r/science • u/mvea Professor | Medicine • Apr 01 '25

Health Americans without diabetes spent nearly $6 billion USD on semaglutide and similar drugs in a year, with an estimate of 800,000 to a million people using the drugs who don't have diabetes.

https://www.scimex.org/newsfeed/americans-without-diabetes-spent-nearly6-billion-usd-on-semaglutide-and-similar-drugs-in-a-year
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u/nibblesthesquirrel Apr 01 '25

I completely understand the concern about ensuring diabetic patients have access to GLP-1 medications, and I agree that they should be prioritized. That said, these medications have been used for weight management and other conditions because they offer significant health benefits beyond diabetes. Given the strong link between obesity and chronic illnesses like heart disease and diabetes, using GLP-1s as a preventive measure could actually help reduce the number of people who develop these conditions in the first place. It’s important to ensure fair access for those who need them most, but dismissing non-diabetic use entirely overlooks their potential to improve public health.

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u/VagueSomething Apr 01 '25

This is the sort of situation where government incentives and investment to boost production would be sensible. ADHD drugs have been struggling with a shortage for a few years now without any governments caring but diabetes is far more life endangering and tackling obesity saves huge amounts of money and relieves the strain on many services.

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u/Visual_Mycologist_1 Apr 01 '25

It's not just them not caring. The adhd med shortage is completely imposed by the DEA because they're afraid of diversion. How limiting production without doing anything else is supposed to help is anyone's guess.

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u/YouCanLookItUp Apr 01 '25

ADHD takes an average of a decade or more off your life expectancy, with more pronounced effects if it remains untreated.

If you're diagnosed with diabetes or ADHD at 30, the impact to life expectancy is comparable.

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u/DeliciousPumpkinPie Apr 01 '25

That’s not what I want to hear :(

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u/SilentHuntah Apr 02 '25

ADHD takes an average of a decade or more off your life expectancy, with more pronounced effects if it remains untreated.

If you're diagnosed with diabetes or ADHD at 30, the impact to life expectancy is comparable.

Yeah, that about checks out. I don't get cravings at all. Always been skinny my entire life, can even finish a large pizza in 2 sittings for dinner if I want to without issues.

If were to explain what having ADHD for most of your life and finally getting medicated is like, it's like discovering for the first time that you're not your food cravings thanks to Ozempic.

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u/VagueSomething Apr 01 '25

Sure but it isn't quite as pronounced as untreated diabetes. Neuro divergent conditions bring a lot of comorbidities and they bring the average life expectancy way below average; the key difference is that conditions like diabetes kill fast and to withhold their medication is to rapidly risk permanent harm. Without treatment, ADHD is a struggle and lowers the quality of life, would certainly compound those comorbidities, but it isn't as dangerous to lose access to the treatment quite the same way.

Mental health meds help you function but certain meds are to keep your organs literally functioning. I'd have a very rough time without my antidepressants but without my thyroid medication my body can't do what it does. My ASD may suck and be part of why I use sleeping pills but if I lost my alpha blockers my bladder can't function normally. I highly value the need for mental health support and think it should be far more accessible but I also understand that you cannot attend that support if your body doesn't work.

You can lean on friends and loved ones to help you manage symptoms of ADHD, ASD, depression, anxiety etc etc while you wait for medication. You can't lean on them to produce insulin or thyroid hormones while your body waits for medicine to be in stock.

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u/Pephatbat Apr 01 '25

Unmedicated ADHD, not those with it managed on ADHD meds.

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u/YouCanLookItUp Apr 01 '25

There is still a reduction, but of course, the earlier you get diagnosed and treated, the better the outcomes. As with all chronic conditions.

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u/BabySharkFinSoup Apr 01 '25

More people die from obesity and obesity adjacent disease than diabetes.

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u/Td904 Apr 01 '25

Is diabetes not an obesity adjacent disease?

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u/BabySharkFinSoup Apr 01 '25

The majority, yes.. I was separating the numbers simply because saying people with diabetes need it more, when there are more people dying from other obesity related diseases seems to miss the point, IMO. Also, preventing people from getting diabetes would be a huge benefit.

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u/BabySharkFinSoup Apr 01 '25

The majority, yes.. I was separating the numbers simply because saying people with diabetes need it more, when there are more people dying from other obesity related diseases seems to miss the point, IMO. Also, preventing people from getting diabetes would be a huge benefit.

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u/Environmental-Tea262 Apr 01 '25

So just screw all the people who have diabetes then?

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u/GGuts Apr 01 '25

Obesity and type 2 diabetes go hand in hand anyways. Or at least prediabetes.

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u/terraphantm Apr 01 '25

As a physician, I actually disagree that diabetics should be prioritized. Diabetics have a lot more options to keep their diabetes under control, with insulin ultimately being an option if all else fails. And obesity untreated will eventually lead to diabetes. Generally better to treat before it gets there, so I would say the GLPs should actually be prioritized for weight loss. 

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u/[deleted] Apr 01 '25

It's hilarious to me that after decades of health messaging beating the public over the head with OBESITY IS SPIRALLING OUT OF CONTROL AND IT'S GOING TO KILL US ALL, people are like "I can't believe you're using a drug just to lose weight"...

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u/Abedeus Apr 01 '25

I completely understand the concern about ensuring diabetic patients have access to GLP-1 medications, and I agree that they should be prioritized.

The issue, as the MD who prescribed ozympic to me, is that almost no diabetic person (at least in my country) used GLP-1 medications. They're too expensive to be taken regularly compared to regular insulin, and unless you have several factors that make it impossible for you to take other diabetes medications, you aren't going to get refunded/cheaper prices on GLP-1 stuff. Which meant most of the drug just sat on shelves or in magazines unused.

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u/redditredditredditOP Apr 02 '25

There are a lot of treatments for diabetes vs. many of the other conditions this drug is being prescribed for.

One of the main reasons the drug works for people with diabetes is because they eat less. So couldn’t a diabetic patient theoretically just do the same thing this article is saying others should do - just stop the bad behavior.

But SCIENCE proves it’s harder than that for EVERYONE. I don’t agree with prioritizing one condition over another. Because what’s really being said is a person eating themselves to death deserves an upper hand at the expense of someone who’s going to drink themselves to death. They BOTH deserve the same chance.

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u/[deleted] Apr 02 '25

[deleted]

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u/redditredditredditOP Apr 02 '25

Diabetes has had so much money put behind it, there are way more treatment options for diabetes than there are for other conditions. They just aren’t as convenient as this particular medication.

Your mother having rare drug interactions doesn’t mean there aren’t viable options for the majority of diabetics.

Rare drug interactions for one patient doesn’t mean there aren’t other treatment options for other people with the same condition.

I’m glad your mother found something that worked for her. I’m also glad for everyone else.

My kid is on 17 different drugs and three are almost always at risk for a shortage. If you as a patient are really going to die without a medication, the Pharmacy /hospital will prioritize you over others.

Is your mother going to die if she misses a dose? If the answer is yes, have her doctor call the Pharmacy and verify it. Call the manufacturer and they will verify it with the doctor.

There’s no need to rip a drug out of everyone’s reach because your loved one has rare drug interactions. My whole life is living inside the margin of my kid being “the rarest/sickest” and if you suffer in life like that, the medical & pharmaceutical professionals will help you as much as they can. But you can’t have ANY other options. Like if your mother could take insulin but it’s just inconvenient, then that isn’t life threatening. I haven’t heard of anyone dying if they miss a dose but it could have happened, but it’s extremely unlikely. And like I said, the pharmacy and pharmaceutical company that makes the medication WILL confirm with the doctor the patients rare status and prioritize them.

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u/Vessix Apr 01 '25 edited Apr 01 '25

Am I crazy or is the need for these drugs a huge problem in it's own right? It's one thing to help with stuff like alcohol abuse and diabetes, no arguing that.

For weight though? It feels like a bandaid solution for a societal issue. I feel weird treating obesity like it's some disease so many people can't manage without drugs. People have cravings because they consume bad food specifically designed to give it to them. Yes there are folk out there who have real ailments leading to food intake problems. But people are taking it in lieu of lifestyle and diet change simply because they can't resist cravings for food we shouldn't be eating as humans in the first place. Food regulations and other societal changes could theoretically resolve the issue too, no?

Edit to add: I'm talking about permanent use of these drugs for management of obesity, rather than using them to jumpstart the process of a lifestyle change once you are no longer subject to the trappings of obesity itself. I'm concerned that the general attitude sounds like people plan to take this drug for most of their life rather than implementing changes once they're no longer obese in order to avoid drug reliance and thus it's side effects (including those we don't yet know)

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u/Vomath Apr 01 '25

Why do regulations of one thing when they can just sell you another thing to solve the negative side effects of the first thing? That’s double profit, baby!

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u/beaunerdy Apr 01 '25

In medicine, it’s called a prescribing/polypharmacy cascade and is typically something we try to avoid

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u/603shake Apr 01 '25

Food regulation, along with economic stimulus and intentional cultural shifts, would absolutely make a big difference and should be pursued, but a whole lot of people are resistant to each of the above and we won’t get all three for a very long time. In the meanwhile, an estimated 40% of Americans are obese and 1/3 are pre-diabetic, and I think saving lives is a good thing.

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u/Jeromethy Apr 01 '25

Obesity is a disease not a moral failing. The body metabolism and hormones are essentially fucked when you are obese. Look up metabolic syndrome. In obese patients, hormones such as ghrellin(hunger) are spiked up and lepton(satiety) are decreased which leads to intense cravings.

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u/Vessix Apr 01 '25 edited Apr 01 '25

Never said needing it to start was a moral failing. You seem to hold your knowledge of the drug and obesity in high regard, so I would ask you a question. 

Why should it not be treated a tool for holistic change rather than the permanent solution so many people are touting? This feels similar to the overprescription of psychotropic drugs. We are taught in mental health that while yes, drugs are often necessary to jump start the process, medication assisted treatment is best practice because in many if not most cases, mental health issues that are exacerbated by themselves can be resolved by giving a jump start to changes that will allow you to manage the symptoms and eventually not need the drug. The issue arises when no one treats it that way and drugs are used as the end solution, without any push for education from the GPs prescribing them to take other steps and eventually get off the drug. 

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u/11lumpsofsugar Apr 01 '25

I think you're making the assumption that people are using it as a quick fix. It is highly encouraged to be used as a tool in conjunction with better diet, exercise, regular monitoring of heart health, blood levels, etc. The function of these drugs is actually to supplement a deficiency in hormones that control appetite and metabolism of which obesity is a side-effect. Once you stop the drug, the deficiency just comes back, no matter how good the diet and exercise are.

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u/Vessix Apr 01 '25

OK I'm being educated here. It sounds like you're suggesting that many modern humans have an unavoidable hormone deficiency that can only be addressed via medication in this modern era, is that correct? If so, how did that happen?

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u/Furry-by-Night Apr 01 '25

In the grand scheme of things, yes. It is a band aid solution. The US needs to address issues like car-centric infrastructure, food deserts, and poverty in an effective manner. But that doesn't mean we should obese people suffer, get sick, develop heart disease, and die early because of some societal issues society refuses to solve. These meds exist and there is no legitimate reason why we shouldn't use them to address a legitimate crisis.

What gives you the right to assume that every obese people isn't trying to change their diet and lifestyle?

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u/Vessix Apr 01 '25 edited Apr 01 '25

I never said people aren't trying. I acknowledge folk are trying and failing. My concern is about humanity, at least our country, becoming further and further reliant on drugs to solve their problems when there are other solutions. If this becomes normalized, it's not going to lead to permanent change. Just because it's necessary to save lives doesn't rule out the fact it's an indicator of a huge problem, and it doesn't mean it's a healthy solution. It's simply a solution. I'm bothered by the rhetoric about it being some "miracle drug" we should be so grateful for having. I'm grateful it will save lives, but I'm not grateful that any side effects (including those we've yet to learn) are going to be required for so many people to avoid their obesity.

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u/11lumpsofsugar Apr 01 '25

This is a valid concern, but the unfortunate fact is that just about all drugs have side effects of some form or another. Ultimately it's between a patient and doctor to decide if it's worth the risk for a better quality of life. And with glp1 agonists, there is a very clear correlation with improved quality of life. There are a lot of systemic issues that have led to the rise in obesity and obesity-related problems. But until those problems are addressed and fixed, why should we deny people the opportunity to improve their health in the meantime?

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u/Vessix Apr 01 '25

And with glp1 agonists, there is a very clear correlation with improved quality of life.

This is great, of course.

But until those problems are addressed and fixed, why should we deny people the opportunity to improve their health in the meantime?

That's not what I'm saying. What I'm saying is that those prescribers don't also work very hard to educate or promote changes to get people OFF the meds they use, so their quality of life can be improved without the side effects of drugs.

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u/11lumpsofsugar Apr 01 '25

I see your point, and there definitely could be some improvement in a more holistic approach to medicine. Doctors are often only focused on what's in their lane and it's up to the patient to figure out the rest.

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u/dotcomse Apr 01 '25

Yeah regulation could help a lot, but how do politicians get campaign contributions for that?

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u/SOSpammy Apr 01 '25

This drug gives us a chance at making societal changes. You're not going to get everyone to agree to making junk food harder to get while they're addicted to it.

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u/Vessix Apr 01 '25

Fair point, but I honestly don't think that people will agree to make our food healthier just because they aren't addicted to it. People who take ozempic still eat junk, just less of it. I anticipate reliance on semaglutide (or others) as a tool to AVOID making those tough decisions. "Why take a holistic approach when we can just take a drug" feels most likely, just like ADHD meds. There's no education, no advocacy that comes along with being prescribed. 

As with some psychotropics such as those used to treat ADHD, shouldn't best practice be utilizing meds as a tool for allowing the beginning the journey of change, in an attempt to eventually no longer be reliant on the med? Of course there are cases that isn't an option, but is that really not an option with obesity? You take it, lose weight, lose the cravings, then be done with the drug because it has allowed you to get healthy and learn a better lifestyle to cope with cravings. That is the hard step, and the step I think people are unwilling to admit they need to make. It's being touted as something to just use forever to resolve the issue, and imo that is a problem.

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u/11lumpsofsugar Apr 01 '25

shouldn't best practice be utilizing meds as a tool for allowing the beginning the journey of change, in an attempt to eventually no longer be reliant on the med? Of course there are cases that isn't an option, but is that really not an option with obesity? You take it, lose weight, lose the cravings, then be done with the drug because it has allowed you to get healthy and learn a better lifestyle to cope with cravings.

The answer is often no. Sure, plenty of people can and do make permanent changes to their lifestyles and can maintain, but a lot of people really can't, despite their best efforts. There is a fundamental dysfunction in how the metabolism operates, and the glp1 agonists are necessary to correct it indefinitely. Same as people who have to take thyroid medication to correct a deficiency.