What fraction of America’s severely obese are being treated for it? (What fraction refuse treatment?)
Of course, the insured has the quality of life incentive of not having to deal with complications from consuming excess calories.
Obesity mostly causes expensive problems years later. People stay in their jobs for an average of something like 3-4 years. By the time anyone has an issue, it's the next guy's problem (or ideally, Medicare's).
They don't.
Because despite being labeled as not-for-profit, they will always scale up their "cost" to match their revenues, and live on the 1-2% difference.
They want the absolute nominal dollar values for care to be as high as humanly possible.
Is that what you meant?
Plus the out of pocket maximums are a pittance compared to what complicated healthcare costs can be, so paying more for premiums to ensure you are not denied coverage would be a no brainer.
Alas, that is not the case, so the reality must be different from the premise.
Also, here's a non profit health insurance company denying coverage:
https://www.theguardian.com/us-news/2024/sep/29/louisiana-ho...
> That premise must be invalid because if true, no one would buy insurance from for profit insurance companies.
What premise? That companies balloon costs or aim to provide less care if they can get away with it? It's a complete non-sequitur if you think so.
>because there are also for-profit health insurance companies (that deny coverage) and not-for-profit ones (that balloon costs)
The claim that for profit health insurance companies deny coverage to save money and non profit health insurance companies balloon costs to maximize healthcare expenses is obviously wrong (as demonstrated in previous comment).
The claim that health insurance companies in general both deny coverage to reduce healthcare expenses and maximize healthcare expenses to increase profit is obviously wrong, because it's inherently contradictory.
>behaviors that are also very well documented in media
I don't see any documentation of this behavior. The documentation that does exist is the whole business limps along on a knife's edge, lagging SP500, while have no power to set their prices (the government has to approve their prices). They certainly do engage in outsourcing and underemployment, perhaps to intentionally delay and deny care, but probably leading to just as many incorrect approvals as incorrect denials (obviously you won't hear about the former in the media).
And capped or not, the pay-vider structure allows intra-company eliminations to bury arbitrary amounts of money as "not profit" even though it effectively is.
And even if that weren't true, the expected coverage term for a US patient is ~4 years due to it being tied to employment, so there is quite literally zero incentive to address any health issue that won't materialize as cost in the next few years (obesity being one such type of health problem).
Source? There are 7 large publicly listed health insurers with public financials, all underperforming SP500 for more than a decade. There are myriad other non profits such as Kaiser/Cambia/Premera/Providence/various BCBS/etc, all with public financials as well.
Where is all this fraud going? And it’s happening across hundreds of executive offices across the country? And getting past 50 state insurance regulators that have to approve prices for insurance?
That would be remarkable levels of corruption and collusion.
Payvider: An entity that is both a payer (insurer) and a provider (medical practice). Most payviders also have vertically integrated PBMs (pharmacy benefit managers), pharmacies, and labs, all of which participate in the same scheme.
A few of the examples you listed are NOT payviders, they're just payers, and therefore do not have these levers available to them.
Vertically integrated companies evade profit caps on their insurance division by shifting money to their unregulated provider, PBM, or labs divisions. It's pretty simple: the insurance arm overpays its own subsidiary doctors and clinics and records these internal transfers as mandatory "medical care" which is recorded as loss on the insurance side. The parent company then pockets the excess money as unrestricted profit on the provider/PBM/lab side, effectively bypassing the legal limit on how much insurance revenue they can keep and completely destroying the incentive to manage costs through their insurance division, at least when those costs originate from their own providers, which given that e.g. UHG is now the largest employer of doctors in the US, is increasingly often!
Is it fraudulent, corrupt, or collusive for a health insurer to employ doctors who deliver care? Not per se, but it gives insurers the ability to more or less arbitrarily convert premium dollars into profit while still getting people to defend them with claims like "they've been underperforming the SP500 for more than a decade."
Here are a few sources about different constituent behaviors, though you'd have to do a decent amount of reading to stitch together the full picture of how this works:
https://www.statnews.com/2024/11/25/unitedhealth-higher-paym...
https://www.healthaffairs.org/content/forefront/insurers-own...
https://www.wsj.com/us-news/unitedhealth-medicare-fraud-inve...
https://www.statnews.com/2024/07/25/united-health-group-medi...
Yes, UNH does better than the other managed care organizations because their healthcare business has higher margins than their insurance business. But it’s certainly not arbitrary, and it’s apparently not enough to make their shares worth buying.
More importantly, UNH competed against other insurers. They don’t get to “arbitrarily” pay their doctors (as if any business wants to overpay their employees). If they pay too much, then they will have to charge higher premiums. Premiums which also have to be approved by state regulators. And it’s a fact that UNH’s premiums are comparable to everyone else’s premiums. Why else would people buy from them?
>Is it fraudulent, corrupt, or collusive for a health insurer to employ doctors who deliver care? Not per se, but it gives insurers the ability to more or less arbitrarily convert premium dollars into profit while still getting people to defend them with claims like "they've been underperforming the SP500 for more than a decade."
The silly claim is stating managed care organizations are booking outsize profits, yet they don’t show up in 10-Ks or even shateholders’ pockets.
Underperformance relative to SP500 is a factual claim. 2% to 3% profit margin (objectively a tiny profit margin is a factual claim for 6 different businesses. UNH is at 5% to 7%, which is decent, but pathetic compared to tech/pharmaceutical/finance/real estate/oil companies.
Hopefully you can see why this all sounds like unfounded conspiracy theories. Just the fact that it’s better to own SP500 than a health insurer stock should be enough to conclude there are no “unrestricted” arbitrary profits being taken. They are very much restricted, and their shareholders know.
UNH outperformed the S&P by a huge margin up until their Medicare Advantage fraud case pummeled the stock price a few months ago. https://www.alphaspread.com/comparison/nyse/unh/vs/indx/gspc
> The silly claim is stating managed care organizations are booking outsize profits,
Is this claim in the room with us now?
My claim is that the pay-vider structure enables these businesses to produce way, way, way more money than their regulatory "profit cap" leads people to believe. They can remove what would be profit from their insurance arm (where profit is capped anyway, so it keeps them under the cap) and dump it into their healthcare arm (proven by above-market self-reimbursement rates) to fund network expansion, which then further strengthens the insurance arm's market position (alleviating their need to "compete against other insurers" [ lol ])
Your claim is actually concordant with mine, which is that this profit doesn't show up as margin and doesn't show up as excellent stock performance. Correct! That's what it means to hide profit in order to stay below profit cap!
Anyway it's clear that I'm talking to a "stocks guy" who lacks the curiosity to actually understand how a business works beyond the 10-K (where all this stuff is discussed, by the way, you can find it euphemistically referred to as "network optimization").
Like I said, you'd have to do some reading well beyond the 10-Ks and the price chart lmao.
This definition of “hide profit” seems to be no different than “invest in the business”.
> which then further strengthens the insurance arm's market position (alleviating their need to "compete against other insurers" [ lol ])
Why is this “lol”? It is true that vertical integration results in efficiencies, and that can lead to lower premiums (not that it will absent sufficient competition). Kaiser has been doing it to much acclaim for almost 100 years.
An electric and gas utility is a structural monopoly, you cannot run multiple power wired and gas pipes to each property.
Health insurance is easily switched. If Kaiser spends too much, then Anthem/United/Aetna/Cigna/etc can gain customers by offering a lower price.
There are many other risks* than obesity from consuming UPFs, and we may find we've just removed the main stop-loss on worse outcomes
*Diabetes, all the biome/gut stuff which is getting better understood, colon cancer, etc etc
If you limit your sugar intake for a bit, American bread becomes quite the tasty treat.
It might not be direct action of the medication, but the medication making it easier to fix your habits can have huge dividends, similar to how giving an ADHD person stimulant meds make them less likely to die from misadventure or substance use because they self medicate less.
Furthermore, GLP-1 users report having fewer cravings or just reduced appetite in general, whereas what you describe would require some sort of "calorie reduction pill" which would allow people to lose weight without altering their relationship to food. But that pill does not exist.
Sounds clever but this is just a labeling trick. When a second order effect is larger than the first order one, we just rename them to first order and intermediate effects.
For example, the first order effects of growing GLP-1 prevalence are actually consumption of prescription pads, new demand on pill bottles, and gas consumption of pharma sales reps.
The second order effect is weight loss in patients who take the drugs.
It's just something that statisticians have observed across many fields: you theorize about how potentially huge a particular interaction effect or knock-on effect could be relative to the main effect, you read about the Jevons Paradox and intuitively feel that it can explain so much of the world today... and then you get the data and it just almost never does. No reason why it couldn't, just empirically it rarely happens.
And correct I agree they wouldn't designate the demand for pill bottles as the first order effect. That's because despite happening first, it's not the most important object of analysis. That's why it's a disproof of your earlier claim that second order effects aren't more significant than first order ones: because if they were, they'd be considered the first order effect.
Only really in the US. In most other countries they use blister packs instead. Global consumption of blister packs is so huge (not just for prescription medications, also OTC, vitamins, supplements, and complementary medicines), even a blockbuster medication likely only makes a modest difference to manufacturer demand in percentage terms.
I take injectable tirzepatide prescribed by an electronic prescription… so impact on pill bottle demand and prescription pad demand in my case is literally zero.
And I doubt pharma sales reps have a lot of work to do selling GLP-1 agonists-who needs to convince doctors to prescribe a drug when there’s dozens of patients inquiring about it?
Yes the article is about pills, but most people are on injectables still (that may change over time). It likely has increased demand for needles and sharps containers. But in dollar terms, that’s a small percentage of the demand for the medication itself.
You are missing the point.
s/pill bottle/blister pack/
s/prescription pad/e-prescriber submissions/
All irrelevant to the convo :)
Maybe, but with the new pressure of "people are eating less" to deal with.
The idea is basically that doctors recommend you keep a high protein diet while on the drugs because a calorie deficit without protein will lead to muscle wasting.
I think the current NOVA Classification for Ultra Processed Foods is flawed and often drops food containing preservatives and stabilizers into the same bucket as nutritionally poor items.
It also doesn't do a good job distinguishing value or health outcomes from consumption and simply lumps all UPFs into the same bucket. In otherwords fortified whole-grain breads and sodas are both UPFs but objectively they are not the same in terms of nutritional value or health outcomes.
The NOVA Classification's intent is to flag products where processing replaces whole foods, or adds cosmetic or functional additives to engineer taste/texture. It doesn't really factor in actual nutritional value or health outcomes from consumption.
We need to come up with a better system to identify to denote healthy or unhealthy foods, and also to identify foods that contain ingredients that have unknown impacts on our health outcome. Our current regulatory environment is to permit until proven harmful, so having something to flag x-factor ingredients would be beneficial.
Probably not. Food manufacturing is not high margin. The things that would make "products actually healthier" are higher cost both in terms of inputs and in terms of shorter shelf life.
If people eat less and total sales volume decreases, there will not be additional money to change products lines. Expect corporate consolidation and a focus on children and glp-holdout populations, similar to cigarette manufacturers.
Similar to vapes, I could see the development of "ceremonial foods" that are chewed but not swallowed, like gum but with broader effects. Imagine something that approximates the experience of the crinkly bag, oily smell and physical crunch sensation of chips that then evaporates after the crunch. It would maybe even have a double bag for discretely spitting out the too small to crunch anymore shards of a saliva-phobic food grade meta-material.
I remember the YORKIE bar which had the letters of the name stamped on each piece (it was a segmented chocolate bar).
Eventually someone in my house noticed the stamped letters were gone, turned out they moved to a smaller bar with only 5 segments. It was hard to notice otherwise.
Reminds me of the markups on AZT back in the day.
Without coming from the manufacturer or being validated by an independent, trusted third party, you do not know that the chemical composition is what is purported.
Drug synthesis can get very complicated. Purity of the drug is unknown.
Which contaminants are present and what are their effects on your body? Unknown.
What if any recourse do you have if they poison you? Minimal to none.
Even if you have a trusted third party doing efficacious testing of the compounds, the consistency of manufacture will be unknown unless they also do inspections. While I have no doubt that you can have private entity do a far better job than the FDA if the incentives are right there will be no business there. Perhaps a charity could work? I have no idea how though.
Now how do you price that? The profits here will reward pharma investors and enable more investments in RnD of new medicines. I feel that's mostly fair.
It could work but there are problems in (1) the amount of money required and (2) the funding research -> getting votes pipeline is borked (credit assignment in general is borked).
The private 'investment' comes in manufacturing, scale and marketing.
Novo Nordisk has spent 41% more on shareholder enrichment (buybacks and dividends) than on R&D over the past five years.
So they are good stewards of their funds and know they can't deploy as much as they have? Berkshire Hathaway does the same thing.
There's a billion-dollar prize if you figure this out, and the food industry is already openly discussing it.
https://www.foodnavigator.com/Article/2025/07/22/glp-1-drugs...
I'm more worried there's some plausible way (like the ginger discussed) to negate the GLP-1 agonist's function itself or its net effects.
They're not going to talk about it in open industry journals, but Big Tobacco actually did do this with engineered high nicotine tobacco used to adjust addictivity levels.
https://en.wikipedia.org/wiki/Y1_(tobacco)#Legal_controversy
So Doritos is too much. A butter or white cheese puffed corn snack tastes pretty good -- but I don't crave them.
The one thing I will literally eat an entire Costco sized pack of even while on my max GLP-1 dosage was Biscoff cookies. Not much else that I could "eat through" the drug when I was at my peak weight loss phase.
Such insight! Of course that could be said about almost anything.
Do you have any evidence of this? Your link doesn't confirm it.
The "prize" I'm referring to isn't a literal X-Prize for addiction haha, but I mean market share, etc. is very worth investing in this.
Defeated by either noscript or mobile's double-tap to select, copy.
Don't know how accurate that is, though.
Literally from the Wikipedia article: “In 2002, Eli Lilly partnered with Amylin to develop exenatide and secure approval to market the drug. Exenatide's 2005 approval by the U.S. Food and Drug Administration showed that targeting the GLP-1 receptor was a viable strategy and inspired other pharmaceutical companies to focus on that receptor” [1].
Gilead has made bank on Solvadi, a drug that cures a previously-chronic disease [1].
> Very few people come off GLP-1 and keep weight off
Rebound can be close to 100% if you’re severely obese, but for most people it’s much less [2]. (Everyone I know who was taking it two years ago is off it, and they eat and exercise healthier than they did.)
Chronic illnesses require chronic medication. The same is true even WITHOUT the medication. If you're obese and want to lose the weight, you need to manage your diet and exercise. Forever. Until the day you die. You can't ever stop that or you'll be obese again.
Some things just don't have one-time solutions, and that's okay.
So, you're weighing a hypothetical risk against and establish risk, and concluding that the unknown risk is scarier than the known risk. Which is irrational.
Imagine if someone asks you if you want to take the "obesity pill," and you looked at the side effects objectively. But instead you weight obesity as "normal" and this as "new and scary."
A whole lot of folks would lose billions of dollars. My first instinct is to think I need to go and take another Europe. The food is better there and I lost a good amount of weight the first time.
The main reason GLP-1 Agonists are suddenly more popular is two things:
- Liraglutide had to be taken daily, instead of weekly.
- Nobody every paid for Liraglutide to be clinically approved for weight-loss. It was an anti-diabetic medication; but the mechanism of action is the same.
Compared with liraglutide, semaglutide was engineered mainly with a longer, differently attached fatty-acid side chain that increases albumin binding and slows clearance, so it lasts longer; both drugs activate the GLP-1 receptor.
Everything is risk calculus. If you're just a bit overweight, then yeah probably not worth the risk. If you're morbidly obese then it's a no brainer.
I will say this: the bar for obesity is lower than most people think.
What is HN's experience with using GLP-1 inhibitors, for those who have used them? I've heard of side effects like bone density loss, but I've heard those side effects are caused by taking too large of a dose.
You won't want to eat much, and if you do try to eat a full meal (if for example you went out to eat) you'll feel like crap for a few days.
But yes, otherwise it works as advertised.
What have you tried ?
Both of the two available GLP-1 have similar side effects, with Tirzepatide being lower at an equivalent effect dose. Their common side-effects are: Nausea, vomiting, diarrhea, and indigestion. With rare serious side-effects being: Pancreatitis, allergic reaction. thyroid cancer, and acute kidney injury.
Generally speaking the common side-effects are dose-dependent. If you suffer too much, you back off the medication until the side-effects are at a level you can manage. This is common.
As a brief summary, it absolutely delivers what it says it does. I've lost weight as it claimed due to appetite suppression and feeling fuller longer. However, it's more complex than that, and the battle to ensure I get enough protein has been tough.
Could you expand on this?
I have a similar issue, what did you come up with?
As confirmed by DEXA scans, I maintained my (very high) bone density and actually put on about 3lb of muscle over a 2-month period on low-dose GLP-1 + a GHRH, while losing about 16lb of my most stubborn fat, including visceral fat that I hadn't been able to crack. I'm in my 40s, and my routine includes weight training, a high-protein diet, and Brazilian jiujitsu.
My approach is minimum effective dose as an amplifier to a good diet and active lifestyle, and it's been pretty damn effective. Primary effects are an effortless relationship with food - the "itch" I used to feel to eat constantly is pretty much gone, and the psychological pain of not eating things is more or less nonexistent. I did a 36 hour fast just to push it a bit, and it was trivially easy.
Side effects include an elevated heart rate (~5-8bpm, in my case taking me into the low 60s at rest) and sweating all the time, both of which are almost certainly due to the glucagon agonist's thermogenesis effect. No problems with constipation, though stools are harder (comparable to those on a keto diet, in my experience). No particular ill effects otherwise. n=1, YMMV.
Seems like GLP-1's are not a cure but treat the symptoms. You need to keep treating the symptoms forever unless you solve the issue.
By not taking it.
> Seems like GLP-1's are not a cure but treat the symptoms
This goes against all of the evidence around rebound, improved diet and exercise after folks have lost weight, et cetera.
You have a lot of results that look like this, with an average bounce rebound of 2/3s of the loss.
https://pubmed.ncbi.nlm.nih.gov/35441470/
However, detailed analysis usually shows a bimodal distribution, with people who maintain or even lose more, and those that go back or even gain relative to baseline.
There is always the risk of regaining weight unless you continue to do whatever caused you to lose weight (e.g. restricting calories) to some extent.
I guess a "cure" would be good but since we don't have one having to periodically go back on glp drugs if you gain weight is no different from periodically having to go on a diet if you gain weight.
On the other hand most people tend to naturally gain weight pretty slowly (e.g. a pound a year) so having to go on glp drugs for a period every few years wouldn't even be that bad, especially if they're available in pill form.
Just finding 10-12 hours in which to exercise every week is challenging on its own. It's much more difficult when the exercise itself becomes harder and less rewarding.
Real question: given the dosage, how would you go about getting the pill and liquefying it? That would provide a huge, cheap supply of semaglutide.
wmf•1d ago
toomuchtodo•1d ago
HN Search: orforglipron - https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...
notJim•1d ago
I'm definitely willing to keep taking it. If insurance won't pay for it, I could pay for the pill out of pocket if I had to, which would be cost prohibitive for the injections.
trueismywork•1d ago
toomuchtodo•1d ago
marstall•1d ago
toomuchtodo•1d ago
mrguyorama•1d ago
Was this plan made with your doctor?
toomuchtodo•1d ago
blobbers•1d ago
toomuchtodo•1d ago
At $300/month cash pay through https://lilly.com, I find the ROI to be exceptional.
SoftTalker•1d ago
toomuchtodo•1d ago
My goal is to drop fat, gain muscle, and be strong with good cardio performance, and a GLP-1 turns off the part of my brain that made me carry excess unhealthy fat and eat the foods that made that fat. GLP-1s also promote thermogenesis, so it is turning on the switch to tell your body to burn fat that you would have to fast or get into ketosis via a ketogenic diet otherwise to get into (by first depleting your glycogen reserves). I do not get any fatigue such that I would when fasting or on a keto diet needed to encourage thermogenesis and burning up fat reserves, which is awesome imho.
My brain says "you are fine" instead "you must eat, feel hungry, and get hangry, even though you already have all of this fat." A bug has been patched.
https://pubmed.ncbi.nlm.nih.gov/?term=glp-1+thermogenesis
(think like a hacker, the body is just another system to hack)
SoftTalker•1d ago
JumpCrisscross•1d ago
Impossible to characterize without height.
SoftTalker•1d ago
badc0ffee•1d ago
mikepurvis•1d ago
ceejayoz•1d ago
https://www.nutrition.gov/topics/healthy-living-and-weight/s...
"A reasonable rate of weight loss is 1 to 2 pounds per week."
Going too fast has downsides.
https://health.clevelandclinic.org/risks-of-losing-weight-to...
yarrowy•1d ago
etyhhgfff•17h ago
ramoz•1d ago
sowbug•1d ago
You're correct that the amino acid with the sequence YA¹QGTFTSDYSIL²LDKK⁴AQA¹AFIEYLLEGGPSSGAPPPS³ is being manufactured and sold. And people are justified in being wary whether the substance they get is actually a pure version of retatrutide. But it's not counterfeit.
It's an important distinction. Counterfeiters are by definition liars, and it's reasonable to assume that liars are cutting corners. But someone correctly manufacturing a specific amino acid is truthfully selling what they claim to be selling. It might turn out that retatrutide causes you to grow extra eyes in five years, and the FDA trials are on the brink of discovering as much, in which case Eli Lilly-branded retatrutide will never come into existence. For that reason it would be prudent to wait for FDA approval.
ramoz•1d ago
So maybe I'm grammatically and formally incorrect. But a lot of this feels very scammy.
sowbug•1d ago
Someone1234•1d ago
Several GLP-1 pills are in the pipeline, and there is near bottomless R&D budgets being spent on the area currently, but it isn't here yet and this isn't "it."
I'd strongly suggest people ignore this release, and keep using injectable Semaglutide/Tirzepatide.
JumpCrisscross•1d ago
Source?
Someone1234•1d ago
As I said above, this is being worked on (inc. by Novo Nordisk), but oral Semaglutide is a very naive early attempt. They got first to market, but that doesn't mean it makes sense for people who can handle injections; you cannot compare doses 1:1 because of how weak oral is, you need to compare action-of-effect. Once you look at effectiveness, oral costs more than injection.
JumpCrisscross•1d ago
Sounds not ineffective.
> oral costs more than injection
Are these being marketed to the same populations?
cm2187•1d ago
tokai•1d ago
JumpCrisscross•1d ago
It could be an anxiety. I developed one after a nasty blood draw. When someone pointed out it was an anxiety response, it sort of just went away.
tokai•1d ago
matthewmacleod•1d ago
A total of 205 participants were randomly assigned to receive oral semaglutide, and 102 to receive placebo. The estimated mean change in body weight from baseline to week 64 was -13.6% in the oral semaglutide group and -2.2% in the placebo group (estimated difference, -11.4 percentage points; 95% confidence interval, -13.9 to -9.0; P<0.001).
At what would be $10/day – why's that ineffective?
Someone1234•1d ago
JumpCrisscross•1d ago
Plenty of people can’t or won’t inject. And plenty of people don’t need 2.4mg injected.
The pill is cheaper to make, distribute and take. That seems to make economic sense to me.
chrisco255•1d ago