This is pretty damn impressive:
A 5-year observational study of ~12,000 individuals with obesity taking GLP-1 drugs (without diabetes) with propensity matched controls
A significant reduction of all-cause mortality (HR 0.23, 95% CI 0.15, 0.34)https://t.co/mbYzzdtOEP pic.twitter.com/4hLCYbm0TS— Eric Topol (@EricTopol) August 25, 2024
Over the course of five years, obese people in the control group had a 3.5% chance of dying. Similar people in the group that took GLP-1 drugs (like Ozempic) had only a 0.75% chance of dying.
What's more they found that the GLP-1 group had lower risk of ischemic heart disease, heart failure, arrhythmias, hypertension, stroke, atrial fibrillation, acute kidney injury, and allergic reactions.
They're going to start putting this stuff in the water supply before long.
I don’t understand what is stopping insurance companies from just covering these drugs regardless of diabetes diagnosis. I guess cost of the drugs? But then, insurance companies covered Truvada to prevent HIV transmission pretty early, even when it was super expensive. Maybe the manufacturers just need to start a discount program like they did with Truvada.
I don’t understand what is stopping insurance companies from just covering these drugs regardless of diabetes diagnosis.
They're in business to make money. What else is there to understand?
I don't know the specifics, but it's possible that, given the vastly smaller market for Truvada, health insurers calculated they'd come out ahead by covering that particular drug. But retail price for semaglutide in the US is around $1,000 a month, and the market is utterly gargantuan in size. There are something like 80 million obese adults in the United States. They could easily be looking at a couple of hundred billion annually in extra costs if they covered it in full, or, say, $100 billion if they covered it to the tune of a 50% discount. Given that the costs of obesity are mostly borne by taxpayers (Medicare), it seems to me a no-brainer for for-profit insurers to refrain from covering semaglutide.
I don't have access to their spreadsheets, so it's possible they're just being stupid with regard to their profitability calculus. But that seems unlikely.
Because they can....obesity is considered a "lifestyle" choice, therefore doesn't have to be covered. Treatment for heart disease--well that's another story...
What matters is whether a health insurer saves money by giving drugs away to the insured. Obesity itself doesn't ring up any hospital bills, but serious (read "expensive") disorders of many kinds are far more likely for the obese.
What matters is whether a health insurer saves money by giving drugs away to the insured.
Which, again, seems vanishingly unlikely in the case of semaglutide, given the reality that most of the costs of treating obesity-related disease are borne by taxpayers. (To give one example: average age of first heart attack for Americans is about 66 for men and 72 for women. Those folks are on Medicare!).
It would be irrational of health insurance firms to increase their costs in an effort to save US taxpayers money. They don't care about us. They care about share price.
We ought to see more numbers before jumping to conclusions here. Average first heart attack at 66 or 72 still allows for a whole lot of heart attacks below age 65, especially among obese persons. For another statistic, the CDC cites a finding that 38% of stroke hospitalizations in the US in 2014 were of people under 65.
But your comment makes me wonder. Does Medicare give semaglutide away? Should they?
Average first heart attack at 66 or 72 still allows for a whole lot of heart attacks below age 65,
Oh, there's zero doubt that people suffer from obesity-related ailments like cancer and CV disease before the age of 65. No argument from me. I'm just positing that the bulk of obesity-related, chronic disease afflicts those who are already on Medicare, surely. The (say) 65-80 cohort is a lot less healthy than the 49-64 cohort. There's not a snowball's chance in hell that the numbers for for-profit insurers would be improved by paying for Semaglutide in the the hope of reducing payments for other healthcare treatments. We're talking up to twelve grand a years for tens of millions of people, most of whom won't suffer catastrophic illness until they're covered by the government.
If insurers thought they could save money (boost profits) by covering Semaglutide, they'd be clamoring to get people to take it on their dime!
Does Medicare give semaglutide away?
It has to be connected to another health issue, such as CV disease or diabetes. I'm not sure how strict Medicare is on this: obviously obesity is a risk factor for CV disease. Someone suffering from even mild hypertension, say—along with obesity and even slightly elevated cholesterol is by definition (I think, but consult an MD) suffering from metabolic syndrome. Which is a precursor to developing heart disease. Does Medicare pay for Semaglutide in such cases (ie, before the onset of diabetes or actual heart disease, in preemptive fashion)? I'm not sure. But I'd say the evidence suggests they should.
It's not just Medicare. If you get insurance through your employer as most Americans do, your insurer has no reason to care what happens to you after you change employers, as most Americans also do every few years (the figure I've seen is 4-6 years, but no idea if it's accurate). You'll be some other insurer's problem after that, so why bother with preventive care that doesn't pay off in that window?
The incentives for just about everyone in our health care system are completely screwed up.
your insurer has no reason to care what happens to you after you change employers
Exactly.The for profit system simply provides zero incentive for insurers to be concerned with the future health status of their current insureds.
Unless, of course, your new employer deals with the same insurer as your old one did.
There are some thoughtful comments here about why insurers aren't motivated to provide anti-obesity drugs at low cost to the patient, but it does depend on what the data tell the insurers, and maybe more data needs to be collected. The chart we see in this post shows a considerable decline in mortality in less than five years of use of the drug. Someone somewhere might be able to zoom in on the average medical costs incurred by those affected by obesity, particularly for those too young to be Medicare-eligible, but lower mortality suggests lower needs for costly medical care, and it might not take decades for cost savings to materialize.
The chart we see in this post shows a considerable decline in mortality in less than five years of use of the drug.
What percentage of a typical health insurance firm's insureds are still on their books in five years? Between death, aging out (Medicare), switching insurance carriers or changing jobs, I'd bet not very many. And while "not very many" doesn't mean zero, it's surely a very small number compared to the guaranteed, immediate hit to their bottom lines that would accompany the decision to start shelling out tends of billions to pay for Semaglutide. Moreover, it's not as if every overweight or obese person will develop expensive-to-treat illness within a five (or even ten) year window, even if they still are on the books. In many cases people live with obesity for decades before they face a health crisis.
If every insurance company were required to provide coverage for obesity medications wouldn't it work out in the end to being less costly for everyone?
They had cross tabs, but I didn't see any if results correlated with weight loss or more precisely, getting weight into a good body-mass index range. (ok, haven't seen full article)
https://www.theguardian.com/society/article/2024/aug/23/fluoride-water-study
Good to know. I grew up on Long Island, which to this day has never put fluoride in its water supply. Maybe we were right thinking we were smarter than everyone else.
Ah, thanks for the bullshit scare-tactic conspiracy clickbait.
"Twice the safe limit."
You know, water is toxic at twice the safe limit. BE AFRAID!
https://www.today.com/health/news/water-intoxication-death-rcna99472
Why do people conspire against our precious bodily solids with their attacks on blessed fluoride?
You’re welcome…
Shirley a publication as august as The Guardian would run only substantive articles? …
Why do I get the feeling that in 10 years or less we’ll be seeing loud ads from bad lawyers about class action lawsuits like so many other “miracle” pills?
Actually, I've seen one such ad already. (Well, not "class action", but "If you've been harmed by the horrible side effects of...")
"They're going to start putting this stuff in the water supply before long."
This is to counter whatever is in the water that is making everyone fat in the first place.
Studies indicate that, compared to a person in the 1980's, a person today has to exercise more and eat less to maintain the same BMI. Even the lab animals are getting fatter.
https://www.vox.com/2015/8/24/9194579/obesity-animals
The thumb is already on the scale...
"To complicate matters, it turns out Allison has faced conflict-of-interest allegations for having received funding from the food industry. So it’s possible the study is biased toward attempting to shift the blame for obesity on environmental factors instead of commercial ones."
I wouldn't rule out the possibility that endocrine disruptors are part of the problem.
There are always side effects. We just don't know what they all are yet. Maybe thyroid cancer or vision loss will be the thing that takes down the miracle status.
I've heard through the Internet gossip line that once on the drug, you stay on it; weaning immediately returns the weight. This is hearsay I again state...
That's the side effect: you become part of the company.
My money would be on colon cancer incidence beyond 10 years, based on what I've heard about their mechanism of action. Which is that one primary thing they do is slow the gut down. Assuming that effect also applies to the large intestine, that would mean longer exposure to slower-moving carcinogens. But colon cancers typically develop over a decade, so it's too early to know whether that'll be a side effect of any magnitude.
Which is that one primary thing they do is slow the gut down.
For similar reasons I suspect Parkinson's could be an issue (vagal nerves), and they already make you sign a release regarding increased thyroid cancer risk.
I'm on it now (started in January) but my tentative plan is to limit my treatment to eighteen months, max.
Not gonna lie, I'm pretty bitter that this miracle drug has bailed out all the people who have let themselves go, while I've managed to stay the same weight since my teenage years through exercise and eating well, yet have to deal with irreversible osteoarthritis at age 42.
It's not bailing out - there are major differences in genetics and propensity to gain weight. You got lucky in the genetic lottery.
I agree there can be major differences. But there is also a major difference between people who think casually walking 10,000 steps a day is sufficient exercise and those that actually exert themselves.
And I'm not talking about genetic outliers. The VAST majority of obese people would not be obese with achievable lifestyle changes.
The VAST majority of obese people would not be obese with achievable lifestyle changes.
Said no one who has done a modicum of serious reading about obesity. Your take is utterly contrary to the vast bulk of the current research. At epidemiological scales (sure, outliers exist) exercising one's way to acceptable weight doesn't work, due mostly to the physiological changes that accompany increased physical activity.
No it’s because they consider 30minutes of walking to be exercise.
I’m not saying it’s EASY, but just throwing up your hands and saying most people simply don’t have the physical ability lose and keep off weight is a pretty sad state of affairs.
Sucker
Contrary to what our popular media is always telling us, trying to permanently lose a large amount of weight through diet and exercise simply doesn't work. One can avoid becoming fat in the first place via a healthy lifestyle, but once a person is obese, they will stay obese unless they have bariatric surgery or use GLP-1 drugs.
The best person I know - the smartest, most competent, best person to be around - is fat. I hate the thought of people judging her negatively because of that.
There are countless examples of people losing weight permanently. I cannot believe the narrative that it's just impossible to keep off weight (for the vast majority of people) is becoming accepted. Just because so many people fail to do it doesn't mean it's not possible.
But even accepting that as truth for the sake of argument, it would be like I said... bailed out for bad lifestyle choices.
"Contrary to what our popular media is always telling us, trying to permanently lose a large amount of weight through diet and exercise simply doesn't work."
My scale disagrees with you to the tune of 80 pounds, sustained for the last 17 years. It absolutely can be done.
The hard part is figuring out how to do it in a way you can commit to and sustain permanently, and each person is going to have a different answer to that. It may take a lot of experimentation. And no matter what you settle on, the media, the diet industry, and the Internet will scream at you that you're doing it wrong and it will never work.
I'm glad I found a way that worked for me that does not require me to take a drug like Ozempic in perpetuity. But I'd be the last person to sneer at anyone who does go that route, or gets bariatric surgery, or stays fat. It's nobody else's damn business how you go about taking care of yourself.
My scale disagrees with you to the tune of 80 pounds, sustained for the last 17 years.
Consider yourself a fortunate outlier. Because the public health data do not lie: you are an outlier.
https://www.vox.com/2018/1/3/16845438/exercise-weight-loss-myth-burn-calories
https://www.vox.com/science-and-health/2018/6/13/17452936/dieting-weight-loss-netflix-explained
We can all celebrate the successful, tiny few who buck the odds (seriously, take a bow: your accomplishment is impressive). But what we cannot do is cite their example to formulate public policy.
Contrary to what our popular media is always telling us, trying to permanently lose a large amount of weight through diet and exercise simply doesn't work
Yes. While outliers exist, at epidemiological scales, this is certainly a valid statement.
We evolved amid massively strong selective pressure to avoid weight loss and indeed to gain weight whenever possible. We're simply not equipped as a species to deal with unlimited calories.
Were all these benefits just side effects of weight loss or were they independent of weight loss?
I'd bet that the two are highly correlated, so it would be borderline impossible to determine that without an enormous study.
There are many studies that try to measure effects of body weight on health. If the effect on health of ozempic is much larger than the expected effect from the weight change, then it is probably something else.
I think it is, but I didn't actually check. The summary of the study doesn't actially say, for some mysterious reason.
To do this right you would need a control group in the same study which lost weight in some other way. But as far as I know getting people to lose weight in other ways is much less probable.
Ozempic does a lot of stuff besides making you lose weight. All sorts of compulsive and self-destructive behaviors just stop, apparently.
One theory I came across is that there are two different "motivation" systems in the brain, one which generates ordinary day-to-day desires and one that generates intense, overwhelming cravings. The latter presumably arose so that when we are starving, or deficient in some vital nutrient, the body can pull the emergency alarm and direct the brain to override all other priorities and meet the immediate need.
There's almost never a genuine need for that "craving" system in modern society, but it turns out that it can be hijacked in all kinds of ways to trigger compulsive behavior, and this may be at the root of problems from alcoholism to compulsive gambling. If the theory is correct, Ozempic suppresses the "craving" system.
Of course, when you stop taking it, that system turns right back on.
"They're going to start putting this stuff in the water supply before long."
People drinking water don't need the stuff. It's more likely the people living on Coca-Colas, milkshakes, and candy bars who do.
I have no issue with people who have health conditions to get any medication they need. But it's a bad idea to think that we can solve the obesity problem in our society if all we have to do is take another drug.
The biggest enemy of good health is the American food industry, with a close second the forces that lead us to live sedentary lives.
Diet and exercise is the cure for what ails us. Leave the miracle drugs for the few people that truly need them.
Contrary to what our popular media is always telling us, trying to permanently lose a large amount of weight through diet and exercise simply doesn't work. One can avoid becoming fat in the first place via a healthy lifestyle, but once a person is obese, they will stay obese unless they have bariatric surgery or use GLP-1 drugs.
I agree that the food industry is bad, and so is our development pattern of car-dependent suburbia. But we've been trying to lose weight via diet and exercise for over a half century and the average American BMI just keeps going up. The strategy has failed and we need to try something else.
If it doesn't work (for the vast majority of people), it is because people revert back to their old habits. I mean have you seriously never known someone who was fat and lost weight and kept it off? It happens!
A bit off topic, but is Vance using the same "orange-man" bronzer as Trump? Some him on a Sunday show and thought maybe my TV's color balance was off...
It's the cloud of evaporate Trump gives off that condenses on everyone around him.
eeewwwwwwww.....
So is the proposed mechanism for all these health benefits via weight loss, or are the glp-1 drugs acting on other pathways that have nothing to do with weight loss?
ETA: here's what AI says:
GLP-1 receptor agonists are known for their broad range of health benefits, which extend beyond weight loss. While weight loss is a significant mechanism through which these drugs exert their effects, they also act on other pathways that contribute to their health benefits.
## Mechanisms Beyond Weight Loss
1. **Glycemic Control**: GLP-1 receptor agonists enhance insulin secretion and suppress glucagon release, leading to improved blood sugar control in people with Type 2 diabetes. This effect is independent of weight loss and is a primary reason for their use in diabetes management[1][2].
2. **Cardiovascular Benefits**: These drugs have been shown to reduce major adverse cardiovascular events (MACE) in patients with Type 2 diabetes. They improve cardiovascular outcomes by lowering blood pressure, reducing blood lipid levels, and promoting nitric oxide production, which improves endothelial function. These effects are partly independent of weight loss[1][4].
3. **Renal Protection**: GLP-1 receptor agonists have demonstrated positive effects on kidney function in patients with Type 2 diabetes, offering renal protection beyond the benefits associated with weight reduction[1].
4. **Central Nervous System Effects**: GLP-1 receptors in the central nervous system, particularly in the hypothalamus, regulate appetite and satiety. These drugs modulate hunger and food intake by acting on specific brain pathways, which contributes to weight loss but also involves direct neural effects[3].
5. **Anti-inflammatory and Anti-oxidative Effects**: GLP-1 receptor agonists exhibit anti-inflammatory and anti-oxidative properties, which can contribute to their cardiovascular and metabolic benefits[1].
## Conclusion
While weight loss is a crucial mechanism through which GLP-1 receptor agonists provide health benefits, these drugs also act on various other pathways that contribute to their overall efficacy. Their effects on glycemic control, cardiovascular health, renal function, and central nervous system regulation highlight their multifaceted role in improving health outcomes beyond just promoting weight loss.
Citations:
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10739421/
[2] https://www.singlecare.com/blog/glp-1-benefits/
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189979/
[4] https://www.uchicagomedicine.org/en/forefront/research-and-discoveries-articles/2024/may/research-on-glp-1-drugs
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10341852/
[6] https://www.nature.com/articles/s41569-023-00849-3
[7] https://www.nbcnews.com/health/health-news/beyond-ozempic-glp-1-drugs-promise-weight-loss-health-benefits-rcna157525
[8] https://www.e-enm.org/journal/view.php?doi=10.3803%2FEnM.2024.1940
I saw somewhere that fat cells live longer than other cells in the body, requiring 18 months before they croak and are replaced. This is why people struggle with diets, because they have to keep it up for 18 months.
If Ozempic has the effect of contracting them without altering your diet even if you keep it up for that long the fat will come right back after you quit.
So, isn't this a crutch for people who can't put down the Snickers bar?
People struggle with diets because you have to keep it up *forever*. You can back off the intensity when you reach your target weight, but you can't go back to eating the way you did before. Those eating patterns are what made you gain weight in the first place; go back to them and the weight will come back too.
Therefore, any diet which requires you to eat in a way that you can't sustain long-term is doomed to failure. And that's most of what the diet industry sells. Long-term weight loss without medical intervention requires figuring out a way to do it that you, personally, can live with and sustain indefinitely, and what that looks like is going to vary a lot from person to person.
As for Ozempic, it's got nothing to do with "shrinking fat cells." Ozempic makes you want to eat less -- effectively causing you to diet without thinking about it -- so you lose weight. As long as you stay on Ozempic, you can sustain the "diet," so the weight stays off. If you go off Ozempic, then the desire to eat returns and the "diet" fails.
And, if it works that well, shouldn't it be required by regulation or law for the overweight?
I don't think anyone on Earth actually wants to be overweight because they like it that way.
why would a treatment for weight loss be required by law when no other medical treatment is?
It's a public health threat.
But, you're right, a law may be going too far.
One item I note: This is a Taiwanese study. Lifestyle and diet matter, and difference in lifestyle and diet between Taiwan and the US could change the results significantly. This study can, and no doubt will, be reproduced all around the world (if it's not already in progress). It's always a good idea to wait and see if results can be replicated.
I've seen other studies that claim that GLP-1 drugs really affect the reward system in the brain. It's not simply that you don't feel hungry - it's that the pleasure of eating is not amplified out of proportion. The evidence is that other addictions are also tamped down: gambling, smoking, drinking, drugs. These are all deliberately designed to tickle the reward system for the sake of profit, so getting away from that kind of over-stimulus is a big deal.
If true, and who knows if it is, the improvements in mortality rates could be because lots of other damaging activities are minimized. Cutting back on alcohol and smoking would have especially large effects.
Recent Nature article claiming that in mice it affects two bits in the hindbrain, one that causes satiety, while the other causes general aversion (maybe something like nausea in humans).
https://www.nature.com/articles/s41586-024-07685-6
No chance in hell this’ll be in the water supply. Just look at the ani-vax crap from Covid.
Yeah. No way widespread water fluoridation could be implemented today. Back then people mostly trusted institutions.
Sounds good, but it seems that they did not have a control group which had comparable weight reduction (if there was such reduction) achieved by other means. That is, how much of improvement was just due to less obesity and how much to other properties of the drug. Of course there really aren't any other weight-loss methods that have the success rate of these drugs.
fyi... the site seems snappier today than it has been recently
Big Audio Dynamite found something like this years ago.
https://youtu.be/MMG3mBXS0M4?si=oGvju8kDWGFbBeY3
This smacks of the excitement at the turn of the century, when statins and a daily low dose aspirin were going to see us all living to be 100.