Studies Show New Weight Loss Medications are the Real Deal
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- Опубликовано: 9 июн 2024
- Back in 2021 we did an episode on Semaglutide, the then-recently-approved drug for weight loss that was originally approved for Type 2 diabetes. Since that episode another paper has come out on what happens to weight when the drug is discontinued, and another on Mounjaro, a drug approved for Type 2 diabetes.
Related HCT episodes:
Semaglutide and Weight Loss: • Does the New Weight Lo...
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Credits:
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i dont know why i havent seen your videos in my subs for a long time, i love everything you do, please never stop you are such a precious and extremely high quality resource
I have PCOS and thus have pre-diabietes and am obese (PCOS makes those 2 things more likely/worse) and have been on Semoglutide for about 6 months (currently at 100 units) and it has been very effective for me with VERY minimal side effects. I realize that my lack of side effects is probably not the norm (I only experience very light nausea/vomiting once every few weeks for only a short time). I have lost 20 pounds as well. It's been a really interesting experience to be eating and suddenly get to a point where I am just...done...like my body hit a squishy but firm wall that I have no desire at all to cross and eat anymore. It keeps me fuller for longer and has really changed my relationship with food for the better. I have absolutely heard the stories of people whose side effects have been moderate to severe and for those people I understand their frustration or regret with the drug and hope we can better understand WHY those side effects were so bad for them. As of now though it has been very effective and I am just taking it one day at a time to see how it keeps going for me.
That's such good news! Wonderful to hear an effective drug that works for you.
My step mom is on it for diabetes, and has minimal side effects. She once said it was almost like a miracle drug for her compared to the medications she had been on in the past. Way more effective at controlling her blood sugar, with way fewer side effects. My aunt tried it for diabetes as well, and could barely live her life because the side effects were so bad. She tried to wait it out to see if they subsided over time, but only lasted a few weeks before she had to stop. It's so weird how huge the difference can be for two people with the same disease. Just goes to show you how complex our bodies are. I love hearing people's success stories with it, so thanks for sharing. Hopefully you manage to avoid diabetes entirely with it. I'm sure the drug will only get more effective for more people as time goes on and more research is done.
Love this for you! I hope your experience stays so positive!
Sounds like it's perfect for you. I'm so happy you've had such a good experience.
Personally, I don't think it's worth it if someone doesn't have diabetes or pre-diabetes because the risks associated are not quite as severe as diabetes and not worse, but they are there.
But a person without any health issues risking that health to lose weight.. That makes me sad. And I get angry at society for treating people like products
AND I respect people's decisions and autonomy. I do kind of worry there is a lack of informed consent because everyone I see talking about it either doesn't mention the health risks or only talks about the health risks and nothing else
It's funny, my partner's youtube is filled with videos criticising it and mine only had videos extolling its virtues with no mention of anything issues besides vomiting and diarrhea
Thank you for sharing! I too have PCOS and am really close to pre-diabetes. My Dr has mentioned trying one of these drugs but I have been hesitant. Perhaps I will give it a try
Thank you, Dr. Carroll, for acknowledging how difficult weight loss is. There's this awful perception that not being able to lose weight is a problem with laziness or just not trying hard enough. But I know that's not true... I've seen family members struggle with weight loss even though I know they're doing the best they can. They have more self control with food than I do, and they still struggle. It's just extremely difficult. The human body just really doesn't want to let go of weight, and it's almost like you have to trick it into doing so.
You've become my first go to, in trying to stay informed on health issues. Thanks for what you do, especially being easy to understand. Source links in the description would be appreciated too.
Very promising news! Thanks for breaking it down for us. And shout out to your recent NYT piece on these medications and the stigma around them, it was great food for thought.
While we're still waiting on more data, there is no reason (that I know of, unless someone else more knowledgeable could chime in) for us to hypothesize that one would *not* have to keep taking the drug forever. Given what we know about yo-yo dieting, and what that does to people's weight and metabolism, taking exogenous GLP-1 and then suddenly stopping seems like a bad idea, I hope if people do stop that they're allowed to taper off gradually.
Respect to the control group losing 6 lbs. Not the results people are looking for, but awesome for you :) Both part of our scientific understanding of willpower, and doing some good on your own :)
Willpower is a meaningless metaphor, no one has come up with an operational definition that withstood scientific scrutiny, nothing that could be replicated.
As someone who's been through a substantial weight loss & fitness journey, I'm convinced drugs like this can be amazing tools to facilitating weight loss, but I really worry about the potential harm that could come from people using them without well considered diet and lifestyle changes too.
Our diets are rarely deficient in anything these days, because we're almost always eating more than enough of everything, but if a substantial portion of ALL overweight people start taking these drugs & eating a lot less, we may see a lot of people suffer vitamin deficiencies, muscle loss, hormone imbalances, etc.
I'd hope that most patients get some decent nutritional advice before being prescribed anything like this, but in the american healthcare system, that feels far from guaranteed, and even then, many patients may not heed that advice.
Deficiencies are definitely a reasonable concern to have about any change in diet. I would argue that, with weight loss drugs like these, that actually work, it's actually *less* of a concern compared to the rather extreme diets people often put themselves through in an attempt to lose weight.
These drugs promote satiety, which allows people to be much more mindful of their diet, without succumbing to cravings for unhealthy levels of nutrient-poor, high-calorie foods. Obviously, it's not a guarantee that the ensuing reduction in calorie intake comes with a corresponding change in the ratio of nutrients, but it certainly makes it easier for people to be deliberate in dietary choices if they're being less driven by pure hunger.
You're not wrong - nutrition education is an important part of helping patients lose weight and should always be part of the conversation. Interestingly, though, a lot of overweight people in developed countries are already malnourished due to poverty and/or their location. The only food they have access to is super high in sugar and carbs but doesn't have anything else. So eating less isn't really going to affect their nutrient intake, since they likely aren't eating any nutrient rich foods in the first place.
Lol, my "nutrition education" was to eat less than 1,000 calories a day and that fruit is bad because of sugar. "Nutrition" information for fat people is to basically develop an eating disorder
It speeds up muscle loss quite a bit, officially you have to do a lot of strength training on it just to *maintain* muscles on it.. But that doesn't compute to me, I don't see how that would work, because most of the muscle in our body isn't impacted by weight training, that's just for *some* of the skeletal muscles, and any body builder who tries a pilates class can attest to that, and even pilates doesnt get them all. Let alone all the non-skeletal muscles.
Also worried about the number of women taking it because it can reduce bone density and women have higher rates of hip fractures and osteoporosis to begin with.
It's worth it if the alternative is literally diabetes, but if you have no risk of diabetes...
We are so manic as a society about the idea that fat is extremely unhealthy, it somehow seems reasonable to vomit, poop your pants, lose muscle mass and bone density, risk pancreatitis and diastasis of the stomach, so you can lose weight.
And it was approved as safe for weight loss because of a study showing it was safe over 2 years, but people are expected to stay on it for the rest of their lives because when you go off it the weight comes back
Thanks so much for this helpful video
My sister has type 2 diabetes and I suspect she is on one of these drugs and it is a life changer for her. I wish I could take them just to help me get to my target weight but I am only 170 and am working on snacking less and drinking more water.
If you are offered the chance to take them, don't forget to look at the risks etc first. Worth it because diabetes is so difficult to live with and risky, but if diabetes isn't on the table do Sooo much homework
I guess I'm working on snacking more and drinking less water then, to get up to 170!
I lost ~85 lbs with Wegovy and had to stop taking it when I got a new job and my insurance wouldn't cover the rx. I, somehow lol, didn't have $1400/month to keep it going. I gained all the weight back after about a year, even though I was exercising and trying to eat well. Wegovy, for me, was basically chemically induced anorexia. I could not eat while on it and would sometimes go days without eating. My body ached, my blood pressure and heart rate were all over the place, and I was miserable. I lost a TON of muscle mass despite trying to keep it with working out. I'd rather be fat and stable (no heart problems, no prediabetes, etc) than skinny and miserable.
Also, I realize this is anecdotal and YMMV.
From your name I guess you made that up 😅
Yeah but if you are skinny and miserable you will be exactly what our corporate overlords want you to be. Won't you please think of the shareholders?!
The muscle loss was due to insufficient protein intake
"trying to eat well" is not an achievable goal
@Praisethesunson what pills are you on brother
Thank you for this
What were the side effects?
I've seen providers prescribe these like crazy. This is good!
Thanks!
Hey thanks!
What do model organism studies show about long-term effects of these drugs? I don't mean to suggest that there is a clear and firm comparison to draw between model organism and human clinical studies, but it can tell us something, yes?
Mice only live 3 years max. There aren't long term trials in humans. We have no idea
Also, bone density loss, which this med causes, is much less of an issue when you are the size of a mouse, and even when you are big but qudrapedal.
Could you cover semaglutide efficacy for addiction? I’ve heard rumbles but can’t find any clear summary!
I was gonna say he already did, but now I think that was Vox
Is there information about where the weight lost is fat or muscle? Have heard that these drugs disproportionately cause loss of muscle mass. Seems like something you would measure in a study of this kind.
Fat, muscle, and bone density, I'm not sure in what ratio
They tell people to do strength training while on it to try to maintain their muscles.
I worry for anyone who is suddenly eating much less than ever before and decides to do cardio
There have been studies. NBC news has an article with citations. 25% to 40% lean muscle mass loss as a proportion of total weight loss. If you don’t exercise, the ratio will be worse than if you do.
Does it make you vomit for 3 days like Ozempic?
is this the one that reduces bone density ?
Or reduces those who are, 'retaining water'.
The thing I find frustrating is when people say that drugs like this are pointless and that 'we' (meaning society at large) should just focus on diet and exercise. On an individual level, diet and exercise is obviously best and if that works for a specific person, great, but as a public health recommendation, it _clearly_ does not work. Healthcare professionals and institutions have been encouraging people to eat well and exercise for decades, entire industries exist to promote it, and yet, obesity just keeps getting worse.
Do people think that if we just start shouting a liittttle bit louder about vegetables and workout routines, it's going to fix the problem?
The way I see it, there are two solutions for obesity as a public health problem - draconian regulation imposed on the food industry completely transform our food environment or drugs like semaglutide. I wouldn't personally be opposed to heavily regulating the food industry, but I know that's not political feasible, at least in Western countries. So drugs like this are basically the only scalable solution.
It seems like there's a lot of negative sentiment towards something like this. Many people have put a moral judgement on diet and weight, resulting in the opinion that only hard work makes you "deserving" of a healthy BMI, and therefore any drug that lets you pay to get healthier is ethically wrong.
this is a really good point that puts words to why I've been so annoyed at people downplaying the potential efficacy of these drugs
@@joshg2188 Yeah, many of the objections are biased if you think about it objectively. People complaining about cost, availability, taking the drug "forever", fearing "unknown side effects" etc. These objections can be raised about any drug. All medicine is about trading benefits vs risks, as this channel often reminds us.
If we found a new cancer treatment, you'd hardly have people ONLY trying to find bad things to say about it while downplaying the fact that it saves lives from cancer...
But with an obesity treatment, somehow people want to complain about these things while downplaying the fact that it is such a significant improvement for so many people's lives.
It is moral. Fat people cost the healthcare system several time more than a normal weight person. That puts taxes and insurance rates up for everyone as the money has to come from somewhere. It’s also very bad for the environment as fat people use three or four times the resources to have food provided for them.
It's like hearing older generations complain, "well, when I was your age, I walked both ways, uphill, in the snow." Like, yes, just because you had to do it the hard way doesn't mean we do. We could go back to not using wheels or fire too, but we're not.
The main concern I've heard is that people who aren't obese and do not have illnesses that require the medication are taking it so they can lose 20lbs or so for cosmetic reasons. A few very influential people have touted its success, and it has created a shortage of the medication where some people who DO need it are unable to get it because it is out of stock.
That seems like a genuine problem. However, these medications have a lot of promise for treating obesity and addiction, and need to be explored further.
And it's been tested as safe after.. Two years... Eh... Wait.. Wouldn't it be nice to know if it was still safe 10 years later? Will my stomach lose elasticity? Will I get pancreatitis? There are mechanisms to suggest this might happen but no one can tell me because there are no studies over 2 years.
Anorexia also makes many people lose weight, while stripping their heart muscles of protein and permanently damaging it
Yes. You can wait until the drugs have been on the market for 10 years to be cautious. But people that want to lose weight now won’t wait that long.
A family member gained a lot of weight during a medical thing that left her bedridden for years, and as a result has a lot of health problems that are worse for the weight she can't shed. She tried diet pills at her doctor's suggestion last year, and it ruined her gut so she can hardly eat anymore without being bedridden. Her meals need to be small and infrequent, she's constantly tired, and she's still having to carry all this weight with muscle loss. The starvation response in this situation does not help her lose weight. She had legitimate reasons to get on the drug, and even so the consequences were dire for her gut.
Be wary of the side effects and weigh how much disruption your gut health can actually take before you start this stuff. Just because it's fine for one person doesn't mean it's fine for another. I hope these sorts of treatments can be life changing for a lot of folks, but I also hope people are cautious, informed, and risk aware. I'm not saying don't use them! I'm saying weigh the risk and benefit and make a choice with active knowledge.
Thanks so much for sharing this experience ❤. One thing I don't get is why they start the dose so high and up it so fast. I feel like if you are still vomiting more often than occasionally, and you're even a little worried about pooping your pants, you don't need to increase the dose yet? *especially * if you are already losing weight at that dose.
Yet they up it again at regular intervals so you can lose weight *faster*!? Even though it means more vomiting and diarrhea?
Titrate up crap (literally in this case) reminds me of oxycodone marketing
I just want them in pill form then i'll consider them.
There is one - Rybelsus
Wait seriously?
*weight
1) Why are the studies reporting the mean instead of the median? I'm more interested in the median given the mean could be influenced by outliers. 2) You say wight lose is complicated. Yes it is, but you then go on to say weight is a definitive factor in health. I'm sure many people interested in a "pill" for weight lose will ignore your second point as there are so many "body positivity" activists drowning out your second point. I'd suggest you take this moment to triply reinforce the negative connection between a high BMI and health issues. 3) The studies properly use BMI, a marker considered by the "body positivity" activists as oppressive to marginalized communities. Have you done a video reinforcing the validity of BMI?
"Weight is a definitive factor in all kinds of health problems"
Really and truly? I understand excess fat being a factor, but weight? Just doesn't sound believable, Doctor
Placibo is my favorite drug. It's so safe, they compare it to everything. Sure 6 out of 8 times the other drug is more effective...so I always take 9.
Why use the brand name for tirzepatide, but generic name for semaglutide? I hope the episode wasn’t funded by Pharma
This drug might singlehandedly save the US
Is this drug supposed to cause weight loss or help you with cravings and motivation to exercise so you can lose weight and keep it off?
The drug literally makes food stay in your system longer, increasing fullness, and simultaneously reduces calorie uptake. So it causes weight loss directly.
It would take actual diet and exercise changes to make that change permanent. It would be a lot easier to get going on an exercise program at under 200 pounds than at 240 though.
I wish there was a pill to counteract the poisoning of the food supply by massive corporate conglomerates.
The... what now?
@@Max-wl5ll Oh. Corporate control over the food system is what's making people so fat. Specifically their putting a shit load of sugar based(the most addictive legal drug on the planet) stuff onto the market, and lying to the public that the sugar coasted trash they are selling is totally food® that can be safely eaten. That's been known since the 1950's.
Now, Thanks to the global spread of our capitalist masters since the 90's. Urban centers across the world are enjoying the same food based death spiral Murica has been living with.
tinfoil hat
@@maythesciencebewithyou Annual Shareholders meeting for ADM and Pepsico actually. You'd know that if you weren't one of the filthy consumerist poors their products are designed for.
@@Max-wl5llPFOAs are everywhere now (water, soils, our bodies), same with microplastics.... maybe this person is referring to that?
diarrhea thats the symptoms! Been on semaglutide for diabetes and can attest the weight is right on the average for me.
When the drug is stopping food digestion, it seems like diarrhea is inevitable.
last
no longer last
@@aplaszcdadgummit
This is horrifying and also preliminary data on a couple of studies. I look forward to follow-up studies on those who discontinue the drug are highly important going forward. Also worth looking at the actual side effects of the drugs use long term. Putting people on a medication that can affect the appetite and metabolism is highly disturbing in the long run versus trying to manage high blood pressure. The majority of the weight being lost in the first string of a few weeks mimics highly restrictive dieting before the body adapts to the new lifestyle. That's not to say people who are severely at risk may find this useful but the fad use of these drugs particularly semaglutide off label takes away from people who may actually need the drug for their diabetes. The pharmaceutical industry will continue to prey on those who will feel pressured by societal factors into taking these drugs. Those who are most vulnerable will now have more pills thrust upon them rather than addressing actual health problems.
It's kinda a good thing if it's off label use is a common problem that actually means the pharma companies have an incentive to make more of it and that brings down costs for our diabetic friends. The caveat being we need pharma companies to not arbitrarily decide how many pills they want to produce in a given year.
@@CEDFTW I agree it would be nice to benefit and lower costs for those suffering from diabetes. Those drugs under comprehensive insurance and other plans lower those costs and are covered. Off label use is not usually covered and that's a whole can of worms I am not going to wade into this is a RUclips comment after all. Ultimately I am hesitant surrounding the use of drugs to solve this problem. The pharmaceutical industry has continued to screw over people.
I don't say that out of malice or that all drugs are bad. I say that out of people who the system has failed through the crises that continue to happen. We continue to fail people and blame it on their weight.
So far it seems those who discontinues find the weight returns, hopefully along with the lost muscle mass! But bone density, once lost, never comes back, I don't get why these are considered ready for mass prescription when there's so much we don't know
@@therabbithat100% it's the yo-yoing of weight loss and gain that restrictive dieting does and with the sort of numbers they're posting it's not meaningful. Bariatric surgery and other highly regulated and restricted diets for those most at risk requires much more care and oversight. Having a pill that might lose you 15% body weight. One that's expensive that they will hand out prescriptions like candy isn't a solution for actively helping people. I can't say I haven't heard anything about it affecting bone density at this point though.
@@air-iq a 68 week study in the new England journal of medicine found adults lost some bone density on it: "Once-Weekly Semaglutide in Adults with Overweight or Obesity"
34 pounds over 68 weeks still seems very low.
That half a pound per week. Obese/overweight people can easily lose 2 lbs per week if they just stopped eating too much. And not even by much as it takes a lot of energy to move their own weight around. Trouble is some people think 1800 or 2000 calories per day is “starving themselves”.
@@piperjaycie We get it, you hate fat people. Now see yourself out.
Just eat/sleep on a regular schedule, try to minimize stress, work out at your own level for 2-3 times a week and eat at a caloric deficit. You are welcome for the results! This works for every single human being who doesn't have a serious medical problem that stops them. But you can always adjust a plan to fit your lifestyle and needs. A workout doesn't have to be 60 minutes long and grueling. For some people it's enough to go up a flight of stairs for the day. Reducing stress is very important, we who have anxiety know this very well. Get your eating habits in check, calculate your caloric intake and usage and then cut them out as needed. If you don't want to do all the calculations you can just eat KETO/LCHF. IF you eat strict KETO you eliminate all pasta, potato, bread, candy, snacks and the like. You will go down in weight naturally, you just focus on eating until you are full. But optimally this must be combo'd with exercise of some sort, regular daily walks and motion + workjout sessions 2-3 times a week.
I'm not a certified anything, i just do bouldering, bike everywhere i go and eat healthy. I have never been obese, but i have worked out more for my mental health problems rather then physical ones.
Well, just because you lost the weight doesn't mean you learned what you did wrong in the first place. Should always come with nutrition assistance and a gym regimen
They go right back to the pizzas, take outs, huge portions, and no exercise and “have no idea” why the weight came back. Plus the side effects sound so bad AND these drugs are expensive. Why not just lose weight normally. No side effects and save money. They could use the money that would have been spent on food and drugs for a gym membership or home gym and actually having good life experiences.
Thats an absolutely absurd take. Just admit you hate fat people instead of making random shit up.
@@piperjaycie Please provide one study that shows a method to "lose weight normally" where the majority of the participants kept the weight of for 5+ years. I'll give you a hint, there isn't one. That's because the most likely outcome of long term weight loss is to regain it, 2/3 of those people will likely regain more people. I exercise very regularly and I work at my nutrition and I am not alone. There are lots of fat people who do.
@remizZ Some people don't do anything "wrong" at all. There are a number of factors that contribute to weight, including genetics, drugs, illness , stress, sleep issues and other factors. I eat pretty well and I exercise very regularly. You can't tell how much someone exercises or how they eat by looking at them.
@@ForgottenAria@piperjaycie has been leaving fatphobic comments like this throughout this post. They have a very clear idea of what they think fat people are like.
Sounds like you're complaining that people aren't being punished sufficiently. Do you also complain about people getting glasses because it doesn't teach them how to see "on their own"?
We don't know if this treatment actually benefits health yet but this is entirely the wrong basis on which to object to it
Weight is not a health outcome. Do better!
34 lbs over 68 weeks is NOT impressive! That’s down right abysmal.
Maybe you shouldn't be commenting on this video if all you want to do is rip it apart without merit or facts.
@@forgotn42maybe you shouldn’t be agreeing with it because you are looking for a lazy fix to a problem you created. 34lbs over 68 weeks is a fact and it’s also a fact that that is an awful result. The side effects are also a fact. Why put a person through that for negligible results that aren’t even sustainable when off the drugs. And yes I’ve done my research.😊😊😊
@@piperjaycie You don't know me and whatever research you did wasn't scientific.
Agreed, after being a slob for about a year I lost 38lbs over 12 weeks by fasting. Never done it before but it worked for me, no exercising just cutting back on how often I ate and how much. I went from 172lbs to 134lbs which is what it normally was and I've kept that weight ever since and no, I don't need to fast or exercise to keep the weight off.
@@forgotn42 By saying something isn't impressive doesn't need to involve 'scientific research' as you put it. Common sense is all that's needed to see how ineffective (if true) the results are and I will bet it will be expensive and the those wanting it will demand it for free, i.e. the tax payer stumps up the money.
Diet and exercise weight loss has staying power but you have to keep doing it! The diet and exercise didn’t fail the person doing the diet and exercise failed.
No it doesn't. There is literally no diet in the world that has been scientifically linked to significant, long-lasting weight loss.
@@forgotn42🤣🤣🤣🤣🤣🤣🤣🤣
@@piperjaycie Prove me wrong, chucklehead.
@@piperjaycie If you think it's so funny, produce a study that shows one. For right now, let's define "long-lasting" as 5 years which isn't actually very long. You can't, because it doesn't exist.
I mean, that is supported by actually no evidence. Study after study shows that less than 5% of people keep weight loss off for more than 2 years.
How is the relationship between obesity and health complicated? Being obese is unhealthy and also very bad for the person, their family who will have to bury them younger, the healthcare system, and the environment.
Incorrect on all counts.
Being obese is not unhealthy. Being obese is highly correlated with a lot of other disorders which are unhealthy.
Personally, I have a BMI of 35 but have very good blood pressure (98/62), low resting HR (49), good blood fats (triglyceride 0.7), no sugar issues (I check yearly). This is because I do daily cardio and have a clean diet IMO, I'm fat because I eat too much volume. I will have different health outcomes to someone with my BMI who doesn't exercise, has bad health stats and eats junk food all day. Am I still more likely to become diseases? 100%, but just because I'm fat doesn't mean I am currently diseased
Obesity has been correlated with health issues, but there has been a study that shows if you partake in healthy habits (the study specifically says not smoking, moderate drinking, exercising, and eating green vegetables) then the hazard ratio of an obese person isn't any different than other BMIs and is lower than a "normal" BMI person who doesn't do those things. jabfm.2012.01.110164
There was also a study of data from the Framingham Hospital that showed the correlation between weight cycling (losing, regaining, over and over) is much more strongly correlated to health issues than obesity.
This doesn't even get into the harm that medical fatphobia does and any contribution it has to the correlation,
So yes, it's complicated.
@@ForgottenAriaIn addition to the studies that how heritable BMI can be
In addition to what others have said, obesity has causes and associations that themselves have negative health outcomes or associations, like psychological trauma and PTSD, chronic stress, poverty, being older and even merely being male.
All this confounds things and makes it harder to pick apart causation vs correlation
Being obease also makes people more likely to undereat due to dieting, which is bad for your heath, as well as try new weightloss pills that have a host of health risks