Weight-Loss Surgery Down 25% as Anti-Obesity Drug Use Soars (harvard.edu) 102
A new study examining a large sample of privately insured patients with obesity found that use of drugs such as Ozempic and Wegovy as anti-obesity medications more than doubled from 2022 to 2023. During that same period, there was a 25.6% decrease in patients undergoing metabolic bariatric surgery to treat obesity. From a report: The study, by researchers at Brigham and Women's Hospital, in collaboration with researchers at Harvard T.H. Chan School of Public Health and the Brown School of Public Health, is published in JAMA Network Open. "Our study provides one of the first national estimates of the decline in utilization of bariatric metabolic surgery among privately insured patients corresponding to the rising use of blockbuster GLP-1 RA drugs," said senior author Thomas C. Tsai, a metabolic bariatric surgeon at Brigham and Women's Hospital.
Using a national sample of medical insurance claims data from more than 17 million privately insured adults, the researchers identified patients with a diagnosis of obesity without diabetes in 2022-2023. The study found a sharp increase in the share of patients who received glucagon-like peptide-1 receptor agonists, or GLP-1 RAs, during the study period, with GLP-1 RA use increasing 132.6% from the last six months of 2022 to the last six months of 2023 (from 1.89 to 4.41 patients per 1,000 patients).
Meanwhile, there was a 25.6% decrease in use of bariatric metabolic surgery during the same period (from 0.22 to 0.16 patients per 1,000 patients). Among the sample of patients with obesity, 94.7% received neither form of treatment during the study period (while 5% received GLP-1 RAs and 0.3% received surgery). Compared to patients who were prescribed GLP-1 RAs, patients who underwent surgery tended to be more medically complex.
Using a national sample of medical insurance claims data from more than 17 million privately insured adults, the researchers identified patients with a diagnosis of obesity without diabetes in 2022-2023. The study found a sharp increase in the share of patients who received glucagon-like peptide-1 receptor agonists, or GLP-1 RAs, during the study period, with GLP-1 RA use increasing 132.6% from the last six months of 2022 to the last six months of 2023 (from 1.89 to 4.41 patients per 1,000 patients).
Meanwhile, there was a 25.6% decrease in use of bariatric metabolic surgery during the same period (from 0.22 to 0.16 patients per 1,000 patients). Among the sample of patients with obesity, 94.7% received neither form of treatment during the study period (while 5% received GLP-1 RAs and 0.3% received surgery). Compared to patients who were prescribed GLP-1 RAs, patients who underwent surgery tended to be more medically complex.
Re:How about (Score:4, Insightful)
so it begins
we've had the fat shamers, now they will transition to being ozempic shamers because you are just miserable fucks who hate everyone because you hate yourselves. find a new easy target i guess eh
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For people that need to lose a little weight*, calorie counting is a myth--in the sense that nobody can count the calories in their food with a high degree of accuracy, unless they subsist on stuff that came out of factories and doesn't belong in their body anyway.
Everybody* actually just relies on their appetites to tell them how much to eat. If I wake up hungry in the night, that's my appetite giving me a stern correction. If I wake up hungry in the morning, my appetite is telling me I did a good job. If
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True, and weight loss surgery more or less provides feedback when your stomach is full, at a smaller size.
Ozempic and its friends (I was calling it 'liquid gastric bypass' 7 years ago, essentially does the same thing by slowing the process of emptying the stomach. Which also is why the acid reflux happens.
Calorie counting is essentially useless. Adjust the foods you eat and activity level to suit, but counting calories is not how to do it. There are ocnfounding factors that throw the count off anyway. L
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drugs such as this are aimed at he
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> In some people, all calories are stored as fat regardless of how little they eat.
That can't happen because there's continuous energy consumption from something. That the hunger signals are wrong and misguided in some people is a certainty though.
> two people eating the same diet may not experience the same changes to their body's mass.
thats the calories out
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Lets try this as an example:
Breakfast:
Morning snack:
Lunch:
Turns out you can count
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If we were machines it would be simple, but we are not.
It has taken me so long to start losing weight because I was taught the wrong things in school, like the old food pyramid that was very carb heavy, didn't dive into refined grains vs whole grain etc.
Even with discipline and daily visits to the gym, I could just not get the weight down. Through trial and error, Searching so much information, I finally learned how to get the right amount of protein, fiber and not refined carbs, avoid sugar that boosts hun
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Cooking your own food is definitely helpful. No processed foods, keep the sugar and salt way down. Makes a big difference.
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Re: How about (Score:1)
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In an otherwise healthy person with normal endocrine function and appropriate muscle mass - sure calories vs calories out, is going to be the driver.
However you have people that:
1) Have far less than normal muscle mass, which means they will NOT have normal metabolism no matter what. That might not be just because the are a couch potato, could well be the result of other disease or debilitating injury. Weight control from them should be part of treatment.
2) Abnormal endocrine function is a thing, sure type-
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yes but also no. One of the reasons people die is things get to far out of balance. At some point atrophy can be so severe that even a small amount of food results in pretty wild blood sugar swings which has negative consequences for other organs like kidneys. As you say it has to some where...
What I am saying is these drugs are tool in the medical practitioners box. They are not inherently bad. They may be a lot better than many alternatives like gastric bypass surgery to bring things back into line. T
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> So this all seams horrible but maybe we should ask some philosophical questions about how wrong it really is to offer healthy-bmi-the-easy-way as a subscription.
About as wrong as offering the healthy-blood-pressure-the-easy-way as a subscription. Or clean-water-on-top as a subscription.
And in truth, the collection of BP medications has saved many people from nasty diseases and poor health.
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Sure, he could have sugar-coated it a little but the fact is that weight management is a matter of simple maths.
And drug addiction is just a simple matter of "stop taking the drugs", right?
If if was that easy, there'd be no fat people. You completely discount the power of cravings that the brain constantly bombards fat people with. In some cases it's quite literally like drug withdrawals where people are desperately Jonesing for that food. Their brain rewards them for eating more and encourages deception and self-delusion. You can draw a direct line between the junkie telling himself "I'll be fine; one more hit and I
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> All you'll do is make yourself addicted, dependent on expensive weight loss shots to make you feel a little bit better.
Does that apply to cholesterol and high blood pressure medications?
Realistically, they are much more efficacious than lifestyle changes, and most people have few serious side effects and it stacks upon personal behavior changes.
And healthy eating is much much easier according to those who are on the GLP-1As. Hunger drives are obviously strongly evolutionarily embedded to the beginning
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As someone who's had weight loss surgery after a lifetime of being overweight, it's not nearly as simple as "moving your ass and not eating like a pig".
And weight loss surgery isn't a magic bullet, at all. I'd argue that in a lot of ways it is way harder than doing a traditional diet and exercise (Which you'll need to do anyways for the surgery to be a success). After a bypass you're going to face a lifetime of potential malnutrition, not being able to properly absorb nutrients and minerals, weird shit like
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Many people get the surgery, lose some weight and then add it all back on. Hope you have good results, but a good result is solely up to you eating better and/or exercising. The surgery is just to solve the fact you have become too fat to do the exercise, not that diet wouldn't have helped (if you don't have the willpower someone has to forcibly remove your food supply), but it may not have been fast or convenient enough.
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>> Many people get the surgery, lose some weight and then add it all back on
Do you have a cite? I don't see how a person could add all the weight back on when most of their stomach has been excised or bypassed. You just wouldn't be able to cram the food in there.
Re: How about (Score:2)
My father in law and his son both have had the surgery and it helped but they are both still over weight.
My wifeâ(TM)s best friend had the surgery and she has kept it off better.
You need a diet change too. You canâ(TM)t eat the same crap in crap quantities.
Fix the diet first and the surgery is almost always successful.
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It sounds like a pretty rigorous regime, more so than I knew about. I don't think most people will do it.
But that would explain the preference for the drugs. One injection a week is relatively easy.
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"Ozempic does exactly NOTHING to your metabolism. It is, however, a powerful appetite suppressant. That's all."
All of this is wrong and you're a moron, if that's not already obvious to everyone after the stupid shit you just spewed.
"Eating less makes you loose weight. Who would have thought."
Everyone would have thought, and already did. The problem lies elsewhere, but you wouldn't know that because you've never experienced the problems others do.
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The previous poster is correct. And semaglutide alters signaling which was damaged or ineffective.
And I'm 100% for it. Lots of diseases have improper signaling and altering energy metabolism is probably clinically risky. The hunger signaling is so deep in evolutionary history it's not possible to override in practice. Changing the setting also is safest--hunger signals are still there with their normal function just lowered in intensity.
People with the problem feel like they are eating 1200 calories eve
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Re:Final nail in coffin for "broken metabolism" pp (Score:4, Interesting)
More than 2/3rds of Americans are overweight or obese, so while you might be correct that someone with enough willpower can lose weight, the reality today in that society is that most of them can't.
It's not like you haven't been berating them for decades either, so it's not like just listening to you is going to help. Where people have been forced to stick to 1200 calories, be it in controlled studies or on TV shows, while it does work in the short term they almost always put the weight back on. And that includes when they get extensive coaching to lead a healthier lifestyle afterwards.
Just telling people it isn't hard and all they need to do is stick to 1200 calories a day does not work. It makes you feel morally superior, but it doesn't help them lose weight permanently.
Ozempic works.
If it helps, look at it as a vaccination against predatory capitalists who bombard us with high calorie unhealthy food. You didn't think they were not trying to do everything they possibly can to make you eat more, did you?
Re:Final nail in coffin for "broken metabolism" pp (Score:5, Insightful)
In addition to being addicted to junk food, Americans are also addicted to treating large scale social issues as individual moral failure.
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People are also somewhat resistant to the "nanny state" telling them what to do, protecting them from predatory businesses, or even giving them useful information like how many calories are in a particular item.
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Okay, the US isn't perfect, but we definitely do this one.
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People are also somewhat resistant to the "nanny state" telling them what to do
Dunno what you are playing at but a having access to a drug that lowers appetite has exactly ZERO applicability to "nanny state" concerns. These drugs empower the individual and as a freedom-loving anti-authoritarian, I think that's absolutely great.
So, don't paint your political enemies as "against weight loss drugs" or anti-weight loss because it sounds downright loony. The only way the "nanny state" comes into this is due to their slow-walking the FDA approvals (Ozempic was submitted December 2016), re
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Interesting perspective, thanks.
I've got plenty of room to do all that but it hadn't occurred to me that many people will have a small living space that makes it much less practical. And if you do cook your own food you will want to do it in enough quantity to have leftovers for additional meals. That requires adequate refrigerator capacity, which may not be available.
Re: Final nail in coffin for "broken metabolism" p (Score:2)
Well there's your problem: All you think about is food and how to get more of it. You're basically a Soviet version of Homer Simpson if the Soviets actually had food in their grocery stores.
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My best friend is from Minsk, Belarus. He remembers starving in the 1980's quite clearly and talks about it often. His mom worked in an optics factory and was given finished merchandise like lenses, cameras
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It is almost as if the entire economic model of the two income household is wrong. We should use policy to encourage one member of a domestic partnership to NOT work outside the home.
I don't think it's a question of willpower (Score:1)
Every time there's an ozempic story it's guaranteed to show up on here but I don't see nearly as many stories about the effects of plastic in our food supply. I do get stories every time some little town tries to ban disposable grocery ba
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Eating less makes you loose weight. Who would have thought.
Current understanding of how metabolic regulation makes this false on its face. Your body has a calorie consumption set point. If you ignore the signals and simply eat below the set point, your body will attempt to conserve energy in various ways. This includes moving less – you will subconsciously fidget less and become lazier generally, and cutting brain activity – you will literally think worse and become more sleepy and sluggish.
It is incredibly hard to beat biology once your body has reac
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Think long and hard before taking Ozempic for weight loss if you're not Type II diabetic. I'm LADA, Agent Orange related and was having trouble with my blood sugar a few years ago, so my Diabetes Doctor suggested that I try Ozempic. It did help, slightly, but in three weeks I lost 17 pounds. Being that I was already underweight, I stopped it
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It's difficult to take seriously someone who can't spell "lose."
Re: Fat in the head (Score:2)
What do you mean "relatively"? Relative to what? Go talk to an actual endocrinologist, they understand the mechanism quite well. If they think you have the aptitude for it they'll even draw you a few diagrams.
Most people get no treatment (Score:2)
“Metabolic bariatric surgery and GLP-1 RAs are both effective interventions for patients with obesity, yet less than 6 percent of patients in our study received either form of treatment.”
Understandable in a way. The drugs are expensive and can have serious side effects. The average cost of bariatric surgery ranges between $17,000 and $26,000, but it reportedly is relatively safe and often results in significant weight loss.
https://www.saintalphonsus.org... [saintalphonsus.org]
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>> weight can come back over time
Very true, you have to keep taking the expensive weight loss drugs that have side effects but the bariatric surgery is a one-time thing.
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Hard disagree. Changes of that degree are rarely due to individual choices. What this really shows is that our society as a whole (led by those looking to make a buck) has made an awful lot of bad lifestyle choices, starting with building ourselves into a car-dependent culture.
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Hard disagree. Changes of that degree are rarely due to individual choices.
Every person who sees their belly expanding and chooses to not make lifestyle changes to counter that effect is making an individual choice.
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In the USA the grocery stores are full of prepared foods that are heavily dosed with sugar, fats, and salt. It tastes good. It comes in attractive packaging and it is advertised on TV. When I line up at the checkout counter I shake my head at what I see people buying.
"The rising obesity epidemic in the U.S., as well as related chronic diseases, are correlated with a rise in ultra-processed food consumption. The foods most associated with weight gain include potato chips, sugar sweetened beverages, sweets an
Obesity is another form of mental illness (Score:2, Insightful)
When you're eating enough to be fat enough it is having a serious negative effect on your life and you're not willing to reduce your food intake... That's a mental issue. A behavior you can't manage to change.
Drugs and surgery are temporary corrections of the symptom, if you don't deal with the problem - wanting and consuming too much food - you're going to need more drugs or surgery, or you're going to get fat again.
Re:Obesity is another form of mental illness (Score:4, Insightful)
Over 2/3rds of Americans are overweight or obese. That seems to rule out mental problems, because what is a normal mental state is defined by the behaviour of the majority. Few people believe in little green men so that's a delusion, but a lot of people believe an omnipotent being controls their life and responds to flattery, so that's perfectly normal.
Would you also say that people who are addicted to tobacco products also have a "mental issue"? It's not an unreasonable comparison. Food companies are strongly motivated to create products that are addictive, and then use every means they can to induce you to buy them.
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If you have the capacity to change your behavior and you're suffering because you won't... It's a mental issue no matter how common it is. This can be heavily influenced by your environment and culture, but the truth is that if you WANT to be healthier, it's not impossible to do so without and easy/quick fix solution. You can even eat healthier in addition to eating less, and save money while doing so.
It takes some effort. Culturally, we're not that big on effort. Most people pretend - taking up a new
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Consider that these medications are not cheap, and a hefty chunk of change every week is a pretty big motivator. Between that, the people fat shaming them, the desire to look conventionally attractive, the health problems obesity causes, the daily inconveniences, the rising cost of food, you would have to assume that the majority of Americans are extremely lazy and willing to put up with a hell of a lot just to avoid your easy and effective solution.
A more likely explanation is that it is in fact far harder
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>the people fat shaming them
I'd never do that. I consider it more or less a choice they've made. As long as they don't demand that I find them attractive or pretend that it's healthy, it's generally none of my business.
>it is in fact far harder than you realize.
I've lost weight. And gained. And lost. Not on a huge scale, but I have been heavy enough my doctor told me I should be quite a bit lighter. I'm still slightly above where I should be, but I know when my weight is going to fluctuate signi
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You are getting fat because you are eating more than your body requires to sustain itself. Or you're staying fat because you are eating enough to sustain your body at that mass.
It's not as simple as that. In the first place, you can be on a ketogenic diet in which you eat a diet fairly high in protein, VERY high in fat, and with small or negligible carb content. You might be consuming 3,000 calories a day, and you will still lose weight; and you'll keep it off, as long as you avoid those carbs - especially the simple ones, and most especially the refined ones. I'm not saying carbs are unimportant, as some of them are our only sources of vital minerals, vitamins, and other compoun
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That's a lot of text just to clarify to 'eat too much of digestible food'.
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That seems to rule out mental problems, because what is a normal mental state is defined by the behaviour of the majority.
Does it? The number of obese Americans has tripled in the last 60 years https://usafacts.org/articles/... [usafacts.org] which pretty much means there's a mental issue at some level here for a lot of people regardless of whatever "normal" is. Everyone knows eating lots of sweet treats will put pounds on, everyone knows fast food will too. The choice to continue heavily consuming such items despite being able to physically see the negative effects on one's health (the expanding belly) is a mental one.
And sure, things like
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So your theory is that more than 2/3rds of Americans have developed mental problems, as opposed to the far more likely hypothesis that foods and eating habits have changed dramatically over the last 60 years?
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No, my theory is that roughly a third of Americans are making bad decisions in regards to their health. Obesity and being overweight has been a thing since well before the current epidemic of it and as I eluded to before those with such predispositions have my sympathies and should consider these drugs as many of them have needs that go beyond what diet and exercise can accomplish. Never the less, there's about a third of the population that clearly just arent taking responsibility for their actions given h
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Maybe its just the kind of food people are being fed.
"The rising obesity epidemic in the U.S., as well as related chronic diseases, are correlated with a rise in ultra-processed food consumption. The foods most associated with weight gain include potato chips, sugar sweetened beverages, sweets and desserts, refined grains, red meats, and processed meats"
https://smhs.gwu.edu/news/proc... [gwu.edu]
Re:Obesity is another form of mental illness (Score:5, Insightful)
Would you also say that people who are addicted to tobacco products also have a "mental issue"? It's not an unreasonable comparison. Food companies are strongly motivated to create products that are addictive, and then use every means they can to induce you to buy them.
When my overweight wife would get hungry, she had exactly the same symptoms as when I would be in withdrawal from nicotine.
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I heard the same thing from a friend, and I'm ashamed to say I didn't believe them at the time.
Re:Obesity is another form of mental illness (Score:5, Insightful)
Re:Obesity is another form of mental illness (Score:4, Interesting)
I dunno about you, but I eat a lot of real food--things that used to be plants and animals. I'm grateful to be in a position to be able to do that. So would I reduce my food intake without altering my appetite? Maybe someone that eats like crap could say "one fewer bag of crisps per day", but what would I say? One less spoon of chicken and black beans? 25% less olive oil in the hummus? Eat smaller fruit? Unless your food comes from cans and boxes, you can't just eat less. You can do something more nuanced, like alter your appetite, learn to detect fullness earlier, or be hungrier.
When you're eating enough to be fat enough it is having a serious negative effect on your life and you're not willing to reduce your food intake... That's a mental issue.
Food for thought: if you eat 1% too much, you will gain over two pounds per year.
No not really (Score:2)
This is before we get into all the gut bacteria problems many of wh
Re: No not really (Score:2)
Nobody makes fun of you because you're fat, they make fun of you because you're such a simpleton. Being fat is just the cherry on top.
Obesity Drugs = I lack responsibility * (Score:1, Insightful)
Okay, how many people are on these drugs, but take no real responsibility? I can name a handful of people, all women, who are on Ozempic, who DO NOT NEED IT. What do I mean, when I say they don't need it? All the people I'm thinking of have the same few points in common:
1. They have terrible diets.
2. They've all tried the fad diets, includi
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Human beings evolved when the food supply was unreliable. Plants and animals had not been bread to be larger and higher in fat, or pumped full of hormones.
Modern foods are produced by people who have a vested interested in selling you as many calories as possible. The US, where this problem is the worst, also has very low food standards compared to other developed nations. Life now doesn't give people much time to prepare or even seek out healthy food.
It's not the case that people today lack the willpower a
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Around here meat is quite expensive relative to other foods, and farmers markets and butchers tend to be higher priced than supermarkets.
Pasta is cheap and very easy to prepare.
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Yes, it's cheap, and easy, but you can't consume crap, and then at the same time whine about your inability to control your weight. The people I'm referring to are all well off, so groceries are not a burden, but, on the other hand, I know someone whose has a burden paying for the basics. He actually has a legit medical reason to need something like Ozempic, but on some sad notes:
1. Can't afford it (our family offered to cover it for him).
2. Can't get
Asthma inhalers = lack of responsibility (Score:1)
What you definitely shouldn't do is consider what the combination of large amounts of gut bacteria destroying plastic and long work hours coupled with cheap junk food that requires a little or no preparation would do to a population.
Because as we all know there are no suc
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On the other hand, someone could live a health lifestyle, never smoke a day in their life, and still get lung cancer, the difference is the second person has every ri
Statistically, obesity is... (Score:4, Insightful)
...less curable than cancer.
Most people who lose weight with dieting gain it all back and more.
Some believe it's simple and insult those who fail to achieve healthy weight.
It's not simple!
Weight loss surgery is a crude and awful approach. The new drugs are a tiny bit better, but still are not the solution. This is a hard problem. We need research, not hate and insults
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Amen! The human body evolved to hunt, gather, and/or farm most the day. Our metabolism etc. is not designed for desk jobs.
Exercise helps, but I lose only about 1/3 a pound per average minutes of exercise per day. Thus, if I exercise 45 minutes a day, I'll lose about 15 lbs. It's like a sub-minimum-wage job: work your ass off for dimes.
I lost 110lbs on Mounjaro (Zepbound) Last Year (Score:2)
I was over weight for 20 years (classic yo-yo dieter. I could lose, but it always came back. I put on 40lbs during the two years I ran marathons)
What is really cool? I turned 12 people on to the same drug. Combined we
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Mounjaro totally reversed my wife's insulin resistance. Her blood sugar doesn't crash when she misses a meal.
Poor messaging (Score:2)
I'm not saying that these medications don't have a place, particularly for folks in extreme cases you need a jump start, but the idea that one would have to take these medications for the rest of their lives is awful. I think the part that's missing from the "balanced diet and exercise" message is that it is definitely not a "get thin quick" plan. Healthy weight loss is between 0.5-1lb per week. That means following those "balanced" routines takes a lot of time, and killing yourself in the gym for two we
Studies do not back that up (Score:1)
Long term effects of Semaglutide (Score:2)
how can they AFFORD IT? (Score:2)
Or.... (Score:2)
We could just eat healthier?
Not a very accurate sample (Score:2)
I don't think the data in the paper is a very accurate representation of the true population. Many insurance plans explicitly exclude bariatric surgery from their covered services, and I'd be surprised if those same plans don't exclude weight loss drugs as well.