initially skeptical of it especially given the massive marketing push for off label usage (reminded me of fentanyl/oxy or certain amphetamines for weight loss).
Personally, just adjusting lifestyle (reducing intake of sugary and artificially sweetened foods; exercise; and intermittent fasting) over a sustained period of time (3-4 months) helped me drop 40 lbs. OTC supplements like vitamin d, and omega fish oil added to regimen (as recommended by doctor).
It's very effective for sure. But I also think it's ripe for abuse. I've seen healthy people on it to lose only 10 lb instead of making slight changes. I don't think we know enough about its long term effects and how damaging it can be to be on severe calorie restriction for some periods of time. It's like an induced eating disorder in a way and I wonder about the psychological changes that accompany it.
We should stop thinking of this complex in terms of "abuse" and "slight changes". We suck to varying degrees and obesity is obviously a societal issue. We need help.
We should keep looking for better options, we can and should always keep an eye on potential consequences down the line — and we can always elongate that line — but the very real, proven consequences of being overweight/having high blood pressure can be calculated like those that are attached to burning coal and they are worth tackling without prejudice, within the guidelines of what good science deems safe.
Anything we can do to help with cardiovascular issues needs to be explored. Doing otherwise would simply be immoral and irresponsible. We have tried eating salads and going for quick walks. It's always great when that's enough to change one person for the better. When it's not, we should help with empathy. Currently, there simply is no clearer, quicker path to doing more than these drugs, on a societal level.
I'm going to be skeptical of putting millions of on a new drug, permanently, to mask some underlying issue in society. Is there any evidence that people can be weaned off this after losing weight? Or is it expected to be permanent? This was not an issue in the past and whatever the root cause is, it's never going to be treated if we can just drug everyone into acting like they used to.
Are you asking what the root cause of obesity is? It's eating too much and not exercising enough. It's not some mystery. Or is the question about why people behave in this self-destructive way? People on average are bad at impulse control. Snack companies take advantage. People feel varying levels of discomfort vs exhilaration when exercising. For some it ultimately feels nice, for some it is unpleasant. Of those for whom it is unpleasant only some have the forethought and leeway to establish and maintain a healthy lifestyle. Of those for whom it is pleasant some face time or schedueling contraints that make an active lifestyle difficult. If there's a root cause to be fixed its that the human body responds poorly to acting on its impulses in our current built environment. You can solve that by altering the environment, the body, or the impulses. Ozempic seems to work by altering the impulses.
I eat as much as I want and don’t exercise enough, why am I far from obese? I’m currently scarfing down tortilla chips and guacamole.
To me, that suggests that maybe that simplistic (and frequently repeated) mental model is inaccurate or insufficient in some way.
My working theory is that most Americans’ gut microbiome is massively screwed up due to some combination of genetic, dietary, and environmental factors, and it changes what they crave, and how their body reacts to the food they eat. But I’m very much a layman on this topic.
Of course not 100% of people are obese. Individual susceptibility varies, and as you mention could well be influenced by how the environment or common diets impacts the body, and further by how those changes in the body impact the mind. That said, its not really surprising that a decent portion of the population crave food rich in starches, fat, refined sugar, and salt. On an evolutionary timescale these nutrients have been scarse, so desiring them was advantageous. At the same time, problems from overconsumption were likely vanishingly rare, so there was no pressure to develope countermeasures like decreases appetite in responce to long-term abundance. In many ways our bodies and minds are not adapted for modern life, and this is a distinct problem from our inadvertent mass-poisoning ourselves.
Stating that you eat as much as you want is meaningless. How many kcal/day is that exactly? Most people are terrible at estimating their calorie intake.
No idea, don’t care to know. I drink a huge amount of whole milk, eat lots of cheese, dark chocolate, etc, etc, so I’m sure it’s not a small number of calories. The point was that I’m eating as much as I want, and not restraining myself at all, so it’s not a matter of willpower or anything like that. I don’t have to fight cravings to stay thin, and I’m not a spring chicken with a super fast metabolism, so there’s clearly some other difference.
People putting it down to eating less are parroting the food equivalent of abstinence-based sex education, and we’ve been drumming on that for like the last 30 years. We have to find what’s making people want to eat to excess, not just tell people to eat less and exercise more. That obviously doesn’t work.
I'm putting it down to eating less. Regardless of what you think you're eating the reality is that your metabolism and digestion (gut microbiome or whatever) is nothing special. If you actually measure and weigh everything you consume, you'll find the total calories are in the normal range for someone your size.
If you think that there's something else going on, then let's see some hard data.
CICO is the mechanical answer. The question OP is getting at is "why" they naturally eat less. The poster is saying "I eat until I'm full and don't gain weight". For other people, they eat until they're full and gain weight.
Personally, my "satiated" level is very low. When trying to gain weight while weightlifting, it was difficult to eat the amount of calories needed. I know others who can easily eat twice as much as me in a sitting and not feel full. Something different in happening in our bodies to signal "stop".
People want to eat to excess because they're psychologically/emotionally rewarded for doing so, because eating whatever and whenever you could was pretty fucking important for tens of thousands of years before we had infinite McDonald's and microwave dinners.
Eating less and exercising more does work. Talk to dedicated lifters about their cutting/bulking, where they want to be, and talk to them about it again in six months if you want to see how effective it is. It doesn't work for a lot of people because in the short, medium, and arguably even long term, it doesn't make you feel good.
There are a handful of people that can struggle to gain or lose weight on a diet appropriate for the amount of exercise they do. You may be one of them. If you are one of those people, asking why other people struggle with it is like being a 6'6" basketball player and wondering why somebody who is 5'9" struggles to dunk like you can.
Yep, of course you lose weight if you starve yourself. But why do so many people seem to have a natural eating “setpoint” that fattens them, and others don’t? My guess is that it’s largely the types of foods they’re eating. Not fatty ones, which have been vilified (like I said, my food mix includes a lot of whole milk, cheese, and other very fatty food), but ones that mess with their digestion and satiety signals. For example, if you drink sweet drinks, they make you hungrier. I’m pretty sure if I eat more McDonald’s and microwave dinners rather than the simple foods I generally eat, I’ll fatten right up, and I’ll join in the ranks of those that crave more food than needed.
>Yep, of course you lose weight if you starve yourself
There is a massive difference between being at a calorie deficit and starving yourself. I don't even know what to say -- this horse has been beaten to death by countless thousands of people and it's wild that anecdotal evidence with a sample size of you is enough to justify theorizing an alternative to an incredibly simple idea that until a few generations ago, there was absolutely no evolutionary pressure to not want to eat everything you can.
Sorry for the hyperbole. I think you're being a bit uncharitable, though, I'm of course not basing this entirely on myself. Lots of people I know have a bar for being satiated that maintains weight without effort. But many clearly do not. Is it obvious why some do, and some don't? It's clearly not down to willpower.
I suppose you'd say that some areas experienced more evolutionary pressure to eat as much as possible than others due to differences in food security?
But being hungry/unsatiated is distracting and can decrease your performance on every other task you do, so I don't really agree that there's no counterpressure. And I doubt that people in even those less food secure regions are just hungry all the time, like some obese people here describe being. It really seems like something just gets messed up in the signalling, which makes it seem more like a health problem/malfunction than some built-in evolutionary drive that doesn't fit the modern world.
At the very base this is mostly true but it's like saying the reason people die is because they stop living. Framing it as people behaving "in this self-destructive way" also isn't helpful because being obese isn't a moral failing.
The true answer is more complex. At least in the US, consumers have been fighting deceptive marketing/branding for things that have been claimed to be healthy choices but are full of sugar and unrealistic serving sizes. Combine that with unhealthy foods generally being cheaper and/or easier to cook and now more accessible/easier healthy eating also has class issues. Exercise does too as most of the places where obesity is most concentrated in the US (the Southeast) doesn't have walkable cities or sidewalks at all.
This has been a common comment left on HN of "it's just move more, eat less" and yeah, at a fundamental level, sure, but really doesn't take into account how difficult it can be for a person that's in that situation.
But (inserting my own narrative), isn't the point that some deeper societal problem is being masked by this?
> Snack companies take advantage.
I'm uncomfortable with these new drugs but they seem to be a net positive so this is a good thing. But we should also look into legislating junk food companies that hijack people's appetite for a quick buck.
Chile banned sugary food TV advertising to children and saw a roughly 10% drop in purchases high in sugar. An unleashed free market in food has been shown to be harmful and the drugs alone are insufficient. Regulation is necessary.
Most dietary changes fail, I don't think that's a good example actually.
In any case, yes I have, but the only time it has worked was when I changed my environment (stopped slouching at home bored with a full pantry) and my impulses (filled my days with activities so that boredom hunger wouldn't strike). Only changing one would make me last a couple of weeks max
> Only changing one would make me last a couple of weeks max
Different people struggle with different impulses. I don’t have much trouble permanently modifying my diet. I struggle, on the other hand, with keeping a normal sleep schedule.
"Impulses" here means the mind. Medication with side effects also effect the body. You're giving three options of altering the mind, body, or environment. On principle I'm against altering the mind and body of millions of people because their environment is shitty. This also doesn't buy anyone any time, it just makes it the new "baseline" normal as companies and society adapt around it like these snack companies you're saying take advantage of people.
Assuming the change really is just limited to being less suseptible to cravings for unhealthy foods, I don't see an issue. That's a big "if" thought. And yeah, fixing the environment in this case would just be a matter of the FDA or regional equivalent resticting the sale and advertising of unhealthy foods, which personally I view the same as anti-smoking laws and would be all for, but the current regulatory climate makes that seem extremely unlikely.
Your principle as stated doesn't apply to a situation where individuals have the agency, which I think is a fair assessment of a drug that they choose to take. They are examining their environment and making a choice, not having their mind and body altered by some exterior force.
Which isn't to say that the overall idea of trying to find other ways to make obesity less common is bad, it just isn't a coherent argument for that.
You fix the immediate problems where you can. You buy time. You find better solutions down the line. When a person is dead, you can't find a better solution.
It's "masking" the issue as much as chemotherapy is "masking" the issue. People are dying. We have tried appeals to salads and quick walks.
Unless you got anything up your sleeve, I recommend we stick to the ol' "keep more people alive with the best stuff we currently got" plan, until information pops up, that makes this look like the morally worse option.
But in that regard preventing death is fairly hard to beat as a baseline.
> We have tried appeals to salads and quick walks.
This bit made me laugh, as if public health initiatives have been taken remotely seriously by the past few decades. It seems quite a jump to go from "maybe try a a salad?" to putting millions of people on medication.
> It seems quite a jump to go from "maybe try a a salad?" to putting millions of people on medication.
It's a hyperbole, meaning to say: The problem is so frustratingly silly and solution is so obvious and simple — just eat a little less, move a little more — that I understand how hard it is to accept that it might just be the completely wrong approach.
What makes it fairly obvious to me is that despite clear and long standing conflicting beauty ideals, the massive societal advantages beauty affords, and an industry build around weight loss (not even drugs, stuff like Weight Watchers), people still struggle.
If you have good insight into why informing about tobacco worked to the degree it did (although lung cancer is still the leading cause of cancer death) other than claiming vague un-seriousness, I am all ears. Otherwise I have a hard time understanding this as an information problem.
> If you have good insight into why informing about tobacco worked to the degree it did
My point here was that we seemed to approach tobacco/alcohol a bit more methodically - taxes (i.e., increasing costs for cigarettes), regulations (i.e., where alcohol can be sold), education (i.e., scary cigarette packaging) - whereas we seem to be saying, "Well, we did very little and got no results, so let's go nuclear!" when it comes to obesity
It seems to me that, if obesity is so harmful to society, places like McDonalds and other (provably) unhealthy food shouldn't be as cheap or as easy to get as it is.
> The problem is so frustratingly silly and solution is so obvious and simple — just eat a little less, move a little more — that I understand how hard it is to accept that it might just be the completely wrong approach.
It certainly is frustrating, and I feel that more than I probably should. Probably something to reflect on.
I agree with you that this does not address the underlying issue. But root cause you speak of may not really be that simple to fix. Is the root cause people spend much more time in their offices working and hence are more inactive? Is it the crappy American diet?
For example, many people around me gained weight after they became parents. Especially women after birth. It is just insanely difficult to work hard in an office job, take care of young kids and exercise etc all at the same time.
As you age things get very difficult as well. I eat significantly less than what I used to just few years ago but still have 5-10lbs extra.
I lost 40 pounds the classic way. Just better diet, eating less.
And like the majority of people who lost weight, I gained it back.
Why? I don’t know. My body just wants to eat more. I have to be constantly vigilant or else I’ll fall into my old habits of what my body demands that I eat. I’ll eat dinner and then still be hungry.
I think you’re getting this backwards. I already have an eating disorder.
My wife and I are both (relatively in my case) skinny, and we both also need to be constantly vigilant, although I find I need to be less so when I walk 4-5 hours per day at my desk.
Of course you’re still hungry - you have a pantry of delicious food right at your fingertips. One Oreo couldn’t hurt, right?
That’s not somehow unique to fat people, though I know some other skinny people will pop in and say “I’m basically never hungry!” Humans didn’t evolve to have delicious food constantly available, and to need to do no exercise to get it.
I wouldn’t say those that are overweight have an eating disorder. They’re (obviously, going by statistics) “normal.” Then there’s those of us that have the will power or specific motivation to not stuff food down our throat. The few that are left are probably the real ones with something biologically unique.
Thanks for the advice. It’s so helpful. Why didn’t I think of that?
All the people who have never been fat have the best advice that us fatties totally appreciate and want to hear even when we never asked for it. In fact, it’s extra awesome when people bring up obvious advice when we don’t ask for it because fat people like me are actually less smart than you! So it’s really helpful to have a helping hand and I thank you for it.
Thank you for downplaying a disease that almost half of the population has and for blaming it on me as an individual. Because obviously if half the country has the exact same ailment as me, it’s really a sign of the dangerous virality of the fast paced chewing lifestyle.
Since most people who lost weight gain it back at some point statistically, it really makes logical sense that it’s all about how fast we are all chewing our food. All the celebrities and pundits on TV and in social media talk about how we need to chew our food faster, so it’s hard to escape that perverse influence.
I'm sorry to hear about your troubles. I have occasionally shared them. :(
If you're interested, I do have a recommendation for you. For my money, Joel Greene is the best scientific thinker on the topic of diet and health, and his recent book "The Way" does a lot to replace frustration and confusion on the topic with sense and helpful advice. I recommend it if you've had success with a diet, and then regained the weight, and now nothing works - that's the exact problem he's focused on. Above and beyond whether you like his suggested solution, he does a lot to uncover mechanisms and explain the complexity of the problem.
For what it's worth, I think your experience is completely normal. Nearly universal, even.
Sorry - didn't mean to offend. I know unsolicited advice on the topic is unwelcome, and I don't exactly mean that I think I can solve your problems. More like, you seem frustrated by simple explanations, and I wanted to point you to the resource that I think does the best job of explaining why you are right -- things are complicated. I know Joel Greene comes off as a nut, and I don't usually recommend him for that reason. But you could also hardly ask for more mechanistic detail and science than he goes into. Seemed something you might be interested in. My bad if it's not.
If you'd rather see the bibliography without the boomer, here's what's directly relevant to what you were writing about - one of the (several) mechanisms for weight regain and why losing weight is so much more difficult the second time around: https://www.cell.com/cell-metabolism/pdfExtended/S1550-4131(... (TLDR: Control of hunger by the hypothalmus responds to dieting by becoming more aggressive, and it stays that way after the diet stops.)
It's not in your head and it's not a character flaw. Purely physiologically speaking, naive, restrictive dieting really does become much harder, if not impossible, the more you do it.
Maybe abuse is not the right term, but certainly not necessary to drop 10lbs. I workout pretty casually, and when I go on a cut I can lose 1lb/day. It wouldn't surprise me if an inactive person could lose that in a month. And the act of practicing self control would be beneficial. Maybe you are onto something with your comment about population-level effects though, I wouldn't know.
Sure some of the weight in those first ten days might have been water, but it stayed off. Possibly because my diet didn't immediately revert to pre-cut levels but it's hard to say given it didn't go back up and I wasn't exactly suffering. A 1000 calorie deficit over a month would still cut 8lbs. No problem for an overweight man who is likely eating well in excess of 3000 calories. The point is that major interventions aren't really necessary for that level of weight loss, and imo practicing the self-control needed to lose 10lbs should be beneficial to pretty much anyone. Let me put it this way: it should be way harder for a couch potato to train for a 5k run than to lose 10lbs on a cut.
> The point is that major interventions aren't really necessary for that level of weight loss
It’s about effective interventions. Obviously major interventions are needed as there is a huge amount of obese and overweight in the US and many other methods have been attempted.
It’s not about theoretically possible (ie, a bodybuilder can do it) but effective population interventions that result in people successfully losing weight.
Think about people going to medical school and becoming a doctor. It’s obviously possible but if you said the solution to income inequality was for everyone to go to medical school and be doctors that would not be a very effective intervention.
Not being obese is not being wealthy. It’s simple what to do, but difficult to stick to a successful plan.
Maybe if messaging wasn't so absurd then people would feel more empowered? Losing weight is as simple as counting calories and cutting some of them. This isn't just theory. But every time the topic comes up I see the comments dominated by discussion about diet and lifestyle optimizations. People really don't have to change their whole lives at once to make noticeable improvements. Most of the advice I see on weight loss feels more like coping or even trying to sell people things rather than actionable advice.
Just like being rich is just hard work. And not being depressed is just thinking happy thoughts.
Etc etc
Life is full of things that are supposedly easy, but yet people don’t do them. I think it’s reductive to just stick with ineffectual interventions that aren’t being used because they seem simple and people should just adjust.
There are multiple "1st world" societies where obesity rates are below 10% and many more near those levels. The United States is above 40%. It is an absurd perspective to believe any amount of weight loss is unattainable for the general population through natural means. We need to have a bit more faith in our abilities.
Feel free to suggest something more effective than ozempic.
Saying “Japan (4.5%) can do it so Germany (19%) should stop being so fat” isn’t very helpful. [0]
The goal is to reduce obesity. It’s not like we can’t also attempt systemic changes while also using ozempic.
If you’re saying we shouldn’t use ozempic because other methods should work (but haven’t in many countries), then that’s a pretty simplistic argument. And one that will likely result in greater obesity and societal harm.
To be clear, I'm not against people medicating for severe cases. Calorie counting does work for billions of people alive today though. It works so well most people never even have to do any real measurements. You're either starting from a false premise by declaring that it "doesn't work" or using a very lax definition of what it means to try. I'm assuming the latter is what you mean, because that makes the most sense. The point I'm trying to make is you would be hard pressed to find someone who actually followed through with measuring their food intake honestly, cut 500+ calories out of it, and still managed to not lose weight over an extended period of time.
One of the reasons I referenced other countries was because it provides very strong evidence that culture is a factor. In America, we presently have a culture of telling ourselves that it's really hard to keep excessive amounts of weight off. We betray ourselves every time we tell that lie.
Also as some other people have noted, those costs seem high now, but they're certain to go down over time (due to competition and other companies entering the market along with other countries), and almost certainly worth the cost -- type 2 diabetes can be very expensive, along with all the other effects from complications of obesity.
For example, Wegovy has actually been FDA approved for reducing heart disease risk:
I've heard from random podcasts (do your own research) you need to make sure you exercise, and perhaps eat high protein, while on drugs like this, otherwise you lose a ton of muscle mass. Could be deadly for seniors, where falls are a leading cause of death.
> I've heard from random podcasts (do your own research) you need to make sure you exercise, and perhaps eat high protein, while on drugs like this, otherwise you lose a ton of muscle mass. Could be deadly for seniors, where falls are a leading cause of death.
This isn't true in the sense that it's because of GLP1 RAs in particular -- it's just that GLP1 RAs are effective at rapid weight loss, and that's what happens when you undergo rapid weight loss REGARDLESS of method.
It's a trade-off -- do you want to manage muscle loss and bone density issues (with an easily modifiable dosage/etc) or manage type 2 diabetes or heart disease for the same patient?
Who spends 10k/year on a car, that seems incredibly high. Also I'd say most people spend more than 10k/year indirectly on upgrading their health, but I'd count things like "not eating cheap food all the time" as one of those, or for example, moving to a places in less crime-ridden areas. And people rationally will spend money like that before they try experimental drugs.
Also - you can't really go buy this OTC anyway so it's not really a substitutable good.
A bit aside, I am bullish on these compounds. Tirzepatide is a discovery on the same order of magnitude as any - even potentially bigger than all the recent ML stuff. It's not even close to it's full potential. The data shows it's the only thing we have that really squashes diabetes and obesity with minimal side effects, but also has big positive effects on addiction, heart, bones, liver, brain, and immune system.
The addiction effects alone could change the world tremendously for the better if it's made easier to get and easier to ingest. I gave one of my Mounjaro shots I wasn't going to use to someone who had been trying to quit cigarettes for a decade and they were basically in tears a few days later telling me they went two full days without smoking, the first time they'd ever even gone a few hours since they were young.
> Who spends 10k/year on a car, that seems incredibly high.
You may need to recalibrate your intuition. Average payment on a new car purchase in the US is almost $9,000/year. Average used car payment is >$6,000/year. This is before taxes, insurance, gas, etc. It is common to spend $10,000/year on owning a car in the US.
The Americans who don't spend a lot of money on car-related expenses are the outliers. Despite this, the median American household still has $12,000 per year leftover after all of their ordinary expenses like paying for cars. Average Americans have high incomes, profligate spending patterns, and poor savings behavior.
The average new car buyer. The average payment on a new car is now $726 per this source (some sources have even higher numbers). That's about $8700 per year. That plus insurance, fuel, and maintenance puts you well over $10k.
If you put 200,000 miles on a $50,000 40 mpg car over 10 years, that's $50,000 for the car, $15,000 for insurance, $25,000 for gas, and almost certainly more than $10,000 for tires, maintenance and repairs.
There is a rule of thumb that the purchase price of the car is 1/3 of the cost over its lifetime. That's pretty generous in 2024 since cars now have better mileage, better reliability and cost more, but it's almost certainly more than half the cost.
And new is appropriate, since used price is payment from one owner to another. IOW, if one side of the transaction gets a good deal the other gets a bad one, leaving average unchanged.
Average annual capital cost is new price divided by lifetime.
First - the average number there is according to Kelly Blue Books "proprietary editorial process", and I have doubts. Given it's spiked in recent years too we can assume that 90% of people today aren't at this new inflated price even if it's true and likely many more are holding out or buying used now.
Second - every one of your numbers is rounded up quite a bit, especially mileage as the average mileage would be 135k by year 10.
Third - You left out selling your 50k car in year 10 given 135k miles.
Fourth - EAC, one way to get to the truth, not the only.
I never claimed the numbers were average. The OP claimed that $10,000 a year on a car is uncommon. I'm saying that you don't have to go much above average to pay $10,000 a year on your car -- that spending $10,000 a year is common, even if a little less than 50% of people do so.
It's not far off. The average new car transaction price is now $47K. I can't understand how so many people are able to afford such expensive cars but somehow they're making it work.
It comes to buy price minus sell price. People buying 47k cars are not driving them to ground or totally writing off them outside rare cases. Not that it is not still significant sum of money, but there is also large second hand market involved.
"incredibly high". This means finding an amount that high strains believability. I don't own one but I see X3s every time I commute to work. Obviously I see far more expensive cars too but I wanted to keep it somewhat reasonable.
You clearly don't know a lot of people who aren't wealthy. The majority of people I know couldn't spend 10k on anything except absolute necessities, let alone a car. Of those who do have vehicles, none of them spend $10k/year and if they did it would damn near break them.
Seriously, I don't mean to be rude, but god damn this is out of touch for people who are struggling.
Before you accuse someone of being out of touch, take a look at the average new car transaction price. It's now up to $47K. When you factor in loan payments, insurance, maintenance, and fuel then a huge number of people are spending $1K/month or more on their vehicles. These are literally average people, not wealthy.
'New car' being the operative term there. Also note that I said out of touch with people who are struggling. No one who's truly struggling to get by is going to be buying a new car and certainly not at those prices.
To clarify further, my response is primarily aimed at the idea that the op couldn't even understand why people would need the government to help pay for things and pre-supposes the idea that all of us can afford $10k per year on a car.
They were clearly talking about the average American, not "people who are struggling". Ignoring whether or not it is wise, the majority of American households can technically afford to spend this much on a car and a large percentage do.
A car directly impacts the ability of many to work/live. Not having transportation can leave you cut off from society if you are in an area without alternatives.
OP said 'we'. Perhaps my psychic abilities are malfunctioning, but how do you see that this is a case for using clearly? The OP can't understand the inability for people to pay for things without government assistance, as if there aren't vast swaths of people who can't afford the very thing he is presupposing. People who are struggling should be considered and the very fact that the use of 'we' somehow excludes them in those considerations is kind of the point.
Show me the data with the average and median of all car purchases, not just new, and I'll show you that $800/mo is far from 'nothing'. Hell, my first 3 cars were under $4,000, with each lasting 5 years or better and I damnwell didn't spend anywhere close to enough on fuel and maintenance to bring my costs to even half that number. Maybe I'm an outlier, but in my bubble of poor folks, I'm certainly not.
The average monthly car payment is $738 for new cars and $532 for used. Several factors determine your payment.
The data source is Experian, so I give it some credence.
If you think it’s high, consider that all the low payments you know of need an ‘equivalently’ high payment to balance out the average. People spend huge amounts of money on cars.
On the one hand, I get what you’re saying and logically it makes sense. On the other hand, you’re seriously downplaying the increasing lack of affordability of modern vehicles.
What $20k car are you talking about exactly?
A new Toyota Camry base model costs nearly $30k.
And that is basically the most sensible no-frills vehicle you can buy.
In my area a $20,000 example of a Camry already has 80,000 miles on it and is a full 5 years old.
You are not keeping a $20k car for 20 years for a total lifespan of 25 years. That isn’t realistic at all.
A new Corolla’s MSRP is $23k, and not every car payment is for a brand new car.
It’s a far more realistic example than the pricey BMW SUVs people are linking with five-year cost summaries here.
The point is “average monthly car payment” and “average money spent per month purchasing cars” aren’t the same stats, just like the cost of a heart transplant doesn’t translate to how much I pay this month for one.
How does a family with three kids fit into a Corolla?
If we just dive down the rabbit hole of cheaper economy cars all we are saying is that the standard of living is declining when we compare to the past.
A 1987 Dodge Caravan cost between $25k and $38k in today's money. You can't even get a base model Chrysler Pacifica for that much.
I agree on the fact that most people are buying used cars...but used car prices are based on the benchmark of new car prices, and they're higher APR loans as well. So really both categories are getting less and less affordable.
I would bet that those numbers don't include a large number of private/p2p sales and cash sales, given that they're from a credit agency. Perhaps I'm wrong, but based on the number of sub-$3000 cash sales I've seen in my extended circle of acquaintances over my lifetime, I'm pretty sure there's a large chunk missing from the data.
But even then, assuming they somehow capture every resale of every vehicle, most people who can barely afford a car are not buying another car as soon as their payments end. Many, such as myself, drive a car until it dies. We tend to also learn a good deal about vehicle mechanics/maintenance to keep it going 'on the cheap' until either the engine or the transmission fails catastrophically and it becomes cheaper to get another used vehicle.
It's about £2,500 ($3,100) per year in the UK if you just buy it online, not subsidised. I don't know how the US massive price hike is justified when the whole western world is buying it from the same supplier (Novo Nordisk in Denmark).
I think this is mostly true. Perhaps truer still is that the US willingly had rules that massively reduced their market power in negotiations, which in a game of parallel negotiations leads to the obvious price discrimination. You cannot blame big pharma for giving a client willing to pay any price without negotiations what the client wants: high prices.
One counterpoint is that in my country we’ve successfully reduced prices for medicines a lot by strong negotiations in the last decade. We are last in line among western nations for medicines now. Shortages all around.
And the US isn't paying for the R&D (that sounds like a regurgitated line from somewhere?) so much as paying for the pharma company's profits, due to the US's totally screwed-up healthcare system and situation.
How is it different from the normal market? If I have a product and sell in Germany for 50 USD and Switzerland for 100 USD because that is what people are willing to pay, would you also say that Switzerland pays for R&D while Germany gets it below cost?
That is right, but it is a global market where Novo Nordisk can decide to sell in a country or not, so I do not think they would sell below cost. I agree with the point that the US pays disproportionately much for the R&D portion of the cost, though.
I bet this will end up saving the government a lot more than it costs. On the other hand, the side effects and long term effects of these new drugs are not well known. I wouldn’t be surprised if some of the common GI side effects become something more serious.
Without discounting the cases that are genetic or as a result of some other illness, for whom such a pill is a godsend, most obesity is due to lifestyle and especially all the processed foods (not to mention soda!) that Americans eat and drink.
I'd rather my taxes go to preventing obesity in the first place then paying for a pill that helps relieve its symptoms (but does not fix the underlying cause), is expensive, and has side effects. Make it harder to life an unhealthy lifestyle, just as we've made it a lot harder to smoke over the past 40 years. Start by taxing sodas and processed foods for one and use the money to subsidize healthier foods and prevention of "food deserts" in lower income areas (given that obesity is highly correlated with low income which is highly correlated with unhealthy diet -- it's hard to stay healthy when all you have nearby are corner stores stuffed with Frito Lay and Coke.
To me it's another example of how we really have our priorities backwards.
Well, and that's exactly what these drugs do: they either make you uninterested in processed foods or make you ill if you consume them. Considering how many people's dietary habits are formed in childhood, and considering how many people learn dietary habits from their parents, I could see GLP-1 agonists having a generational effect where the children of people who take them never get hooked on bad food to begin with.
Although for what it's worth, you're absolutely right about food deserts and income, I sadly just don't see those things getting tackled head-on unless political winds in the US shift dramatically. On the other hand, making junk food less profitable to its creators might actually force some change, as backwards as that is.
They do make you feel full, but it seems like they also change how you digest food that's too fatty/oily/etc. I've heard some rough stories about people who ate certain foods on Ozempic and very much regretted it.
It’s not that there are no other interventions for obesity, it’s just that this is the cheapest and most effective.
If taxing sodas had the effect of reducing body weight by 1/3, then I’d be all for it.
But behavioral interventions are really hard to stick. The reason ozempic is taking off is that it works given the systemic issues we have.
It’s the equivalent of saying people shouldn’t take anti-depressant meds because we can just change systemic factors they cause depression.
We can do both, but it’s not like we’d discourage food deserts instead of ozempic. We need to do both. And cynically, I think ozempic will work to reduce obesity.
> It’s the equivalent of saying people shouldn’t take anti-depressant meds because we can just change systemic factors they cause depression.
Fair point, but the systemic factors that cause depression are much more diverse, harder to identify, and much more difficult to rectify. (Also, I would argue that we have become a highly over-medicated society.)
Edit: Also, we did successfully change social behavior when it comes to smoking (younger people don't realize just how prevalent smoking was in 60s and 70s, perhaps as prevalent as drinking Coke and being overweight is today), though it did take massive class-action law suits. Maybe that's what it will take, though smoking -> lung cancer was perhaps a particularly easy link to prove.
Realistically, none of those things have happened in a way that puts a dent in ever climbing obesity rates. I think it’s time we celebrate the pharmaceuticals and pay up. This is one of those times where technology might solve a social problem.
None of those things have happened to any significant degree period. There is a reason why obesity has skyrocketed in only 50 years and it’s not genetic. It’s of our own making. And yet instead of focusing on prevention we’re focused on symptom relief which granted is much more profitable if you’re Big Pharma ;). One of the reasons why healthcare costs so much in the US for everyone is because of the unhealthy lifestyle choices that people make either out of necessity (low income, cheapest option) or addiction (stuff yourself now, pay later).
I guess what I’m saying is if those preventative things were talking about, have not been implemented in the decades that they’ve been known about, I’m pessimistic thet they ever will be implemented.
Identify a cheaper way of getting people to change lifestyle that is actually possible to get agreement on and that actually works, and you'd be showered with money.
Trying to get support for changes to what food is available etc. may well be better in the long term, but in the short term you're doing the equivalent of asking a bunch of addicts (me included) to voluntarily vote to banish our dealers.
Many of us will, but the measures will remain weak enough that we'll still find ways of satisfying the addictions anyway.
A friend of mine is earning millions of dollars / month connecting people to this drug. The trick is working out the insurance company rules. With Medicare they're going to be rich as fuck. Just a giant pump of taxpayer dollars into this. It's going to be fantastic.
Treating refined sugar as the addictive substance it is, and keeping those products in a separate part of the store rather than at the checkout line. Removing subsidies for unhealthy ingredients, subsidising healthier ones. More education in schools. Better funding and requiring school districts to meet certain quality standards for the food they provide to children. Ensuring all children have the right to a healthy meal. Where previous initiatives have fallen short, critically evaluate why and make them better. Thinking about social psychological factors for our collective mental health and thinking about how this influences our dietary and exercise choices.
There are lots of actions that could be taken that are not just pharmaceutical.
This is more than just children, the food environment adults are subject to encourages unhealthy habits too. Locking kitkats up won't change a thing.
Just look at American portion sizes at any restaurant -- they're huge! The common mantra is that we want to ensure we get our money's worth. I was astounded on my trips to France. The dinners were still filling, but were much smaller than most American restaurants I've dealt with on the East Coast, Southeast, and Midwest.
Plus we put sugar/HFCS in literally everything. If you wanted to save a few calories and eat a ham sandwich at home, the basic loaf of white bread you're yanking off the shelf has HFCS, and for what?
This isn't even getting to the usual punching bag of fast food/fast casual, where you're easily set back 1000-1500kcals on the default menu selection.
The epidemic itself is pretty strong evidence. Gastric bypass and these new drugs are basically the only proven effective ways of reliably helping people lose.
There are cultures in which obesity is rare and yet they achieve it without drugs and surgery. That itself is pretty strong evidence that the claim that they're the only things that could possibly help is wrong. I'm glad those are options, because they certainly do help people, but if you take that and run with "welp, more pharma is the only way!" then you're not thinking very hard.
I mean, I didn't say it was. Most things worth doing aren't easy. Listen, all I'm saying is we should strive for something better than to be content with producing lots of obese people and then "fix" them with drugs. Pharma would love that, I'm sure, but it's a tactical fix that needs a strategic solution.
Except they can’t. We know this. Telling obese people “just change your diet and exercise” has roughly the success rate as hiring a witch to cast a spell.
“The largest placebo-controlled trial enrolled adults without diabetes. The average age at the start of the trial was 46 years and 74% of patients were female. The average body weight was 231 pounds (105 kg) and average BMI was 38 kg/m2. Individuals who received Wegovy lost an average of 12.4% of their initial body weight compared to individuals who received placebo.”
These were multi-year trials with thousands of patients.
It still stands that it is incredibly ineffective use of money. I've helped a number of people lose between 50-100lbs and it didn't cost them but a few dollars a month for a gym membership and changing a few eating habits. 99% (made up but close) of the people this medicine will be prescribed to will not actually follow the still only way to actually lose weight. Exercise and proper diet. The main benefit of this drug will be enriching rich people, not getting the average person healthy.
You know, I know it works better for some but those numbers don’t seem great to me. If the average person is 231 pounds and loses ~28 pounds they’re still pretty darn overweight, if not obese. According to the study on their own website it looks like it levels off at about 68 weeks, which is where those numbers come from.
So we’re paying $1,000 a month for most of the people that take it to stay fat, just less so.
> most of the people that take it to stay fat, just less so.
Exactly my point. Everyone will be getting increased insurance premiums so that we can have a 5%-%10 reduction in heart/diabetes risk for people that will continue to ignore their health. The only cure for that is to stop ignoring your own health.
I'd love if it were possible to walk into a store dial in a set of pill that maintains whatever health level you want with your lifestyle. Hopefully this is a step in that direction is the only good thing about this drug.
Do you know anyone taking these drugs? They can dramatically reduce cravings for food - the effect is significant. Not to say there aren't plenty of valid concerns about such drugs...
As someone taking another medication with similar effects, it can be hard to describe to folks who haven’t experienced how a “simple” tablet can reduce or kill hunger altogether.
This is a pretty biased take in my opinion. I personally know at least one person who has lost more than 80lbs on Wegovy, after not being able to lose weight for years. It's been a literal sea change for her life, at least.
Like most problems we've accepted them as a base layer (obesity is inevitable because decades of SAD diet proliferation from homes to public schools) so the only solution are pharma drugs, elective surgeries and subsidies of those. Basically we ignore or find new ways to define the base layer as to accept it as nature, and pharma is the cure to these defects of natire
Does no one remember what happens when we don’t have effective pharmaceuticals at all?
I balance vague dark assertions of conspiracy against the clear issues obesity can cause the health of the population. I’ve got a loved one who needed a gastric bypass; I’m glad there are less invasive options available now.
Why ? Leaving aside the obvious issue of humanity and basic decency, You are paying for the insurance no matter what anyway due to all the related illnesses [1] from obesity
Should now insurance not cover heart attacks or diabetes or other illnesses strongly correlated with weight for obese people ?
Where does that stop ? When is it not fault ? Should insurance not cover if you injured in sports(been careful) Or work place injuries (choosen a different job ) ?
[1] this is the same dumb deserving argument for uninsured, they are still getting treated in ER usually repeatedly when it would be cheaper to cover them
> this is the same dumb deserving argument for uninsured, they are still getting treated in ER usually repeatedly when it would be cheaper to cover them
This is a myth. Insurance is low-cost or usually free for all low income people in the US.
I would say that insurance is low-cost or free for anyone is the myth.
Since the emergency over Covid was declared over last year, the number of people and kids being kicked out of Medicare and Medicaid ostensibly because of procedural issues or some imaginary fraud has been constantly in the news.
The forever argument on the right is link coverage to employment or some other ridiculous reason deserving reason invoking the welfare queen caricature, just last week John Oliver did a segment on this .
I didn’t say it was low cost or free for everyone, only low income people.
I’m sure you can dig up some exceptions where someone was denied coverage for some reason or bureaucratic screw up, but my above statement is broadly true.
Also, I wouldn’t consider John Oliver a good source for anything. His show is biased infotainment pandering to a specific group.
That’s a solid 12k+/year for eligible patient. Have no issue so long as it’s capped to an order of months to avoid it being a forever med. otherwise we’ll see all our insurance premiums and Medicare taxes rise dramatically.
Of course, would be nice if they would negotiate a lower price as it’s really expensive.
But Medicare covers other chronic preventative meds, PReP coming to mind and that’s like $10k/year. But still way cheaper than HIV treatment that it prevents.