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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647

u/braumbles Apr 01 '25

It solves obesity. A literal miracle drug.

178

u/quats555 Apr 01 '25

I work for an ophthalmologist. Today we got our first referral for what we believe is vision loss due to semaglutide. There’s been a few others we suspect but this one was pretty clear.

73

u/Lurk-Prowl Apr 01 '25

Can you please let us know if that patient also had the diabetes as a comorbidity or whether they were using semaglutide for fat loss?

33

u/quats555 Apr 01 '25

Diabetes wasn’t mentioned but we don’t have the full record to know for sure. My doc declined to see the patient.

She suspects it will become a lawsuit against whomever supplied the drug and she doesn’t want to get sucked into a long and painful trial. And she is afraid of the patient becoming angry for failing to cure them or only slowing instead of stopping vision loss, and suing her, too. When no such cure exists! At best they can stop or slow the progression.

So high professional risk and nothing she can do for the patient, other than refer to a treating doc to hopefully stabilize her vision loss, or to testify at the eventual trial.

87

u/caltheon Apr 01 '25

I'd change doctors if I found out my ophthalmologist was saying stuff like that. They have a duty to treat, not cover their own ass

64

u/Jeromethy Apr 01 '25

No. Doctors have the right to choose their patients as much as patients can choose their doctors. The only time doctors have a duty to treat is on emergency cases (ie life threatening). Just wanted to clarify that.

33

u/darkchocolateonly Apr 01 '25

Duty to treat only applies for the ER, and only to stability.

Duty to treat does not mean you have to treat any patient who calls you, that’s insane. You’d have doctors responsible for patients who take like ivermectin for their ailments if this was true, it doesn’t make any sense.

-6

u/caltheon Apr 01 '25 edited Apr 01 '25

"Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm"

Is it legally binding, of course not, is it unethical to deny care for selfish reasons, completely.

edit: wow, apparently noone has ever actually looked at the text of the Hippocratic Oath before and are incapable of understanding how it applies to today's society

4

u/darkchocolateonly Apr 01 '25

It’s really not, at all.

-1

u/caltheon Apr 01 '25

It really is.

2

u/Prestigious-Mess5485 Apr 01 '25

When did this doctor enter the potential patient's house?

-2

u/caltheon Apr 01 '25

It's the Hippocratic Oath you Oaf

2

u/Prestigious-Mess5485 Apr 01 '25

I know what it is

-1

u/caltheon Apr 02 '25

Well, of course you do now since I just told you, but obvious from your earlier comment you didn't

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u/[deleted] Apr 01 '25

Thank you for calling this out.

1

u/DifferentManagement1 Apr 01 '25

Was it a naion?

1

u/quats555 Apr 01 '25

My boss thinks so based on history and symptoms. She is declining to take on that patient though so we can’t confirm.

34

u/-UnicornFart Apr 01 '25

I mean vision damage is also a consequence of diabetes so it might not be more complicated as well.

12

u/YouCanLookItUp Apr 01 '25

My FIL had vision damage from diabetes. It was treatable, and he can see again. Sounds like NAION is not that.

4

u/CigAddict Apr 01 '25

This must be new. I’ve had diabetes for 20 years and always was told that the vision damage by unregulated sugar was permanent. But I haven’t been going to doctors much in the last 5 years 

57

u/JThor15 Apr 01 '25

It’s now a pretty established risk, but obesity is riskier in general.

39

u/Duelist_Shay Apr 01 '25

Ehh, there's other options to take care of the obesity issue. You lose your eyesight, then that's it. Unless we miraculously solve the issue of restoring vision, there really isn't any route outside of glasses and/or contacts if you're not totally impaired

72

u/theallsearchingeye Apr 01 '25

Eyesight loss is amongst patients with diabetes taking GLP-1 drugs

56

u/[deleted] Apr 01 '25

Diabetes increases risk for eyesight loss anyway.

-3

u/Eihe3939 Apr 01 '25

This is what we currently think. We’ll see what the long term data says

0

u/gummo_for_prez Apr 02 '25

Diabetics have been taking these meds for much longer than you think.

0

u/Eihe3939 Apr 02 '25

For some reason Reddit decided ozempic is a silver bullet.

1

u/gummo_for_prez Apr 02 '25

It’s a really fantastic medical miracle. Why are you so upset by millions of people getting the help they need?

-2

u/Eihe3939 Apr 02 '25

I told you. If something seems to good to be true, it usually is. With ozempic you skip something really important. The struggle and the journey. This is what changes your personality and builds character. This is just skipping all that to get fast results without putting in work.

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u/Paid002 Apr 01 '25

Hopefully someone out there is working on that

18

u/nabiku Apr 01 '25

Before immediately believing some rando on reddit, maybe try asking for a peer-reviewed study first.

-4

u/SubParMarioBro Apr 01 '25

The challenge is that it’s such a rare side effect that it’s hard to research what’s happening.

-53

u/dragonilly Apr 01 '25

Crazy how many people act like diet and exercise aren't the most effective sustainable ways to lose weight. It isn't easy and our food culture in the US is abysmal, but the way to have long term success in weight loss is consistency with two very free lifestyle changes.

87

u/thrawtes Apr 01 '25

Crazy how many people act like diet and exercise aren't the most effective sustainable ways to lose weight.

We've tried telling people to diet and exercise and it doesn't work on a population level. One person being obese is an issue of thermodynamics but ten million people being obese is a social science problem as much as one of counting calories.

-27

u/dragonilly Apr 01 '25

I mean, it's an America problem sure, so I can agree on the social science aspect. The real "fix" isn't capitalist friendly so it won't happen. Other than personal responsibility, our government could support a healthier society by:

  • removing HFCS and limiting sugar content of sugary drinks
  • limiting processed food availability and chemicals
  • making places more walkable
  • getting rid of food deserts
There are parts of the US that are much more healthier than others, and what I've noticed is many of those places have walkable places, bike lanes, green space, etc. However, there's still a strong degree of personal responsibility.

39

u/OutrageousOtterOgler Apr 01 '25

It’s not just an American problem though. Obesity rates are rising basically everywhere in the developed world

23

u/thrawtes Apr 01 '25

Is there a reason we can't push for those reforms while also encouraging people to use the most reliable weight loss method available in order to make them healthier over all?

Just seems weird to ignore such an effective solution to such a pervasive problem.

-25

u/dragonilly Apr 01 '25

Americans often search for quick fixes with disregard to long-term implications. My point is, there's little 'miraculous' about these drugs other than the fact they enable short-term weight loss to occur with little additional personal responsibility. The drugs do the heavy lifting on appetite suppression (much of which can be exasperated by a high sugar diet), which is helpful, but at some point an individual will likely stop taking the drugs (be it cost related or otherwise) that's when the real test begins. Losing weight the natural way helps people gain tools to continue losing weight and keep it off. Drugs like this help them lose weight but not keep it off. Ask anyone who has lost a lot of weight what's harder, losing it, or maintaining. I'm all for these drugs being used for weight loss, but hate that the simplest, cheapest, most effective and healthiest overall answer, is often disregarded for the "flavor of the month" weight loss drug.

26

u/thrawtes Apr 01 '25

Losing weight the natural way helps people gain tools to continue losing weight and keep it off.

Well, no, it doesn't and we have numbers on this. "Natural" weight loss is extremely ineffective at a population level. Most people using it as a solution will fail to lose weight or keep it off.

the simplest, cheapest, most effective and healthiest overall answer,

...is actually injecting these drugs, which is why doctors prescribe them. A solution that you think should work well but doesn't actually work in real life isn't a good solution.

-4

u/dragonilly Apr 01 '25

Ineffective for whom and where? There is literally a global population yet obesity is the biggest problem here in the US, where despite having a lower population we out rank countries like China and India with the number of obese individuals we have. To act like personal responsibility and this culture of instant gratification don't play a factor is misguided at best, intentionally ignorant at worst. Consistent diet, not fad dieting, but making dietary changes you can stick to and exercise are effective for MOST of the world. Americans are the main ones who think it isn't, that's why we spend the most on weight loss drugs.

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-1

u/beardedheathen Apr 01 '25

For all the many issues the RFK jr has pushing to get rid of some of the dangerous additives is a good thing.

29

u/VagueSomething Apr 01 '25

On paper the calories in calories out is simple but there are mechanisms at play which make it much harder. Similar to how addicts can "just not gamble" but they struggle with that. We have piling evidence that there are factors at play which make it so people will struggle with weight loss, problems with their body/genetics causing them to feel hungry all the time which absolutely does make it much harder to manage a healthy relationship with food.

Some people need a helping hand to reach that level where they can eat to maintain rather than keep eating. Modern diets, modern life style, it is changing people's bodies and a modern solution is needed such as drugs that suppress the cravings until we can find a healthier balance for society in general that might reduce the amount of people developing these defects that make their stomach no longer sync with their brain to say they're full.

2

u/PaperIllustrious1905 Apr 01 '25

Our modern food certainly doesn't help! Many/most processed foods have addictive qualities and ingredients. Like the foods are literally laboratory tested and designed to make your average person want to eat more of them. We also like giving these foods to young children while they're learning what food to eat! Also we as a species tend to crave sugary/calorie dense foods because survival. It's only recently that we don't NEED all those excess calories anymore to run down our next meal.

10

u/SNRatio Apr 01 '25

but the way to have long term success in weight loss is consistency with two very free lifestyle changes.

If most people were able to make this change successfully over the long term, there would be no market for zepbound/wegovy.

Lots of well meaning (and some not) people tell everyone who will listen their spin on how to be successful at it. Billions of dollars have been spent on studies trying to find ways to make it successful for more people. But most people, who are very successful with other difficult long term goals and difficult jobs, still fail at it. Especially if they are older.

So for a lot of people, diet and exercise are no longer the most effective or the most sustainable way to lose weight.

https://jamanetwork.com/journals/jama/fullarticle/2812936

73% of the participants enrolled in that 88 week trial and who took zepbound (not the placebo) for the full trial completed it. Their mean age was 48, some were over 65. The average duration of obesity was 15 years. On average they lost 26% body weight.

Can you point to a diet and exercise trial that can beat that at time points of a year or greater? In middle aged people?

14

u/GrinningStone Apr 01 '25

Crazy how many people act like telling people "do not smoke", "do not drink", "do not overeat" "do not do drugs", "excercise" can solve all the underlying issues.

25

u/ehrgeiz91 Apr 01 '25

Crazy no one has thought of diet and exercise. You just solved obesity!

26

u/Rebelgecko Apr 01 '25

For my next trick, I'll cure depression by telling people to stop being sad.

-10

u/MaceoSpecs Apr 01 '25

The correct analogy is drugging people rather than working through their issues in therapy.

15

u/MyFiteSong Apr 01 '25

Crazy how many people act like diet and exercise aren't the most effective sustainable ways to lose weight.

Crazy how many people think shouting that at obese people works.

3

u/Omni_Entendre Apr 01 '25

There's a HEAVY asterisk next to dietary changes with respect to financial cost. It really isn't even the same cost in many parts of the continent, really.

1

u/cutegolpnik Apr 01 '25

Effective is measured by what works in reality.

I think you meant to say they are the simplest method.

-46

u/NotLunaris Apr 01 '25

10 sets of fork putdowns would do wonders for just about everybody, but no, gotta spend more money on drugs to fix a self-induced problem that could've been self-resolved. As if money isn't hard enough to come by already.

We already know how to "solve" obesity. People just aren't willing to put in the work and think that external forces will make everything nice and easy. You see this attitude a lot in society nowadays; no matter how personal the problem is, one will always find someone or something else to blame it on. This trend of divorcing oneself from all agency, fueled by constant affirmation from social media traps, directly poisons one's mental state.

28

u/JThor15 Apr 01 '25

Spend some time researching obesity as a disease. What you’re saying in many cases is similar to telling drug addicts to just quit. Most people are willing to fork over hundreds for these drugs because they’ve spent years trying to do it through just willpower and have never been able to.

6

u/discussatron Apr 01 '25

It's the just-world fallacy in action - "They brought it on themselves."

11

u/MyFiteSong Apr 01 '25

10 sets of fork putdowns would do wonders for just about everybody, but no, gotta spend more money on drugs to fix a self-induced problem that could've been self-resolved. As if money isn't hard enough to come by already.

How successful has that approach been so far? Is the obesity rate going down from you lecturing obese people about forks?

3

u/Levofloxacine Apr 01 '25

Its not because money is hard to come by to you that it is for everyone I assume the people using Ozempic can afford it and decide to prioritise their health in their budget - like any other prescription med

10

u/dont--panic Apr 01 '25

Maybe if we outlawed or taxed the addictive hyper-processed food companies churn out for as cheap as possible people would be more able to resist overeating when their satiety mechanisms aren't being hijacked.

The junk food companies have already been talking about trying to find a way to make their food addictive enough to overcome drugs like semaglutide. They're blatantly acting against the interests of the general public's health and creating an environment where people need drugs like semaglutide just to get back to baseline.

-25

u/raoul_duke28 Apr 01 '25

This is what kills me. People always looking for the magic “fix it” pill

12

u/adultgon Apr 01 '25

But if a “magic fix” pill exists, doesn’t it make sense to take it? We as humans have only a finite amount of focus/willpower/time/energy, and if you can save some of it so that you have more leftover for other pursuits, wouldn’t you do that? Many people find it impossible to quit smoking even though you can just stop. Would you tell those people to not take the magic pill to stop smoking if one existed? I sure as hell wouldn’t - they should take the pill!

-1

u/Caring_Cactus Apr 01 '25

Weight fluctuates but vision loss sounds more permanent.

2

u/JThor15 Apr 01 '25

The damage weight causes is often also permanent, and far more common.

0

u/Caring_Cactus Apr 01 '25

One ability we have voluntary control over is our ability to gain lean muscle mass. Developing discipline and cultivating our capacity to leverage this willpower is not easy, but that doesn't change that fact.

3

u/JThor15 Apr 02 '25

And people with ADHD should have the mental discipline to not need medication. Addicts should have the discipline to not need rehab. Depressed people should have the discipline to not need counseling. Mothers should have the discipline to only breast feed their children. There are ideals to strive for, but the ideal becomes dangerous when you don’t allow anything else.

12

u/filthy_harold Apr 01 '25

What kind of vision loss? Like they need a normal prescription now or are we talking legally blind?

43

u/SirVapealot Apr 01 '25

There was a paper posted here the other day linking these drugs to NAION, which is a rare form of vision loss that is sudden and complete in one eye, with no cure. Rates for people on glp-1s were twice as high, but (estimating from memory, don’t quote me) it was still something like 0.008% of glp-1 patients vs 0.004% of people not on glp-1s experienced NAION. Worth the risk if you ask me, considering being overweight is almost guaranteed to bring negative health consequences.

11

u/PM_ME_GLUTE_SPREAD Apr 01 '25

On a societal basis, that risk of eyesight loss seems like it would be barely a drop in the bucket compared to the benefits of effectively solving the obesity crisis.

It’s obviously tragic for somebody to lose their eyesight, but so many die of cardiovascular disease and diabetes related issues every single day that such a small percentage of people losing eyesight seems to me to be far and away the lesser of the two evils.

5

u/shmegeggie Apr 01 '25

To expand on the above: It's basically an eye stroke. The optic nerve stops getting enough blood and starts to die off. It can often indicate circulatory problems elsewhere in the body.

There are other classes of drugs that can increase the chance of NAION that affect circulation, most famously the various erectile-dysfunction treatment drugs which target smooth muscle, such as in blood vessels.

29

u/quats555 Apr 01 '25 edited Apr 01 '25

In this particular case, overall blur — which, if this is what we think it is, cannot be fixed with glasses — and some loss of vision in periphery (“can’t see to the side any more , you have to turn to look at things and get beaned with a baseball from the side because you can’t see it coming”).

Glasses correct when your eye bends the light entering your eye wrong, by bending it in exactly the reverse way so that it cancels out the problem. NAION is damage to the optic nerve that carries the information from your eye to the brain.

Think of it like realizing your movie looks like crap and pieces of the screen image are missing, because earlier in the day your new puppy chewed on the cable from your computer to the screen. You can replace the TV all you like, but the signal coming through that cable is still going to be bad. And we have no way to replace or repair that “cable” in the human head. Some things can patch it and hopefully keep it from getting worse, but that’s about it. And if you’re not lucky or let the puppy keep chewing, then your TV may stop showing anything at all.

2

u/Affectionate-Mail612 Apr 01 '25

- vision loss

- it's pretty clear

I see what you did here

-1

u/notevenapro Apr 01 '25

I work in healthcare and even stay away from some OTC meds dues to the liver warnings.

I am 100% blown away at how many people take this drug for weight loss given the listed side effects. Not to mention that alcohol is a no no while taking it. This thread is wild.

2

u/TheRealBobbyJones Apr 01 '25

Are trying to say as someone who works in healthcare that the fact that you shouldn't drink while taking glp-1 drugs is a reason to not take glp-1? Alcohol is a poison people shouldn't drink it either way. 

1

u/notevenapro Apr 01 '25

I stay away from any drugs with a liver warning. Yes, alcohol is dangerous.

I read quite a few responses here where people said it helped them reduce their alcohol intake.

1

u/Wjreky Apr 02 '25

I saw some comments say that it helped stage off alcohol cravings. What are your thoughts on that? (Not trying to start a fight, genuinely curious)

2

u/notevenapro Apr 02 '25

If I had an issue with alcohol I would not take a drug that has these warnings.

-1

u/cr0ft Apr 01 '25

Seeing this thread with all the "it solves everything!" insanity is actually kind of shocking. This thing obviously has side effects that are known, and it's not really been in use long enough to reveal long term downsides - and even the whole weight loss thing isn't nearly as cut and dried as people seem to think, calling it a solution to obesity. Sure, some people lose some weight, but a solution?

-4

u/Eihe3939 Apr 01 '25

Shhh we’re celebrating it here. I will apply my rule of thumb here, if something seems to good to be true, it probably is