GLP-1 Drugs — the Questions Continue

Last fall, Brooke Steinberg of the New York Post wrote about a product line characterized as “companions for weight-loss drugs.” The purpose of these companions is to “allow those on the appetite-suppressing drugs to get the minerals and nutrients they need…”

Specifically, the “companion” turns out to be some sort of candy, but leaving that aside for the moment, the product is intended to partially prevent the loss of lean muscle mass, while preventing the rapid regain of weight. Admittedly, in the quest to escape the overweight condition, lean muscle mass is a thing that ought not to be sacrificed.

Obviously, the rapid regain of weight after quitting weight-loss drugs is a fate to be avoided. A question that presents itself is: In a perfect world, would candy be the perfect choice of vehicle to produce that result? It seems that the public might already be a bit too comfortable with such items as beet chewies which, even if they do not contain a single inappropriate calorie, are potentially dangerous because they habituate a user into thinking that whatever looks like candy and tastes like candy, is okay to consume.

Historically, the corporation behind this companion candy has misbehaved in all sorts of ways, like trying to corner the market on the world’s entire supply of potable water. In recent history, there has been credible evidence that, wherever babies are given enough free formula to allow their mothers’ milk to dry up, forcing the mothers to somehow find the money to buy more formula, just look around and this mega-corporation will be found.

Obviously, Nestlé is not the only outfit that profits extravagantly shady machinations — but it is rather notorious. A striking similarity can be seen between the baby formula scandal and a more current situation, namely, the weight loss drug craze.

Sneaky sales strategy

By creating a situation where mothers could not nurse their babies, the company guaranteed that sales of formula would continue. This created a situation worse than addiction, because those infants literally could not live without the substance they craved.

Today, by selling weight-loss meds that only work as long as people are taking them, the companies guarantee that sales of GLP-1 drugs will continue into infinity, because people who want to keep the weight off can’t get along without them. This may not exactly be addiction, but it certainly is a very compelling dependency.

So that is one of the current big questions. Whichever subcategory of the new weight-loss drug is involved, do patients/customers need to stay on it forever? Is the prescription tantamount to a life sentence?

A Scientific American article cites an example of why this is controversial:

A subset of clinical-trial participants who ceased taking semaglutide and stopped the study’s lifestyle interventions regained about two-thirds of their lost weight after one year.

Even if you have to do it forever, do you have to continue to do it the same way? Or will the necessity for periodic injections segue into the discovery of how to make wider and more efficient use of alternate routes? For instance, about a year ago statnews.com took a stab at answering the question, “Will oral administration replace injections?” by describing a new drug that would be taken as a pill twice a day:

Pfizer is running a Phase 2 study testing whether danuglipron can meaningfully reduce body weight for patients diagnosed with obesity, and Leerink Partners analyst David Risinger expects the company to disclose results as early as Oct. 31.

Last month, the same website updated the situation by noting that danuglipron is now being described as a once-a-day pill — when it comes out. But in the meantime,

[…] Pfizer is adding yet another preliminary study before beginning larger clinical trials that could eventually result in the medicine’s approval.

Your responses and feedback are welcome!

Source: “Nestlé rides Ozempic boom with new ‘companion’ candy for weight loss drugs,” NYPost.com,” 10/20/23
Source: “‘Breakthrough’ Obesity Drugs Are Effective but Raise Questions,” ScientificAmerican.com, 01/10/23
Source: “Pfizer’s twice daily pill for obesity hopes to rival Wegovy and Mounjaro,” StatNews.com, 10/26/23
Source: “Pfizer says it will advance once-daily GLP-1 pill after all,” StatNews.com, 07/11/23
Image by Judy Gallagher/Attribution 2.0 Generic

Freed From The Burden — Louis Anderson

In the context of “obesity plus happiness,” a recent post brought up the subject of professional comedians. There is a lot more to say about that particular demographic, and since one of the traits of an accomplished comedian is to speak with extreme honesty, most of them are worth listening to. This is especially true of Louie Anderson, who performed stand-up comedy for around 40 years, and acted in films and on TV; and who died (of cancer) two years ago at the age of 68.

Matt Zoller Seitz described Anderson as being conscious that if he ignored his size, audiences would ignore him. Consequently, at any given time, his standup act might be 50% fat jokes. Seitz writes,

The jokes were preemptive: He knew if he didn’t make them, someone else would. [He] felt he had to do them, otherwise viewers would be looking at the TV saying, “D’ya think he knows he’s fat?”

Childhood Obesity News has also mentioned, more than once, a fear that is believed to be universal among fat funny folks: If they no longer inhabit such an identifying trademark of a body, perhaps they will lose their comedic edge and be hounded out of the profession. This apparently was not the case for Anderson, who was asked by Conan O’Brien whether an extreme weight loss would cause him to drop the fat jokes from his repertoire. In that eventuality, Anderson replied that he would retire his fat jokes because “I think I’ll always be funny.”

Dark days transformed

His comedic mood varied, especially when the narrative concerned his alcoholic, abusive father, but in general what he wanted, and achieved, was to offer a gentle sort of comedy that could help people forget their troubles. He was described as a generous, beautiful, loving soul, whose pre-comedy activities included working as a counselor for troubled children.

At the beginning of the COVID-19 pandemic, Anderson already had a head start on becoming the behemoth that inactivity caused millions of other people to dread turning into. (Government agencies and medical institutions all over the world have quoted childhood obesity statistics that vary, but are universally dismaying.) Entering the COVID-19 era at close to 400 pounds he joked, “I’m on the intermittent fast. One minute I’m eating, the next minute I’m not. Then I’m eating again.”

Anderson wrote five books, including Goodbye Jumbo, Hello Cruel World, which…

[…] dealt with his lifelong efforts to come to terms with being overweight. In it, he recalled how his mom would overcompensate for the trauma her children were experiencing by overfeeding them.

He told journalists Christie D’Zurilla and Nardine Saad that the process of writing that particular autobiographical volume completely changed his life:

I was able to be freed up from that burden, and that low self-esteem and self-hatred that you get into… I decided that I was gonna change all that, and I was not gonna hate myself anymore. That I had gone through enough guilt, and enough shame, and I wanted to move on. And that I had something to offer.

Your responses and feedback are welcome!

Source: “Honoring His Mother Was Louie Anderson’s Life’s Work,” Vulture.com, 01/22/22
Source: “Comedian Louie Anderson Says He’s Lost About 40 Lbs. Through Intermittent Fasting,” People.com, 03/17/21
Source: “Stand-up comic and actor Louie Anderson, Emmy-winning ‘Baskets’ star, dies at 68,”
LATimes.com, 01/21/22
Image by Walt Disney Television/Attribution-NoDerivs 2.0 Generic

Food Is Life Is Love Is Food

Imagine being the restaurant critic of The New York Times, which is tantamount to being a professional eater. There you are in one of the world’s largest and most opulent cities, famous for (among other things) its abundance of fine dining establishments, with not only the opportunity but the obligation to eat, eat, eat. Actually, we don’t need to imagine the experience, because Frank Bruni, author of Born Round: The Secret History of a Full-Time Eater, has described the dilemma in 354-page detail.

During his five years as “one of the most loved and hated tastemakers in the New York restaurant world,” it was Bruni’s profession to dine not only in his newspaper’s native city but all over the USA. This duty coincided with his lifelong struggle against obesity.

Several Childhood Obesity News posts have mentioned the particular difficulty that many people experience in getting through holidays, when family gatherings are fraught with the emotional obligation to eat everything that isn’t nailed down. For chubby and perpetually hungry little Frank, whose mother and grandmother both existed with one purpose — to cook massive, calorie-laden meals — this was every day of his young life.

Even when his mom had misgivings and tried to impose some limits, it was impossible to avoid constant clashes with the overwhelming emotional equation: If you don’t love Grandma’s food, you don’t love Grandma. Eventually, his mom gave up and, just like Grandma, “cooked with a ferocity.”

Growing up — and out

To complicate matters further, little Frank was a naturally inactive child. If reading books could burn calories, he would have been fine. Sadly, that was not the way of things. Heading into his teens, Bruni got into swimming, but basically remained a fat kid. Then there was the considerable matter of realizing that he was gay. All the while, and rivaling his massive love for his family, the abiding passion of his young life was food.

As a college freshman, he was already into diet pills, laxatives, and bulimia. Embarking on his journalistic career, the young man weighed well over 250 pounds. Eventually, a friend hooked him up with her personal trainer, and change began to occur. By the time he became a restaurant critic, he had mastered the technique of portion control.

Reviewer Dominique Browning notes that this life story is not only told with humor, but is “embarrassingly, inspiringly honest” and adds,

I could feel the profound pleasure he took in his work — both the dining and the writing. No matter whether he was covering slow food or fast, fancy or fraught or both, he seemed to want to invite everyone to the table with him…

Another reviewer, George Ilsley, seems to have approached this autobiography from a strictly psychological angle, saying,

Even when others like him and admire the way he looks, Bruni still seems to feel fundamentally unattractive. In my opinion, he never reached the core of that false core belief, and the societal programming that drove it, like poison, into the depth of his soul.

Yet another description characterizes Born Round as a “heartbreaking and hilarious account of how he learned to love food just enough,” and opines that the book “will speak to every hungry hedonist who has ever had to rein in an appetite to avoid letting out a waistband.”

Your responses and feedback are welcome!

Source: “Weight Watcher,” NYTimes.com, 08/19/09
Source: “Born Round: The Secret History of a Full-Time Eater,” Goodreads.com, undated
Source: “Born Round: A Story of Family, Food and a Ferocious Appetite,” Goodreads.com, 09/18/17
Image: Book cover/Public Domain

Fat and Happy… Not

Just for grins, compare the latest statistics on the world’s happiest countries and the most obese countries. Recently, writer Frank Jacobs noted,

As usual, the country ranking in the annual World Happiness Report is topped by Nordic countries.

According to the Gallup World Poll, they are Finland, Iceland, Sweden, and Denmark. How do those felicitous lands stack up against the most obese countries? There are different ways to compare the statistics, mainly by “mean BMI of both sexes.” But BMI has been discredited and while most places still go by it, the more advanced have switched to other metrics, like the combined male and female obesity rate.

Still, according to the currently accepted standard of measurement, in the four happiest countries, the percentage of obese adults looks pretty good with these figures: Finland 22.2%, Iceland 21.9%, Sweden 20.6%, Denmark 19.7%.

In contrast: When measured by the combined obesity rates of both sexes, the “percentage of obese adults,” in the world’s direly affected countries is as high as 61% (Nauru), 55.0% (Cook Islands), 55.3% (Palau) and 52.9% (Marshall Islands).

Big picture, little picture

So, on a global scale, and for many reasons, the happiest humans and the most overweight humans constitute very different populations. However, narrowing the assessment down to a certain population, the professional comedians of the world look pretty darn euphoric. Of course, laughter is not always synonymous with happiness, as they will be the first to attest.

An entire sub-genre of professional comedians have suffered from the belief that if they give up their addictions — whether to alcohol, downers, uppers, food, or whatever — they will no longer be able to either mentally generate material, or perform in front of crowds. One way they handle this almost ubiquitous problem is by organizing for mutual help toward the practice of self-help.

In Atlanta, for instance, an outfit called Stand Up 4 Recovery was founded by comic Ricky Satori who, now more than 10 years sober, told reporter Kenny Murry about the early stage of his recovery process:

I could be onstage, I could say something confessional about my drug use … and I could follow it up with a punchline and experience the therapeutic value of not being suffocated with secrecy. Also, if it came up in court, I could say, “I was just kidding!”

This innovator is registered as a Certified Addiction Recovery Empowerment Specialist, and is qualified to train people to use naloxone (which saves users who overdose on opiates). He runs a mobile comedy club that honors individuals celebrating their Soberversaries by giving them support, encouragement, and even gifts. He also created a special array of “mocktails” for customers to enjoy. Collaborators include comedian/actor Taylor Neely, who also hosts the podcast “Sober Boyz.”

Father of them all

Another example of this type of service organization is the Lenny Bruce Memorial Foundation, founded by the legendary comedian’s daughter Kitty Bruce. It provides scholarships for sober living programs aligned with the foundation’s core values, which include education on how to survive daily life without using substances; focus on positivity and spirituality; self-esteem building; volunteer work; and enjoyable sober experiences.

Your responses and feedback are welcome!

Source: “Mapped: The highs and lows of the world’s happiness landscape,” BigThink.com, 05/07/24
Source: “Most Obese Countries 2024,” WorldPopulationReview.com, undated
Source: “Atlanta comedians ‘Stand Up’ for addiction and mental health recovery awareness,” WABE.org, 01/23/24
Source: “The Lenny Bruce Memorial Foundation,” LennyBruce.org, undated
Image by Stand Up 4 Recovery

Dicey Substances and Treacherous Fakes, Part 2

This post continues a recent post, and this one is as disturbing as the other. Last month, Registered Dietitian Catherine Rall told Healthline.com,

Any time you’re taking an unregulated drug, you’re taking a huge risk since it could literally contain anything. The best case scenario, outside of the unlikely idea that someone is selling Ozempic at below-market prices, is that you get an inert placebo. There’s also a huge risk that you’re putting something dangerous into your body.

The article also notes the warning voiced by Registered Nurse Nancy Mitchell, that the customer risks receiving harmful toxins, including heavy metals:

Every year, hundreds of people show up in the ER with severe allergic reactions or lead poisoning that they acquired from some unknown generic source.

Of course, the World Health Organization warns the public about counterfeit websites, but given the high prices of bona fide pharmaceuticals, the widespread shortages, and the human tendency to hope for and believe in the impossible, caution is unlikely to be observed. Face it, most of us are nice people who can’t really believe that someone would sell us fake medicine that might be worse than useless.

Potential users are urged to verify the legitimacy of online pharmacies, but who knows how to do that?

And to be realistic, do people really care? The perils that may result from giving away any personal information online are just beginning to register in the average person’s consciousness. The world is full of endearing, lovely people who trust strangers enough to willingly fill out social media “get to know me” quizzes. Clever criminals collect all kinds of facts, and know more than anyone needs to about a person’s first pet, the color of their first car, and who their prom date was in 1980.

Be afraid… Be very afraid

A VanityFair.com piece by Katherine Eban reinforces all the caveats:

Under US law, drugs are supposed to travel seamlessly from a manufacturer’s loading dock to a distributor’s pristine warehouse to a pharmacy shelf through a protected chain of companies that follow strict requirements for handling medications and documenting sales.

“On the contrary,” says her story which traces the meticulous investigation into a particularly odious and huge batch of thousands of fake Ozempic pens that were dumped on the market last year, and also goes into the matter of drugs that are real enough, but “diverted” from the legitimate channels. Eban writes,

The drugs may well be authentic, but they might also be expired, improperly stored, or contaminated. Under FDA rules, diverted drugs are considered adulterated and not fit for human consumption, because their safety and quality cannot be guaranteed.

The globe is populated with criminals who “have been learning as they go how to breach America’s defenses in order to sell their counterfeit medicine in the most expensive, and lucrative, market in the world.” This market includes the proprietors of some weight-loss spas whose practices are unsavory, to say the least.

The Illinois Poison Center’s medical director, Michael Wahl, M.D., told the reporter that many patients have injected insulin disguised as Ozempic — which for non-diabetics can be seriously life-threatening, because if the body’s glucose level is too low for too long, irreversible brain damage may result.

In addition to the outright fakes and the stolen or “diverted” goods, there is the additional problem of legal but under-scrutinized and possibly untested substances. There are loopholes, under certain conditions of unavailability, that allow licensed “compounders” to manufacture drugs. Their ingredients are sometimes obtained from sources that cannot be described as either impeccable or acceptable:

Not every pharmacy compounder is equal in adherence to the law… The result has been a quality control disaster.

It looks as if people need to seriously ask themselves whether losing some pounds of flesh can be worth the price of losing an organ or even a life, especially when other methods, though difficult, are possible.

Your responses and feedback are welcome!

Source: “WHO Issues Global Warning About Fake Ozempic Being Sold Online,” Healthline.com, 06/24/24
Source: “Why Counterfeit Ozempic Is a Global-Growth Industry,” VanityFair.com, June 2024
Image by Richard Patterson/Attribution 2.0 Generic

Are Important Questions Being Asked?

A ScientificAmerican.com article published last year was not alone in raising a valid point or two. Writer McKenzie Prillaman speculated on the validity of welcoming the GLP-1 drugs as some sort of medical messiah:

Another unknown is who will respond to these drugs — and who won’t. It’s too early to tell now, but the drugs seem to be less effective for weight loss in people with type 2 diabetes than in those without. Conditions such as fatty liver disease and having fat around the organs, known as visceral body fat, might also affect how people respond to different drugs.

Aspersions have been cast by, among others, Matthias Tschöp, a German physician and scientist. Who will respond to these drugs and who won’t? Hesitancy and caution bring up other questions that many professionals feel really must be answered first: exactly who needs to respond to these drugs, and why do they need to? Because there is still doubt in some minds about whether “obesity” is such an enormous problem after all.

The link between excess weight and health is not proven to the satisfaction of everyone. Why?

One study found that nearly 30% of people who are considered obese are metabolically healthy. Another showed that other health problems tend to be a better predictor of someone’s risk of death than is weight, demonstrating the need to consider factors other than weight when judging health.

And indeed, it is possible that a person whose eyelashes fall out or whose fingernails show grooves is more likely to develop some fatal condition than an obese person is. Biology and medicine are two fields that never run out of surprises, so who knows?

Keeping up, or being led by the nose?

Then along comes another expert, like biologist Timo Müller, to point out that times have changed, especially after semaglutide arrived on the scene. Previously, using pharmacology to reduce weight by more than 10% had proven to be unsafe for patients’ overall physical well-being.

Still, these newer drugs held out the promise of performing other services, like improving cardiovascular health. Tirzepatide increased the “wow” factor even more, with its ability to rival the effectiveness of bariatric surgery by enabling the loss of, in some cases, 20% of the patient’s body weight.

And yet… did that individual really need to be changed into four-fifths of their former self? Misgivings were expressed by psychologist Sarah Nutter, whose main areas of interest are body image and weight stigma. The particular concern here is that patients are letting themselves in for a lot of misery, what with nausea and vomiting and so forth — “to escape weight stigma, rather than to serve a true health need.” There is also concern that people are overly influenced by reports from celebrities, and by news stories aiming to convince folks that once they lose weight, all their pesky life problems will disappear.

Celebration or desperation?

There is a feeling in some quarters that the public is being brainwashed into paying well over $1,000 a month to solve what just possibly might be a non-problem. Perhaps these individuals could be better served by spending that money on psychological counseling, or any kind of therapy, rather than ingesting substances that may not offer permanent health, and indeed might cause actual harm.

The insurance companies that balk at dishing out the dollars may not be solely motivated by reluctance to part with the cash. Their reluctance to pay for “vanity drugs” might even indicate genuine concern for the patients’ well-being. After all, stranger things have happened. But then, the other side comes along with multiple proofs of the enormous damage that can be caused by untrammeled obesity.

When a large number of 20-year studies about GLP-1 drugs and their close relatives have been completed, we can rest assured that someone will always say, “That is all well and good, but what about the 30-year studies? We need those.” It might be that some answers will never satisfy.

Your responses and feedback are welcome!

Source: “Breakthrough’ Obesity Drugs Are Effective but Raise Questions,” ScientificAmerican.com, 01/10/23
Image by airpix/Attribution 2.0 Generic

The GLP-1 Drugs — More Questions and Issues

As mentioned in a previous post, there are a lot of things nobody knows very much about. The GLP-1 drugs have been around for a while, although mainly as a diabetes treatment. As weight-loss drugs, however, they are relatively new and untried. Just as with any discovery that comes down the road, questions arise.

Which patients could or will be harmed? Which sufferers will receive the most benefit? How much will they pay? How much would they be willing to pay if they had a lot more money to start with? Where will the funds come from instead? How about the pharmacology? What other drugs does this new thing clash with, causing iatrogenic disaster and/or scandal? Can the team that wrote a particular paper continue to do meaningful work in this area?

Bloomberg journalist Lisa Jarvis raised several questions, such as:

Why do some people on GLP-1s […] experience a total body transformation, while others lose only modest amounts of weight — or nothing at all?

Is there a way to figure out who needs these drugs to avoid a heart attack or diabetes, and who is perfectly healthy in their larger body?

Is constant therapy sustainable — or even required?

Jarvis states, “Some 44% of people taking Wegovy report nausea, and nearly a third experienced diarrhea.” People know this is going on but give it a chance anyway, and a very large number of them seem to stay with it despite the discomfort. The sickness seems to be a feature, not a bug. If that’s what is required, people seem willing to put up with it.

Time out?

Apparently, huge numbers of users want to know if they may self-prescribe a break from their medication regime. The professional consensus on that is, “No.” Resistance understandably crops up a lot, around holiday times. Reportedly, someone who stops their meds abruptly will become ravenously hungry, and prone to eat an enormous amount of barbecued ribs and hot fudge sundaes.

If somebody does take a break, the next big question seems to be whether they should pick up again with the dosage they previously used, or whether they need to fall back to a smaller dose and then crank it up again. Journalist Ross Wollen wrote,

It takes the body some time to adjust to these potent medications, and those infamous gastrointestinal side effects tend to be at their very worst in the first few days of a new higher dose. With longer pauses, the worry is that your body might lose some of the tolerance that originally allowed you to step up your dosage.

Starting over with the high dose that was typical before the break “could be more than your body is ready to handle, resulting in extremely uncomfortable side effects.” Medical professionals prefer to stay on the side of caution, recommending a wary approach before ramping up. Apparently this is not yet verified by published studies — but it is the tactic preferred by doctors, who definitely want to be consulted, rather than see patients improvise their own unauthorized medication calendars.

Patients who go rogue with their dosage schedules might meet with surprises. They may not be aware that it takes at least a week for the last dose to clear their system. If someone wants to devour a big meal on a certain day, careful planning is needed. Even then, the mere ability to chew and swallow a large amount is no guarantee that the organs farther down the line will cooperate. What polite society calls “ugly gastrointestinal side effects” may occur.

Your responses and feedback are welcome!

Source: “Do You Really Have to Take Wegovy Forever?,” WashingtonPost.com, 10/19/23
Source: “Is It Okay to Skip an Ozempic Shot Now and Then?,” EverydayHealth.com, 11/15/23
Image by Camdiluv/Attribution-ShareAlike 2.0