Is nobody here going to talk about the OBVIOUS reason people stop?
I have just completed a year on tirzepatide. I paid for it using the proceeds of a viral story from a year ago. That’s gone and some steady freelance work that used to bring in a thousand bucks a month just evaporated. I no longer have a way to pay for these drugs. Insurance won’t cover them. I am looking at purchasing from the gray market or seeing if I can maintain by stretching doses to one shot a month. I’m four pounds from a normal BMI and would be fine with this weight. Lost 68 pounds in a year without changing a thing. My diet was already pretty close to optimal and still is. I feel satisfied with slightly smaller portions and don’t experience food noise. I have the same relationship with food as my always-slender adult kids now.
I’m not going to go back to where I was a year ago. I will do whatever it takes. I’d sooner be homeless, and that’s not out of the question.
Great post. To totol aside, but agree on asking questions and even better ask something that challenges the panel - not debate but get them to say “that’s a good point “ or “glad you asked “.
Thanks, Jim. I’ve learned that asking good questions is a skill. And not everyone has that skill because they are too busy wanting to be seen as intelligent rather than asking from a place of genuine, good hearted curiosity.
That’s not how they work at all. I still feel quite a bit of pleasure in eating. I just now – for the first time ever in my life – have an “off” switch.
I had a one-scoop hot fudge sundae yesterday (the first time I’ve had ice cream in probably six months). I ate less than half of it and then I was just… done.
The first time I realized the feeling of being full I nearly cried. For 50 years I didn’t understand how it was that some people could just leave food on their plate, and now I’m one of those people.
The quick explanation is they change how insulin deals with sugar/stores fat. As a result, you aren’t constantly hungry anymore. Your body functions just like the bodies of people who are naturally thin.
I’ve eaten sweets a few times this year. They still taste good but I don’t feel the urge for them. I can walk right by the most luscious treats and feel no temptation. I had a sample of a treat in Costco yesterday. I enjoyed it. But I was good with one bite. I didn’t even consider purchasing some to take home. Without this drug I’d have wanted to.
Obesity is a chronic neuroendocrine condition. It is not a systemic problem.
People who have obesity have bodies that behave differently than people who do not. “Calories in calories out” doesn’t apply to obese people the same way it applies to people who don’t have the disease.
The neuroendocrine system determines, simply speaking, whether one stores or releases excess energy as fat. Storers have an advantage when there is food scarcity. Releasers have an advantage when there is food abundance.
GLP1’s change the brain chemistry of fat storers and allows their bodies to function like fat releasers.
Seems like insurance companies are going to reap a windfall on all those GLP-1s. The time people WILL start staying on GLP-1s, regardless, is when they get type II diabetes. Before then the choice is gain back some weight or stick yourself with a needle. After the diabetes arrives the choice is insulin or GLP-1s. Easy choice. And choosing GLPs means they will live a lot longer. How much longer? 10 years? I don't know, but maybe. The GLPs seem to cut down on the cancer risk and the Alzheimers risk too, so I would think it would be significant.
But, most of the patients who start taking GLPs for something serious will be people who signed up for life insurance decades ago. So, the insurance companies are surely also, going to experience a wave of policies that unexpectedly DON'T cash in 'on time'. Can you have a wave of something not happening? ha. Anyway, it seems like that would be a big positive impact to their bottom line.
Oh, insurers will find a way to game this in their favor. Insurers hate information asymmetry where they are the dummies. "Adverse selection" freaks them out to no end.
Vegas wasn't built on winners, and neither was Hartford, CT.
Ashwin, as a kid I was morbidly obese. In the 4th grade I weighed over 180lbs. Around the 6th or 7th grade I put myself through an exercise program, and changed my diet. By the time I hit high school, I still weighed 180lbs. I'm really concerned about the thought of giving people a weight loss drug for the rest of their life, especially since all drugs have side effects. I understand for certain people - like I used to be - it's worth any risk to get their weight down. But isn't lifestyle change greatly better, instead of just relying on a medication you can never get off of. It's almost too good of a scenario for pharma companies - customers for life, who may be sentenced to death without a chemical. It makes me doubly glad that I never had to make this choice myself.
An intervention with a 95% failure rate is not "greatly better" than an intervention with downsides but that actually works for the majority.
"Well people just need to be better and work harder!" They aren't though. I worked really hard at this and I could not keep it up until I started using a GLP1. Now I'm 70+ pounds down.
You're wishing the world was different than it is. While I'd love to live in that world, that's not the world we live in.
Really interesting read, especially from the vantage point of a UK doctor. While our healthcare model is different from the US, because of private prescribing, the downstream impact of GLP-1s is already becoming apparent. We’re seeing patients not only lose significant weight, but also improve blood pressure, lipid profiles, and HbA1c - sometimes to the point of deprescribing multiple meds.
It does raise fascinating questions about how institutions like insurers, pension schemes, and even occupational health policies will respond. I haven't seen any specific questions about GLP-1s on any insurance medical forms yet mind you! I'm sure it's only a matter of time.
If a once high-risk individual is now metabolically healthier than average thanks to semaglutide or tirzepatide, does their risk profile reset? Or will models lag behind the science?
When I was studying epidemiology in 2006, I was surprised by how interesting mortality predictions and actuarial tables were. This post points out a few very interesting elements that are largely missing from the public debate about Ozempic and other apparent wonder drugs.
I would have some concern about the underlying actuarial mortality and morbidity data. Post 2008 financial crisis, there was a big spike in middle aged male mortality, primarily related to suicides and opioids. And, the habits of the Covid years also changed the data trends.
Also, if an individual is concerned enough about their health to shell out $1,000 a month and take an injection once a week, doesn’t that indicate the kind of concern and consciousness that would in fact make them a better insurance risk?
Great perspective on how new technology affects underwriting, thank you for sharing. Insurance companies have the ability to assess your claim in the case of a bad event by looking back and seeing that you did indeed have prediabetes, obesity, high cholesterol, or hypertension, even if you didn't claim this at first. And while the initial clinical appearance on a GLP1 is more favorable, this new technology suffers from the same fate as CGMs, statins, and exercise in that it tends to not have a long half life of adherence. Hopefully we can solve for this in the future but for now, in aggregate, I suspect that the mortality tables won't change much over the long-term with the use of these medications.
Is nobody here going to talk about the OBVIOUS reason people stop?
I have just completed a year on tirzepatide. I paid for it using the proceeds of a viral story from a year ago. That’s gone and some steady freelance work that used to bring in a thousand bucks a month just evaporated. I no longer have a way to pay for these drugs. Insurance won’t cover them. I am looking at purchasing from the gray market or seeing if I can maintain by stretching doses to one shot a month. I’m four pounds from a normal BMI and would be fine with this weight. Lost 68 pounds in a year without changing a thing. My diet was already pretty close to optimal and still is. I feel satisfied with slightly smaller portions and don’t experience food noise. I have the same relationship with food as my always-slender adult kids now.
I’m not going to go back to where I was a year ago. I will do whatever it takes. I’d sooner be homeless, and that’s not out of the question.
Great post. To totol aside, but agree on asking questions and even better ask something that challenges the panel - not debate but get them to say “that’s a good point “ or “glad you asked “.
Thanks, Jim. I’ve learned that asking good questions is a skill. And not everyone has that skill because they are too busy wanting to be seen as intelligent rather than asking from a place of genuine, good hearted curiosity.
Ohh well said!
IMO there is a systemic problem leading to obesity. Take away that systemic problem and people can be non-obese again.
GLP-1 is a treatment looking for a reason to exist. That was the statin playbook that worked so well.
GLP-1 causes people to have no pleasure in eating. Let that sink in.
That’s not how they work at all. I still feel quite a bit of pleasure in eating. I just now – for the first time ever in my life – have an “off” switch.
I had a one-scoop hot fudge sundae yesterday (the first time I’ve had ice cream in probably six months). I ate less than half of it and then I was just… done.
The first time I realized the feeling of being full I nearly cried. For 50 years I didn’t understand how it was that some people could just leave food on their plate, and now I’m one of those people.
No, they don’t cause people to take no pleasure in eating. That’s not how they work at all!
How do you think they work? From what I can tell food still tastes good to people on GLP-1s but the desire for food is less.
I know how they work.
The quick explanation is they change how insulin deals with sugar/stores fat. As a result, you aren’t constantly hungry anymore. Your body functions just like the bodies of people who are naturally thin.
I’ve eaten sweets a few times this year. They still taste good but I don’t feel the urge for them. I can walk right by the most luscious treats and feel no temptation. I had a sample of a treat in Costco yesterday. I enjoyed it. But I was good with one bite. I didn’t even consider purchasing some to take home. Without this drug I’d have wanted to.
Obesity is a chronic neuroendocrine condition. It is not a systemic problem.
People who have obesity have bodies that behave differently than people who do not. “Calories in calories out” doesn’t apply to obese people the same way it applies to people who don’t have the disease.
The neuroendocrine system determines, simply speaking, whether one stores or releases excess energy as fat. Storers have an advantage when there is food scarcity. Releasers have an advantage when there is food abundance.
GLP1’s change the brain chemistry of fat storers and allows their bodies to function like fat releasers.
That tracks with how I haven’t changed my diet (because it was already good) but lost weight.
Seems like insurance companies are going to reap a windfall on all those GLP-1s. The time people WILL start staying on GLP-1s, regardless, is when they get type II diabetes. Before then the choice is gain back some weight or stick yourself with a needle. After the diabetes arrives the choice is insulin or GLP-1s. Easy choice. And choosing GLPs means they will live a lot longer. How much longer? 10 years? I don't know, but maybe. The GLPs seem to cut down on the cancer risk and the Alzheimers risk too, so I would think it would be significant.
But, most of the patients who start taking GLPs for something serious will be people who signed up for life insurance decades ago. So, the insurance companies are surely also, going to experience a wave of policies that unexpectedly DON'T cash in 'on time'. Can you have a wave of something not happening? ha. Anyway, it seems like that would be a big positive impact to their bottom line.
Oh, insurers will find a way to game this in their favor. Insurers hate information asymmetry where they are the dummies. "Adverse selection" freaks them out to no end.
Vegas wasn't built on winners, and neither was Hartford, CT.
Ashwin, as a kid I was morbidly obese. In the 4th grade I weighed over 180lbs. Around the 6th or 7th grade I put myself through an exercise program, and changed my diet. By the time I hit high school, I still weighed 180lbs. I'm really concerned about the thought of giving people a weight loss drug for the rest of their life, especially since all drugs have side effects. I understand for certain people - like I used to be - it's worth any risk to get their weight down. But isn't lifestyle change greatly better, instead of just relying on a medication you can never get off of. It's almost too good of a scenario for pharma companies - customers for life, who may be sentenced to death without a chemical. It makes me doubly glad that I never had to make this choice myself.
An intervention with a 95% failure rate is not "greatly better" than an intervention with downsides but that actually works for the majority.
"Well people just need to be better and work harder!" They aren't though. I worked really hard at this and I could not keep it up until I started using a GLP1. Now I'm 70+ pounds down.
You're wishing the world was different than it is. While I'd love to live in that world, that's not the world we live in.
Really interesting read, especially from the vantage point of a UK doctor. While our healthcare model is different from the US, because of private prescribing, the downstream impact of GLP-1s is already becoming apparent. We’re seeing patients not only lose significant weight, but also improve blood pressure, lipid profiles, and HbA1c - sometimes to the point of deprescribing multiple meds.
It does raise fascinating questions about how institutions like insurers, pension schemes, and even occupational health policies will respond. I haven't seen any specific questions about GLP-1s on any insurance medical forms yet mind you! I'm sure it's only a matter of time.
If a once high-risk individual is now metabolically healthier than average thanks to semaglutide or tirzepatide, does their risk profile reset? Or will models lag behind the science?
It's ridiculously expensive. A single mistaken classification can cost insurers millions in unexpected payouts over the life of a policy.
Can you please explain this? How many life insurance policies pay out more than one time and are for millions of dollars?
That Venn diagram is confusing to me. Heart failure intersects with diabetes and obesity, but not cardiovascular disease?
Sounds like life insurers should be paying for GLP-1 drugs
Reminds me of this scene from Disney’s original 1982 TRON movie (38 seconds)
https://m.youtube.com/watch?v=QIgl6jJZVnU&pp=ygUOVHJvbiBhY3R1YXJpYWw%3D
When I was studying epidemiology in 2006, I was surprised by how interesting mortality predictions and actuarial tables were. This post points out a few very interesting elements that are largely missing from the public debate about Ozempic and other apparent wonder drugs.
Great post. Very informative and thought-provoking. It is the constant battle, cat vs mouse :)
I would have some concern about the underlying actuarial mortality and morbidity data. Post 2008 financial crisis, there was a big spike in middle aged male mortality, primarily related to suicides and opioids. And, the habits of the Covid years also changed the data trends.
Also, if an individual is concerned enough about their health to shell out $1,000 a month and take an injection once a week, doesn’t that indicate the kind of concern and consciousness that would in fact make them a better insurance risk?
Great perspective on how new technology affects underwriting, thank you for sharing. Insurance companies have the ability to assess your claim in the case of a bad event by looking back and seeing that you did indeed have prediabetes, obesity, high cholesterol, or hypertension, even if you didn't claim this at first. And while the initial clinical appearance on a GLP1 is more favorable, this new technology suffers from the same fate as CGMs, statins, and exercise in that it tends to not have a long half life of adherence. Hopefully we can solve for this in the future but for now, in aggregate, I suspect that the mortality tables won't change much over the long-term with the use of these medications.
I cannot find a source for that 98% figure in the doc. you link to. Could you expand on where in the doc. it comes from?
IMO there is a systemic problem leading to obesity. Take away that systemic problem and people can be non-obese again.
GLP-1 is a treatment looking for a reason to exist. That was the statin playbook that worked so well.
GLP-1 causes people to have no pleasure in eating. Let that sink in.