I was wondering if there really are no negative long term side effects, could this finally lead to universal healthcare in the US? It seems like a lot of our costs (aside from the obvious medical industrial complex skimming massive profits) comes from health complications related to our obesity epidemic.
> I was wondering if there really are no negative long term side effects
Weight loss via caloric restriction inevitably results in losing lean muscle mass along with body fat.
That's why diet and exercise are paired -- diet loses the weight, and exercise helps to reduce the loss of muscle.
While there's nothing stopping people from pairing Ozempic with exercise to achieve a similar result, I doubt many are. Those ecstatic about the rapid weight loss achieved by these drugs may not be so happy if they were viewing their progress on something that measured their full body composition, rather than just their weight.
These are miracle drugs for people who are morbidly obese and suffering from severe weight-related problems. Those folks can use Ozempic to rapidly lose fat and muscle to get them out of their immediate crisis, and then work to rebuild as much of that lean muscle mass as they can later.
However, people who are just using Ozempic as an easier alternative to diet and exercise are not only taking away supply of this drug from people who really need it to deal with morbid obesity, they're setting themselves up for health problems later in life if enough of their muscle mass has degraded that they start struggling to do everyday activities. Unfortunately, by the time people reach this point, it's unlikely that they'll be able to do anything about other than resort to assistive technology like wheelchairs to regain their mobility.
Yes! GLP-1 agonists came out of nowhere (from a relative timeline perspective), and the positive potential is massive (with some side effects, which may be acceptable in the aggregate compared to the aggregate benefit). What is more likely to occur, based on all available evidence? Humans are going to change their behaviors at scale? Or we're going to use bioengineering to help folks achieve their goals? Don't be mad at the human, they are only human; help the human be a better human via path of least resistance. The human didn't elect to be here, nor exist with the genetic makeup they were given.
If you can build a system to stick to strength training, excellent, but many cannot. I struggle myself sticking to my strength training routine.
> If you can build a system to stick to strength training, excellent, but many cannot. I struggle myself sticking to my strength training routine.
I struggle to just make myself take a daily 1 mile walk. It's not that I can't, it's just that my brain keeps telling me there are better things that I can be doing with my time. Bring on the bioengineering!
I don't know why you're saying that like it's a bad thing.
Clearly, the self-discipline approach just doesn't work. Not on a soceital scale.
Less people dying and people feeling healthier is a good thing. For everyone, you and I included. It also helps that Ozempic also reduce addiction to nicotine, alcohol, and potentially other drugs.
The human condition is complex and it's becoming obvious, to me, the human body and brain were never meant to exist in the kind of society we have. A society of food surplus, sedentary work, and high stressors. Yes, we will adapt - but tools to aid our survival along the way I think could be good.
Not sure on leading to universal healthcare, but it will absolutely impact healthcare. The obvious ones like less heart disease are huge. Then others like fewer knee replacements, and fewer CPAP machines required, the list goes on.
GLP1s have also shown to help with drug and alcohol cravings so there's an entire other area to explore.
I could see where the government simply makes them available to most people.
Buying the stuff from the drug manufacturers is crazy expensive. Over $1000 a month. Going through a compounding phramacy is much cheaper, I pay around $249/month for my script.
You can go even cheaper and buy the peptide yourself from places like peptide sciences and compound it yourself, less than $100 for a 3 months supply, but you increase your risk profile pretty significantly going that route. My partner is a pharmacist and that type of mixing (assuming you do everything correctly) is considered acceptable for "immediate emergency use", not mix up and use for a month or three and keep it in the fridge in the meantime. It's a small risk to be sure, but non-sterile compounding at home is riskier than having a compounding pharmacy do it the right way.
Only one way to know for sure on the long term effects.. However, we do know the long term side effects of obesity - and it is quite costly, by some estimates $200B+/year in the US alone. Not as bad as smoking ($300B+/yr), but entirely preventable regardless.
Most of the data defending the economic harms of obesity are deeply flawed for various reasons, such as:
- Generally low-quality data
- Data that ignores external factors
- Data that doesn't account for behavioral issues like doctors ignoring or minimizing medical complaints made by obese people simply because they're obese
- Data that overemphasizes BMI, an extremely flawed health metric, etc.)
- The criteria for "obesity" itself having changed over the years (based on BMI, of course),
- and others.
There are definitely issues that obesity exacerbates in many people (mobility and cardiovascular), but the overarching purpose behind stats like the ones that you pointed out is to shame people who are (a) naturally hungrier than the average person with a "socially acceptable" frame, while (b) living in car-centric suburbs that discourage things like walking because (c) these suburbs are cheaper than living in cities that have somewhat-functional public transportation because they were created before the car was invented.
No, actually it will make it worse since obesity generally lowers lifetime healthcare spending. This is counterintuitive but we barely spend anything on anyone who’s not a senior, so anything that helps people live longer generally results in higher costs. Dying of heart failure at 50 is comparably cheap to lingering for 10 years in assisted living and bouncing in and out of a hospital for 3 years before the end.
What’s even worse is that from a financial sense, private insurance generally covers the deaths earlier in life, while ozempic (or any other anti-obesity drug) will push a lot more of that spending onto the federal Medicare budget in the long term.
Ozempic is apocalyptic for the Medicare and social security budgets, even if it were free (and Medicare doesn’t cover anyone who’s not a senior anyway). Any drug that broadly extents life would be - we would be equally affected by a free pill that gave everyone another 2 years of life, too. We budgeted based on X number of fat people paying in, but never receiving benefits (via life-expectancy actuarial tables), if you extend life then the payout increases.
If there are no long-term side effects to taking GLP1 agonists (remains to be seen), then I think the following will happen:
- In the short term, the fitness industry (a multi-billion dollar market) and its dependents will crater,
- Smaller, European-like, serving sizes will become the norm, and
- You'll see more and much larger investments in de-alcoholifying beers, wines and spirits.
I do not think this class of drugs will accelerate the adoption of universal healthcare in the US.
For one, the healthcare industry employs a ton of people in towns like Bowling Green. (HCA, the biggest healthcare network in the US, is headquarted in Nashville, TN. Nashville is definitely bigger than Bowling Green, but people that lie in Murfreesboro and other small towns around Nashville work at HCA. Also, many insurance companies are headquartered in the Midwest, where jobs are relatively scant compared to the big coastal cities.) Any policy that ends with "and tens of thousands of jobs will be lost" is political suicide.
Also, the modern healthcare industry in the US was built and designed around private, employer-provided health insurance. Reverse-engineering decades-old business logic and institutional process to fit a government-provided system would be a gigantic and extremely expensive underatking that we would pay for (through taxes).
Fractyl Healthcare is working on a gene therapy targeting this pathway. Chronic maintenance is a temporary hack imho. Long term fix is patching the genetic bug around a miswired reward center.
Magical thinking. Universal healthcare will not happen in the US because for-profit hospital owners and big pharma would lobby against it. US healthcare costs 2x as much per person than other countries but outcomes are worse. Outcomes are not a concern, profits are.
1) There are very serious long term side effects, people are just either unaware or value weight loss enough to tolerate/accept the risks and harms.
2) Your "aside" there is the whole thing though. Obesity drives a lot of costs sure, but Obamacare legislation enshrined health insurance companies and pharmacy benefit managers as essentially government-backed money printing machines, so it's going to take tremendous effort to change any legislation, because they can and will spend literally billions of dollars to keep their monopolistic position.
Severe obesity can take off 10+ years off your life. I would say thats a pretty serious side effect.
Heart disease, diabetes, liver diseases, kidney diseases, gallbladder diseases, pancreas diseases, cancer, sleep issues, fertility issues, sexual health disfunction, mental health problems, to name a few obesity related side effects
>“Either obesity or big pharma’s newest cash cow”?
Pharma is obviously not the only solution to obesity, but the alternatives don't look like they are working very well so might as well give it a shot.
Also whats with the bias against pharma companies? They made/make some very important drugs that save millions of lives. I am not saying they are the good guys, but they certainly have a financial incentive to make stuff that works - and the markets have spoken that a drug that can effectively "cure" obesity is something very very valuable to people.
These seem like criticisms of the US healthcare system and not against pharma companies in general. The wikipedia article you linked even says so:
> The epidemic has been described as a "uniquely American problem". The structure of the US healthcare system, in which people not qualifying for government programs are required to obtain private insurance, favors prescribing drugs over more expensive therapies.
Also, not all pharma companies are criminals like Purdue pharma.
It's pretty awkward to talk about making people form a lifelong addiction to one drug (semaglutide) to counteract the effects of making people form a lifelong addiction to a poison (sugar).
If we spent half the money involved in this scam in removing added sugar from the grocery store shelves we'd beat that epidemic (don't believe me? Look at pictures of people living before the low-fat high carb poisoning in the 80s and 90s)
We already know that people on semaglutides buy less junk food because to them it is less addictive. Less demand, less supply. If anything, this seems like a useful way to smooth the transition to less unhealthy food supply.
People are effectively on these medications permanently or they regain whatever weight they lost on them. So unfortunately the transition isn't so much to healthier diets, but to taking weight-loss drugs forever.
Is this true? Is the rebound effect as high as you think? Because I know 2 people who took it for like 3 years, and while they took some weight back, they're not obese anymore.
The same trend was seen after the 2021 trial, known as Step 1. After 68 weeks of semaglutide injections, the average patient lost more than 15% of their body weight, but within 12 months of treatment ending, patients regained two thirds of their prior weight loss on average. This was associated with a similar level of reversion to the patients' original baselines in some markers of their cardiometabolic health – a category which includes conditions such as diabetes and heart attacks.
Both Rubino and other experts around the world have seen similar patterns when administering GLP-1 drugs in their clinics. "There will be a small proportion of people, 10% maximum, that are able to maintain [all] the weight they've lost," says Alex Miras, a clinical professor of medicine at Ulster University.
To be fair, semaglutide also lowers addiction to nicotine and alcohol, and maybe other drugs.
It seems to me some people have a broken reward system and some... don't. Some people can live life without ever seeking out a vice, and some people are unable to live without a vice.
Probably, from an evolutionary perspective, this made sense. But when you have a surplus of addictive things like sugar, nicotine, and alcohol, combined with mass society-wide manipulation to indulge via advertisement... well this functionality of the human brain makes less sense.
"South Park" did a special on this, "The End of Obesity", which is available on Paramount+. It's hilarious, and, as is often the case with South Park, also quite accurate in the underlying themes.
With the advent of Ozympic, it would be cool if at some point being slim became so commonplace and boring that we flipped back to being attracted to fat people like the middle ages.
That won't happen because it never happened in the first place. The people of the middle ages were like us -- they broadly liked slender people, women with perky breasts, and men with broad shoulders.
This should not be surprising. Attraction is pretty hard-wired into humans by evolution, and for most of our existence, food has been scarce. There is absolutely no reason why a time of more plentiful food due to agriculture (relative to most of human history) would have resulted in changing the body types we generally prefer. To say nothing of evolution's timescales, which are measured in tens of thousands of generations for significant changes like that.
The post has a ton of links, and r/askhistorians is one of the most heavily vetted and moderated subreddits in existence. I'm sorry it's not what you wanted to hear, but no, fat people were not attractive in the middle ages because of food scarcity. Because there was no food scarcity. Relative to human history at the time, there was an abundance of food.
- plastic surgery (like the russian/housewives-of inflated lips)
People are lazy, I get it, but ozempic should provide the enabler for big people to get fit: it gets rid of a whole lot of fat that increases stresses on their joints. So you lose weight with ozempic, and then you could ... ideally ... start a good fitness program.
But we all know it will be used just for the pill popping convenience.
Yes, Ozempic removes the fat (and obesity related health problems) but doesn't remove the need for exercise. Exercise has a whole host of positive effects beyond weight management.
I believe Ozempic will probably lead to a lot of thin, but sarcopenic people.
It also doesn't remove the need for a healthy diet. For a bit, I had a personal trainer. He would always tell me stories about guys he trained that were super fit and seemed like they were in great health, but they ate like shit and ended up having heart attacks and all that in their 40's anyways.
Ozempic makes it so much easier to have a healthy diet too. I've been taking it for ~5 months now, losing a steady ~0.75lb/wk which is a perfectly health rate to lose at.
Greasy, fatty, hyper processed foods are a quick trip to nausea-ville for me. The thought of a meatlovers pizza physically turns my stomach now. I am irrationally happy when my partner wants to go out to eat and we go somewhere that has grilled salmon on a salad. I'm not being driven by all the little fats and salts and cheeses they add to food to make it more additive, I can freely choose, and enjoy, healthier less processed options.
It's also crazy the portion sizes. Like I'm losing just under a pound a week, that should mean I have roughly a 400 calorie a day deficit (roughly 1.5 klondke bars). I routinely eat half of what's served in restaurants, or a third, and still have a minuscule deficit. Portion sizes in the US are just too damn big, and everyone expects them.
My partner has found it harder to eat large meals since I'm not eating large meals and he's lost weight too. It's been fantastic for both of us.
We are dealing with a global crisis of obesity. We have a disease more prolific than ever before. There is something about the human brain that is wrong or imcompatible with the modern surplus of food. Something about our reward centers doesn't work. Not with modern society.
Addiction of this scale cannot be solved with individual actions. "Just stop" doesn't save an alcoholic, nor does it save a smoker. Fundamentally we need to rewrite how we view obesity.
We need solutions. Not more of this "try harder" fluff. Because it just doesn't work. If what you're saying is true, we wouldn't be in this mess. Obesity is more complex than we give it credit. It goes back to the food industry, health industry, advertisement. We can't just ignore everything and continue our "do nothing" approach.
This is not a discipline problem, this is a human problem. The solution MUST then target humans, not their actions. If that's a drug, for now, that's fine.
Except there are classes of people (often athletes or former athletes) that are spectacularly good at using exercise/staying fit.
And there are examples like Iceland (this is secondhand from when Iceland made the World Cup, I don't have stats) where strongly enforced/encouraged sports participation leads to huge generational improvements in overall health.
Exercise has a 1 month hump. You need to stick to it for 1 month before it sticks and your body's endorphin rush + increased pain tolerance overcomes the initial discomfort/shock of exercise. One month is obviously a long way.
It does seem insurmountable to some degree based on decades of slow descent to the obesity valley that is America, but there are counterexamples in the world.
But we also have never had a government that REALLY embraced comprehensive fitness and health policies over a generational timespan, despite ample evidence it would improve productivity, reduce health care costs, increase mental health, improve quality of life, increase intelligence, improve cooperation / social interaction / culture, and probably increase fecundity and turn around the demographic declines of advanced first world economies.
That means extensive changes to schooling, heavily incentivizing the reconfiguration of urban centers for more human power transport, lots of facilities, probably a sea change of health care policy. There are huge and powerful lobbies that would probably kill those initiatives, from big corn syrup, big tobacco, big media, AMA, etc.
Most of weight loss actually happens in the kitchen, not the gym. A candy bar is roughly equivalent to a 20 minute run, in terms of Calories. Weight loss drugs surpress appetite urges. Even if you got super fit on the drug, without long term habit changes, most people are likely to put back on the weight quickly. Somewhat counter intuitively, fat people tend to have strong muscles to move all their mass around. My understanding with these drugs is that they artificially inhibit cravings, reducing the urge to eat, thus effectively stimulating weight loss. As soon as the drug stops being administered, the cravings return (and thus the weight) regardless of how fit you are.
Just as an anecdote, I used to not understand how people got so fat. Just eat less lol? I’ve been a little light for my size pretty much my whole life, so I didn’t quite understand. In fact, if it were up to me I probably wouldn’t eat at all. So the concept of being overweight was foreign to me and I assumed that fat people must be lazy/weak/whatever. As I got older and a little more in tune with my body, I noticed what sugar cravings are really like. And my god, when that part of the brain complains, it gets front and center stage. I specifically remember trying hard to resist reaching for a soda for like an hour. I conceded and drank one. I couldn’t focus otherwise. Then I realized that there are people (typically easily spotted) that live every day of their life like this. And I get that the brain is hardwired for gluttony- I will literally never eat enough food in my life- so it’s a rather natural thing to want Calories. I’m lucky that I’ve got a passable relationship with food. I feel for those who struggle with it. I’m also glad that there is a stop-gap in drugs like ozempic that help effectively curtail eating, today. I’m also hopeful that the drugs of tomorrow will be even safer and more effective than we have now and that the systemic sources of obesity in society erode away. I think the future is only getting brighter (and lighter) for the millions struggling with their weight.
> Most of weight loss actually happens in the kitchen, not the gym
This isn't really true. Or it doesn't have to be.
If you look at people with high muscle mass, you'll notice something. They eat a lot. Like... a lot.
Michael Phelps famously ate close to 10,000 calories a day. Now granted, he swam a lot. But did he burn 8,000 calories a day swimming and hitting the gym? No.
When you have more muscle, you burn more calories. Always, even when you sleep. So while a 20 minute run might only burn 150 calories... how many did you burn by running 20 minutes every day and building up leg muscles? Now it's harder to tell.
Yeah, if you burn 1,000 extra calories per day exercising (which is a lot of exercise for beginners but not that much for people training for anything major like a marathon) you can certainly do more with exercise than with diet.
Personally I always used exercise, then you don't need to starve yourself, and you get all the benefits of hard exercise. But it's a discipline either, and hard for your typical weak-willed average first worlder.
As an ex-obese, you partly understand the issue. It's true that craving are omnipresent (still are for me, and I'm at 25 BMI now, used to be 34). The main issue is hunger and physical pain caused by hunger though.
It's an hormonal imbalance, I 'fixed' it by fasting (you need access, time and money to do that in a controlled way, but you can also wing it. Careful, the second day is extremely painful). If you can fix it with medication and without torturing yourself (which the fast felt like), more power to everyone.
[edit] also you have a pretty empathic way of thinking.
I highly doubt your thesis. People losing weight with no effort is not going to enable them to put in effort to actually get fit. Especially later in life for folks that have spent most of their adult years not moving a lot. Coupled with that is the potential muscle loss from losing weight this way; trying to regain that lost muscle could be discouraging at first, especially without the right diet.
these medications are pulling the same metabolic levers as the ketogenic/carnivore diet. the exact same thing happens on each: everybody gets pregnant after not being able to, everybody loses fat, everybody is cured or nearly cured of alcohol addiction and various mental health ailments (keep an eye out for the impact of ozempic-like medications on PTSD), heart disease and many other kinds of diseases are massively improved. ozempic doesnt do this for everyone and there are way more and more serious side-effects with ozempic but the overlap is absolutely unmistakable. keto and these medications arent making people lose weight, they are making people fundamentally healthier (ignoring side effects). they are doing something that addresses the pathological nature of an agriculture-based diet. some day very soon, we will discover the exact pathways and levers that are being modulated by these therapies and we will create a solution that wipes out most modern diseases in one fell swoop with essentially no side effects. that is coming very soon because with ozempic, there is now a north star for researchers to follow. very exciting times. savor and appreciate this insane, backwards and brutal time before the great health revolution while you still can!
No such thing as free lunch. Up to the individual to decide whats worse but the "miracle cure" positioning these drugs are enjoying in popular media is troubling.
Thank you. "No free lunch" is perhaps my least favorite saying.
Free lunch is good. We should strive for free lunch. You can actually make things better with no cost.
These days is feels like a good segment of the population is decidedly anti-solution. Doesn't matter what the solution is, they don't want it. They take a "do nothing and hope it works" approach to everything.
IMO "No free lunch" is not anti-solution at all, on the contrary its a problem solving (engineering?) tenet that simply acknowledges there are always trade offs and constraints. Just like any software engineering project can't be expected to do everything for all people with no cost.
The "magic pill of health" aura that surrounds these new drugs is clearly opaque in terms of what the trade offs are, partly because its still way too early to know.
Back to my original post, there is some evidence of risk of going blind as a result from taking Ozempic et al. Might be worth the risk for some, even many. I'm fully in support of options and letting people make informed choices. Informed being the key word here. It will take time for things to shake out, I do hope there is a net positive since we are talking about millions of people after all.
Your study you linked compares the diabetic population taking GLP-1s against a healthy population. Of course they're going to find more eye problems in the diabetic population, diabetes damages the eye.
Correlation does not imply causation. Especially this one.
"The researchers compared patients who had received prescriptions for semaglutide compared to those taking other diabetes or weight loss drugs. Then, they analyzed the rate of NAION diagnoses in the groups, which revealed the significant risk increases."
I don't interpret it at all as you do - if they're taking "other diabetes or weight loss drugs" they're clearly not part of the "healthy population".
Ozempic is a dosage for type-2 diabetes, Wegovy is a dosage for weight loss due to obesity. It's the same medication, but FUD scapegoating or conflating one with the other leads to misinformation.
Yep, but Mounjaro is not approved for weight loss. It's for type-2 diabetes.
After a month of Wegovy, I was barely eating and not hungry. Have lost 35 lbs. so far after going just on the side of obesity due to complications of the only antidepressant I've ever found to pull me mostly out of otherwise treatment-resistant depression. Too often, people will casually blame others for not having "stronger self-control" when the motivations, opportunities, and compounding factors make it extremely difficult or impractical to resist. Even so, Medicare doesn't cover Wegovy or Zepbound, but will cover Ozempic and Mounjaro because it's all about discriminating against obesity.
There's no call to insult something like that. If they choose to eat at Chick-fil-a because they don't have time (or don't know how to cook) that's fine. They should be commended on their food choices there. Chick-fil-a has so many fatty, fried food options and they choose something grilled, with vegetables.
Besides, what toddler do you know of will choose to eat a kale salad?
This isn't really a constructive way to look at the problem and I'm saying this as a former coach. If it was as simple as just eat less and exercise, everyone would do it. The thing is, it's not. It might be for you, in which case good for you, but a lot of people have been brought up with absolutely disastrous food habits, mental triggers for stress eating, etc, and all of these are ingrained in their body. It's often to the point that the way their body functions is fundamentally different from how it does for other people. Biological signals, their amplitude, how your brain perceives them, it's all way off.
All of this is a very long winded way to say: these people are unwell and rather than criticize them for being lazy or unwilling, we need to support them. Many (most?) of them come from an environment where they had very little say in achieving a positive outcome and now they're stuck with what they got. Breaking out of it is hard — statistically nearly all eat less and exercise regimes fail. Rewiring your body isn't an easy thing to do.
But it IS as simple as eat less and exercise. And no, not everyone would do it. Everyone isn't doing it. Because people are lazy, want instant gratification, and consequence-free eating habits. If 99.9999% of the people taking these drugs were to cut their caloric intake to something reasonable (1500-2000 calories per day) and exercise for half an hour to an hour a day, every single one of them would lose weight. It's not that they can't, it's that they don't want to.
And whats the problem with that? Our entire world is built upon conveniences. We don't grow or hunt our own food, or travel cross country with our own two feet, or countless other things.
Its not that I can't do those things. I don't want to. I rather spend my time, physical and mental energy on the things that are more important to me. Does that make me lazy?
> Because people are lazy, want instant gratification, and consequence-free eating habits.
At what point does it stop being an individual problem, and a human problem?
This is a global crisis. Can you really not think that maybe, maybe, the human brain and body is not built for our current world?
At what point do we admit "do nothing" isn't a viable solution? At what point do we look around and see HALF of people struggling with obesity and say "okay... something is wrong here".
I'm sorry, what you're saying is directly at odds with reality and I think you're only saying it because you got lucky. You don't have food addiction so it isn't real.
But evidently it is. To me it's obvious. When I look around I don't see lazy people, I see an epidemic of addiction. This feels, to me, identical to smoking. Identical.
This is like saying not being poor is as simple as earn more and spend less. It's simple as. It's not that people can't do this, it's that they don't want to. Hopefully you can see how absurd this framing is.
It is very simple when you realize both these problems are very fixable with elites that care about their people and don’t seem them as things to extract resources from.
I understand your argument but this supportive coddling methodology which has dominated our culture over the past few years has gotten us fatter and more unhealthy. Maybe for children or mentally ill people that is a compassionate strategy but grown adults need to accept responsibility for their actions. This rhetoric that its not their fault, or they have to rewire their bodies, is fueling this. It makes it seem like the only solution is a drug (which these companies no doubt love) and they have no free will. There are probably a few cases of genetic abnormalities, but lets be real, most users of these drugs are eating too much garbage. They know it too. I think shame is a valuable tool in this regard. A public health campaign by the CDC mocking fat people would probably do wonders. I'm talking billboards and creative art installations.
A considerable part of modern culture and industry revolves around shaming people for not being slim, clearly it is not having the effect you describe since the problem is getting worse. No one says people should be coddled, but saying just eat less is as useful as saying just stop being poor.
> saying just eat less is as useful as saying just stop being poor.
how is that the same? eating less doesn't cost you more money .. it actually cost you less. so if you have the means to eat alot, you have the means to eat less. if you're a minimum wage worker and you need to make 3-4x that to get by, that is nearly impossible. eating less doesn't require a degree or a large network or requires you to relocate to the SF bay area. the only thing it requires is discipline and we know money can't buy that (source: all fat celebrities taking ozempic despite having world class chefs/trainers/gyms).
I used to think the same way. Big proponent of the "stop eating so much" diet. It seemed so obvious.
However, I can be whatever weight I want because I simply don't mind being hungry. I often just forget to eat. That is not the same for everyone.
It wasn't until someone close to me started using Ozempic. After years of me suggesting they just eat less, now they could. They aren't hungry all the time. They can skip meals. They don't get hangry.
Telling people to just stop eating so much is not unlike telling stupid people to just be smart.
Simpler explanation is that people with addictive personalities both are more likely to get addicted to opioids and to be obese and benefit from ozempic.
This is an ill-informed take. My lifetime has seen transformative, inexpensive medications dramatically increase the healthspans of literally billions of people. Atorvastatins have reduced heart disease and extended lives across the globe for pennies a day, and GLP-1 drugs are helping countless people overcome an epidemic of obesity - those, too, will fall in price over time.
