Minimal, but minimal progress in the US was/is still progress.
If you know a "customer" of yours (an individual employee) is only going to be with you until they either change jobs or go on Medicare, then it seems the name of the game then is to make sure that nothing catastrophic happens to them until you can hand them off to someone else.
In which case, they should definitely go on ozempic. Even if the effects of ozempic immediately come off after usage, it's a short-term enough solution that benefits the insurance company, no?
The problem is, prediabetic and folks who may have crossed 7.0 A1C once, and just overweight folks with docs who are willing to play fast and loose are demanding it. Skipping metformin and other first line treatment options that are way cheaper. For those folks, complications might be the next guys problem.
Most people don’t change jobs or insurance companies every few years. When they do, it’s often within similar regions and industries so the chances of ending up right back under the same insurance company are significant.
Regardless, the issue is more complicated than your line of thinking. Insurance companies have very small profit margins. Current GLP-1 drugs are expensive, around $1,000 per month.
So each patient on GLP-1 drugs costs an extra $12K per year (roughly) or $120K per decade. That would have to offset a lot of other expenditures to break even from a pure cost perspective, which isn’t supported by the math. So the only alternative would be to raise everyone’s rates.
I know the insurance industry is the favorite target for explaining everything people dislike about healthcare right now, but at the end of the day they can’t conjure money out of nothing to cover everything at any cost demanded by drug makers. These drugs are super expensive and honestly it’s kind of amazing that so many people are getting them covered at all.
In the US, insurance companies are generally legally mandated to cover ACIP recommended vaccines at no cost to the insured, which includes flu vaccines for everyone six months or older without contraindications.
That the NHS is getting to a place where it’ll provide it, I’d say yes.
The article is about life insurance, which is very different from medical insurance.
Medical insurance companies often already go out of their way to pay early to save in the long run (e.g. free preventative care, checkups, etc.). I can’t speak to GLP-1s, but it’s possible that right now there are still active patents when used for obesity that make them crazy expensive for a few more years.
Life insurance is all about models and predictions about when you’re going to die. Any sudden change that massively impacts those models suck, because life insurers are basically gamblers with gobs of historical data they use to hedge their bets.
Literally LOLed when I read this. Health insurance companies might pay lip service to this and make some token gestures like free preventative care, but in my experience health insurance companies frequently shoot themselves in the foot by denying care that later ends up costing them even more when the patient's untreated condition worsens.
Some do. My insurance requires a prior authorization due to the previous shortage, but it's $12/mo
Medicaid in my state also covers it for $3/mo
But it's also worth remembering the relative risks involved. Obesity isn't quite the ticking time bomb / public menace it's often made out to be... For smoking, you'll find studies with relative risk numbers for lung cancer over 5 for casual 1-4 times a day smokers, and the number quickly exceeds 20 for heavier smokers. In contrast, with obesity, the most severe relative risks for things like heart disease or diabetes you'll find topping out around 4 to 5 for the most obese, even then often under 3, with milder 1.1 to 2 for the bulk of obese people. (Here, ~31% of the US has BMIs between 30-40, and ~9% have BMIs over 40.) For other harms, like there was a study on dementia a few years back, you'll also find pretty mild (1.1ish) relative risks, but these end up being similar with other factors like "stress", "economic status", or "low educational attainment". Just some thought for people thinking about subsidizing or providing free stuff, the cost tradeoff with paying for other things later might not work out so neatly, and there's reason to not focus solely on obesity but also do the same sort of analysis with other factors and severity of a factor as well.
On-patent GLP-1s (all of them right now) are actually extremely expensive. Right around $1000 per month.
I don’t want to discourage anyone who needs them from seeking treatment, but their discontinuation rate can be somewhat higher than you’d think from a life-changing drug because many people don’t like certain effects or even encounter side effects.
Weight loss drugs are also a challenging category for OTC because they’re a target of abuse. People with eating disorders and body dysmorphia already seek out black market GLP-1s at a high rate and it would be a difficult situation if they could pick them up impulsively from the medicine aisle. It’s also common for people to misuse OTC medications by taking very high doses hoping for faster results, which has to be considered.
There’s a libertarian-minded angle where people say “Who cares, that’s their own problem. Medications should be free for everyone to take.” I was persuaded by those arguments when I was younger, but now I have a very different perspective after hearing about the common and strange world of OTC medicine abuse from my friends in the medical field. Just ask your doctor friends if they think Tylenol should still be OTC if you want to hear some very sad stories.
what does that mean? in the UK it's for sale from numerous national-chain pharmacies on a private prescription (ie the pharmacy is selling it commercially and customers are paying cash, no insurance and no state subsidy) for less than $US270/month. it seems unlikely to me that the pharmacies or the manufacturers are taking a loss on this, and the UK has at least as strict drug quality standards as the US.
sounds like the US monopoly-holders are just charging a lot more because they can, because the insurance system obfuscates prices and gives everyone involved cover to rip off patients?
Doctors' jobs are to deal with the cases that go wrong. These anecdotes have no relevance without actual data on how often these problems occur.
This thinking seems correct to people who grew up knowing about the dark web, Silk Road, and who believe they could access any substance they want if they wanted it.
It is not accurate for the majority of the population. For the average person, misuse of drugs isn’t a calculated decision. It’s one of convenience and opportunity.
> In 1920, 1970, and now, heroin was legal, illegal with minimal enforcement, and illegal with harsh enforcement (except in SF), and the same percentage of the population was addicted at each time.
This is a very misleading statistic for multiple reasons, as if it was engineered for the purpose of obscuring the problem.
Why pick 3 separate dates and limit only to 1 drug? There is a massive opioid epidemic that was fueled by increased availability of different forms of opioids beyond heroin. In the 1920s and 1970s they didn’t have OxyContin being diverted, Fentanyl flowing into drug distribution networks, or even Kratom products available at the local gas station. The availability and convenience of these different opioids has unquestionably increased opioid addictions.
Even more recently, the widespread legalization of marijuana has led to an increase in the number of daily users and the doses that people consume, even thought the libertarian arguments maintained that no such thing would happen.
At this point I can’t buy any arguments that claim that availability of drugs has no impact on misuse or addiction.
You are making my point for me. The harsh restrictions on opioids haven't actually decreased the availability for addicts who are willing to go to black markets and risk dangerous injectibles and fent laced street drugs. All the restrictions have done is make it much more difficult for legitimate users like me. I broke my collar bone a few years back and was barely given any pills and had to live with a lot more pain than I should have. And the justification is that these harsh restrictions make it harder for addicts to get it, but as you pointed out, it actually doesn't even do that.
As for marijuana I would bet that the increase in the number of users has been more due to the decrease in public perception of how harmful it is rather than from its legalization. Is the usage increase limited to the states where it has been legalized? Furthermore, it doesn't matter if the usage increases, only if the problematic usage increases. Is there any indication that this increase corresponds to more serious potheads or just more casual smokers?
"Life insurers can predict when you'll die with about 98% accuracy."
This conclusion isn't supported by the linked document. The document instead is talking about expected vs actual deaths among demographic groups as a whole, not individual people. And that expected vs actual is just history + trends. This doesn't mean that insurance can say that Joe Blow is going to die in June of 2027 with "98% accuracy", obviously.
Will you be one of them? Click here to find out!
Pretty easy to predict if you're willing to make it happen.
edit: and then Big Annuity lobbying to oppose this
Big Annuity can charge you more, in fact, if it has reason to believe you're going to live unusually long, so playing the GLP-1 dance with them would only be profitable in reverse. Pretend to be the unhealthiest person on the planet, lock in an annuity, then get on the drip stat.
The biggest part of that equation is regain part. Most people quit GLP-1s because of costs. Let's fix that.
The safety profile of the drugs with diabetics, and the health benefits that come from the associated weight loss may make permanent use a net benefit for most people. There appears to be little, if any, "course correction" effect from taking it for short periods of time.
I am not saying that those variations are great from a health point of view, but they are certainly not as bad as staying obese.
Letting your weight fluctuate up and down in giant swings is, in many ways, harder on the body than just staying at a steady weight, even if it's overweight.
There’s nothing in these drugs that makes you lose more muscle than fat, you don’t lose any more muscle than if you do a regular diet, not even slightly.
Second, the drugs don’t do anything to cause you to gain back mostly fat, and people going off them have more success, not less, than your average person who loses weight rapidly whether through diet or other means.
The average person who is 50lbs overweight because they gained 5lbs a year for a decade will lose all of that weight within 6 months with nearly entirely positive side effects, and if they stop taking it, will regain a bit less than they did before, meaning it would take another decade to get back to where they were. That is unequivocally a huge net positive.
It’s not like Testosterone which does have dramatic negative effects when taken long term and can cause dependency.
It also happens to be extremely effective at reducing bad habits, and yes those habit changes persist after quitting - not perfectly, but surprisingly so. This even works for smoking, drinking, and gambling.
Also it should be mostly used as an adjunct to strict diet and exercise.
Making millions of people dependent on a drug to maintain basic health does not strike me as the best of ideas regardless. I understand why it's a good idea for many from an individual perspective and I'm not judging anyone, but from a societal perspective it does not seem like a reasonable solution.
The scale of the solution is allowed to match the scale of the problem which is on the order of 2/3 of adults or 200,000,000 people.
With AI glasses doing this automatically for you upon seeing what your eating without u having to do anything some people may be shocked to learn how many calories they consume daily.
Currently, it's too time consuming now for the majority to do (i use GPT via texting it or talking to it to keep track as I eat out daily at healthy chains) but if it was done automagically I believe it definitely would be a substitute to Ozempic. I bet some or more would use that easily captured data that's shown to them (in the glasses or on their mobile device) to strive, make and possibly compete with their friends/family to eat less calories and carry less weight on them (be healthier). You can train your body to eat less to a lot less and for some that would definitely help them shed weight. The glasses could as well deduct calories burned from your daily walk, jog, etc.
*Being downvoted hmmm do you think AI by seeing it can't via an image calculate the calories of a burrito bought from Chipolte and other chains? All chains have nutrition information on their websites now that GPT goes and fetches. As for home cooked prepared meals I have taken pics of my food via GPT and it seemed to come close.
Maybe I live in a bubble, but I don’t put stuff in my body unwillingly, so yes I control my diet.
It also isn’t rocket science, I know doughnuts have a shit ton of calories and vegetable shortening which will clkg your arteries, so I don’t eat doughnuts. I don’t have to look at the packaging.
Maybe the missing part is a proper education on nutrition in school, but we live in the age of the internet. All the information is there, you can get meal plans, you can figure out what foods are more likely to put you at risk.
Again, I don’t believe awareness is an issue. People know that chips and doughnuts are bad, but they eat them anyways because they are addicted to food which is engineered to be addictive.
The example I'm thinking of is cultures with near-religious obligations to listen to their parents. Like Italian-Americans all act like they'd die if they ever ate less than all of their grandmother's cooking or ever changed any of the traditional recipes. Even though the recipes were all invented in 1970 in NYC and have inhumanly large amounts of carbs.
Yet majority of all people have no idea the amount of calories they eat daily. Im sure being shown this automagically will be valuable data to all people just how they choose to use this optional feature to make changes or not.
Obesity is not (in general) a result of addiction.
If what you're suggesting worked, then the horrible cancer pics on cig packs would have long eliminated smoking.
For those who don't have the will power there's the Ozempics to utilize at their discretion. For those who do have some or a lot of will power to change their lifestyle forever then this is going to be extremely helpful and those types wont be using Ozempics as Im sure such types are using it now.
As an aside, I watched Poor Things this afternoon, and it came with a "Contains Tobacco Depictions" warning at the start. Never seen that before. No warning for the nudity, sex, or profanity.
I already do this with chatGPT but i have to do something vs. just living and glasses doing it automatically.
1. Expected high stress work day -> Coffee w/ food item in the morning
2. Stress during the day -> No exercise + large lunch.
3. Post-day -> door dash due to not feeling up for cooking.
4. Sleep -> Get 6 hours of sleep due to not having the energy to maintain bedtime discipline, getting paged, or late night meetings + childcare obligations.
5. Repeat.
This cycle continues for a few months leading to 10-20 pounds of weight gain, followed by a year long push to rebalance life and lose the weight. There is nothing that a magic calorie counter could do for this cycle other than guilt me over my door dash order at the end of the night.
Why should that be? Is it not possible to order healthy food in? If not this would surprise me as it seems a number of people would be seeking this.
I'm asking as I don't have personal experience.
For those who are not interested cutting down daily on what they eat this data would not be valuable to them just as the data their phone captures now how many steps you walked in a day.
Myself I eat Cava bowls for lunch that are less then 600 calories, drink 70 percent water (not consuming calories from what I drink) and unsweet tea (zero calories in tea) with some lemonade to sweeten it a bit as the remainder. Other chains you can find similar meals that are less then 600. If you eat as such and keep at (change ur lifestyle for good) it some weight will be lost if the person wants to as well go for a walk on their lunch break. But again all about to how people want to live and enjoy their lives!
I recently switched from a major tech company to an academic position and lost 5 pounds in the first month. Simply due to lower stress making the healthy habits seem “easy.”
For the aware user, combined with a scale, it helps normalize estimations of calories which can be incredibly deceptive. For example, try getting a group of people to estimate how many calories are in a store-bought muffin or donut, a bowl of nuts, a sweetened coffee drink from a drive-thru, or their typical bowl of a favorite cereal. I'm used to the casual observer's guess being about 1/3 of the true total if you weigh the item and read the label.
So in your scenario, the calorie counter would be a signal that you need to cut portions or cal density if your weight is going in the wrong direction, not unlike how a compass is just a tool if you're lost - you still need to know how to use it.
And I'm guessing just based on my own experience paying for term life that the actual premia differences aren't actually enough in most cases for the life insurer to simply pay out of pocket themselves; the differences probably add up to a few hundred per year per customer, whereas a year's worth of a GLP-1 agonist probably costs a couple thousand (for now, in 2025, and probably dropping rapidly).
Huh. Second order implementation details aside, this is an extremely fortunate turn of events for us.
I'll add that while it isn't a big deal, I definitely feel the needle; sometimes worse than others. (I'm using 8mm 30 gauge needles.)
If you have very little body fat, your glutes are probably a better place.
Source: I take HCG and have to use injection 2x a week. 27G is my favorite..
https://medneedles.ca/products/1ml-27g-x-1-2-sol-care%E2%84%...
It’s a rapidly absorbed peptide suspended in water, it could even be used with a transdermal patch, so it doesn’t matter that much where it gets in or how deep. Best to avoid painful areas though.
You do not want the drug meant to subcutaneous to go into the blood steam. This is true for GPL-1s (all peptides for that matter), as well as insulin, and definitely mRNA vaccines.
Eli Lilly will soon release key data on its weight loss pill orforglipron - https://news.ycombinator.com/item?id=43465346 - March 2025
I feel sick for three days in a row after taking it. Even after several months on the same dose. I get horrible gut cramps, sour stomach, near constant nausea, and occasionally vomiting and diarrhea. I have to take my shot on Thursday night because I'll feel bad the next day and supremely sick the next two days. If I took it earlier or later in the week it would absolutely impact my ability to work during the work week.
It has had amazing effects. I've lost about 60 lbs in the last year and my A1c is now around 6.2.
It's a very effective drug, but it is brutal on my body. I'm not sure anything in the medication is causing the weight loss. It just makes me feel so sick that even if I'm hungry I don't feel like eating.
What dosing are you on? If you’re still doing 2.5mg (smallest available in the auto injectors) perhaps try a compounding pharmacy for a month or two and you can experiment with lower doses and a different dosing schedule?
During my peak weight loss period I found that matching my injection schedule to the 5 day half life of Tirzepatide and adjusting the dose downwards to match this schedule helped with any side effects - including the “fading” of effects those last 2 or 3 days for me. There are half life calculator spreadsheets available on the internet that can help dial it in and keep your theoretical concentration more flatline vs peaks and valleys.
The current dosing regime is based on the single FDA trial that LLY did and is certainly not going to be the common practice a decade from now. It’s largely designed around patient compliance than anything else.
That said - everyone responds to this drug much differently. My little group I’m in is all over the map. Some folks lose weight consistently with tiny doses every 2 weeks, some are going above the recommended maximum weekly dose.
I also found food choices matter. A lot. The best part of tirz for me was being given mental space to stop eating shit food and start eating “clean” consistently. When on high dosing I absolutely would have a bad day if I decided to take my shot and then eat a typical American diet later.
The primary mode of action from the drug is simply you eat less. But it shouldn’t be due to you feeling too sick to keep anything down. That sounds pretty horrible.
https://glp1.guide/content/are-glp1-side-effects-all-the-sam...
It was a while ago, but IMO the list still plays
Seriously, that's just not that big of a deal. It takes like a few days at most for simple term life. Can't speak to the other policies, which I understand are mostly tax vehicles anyway, but it's not hard to simply get a new life insurance policy if your current one goes kaput.
Jeez.... I guess in that scenario I become a billionaire because it will be very easy to scoop up some VC money to snoop up some of those newly unemployed actuaries to monopolize the market at a profit margin an order of magnitude larger than any of my now non-existent competition, because this is a financial product and doesn't require months of building a factory or something to offer.
How many years experience do you have in the insurance industry that you're so confident to talk like this?
> because this is a financial product and doesn't require months of building a factory or something to offer.
How many financial instruments have you launched? If the answer is zero, you should refrain from any conversations on the topic because your opinion literally means nothing.
Onus is on you to prove that if every single life insurance provider was suddenly Thanos snapped out of existence tomorrow, we wouldn't see a swarm of hungry financial professionals swoop right back in to recreate the service within weeks. That seems like a laughable claim to me, but maybe you know something I don't.
(Edit, for future readers: ecb_penguin seems to have missed the question earlier in the thread I was responding to:
>... and the question was about the aggregate effect. What happens if all life insurers go bankrupt?
Emphasis mine. This was to clarify that yes, the original commenter meant literally all providers.)
> Term life is just not that complicated a product at heart
Sure, it's easy if you don't know what you're talking about and just make stuff up!
> Onus is on you to prove that if every single life insurance provider was suddenly Thanos snapped out of existence tomorrow
Literally nobody said that would happen. Now you're arguing points that nobody made.
You have no experience in the area, arguing things nobody said. You're perfect for VC money, lmao.
> That seems like a laughable claim to me
Nobody made that claim. Why are you laughing at things nobody is saying? That's weird.
> That seems like a laughable claim to me, but maybe you know something I don't.
I would 100% guarantee people that have worked in an industry know more about it than you do.
Textbook demonstration of the Dunning-Kruger effect. You have no knowledge or experience in an area, but you're confident you know how it works, moreso than the actual experts. https://en.wikipedia.org/wiki/Dunning%E2%80%93Kruger_effect
I think this very accurately sums up your comments.
It's not a gamble, you transfer your risk to a collective.
I'd argue that it should be illegal again, as a moral hazard (directly contributing to countless murders and other schemes) and as a particularly morbid form of gambling.
People with more complex medical conditions often can get life insurance from smaller, specialized providers... and at much higher rates. But the big mass-market players offering inexpensive term life products are only offering them that cheaply because they really control the risk profile during underwriting.
I would feel bummed out, but not angry or like I actually got ripped off, in other words. When I signed up for the 20-year term, part of what I was being asked to do was estimate how likely I think it is for this firm to actually be around for that full 20 years. That's just part of the game.
I don’t think that’s a typical experience for most people, other than the price
As far as I can tell from forums, it's not like 5% have the side effects, it's like 80-90%.
But for the first time in decades, I felt full. I didn't want to finish a meal, it was too much.
My body regulated my food intake in what felt like a natural way.
I hadn't even realized my body had somehow lost that fundamental mechanism of appetite control. It made me realize I wasn't weak willed, something is different about my body than other people.
But it comes with a price. The side effects I had were quite bad and so I stopped (though I now read that if I switch to a different brand, I might be ok).
I often didn't want to leave the house due to a dicky tummy. It could come/go in waves. But often can last a whole week.
Plus you've got to inject yourself every week. Often you can't drink as it makes you sick. Even when you're doing everything 'right' you can feel a bit off.
If you do over-indulge (with food or drink) the side effects can sometimes be massively amplified and you feel terrible for days.
So amazing in some ways, but it's not like taking a vitamin tablet. There are costs and making one slip up can result in suddenly feeling awful for a day or two.
Perhaps I was just particularly prone to the side effects, but it seems to happen to a lot of people (I found Mumsnet threads about it useful, they are quite revealing as they seem to be fairly honest and willing to share their experiences)
> If you do over-indulge (with food or drink) the side effects can sometimes be massively amplified and you feel terrible for days.
Never had anything like that.
I wouldn't recommend that to everyone, but it helped a lot for me.
Happy people with no issues are less likely to post, or post as often.
That said, much sympathy for the people who do experience particularly bad side effects.
- change your diet. you can't eat the same food at the same volume. or even is smaller volume if the food is a burger, etc.
- watch your drinking, your tolerance for alcohol is reset, and again on the volume thing
- drink a lot of water. apparently opposite to all the volume warnings above, lol
- split dosage and inject twice a week. (i dunno, talk to your doctor. also this only works when you have a vial and not the auto-injectors, though apparently the autoinjectors are way more expensive)
On the other hand, when i ask about what happens if you go on a bender and eat two burgers and lots of fries and drink a six pack?? From people that used to gladly do that: "gross, why would i do that?" That there is the real change.
Did I misread the article, my TL;DR of the article is that GLP-1 reduce the indicators or mortality without modifying the actual mortality (because most users return to normal indicators within about 2 years).
Because they stop taking GLP-1s after 1-2 years, not, it seems, because the meds stop working.
So in addition to the quitters returning back to normal after they got life insurance underwritten when they were healthy, we have the unknown of the longevity of people on the glp-1 drugs.
Then from there, I click through the 65% #, assuming they have a good study on 65% of people stop after a year. Nah, they don't. It's super complex but tl;dr: specific cohort, and somehow the # getting on it in year 2 is higher than the # of people who quit in year 1.
I have a weak to medium prior, after 10m evaluating, that the entire thing might be built on more sand than it admits.
Lot of little slants that create an absolute tone - ex. multiple payouts over the "lifetime" of a life insurance policy. (sure, it's technically possible)
Also there's no citation for the idea this mortality slippage happened because of GLP-1, and it's been out for...what...a year? Maybe two?
That's an awful lot of people who were about to die, saved in the nick of time by...losing weight? Again, possible, I'm sure it even happened in some cases.
Enough to skew mortality slippage from 5.3% to 15.3%?
I thought they were 98% accurate?
Wait...is the slippage graph net life increase slippage? Or any slippage?
Because it's very strange this explosion happened in exactly the year of a global pandemic that had sky-high mortality rates for older people.
Regarding the graph about slippage: yes, that looks like the Covid peak. However, even assuming this recent trend is an anomaly, the industry is in a changing landscape and needs to adapt. New metrics and criteria, and the fastest mover will capture the market. Business as usual.
I don't feel sad except for the people who managed to bring their health issues under control and now can't get life insurance.
That's kinda wild, because it seems like holy shit if you're taking a drug that lets you drop 10-20% of your body weight from obese down to normal why would you stop taking it, but people do.
In this sense it's like any diet: they "work", but if you don't permanently modify your food intake, the weight comes back as soon as you go off the diet.
I think that in a few more years the number may stay at 25% (or whatever) but that the makeup of the 25% may be different. That is, people will go off it and back on it if they see their progress reverse but that will happen to different people at different times.
Source: UK based friend who says the pharmacy will refuse to sell them once they fall under BMI 25 (still overweight). They'd prefer to be on the tiny maintenance dose but it seems to be very hard to achieve (unless you're going off the market completely).
Source? Everyone I know who stopped taking it rebounded a bit, but not to where they were. And no literature shows 100% rebound to my knowledge.
Some of the prediabetics I knew who stopped taking it (N = 2) stopped being prediabetic (N = 1).
I wonder why life insurance isnt funding more research into things like metformin, where we have amazing long standing data but haven't done the real research. See: https://www.afar.org/tame-trial
The current FDA guidelines support your assertion that GLP1s should be prescribed in addition to other tools to help people change their eating habits.
What the FDA does not prescribe is moralism, which is what “help learning discipline” tends to imply. If you didn’t intend to frame your argument in terms of moralism, you might consider a different word choice.
Chronically obese people, who are prescribed GLP1s to enable them to eat fewer calories. Are you interested in the reasons why people are unable to eat fewer calories without medication? It’s a pretty fascinating problem, one that intersects genetics, environment, and culture.
There is no single main root cause for obesity. We just combine it as one because there isn’t a lot of long term research or funding for it right now. There is a lot of sigma against obesity and people keep blaming other people instead.
Thyroid hormone disorders have been linked to cause weight gains. This can’t be fixed by simply eating less, it can literally do far more damage.
Medications have been linked to cause weight gain as side effects. This wouldn’t do anything to eat less until they stop taking meds and for some, they cannot do that.
Americans’ increasing desire for sweets have increased the sugar content in all of our food including the fruits and vegetables over time. We’ve intentionally bred our healthy stuff to be sweeter. So eating less can make us even more hungrier because we go into sugar crush without realizing it. Changing diets is difficult without us doing all sorts of calculations of finding the right cheap healthy food at the right store and that is you are lucky enough to have any.
Relatedly: it validates that people are assholes for making fun of others who are overweight. And not many people like feeling like an asshole.
Edit: starlevel004 is right.
Contrast this with Parkinson's which is a neurodegenerative disease with no known non-pharmacutical treatments and even the pharmacutical ones lose effectiveness as it progresses as they only treat symptoms, not the disease itself.
This is precisely what the FDA guidance contains: that GLP1s be mixed with lifestyle modifications.
I haven't tried a GLP-1 agonist myself because I'm not exactly severely overweight, but I do absolutely struggle to keep weight off. It's amazing how easy it is to re-gain weight and how hard it is to keep it off. If the worst side-effect of GLP-1 agonists is that it makes life insurance quotes harder, whatever; I think it's totally acceptable that some people will still struggle with improving their habits, I don't think it's likely to make it any worse. In my opinion I suspect it is likely to make it a bit better, by helping you break out of the cycle.
P.S.: since there is some neighboring discourse about whether being fat is a disease or a lifestyle choice, I'll just say this: I don't personally think it matters. I don't think arguing this distinction will actually help anyone. I don't really care for body positivity and I don't make excuses for my poor habits or being overweight, but I still don't think it makes losing weight much easier.
Blood pressure medication comes to mind.
Can you show me what we're doing in USA to help children and people develop the habits and discipline for long term lifestyle change?
Because I've never learned anything about nutrition, macros, high sugar content and all of the healthy food I should learn to eat on my own.
We did not have home classes in any of my education in US at all, they were a thing in the past but that wasn't a thing in my middle hs or hs or college at all in NY in 90s/2000s.
All of my bad habits were from my parents and they were not good eaters.
My work offered me five visits with a dietician and then I got a health coach and a nurse all paid for and monitoring me on the side through the Vida service. Not everyone has that
See how ridiculous that sounds?
This is deeply misguided. I’m glad that the little assist was enough for you, but if “healthy habits” were enough then people who’d lost weight the traditional way would keep it off.
Further, unless you’ve been off it for more than six months, I’d hold your judgement on this one.
After I stopped, a coworker told me about Vida which my work offers as a health benefit.
Using the Vida service where I got a registered dietician to show me what to eat, I tracked my food and water intake and tracked my exercise. I had protein and fiber goals to hit.
You can’t do it all on the medicine - it is a lifestyle change. The medicine was the catalyst but not the reason I kept the weight off. I wanted it. But because I wanted it, I wanted to use the support system that my work paid for.
I think there is a lesson to be learned here
That's because a lot of the "traditional way" methods are pseudoscience at best, outright quackery that's going to send you into serious malnutrition issues or eating disorders at worst. Every two or three months you see a new diet fad pushed through the yellow press rags, and none of it anywhere near being considered scientifically valid - usually it's some VIP shilling some crap story to explain how they lost weight, of course without telling the people that they have the time for training and the money to pay for proper food, 1:1 training and bloodwork analysis.
The good news is that it is not impossible, and it really is possible to change bit by bit for most people suffering from obesity.
I don't think somebody who walks 10k+ a day, maybe goes to gym a couple of time a week, limits calorie intake to a comfortable and reasonable 2000 kcal per day, would suddenly bounce back to 130kg!
I've had pretty good hb1ac's when my blood sugar's were all over the place and in no way healthy.
Personally I lost a ton of weight doing full-on keto (I specify, because some people just kinda cut out carbs) and then kept it off for over 2 years. But I put the weight back on after that, albeit slowly (over the course of maybe 7 years).
I've also done Mounjaro, and I can keep it off a while after I go off it, but not that long.
YES, you have to change your habits, maybe lifestyle, maybe deal with other issues in order to keep it off. But I think, not only is that difficult, it's not a "you did it and you're done" deal. It's easy to slip backwards, and I won't make any claims about you personally, but for anyone who's kept it off for less than a year, I think the good money would be on it coming back within another year. I doubt someone is "out of the woods" even two years on.
Perhaps that works for some people. I'm glad it seems to have worked for you. But the facts of the world we live in show that it doesn't work for most. "Learn the lesson and be disciplined!" is not effective advice.
GLP-1 in those cases helps manage the problem better.
But for those who are not in those cases where Type 2 Diabetes has sunk in, then they need to use the opportunity to get better while on it and kick themselves into high gear or they will have learned nothing from the experience
In practice, this doesn't happen that often, no, but it's a theoretical goal. Probably because we're in the pre-GLP-1 era with regard to mental health meds. Maybe that will change.
GLP-1s don't do that directly.. but at least they might help people move more, and give them confidence to do more for their health instead of seeing it as a lost cause.
Considering it took you a miracle drug to learn the lesson, that seems like a humorously arrogant take.
I also quit smoking with relatively little effort twice (once in my early 20s, and then again a few years ago after I picked up smoking again during COVID). It wasn't easy-easy, but if I hear the struggles some other people go through, it was relatively easy.
Some people are just wired different. I have plenty of other issues, but on this sort of thing, for whatever reason I seem to be lucky.
humanity
Likely protective of a wide array of internal organs, likely life extending.
Imagine that, people make up bullshit that isn't grounded in reality. Who would have thought!
The article also misses regarding slippage is that Swiss Re in the link calls it a modest increase And that is mainly due to insurers Not performing the same level of medical intake (accelerated versus full underwriting). Increased competition leads to less profits. That’s pretty straightforward and not per se GLP-1s related.
And then the kicker. For not diversified portfolios of mortality risks. Those have been massively profitable for decades, in line with the general increase in age and health. GLP-1s just expands on that profitable aspect. Did I mention that the long term expected rate of return on an insurers book is quite good?
Insurers can weather a bit of slippage. Reinsurers will kick the worst offenders back in line with their AUC performance, because without diversification Or reinsurance it’s hard to stay in the market. (Capital requirements strongly favor diversification. Mono line is very hard.) That’s why Swiss Re is bringing out such rigorous studies of detailed policy events. Signaling to the reinsurance markets and the insurance companies and their actuaries!
Furthermore, there are more people not on GLP-1s than on them (even with the recent surge in popularity) so this population that can give life insurance companies "excess" profits must outnumber those the article describes where the insurance company takes a loss.
Why can't they focus on this profit opportunity?
Source? I agree that some people will regain the weight, but "usually" is an unfounded (without some data) generalization.
That same year, it paid out roughly $800B in claims.
TL;DR: there's no violin tiny enough for me to play for the life insurance industry's 'woes'.
Or any slippage?
It caught my eye this explosion in slippage happened years before GLP-1s, and exactly in the year of a global pandemic that had sky-high mortality rates for older people.
The problem continues to be the pharmaceutical and health insurance industries, particularly in the West. Under pressure to deliver infinite growth forever to shareholders on a quarterly basis, companies have a vested interest in making less medication at a higher price, and lobbying the government to prohibit price negotiations while mandating insurance coverage for many of these drugs.
GLP-1s might be the proverbial straw that broke the camel’s back, but there’s decades of research - and bodies - saying this over, and over, and over again.
Which reminds me: I need to call my new health insurance company to get them to cover my medication, and hopefully extend it to 90 day supplies. Because god forbid that just be an automatic thing for someone who’s taken the same medication daily in some form for a decade without adherence issues.
Predictions of when you will die need a range in order to be attached to a number like accuracy. The attached report is not about this but about population-level mortality trends.
From a quick search, Jarrah et al. (2023) "Medication Adherence and Its Influencing Factors among Patients with Heart Failure: A Cross Sectional Study" [0] discusses some of the relevant details.
I saw this:
https://media.nmfn.com/tnetwork/lifespan/index.html#0
is there anything better?
Often, I think that it’s a bad move, as the clinical effect of losing around 20 kg would have to be matched by some extremely high frequency and severe side effects. Overweight is still not sufficiently appreciated for how dangerous it is, especially after they ramped up production so much that there isn't a real shortage anymore.
Ironically, most of the people who respond well to Ozempic and stay on it have few psychiatric problems. But those who almost desperately want to get off it after a while might be those who have a psychological component to their overeating. The obvious suspect then is eating as emotional regulation. So one could extrapolate, at least as a hypothesis, that the ones who have worse life expectancy due to regained weight after a year of usage are the ones who have a double set of problems stacked against them: overweight and emotional problems. That would have a huge effect on longevity.
This is PURE free association though, no deep analysis behind it.
Are there any alternatives coming out soon or generics?
United States: The main patent is expected to expire around 2032. Monthly Price: $950 - $1,350+ (cash price without insurance)
Norway: The main patent is expected to expire around 2031. Monthly Price: $109 - $301 (cash price equivalent in USD)
Tirzepatide is the most potent GLP1
https://glp1.guide/content/semaglutide-vs-tirzepatide-clinic...
There are group chats with tens of thousands of people and I havent seen any issues with the drug
Basically, Tirz > Sema > Lira
https://glp1.guide/content/semaglutide-vs-tirzepatide-clinic...
https://glp1.guide/content/semaglutide-liraglutide-continue-...
https://glp1.guide/content/another-generic-liraglutide-launc...
N=1, I'm on ZepBound and in general my brain is less likely to give in to things that give instant satisfaction.
The blind spot related to COVID is huge. There are lots of health data going haywire since 2020 and everyone seems to find any other reason but COVID for it.
Took Wegovy (Semaglutide) for about 6 months. Barely lost any weight, would occasionally get nauseous.
Then the doc switched me to Mounjaro (Tirzepatide) + Phentermine, and holy shit, I just don’t feel like eating, almost ever. Lost 20kg in 6 months, which is all I needed to lose, never had any side effects. None.
I did feel a little weird/buzzed the first time I took Phentermine, but it went away the next day.
I feel like for many people it’s not really the physical hunger that makes them fat, it’s that annoying voice in your head telling you to snack something for no reason at all. It sometimes felt almost like drug addiction.
Tirz+Phent are great for that.
The idea that a few pharmas artificially juicing a desperate population [who just want to feel good about themselves and live longer, happier lives for more than many can comfortably afford] is interfering with insurance adjustors ability to maximize profits doesn't leave me heartbroken.
It's precisely this shit that leads to people celebrating when pharma CEOs get tapped.
GLP1 significantly reduces the risk of many mobidities and is increasingly prescribed to older people.
Also, this is incredibly likely to resolve itself once the drugs become common place after patent expiries, the actuaries will update their tables and the curve will smoothe out.
[0]: https://glp1.guide/content/if-glp1-is-so-great-why-dont-peop...
[1]: https://glp1.guide/content/patent-expirations-for-glp1-recep...
1. People do not stay on GLP1s for long, despite how effective they are
2. People often rebound harder from other forms of weight loss (dieting, temporary lifestyle changes, etc)
3. GLP1 reduces a LOT of health risks linked to obesity (heart disease being the most important IMO)
4. Older people are taking GLP1s in droves
5. Once these drugs are everywhere (they will be soon IMO in < 7 years obesity will probably be ~gone), the effects will get "priced in" to actuary tables.
No social commentary or dark humor intended -- GLP1s aren't miracle drugs but the effects (and relative lack of side effects) is miraculous.
toomuchtodo•6h ago
prasadjoglekar•6h ago
But to your broader point, at least in the US, incentive mis-alignment on all healthcare and health insurance is possibly irredeemably broken.
toomuchtodo•5h ago
https://www.labiotech.eu/in-depth/novo-nordisk-semaglutide-p...