Why are many severely overweight people not using GLP-1 treatments?

[Donteatmychips]

Just a pondering when I was on a day out yesterday. I know of course that there is an economic cost to GLP1s, but is there really really any excuse to such widespread obesity these days? I was walking around a seaside town and a National Trust property, and I would say a good half of those around were still large. I understand they are not that easily prescribed on the NHS, but I believe you can shop around and find deals from various online pharmacies. Is it just more that people don’t want to?

For full disclosure, I am on a GLP1 that I acquired elsewhere by walking into a pharmacy and just asking for it. Yes, it cost a lot of money and I know I am lucky to be in a position to have done that. I fought being on one for a long time and it’s not a magic bullet, but it does help and I’m grateful for that.

I know that modern versions of obesity are skewed, but I am talking really about people maybe 250lbs or over now, not just a stone to lose.

The stats are attrition down to 15% at year 4 and only 15% average weight loss...the manufacturers just this week were condemned by the FDA for hiding deaths and adverse side effects.

Horrible routine side effects. Dr Chris Whitty was sounding alarms only a few weeks ago.

Seek out Ragen Chastain for legitimate research findings and analysis on this drugs

Cost. Of course. It’s very sad. Healthcare for the people who can afford it. I’m very fortunate I can.

For me, thinking about food and choosing to delay eating it isn’t what I think of when I hear the phrase “food noise”. To me, that’s normal hunger and self-control.

In my experience, food noise was waking up at 2am and shovelling crisps into my face because I’d bought them the night before and fallen asleep before eating them. Or running out late at night with the kids in the car to buy family bags of crisps, chocolate and pizza because the idea of them going to bed and me not having food was genuinely panic inducing. Or planning a day out around where we were going to eat, when & how many times. Or shovelling in leftovers even though I knew I was about to go out for dinner.

I agree the term itself is contrived but the behaviour isn’t. It just gives people who experience that level of compulsion a way of recognising it in themselves and in others. I always thought it was a failure in my lack of self control & that others were just more disciplined than me but given how the GLP-1 has completely removed it from day 1, I'm inclined to agree that there is a biological component. That said, it probably is now overused by people who think simply enjoying food is the same thing.

As an aside, I did lose 7 stone without weight loss injections in 2020/21, and the “food noise” didn’t go away, it just reversed. I went from obsessing over eating to obsessing over not eating & it tipped into disordered eating in the opposite direction. I regained the weight and more. I've since lost it again with injections.

So I’m not saying people need them to lose weight. I’m saying that for people like me, they’ve made it possible to lose weight without damaging my mental health in the process. That won’t apply to everyone, but if something genuinely helps people in that way, it probably shouldn’t be dismissed out of hand.

I don’t necessarily think they’re cheating, but I’d rather lose weight slower and more naturally by making the changes without help.

For me, it wouldn’t be sustainable once I stopped taking them, and I would have learned precisely zero about changing my behaviours or relationships with food.

I think the only way I can learn how to be “better” is by forcing myself through the difficult process, rather than medicating away the desire.

100% this.

Your hair is not falling out because of the GLP-1. It is falling out because you're malnourished. If that is what is happening to your hair despite your protein yoghurt drinks, imagine what is happening to your bones and heart?

I've no issue with WLI for those who want to use them and can afford them, but use them properly, and if you cannot do that because you'd prefer to see the number on the scale go down faster (and I get that, I do, I've done that myself and my hair did fall out), then FGS stop posting online as if you're healthy and normalising the very scary side-effects you are having to others.

Money and fear.
They are very expensive, if you look at obesity it is actually more common in lower incomes, and that will become more so since these jabs are so expensive. They are a price that is far out of reach of many.
Fear of side effects, these are new and there are many stories out there on the side effects and people not yet knowing what the side effects are.

There is definitely a need to want to. I have lost 4 stone in about 9 months. Working well. But I can go out and eat 3 courses (albeit requiring long breaks between courses) and drink a couple of glasses of wine if I want to. You do need to think about what you're eating, when, why, amounts involved etc. It might be a quick fix for some but I suspect those are people taking the higher doses and effectively unable to eat. I can't afford anything above 7.5ml so have to take care with what I'm putting in my mouth still. It's perhaps sold as a quick fix but it really isn't. It just helps if you're making all the other necessary adjustments along the way.

Hair falling out, if it happens, is temporary. It's called telogen effluvium, and can happen if you lose weight via any method. It happens about 3 months in to consistent calorie deficit, lasts about 3 months, and then (usually) self-resolves. It's not a sign of dire malnutrition, and does not reflect on the condition of your bone or muscle health.

OP do you want to make a post about how very thin people should be encouraged to eat to avoid frailty?

Your body your choice, other bodies...their choice. Simple isn't it?

Your attitude creates a hostile environment to people already struggling with visible difference .. where do you think this leads?

A. More stigma and more health impacts

History of eating disorder - automatically denied a prescription.

Pancreatic cancer risk

Side effects too severe (perhaps they tried it and couldn't cope with shitting their brains out)

Comorbidities

Money

Come on OP, you know the answer very well but I suppose you've succeeded in your goal to fire everyone up. Nothing like a bit of fat bashing to pass the time eh.

Yeah that’s why people eat cookies.

I think this is a bit of a misrepresentation of the evidence. The lower “real world” numbers people quote are largely driven by discontinuation, not lack of effect while taking the drug. Trial data shows much higher average weight loss than 15%.

The FDA issue was about reporting/compliance, not confirmation of hidden deaths or a conclusion that the drugs are broadly unsafe. That’s quite a leap from what was actually said.

There are side effects but calling them “horrible routine side effects” is an exaggeration. Most people experience mild to moderate gastrointestinal effects that usually improve over time & a significant number of users stay on the medication long term. If the side effects were routinely horrible, they wouldn't be used in the numbers they are.

I know Ragen Chastain is often referenced in critiques of these medications, but she isn’t a clinical researcher or pharmacology authority. Her work is more rooted in weight stigma and social analysis than medical evidence, so I wouldn’t treat her interpretation as representative of the scientific consensus.

None of this means the drugs are risk free. They clearly have side effects and they’re not for everyone but it’s not accurate to frame them as ineffective or broadly condemned.

I don't like apples or cookies, but I imagine if I only had 50p left and I had three kids to feed, I'd probably buy the 50p pack of cookies over one apple.

Note: I have no clue how much apples or cookies cost, btw.

Me too.
I also think of the saying my dad used to say "if it looks too good to be true, then it probably is too good to be true" and worry it will throw up side effects many years later.

But also for me I have a bad history with eating, and I suspect could end up with me then going too far the other way and I know I would struggle to start eating again.

It's obviously cost, for some people it's a huge amount of money and a long commitment. A high number of people will need to stay on them for life or regain the weight.

I disagree with your interpretation.

RC looks at the data published, investigates links declared and undeclared to the GLP manufacturers and highlights the mass attrition and lack of long term data...quoting and referencing the research papers through out.

Time will tell..it already is..showing them for what they are. 85% drop out rate

I am not sure money is really the issu. If someone is obese then they are likely spending a lot on food/drink over course of month.

I lost 3 stone on medication and I was amazed at how much money I saved on not buying so much crap… no packets of crisps when hungry from a newsagents, only one course vs three when out for dinner, massively cut back on wine etc. I think this would easily cover the cost of the medication. That said, I didn’t realise it would be that way when I started so ca appreciate if I dint have a spare £150 a month to begin with then it would be a big gamble to start and assume I would save that on groceries.

What planet are you on?

Lower food bills?

People don't have lower food bills when they lose weight! Healthy food can be more expensive than cheap crap (unless you have the will power to live off home made lentil broth).

People don't put on weight because they're feasting on caviar!

Lots of people don't spend £200 a month on food so saying it is offset by their food bill is a bit ridiculous.

Lots of people don't have £200 a month spare and aren't eligible for WLI on the NHS. Lots of people don't want to take them as they have no issues with being overweight.

Basically there's loads of reasons, but money is probably the number 1.

I've been on the jabs for a year and a half now and I can safely say my food bill has risen by a fair bit. I never did eat tons of junk, a takeaway maybe once every three months, and no alcohol for the past 20 years, so there were very few savings to be made, and I need more protein now, which is more expensive.

The side effects are terrible. I wouldn’t touch it

Because we don’t want to put medications with loads of unwanted side effects into our bodies, especially a product with lack of testing for current use - it’s causing serious harm with gallstones for starters. It’s also very expensive

All weight loss has the potential to cause gallstones, especially if it's rapid. I gave myself gallstones long before GLP1s were a thing because I crash-dieted.

It may not have been tested as a weight loss drug for very long, but the mechanism by which it works on the body is exactly the same as it is in people using it for diabetes, which means there's tons of data out there showing it is broadly safe.

Me too.

Well yes and no, I think you’ve misunderstood, the fda state none of the deaths are directly attributable to the drugs, so it’s a reporting issue, not as you’re playing it. As deaths are investigated by the coroner or medical examiner, who decide cause of death and these are reported up. It’s not on the manufacturer. In this case deaths whilst on the drugs, not caused by the drugs were not listed by the manufacturer, the fda wants them as well. Which I guess j can see both sides to.

chris witty youve also misunderstood, he is not against the drugs, he is very pro them what he said was if we get to the stage everyone becomes obese and on them we have failed as a society we need to prevent people becoming obese in the first place. He’s not wrong. But how do you do that. He says we need to be like France and focus on healthy eating.

france has a much lower rate of obesity at 17 percent v us at 29 percent.
france has 50 percent of the population over weight or obese. V us at 65. So they are still fat. Just less fat.