In 2011 I paid a statistician at NYU convert the phony BMI numbers into the HAMWI formula which we had used until 1985 when the CDC decided we were too fat so they gave everyone A just for breathing. All the states showed 50% obesity. Now this BMI calculation has failed and we are 70% OBESE. I know more about this subject than anyone because I don't have a D after my name-- no RD PHD or MD. The Wellness Bitch narrative that we were wholesome and ate "healthy"-- everything was cooked in Crisco so NO!-- and we also knew about adverbs-- is WRONG. We had adult pacifiers and we were sexy not sad. I should be on your PODCAST. I am 85 and know the truth. I just contacted the ACLU because the new stats showing us at 70% are being covered up by the CDC and the Media who both pretend that we are only 40% fat. If you talked to me Professor you would see a strategy to fixing this mess. My office is in SOHO.
hahaha! eager to see him take you up on it. (altho being outraged is not enuf criteria to get on the air). I never heard of HAMWI and will ck it. Thanks
I started seeing a concierge doctor a year ago because I could afford it. I've lost over 50 pounds. I reduced my blood numbers for my 3rd stage kidney disease dramatically. I've lost nearly all my visceral fat and increased my muscle mass by being much better at my daily routine. No longer on the edge of diabetes. More, I can get up off the ground easily, which is a big plus at 82! Thanks to Kara Swisher and Scott Galloway's ads, I found 'Quince,' and I've purchased 8 new cashmere sweaters, a dozen new pants, and a dozen new shirts in my much smaller size.
Thanks to GLP-1, I've been dealing with weight my entire life. Did you see I'm 82?
Another great article, Scott, thanks. I have some additional background for you. In the mid 90s, I launched a startup called Health•Zone which offered a dietary service. We built an expert-system, the precursor to AI, which embodied the expertise of dietitians, home economists, doctors, nutritional experts and chefs. For $29.95, you answered around 40 questions on your current eating habits and food preferences (likes and dislikes). You clicked a box to indicate your goal: weight-loss, reducing high-cholesterol, diabetes, or plain healthy eating. The system then generated a menu for a week's worth of eating: three meals and two snacks a day, designed expressly to suit your tastes and goal. The package included recipes and an ingredient list (tailored to your local store's stocks).
We marketed it as the easiest way to diet, given it was your preferred foods. Over three years we treated 4,000 people, and even landed a trial at the Ottawa Heart Institute—who loved it.
I should have taken the advice of the head dietitian we hired, who asked why we would even attempt this, and answered my response with, "You don't seem to realize that diet is a four-letter word."
We tried to sign up the medical profession. We hosted a dinner, served the healthy meals our chefs had designed to 100 doctors. Handed each one a small pad of "prescriptions," on which they would tick appropriate boxes and tell their patient the official medical line: the way to achieve the right result is via diet and this is the best and easiest way. We offered to pay them $5 for each patient they referred. A grey area, but then not nearly as grey as the pharmaceuticals use. And the doctors never sent us a patient—they prescribed a pill instead.
We struggled for 3 years to gain some traction, and then folded the company after burning through almost $2 million. My own money, at that. The strange thing is, I don't regard the money as a total waste Taught me how to eat. How to actually shed weight and be more healthy all round and now, 30 years later, I'm a spry 77 year old. That has to be worth something, right?
But I also learned a valuable marketing lesson: You can sell things to people that they want and don't need, but you can't sell them something they need but don't want.
So, to your post. I read about all the new drugs and new attempts to solve a basic problem which, for many people, is addressable without the cost or the lifelong lock-in. What we need is less pharma and more education. More companies like Health•Zone to promote the better alternative. But sadly, at the end of the day, popping a pill and overeating seems to be the American way. And yes, Canada is not in quite the same boat. Our government ran a national fitness-education campaign, ParticipACTION, for decades from the 1970s, encouraging people to get active. It worked—somewhat. It moved the needle on awareness more than on waistlines, which may be the whole lesson: education can make people more aware, but knowing is never the same as doing the hard thing. Which loops right back to what I learned the expensive way—you can't sell someone something they need but don't want.
GLP-1s are the perfect addition to the Instagram filtered, Botox era. Look, there are people out there who really have no alternative to losing weight than using GLP-1s; and for those instances these drugs are a godsend. However, there are many others using these things to achieve cosmetic, not medical, goals; and these users, just like 99% of IG posters, want to only tout the benefits and GLP-1s and never discuss the nausea, gas, vomiting, etc. that so many experience.
If one is overweight and goes to the doctor, the prescription used to be "diet & exercise". We all know what we need to do, but we don't have the discipline to do it. These GLP-1s address one side of that prescription as they reduce your appetite and put you into a starvation mode. But, what is not discussed enough, is how this level of starvation makes the exercise component of the prescription even more important. Without exercise and a diet high in protein, GLP-1 users will lose muscle mass that is otherwise vital to living a long & healthy lifestyle. There's no reason to believe that a GLP-1 user is going to magically lock into the one portion of the "diet & exercise" prescription that they ignored from the doctor for years prior to GLP-1s.
For nearly 18 months now, I've been grinding through the traditional diet & exercise path. It's not easy or fun, but it's sustainable and has made me feel younger because I've gotten stronger - not weaker - in the process. I worry that those who, like me, who were overweight but have reasonable blood chemistry values will be disappointed long-term by the quick fix that GLP-1s provide and still be left needing to find a way to be discipline on their own accord of dieting & exercising.
This phase of the GLP-1 cycle reminds me of the gastric bypass fad from the prior decade. People lost a massive amount of weight, but they tended to fall into one of two camps: 1) adjust diet but ignore exercise and end up having the frailty of a 90-year old or 2) not adjust diet and ignore exercise and end up even bigger than they were before. No matter what the new miracle drug or procedure is, there is nothing we can do to escape that ultimate prescription of diet & exercise.
Oh, side effects, none to speak of except at the very beginning. Occasionally, feelings of, you know, throwing up, but very short-lived, maybe five minutes. Bowel movements, aided with an over-the-counter magnesium clean and made easy. Always use Metamusial
Ozempic has been around since 2017 when it was first approved to treat Type 2 diabetes. It cost asbout $3,000 per month in those days and there were a ton of free trials.
Ozempic has been approved for weight loss since 2021.
The big issue is SIDE EFFECTS. Games are being played with side effects by using only patient reactions since the weight loss approval. These are, of course, very short term side effects.
Persons who have been using Ozempic since 2017 have experienced a far greater depth and breadth of side effects. Scary and totally disqualifying in my view.
I am a 75-year-old diabetic for 30 years -- everybody in my family get Type 2 at age 45 -- who has managed my disease well within A1C standards through diet and exercise -- walk on Tybee Island 4X per week 5 miles, lift 3X per week, garden 20-40 hours per week.
I take a $7/month Metformin pill from Mark Cuban's drug company twice daily and get lots of sleep.
BTW, this is one of your best articles as you didn't exhibit any symptoms of TDS. Bravo and well played.
If GLP-1s are the miracle cure Wall Street thinks they are, maybe the real investment isn't pharma or AI — it's cemeteries. After all, nobody seems interested in fixing the root causes of unhealthy lifestyles anymore; we're just creating lifelong subscribers to the food, medical, and pharmaceutical industries. The only thing guaranteed to keep growing might be the number of people paying monthly fees until the day they don't.
The employer paradox has a clean explanation, and it isn't stupidity. Median job tenure in America is about four years. The payoff from treating obesity arrives over decades, the avoided heart attack at 62, the diabetes that never develops. So an employer covering GLP-1s is buying a thirty-year asset it will hold for four. The return accrues to the next employer and eventually to Medicare. Dropping coverage is individually rational and collectively mad, which is how most underinvestment works.
It also explains the July 1 flip. Medicare is the one payer that can't pass the long tail to anyone else, it owns the heart attacks either way. Of course it moved first. The value of this drug lands on whoever holds the patient longest, and nobody holds a patient longer than the government.
So the rationing question at the end is a balance sheet question. I'd say maybe 70% coverage splits cleanly along payer horizons within five years, lifetime payers in, four-year payers out. Gas and brakes at the same time is exactly what you'd predict when the foot on each pedal belongs to a different owner.
The employer paradox has a clean explanation, and it isn't stupidity. Median job tenure in America is about four years. The payoff from treating obesity arrives over decades, the avoided heart attack at 62, the diabetes that never develops. So an employer covering GLP-1s is buying a thirty-year asset it will hold for four. The return accrues to the next employer and eventually to Medicare. Dropping coverage is individually rational and collectively mad, which is how most underinvestment works.
It also explains the July 1 flip. Medicare is the one payer that can't pass the long tail to anyone else, it owns the heart attacks either way. Of course it moved first. The value of this drug lands on whoever holds the patient longest, and nobody holds a patient longer than the government.
So the rationing question at the end is a balance sheet question. I'd say maybe 70% coverage splits cleanly along payer horizons within five years, lifetime payers in, four-year payers out. Gas and brakes at the same time is exactly what you'd predict when the foot on each pedal belongs to a different owner.
While I enjoy your passion for these weight loss drugs and the potential positivity for young people's self-respect, there is insufficient information, little research, and virtually no reporting on the side effects. Several nutrition experts and physical fitness trainers I know have experience with clients suffering from very severe issues after taking these. There needs to be more comprehensive studies before such an aggresive roll out.
... and one of the biggest advertisers of FIFA? Coca-Cola. FIFA kicked tobacco out of their ad lineup years ago - maybe it's time to start recognizing the addictive and harmful component of sugary drinks too.
FWIW - as a single substance - sugar has a health consequence that Credit Suisse estimated (years ago) at over $1 trillion - per year. Just for the U.S.
In 2011 I paid a statistician at NYU convert the phony BMI numbers into the HAMWI formula which we had used until 1985 when the CDC decided we were too fat so they gave everyone A just for breathing. All the states showed 50% obesity. Now this BMI calculation has failed and we are 70% OBESE. I know more about this subject than anyone because I don't have a D after my name-- no RD PHD or MD. The Wellness Bitch narrative that we were wholesome and ate "healthy"-- everything was cooked in Crisco so NO!-- and we also knew about adverbs-- is WRONG. We had adult pacifiers and we were sexy not sad. I should be on your PODCAST. I am 85 and know the truth. I just contacted the ACLU because the new stats showing us at 70% are being covered up by the CDC and the Media who both pretend that we are only 40% fat. If you talked to me Professor you would see a strategy to fixing this mess. My office is in SOHO.
hahaha! eager to see him take you up on it. (altho being outraged is not enuf criteria to get on the air). I never heard of HAMWI and will ck it. Thanks
I started seeing a concierge doctor a year ago because I could afford it. I've lost over 50 pounds. I reduced my blood numbers for my 3rd stage kidney disease dramatically. I've lost nearly all my visceral fat and increased my muscle mass by being much better at my daily routine. No longer on the edge of diabetes. More, I can get up off the ground easily, which is a big plus at 82! Thanks to Kara Swisher and Scott Galloway's ads, I found 'Quince,' and I've purchased 8 new cashmere sweaters, a dozen new pants, and a dozen new shirts in my much smaller size.
Thanks to GLP-1, I've been dealing with weight my entire life. Did you see I'm 82?
Another great article, Scott, thanks. I have some additional background for you. In the mid 90s, I launched a startup called Health•Zone which offered a dietary service. We built an expert-system, the precursor to AI, which embodied the expertise of dietitians, home economists, doctors, nutritional experts and chefs. For $29.95, you answered around 40 questions on your current eating habits and food preferences (likes and dislikes). You clicked a box to indicate your goal: weight-loss, reducing high-cholesterol, diabetes, or plain healthy eating. The system then generated a menu for a week's worth of eating: three meals and two snacks a day, designed expressly to suit your tastes and goal. The package included recipes and an ingredient list (tailored to your local store's stocks).
We marketed it as the easiest way to diet, given it was your preferred foods. Over three years we treated 4,000 people, and even landed a trial at the Ottawa Heart Institute—who loved it.
I should have taken the advice of the head dietitian we hired, who asked why we would even attempt this, and answered my response with, "You don't seem to realize that diet is a four-letter word."
We tried to sign up the medical profession. We hosted a dinner, served the healthy meals our chefs had designed to 100 doctors. Handed each one a small pad of "prescriptions," on which they would tick appropriate boxes and tell their patient the official medical line: the way to achieve the right result is via diet and this is the best and easiest way. We offered to pay them $5 for each patient they referred. A grey area, but then not nearly as grey as the pharmaceuticals use. And the doctors never sent us a patient—they prescribed a pill instead.
We struggled for 3 years to gain some traction, and then folded the company after burning through almost $2 million. My own money, at that. The strange thing is, I don't regard the money as a total waste Taught me how to eat. How to actually shed weight and be more healthy all round and now, 30 years later, I'm a spry 77 year old. That has to be worth something, right?
But I also learned a valuable marketing lesson: You can sell things to people that they want and don't need, but you can't sell them something they need but don't want.
So, to your post. I read about all the new drugs and new attempts to solve a basic problem which, for many people, is addressable without the cost or the lifelong lock-in. What we need is less pharma and more education. More companies like Health•Zone to promote the better alternative. But sadly, at the end of the day, popping a pill and overeating seems to be the American way. And yes, Canada is not in quite the same boat. Our government ran a national fitness-education campaign, ParticipACTION, for decades from the 1970s, encouraging people to get active. It worked—somewhat. It moved the needle on awareness more than on waistlines, which may be the whole lesson: education can make people more aware, but knowing is never the same as doing the hard thing. Which loops right back to what I learned the expensive way—you can't sell someone something they need but don't want.
FWIW.. I was an early adopter of both Ozempic and then Mounjaro. The side effects weee too much for me. Not enough is said about it
Generics are the answer eventually
GLP-1s are the perfect addition to the Instagram filtered, Botox era. Look, there are people out there who really have no alternative to losing weight than using GLP-1s; and for those instances these drugs are a godsend. However, there are many others using these things to achieve cosmetic, not medical, goals; and these users, just like 99% of IG posters, want to only tout the benefits and GLP-1s and never discuss the nausea, gas, vomiting, etc. that so many experience.
If one is overweight and goes to the doctor, the prescription used to be "diet & exercise". We all know what we need to do, but we don't have the discipline to do it. These GLP-1s address one side of that prescription as they reduce your appetite and put you into a starvation mode. But, what is not discussed enough, is how this level of starvation makes the exercise component of the prescription even more important. Without exercise and a diet high in protein, GLP-1 users will lose muscle mass that is otherwise vital to living a long & healthy lifestyle. There's no reason to believe that a GLP-1 user is going to magically lock into the one portion of the "diet & exercise" prescription that they ignored from the doctor for years prior to GLP-1s.
For nearly 18 months now, I've been grinding through the traditional diet & exercise path. It's not easy or fun, but it's sustainable and has made me feel younger because I've gotten stronger - not weaker - in the process. I worry that those who, like me, who were overweight but have reasonable blood chemistry values will be disappointed long-term by the quick fix that GLP-1s provide and still be left needing to find a way to be discipline on their own accord of dieting & exercising.
This phase of the GLP-1 cycle reminds me of the gastric bypass fad from the prior decade. People lost a massive amount of weight, but they tended to fall into one of two camps: 1) adjust diet but ignore exercise and end up having the frailty of a 90-year old or 2) not adjust diet and ignore exercise and end up even bigger than they were before. No matter what the new miracle drug or procedure is, there is nothing we can do to escape that ultimate prescription of diet & exercise.
Oh, side effects, none to speak of except at the very beginning. Occasionally, feelings of, you know, throwing up, but very short-lived, maybe five minutes. Bowel movements, aided with an over-the-counter magnesium clean and made easy. Always use Metamusial
Ozempic has been around since 2017 when it was first approved to treat Type 2 diabetes. It cost asbout $3,000 per month in those days and there were a ton of free trials.
Ozempic has been approved for weight loss since 2021.
The big issue is SIDE EFFECTS. Games are being played with side effects by using only patient reactions since the weight loss approval. These are, of course, very short term side effects.
Persons who have been using Ozempic since 2017 have experienced a far greater depth and breadth of side effects. Scary and totally disqualifying in my view.
I am a 75-year-old diabetic for 30 years -- everybody in my family get Type 2 at age 45 -- who has managed my disease well within A1C standards through diet and exercise -- walk on Tybee Island 4X per week 5 miles, lift 3X per week, garden 20-40 hours per week.
I take a $7/month Metformin pill from Mark Cuban's drug company twice daily and get lots of sleep.
BTW, this is one of your best articles as you didn't exhibit any symptoms of TDS. Bravo and well played.
Cheers.
If GLP-1s are the miracle cure Wall Street thinks they are, maybe the real investment isn't pharma or AI — it's cemeteries. After all, nobody seems interested in fixing the root causes of unhealthy lifestyles anymore; we're just creating lifelong subscribers to the food, medical, and pharmaceutical industries. The only thing guaranteed to keep growing might be the number of people paying monthly fees until the day they don't.
The employer paradox has a clean explanation, and it isn't stupidity. Median job tenure in America is about four years. The payoff from treating obesity arrives over decades, the avoided heart attack at 62, the diabetes that never develops. So an employer covering GLP-1s is buying a thirty-year asset it will hold for four. The return accrues to the next employer and eventually to Medicare. Dropping coverage is individually rational and collectively mad, which is how most underinvestment works.
It also explains the July 1 flip. Medicare is the one payer that can't pass the long tail to anyone else, it owns the heart attacks either way. Of course it moved first. The value of this drug lands on whoever holds the patient longest, and nobody holds a patient longer than the government.
So the rationing question at the end is a balance sheet question. I'd say maybe 70% coverage splits cleanly along payer horizons within five years, lifetime payers in, four-year payers out. Gas and brakes at the same time is exactly what you'd predict when the foot on each pedal belongs to a different owner.
The employer paradox has a clean explanation, and it isn't stupidity. Median job tenure in America is about four years. The payoff from treating obesity arrives over decades, the avoided heart attack at 62, the diabetes that never develops. So an employer covering GLP-1s is buying a thirty-year asset it will hold for four. The return accrues to the next employer and eventually to Medicare. Dropping coverage is individually rational and collectively mad, which is how most underinvestment works.
It also explains the July 1 flip. Medicare is the one payer that can't pass the long tail to anyone else, it owns the heart attacks either way. Of course it moved first. The value of this drug lands on whoever holds the patient longest, and nobody holds a patient longer than the government.
So the rationing question at the end is a balance sheet question. I'd say maybe 70% coverage splits cleanly along payer horizons within five years, lifetime payers in, four-year payers out. Gas and brakes at the same time is exactly what you'd predict when the foot on each pedal belongs to a different owner.
Weight loss drugs are complete human destruction. Obesity is a 100% diet and lifestyle choice.
While I enjoy your passion for these weight loss drugs and the potential positivity for young people's self-respect, there is insufficient information, little research, and virtually no reporting on the side effects. Several nutrition experts and physical fitness trainers I know have experience with clients suffering from very severe issues after taking these. There needs to be more comprehensive studies before such an aggresive roll out.
... and one of the biggest advertisers of FIFA? Coca-Cola. FIFA kicked tobacco out of their ad lineup years ago - maybe it's time to start recognizing the addictive and harmful component of sugary drinks too.
FWIW - as a single substance - sugar has a health consequence that Credit Suisse estimated (years ago) at over $1 trillion - per year. Just for the U.S.
http://hc4.us/sugar