Do Drug Makers Tell It Like It Is?

As we have seen, the manufacture and promotion of new weight-loss drugs have done a few funny things to the English language, intentionally or not. Some of the results are funny just for being dumb, like the prediction that a change in the drugs’ cost may improve affordability. Sure; or it may make affordability even more impossible. A change will be either positive or negative, and “may” is a weasel word that leaves the field wide open.

A mildly amusing linguistic trick is to mention how, if patients who are prescribed the -tide drugs want the results to last, they will have to stay on them “indefinitely.” Apparently, the word is easier to digest than “forever,” or even the classy phrase “in perpetuity.”

Another thing a manufacturer can do, which has been done, is to announce that severe, painful side effects are normal. Perhaps so, but after exposure to certain natural substances radiation burns are also “normal.” That does not mean it’s acceptable to nuke a city. Invoking the word “normal” does not magically make everything okay.

Unwarranted optimism

There are ways of expressing an idea that, while not pointedly deceptive, can still shed a more rosy light on the matter than is actually deserved. Here is an example:

Dr. Devika Umashanker […] says a significant number of patients gain back weight when they come off the drug, especially if they haven’t made real changes to their diet and exercise routine. Dr. Priya Jaisinghani […] tells her patients that stopping the drug is a bit like no longer going to the gym after having a three-times-weekly exercise routine.

Sure, if people stop doing whatever led to the weight loss, there’s a chance that the weight will be regained. The article goes on to say that “it is possible to be weaned off the medications while avoiding a rebound, but it requires a lifelong commitment to lifestyle and dietary modifications.” This turns out to be not quite the case. It seems pretty clear, by this time, that if a person were capable of a particular lifelong commitment, they would have already exercised that capability, and not be in this situation in the first place.

This brings up another word that perhaps doesn’t sound so serious when it is in Latin — “caveat” — which means warning. An authority issues a caveat about the GLP-1 drugs, namely, “When users stop the treatment all the weight lost is regained!” Yes, all, and with an exclamation mark — which is not so much a warning, as the prediction of an absolute certainty.

People want a cure to be a cure. If someone has an infection and takes antibiotics and the infection goes away, they don’t expect to have to keep taking antibiotics for the rest of their life, and that would indeed be pretty destructive. Another authority says,

And when people stop taking it, there’s often rebound weight gain that’s hard to control. In fact, a study found that most people gain back most of the weight within a year of stopping the medicine.

Not some, but most. And within a year — much more quickly than they put it on the first time. And there’s this: Journalist Allison Aubrey explains how a patient whose insurance company, going forward, will not pay for her weight-loss drug. She will have to get back on what she used to take for control of her blood pressure and blood sugar. “She is at risk of having these conditions worsen with regain of weight.” So, having been able to access her -tide drug for a short time, this woman will now be in a worse condition than before.

Your responses and feedback are welcome!

Source: “Obesity Could Be Pharma’s Biggest Blockbuster Yet,” WSJ.com, 05/05/23
Source: “Mounjaro Weight Loss UK,” OutlookIndia.com, 08/25/23
Source: “Wegovy works. But here’s what happens if you can’t afford to keep taking the drug,” NPR.org, 01/30/23
Image by Mike Steele/CC BY 2.0

Personality, Behavior, and the New Weight-loss Drugs, Part 3

Extremely disturbed people do not care how full they feel; they will carry on eating anyway. Which may be a clue as to how much compulsive eating is accounted for by behavioral addiction. Some folks who eat are not looking to experience satiation; they are looking to shove things into their mouths, and chew.

The thrill is in the endless indulgence of a deviant behavior where the satisfaction is in the process, gained through repetitive actions, to which they are apparently addicted. Among other rewards, there is the sensual enjoyment of swallowing. There are all kinds of peripheral rewards that have nothing to do with nutrition, or even with food quality or flavor. It’s more about the mouth feel and gullet feel.

Would one stick oneself weekly with a needle and then sabotage that effort in such a way? More than likely, yes. After all, there are people who go through the huge ordeal of bariatric surgery, and then keep eating until their stomachs stretch back out. Likewise, just as a certain number of patients make it impossible for their bariatric surgery to work, some percentage will intentionally circumvent any benefit provided by the drug, and get themselves in real trouble. That is a danger inherent in approving weight-loss drugs.

Not training wheels

Originally, there was some hope that these meds could allow a patient to experience a grace period during which old behaviors could be abandoned and new ones learned. Then, according to this attractive myth, the patient could quit taking the stuff, and sail forth into life retrained and refurbished, and equipped to cling staunchly to a new set of behaviors throughout a new, slimmer life.

But no. Journalist Tara Haelle consulted Canadian weight management physician Ali Zentner, and wrote:

These obesity medications “are still viewed as a ‘training camp’ for teaching you how to eat, which is not how they work,” Zentner said. Just as people with chronic conditions, such as depression or diabetes, need to keep taking a medication to keep their symptoms at bay, so do people who have obesity.

[T]hese “medications are a compensation for what the body’s not doing in the first place, not an education for the body. If it’s not a behavior, then there’s nothing to learn.”

This discussion calls forth echoes reminiscent of the set-point theory. It’s as if a -tide drug is capable of overcoming the set point as long as it is used, but once it is discontinued, the body will spring with agility right back to its inescapable set point.

Speaking of behavior, in relation to these drugs, in the U.K., a medical regulatory agency is looking into the prevalence of suicidal thoughts among users. Elsewhere “The European Medicines Agency is now evaluating about 150 reports of possible cases of self-injury and suicidal thoughts…” What behavior could be more definitive than ending one’s own life?

Your responses and feedback are welcome!

Source: “Is Mounjaro the weight-loss drug we’ve been waiting for?,” NationalGeographic.com, 05/02/23
Source: “European regulator expands investigation into risks of suicidal thoughts in users of popular weight-loss medications,” CNN.com, 07/12/23
Image by Nikk/CC BY 2.0

Personality, Behavior, and the New Weight Loss Drugs, Part 2

The mission of the newly available or soon-available substances is elegantly expressed in this AP article:

The obesity drugs lower blood sugar and slow down digestion, so people feel full longer. They also affect signals in the brain linked to feelings of fullness and satisfaction, tamping down appetite, food-related thoughts and cravings.

Because people feel full longer, they eat less and lose weight.

That is one reason why neither tirzepatide nor its semaglutide rivals can work for everybody. People are just wired differently, and some of them act on beliefs and motives that others find bizarre. Behavior is multi-factorial, and one of the possible factors is patient non-compliance, a subject that Childhood Obesity News has examined at length.

No matter what, a certain amount of non-adherence will always be with us. Imagine the frustration of a doctor who helps a patient gain access to -tide injections at a steep cost or, worse yet, at a discount — and then the patient doesn’t use the stuff.

Different demographics

People with diabetes do want to not suffer the consequences of the disease. They don’t want to pass out in public, or lose a foot, so they might be more diligent rule followers. But when the same drugs are injected or swallowed for weight loss, that crowd might justify a fear that has already been expressed.

It is both sad and likely that, once embarked on a course of -tide drugs, many overweight and obese people would take a deep dive into fat-logic. “I’m covered, let the drug worry about doing the work,” such a person might think, and go on to fool herself or himself into believing that now, they can eat more than ever, because the drug will fend off further weight gain.

Even more serious is the problem of people who don’t even bother to rationalize what they basically want to do in any case. These meds work by persuading the body that hunger has been assuaged. The stomach is filled to capacity, and there is no actual need to add any more food. That is a rational conclusion, but rationality has nothing to do with this kind of hunger.

If the person is simply into “eatertainment” or “recreational eating,” what then? Someone who enjoys a video game can sit there and play it for 10 hours at a stretch. Someone who enjoys chewing and swallowing can do that for half a day, too. If the hunger is not physical but emotional, a distended belly can’t fool the emptiness inside.

Ambition

The persuasive information (aka advertising) aimed at people who are curious about the -tide drugs has quite a lot to say about things like neurotransmitters that need boosting, and about cravings and hunger. But hunger does not all come from the same place.

A popular media platform published an article whose title suggested that the new class of weight-loss drugs could end obesity. That is quite an ambition, and an impossible one. Like many other things in life, obesity is multifactorial. One factor is, some folks are not reachable by logic, or even by an appeal to their own self-interest. Somehow they forget the other attractive features of life, narrowing self-interest down to “I’m interested in eating more. And I’m interested in it now.”

Your responses and feedback are welcome!

Source: “How do Ozempic, Wegovy and Mounjaro work? What to know about drugs promising weight loss,” APNews.com, 04/27/23
Image by Sam Nabi/CC BY-SA 2.0

Personality, Behavior, and the New Weight Loss Drugs

After researchers scoured eight databases and came up with seven suitable English language studies published as recently as last month, they undertook a brand new multi-author meta-analysis of information on personality traits associated with childhood obesity.

Despite multifaceted ongoing attempts to prevent and impact the problem, “the overall progress of childhood obesity interventions has been far from satisfactory.” Childhood obesity continues to rise in countries with low, middle, and high-income levels. Meanwhile, adult studies show that the influence of personality traits on obesity counts more than socioeconomic factors or even the highly suspect FTO gene.

About the lack of success thus far in controlling childhood obesity the authors say,

One critical reason is that most of the existing interventions only focused on the proximal factors of obesity such as behaviors, but paid little attention to the rooted drivers motivating behavioral changes such as personality traits.

The Five-Factor model posits five dimensions of personality traits, namely extraversion,
agreeableness, neuroticism, openness, and conscientiousness. Together, these are said to
“reflect a person’s inherent patterns of cognition, attitude, emotion, self-regulation or coping strategies and have been shown to be related to multiple health-related behaviors.”

As it turns out, the only trait that merited attention in this context was conscientiousness, “the tendency to be self-controlled, perseverant, and disciplined to social norms” and the association is a negative one. In other words, children who score low on that quality have more of a tendency to be obese. And, “No consistent patterns were found in the associations between the other 4 dimensions of personality traits and BMI/obesity in children.”

According to the study results, the conclusion is:

Low conscientiousness has been found to be consistently associated with childhood obesity. Causal associations of personality traits with the risk of childhood obesity remain to be clarified in future studies.

“A growing body of evidence has revealed an association between personality traits and obesity, but the findings regarding this association among children remain mixed.” Not much there yet, but this is definitely the sort of thing that needs to be looked into before blithely authorizing the prescription of the -tide drugs to kids. How do the drugs’ known side effects mix with the five dimensions of personality delineated by the Five-Factor model?

And what about the one that stands out, the negative association between obesity and conscientiousness, “the tendency to be self-controlled, perseverant, and disciplined to social norms.” Those traits definitely show up in a child’s behavior, and many behaviors can be taught and cultivated, especially at a young age.

Is it possible that training designed to teach children to pick up after themselves, keep quiet in class, and persist in trying even after they fail at a task — is it possible that this kind of upbringing could also help them avoid obesity? And avoid the necessity for weekly injections of the latest weight-loss drugs?

Your responses and feedback are welcome!

Source: “The association of personality traits with childhood obesity: A systematic review and meta-analysis,” ScienceDirect.com, August 2023
Image by FolsomNatural/CC BY 2.0

Behavior, a Big Word

One problem with people is: Often it is not that difficult to put a finger on What Is Wrong, but sometimes people want to take a deep dive into the cesspit and spend a monumental amount of energy, endlessly elaborating on what is wrong.

Another way to do things would be like Abraham Maslow. Study the people who are doing well, and figure out which of their traits might be transmissible. Traits are expressed by behavior, so concentrate on behaviors that can be taught and learned. Then, devise a way to get people to want to learn them.

It covers a lot of ground

Just as our diet basically means everything we eat, our behavior basically means anything we do. It encompasses all of human nature. There has been a lot of talk, probably ever since people could talk, about how much anyone ought to take it upon themselves, or be empowered, to interfere with other people’s behavior.

Imagine a very basic society, confronted by a member who will neither hunt nor gather. Life was rough for everyone, and a person who refused to fulfill the most obvious societal obligations might very well be ostracized. Snubbed, shunned, excluded, avoided, rejected, shut out, expelled. Even though they did not possess the brains we have today, early humans probably thought, “When this perfectly capable person refuses to help himself, the rest of us suffer for it. We don’t need the aggro. We’re letting him go.”

The pain of largeness

And what does ostracize itself mean? To leave a person out of conversations, friendships, groups, privileges, rights, comfort… which is what, in our society, often happens to obese people. The younger ones are especially vulnerable to ostracism, not having other means to compensate for the social handicap of being too big. They get left out and pushed out. It is a variation of the ancient scenario in the previous paragraph. Even though we are now very advanced, it inspires a similar thought. “If someone with excessive fat does not care enough to help himself, it weakens and endangers all of us.”

Then, we rationalize our distaste by listing all the different ways in which uncontrolled obesity statistics will mean the end of civilization, or an equally dire outcome. One expert sees things differently. In the pages of his book, Overweight: What Kids Say, Dr. Pretlow refers again and again to the depression, unhappiness and misery of children and teens who are stuck in a bad situation and don’t know how to get out. His personal empathy and compassion are obvious. The work leaves the reader feeling that helping obese young people to thrive is an ambition both worthy and doable. If we take care of these kids, civilization will have an easier time taking care of itself.

Your responses and feedback are welcome!

Source: “Abraham Maslow, His Theory & Contribution to Psychology,” PositivePsychology.com/ 09/29/17
Image by Sandra Cohen-Rose and Colin Rose/CC BY 2.0

Enhancing the Language With Drugs

First came the “Ozempic face,” in which the buccal mucosa, or fat, goes away, leaving the face looking gaunt and aged, and which may or may not be reversible. Even with a loss as relatively minor as 20 pounds, women are left gasping at the appearance of the stranger in the mirror.

Predictably, the “Ozempic butt” was not far behind (haha). This is “the saggy, deflated appearance of the buttocks following rapid weight loss.” A quotation is attributed to Zsa Zsa Gabor: “As a woman, you have to choose between your fanny or your face.” Sadly, it seems that the -tide drugs do not leave room for even that choice, but remove fat indiscriminately from places where it needs to be:

Several frustrated users recently told The Post that their fingers and wrists are shrinking before their eyes, making it impossible to keep on their expensive wedding rings and bracelets.

Malnutrition is part of the picture, too. Depending on how much of a handicap the patient is burdened with, due to age and genetic makeup, this tragedy might be avoidable with slower loss goals, a very nutritious diet, and weight-bearing exercise.

The manufacturers are quick to declare “not our fault,” which is fair enough. The medication is not directly responsible, but shedding the pounds too fast definitely is. The condition can be helped by the surgical removal of extra skin, or the use of dermal fillers, and also by non-surgical means such as “radiofrequency, energy-based devices, and lasers.”

Psychological damage

Then, there is the term “Ozempic shaming.” Random citizens just love to hop on the nearest social media platform and vent about their disapproval of others who utilize the -tide family of pharmaceuticals for weight loss — especially when those others are celebrities.

If a media personality tells the truth about taking one of the -tide drugs, a legion of critics stand ready to pounce. If such a person is suspected of lying about it, the criticism is even more fierce. And if they take neither course, but just stay chubby, another contingent of judges descends upon them with harsh condemnation. Actor Emily Simpson (“Real Housewives of Orange County”) says the phenomenon boils down to, “damned if you do, damned if you don’t.”

Even Simpson’s admitted use of liposuction did not draw as much wrath as the mere suspicion of Ozempic use. Aimed at her and other media types, headlines tend to include some form of the word “accuse,” as if they were in danger of being arrested for something much, much worse.

And it hurts. Simpson, a three-time mother who happens to be an attorney, told the press,

I’ve done so many things in life and I’ve accomplished so many things, but the one thing that everybody wants to talk about is my size. And it’s just exhausting to me.

The accusers tend to be righteous, claiming that their concern is for diabetes patients endangered by shortages of the drugs. Or they are mad at anyone who “takes the easy way out” rather than working hard to earn a slimmer figure. Others want to decide exactly how overweight a public figure ought to be, before opting for the -tide drug option. Many angry randos resent the ability of celebrities to afford drugs when ordinary people cannot. Overall, it makes for an ugly situation.

Your responses and feedback are welcome!

Source: “Understanding Ozempic Butt: Can You Avoid It?,” HealthNews.com 06/19/23
Source: “Ozempic users spark spike in ER visits: Shocking new side effects,” NYPost.com, 06/19/23
Source: “Those experiencing ‘Ozempic shaming’ speak out about the backlash they faced,” ABC7NY.com, 08/09/23
Image by Mike Lewinski/CC BY 2.0

The New Drugs, Through a Jaundiced Eye

Somebody started calling them the -tide drugs, which is neat and concise; and Leon Gussow, M.D., an expert in the areas of emergency medicine and poisons, writes about them. GLP-1 receptors occur in the stomach, the pancreatic islet cells, and the brain, from where they send messages to each other and the rest of the body, answering vital questions. Is it time for the stomach to empty? How much insulin needs to be produced? Are we full yet?

And here is the answer to a question that is rarely addressed in the popular press: Why does this stuff have to come in a needle, anyway? Dr. Gussow writes,

Naturally occurring GLP-1 has a half-life of a minute or two, while semaglutide has a half-life of 165 hours, which allows it to be injected subcutaneously once a week. These drugs […] do not rev up metabolism. Semaglutide and tirzepatide can be thought of as eating disorders in an injection pen.

As we know, malnutrition is not good for anybody, even one that is trying to lose weight. But Dr. Gussow also mentions that patients who take semaglutide or tirzepatide can get queasy just by looking at food, sometimes to the point where they prefer not to eat. It sounds as if a person could get the same effect and save $1,000 a month, just by carrying around a photo of something aversive (yucky), and looking at it periodically.

A deep downside

He also brings up details that not enough people seem aware of: “[W]eight reduction from the drugs alone can involve significant loss of lean body mass,” and oh, by the way, when the patient stops using the -tide drug, not only will the weight return, but instead of lean body mass it will be fat.

Some would say the solution is obvious: Just stay on the drug forever. At this point, that seems unlikely. Mansur Shaheen reported for The Messenger:

32% of patients using Wegovy, Ozempic, or a similar competitor were still using the medication a year after prescription. A British study published last year, partially funded by Wegovy and Ozempic manufacturer Novo Nordisk, found that users of these drugs regain around two-thirds of lost weight after stopping the injections.

In other words, around two-thirds of patients quit just after the one-year mark. Cost is definitely a factor. Because of the expense, the shortages which will probably recur at least periodically in the future, and the side effects, it seems reasonable to expect that most users will soon just give up.

Obesity medicine specialist Dr. Christopher McGowan reminds us, “As I stress with all my patients, medications like Wegovy and Ozempic are designed for chronic, continuous, potentially life-long use. They are not short-term solutions.”

The lizard king

As for the new weight-loss drugs, Dr. Gussow wrote about the original members of the group:

These injectable synthetic drugs — semaglutide (Ozempic and Wegovy) and tirzepatide (Mounjaro) — are derived from a peptide found in Gila monster venom.

In itself, that is not a bad thing. Nature is a bountiful pharmaceutical resource, and humans have always been grateful to get the medicine out of any obliging plant or animal.

Almost 30 years ago, endocrinologist Daniel Drucker was fascinated to learn that the poison produced by a lizard could regulate blood sugar. He put that together with the ever-increasing diabetes demographic, got his own Gila monster, and went to work. Recently, Julia Belluz elaborated on the subject:

Ten years later, a synthetic version of a hormone in the venom became the first medicine of its kind approved to treat type 2 diabetes. Known as a GLP-1 (for glucagon-like peptide-1) receptor agonist, the medicine set off a cascade of additional venom-inspired discoveries.

Your responses and feedback are welcome!

Source: “More Questions than Answers about Injectable Weight Loss Drugs,” Journals.lww.com, July 2023
Source: “A Majority of Ozempic, Wegovy, Patients Stop Using the Medication After Only a Year, Likely Regaining Lost Weight,” TheMessenger.com, 07/12/23
Source: “How a lizard’s venom inspired the promising weight loss drug Wegovy,” Vox.com, 07/05/23
Image by Verde Canyon Railroad/CC BY-ND 2.0

Processed Food Documentary Stirs Things Up

A 42-minute video report from the German broadcast service DW has proven quite popular on YouTube, with well over a million and a half views and nearly three thousand comments since it appeared a month and a half ago. “Junk Food — The Dark Side of the Food Industry” is about allegedly healthful junk food and obesity.

It highlights, among other atrocities, the ability of giant corporations to extend their tentacles into every nook and cranny of any country. This is especially true of Nestle, the most massive food and beverage company on earth; which among other egregious errors believes that it should be able to buy all the water in the world and sell it back to people for many, many times more than what the corporation pays for it.

Nestle produces over 2,000 brands of products, and the public relations department claims a “presence” in 188 (or, according to another source, 194) countries, although that just means an office or something. Actually, it is unlikely that the behemoth’s presence is not felt in every single country there is.

People need jobs, so it would be unfair to hate on most of the over 300,000 employees. The blame accrues to the relatively small number of top executives… and to the lust of investors for “passive income,” no matter how much damage is inflicted on the world’s population or the planet it lives on.

Too little, too late

The guilt resides within the processed foods that are high in caloric content, but often do not even make a person feel full. Nestle acknowledged it, at least within the company. Admittedly, it has since removed some products from its roster, which might not even be among the most harmful, and may have been slated for extinction anyway, for any number of reasons. The record of correction is not very impressive, and only makes critics ask, “Why haven’t you done more? And sooner?”

Back in 1999, in a secret meeting of top food industry execs from the USA’s eight biggest food-selling giants, one CEO admitted culpability and the need for change, but all the others were angry at this betrayal.

At the same time, Nestle and other corporations continue to legally challenge the rules against misleading labels. They resist including any sort of warning labels, which supposedly inspire “unnecessary fear” in consumers. They try to deceive the public with claims that labeling is not beneficial. This behavior, in turn, brings about accusations that they show nothing but contempt for customers, and indifference to the suffering caused by intensely processed foods containing way too much sugar, salt, and fat.

But the corporations are kind enough to tell governments that the real need is for education programs, a spurious argument to which any government might very well reply, “No, we would prefer for you to stop doing those reprehensible things that the public, unfortunately, needs to be educated about.”

Speaking of deceptive labels, there are 15 pseudonyms for sugar (or more like 56, according to another source), so customers can be easily fooled.

This site lists several categories of Nestle sins, including “Promoting Unhealthy Food and Mislabeling.” Out of all the various breakfast cereals, they make half the ones that contain the most sugar, fat, and salt.

The big companies which should concentrate their resources and efforts on feeding people decently, instead are top-heavy with gigantic legal departments. All this litigious talent allows them to continue abusing their customers and, less directly, everyone else.

Your responses and feedback are welcome!

Source: “Junk food, sugar and additives — The dark side of the food industry | DW Documentary,” YouTube, July 2023
Source: “Nestle’s Water Controversy, Explained,” Mashed.com, 12/27/21
Source: “About Us,” Nestle.com, undated
Source: “Why Nestle is one of the most hated companies in the world,” ZMEScience.com, 05/08/23
Image by Fitmomtribe.org