Loving Sarah Vine on This Morning -Ozempic

[AmyFFowler]

She said we live in an obesogenic society and need to be realistic about the need for weight loss drugs like ozempic. She also said we are genetically programmed to eat as much as possible when we can as our ancestors didn’t know when the next wilderbeast would come along. Now we can just sit in our house and deliveroo will bring us food.
Completely agree with all of the above. I am currently working very hard and managing to lose weight without the help of drugs, so I do also ‘get’ the personal responsibility side to this. I just think as a society we are fighting a losing battle if we don’t embrace the new wave of weight loss drugs. Hopefully in time there will be more studies into long term use.

So does this show it’s more complicated than calories in vs calories burned? Assuming the same level of activity in your 50s vs 30s? Or is just due to less muscle mass meaning less calories burned?? Because i hear women who are still going to the gym in their 50s/still burning off the same amount of calories and eating the same saying this. Which suggests there’s a hormonal element?

Let's not treat any medical condition and you'd get your wish a lot quicker

@CormorantStrikesBack doesn’t muscle mass decrease with advancing age too? Despite our best efforts to maintain.

Yes quite dramatically when you hit 30 together with bone density.

@ZestofCoffee doesn’t this mean that NHS Calorie guidelines should be adjusted for age? Also doesn’t it mean some weight gain by late middle age pretty inevitable? That’s before we talk about hormones.

Menopause websites etc suggest, some of them, weight gain rare, prob your own fault & just up the exercise a little.

I work in diabetes and weight management.
GLP1 agonists have been around for pushing 20 years. Victoza (Liraglutide) was the original one.
In people with diabetes the benefits of weight loss and glycaemia tend to tail off after 2 years.
So while they are absolutely brilliant for people who are really struggling with weight loss, there absolutely has to be a sea change in our eating habits too

@gingercat02 after 2 years what does not being as effective mean? Increasing patient doses? How do you mitigate? Thanks

https://pubmed.ncbi.nlm.nih.gov/37409733/#:~:text=After%20HF%20screening%2C%20we%20suggest,preserved%20ejection%20fraction%2C%20GLP%2D1

An example of a scientific study where these drugs may increase risk of heart attacks etc-for those interested

I eat very little and it's getting less now that I'm 60ish. I'm aware that it looks like disordered eating to many, but maybe it isn't?

Yesterday I had a bunch of around 12 grapes. Today, the same again plus a bit of cheese, a rye cracker, green pickle and tomato. I'm on oestrogen gel and do physio/stretches. Go to Tai Chi and have 'balance classes' coming up. I am by no means slim any more. I'm arthritic though and it's tough to simply 'move more' to the extent that I'm burning calories. So I eat less.

It's all very intriguing.

The same drugs, exactly the same drugs that are routinely prescribed to type 2 diabetics? Really?

There is research which shows metabolism in adults doesn't slow till the age of 60. Which goes against what most people believe and probably other studies.

www.health.harvard.edu/blog/surprising-findings-about-metabolism-and-age-202110082613

What I think people need to be aware of is declining activity levels as we age. And not big reductions. If you make a tiny change or two to how active you are, you might burn 50 calories a day less. You probably won't even realise you have done a bit less.

But if you do that for a year that's 365 x 50 = 18,250 calories burned in a year. If your eating remains exactly the same as before you will put on over 5lbs. Over a decade that's 50lbs weight gain coming from just a 50 calorie a day change. If you are getting into a habit of a biscuit or two with an afternoon tea on top of that the gain could be 150lbs over a decade. Yet we would say we still have the same activity levels and aren't really eating differently so it must be our metabolism.

I think that's where my weight gain came from.

@Zopicloned i advise coming of zopiclone, it’s warping your mind 🤣

To add to what @Limberinta said, it’s not that the study that’s all over the news is necessarily wrong or biased, but accepted scientific practice requires a study to be published in a peer reviewed scientific journal-that means the study and findings are independently verified by other scientists. It’s how scientific research works. There are too many examples of studies funded by pharmaceutical , tobacco, alcohol or food companies where there is a potential vested interest in promoting a product to boost sales. That is why the findings of this study should be considered with caution. The fact the study was published in full is meaningless as it was published by the pharmaceutical company..and therefore not peer reviewed. If anyone recalls the MMR vaccine scandal-that came about due to newspapers picking up on a study which had also been ‘published’ but not in a scientific journal and not peer reviewed. The moment it was scrutinized, the serious flaws in the study were plain to see and the findings discredited. But not before a huge amount of damage had been done.

Precisely. Even looking at photos of people in the 80s there was much less obesity and we had junk food then but probably were more active and no delivery etc

You also only need to go to some Asian countries where hardly anyone is obese to see the differences in culture. Japan for example. They still have McDonald’s and whatever. But they take care of their health and exercise well into old age.

The reason that smoking was persecuted to such a degree was because of passive smoking. Smoking impacts other people's health directly. Obesity does this too, but not to the extent of smoking.

@Choux if muscle mass declines with age from 30s doesn’t metabolism? At 18 I was pretty inactive, junk food etc, not much movement, pin thin. At 25 weight going on, moving much more, eating better & less (?)

Thank you for understanding and expanding on what I was saying :)

I don’t know re calories - just know you drop muscle mass and bone density.

Did you read this link? The abstract says that weight loss drugs have been used to... "improve glycemic control and cardiovascular outcomes among people with type 2 diabetes and a high cardiovascular risk"

BUT to identify patients with heart failure (which is a serious medical condition - my 83 year old dad died of it last year) they suggest performing screening and then, IF the patient has heart failure and IF they have a reduced ejection fraction (which is the heart not pushing out as much blood when it contracts), you should be cautious of using weight loss drugs as there have been many studies on how the drugs might affect their existing illness and could make it worse.

So for most people the drugs improve cardiovascular outcomes. For a small number of people already sick the need to be cautious is there isn't enough studies done yet and it MIGHT be a problem.

Full abstract text:
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been used to reduce body weight in overweight or people with obesity and to improve glycemic control and cardiovascular outcomes among people with type 2 diabetes (T2D) and a high cardiovascular risk. However, the effects of GLP-1 RAs may be modified by the presence of heart failure (HF). In this review, we summarize the evidence for the use of GLP-1 RA across a patient's risk with a particular focus on HF. After a careful review of the literature, we challenge the current views about the use of GLP-1 RAs and suggest performing active HF screening (with directed clinical history, physical examination, an echocardiogram, and natriuretic peptides) before initiating a GLP-1 RA. After HF screening, we suggest GLP-1 RA treatment decisions as follows: (1) in people with T2D without HF, GLP-1 RAs should be used for reducing the risk of myocardial infarction and stroke, with a possible effect to reduce the risk of HF hospitalizations; (2) in patients with HF and preserved ejection fraction, GLP-1 RAs do not reduce HF hospitalizations but may reduce atherosclerotic events, and their use may be considered in an individualized manner; and (3) in patients with HF and reduced ejection fraction, the use of GLP-1 RAs warrants caution due to potential risk of worsening HF events and arrhythmias, pending risk-benefit data from further studies.

Have you been in a French supermarket?? Delicious food, but very little ready meals, a small selection of 'crap' food .

Funnily enough, I was in one on Friday. A wonderful large Leclerc in Villaneuve sur Lot. HUGE aisle of crisps and snacks (If you gave my french dad a glass of wine without some salty snacks he’d think there was something wrong with you so my mum spends a lot of time in this aisle). If you wanted biscuits there was an impressive selection. Lovely chocolate aisle with a really great choice of bars. And then the fresh cakes… oh my god. So many tartes, gateaux. Of course lots of ice cream… Then there were the baked goods, croissant, pain au chocolate, pain au raisin, baguettes. Cheese. Fuck me, the cheese is just incredible. Endless rows of lovely fatty cheese. Oh and yes, lots of ready meals, pizzas etc. People of all shapes and sizes and a few super slim, chic ladies that actually stood out for being less the norm than the exception.

The driver for french women (less the men) to stay slim isn’t that the supermarkets lack what you would call “crap food” and what my french dad would just call food. He’s very slim btw. No one knows why as he eats like a horse. His daily breakfast is porridge with milk and honey, two croissants and two slices of toast with jam. My mum has to eat a minuscule amount of what he does just to stay a size 12/14.

Anyway, the only way for two of my menopausal friends to lose weight was to resort to VLC diets. Another of my friends is on Ozempic and another is on Mounjaro. And yet one of my friends is very, very slim and gets hangry if she doesn’t eat every two hours. If I ate like her I’d be severely obese. I eat - by a long way - the least in my family who are all skinny Minnies yet I am fat (and I have an under active thyroid which makes it especially shit trying to lose weight).

We are all very different and if people who struggle with their weight need a helping hand and are willing to pay for it so what? The number of women on mumsnet who feel morally superior for being below a size ten is quite astounding. You know what they say… I can lose the weight but you’ll always be a xxxx (chose your favourite).

If you mean around the UK, the majority of the population is either overweight or obese. The numbers of people with a healthy BMI are in a minority, which is getting smaller

If you mean around the world, well some countries dont have the same struggle with obesity that we do, and some have more of a struggle. The countries where food is plentiful, cheap, processed, easily accessed and available have more of an obesity and overweight problem. We have, naturally because its part of our instinct, created ways to ensure we eat, eat lots, eat calorie dense foods. Its a basic human wiring, people forget that we are animals first and foremost and like most animals we seek out food, shelter, sex primarily above all other things. What format those things come in, is cultural and varied of course.

I thought similar!

What happens when people stop taking it though - do they pile the weight back on? Is it a drug you need to be on for life - that would be great for the pharmaceutical companies!

Guess we all need to get weight lifting 💪😁

@OolongTeaDrinker

I'm thinking of taking it as I'm horrified at the amount of weight I have gained since hitting peri. My thinking is that I will lose weight AND retrain my brain on how much and what I eat. I will only need it for a short time and hopefully, lose my severe sugar addiction.

The fact muscle mass and bone density drop as we age and lots of people say they have to eat much less to not gain weight is presumably linked. Is there any evidence exercising to maintain muscle mass changes this?