So... There's a miracle drug powerful enough to robustly lower people's all cause mortality, but since health insurance and life insurance are industries with vastly different time preferences, this is not a good thing for the life insurers because people just keep getting off the magic longevity drug and screwing up their predictions. Because, admittedly, it kind of sucks in the moment to be on.
And I'm guessing just based on my own experience paying for term life that the actual premia differences aren't actually enough in most cases for the life insurer to simply pay out of pocket themselves; the differences probably add up to a few hundred per year per customer, whereas a year's worth of a GLP-1 agonist probably costs a couple thousand (for now, in 2025, and probably dropping rapidly).
Huh. Second order implementation details aside, this is an extremely fortunate turn of events for us.
They aren't even that awful in maintenance -- just expensive. The unpleasant part is when you're increasing the dose. After a while at the same dose, it's more or less unnoticeable IMO.
I wouldn’t say unnoticeable, but rather a trade-off that’s fine. My stomach is definitely more sensitive, can’t handle coffee in the morning anymore, etc. It probably depends on the person.
Huh. I’m at a healthy weight but I’m taking retatrutide for IBS and it’s working wonders. Very low dose, though. I originally tried it with semaglutide before the weight loss craze kicked off and the first few days of the week were worse and the latter half of the week was better, so that didn’t make sense for me to stay on.
Maybe in the first few weeks, but their half-life is 7 days. You're not doing much besides making a hassle for yourself if your doing that after the first couple of weeks
Can you say more about retatrutide for IBS? My IBS is debilitating to the point where I usually refuse to eat food on week-long work trips, because the unplanned emergency toilet trips wreak havoc with my schedule and ability to sit in meetings all day. I'd never heard there was a solution to it.
Sure, and I totally get your issues. I was a damned wedding photographer and I'd only eat towards the very end of the night, and still had a few iffy days.
As I stated, I originally tried semaglutide with no luck. I didn't try tirzepatide. I've been taking a very low dose of retatrutide - about .5mg twice a week. It seemed to be waning in effectiveness a bit so I upped the dose to 2mg/week for now. It's a night and day difference. Most days I go to the bathroom maybe two times, as opposed to the maybe 5-10 times I would need to unmedicated.
To be clear, this isn't an approved use of the medications (and retatrutide isn't approved at all yet, though it pretty clearly will be). However, they slow down gut motility - and as a bonus for your refusing to eat during week-long work trips, they'd probably at least help with that too, in terms of hunger.
I'm not on any medications, and I've never been able to handle tea in the morning. Green, black, iced, hot, matcha. It always makes me feel nauseated unless I've eaten breakfast first. I always drink black coffee though, without problems.
I’ve been on 15mg (the highest dose) of Zepbound for the past six months. As of right this second I’ve lost 74 pounds since September 2024 when I switched to Zepbound after having a terrible experience with Ozempic/Wegovy and gaining from 260-308.
I notice no ill effects, I just had my three month checkup with the doctor and he thinks I’m good on maintenance mode at max dose, I’ve still got about 34 pounds as my total weight loss goal. Really an ideal case.
For my wife on the other hand she just has constant diarrhea which she blames on the drug, and is only on 5mg. She also gets headaches from the medicine. She’s lost only 20 pounds, even though she needs to lose another 120 or so to be “healthy weight”.
However, before she started taking Zepbound she was only able to walk a few hundred feet at a time, because her back hurt so terribly. The anti inflammatory “side effects” she’s experiencing have massively improved her quality of life, even without huge amounts of weight loss.
I'm sorry to hear about your wife's issues with it. My experience was completely the opposite. Since glp-1s slow gastric emptying they've completely ameliorated my IBS-D. It's been marvelous
I'm on 2.5mg and I just got sulfur burps, which, to me, is the worst side-effect of the lot. I've also gotten terrible diarrhea previously, even on the lowest dose, I've started and stopped it around five times. Hopefully fifth time's the charm, but yes, side-effects very much depend on the person. I have friends on 10mg and 15mg and they're fine.
My lowest sleeping heart rate is now at least 10 beats higher than before starting (it comes down during the week to about 10 over)
The night after taking the injection my sleep is crap, and the heart rate is 5+ higher again
I have lost 20lbs since mid March with no real effort, and we’re about to do some blood tests for specific cholesterol numbers, which was one of the reasons to try this out.
Parent is not saying hunger supression is a bad side effect, they just clarify that the difference in noticabeality talked about a few comments up refers to the bad ones - but the good one's remain the same.
Like if your stomach really hated taco bell and you start taking a pill and now you get the same effect from artificial sweeteners you don't care because you're still within what's normal.
That's the level of side effects these things have.
Pharmaceuticals generally do not drop in price while they are under patent. They will lobby like crazy to get on the approved 3rd party payment schemes though as that makes it "affordable" to more as then everybody pays regardless of wether you use or not.
And a treatement that you have to continue forever or fall back? Pure gold!
Insurers certaily don't mind you living longer. More payments, less payouts. They just need to update their predictive models or coverage policies to safeguard their margins. The 'problem' is transitory.
> Insurers certaily don't mind you living longer. More payments, less payouts.
There are times when this is a problem, but even then it isn't the insurance companies that are complaining. There was a big "problem" during the beginning of the AIDS epidemic. For reasons I don't quite understand, the holder of the policy (the insured) can sell their policy to a random third party. The seller sells because they need immediate cash for end of life hospice treatment. The buyer buys because they know this person is about to die and they are going to get a cash payout of more than they paid for. This was a guaranteed payout because there was no treatment. This was a rare example of an investment with zero risk and high return. If you got the virus, you were going to be dead in a few months. This is a win-win for both the deceased and the new buyer, and it is neutral for the life insurance company because either way they have to pay the same amount to someone at the time of death.
The arrival of AZT cocktails threw a monkey wrench into the whole plan because suddenly a guaranteed death is no longer guaranteed and it leads to an ethical quandary because the "investor" doesn't get a return for their "investment" unless that person dies, and now they are literally wishing death on someone. (see also: There is no such thing as a risk free investment.)
Hi there - Mounjaro user here. I've been using it for about a year at this point.
I feel sick for three days in a row after taking it. Even after several months on the same dose. I get horrible gut cramps, sour stomach, near constant nausea, and occasionally vomiting and diarrhea. I have to take my shot on Thursday night because I'll feel bad the next day and supremely sick the next two days. If I took it earlier or later in the week it would absolutely impact my ability to work during the work week.
It has had amazing effects. I've lost about 60 lbs in the last year and my A1c is now around 6.2.
It's a very effective drug, but it is brutal on my body. I'm not sure anything in the medication is causing the weight loss. It just makes me feel so sick that even if I'm hungry I don't feel like eating.
These are pretty extreme side effects for being on the drug thus long.
What dosing are you on? If you’re still doing 2.5mg (smallest available in the auto injectors) perhaps try a compounding pharmacy for a month or two and you can experiment with lower doses and a different dosing schedule?
During my peak weight loss period I found that matching my injection schedule to the 5 day half life of Tirzepatide and adjusting the dose downwards to match this schedule helped with any side effects - including the “fading” of effects those last 2 or 3 days for me. There are half life calculator spreadsheets available on the internet that can help dial it in and keep your theoretical concentration more flatline vs peaks and valleys.
The current dosing regime is based on the single FDA trial that LLY did and is certainly not going to be the common practice a decade from now. It’s largely designed around patient compliance than anything else.
That said - everyone responds to this drug much differently. My little group I’m in is all over the map. Some folks lose weight consistently with tiny doses every 2 weeks, some are going above the recommended maximum weekly dose.
I also found food choices matter. A lot. The best part of tirz for me was being given mental space to stop eating shit food and start eating “clean” consistently. When on high dosing I absolutely would have a bad day if I decided to take my shot and then eat a typical American diet later.
The primary mode of action from the drug is simply you eat less. But it shouldn’t be due to you feeling too sick to keep anything down. That sounds pretty horrible.
I wouldn't trust a compounding pharmacy with making this given some of the truly horrible horror stories I've heard, and I'm on it primarily for type 2 diabetes. This is the minimal dose that keeps my A1c and blood sugar where my internal medicine doctor wants them. The weight loss is a welcome side effect. That said, I have lost about 120 lbs in the last two years, so something I was doing before I got on Mounjaro was working. Mounjaro just helped make it consistent.
tbqh being extremely overweight sucks in a whole lot of ways. While the side effects sound miserable, they will only be temporary. The damage done to my body and metabolism as a result of being this heavy for this long piles up every day, so if I have to suffer like this then I'd rather do that than have a stroke and die in front of my family.
I’m curious what your diet is like, especially at the end of the week when the medicine is weakest. If I eat dairy, sugar, etc in the day or two before my semaglutide, I feel similarly.
It's typically a salad for lunch, usually lean protein over a complex carb for dinner (latest this week was slow cooked pulled chicken over brown rice), and typically a piece of fruit and a hard boiled egg for breakfast.
The hardest part about this diet for me has been finding sources of protein that get me at my goal with the small sizes of the meals I do eat.
I don't know how overweight you are, but could you not just reduce the dose to get fewer side effects & still have reasonable weight loss? & Did you try other GLP-1s?
I've lost 120 lbs from my peak weight. I have about 130 to go before I'm comfortable with my weight. I was severely overweight, now I'm just very overweight.
I am at the second dose up from the starting dose (5 mg vs 2.5mg), and the side effects are about the same between the two doses. They didn't start out that way, but they ended up at about the same level of misery.
I tried Trulicity when it first came out. It was not as effective, but the side effects for me personally were less.
I'm on Mounjaro for type 2 diabetes, not weight loss, so my main focus is on how it treats my t2d. The weight loss is a nice side benefit.
I mean no offense, but you have a fairly substantiated body of evidence that something in the medication is causing the weight loss. The side effects do sound really shitty though.
These medications don't work in the way many people think. The drug doesn't make you "lose weight" in the sense that it causes the body to excrete fat. Rather it interferes with the constants in the gut/brain signaling/programming system such that your brain doesn't want to eat as much. That in turn leads typically to weight loss.
The effects of the drug have helped me lose weight in two ways - one intentionally and one as a side effect.
The medication does make me feel fuller faster, so I eat less when I do eat, and I stay fuller longer. This helps me lose weight because it reduces the number of calories I consume.
The side effects make me feel so sick in those days after that I am effectively fasting all day (I have a small dinner, but keep drinking water so I don't dehydrate). That helps in losing weight.
That said, my original comment was meant slightly tongue in cheek - I know it is effective, but sometimes it's kind of darkly funny to think feeling bad from it is having the highest impact.
Which of these are issues that diabetic/pre-diabetic/obese people would be likely to suffer from anyway?
And which of them are issues that people massively changing their diet and dropping weight, while also making lifestyle changes like exercising more (due to finding it easier after losing weight) would be likely to experience?
I'm just reporting my cached knowledge of people saying they experienced some adverse side effects. Also injections are not fun, even though they are probably a lot less annoying than they look.
A once-weekly subcutaneous injection is not a big deal for most people I think, outside of those who are very afraid of needles. It's a tiny needle and you don't even feel it. I've given injections to people who are afraid of needles, and they sometimes close their eyes in fear and are begging me to "just get it over with" without even realizing that I'm already done. Anyway, all this to say that outside of needle-phobic people I think the annoyance of the injections is probably not the reason people stop taking GLP-1 agonists.
As someone who is mildly needle-phobic, I'll agree it's no big deal, but you definitely can feel it, and if you hit a blood vessel by accident, there's a (mostly painless) bump and 2-3 week bruise at the injection site, which might be a major issue for some.
Be sure to pull back on the plunger and ensure there the needle is not in a blood vessel (pulling back will draw blood into the thing and you will see).
You do not want the drug meant to subcutaneous to go into the blood steam. This is true for GPL-1s (all peptides for that matter), as well as insulin, and definitely mRNA vaccines.
Mounjaro uses a single use fully autometed injector--clean your skin, remove the cap, press the injector against your skin, then press a button. A springloaded needle penetrates you skin and a spring loaded plunger injects the medicine. You have no way to pull backthe plunger to see if you are in a vein/artery.
I've never used Ozempic, but my understanding was it used a device similar to insulin pens--dial you dosage, attach needle, insert needle, press at the base of the pen to inject the selected amount. Also no way to pull back to see if you hit a vein/artery.
Yeah, both Ozempic and Trulicity have automated systems like this, just press a button and pop. Is there even a way to hit a vein? The needle is not very deep (it's subcutaneous, just barely under the skin). And it's the stomach, which AFAIK, doesn't have a lot of exposed veins?
Either way super simple and quick. Fairly painless. I had a weird rash one time, but apart from that a total of about 15 injections haven't had any issues on either Ozempic or Trulicity in terms of injections. Others may have difficulties, but it's been super easy IMO.
You can get these drugs with a vial and needles and it’s cheaper that way. Not familiar with the autoinjectors, but the instructions when using a vial and insulin needles is definitely to pull back.
Peptides don’t have the same negatives as say insulin, but preferable to not have them in your bloodstream nonetheless.
Mounjaro uses very different designs across the world. The UK has an included needle; here in Germany you need to get them yourself, and neither is an auto-injector.
I understand if you have an autoinjector, you _can't_ do this, but this is how I was trained to give injections as an EMT-B (and paramedic training provided by the Army, as I was an Army medic).
It was common practice at some point, and keeps being taught, but it's no longer recommended even for IM by most medical associations (unless your injection site is considered high risk; but that pretty much is never the case for SubQ 4-6mm with 4-6mm needles).
I went down this rabbit hole after being handed a 100 pack of insulin needles and an estradiol vial with zero instruction - seemed irresponsible at first, but it turns out it's pretty hard to mess up.
Not sure why you are being downvoted. Some of the people using the brand name medication have some sort of auto-pen style injection but anyone using generics simply injects with an insulin pin. I always just pull back on the plunger (aspirate) before injecting. I currently take 18 shots a week (I'm very pro better living through chemistry) and do this every time. No issues.
I take 18 shots a week - Big fan of better living through chemistry
I don't even notice the SubQ shots anymore. The only annoying part is I have to lean forward to find enough belly fat when I shoot there.
Still not a huge fan of the IM injections into my legs but we all suffer for our art.
It is correct (belly). :-) I think I remember it being less painful when I was fatter? The 30G/8mm needles I'm using are smaller than your 27G/13mm needles in both dimensions; should be better, if anything. Again, it's not a big deal, but I feel it.
It’s mostly random and some people do feel it more than others.
It’s a rapidly absorbed peptide suspended in water, it could even be used with a transdermal patch, so it doesn’t matter that much where it gets in or how deep. Best to avoid painful areas though.
There's already Rybelsus. It's a bit more of a pain though as it needs to be taken on an empty stomach and you then need to wait 30-60 minutes before eating.
In the 10 or so people I know who are on it, nearly all actually seem to enjoy it - reduced addictive tendencies/bad habits, appetite control, and reduced allergies seem to pretty well outweigh the minor side effects.
I was a heavy alcoholic, and the ability to quite drinking was... amazing.
Now that I'm off, I just remind myself I never want to get back at that dark place, but I'm so very glad it made quitting just... happen. It's wild how easy it was. A little mental control in terms of "no, don't go to the liquor store" but it was habit more than physical addition at that point. This was with Rybelsus. Sober 4.5 years now. It was definitely not an intended side effect but I'm glad I was rx'd when I was. I was not in a good state.
Crazy to hear all these stories. My wife’s friend was a pack a day smoker for a decade that had transitioned into a heavy vape smoker, normal weight but couldn’t get off vaping despite trying. She tried Tirz to see if it would help and after only about 3 months she quit entirely, now completely smoke free for two months.
I'm on semaglutide for weight loss purposes, while having no other health issues relevant here.
I don't think it's made any difference to any addictive tendencies or my bad habits (and with ADHD, those certainly exist). It certainly helps with the appetite of course.
This is definitely anecdotal evidence, but it's wise to hold on longer for more data to come in before advocating for it on those grounds alone.
I’ve lost 80 pounds before GLP-1s were a thing and didn’t gain this superpower, and the last time I lost weight (about ten years ago) I went from front line desktop support to teaching myself to code and getting a job as a software engineer, so honestly maybe it’s just “not having sleep apnea”, then when I regained the weight it felt like I lost some IQ points. So you may be on to something. Also it seems to generally reduce inflammation.
My heartburn I suffered from is completely gone but that’s because I just absolutely stuffed my face, I felt like I could never eat enough food.
I had terrible side effects with Ozempic but have had minimal side effects with Zepbound that have disappeared over time. I just wake up on Thursdays and inject it first thing.
The auto pen misfired the other day and I called Eli Lilly and they immediately emailed me a voucher for a free 4 pack of the shots. It’s also eliminated my sleep apnea (via the weight loss).
Subcutaneous shots with insulin needles are basically painless. You don't even feel a prick, it's just a little pressure and then it slides in. When you get a shot at the doctor it's painful because they're intramuscular.
Ah, auto-injectors, a curious piece of technology. I've always wondered how it is to actually use one since we had these in everyone's medkit in the German army, loaded with nerve agent antidotes. Just slam it on you leg and inject through the pants were the instructions... Kinda grisly, I guess it's less emotionally charged for a weight loss drug!
For drugs like these it isn't that different from a normal injection.
The pen has about 4 doses in it so you twist it to set your dose. You attach a needle tip to the pen and give yourself a poke, press an inject button on the top and a spring loaded ratchet system pumps in the dose amount you set (making a wonderful ticking noise as it progresses). Pull out and toss the needle and put it back in the fridge for next week.
I do manual injection which involves doing the full prep work. It takes about 3x as long to setup but is still only about a 3-5 minute process in total.
I've taken these and self injected, and it was surprising that I really felt nothing - no pain at all. I suppose because they recommend in stomach, and it's not in muscle, etc.
I cant think of anything.
I take 18 shots a week, including the GLP-1 shot once a week. I don't even notice it.
I even give my wife her shot. Gotten to the point where I don't have a lot of belly fat to inject into so I have to lean forward but that's really it. I've never had a side effect from GLP-1. No nausea, nothing. Only side effect is I now have the will power not to kill a pint of ice-cream after 6pm. Its been 100% a willpower increase for me vs a physical change. Started in January at 240lbs. 210.8lbs as of this morning. Every ab is defined. Stuff is great, no idea why anyone would want to come off.
I can still eat whatever I want I just choose not to. For example, had burgers, fries and ice-cream for lunch on Saturday with the family and then just a protein shake for dinner.
I also don't snore anymore. I used to snore terribly, my wife would wake me up at least once a night to tell me to roll over. Not at all now.
Most importantly, even though I am on a ton of test and deca, my blood pressure is normal, and my cholesterol has actually gone down.
There's often side effects, including nausea, diarrhea, headaches, bloating, discomfort, etc.
As far as I can tell from forums, it's not like 5% have the side effects, it's like 80-90%.
But for the first time in decades, I felt full. I didn't want to finish a meal, it was too much.
My body regulated my food intake in what felt like a natural way.
I hadn't even realized my body had somehow lost that fundamental mechanism of appetite control. It made me realize I wasn't weak willed, something is different about my body than other people.
But it comes with a price. The side effects I had were quite bad and so I stopped (though I now read that if I switch to a different brand, I might be ok).
I often didn't want to leave the house due to a dicky tummy. It could come/go in waves. But often can last a whole week.
Plus you've got to inject yourself every week. Often you can't drink as it makes you sick. Even when you're doing everything 'right' you can feel a bit off.
If you do over-indulge (with food or drink) the side effects can sometimes be massively amplified and you feel terrible for days.
So amazing in some ways, but it's not like taking a vitamin tablet. There are costs and making one slip up can result in suddenly feeling awful for a day or two.
Perhaps I was just particularly prone to the side effects, but it seems to happen to a lot of people (I found Mumsnet threads about it useful, they are quite revealing as they seem to be fairly honest and willing to share their experiences)
From the people I know on trizepitide, side effects were strongest when upping the dosage in the protocol, particularly two days after. The advice I have received while considering it:
- change your diet. you can't eat the same food at the same volume. or even is smaller volume if the food is a burger, etc.
- watch your drinking, your tolerance for alcohol is reset, and again on the volume thing
- drink a lot of water. apparently opposite to all the volume warnings above, lol
- split dosage and inject twice a week. (i dunno, talk to your doctor. also this only works when you have a vial and not the auto-injectors, though apparently the autoinjectors are way more expensive)
On the other hand, when i ask about what happens if you go on a bender and eat two burgers and lots of fries and drink a six pack?? From people that used to gladly do that: "gross, why would i do that?" That there is the real change.
So, in a way it tortures you so much, that your brain/psyche has no other choice to very quickly adapt to it and stop you from doing the old habits that used to give comfort and joy?
I had more side effects ramping up the dose than after a while at the same dose. But they were all fairly mild. (I'm on 5mg/week of Tirzepatide; higher doses probably have more side effects.)
> If you do over-indulge (with food or drink) the side effects can sometimes be massively amplified and you feel terrible for days.
> As far as I can tell from forums, it's not like 5% have the side effects, it's like 80-90%
This is likely a sampling error, and you see it with all drugs to some extent. No-one goes on a forum to announce to the world that they’re not having any side effects from [whatever].
I’m sorry, but as one of the rare (decently) fit & nondiabetic people that have taken these drugs I’m going to call out your comment a bit.
While I have no doubt that obese people have gradually made appetite control harder for themselves, the full feeling you get on GLP meds is in no way the way us normal-weight people feel.
I too, could easy eat a whole bag of doritos after some pizza and then decide I want ice cream. I don’t do that because I know it’s an awful idea and so I maybe just have a pickle after the pizza instead.
On GLP-1 medications at a decent dose I don’t know if I could force myself to eat anything after half of my normal serving of pizza.
That’s not the way the rest of us normally are apart from rare exceptions, I assure you.
Yeah but right now we're just arguing about how strong each person's feeling of "I could eat more" is.
Personally, I really like how, on the medication, it's easy to say "nah, I'd better not". Off the medication, it's impossible, as I have to eat whatever is in front of me, or I won't stop thinking about it.
Sure, obviously there's no real way to compare that. I was just pointing out that the way it makes people feel isn't natural - as in, that's not how most skinny people feel either.
I apologize for ruining your day, that wasn't my intention. As I stated in my post I don't doubt that obese people have screwed up that signaling over time. Are your cravings off medication worse than mine? Probably. We'd pretty quickly get in to a "Is your green my green?" type discussion talking about that, which obviously has no conclusion. However, I've seen many, many people repeat something along the lines of "Wow, I guess this is what skinny people feel like all the time!" in reference to these medications. I was just pointing out that it absolutely is not how we feel, and I'm one of the fairly rare people out there that can confirm that.
The one thing that helped blunt the side effects for me was cannabis. Just a few puffs at night on the three nights after my injection made a huge difference.
I wouldn't recommend that to everyone, but it helped a lot for me.
> And I'm guessing just based on my own experience paying for term life that the actual premia differences aren't actually enough in most cases for the life insurer to simply pay out of pocket themselves; the differences probably add up to a few hundred per year per customer, whereas a year's worth of a GLP-1 agonist probably costs a couple thousand (for now, in 2025, and probably dropping rapidly).
I wonder why life insurance isnt funding more research into things like metformin, where we have amazing long standing data but haven't done the real research. See: https://www.afar.org/tame-trial
>There's a miracle drug powerful enough to robustly lower people's all cause mortality
Did I misread the article, my TL;DR of the article is that GLP-1 reduce the indicators or mortality without modifying the actual mortality (because most users return to normal indicators within about 2 years).
They do? I was under the impression people stopped taking them because they’re massively expensive. And weekly injections is a bit annoying (though should be less annoying than diabetes or death or whatever else).
There is a set of the population, and not a small one, that will quit the drug as soon as they hit the weight they feel is good enough. Even if they can afford it and are used to the shots they just feel that it is done and don't feel like they'll rebound (although most do) once off it.
No, it's a miracle drug that drops mortality by a ton. The indicators aren't being faked. The weight causes the mortality, and the weight loss reduces it, and the weight regain reintroduces it. GLP1RAs introduce some noise to the indicators but not enough to cause what you're implying.
And it's under-commented upon because it's counterintuitive, but most people stop taking it. Like, two year continuation of use is about 25%.
That's kinda wild, because it seems like holy shit if you're taking a drug that lets you drop 10-20% of your body weight from obese down to normal why would you stop taking it, but people do.
Because it costs $1000/mo and insurance wants to make it as hard as possible to get that covered because they cannot afford to pay $1000/mo * 45% of Americans without doing things to their rates that are forbidden by the ACA and, for that matter, any approximation of good sense. If people cannot afford an additional $450/mo each on average for their health care, how do you cover a critical long-term $1000/mo drug that 45% of the population needs?
Gating it behind mandatory expensive, difficult-to-schedule appointments with a specialist who is in abruptly short supply where the insurance company is doing their damndest to kick as many of them off their network as they can without getting caught to keep the shortage going is certainly part of that strategy. And the result is “people do not stay on the drug”, which is their goal, and if they don’t meet that goal they have an even bigger problem and can’t continue to exist as a functioning company.
Because the pharmacy will refuse to sell it to you.
Source: UK based friend who says the pharmacy will refuse to sell them once they fall under BMI 25 (still overweight).
They'd prefer to be on the tiny maintenance dose but it seems to be very hard to achieve (unless you're going off the market completely).
I'll dispute that, I work for one of the online pharmacies and we won't stop selling it to you once you've reached BMI 25. We do have criteria to guard against sudden or extreme weight loss, but I think the BMI criterion for that is something like < 20 BMI (don't quote me on that, as I'm not sure, but it's not 25).
We'll also keep you on a small maintenance dose if you want, that's a conversation you'll have with your clinician and they'll judge whether it's medically appropriate. As far as I know, there's usually no reason to prevent you, though.
My friend orders from Medexpress - could you maybe share at least the first letter of your pharmacy or a hint so we can try to guess the name of the helpful one?
Oh, it's Numan. If your friend has a different experience with us than what I describe, please email me and I'll look into it (email in profile or just username at Numan.com).
As far as I know, though, you can move to us from another pharmacy even with a BMI of < 25, as maintenance has different criteria than new prescription.
I'm not a clinician, though, so I may be wrong. If you want to email me, I can ask the clinicians and tell you for sure.
You can also think about it the other way - if a drug caused you to lose 10-20% of your body weight, and you're now at a good body weight after 2 years, why would you want to lose another 10-20% body weight?
I understand that's not really how it works, but people often go very much by feel more than anything else.
Because they're now "normal", so why would they continue paying for it, taking unpleasant injections, and enduring the side effects?
In this sense it's like any diet: they "work", but if you don't permanently modify your food intake, the weight comes back as soon as you go off the diet.
Another way of putting it is that people achieve their goals and wind down the usage of the drug that got them there.
I think that in a few more years the number may stay at 25% (or whatever) but that the makeup of the 25% may be different. That is, people will go off it and back on it if they see their progress reverse but that will happen to different people at different times.
I mean roughly in reference to the underlying mechanism it directly addresses, not all the downstream effects. And even that was, admittedly, sloppy, because there's some complex feedback loops involved. I guess it would be more accurate to say it is a maintenance medicine and not a complete cure, and so stopping taking it unmasks the continuing condition that is treating.
It's not like it's impossible unmedicated. Plenty of people have and will do it. Obviously most people are unable to. I was always surprised just how few prediabetics did though.
"If we assume about 65% of people who start GLP-1 medications quit by the end of year one, that creates a big problem. When someone stops the medication, they'll usually regain the weight they lost, and in two years, most of those key health indicators (like BMI, blood pressure, blood sugar and cholesterol) bounce back to their starting point. "
So in addition to the quitters returning back to normal after they got life insurance underwritten when they were healthy, we have the unknown of the longevity of people on the glp-1 drugs.
Except for extreme obesity, it is about the same as people not on the drugs . Even moderate obesity only lowers life expectancy by a few years in men and about none in women. of course, quality of life will may be worse. Obesity only meaningfully lowers life expectancy at a BMI of 40-45+ for men
Subtly different: you read "most...return to normal...within 2 years", it says "When someone stops the medication, they'll [return to baseline]"
Then from there, I click through the 65% #, assuming they have a good study on 65% of people stop after a year. Nah, they don't. It's super complex but tl;dr: specific cohort, and somehow the # getting on it in year 2 is higher than the # of people who quit in year 1.
I have a weak to medium prior, after 10m evaluating, that the entire thing might be built on more sand than it admits.
Lot of little slants that create an absolute tone - ex. multiple payouts over the "lifetime" of a life insurance policy. (sure, it's technically possible)
Also there's no citation for the idea this mortality slippage happened because of GLP-1, and it's been out for...what...a year? Maybe two?
That's an awful lot of people who were about to die, saved in the nick of time by...losing weight? Again, possible, I'm sure it even happened in some cases.
Enough to skew mortality slippage from 5.3% to 15.3%?
I thought they were 98% accurate?
Wait...is the slippage graph net life increase slippage? Or any slippage?
Because it's very strange this explosion happened in exactly the year of a global pandemic that had sky-high mortality rates for older people.
Since it's so new, of course there aren't any long-term data on GLP-1 takers. However, relying on prior knowledge about people who are good on the metrics, it can be presumed that they will do fine. And won't create financial risk for the insurer due to passing on earlier than expected. But only if they keep taking their meds and/or fix any underlying behavioral and health issues that made them obese in the first case!
Regarding the graph about slippage: yes, that looks like the Covid peak. However, even assuming this recent trend is an anomaly, the industry is in a changing landscape and needs to adapt. New metrics and criteria, and the fastest mover will capture the market. Business as usual.
I don't feel sad except for the people who managed to bring their health issues under control and now can't get life insurance.
GLP-1 isn’t new - the first trials were 20 years ago & there’s a lot of long term data from its use in diabetes management, prior to the weight loss application.
Ok, sure - but are diabetes patients representative of the whole target market for GLP-1? And there will still be an uncomfortable variable that controls the outcome - patient compliance. That's what makes life insurers woozy.
I didn't have look on the studies but I would not be surprised if a decent amount of participants were completely healthy individuals. And maybe (more from random sampling) some unsuspicious mildly overweight without other problems. Especially in the earlier cohorts of testing.
Right, you should read it though, we're in the weeds over here, it's not just sort of free-assocating chat, we're picking apart specific things about the article. One of them, as I mentioned 4 up, is that the study with the 65% # is confounded because the groupings involve type 1 diabetes, and also, the number rebounds higher than the # who stopped
I've been on GLP-1 for a month and my triglycerides halved, and my cholesterol dropped to the levels it was in my twenties. If that's not a predictor of lower mortality, there's something wrong with our fundamental medical knowledge.
Yes, I lost around 4kg. Though the triglycerides and cholesterol are mostly because I stopped eating sweets and fatty foods, not because of the weight loss itself.
The drugs do not reduce mortality much or even at all. Such drugs may improve quality of life though. Except for severe obesity, 40+ BMI, life expectancy is not lowered much in men and even less in women in the setting of obesity. It's just that being obese makes all sorts of markers worse, yet people do not die much sooner. It's more about improving quality of life.
I think this is pretty far off the cusp and seems like a bit of reddit logic "health insurance is scam, internet said so".
Health insurance is one of the rare services where incentives between consumer and business are well aligned. The vast majority of people are healthy. Healthcare is expensive in the US because the uninsured population continues to rise out of "they're not making me pay for it": There are entire tranches (in the US) also don't buy insurance and use the ER and abuse EMTALA for their primary care (most of this is actually unintentional in my opinion, it's less educated populations in the US who are repeatedly taken advantage of and left to ride on government, which is extremely eye-wateringly bad at spending money). Personal experience here working in an ER.
The real pathway in the US to success is getting those populations onto private health insurance. Obama tried a heavy handed "health insurance mandate" that hilariously somehow passed the supreme court, but was so laughable mis-aligned with American ideals even Biden wouldn't enforce it.
What is apparent though is these populations are completely willing to pay bills like their cell service, gasoline, car payments, etc before investing in the most important thing (their health). This gives me hope there is a way forward by riding these perceived essential services somehow. I'm not really sure what the answer is here, but there is at least opportunity for some creative solutions.
I also think the disagreement here between red vs blue isn't the outcome: both want people to be healthy. Red doesn't want single payer, whereas blue does. Red ignores the fact these systems don't exist, blue ignores the fact that no other country in the world has the diversity of America and there are not functional examples.
I thought about it quite a bit and I came to conclusion that it is not 100% alignment between consumer and insurance, like it would appear on the surface. To me it seems insurance in the long term is interested in health services becoming more expensive (bigger pie they can manage), but steadily. I.e. it will affect insurance negatively if costs will suddenly increase by alot in a single year while premiums are locked in. But if it will keep inflating steadily and predictable - it only gives them a larger chunk of cash to manage and profit from. There are of course limits, so it needs to align with income inflation to avoid situation where their pie is shrinking because people/government simply can't afford it anymore.
These types of arguments are somewhat worthless when they're not made in context to obesity.
What I mean is, you should be comparing the risk of GLP-1s versus the risk of obesity, because realistically this is the vast majority of people's risk analysis criteria here.
Obesity increases your risk of CVD, metabolic syndrome, diabetes, liver disease, kidney disease, joint diseases, and overall mortality. CVD, in particular, is the number 1 cause of death in many developed countries.
Like all drugs, GLP-1s come with risk. This fact, however, is worthless. We must ask if it is less risky than the aggregate sum of the above diseases. I think the answer is overwhelming yes.
Therefore, obese people should probably consider GLP-1 medications. Particularly if they have tried, and failed, weight loss before. Which every obese person has.
In addition, when considering the downside of medication, we MUST compare it to the alternatives. Many obese people are already on multiple life-long medications. Statins, hypertension medication, insulin and other diabetes management drugs, etc.
Not only do these medications require significantly more management than a GLP-1, but they, too, come with their own set of risks, which we must then add to the risk of disease.
I, personally, have taken multiple chemotherapy drugs to cure my cancer. These drugs make GLP-1s look like nothing. They have damaged my body in irreversible ways. They've aged my blood, exposed me to extreme levels of known carcinogens, raised my risk of mortality, and overall lowered my quality of life.
However, I am thankful for them. Yes, my risk of mortality is much higher. But, compared to cancer, which has a 100% chance to kill me, it was a worthy tradeoff.
Your citation measures 15-year mortality in adults 20-49. The P values for BMI's relationship with all-cause mortality and cardiac mortality were 0.071 and 0.030 respectively. It compares BMI against waist circumference and body fat percentage and suggests that the latter measures are better. I think it's misleading to say that "weight is not a primary predictor of health" based on this evidence.
First, the paper is talking about BMI rather than weight.
Second, what most people mean by "weight" in ordinary conversation is closer to body fat percentage than it is to BMI: Arnold Schwarzenegger was famously obese by BMI, but anybody who called him overweight during a conversation at the pub would likely be told he doesn't count.
Thirdly, the paper was close to statistical significance, even looking at young people and even with a cohort of a bit under 5000 people, so it doesn't rule out a correlation with BMI either (although yes, it does suggest BMI is a proxy for body fat, but this isn't a controversial statement).
Fourthly, GLP-1 agonists do reduce body fat[0], and body fat is the measure suggested by the paper you cited as being better than BMI.
I would appreciate citations. I'm a doctor on GLP-1s,who had previously convinced my mother to commence the same. In her case, it was driven clearly by failure of other methods to control her obesity and worsening liver fibrosis, on top of pre-existing diabetes. On my end, no such issues at present, but I consider it safe enough that it's a first-choice approach to robust weight loss, and I personally use it in conjunction with diet and exercise.
"Relatively high levels of significant side effects" is a vague and unhelpful claim:
High compared to what? What counts as a significant side effect here? What actually are the side effects in question? Are those side effects permanent and irreversible? Can they be avoided by adjusting the dose? Dozens of such considerations come into play.
No drug I'm aware of is perfectly safe, and I know many drugs indeed.
To the best of my knowledge, the combined risk of taking semaglutide utterly pales in comparison to the clear and present harms of obesity. The only clear downside is cost, and while I'm lucky enough to to have access to cheaper sources, they're not even that expensive when you consider the QOL and health benefits.
> Conclusion: Semaglutide displays potential for weight loss primarily through fat mass reduction. However, concerns arise from notable reductions in lean mass, especially in trials with a larger number of patients.
That's a significant long-term damage to health, quite possibly permanent for 40+ patients.
That's simply how the body reacts to a caloric deficit, without additional exercise. If you combine both IFT and resistance exercise, you find no muscle loss at all:
>Based on contemporary evidence with the addition of magnetic resonance imaging-based studies, skeletal muscle changes with GLP-1RA treatments appear to be adaptive: *reductions in muscle volume seem to be commensurate with what is expected given ageing, disease status, and weight loss achieved, and the improvement in insulin sensitivity and muscle fat infiltration likely contributes to an adaptive process with improved muscle quality, lowering the probability for loss in strength and function*
Interpreting the risks and benefits of medication isn't a trivial exercise, if you're driven by a handful of studies or ignorant of the wider context, then it's easy to be mislead.
> That's an apple to oranges comparison, because there's nothing preventing someone from taking Ozempic from exercising on the side.
Strongly disagree on this. If there was nothing preventing the patient from changing their diet and physical activity / exercise level they could lose the fat through diet and exercise without resorting to taking semaglutides in the first place. Withdrawal studies show that there is a clear tendency for the weight to rebound after withdrawal from semaglutide use, therefore it's very hard to argue that it is the weight / fat mass alone blocking patients from indulging in a healthier lifestyle.
Semaglutide may help manage sustained weight loss by e.g. reducing the effect of reduced leptin baseline, however overall I remain highly skeptical of possibility for semaglutides to be "a first-choice approach to robust weight loss".
That has nothing to do with GLP-1 agonists and everything to do with the fact that rapid weight loss without exercise and sufficient protein intake leads to substantial lean mass reduction.
It's still better unless you were woefully weak, in which case a doctor should have prescribed adequate nutrition and physical activity.
Seriously, that's just not that big of a deal. It takes like a few days at most for simple term life. Can't speak to the other policies, which I understand are mostly tax vehicles anyway, but it's not hard to simply get a new life insurance policy if your current one goes kaput.
That’s a pretty bad deal if you’re 10 years into a 20-year term, and your rates were determined prior to a decade of inflation and new pre-existing conditions.
I admit that's unfortunate. I don't think that was a "bad deal" in the sense that anyone grievously misled you or anything.
I would feel bummed out, but not angry or like I actually got ripped off, in other words. When I signed up for the 20-year term, part of what I was being asked to do was estimate how likely I think it is for this firm to actually be around for that full 20 years. That's just part of the game.
Maybe in some platonic ideal, but in practice a) consumers (and even brokers) aren’t that sophisticated, and b) likelyhood of the company being around in 20 years isn’t baked into the price. When I shopped for insurance there were only 3 options with contract terms that passed muster, and all three companies are large ones that I’d expect to be around in 20 years to a degree that has no relation to the price quotes I got.
You will be going through underwriting again, your new rate will be based on starting at an older age, and you'll have a new exclusion period begin (unless there are some provisions which prevent these in the event of a company failure). Hopefully you haven't had any significant health conditions present themselves since the original policy went into effect.
With term life insurance specifically the lifetime policy premiums are typically so low relative to the value of the policy that there's a natural bias towards insuring generally healthy people. Its not uncommon to see policies that are something like $40/month for 20 years ($9600 in premiums) for a $1mm death benefit, for example.
People with more complex medical conditions often can get life insurance from smaller, specialized providers... and at much higher rates. But the big mass-market players offering inexpensive term life products are only offering them that cheaply because they really control the risk profile during underwriting.
Yes, some life insurance companies can make mistakes or get unlucky. after a few went bankrupt from whatever you are imagining, you'd think that the remaining companies would change their risk models or simply charge higher premiums?
No. Many people have family/kids and want to care for them, and their plan A is to work until retirement. If they die prior to that, the family/kids would be in dire straits. That's plan B, the issue life insurance solves perfectly well.
That, in fact, is the general (and beneficial) function of insurance: You only need to provision for the expected loss (plus some fee for the insurance), not the maximum loss (which many people could not afford).
Suppose you want to insure your home against fire, which could create damage of say $1m with probability 0.1%.
Without insurance, you'd have to put aside savings of $1m (the maximum loss), that would remain untouched with 99.9% probability, and be used to cover the fire damage otherwise.
With insurance, you'd pay the insurer $1m * 0.1% = $1000, plus a bit on top to cover their cost and profit. In case of fire, they cover your loss. Everyone wins.
So, with insurance you replace provisioning for the maximum loss by provisioning for the expected loss plus a fee.
(That's why one should not get insurance for small items (where one can cover the max), such as baggage or mobile phones or so, but for large items, such as house, life, health).
Oh, that's what you mean. Yes, insurance is there to smooth out risks. And I agree that items you can self-insure, you probably should.
Similarly, I can't really understand insuring against expenditures that are certain. Eg insuring for the cost of routine pregnancy (as opposed to insuring for complications only). Or even worse: yearly allowances like 100 dollars flat for new glasses: just decrease my insurance premiums by that 100 dollars, please. (Unless it's a tax dodge, then it makes sense.)
Perhaps some life insurance products fall into that category. For many families, though, term life insurance plays a big part into ensuring financial security if one income earner dies prematurely.
It doesn't matter whether your counterparty for your insurance is a collective or a single individual like Warren Buffett.
The 'collective' part is a distraction when trying to understand insurance.
Similar for insurance to work you don't need to have a group of people who are in the same situation as you: in principle an insurer can work out the risks, even if you are in a unique situation.
It's just that working these things out costs time and money, so it's cheaper for you, if you are like everyone else.
Life insurance, in the past, was frequently illegal.
I'd argue that it should be illegal again, as a moral hazard (directly contributing to countless murders and other schemes) and as a particularly morbid form of gambling.
In the US, a reasonable estimate is dozens of murders per year. I don't know if we can do any better without running a study: There's no good data easily available; the murder clearance rate in the US is now quite low; most insurance killings are, of course, staged to look like accidents.
Jeez.... I guess in that scenario I become a billionaire because it will be very easy to scoop up some VC money to snoop up some of those newly unemployed actuaries to monopolize the market at a profit margin an order of magnitude larger than any of my now non-existent competition, because this is a financial product and doesn't require months of building a factory or something to offer.
If you think it's that simple, you have no idea what you're talking about.
How many years experience do you have in the insurance industry that you're so confident to talk like this?
> because this is a financial product and doesn't require months of building a factory or something to offer.
How many financial instruments have you launched? If the answer is zero, you should refrain from any conversations on the topic because your opinion literally means nothing.
I think you are misunderstanding the counterfactual.
Right now, it would be hard for an amateur to make a living starting up a new life insurance company, because there's lots of competent competition.
However, _if_ all existing life insurers went bankrupts, then, yes, you could easily make a killing by starting a new slightly less incompetent life insurance company.
I do actually think it's that simple, yes. Term life is just not that complicated a product at heart.
Onus is on you to prove that if every single life insurance provider was suddenly Thanos snapped out of existence tomorrow, we wouldn't see a swarm of hungry financial professionals swoop right back in to recreate the service within weeks. That seems like a laughable claim to me, but maybe you know something I don't.
(Edit, for future readers: ecb_penguin seems to have missed the question earlier in the thread I was responding to:
>... and the question was about the aggregate effect. What happens if all life insurers go bankrupt?
Emphasis mine. This was to clarify that yes, the original commenter meant literally all providers.)
Ok, so you have no experience and you're just making things up.
> Term life is just not that complicated a product at heart
Sure, it's easy if you don't know what you're talking about and just make stuff up!
> Onus is on you to prove that if every single life insurance provider was suddenly Thanos snapped out of existence tomorrow
Literally nobody said that would happen. Now you're arguing points that nobody made.
You have no experience in the area, arguing things nobody said. You're perfect for VC money, lmao.
> That seems like a laughable claim to me
Nobody made that claim. Why are you laughing at things nobody is saying? That's weird.
> That seems like a laughable claim to me, but maybe you know something I don't.
I would 100% guarantee people that have worked in an industry know more about it than you do.
Textbook demonstration of the Dunning-Kruger effect. You have no knowledge or experience in an area, but you're confident you know how it works, moreso than the actual experts. https://en.wikipedia.org/wiki/Dunning%E2%80%93Kruger_effect
"the Dunning–Kruger effect is the thesis that those who are incompetent in a given area tend to be ignorant of their incompetence, i.e., they lack the metacognitive ability to become aware of their incompetence. This definition lends itself to a simple explanation of the effect: incompetence often includes being unable to tell the difference between competence and incompetence."
I think this very accurately sums up your comments.
It's not different time preferences. According to time preference theory the insurers have perfect information about the future so they would have taken the change in lifespan induced by GLP-1 into account before it was even invented. The assumption that mistakes are impossible is one of the core foundations of neoclassical economics. In time preference theory the bias towards the present or future is a moral issue that you get beaten over with to enact a just world fallacy.
In liquidity preference theory insurers do not have perfect information so they must make a tradeoff between collecting information and acting on the information they already have. There will be a bias towards the present and the past, because more information is available about the past and present than the future. What's being "discounted" is uncertainty, not time. Hence there is also a general bias towards stability and conservatism (sticking with existing decisions, even if they are bound to become obsolete).
Now let's apply this to the article:
The insurers don't know if you can stick with your weight loss, so they will conservatively deny coverage until they are certain that they know your health/risk profile. According to time preference theory this would never happen since the insurer already knows whether you will succeed at weightloss or not.
And I'm guessing just based on my own experience paying for term life that the actual premia differences aren't actually enough in most cases for the life insurer to simply pay out of pocket themselves; the differences probably add up to a few hundred per year per customer, whereas a year's worth of a GLP-1 agonist probably costs a couple thousand (for now, in 2025, and probably dropping rapidly).
Huh. Second order implementation details aside, this is an extremely fortunate turn of events for us.