Weight Loss Meds (Wegovy, etc)

[prototoast]

Originally Posted by fourflys

thanks for all the responses!

As the OP, I haven't felt attacked by anyone on this thread yet.. there have been some folks who have some interesting thoughts, but I don't think there was any malice intended.. for the record, I have also, in the past, thought that folks can just "eat better".. and I could totally eat better and do more exercise for sure, and maybe that is the direction I go with this..

I will say that these meds are a great option for folks who have tried everything else and haven't success, for whatever reasons..

Thanks all!

If someone asks how they can get faster on the bike, one answer is "train more." Another answer is "quit your job." Obviously quitting your job doesn't directly make you faster, but it removes what for many is the largest impediment to training more.

Similarly, to lose weight, you have to "eat better." GLP-1 agonists work by removing what for many is the largest impediment to eating better (excess desire for unhealthy foods).

Many people can eat better without the help of GLP-1 agonists, just like many people can get up at 5am and get a good workout in before work. But it's hard, and even people who set out with that goal cannot always consistently achieve it.

At a population level, the introduction of these drugs seems to be the only thing that has broken our decades-long trend of increasing obesity. On an individual level, it's fine to try to lose weight without these drugs (I know I am), but statistically speaking, you're more likely to be successful if the drugs are an option compared to if they're not.

[fourflys]

Originally Posted by AngryScientist

This has been an interesting discussion.

As far as I know we are all just armchair physicians here though.

I would still like to know if the OP is under the care of a medical professional, and what they advised fort the OP??

There has also been no mention of what, if any steps the OP has taken to reduce the weight (or weight gain) already.

To be clear, I mean no disrespect or attack of the OP at all. I think to have this conversation better, it would be helpful to have a more clear picture of the situation.

not that it's pertinent to the original question in post #1, but..

I have been seeing a nutritionist through the VA for a bit and she has referred me (through my PCM) for the meds.. I have an appt to speak with someone about them.

Steps taken would include working with a nutritionist and exercise.

At this point, I don't know for sure if the meds are an option, but it feels like they will be. That's the reason I'm asking the questions.. I've spoken to non-cyclists who have taken the meds, but wanted to, hopefully, get a rider's experience..

so really, while I've entertained all the back and forth on why a person is overweight, etc, that's not what my original post is about.. why I may or may not take the meds isn't really what the post is about.. the post was asking if anyone had any experience with the meds..

also, there is at one least board-certified Doc here.. PurpleBikeChick, but this doesn't sound like her speciality..

[fried bake]

I think we are increasingly moving away from the notion of shaming in discussing obesity and other illnesses or addictions (all unhealthy forms) which is helpful especially because judgement is the last thing many people struggling with this need. I have a sibling on this drug who is at severe risk of diabetes if he doesn’t lose weight. Did he gain weight because of poor lifestyle? Yup. Am I happy to see him achieve health through a pill? Absolutely. It’s a journey and the road is rarely straight and smooth but I’m grateful to see his progress and wish the same for all who struggle with this condition.

[Rev Bob Dobbs]

My best friend, a former swimmer at Duke who kept eating like a swimmer is now on GLP-1s. He has lost 80lbs in a little over a year and his life and health have change dramatically for the better. In the 30 plus years of knowing him after college he tried every weight loss program in the book including gastric bypass surgery. Nothing worked except with GLP-1s..

He takes his shots on Sunday and is nauseous and has no energy til about Monday evening. Earlier on this side effect lasted longer. The other side effect is massive muscle loss.

All his vitals are better. He is not pre diabetic. Psychologically he is better and happier. An interesting note is GLP-1 really affected his psychological relationship with food. He told me he would be sitting there and think to himself “I should be eating right now but I am not … weird. “

Anyway, I am sure glp-1s have put 10 good years on him. So it is hard for me to argue against them.

BTW for those who say toughen up buttercup. Dude graduated with honors in 3 years while swimming D1 at a top academic school

[fourflys]

Originally Posted by Rev Bob Dobbs

My best friend, a former swimmer at Duke who kept eating like a swimmer is now on GLP-1s. He has lost 80lbs in a little over a year and his life and health have change dramatically for the better. In the 30 plus years of knowing him after college he tried every weight loss program in the book including gastric bypass surgery. Nothing worked except with GLP-1s..

He takes his shots on Sunday and is nauseous and has no energy til about Monday evening. Earlier on this side effect lasted longer. The other side effect is massive muscle loss.

All his vitals are better. He is not pre diabetic. Psychologically he is better and happier. An interesting note is GLP-1 really affected his psychological relationship with food. He told me he would be sitting there and think to himself “I should be eating right now but I am not … weird. “

Anyway, I am sure glp-1s have put 10 good years on him. So it is hard for me to argue against them.

BTW for those who say toughen up buttercup. Dude graduated with honors in 3 years while swimming D1 at a top academic school

thank you for sharing this, I appreciate it!

[bironi]

meh

[Alistair]

Originally Posted by AngryScientist

Are these pills we are discussing by prescription only, I assume?

These are currently injections that can be self-administered at home.

Yes, prescription only, and the on-label use is weight-loss for pre-diabetic patients. The patient is supposed to be over a certain obesity threshold or have other signs of diabetes.

Anyways, 40# overweight as described by the OP is likely at/over that threshold.

Off-label use for marginally obese patients got common over the last few years, leading to supply shortages. Not sure if that's still a problem.

[biker72]

Lifestyle change is what worked for me. Over a number of years I went from over 300 pounds to my present 177.

No meds, no gastric bypass, just changed what I was eating.

Recently I've had to reduce my carbohydrate intake because of blood sugar problems. I lost about 4 more pounds.

[benb]

Originally Posted by prototoast

At a population level, the introduction of these drugs seems to be the only thing that has broken our decades-long trend of increasing obesity. On an individual level, it's fine to try to lose weight without these drugs (I know I am), but statistically speaking, you're more likely to be successful if the drugs are an option compared to if they're not.

I think this is not as set as you are making it out to be. Long term ability for people to stay on these drugs has not been proven. They are definitely helping people lose weight, but they are not necessarily successful in the long term at helping people stay at a healthy weight and stay healthy/fit. An awful lot of reports are saying people have a hard time tolerating these drugs over a long period, when they get off the drugs all their urges to overeat come back, etc.. On top of that these drugs haven't even been on the market long enough for anyone to really know whether they are truly successful at a population level.

I think what is so interesting about the "disease" aspect is it almost seems like a mental thing. All these drugs do is control the urge to eat a lot. Many people have conjectured some people just gain weight "no matter what" as if it is indeed some genetic thing or some disease that violates the laws of thermodynamics. But the drug does not work by making the laws of thermodynamics apply again, it just makes people eat less.

It is not hard to see how much food people with a problem in your own life eat. There is denial but an awful lot of it seems to be a) urge to eat that is uncontrollable b) food is cheaper and more plentiful than ever, easier to afford to eat restaurant food more often, bigger portions when you do c) more calorie dense foods available (processed foods) d) less likely to actually need to cook yourself something to eat

The drug just takes care of that urge to eat. All the rest of us who constantly say "just eat less" just don't have that uncontrollable urge. What is interesting is if something in the environment has made that urge more prevalent. It could also be something that has disappeared from the environment that was suppressing the urge. E.x. smoking/nicotine usage was depressing appetite.

Nobody ever shows this and I certainly don't want to smoke but you can probably manipulate graphs to correlate the drop off in smoking with the rise of obesity.

[tommyrod74]

As a RD, my main concern with GLP-1 angonists is the long-term consequences.

If they can't be tolerated long-term, and going off them causes the urges to overeat to return, and in the procees one has lost significant muscle mass due to long-term caloric deficit, will people end up worse off (metabolically) than before? It seems likely.

[CAAD]

Originally Posted by benb

I think this is not as set as you are making it out to be. Long term ability for people to stay on these drugs has not been proven. They are definitely helping people lose weight, but they are not necessarily successful in the long term at helping people stay at a healthy weight and stay healthy/fit. An awful lot of reports are saying people have a hard time tolerating these drugs over a long period, when they get off the drugs all their urges to overeat come back, etc.. On top of that these drugs haven't even been on the market long enough for anyone to really know whether they are truly successful at a population level.

I think what is so interesting about the "disease" aspect is it almost seems like a mental thing. All these drugs do is control the urge to eat a lot. Many people have conjectured some people just gain weight "no matter what" as if it is indeed some genetic thing or some disease that violates the laws of thermodynamics. But the drug does not work by making the laws of thermodynamics apply again, it just makes people eat less.

It is not hard to see how much food people with a problem in your own life eat. There is denial but an awful lot of it seems to be a) urge to eat that is uncontrollable b) food is cheaper and more plentiful than ever, easier to afford to eat restaurant food more often, bigger portions when you do c) more calorie dense foods available (processed foods) d) less likely to actually need to cook yourself something to eat

The drug just takes care of that urge to eat. All the rest of us who constantly say "just eat less" just don't have that uncontrollable urge. What is interesting is if something in the environment has made that urge more prevalent. It could also be something that has disappeared from the environment that was suppressing the urge. E.x. smoking/nicotine usage was depressing appetite.

Nobody ever shows this and I certainly don't want to smoke but you can probably manipulate graphs to correlate the drop off in smoking with the rise of obesity.

This^

These drugs essentially do the calorie counting for you.

[benb]

Originally Posted by CAAD

This^

These drugs essentially do the calorie counting for you.

It seems like the next step is to figure out how to make one of these drugs that's more subtle so it makes you cut your intake by 10% or whatever it actually takes to be healthy and maintain weight + good body composition as opposed to the current drugs which seem to make people starve themselves but have lots of side effects and losing muscle, etc..

[fourflys]

Originally Posted by benb

I think this is not as set as you are making it out to be. Long term ability for people to stay on these drugs has not been proven. They are definitely helping people lose weight, but they are not necessarily successful in the long term at helping people stay at a healthy weight and stay healthy/fit. An awful lot of reports are saying people have a hard time tolerating these drugs over a long period, when they get off the drugs all their urges to overeat come back, etc.. On top of that these drugs haven't even been on the market long enough for anyone to really know whether they are truly successful at a population level.

I think what is so interesting about the "disease" aspect is it almost seems like a mental thing. All these drugs do is control the urge to eat a lot. Many people have conjectured some people just gain weight "no matter what" as if it is indeed some genetic thing or some disease that violates the laws of thermodynamics. But the drug does not work by making the laws of thermodynamics apply again, it just makes people eat less.

It is not hard to see how much food people with a problem in your own life eat. There is denial but an awful lot of it seems to be a) urge to eat that is uncontrollable b) food is cheaper and more plentiful than ever, easier to afford to eat restaurant food more often, bigger portions when you do c) more calorie dense foods available (processed foods) d) less likely to actually need to cook yourself something to eat

The drug just takes care of that urge to eat. All the rest of us who constantly say "just eat less" just don't have that uncontrollable urge. What is interesting is if something in the environment has made that urge more prevalent. It could also be something that has disappeared from the environment that was suppressing the urge. E.x. smoking/nicotine usage was depressing appetite.

Nobody ever shows this and I certainly don't want to smoke but you can probably manipulate graphs to correlate the drop off in smoking with the rise of obesity.

I think a lot of what you say is relevant, but a lot what you say can be twisted to support a couple different, IMHO dangerous, arguments..

Do we all have the ability to say "no thanks" when we walk by that plate of cookies? In theory, yes, no one is forcing us to eat that cookie.. is there an almost autonomic response that has been honed over years of less than stellar eating, parenting, relationships etc that, for some, makes it almost impossible to pass up that tray of cookies? I would say yes.. the body/brain seems to like pleasurable things and we will often get addicted to those pleasurable things (some more than others, genetics?).. whether it be food, drugs, alcohol, sex, etc.. while many folks will look down at alcoholics or drug addicts, most will also acknowledge they are in a place where their body craves the substance and they have a physical addiction to that substance.. why would food be any different? No one would ever expect an alcoholic/addict not in recovery to walk past that next hit or shot, why would a food addict be any different?

Now, I'm not saying I'm a food addict.. I can walk past a plate of cookies for sure.. but some of rhetoric in this thread seems to put folks who have issues with eating in a different category than folks who have issues with other addictive behavior.. I am not a therapist/counselor/MH professional at all, but I did work in medicine for 20+ years and in social services now, so have some knowledge on the subject.. I would welcome anyone who works in this space to weigh in for sure..

[AngryScientist]

Originally Posted by fourflys

so really, while I've entertained all the back and forth on why a person is overweight, etc, that's not what my original post is about.. why I may or may not take the meds isn't really what the post is about.. the post was asking if anyone had any experience with the meds..

You are right, and that's totally fair. Seeking first hand opinions from other cyclists is a good idea.

Based on some of your other posts, it sounds like you are going to be making a move somewhat soon. Perhaps that also involves a change in jobs? Maybe when you settle into your new position(s) - your weight loss situation will improve too? Just a thought?

I hope my posts here have not come across as harsh or judgemental, not intended. I wish you luck on your journey!

[benb]

I mean all this drug does is activate receptors for a hormone that suppresses your appetite. They don't give the hormone directly because it has a really short half life apparently.

They haven't really said if "people who don't seem to gain weight" just naturally produce more of the hormone. If it turned out that's really what's going on is there really any shame in any of it? It's definitely not the same as alcohol or drugs.

Most of our history food was scarce so being more hungry was probably an advantage.

The Hormone:

Glucagon-like peptide-1 (GLP-1) is a 30- or 31-amino-acid-long peptide hormone deriving from the tissue-specific posttranslational processing of the proglucagon peptide. It is produced and secreted by intestinal enteroendocrine L-cells and certain neurons within the nucleus of the solitary tract in the brainstem upon food consumption.

The drug:

Commercially known as Ozempic (semaglutide), is a medication that belongs to a class of drugs called glucagon-like peptide-1 receptor agonists (GLP-1 RAs). It is primarily used for the treatment of type 2 diabetes and has shown potential benefits in addressing obesity as well. Semaglutide has an experimented half-life of 183 hours compared with Liraglutide (15 hours).

Concerning obesity, semaglutide has also shown effectiveness in treating obesity. In higher doses than those used for diabetes management, it can help reduce body weight. The precise mechanism by which semaglutide induces weight loss is not fully understood, but it is believed to involve various factors. Semaglutide decreases appetite by acting on the brain's centers responsible for appetite regulation, leading to a feeling of fullness and reduced food intake. It also slows down the emptying of the stomach, which can contribute to a decreased caloric intake. These combined effects on appetite and digestion help individuals lose weight.