thoughts on ozempic and the like

SweatLikeDog wrote: »

Ozempic aka Semaglutide will make you lose weight faster even if you did the same calorie restrictions without it. You won't want to eat as much though because you'll feel full. The hard part is keeping the weight off afterwards if you return to bad eating habits. It's your call.

It helps people maintain a calorie deficit. The studies I've seen show that it is the same, or less, as with intentional calorie restrictions. Studies show about 1 pound per month weight loss (which is very, very slow, and rather minimal). The average total was about 10% of body weight (ie if you weighed 200 pounds you could expect to lose around 20 pounds). This was maintained for about 4 years, at which point weight began to slowly be regained. It can undoubtedly be a helpful tool, and I'm all for it for people who want it, but it does not appear to make people lose weight faster, it just makes it a bit easier (which is great).

dydn11402 wrote: »

I'm more concerned with the effects that will become known years from now. Putting something in my body that messes with my natural hormones...we don't really know what that can do longterm. Plus all the risks that we do know about already.
The point about needing to change eating habits etc when one comes off is obvious. It's like any diet, if you stop the weight comes back.
I'm coming at this as someone who has 20lbs to lose and just cannot seem to lose it (I'll lose 10 with extreme effort and put it back on in 2 seconds). I am healthy, eat healthy, exercise regularly and in general have a healthy lifestyle. So is it better for me to just keep plugging away even if I stay at this weight or use the shot mostly for vanity reasons? Is there a downside to using it?

This is going to sound kind of dumb, but have you tried losing 10 pounds with the most minimal effort it takes, over whatever period of time it takes, instead of "extreme effort"? That kind of approach, IMO, is more likely to stick, because it relies more on learning sustainable habits.

Everyone (me included) wants to lose weight fast, so they go hard. That may not be the best route, especially when down to a reasonably healthy weight, i.e., weight itself is no longer a significant health threat or causing risky health conditions.

The desire to lose weight faster (plus internet marketers' trendy nonsense) drives many people toward eating restrictions they can't sustain (cue the periodic overeating at social events, or even out of cumulative sense of deprivation), or toward tiring levels of exercise (cue the under-recovery that hinders fitness development and the cumulative fatigue that bleeds calorie burn out of daily life activity because we're dragging) . . . or both. Maybe that's not it for you, but at least consider the possibility and implications.

I'd let my weight creep up over about the first 4 years of maintenance, maybe 10-12 pounds or so. I was still in a healthy range, still in the same jeans size, but with more body fat than I prefer (because of OA among other things) and the jeans were getting snug (I hate to clothes shop with a fiery passion).

By that time - several years of logging - I had reasonably reliable logging skills and a clear estimate of my calorie needs. Instead of going into a serious deficit, I set base calories for maybe half a pound a week loss, but let myself eat up to maintenance now and then, even over on the rare occasion. It was almost completely painless. Yes, it took over a year to lose down to the weight I preferred, but no "extreme effort" at any point, just dogged (pretty painless) persistence.

That is not a solution for someone with lots of weight to lose, generally. But it might be for people with smaller amounts, and some patience. (Even with more weight to lose, I'd argue for a "make X loss rate as relatively easy as possible" vs. "go hard by revolutionizing eating and exercising from day 1".) From the start (only class 1 obese), I decided I wasn't going to do anything to lose weight I wasn't willing to continue long term to stay at a healthy weight, except for a moderate calorie deficit to cause the weight loss. What does that mean? Calorie-appropriate foods I like eating (plus occasional treats, within reason), fun ways of moving (daily life and exercise) that mostly were fun, but at minimum tolerable and practical.

I understand and respect it when people like Riverside above say the last pounds are inherently hard. I'm not arguing otherwise. I know that some people struggle throughout much more than I did, too, for reasons both psychological and physical. I'd still say "don't make it harder than you must". (For some, medications may be part of that solution. I'm not judging.)

One last thing: It's starting to be more publicized, but for those who haven't seen it, note that it's being found that some foods increase natural GLP-1 production in the body, slow digestion, and generally have some of the effects as the drugs. The natural GLP-1 isn't as persistent in the body as the medication, among other issues. But it might be worth considering taking a look at those types of foods, seeing whether there are some you like (or haven't tried and might like, given a fair chance), and working them into your rotation to see if it helps you. (Yup, there will be some overlap with that "eat more whole foods" thing that quite a few people here suggest as part of a reasonable solution, but the overlap isn't total.)

I'm mostly suggesting this last to the "not so many pounds to lose" group, who might be borderline as to the suitability of drug interventions, as part of a solution. It's rational for those more overweight/obese to consider as one tool in a toolkit, but it likely has less potential to create a tipping point.

Repeating, if the drugs help people, that's great. If the people using the drugs focus on new habits while on the drugs, that's even better.

I relate to what you’re saying. Losing 20 lbs is insanely challenging. For me personally, my tdee is low (short lady problems), so my deficit is minuscule, at maximum 250 calories. There’s zero room for tracking error, and I need to be diligent and consistent. It’s my life now to know what I eat, when I eat, saying no to things I want every day (because I’m out of calories), to feel some hunger, with no mental days off. The alternative is joint pain, gaining weight, feeling exhausted, moody, and reclusive. They’re both less than ideal.

So, I completely understand wanting to:
1. Remove hunger pains
2. Remove food noise
3. Take a break from the mental load of dieting

For these reasons, I get why a shot seems really enticing.

Many people think, because I’m at my goal now, that it’s different/easier for me than them. My issues are invisible to most people, but still very real. Personally, I don’t think it matters if you’re using medication to help you lose weight, or maintain, if it’s alleviating some of the extreme challenges some of us have.

Your experience is personal, but your decision shouldn’t be taken lightly. The side effects can be severe, and like others noted, we don’t have long term studies yet, so it’s important to know what you’re willing to gamble. But, honestly, no judgement from me, and I hope whatever you decide, you don’t feel the need to explain it to anyone.

sollyn23l2 wrote: »

SweatLikeDog wrote: »

Ozempic aka Semaglutide will make you lose weight faster even if you did the same calorie restrictions without it. You won't want to eat as much though because you'll feel full. The hard part is keeping the weight off afterwards if you return to bad eating habits. It's your call.

It helps people maintain a calorie deficit. The studies I've seen show that it is the same, or less, as with intentional calorie restrictions. Studies show about 1 pound per month weight loss (which is very, very slow, and rather minimal). The average total was about 10% of body weight (ie if you weighed 200 pounds you could expect to lose around 20 pounds). This was maintained for about 4 years, at which point weight began to slowly be regained. It can undoubtedly be a helpful tool, and I'm all for it for people who want it, but it does not appear to make people lose weight faster, it just makes it a bit easier (which is great).

SweatLikeDog wrote: »

I took a deep dive into the GLP-1s because they're very interesting. You WILL get a metabolic boost on these drugs because they make your body more sensitive to insulin. In other words, your body makes less insulin. Less insulin means less fat accumulation. Dieting alone can do the same thing, but not to the same degree because it doesn't slow down digestion - the sugar spike isn't blunted. As for the studies, the people that regained weight were those that were most obese highlighting the difficulty of changing eating habits and they didn't really focus on the "20-pounds-to-lose" crowd.

Another poster was concerned about long term unknown effects. The GLP-1's came out in 2005 and became popular for type 2 diabetes over 10 years ago, so there's a pretty extensive experience out there and most of the issues are simply side effects of rapid weight loss and extreme calorie deficits.

If you did a deep dive, I assume you saw that GLP-1 drugs increase insulin production. Though it does appear that there is a possibility it slightly increases insulin sensitivity as well. Either way, the insulin model of obesity was disproven, so I'm not going to discuss that point. And yes, slowing digestion means you are less hungry, which makes it easier to maintain a calorie deficit, which is great. I'm not against glp-1 drugs for people that want them. I say if you want to, go for it.

So funny you ask because I literally was talking to doctor at my job last night about this. He said that this is a temporary fix meaning that once you loose the weight, if you don't manage to keep a healthy eating lifestyle, you could gain all that weight again !! He said a few of his patients complaints have been nausea. I decided not to move forward with it and just count my calories and really am going to start walking everyday.

I personally wouldn't take it to lose weight.

I did it the old fashion way with calorie deficit and time. Currently maintaining and not struggling to maintain because my appetite has now adjusted to my new body weight.

dydn11402 wrote: »

@ddsb1111 yes! you sound like me with the "short lady problems" as you call it . i feel like im constantly spinning my wheels and it is exhausting. i wish i didnt care so much.
for now, im just too worried about possible long term effects that may come out later because at the end of the day, its not worth possibly jeopardizing my health if i dont have a real need to take that gamble.
i appreciate your comment. good luck to you!

I have seen some report that these drugs can permanently paralyze the stomach, and some people have died. Or they are made unwell even after they have stopped taking the drug. So i would try anything else.

I'm short (5.3-4) and post menopause and i've lost a lot of weight the past month on a low carb low salt diet. About 2 pounds a week. Lots of walking, and about 1200 calories a day.

I suspect it gets tiring seeing most of your patients not getting any better after years of advice, enter GLP-1's. At least it puts a temporary smile on your patients which is better than nothing.