Often, I think that it’s a bad move, as the clinical effect of losing around 20 kg would have to be matched by some extremely high frequency and severe side effects. Overweight is still not sufficiently appreciated for how dangerous it is, especially after they ramped up production so much that there isn't a real shortage anymore.
Ironically, most of the people who respond well to Ozempic and stay on it have few psychiatric problems. But those who almost desperately want to get off it after a while might be those who have a psychological component to their overeating. The obvious suspect then is eating as emotional regulation. So one could extrapolate, at least as a hypothesis, that the ones who have worse life expectancy due to regained weight after a year of usage are the ones who have a double set of problems stacked against them: overweight and emotional problems. That would have a huge effect on longevity.
This is PURE free association though, no deep analysis behind it.
I have also heard about people with ADHD being on GLP1 agonists that it does a lot for their reward seeking behavior and impulse control.
This makes me wonder two things:
- Whether at some point these molecules will also start being used for ADHD and addiction treatment in general. I think they hold a lot of promise for issues rooted in the reward system.
- Whether a sizable portion of people who struggle with their weight have co-morbid ADHD which creates or worsens their overeating issues.
Have you noticed anything along these lines in your practice?
That being the case, the same behaviours have led me to a compulsive need to plan meals. Doing so has helped me lessen (not eliminate) food noise. Anecdotally, I've noticed with others as well, that this is the way. Prep - be fine. Don't prep - eat a small village.
But to add to this, I feel like there are different kinds of addictive behaviors at play that are more susceptible to one medication or the other and are based on different systems.
For instance, the food-craving reduction in GLP-1 is almost certainly not just related to reward and goal-seeking behavior. It literally affects hormone signaling for satiety, and slows down the movement of food through the stomach, and affects, globally in the body, responses to metabolic signals. And it probably has a global effect on the way every cell in the body works, which might be why there are positive health effects beyond just the weight loss.
ADHD medication, on the other hand, targets the goal-directed activity system directly. It seems much more likely to me that reduced appetite is just as much driven by the focus and "let's get shit done" mode that is artificially increased with dopamine. Both result in reduced eating but through massively different pathways. Basically, you pay attention to the biggest wave in the pond (the waves in the pond being a metaphor for all the things your brain COULD pay attention to). So when the goal-stuff gets increased in size, the food-seeking is automatically smaller by comparison, and less likely to drive your behavior and thinking.
I don't think I can say that there is much of a pattern between ADHD and overeating, just based on how easily I can predict if someone is overeating or not if I know they have ADHD. That is, it would be a coin toss.
The simplistic answer would be: Semaglutide reduces addictive behavior if it's driven by emotional regulation needs, and ADHD medication reduces pure drug-like craving. As seen in studies where people that start lisdexamfetamine (ADHD medication common in the EU) have a huge reduction in actual amphetamine abuse.
Case in point: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/... Findings In this Swedish nationwide cohort study of 13 965 individuals, lisdexamphetamine was significantly associated with a decrease in risk of hospitalization due to substance use disorder, any hospitalization or death, and all-cause mortality.
N=1, I'm on ZepBound and in general my brain is less likely to give in to things that give instant satisfaction.
It was like whatever enjoyment lightbulb that is usually activated was completely unscrewed, or like trying it for the first time as a kid when an adult lets you try a sip on a holiday. Just sitting here typing and thinking about it has me slightly nauseated. I've been telling people recently I CAN'T drink because of some new medicine I've started.
I also have BPD and am in therapy for it, but man. Food is the drug that always works. When I get into a certain mode, it's like I don't care that I'm overweight and have high blood pressure. I just crave the deliciousness and the "full feeling." And it never fails to work! I always feel more calm and happy after I eat.
Incidentally, I had been nagging him about trying ANYTHING (in addition to the therapy we were doing to find a life goal he believes in) that might help him get SOME help. Be it Adderall or Ozempic. But people are complex, and at best, a person is a Venn diagram with massive overlapping "biological susceptibility," "life situation," "negative thinking style," and inertia. The best one can do is to pull at as many threads as possible to hope the suffering unravels. So one of the threads one can pull at are medication.
Not to give advice, but just for shits and giggles, look into "vulnerable narcissism." Many describe stuff like you do and fit those traits. And don't give a shit about the negative associations and stereotypes regarding this personality. I love narcissists! It's one of the coolest personalities there is! But when you are not allowed to be proud of yourself, and all the desire for status and power gets refocused onto self-hate and learned helplessness, then it's a monster of a situation. Had so many people become awesome versions of themselves when they stop being so afraid of being arrogant :) .
Just to remember when you read about it, that the descriptions are only in the context of things having gone wrong. Every trait can manifest as something good or negative. Even psychopaths can have good and prosocial lives. For instance, some of the best ambulance workers often have high loading on psychopathy, and that makes them better at their job. Because they don't get scared. I’d rather be picked up by an ambulance worker that is curious and thinks the situation is interesting than one that is panicking and losing due to anxiety and empathy overload.
This is just a long-shot association/pattern I noticed, though. It's not worth a dime more than the sentences you put into the machine. :P
Have you observed persistent GI side-effects in your own practice, and if so, do you believe these are legitimate? Or… are they a social cover for individuals to get back to eating for psychological coping?
There has been almost a hysteria, it seems, regarding "Pancreatitis." And when I see multiple diagnoses, medications, and reports associated with Pancreatitis, I recognize a pattern I have seen many times before. Both the mental health and medical fields have periodic fixations on certain symptoms or diffuse diagnosis, and when it has the "wave-like" pattern like this, I am willing to bet it's just the latest version of "Fatigue," "Whiplash," "Repetitive Strain Injury", "lactose intolerance" or the dental amalgam controversy. Don't get me wrong. These are real things. But sometimes they just balloon beyond anything reasonable, and an unreasonable amount of people suddenly get diagnosed with it or suspect they have it. Pancreatitis is giving me that vibe over the last year or so. Copy paste this for "Stomach Paralysis".
But let's say the social benefit of alcohol has a value of 100 and a health risk score of 100. I would say that GLP-1 agonists have a health value of 500 and a risk score of 20. Nothing is without risk, but mathematically speaking, if you are overweight, I would be 25x more positive about injecting myself with Ozempic than alcohol... mathematically at least.
And to answer your question, I personally haven't seen many people stop early due to GI symptoms. And if they did stop early, I would think it was because they genuinely had a physical negative response that was horrible for them. Anecdotally, I feel the people that stop so they can get back to eating usually last at least 6 months, and probably more. I am 100% in agreement with the studies that many stop at around 1 year. So if someone stopped at 2 months, I would belive them when they said it was due to GI symptoms. But if they stopped at 1 year and CLAIMED it was due to GI symptoms, I would doubt; and guess that it was driven by missing food.
Please note that I am speculating wildly, and this is just PURELY anecdotal and stream of consciousness.
Overweight due to emotion-eating and stress-eating, taking GLP1.
Now I can binge-eat until I'm full or sick (mostly sick) and maintain weight. If I'd go off GLP1 now my weight would skyrocket.
Are there any alternatives coming out soon or generics?
United States: The main patent is expected to expire around 2032. Monthly Price: $950 - $1,350+ (cash price without insurance)
Norway: The main patent is expected to expire around 2031. Monthly Price: $109 - $301 (cash price equivalent in USD)
Basically, Tirz > Sema > Lira
https://glp1.guide/content/semaglutide-vs-tirzepatide-clinic...
https://glp1.guide/content/semaglutide-liraglutide-continue-...
https://glp1.guide/content/another-generic-liraglutide-launc...
There are group chats with tens of thousands of people and I havent seen any issues with the drug
Minimal, but minimal progress in the US was/is still progress.
Doesn't disagree with your original claim that there is low incentive for any private insurance to care regarding longevity, but figured I could add some color
If you know a "customer" of yours (an individual employee) is only going to be with you until they either change jobs or go on Medicare, then it seems the name of the game then is to make sure that nothing catastrophic happens to them until you can hand them off to someone else.
In which case, they should definitely go on ozempic. Even if the effects of ozempic immediately come off after usage, it's a short-term enough solution that benefits the insurance company, no?
Most people don’t change jobs or insurance companies every few years. When they do, it’s often within similar regions and industries so the chances of ending up right back under the same insurance company are significant.
Regardless, the issue is more complicated than your line of thinking. Insurance companies have very small profit margins. Current GLP-1 drugs are expensive, around $1,000 per month.
So each patient on GLP-1 drugs costs an extra $12K per year (roughly) or $120K per decade. That would have to offset a lot of other expenditures to break even from a pure cost perspective, which isn’t supported by the math. So the only alternative would be to raise everyone’s rates.
I know the insurance industry is the favorite target for explaining everything people dislike about healthcare right now, but at the end of the day they can’t conjure money out of nothing to cover everything at any cost demanded by drug makers. These drugs are super expensive and honestly it’s kind of amazing that so many people are getting them covered at all.
The article is about life insurance, which is very different from medical insurance.
Medical insurance companies often already go out of their way to pay early to save in the long run (e.g. free preventative care, checkups, etc.). I can’t speak to GLP-1s, but it’s possible that right now there are still active patents when used for obesity that make them crazy expensive for a few more years.
Life insurance is all about models and predictions about when you’re going to die. Any sudden change that massively impacts those models suck, because life insurers are basically gamblers with gobs of historical data they use to hedge their bets.
Literally LOLed when I read this. Health insurance companies might pay lip service to this and make some token gestures like free preventative care, but in my experience health insurance companies frequently shoot themselves in the foot by denying care that later ends up costing them even more when the patient's untreated condition worsens.
But it's also worth remembering the relative risks involved. Obesity isn't quite the ticking time bomb / public menace it's often made out to be... For smoking, you'll find studies with relative risk numbers for lung cancer over 5 for casual 1-4 times a day smokers, and the number quickly exceeds 20 for heavier smokers. In contrast, with obesity, the most severe relative risks for things like heart disease or diabetes you'll find topping out around 4 to 5 for the most obese, even then often under 3, with milder 1.1 to 2 for the bulk of obese people. (Here, ~31% of the US has BMIs between 30-40, and ~9% have BMIs over 40.) For other harms, like there was a study on dementia a few years back, you'll also find pretty mild (1.1ish) relative risks, but these end up being similar with other factors like "stress", "economic status", or "low educational attainment". Just some thought for people thinking about subsidizing or providing free stuff, the cost tradeoff with paying for other things later might not work out so neatly, and there's reason to not focus solely on obesity but also do the same sort of analysis with other factors and severity of a factor as well.
On-patent GLP-1s (all of them right now) are actually extremely expensive. Right around $1000 per month.
I don’t want to discourage anyone who needs them from seeking treatment, but their discontinuation rate can be somewhat higher than you’d think from a life-changing drug because many people don’t like certain effects or even encounter side effects.
Weight loss drugs are also a challenging category for OTC because they’re a target of abuse. People with eating disorders and body dysmorphia already seek out black market GLP-1s at a high rate and it would be a difficult situation if they could pick them up impulsively from the medicine aisle. It’s also common for people to misuse OTC medications by taking very high doses hoping for faster results, which has to be considered.
There’s a libertarian-minded angle where people say “Who cares, that’s their own problem. Medications should be free for everyone to take.” I was persuaded by those arguments when I was younger, but now I have a very different perspective after hearing about the common and strange world of OTC medicine abuse from my friends in the medical field. Just ask your doctor friends if they think Tylenol should still be OTC if you want to hear some very sad stories.
I think the short answer is that these drugs are only cost effective when applied to people actually experiencing costly diseases, rather than simply being obese. A large part of that has to do with the drugs being very expensive still.
For example, fire extinguishers and security cameras will reduce crime by more than their costs, but instead of charging you for them, plus administrative costs, and shipping them to you, your insurance provider will offer you a discount if you have them. (Really it's a price increase if you don't have them, but regulators don't like it when they call it that.)
Not everyone will benefit from GLP-1, so in this case, the most beneficial solution would be to charge higher premiums for anyone that could benefit from GLP-1 but doesn't use it.
In the US, insurance companies are generally legally mandated to cover ACIP recommended vaccines at no cost to the insured, which includes flu vaccines for everyone six months or older without contraindications.
Some do. My insurance requires a prior authorization due to the previous shortage, but it's $12/mo
Medicaid in my state also covers it for $3/mo
That the NHS is getting to a place where it’ll provide it, I’d say yes.
The article also misses regarding slippage is that Swiss Re in the link calls it a modest increase And that is mainly due to insurers Not performing the same level of medical intake (accelerated versus full underwriting). Increased competition leads to less profits. That’s pretty straightforward and not per se GLP-1s related.
And then the kicker. For not diversified portfolios of mortality risks. Those have been massively profitable for decades, in line with the general increase in age and health. GLP-1s just expands on that profitable aspect. Did I mention that the long term expected rate of return on an insurers book is quite good?
Insurers can weather a bit of slippage. Reinsurers will kick the worst offenders back in line with their AUC performance, because without diversification Or reinsurance it’s hard to stay in the market. (Capital requirements strongly favor diversification. Mono line is very hard.) That’s why Swiss Re is bringing out such rigorous studies of detailed policy events. Signaling to the reinsurance markets and the insurance companies and their actuaries!
Perhaps that works for some people. I'm glad it seems to have worked for you. But the facts of the world we live in show that it doesn't work for most. "Learn the lesson and be disciplined!" is not effective advice.
In practice, this doesn't happen that often, no, but it's a theoretical goal. Probably because we're in the pre-GLP-1 era with regard to mental health meds. Maybe that will change.
I would say that controlling what you put into your mouth is easier than controlling your anxiety.
GLP-1 in those cases helps manage the problem better.
But for those who are not in those cases where Type 2 Diabetes has sunk in, then they need to use the opportunity to get better while on it and kick themselves into high gear or they will have learned nothing from the experience
GLP-1s don't do that directly.. but at least they might help people move more, and give them confidence to do more for their health instead of seeing it as a lost cause.
There is simply no way around the simple fact that there is only 1 way to eating well long term - that is lesser, more healthy portions. GLP1 may show a person what things could and should look like, what is achievable but the path needs to be walked by themselves. The alternative is either lifelong consumption of this chemical with various bad side effects or premature death (or both, to be seen since nobody has a clue).
Considering it took you a miracle drug to learn the lesson, that seems like a humorously arrogant take.
I also quit smoking with relatively little effort twice (once in my early 20s, and then again a few years ago after I picked up smoking again during COVID). It wasn't easy-easy, but if I hear the struggles some other people go through, it was relatively easy.
Some people are just wired different. I have plenty of other issues, but on this sort of thing, for whatever reason I seem to be lucky.
I have been off since Oct 2024. Also, I did continue to lose weight the traditional way. After I stopped, a coworker told me about Vida which my work offers as a health benefit.
Using the Vida service where I got a registered dietician to show me what to eat, I tracked my food and water intake and tracked my exercise. I had protein and fiber goals to hit.
You can’t do it all on the medicine - it is a lifestyle change. The medicine was the catalyst but not the reason I kept the weight off. I wanted it. But because I wanted it, I wanted to use the support system that my work paid for.
I think there is a lesson to be learned here
This is deeply misguided. I’m glad that the little assist was enough for you, but if “healthy habits” were enough then people who’d lost weight the traditional way would keep it off.
Further, unless you’ve been off it for more than six months, I’d hold your judgement on this one.
After I stopped, a coworker told me about Vida which my work offers as a health benefit.
Using the Vida service where I got a registered dietician to show me what to eat, I tracked my food and water intake and tracked my exercise. I had protein and fiber goals to hit.
You can’t do it all on the medicine - it is a lifestyle change. The medicine was the catalyst but not the reason I kept the weight off. I wanted it. But because I wanted it, I wanted to use the support system that my work paid for.
I think there is a lesson to be learned here
The good news is that it is not impossible, and it really is possible to change bit by bit for most people suffering from obesity.
I don't think somebody who walks 10k+ a day, maybe goes to gym a couple of time a week, limits calorie intake to a comfortable and reasonable 2000 kcal per day, would suddenly bounce back to 130kg!
I've seen a few obese friends of mine lose weight and gain it back. And while I can't put words in their mouths, I have never noticed them have the attitude that "being obese will kill me."
That's because a lot of the "traditional way" methods are pseudoscience at best, outright quackery that's going to send you into serious malnutrition issues or eating disorders at worst. Every two or three months you see a new diet fad pushed through the yellow press rags, and none of it anywhere near being considered scientifically valid - usually it's some VIP shilling some crap story to explain how they lost weight, of course without telling the people that they have the time for training and the money to pay for proper food, 1:1 training and bloodwork analysis.
The biggest part of that equation is regain part. Most people quit GLP-1s because of costs. Let's fix that.
The safety profile of the drugs with diabetics, and the health benefits that come from the associated weight loss may make permanent use a net benefit for most people. There appears to be little, if any, "course correction" effect from taking it for short periods of time.
I now take a one week break every few months and have not noticed any decline in effects over time.
My suggestion would be to find an endocrinologist that specialises in obesity and these weight loss drugs. They will have dealt with patients who have experienced tolerance and have developed ways to work around it from real life experience. Obviously well-studied protocols with evidence would be preferable, but with how new these drugs are there hasn't been long enough to collect it yet.
Also it should be mostly used as an adjunct to strict diet and exercise.
Letting your weight fluctuate up and down in giant swings is, in many ways, harder on the body than just staying at a steady weight, even if it's overweight.
Making millions of people dependent on a drug to maintain basic health does not strike me as the best of ideas regardless. I understand why it's a good idea for many from an individual perspective and I'm not judging anyone, but from a societal perspective it does not seem like a reasonable solution.
The scale of the solution is allowed to match the scale of the problem which is on the order of 2/3 of adults or 200,000,000 people.
Took Wegovy (Semaglutide) for about 6 months. Barely lost any weight, would occasionally get nauseous.
Then the doc switched me to Mounjaro (Tirzepatide) + Phentermine, and holy shit, I just don’t feel like eating, almost ever. Lost 20kg in 6 months, which is all I needed to lose, never had any side effects. None.
I did feel a little weird/buzzed the first time I took Phentermine, but it went away the next day.
I feel like for many people it’s not really the physical hunger that makes them fat, it’s that annoying voice in your head telling you to snack something for no reason at all. It sometimes felt almost like drug addiction.
Tirz+Phent are great for that.
Usually it's prescribed for no more than 3 months, but the doc recommended taking it for longer. He mentioned that addiction risk is negligible for most people. Very solid doctor who specializes in those thing, so I took his word for it after a bit of Googling.
But I had a lot of muscle mass to begin with, due to years of bodybuilding. And I still have significant muscle after the diet, despite of not touching a weight during all this time (I know I should have). People still ask me about my lifting routine even though I didn't lift in like 2+ years.
Knowing myself, it'll come back within a couple of months of lifting weights and getting proper protein, once I get back to it. And I plan on doing exactly that. Being fat kind of made me lose motivation to go to the gym. It's a vicious cycle I imagine many fat people struggle with. So I prioritized losing fat first and foremost.
It has the same effect as starving yourself. Go look up pictures of "ozempic face"
"Life insurers can predict when you'll die with about 98% accuracy."
This conclusion isn't supported by the linked document. The document instead is talking about expected vs actual deaths among demographic groups as a whole, not individual people. And that expected vs actual is just history + trends. This doesn't mean that insurance can say that Joe Blow is going to die in June of 2027 with "98% accuracy", obviously.
Will you be one of them? Click here to find out!
Pretty easy to predict if you're willing to make it happen.
The problem continues to be the pharmaceutical and health insurance industries, particularly in the West. Under pressure to deliver infinite growth forever to shareholders on a quarterly basis, companies have a vested interest in making less medication at a higher price, and lobbying the government to prohibit price negotiations while mandating insurance coverage for many of these drugs.
GLP-1s might be the proverbial straw that broke the camel’s back, but there’s decades of research - and bodies - saying this over, and over, and over again.
Which reminds me: I need to call my new health insurance company to get them to cover my medication, and hopefully extend it to 90 day supplies. Because god forbid that just be an automatic thing for someone who’s taken the same medication daily in some form for a decade without adherence issues.
"Life insurers can predict when you'll die with about 98% accuracy."
"98%" appears in the citation[1], but as the ratio of actual deaths to expected deaths. (i.e. 98% of the deaths they expected actually occurred.) Some months that figure was ~104%, so it's not a measure of accuracy.
1: https://www.soa.org/4aa060/globalassets/assets/files/resourc...
Anyway, it's a pretty vague statement. What it sounds like it's saying is for the average person they can predict when they will die, and you have to decide if they mean the day, the year or the decade. But chatgpt gave me an interpretation that seems to make more sense:
> The 98 % figure is about aggregate forecasting, not clairvoyance. It means that when an insurer predicts, say, 10 000 deaths across its book in 2024, the actual count typically falls within roughly ±200. For any single customer, the prediction is still just a probability curve, not a calendar appointment with the Grim Reaper.
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.
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.
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.)
https://www.theatlantic.com/health/archive/2018/10/viatical-... "The Gay Men Who Have Lived for Years With Someone Waiting on Their Death"
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.
https://glp1.guide/content/are-glp1-side-effects-all-the-sam...
It was a while ago, but IMO the list still plays
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.
I don’t think that’s a typical experience for most people, other than the price
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)
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
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).
Because they stop taking GLP-1s after 1-2 years, not, it seems, because the meds stop working.
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.
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.
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.
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.
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.
[citation needed]
I plan on being a GLP-1 for the rest of my life. Perfectly fine with that. It seems like society has more problems with GLP-1s than its users do.
Can you share what dose?
how was this measured?
For me personally, the little bit of help in the form of forward progress on weight loss has given me a reason to be a little more methodical in my strength training, and I'm seeing a slow but consistent payoff. And as far as I can tell, I'm not fighting an uphill battle in terms of adding muscle mass at all because of the GLP-1.
Predictions of when you will die need a range in order to be attached to a number like accuracy. The attached report is not about this but about population-level mortality trends.
When I have a “refill” (here in Australia we call them “repeats”) due, my pharmacy sends me an SMS… I just reply “yes please” and that goes straight to the pharmacist who dispenses, and I get another SMS telling me the dispensed medication is ready to pick up
I’m on tirzepatide and I’m committed but I’m “going a bit slow” because the side effects started to get a bit too much. Still, my base expectation is I’m taking a GLP-1 agonist for the rest of my life, unless my doctor tells me I have to stop for some reason, or I somehow go bankrupt and can’t afford it any more.
Furthermore, there are more people not on GLP-1s than on them (even with the recent surge in popularity) so this population that can give life insurance companies "excess" profits must outnumber those the article describes where the insurance company takes a loss.
Why can't they focus on this profit opportunity?
The social difference is that we frame smoking as an addiction, and smokers as victims of the Tobacco industry. But we frame obesity as a moral failing. So, the former we're ready to jump in and help. But, the latter, we are much more hesitant.
Theoretically, economic outcomes would override these social and moral effects. But leadership is often stupid, so we'll see.
edit: and then Big Annuity lobbying to oppose this
Big Annuity can charge you more, in fact, if it has reason to believe you're going to live unusually long, so playing the GLP-1 dance with them would only be profitable in reverse. Pretend to be the unhealthiest person on the planet, lock in an annuity, then get on the drip stat.
But to your broader point, at least in the US, incentive mis-alignment on all healthcare and health insurance is possibly irredeemably broken.
https://www.labiotech.eu/in-depth/novo-nordisk-semaglutide-p...
The blind spot related to COVID is huge. There are lots of health data going haywire since 2020 and everyone seems to find any other reason but COVID for it.
GLP1 significantly reduces the risk of many mobidities and is increasingly prescribed to older people.
Also, this is incredibly likely to resolve itself once the drugs become common place after patent expiries, the actuaries will update their tables and the curve will smoothe out.
[0]: https://glp1.guide/content/if-glp1-is-so-great-why-dont-peop...
[1]: https://glp1.guide/content/patent-expirations-for-glp1-recep...
1. People do not stay on GLP1s for long, despite how effective they are
2. People often rebound harder from other forms of weight loss (dieting, temporary lifestyle changes, etc)
3. GLP1 reduces a LOT of health risks linked to obesity (heart disease being the most important IMO)
4. Older people are taking GLP1s in droves
5. Once these drugs are everywhere (they will be soon IMO in < 7 years obesity will probably be ~gone), the effects will get "priced in" to actuary tables.
No social commentary or dark humor intended -- GLP1s aren't miracle drugs but the effects (and relative lack of side effects) is miraculous.
I was wondering how big the price differences would be so I set up a quick form to collect some data points from several countries and for several products.
It would be cool if you could provide some data - I would then share it back as a reply to this thread within 1-2 days after closing the survey. The latest data entry will be possible on Sunday.
I live in California and have no claims ever. My home insurance has doubled in 4 years to almost $4000 a year. My car insurance is about $2800/yr.
So I hope insurance companies break. Like Danerys said in Gamr of Thrones, I hope someone breaks the wheel.
Car insurance companies in CA actually lose money on the state, if that makes you feel better: https://money.com/car-insurance-policies-problems-california...
There are laws that prevent them from charging enough to even break-even on the policies.
Pay some broker for a one-off consultation to advise you on how to save money.
Reality is insurance companies are now going though a cycle of "price in the actual risk" rather than "drop prices to gain customers"
I saw this:
https://media.nmfn.com/tnetwork/lifespan/index.html#0
is there anything better?
Or any slippage?
It caught my eye this explosion in slippage happened years before GLP-1s, and exactly in the year of a global pandemic that had sky-high mortality rates for older people.
humanity
Imagine that, people make up bullshit that isn't grounded in reality. Who would have thought!
Likely protective of a wide array of internal organs, likely life extending.
That same year, it paid out roughly $800B in claims.
TL;DR: there's no violin tiny enough for me to play for the life insurance industry's 'woes'.
From a quick search, Jarrah et al. (2023) "Medication Adherence and Its Influencing Factors among Patients with Heart Failure: A Cross Sectional Study" [0] discusses some of the relevant details.
The idea that a few pharmas artificially juicing a desperate population [who just want to feel good about themselves and live longer, happier lives for more than many can comfortably afford] is interfering with insurance adjustors ability to maximize profits doesn't leave me heartbroken.
It's precisely this shit that leads to people celebrating when pharma CEOs get tapped.
Huh? How would one get these electronic health records? I thought each provider keeps these and there's no public database except for vaccines? And it doesn't exist because HIPAA would make it hard?
Source? I agree that some people will regain the weight, but "usually" is an unfounded (without some data) generalization.
I understand where you're coming from, though, I used to think the same - I remember a specific situation where an obese person next to me was breathing heavily from doing something easy and me thinking "how do you hear yourself breathing audibly from doing almost nothing and not decide and just change it". Unfortunately, I got into a situation where I now understand the issue and am struggling to lose weight, despite hearing myself breathing audibly after picking up something from the floor and all the rational understanding and knowledge of what I need to do.
IMO, in a lot of cases, the first step should be going to a therapist.
With AI glasses doing this automatically for you upon seeing what your eating without u having to do anything some people may be shocked to learn how many calories they consume daily.
Currently, it's too time consuming now for the majority to do (i use GPT via texting it or talking to it to keep track as I eat out daily at healthy chains) but if it was done automagically I believe it definitely would be a substitute to Ozempic. I bet some or more would use that easily captured data that's shown to them (in the glasses or on their mobile device) to strive, make and possibly compete with their friends/family to eat less calories and carry less weight on them (be healthier). You can train your body to eat less to a lot less and for some that would definitely help them shed weight. The glasses could as well deduct calories burned from your daily walk, jog, etc.
*Being downvoted hmmm do you think AI by seeing it can't via an image calculate the calories of a burrito bought from Chipolte and other chains? All chains have nutrition information on their websites now that GPT goes and fetches. As for home cooked prepared meals I have taken pics of my food via GPT and it seemed to come close.
1. Expected high stress work day -> Coffee w/ food item in the morning
2. Stress during the day -> No exercise + large lunch.
3. Post-day -> door dash due to not feeling up for cooking.
4. Sleep -> Get 6 hours of sleep due to not having the energy to maintain bedtime discipline, getting paged, or late night meetings + childcare obligations.
5. Repeat.
This cycle continues for a few months leading to 10-20 pounds of weight gain, followed by a year long push to rebalance life and lose the weight. There is nothing that a magic calorie counter could do for this cycle other than guilt me over my door dash order at the end of the night.
If what you're suggesting worked, then the horrible cancer pics on cig packs would have long eliminated smoking.
