Diabetes drug Mounjaro was available at $25/month, then increased to $1k/month • Hacker News Board

Re: Diabetes drug Mounjaro was available at $25/month, then increased to $1k/month

#271

Post by yunwal » Sat, Feb 25, 2023, 4:25 PM UTC

HyperSane wrote: post #261

yunwal wrote: post #250

Earlier quoted context omitted.

> It absolutely can It can’t. There are many people who, if they simply scaled down their diet without otherwise modifying their nutrient intake/lifestyle, start having health problems well before they lose weight. Hot flashes, fainting, severe stomach pains, nausea.

This sounds false to me. I suppose for someone used to eating 10 to 20 thousand calories per day suddenly going to 1500 would be stressful but if gently tapered no one should have any issues.

I mean the obvious counterexample is someone who eats 1500 calories of real food and 2500 calories of junk food a day. If you scale that down by half you start getting all sorts of nutrient deficiencies well before hitting your target weight.

But there are subtler versions of this. People who live in food deserts, only have access to iceberg lettuce and freezer-burned tomatoes as produce are gonna have a tough time getting all the nutrients they need in 2000 calories or less. There’s also others who have very specific dietary needs that they’re not yet aware of.

Re: Diabetes drug Mounjaro was available at $25/month, then increased to $1k/month

#272

Post by HyperSane » Sat, Feb 25, 2023, 6:59 PM UTC

kilgnad wrote: post #267

HyperSane wrote: post #264

Earlier quoted context omitted.

My bias is for basic laws of thermodynamics. https://www.diabetes.co.uk/blog/2018/02/story-angus-barbieri... "The fact of the matter is, people weighed less in the 80s then they do today. " Because they ate less. Portions were smaller, Food wasn't marketed as much. "No amount of stretching can change this quantitative measurement." Self-reported calorie intake is not a reliable quantitative measure. "You can continue…

>I really don't understand why you think this statement proves. A heroin overdose IS caused directly by an excess amount of heroin in a given time interval, just like obesity IS caused directly by excessive calories in a given time interval. The time interval for obesity is years instead of hours. This is the part you're not getting. You DIRECTLY say you don't understand here, and I am here to confirm that you in act…

"I'll just be blunt. You sound like a fucking idiot for regurgitating something SO OBVIOUS"

First, don't be so rude. You think what I'm stating is obvious but there is an entire industry built to deny it. Even on this thread there are people who deny it.

Re: Diabetes drug Mounjaro was available at $25/month, then increased to $1k/month

#273

Post by HDThoreaun » Sat, Feb 25, 2023, 7:39 PM UTC

finneganscat wrote: post #169

JaimeThompson wrote: post #154

Earlier quoted context omitted.

>Doctors are prescribing this for people who have medical conditions that make them dramatically overweight I know multiple people < 150 lbs who have gotten scrips for it with no history of diabetes.

How many? Enough to make this comment anything other than a meaningless anecdote? I'm over 375lbs and nobody will prescribe it for me. There's my counter-anecdote.

There are online providers that are effectively just pill mills for these drugs if you're actually interested. They're' expensive though... https://joinnextmed.com/weight_loss

Re: Diabetes drug Mounjaro was available at $25/month, then increased to $1k/month

#274

Post by HDThoreaun » Sat, Feb 25, 2023, 7:52 PM UTC

msrenee wrote: post #152

HDThoreaun wrote: post #74

Earlier quoted context omitted.

Depressed people take ssri’s their entire life. People with ADHD take adderal or the like. I don’t see any reason to think of obesity as a different type of disease. Some people just find it extremely difficult to keep off weight, it doesn’t matter what kind of food they’re eating. Yes they could eat less, just like I could keep my thermostat at 45 in the winter to save on my heating bill. But that’s not a realistic…

If the weight stays off even after 10 years on the drug, then that's great in my book. Nicotine, caffeine, and bariatric surgery all reduce your appetite in the short run, but your body eventually adapts and your weight starts climbing again. Until we've got more than a couple years of data, I'm not holding out hope that this drug won't eventually lose its punch for maintaining a lower weight. The main problem to my…

> How many miracle weight loss drugs have come and gone over the last decade?

Realistically, none. These are the only ones that have ever been found to actually work, everything else is either homeopathy or has terrible side effects. I agree that having food that tastes better is the main culprit for the obesity epidemic, but I don't think the answer is making tasty, addictive, food harder to access. Those foods are popular because people like them, they bring people happiness. It absolutely is a lot of work to eat right, but it doesn't have to be with these drugs.

Re: Diabetes drug Mounjaro was available at $25/month, then increased to $1k/month

#275

Post by HDThoreaun » Sat, Feb 25, 2023, 7:55 PM UTC

jeroenhd wrote: post #153

HDThoreaun wrote: post #37

https://astralcodexten.substack.com/p/semaglutidonomics These new weight loss medications are the solution to obesity. Imo this is one of the biggest medical advances of the century and at least in urban areas of wealthy countries, I don’t think we’ll see obese people anymore in 10 years. The pharma companies realized they’ve got something truly revolutionary so they took the old tried and true drug dealer strategy.…

The solution to obesity is a lifestyle change, or dealing with the underlying (psychological) problems. I'm all for aiding people in their lifestyle changes, through medicine or other means, but there is no drug that can fix obesity. Medicating obesity is like taking pills to make smoking healthy. This is just the next step in the ultimate dream, losing weight without putting in effort necessary. If you need to keep…

This is about as helpful as saying the solution is to pray more. You're not wrong, but very few obese people are willing/able to do it.

> Medicating obesity is like taking pills to make smoking healthy.

This is wrong though. Eating is not unhealthy. Overeating is. These drugs stop people from overeating.

Re: Diabetes drug Mounjaro was available at $25/month, then increased to $1k/month

#276

Post by rs_rs_rs_rs_rs » Sat, Feb 25, 2023, 8:35 PM UTC

pwinnski wrote: post #120

counttheforks wrote: post #90

Earlier quoted context omitted.

Like taking the drug? If you're implying people should "just eat less", that's clearly not very reliable.

Not only unreliable, but ignorant. There is so much in hormone responses and often-undiagnosed conditions that makes "just eat less" absolutely irrelevant to many people.

>There is so much in hormone responses and often-undiagnosed conditions that makes "just eat less" absolutely irrelevant to many people.

I agree with your that's why you see many obese people in parts of the world with food shortages.

Re: Diabetes drug Mounjaro was available at $25/month, then increased to $1k/month

#277

Post by hgomersall » Sat, Feb 25, 2023, 8:44 PM UTC

HyperSane wrote: post #259

Dove wrote: post #253

Earlier quoted context omitted.

>>"The idea that obesity could be avoided or cured with a little bookkeeping and self control" > It absolutely can. No it can't. ;) Well, not always. I've experienced both sides of this: an effortless loss of 60 lbs with easy diet changes and bookkeeping over the course of a year and a half. And a few years later, an abject failure as the same strategy -- a moderate calorie restriction -- resulted in such profound ph…

"I know you're really attached to the energy imbalance theory of obesity. " It isn't a theory, it is a fact. It is basic thermodynamics. The human body requires a constant amount of energy for basic operation and activity. Any excess is stored as fat for future use. Creating fat requires calories that HAVE to come from food. Eat few enough calories and you WILL lose weight. Eat zero and you WILL die. Eat 20,000/day f…

The problem, which I can't work out if you know about but ignoring or are ignorant of, is that humans have inordinately strong control systems to maintain some state, as well as hugely influential effects from e.g. a gut biome.

To say "it's just thermodynamics" might be right as far as the physics goes, but it doesn't recognise that biological drives overwhelm everything. It's hugely complicated how energy expenditure and steady state energy consumption interacts with weight gain, not least because the body will invariably work to make your actions as efficient as possible to maintain weight. For example, observational studies of hunter societies that might travel large distances daily, energy requirements bear little relation to daily activity after any transition time has elapsed when compared to relatively inactive Western counterparts. These people can't just will their activities to be less efficient if they hypothetically wanted to consume more energy.

Ultimately, the biology will decide what the effect of any intervention is, regardless of how motivated or not you are. Any advice that doesn't explicitly factor that in is just hot air.

Re: Diabetes drug Mounjaro was available at $25/month, then increased to $1k/month

#278

Post by Vecr » Sat, Feb 25, 2023, 8:59 PM UTC

JaimeThompson wrote: post #154

pwinnski wrote: post #119

Earlier quoted context omitted.

I'm aware that you're upset because of shortages in the medicine you need. I think your beef should be with the pharma company seeking to maximize profits by constraining supply such that they are easily overwhelmed by off-label use, not with people seeking effective medical treatment. There's a common meme among what I've seen from diabetics complaining about the shortages: that this is a tik-tok thing, or prompted…

>Doctors are prescribing this for people who have medical conditions that make them dramatically overweight I know multiple people < 150 lbs who have gotten scrips for it with no history of diabetes.

How tall are these <150lbs people? How old? Are they men or women? Do their doctors think they show signs of possibly getting diabetes in the future? Obviously if there's a 5'10" 25 year old male with negligible risk of diabetes, they should keep their current weight or even increase it slightly by changing their body composition from majority fat to majority muscle by doing exercise. If someone's short, old, can't exercise for some reason, and might get diabetes at some point, there could be a role for a drug there.

Re: Diabetes drug Mounjaro was available at $25/month, then increased to $1k/month

#279

Post by argella » Sat, Feb 25, 2023, 9:35 PM UTC

HyperSane wrote: post #259

Dove wrote: post #253

Earlier quoted context omitted.

>>"The idea that obesity could be avoided or cured with a little bookkeeping and self control" > It absolutely can. No it can't. ;) Well, not always. I've experienced both sides of this: an effortless loss of 60 lbs with easy diet changes and bookkeeping over the course of a year and a half. And a few years later, an abject failure as the same strategy -- a moderate calorie restriction -- resulted in such profound ph…

"I know you're really attached to the energy imbalance theory of obesity. " It isn't a theory, it is a fact. It is basic thermodynamics. The human body requires a constant amount of energy for basic operation and activity. Any excess is stored as fat for future use. Creating fat requires calories that HAVE to come from food. Eat few enough calories and you WILL lose weight. Eat zero and you WILL die. Eat 20,000/day f…

"The human body requires a constant amount of energy for basic operation and activity. "

no, it doesn't. the amount it uses for basic operation and activity will change. shrinking in response to your attempts to lose weight.

Re: Diabetes drug Mounjaro was available at $25/month, then increased to $1k/month

#280

Post by azan_ » Sat, Feb 25, 2023, 9:42 PM UTC

jeroenhd wrote: post #153

HDThoreaun wrote: post #37

https://astralcodexten.substack.com/p/semaglutidonomics These new weight loss medications are the solution to obesity. Imo this is one of the biggest medical advances of the century and at least in urban areas of wealthy countries, I don’t think we’ll see obese people anymore in 10 years. The pharma companies realized they’ve got something truly revolutionary so they took the old tried and true drug dealer strategy.…

The solution to obesity is a lifestyle change, or dealing with the underlying (psychological) problems. I'm all for aiding people in their lifestyle changes, through medicine or other means, but there is no drug that can fix obesity. Medicating obesity is like taking pills to make smoking healthy. This is just the next step in the ultimate dream, losing weight without putting in effort necessary. If you need to keep…

Oh yes, weight loss has to have this moral purity where it is achieved through pure willpower, otherwise it does not count.