At our recent HS football game in the suburbs, my wife remarked that the parents seemed...thinner. I guess I had been paying more attention to my own physique, but I've been noticing it more. I guess there are a lot of people in the 20lb overweight category who are using this stuff "off-label." However, I'm also seeing some of them who just look gaunt, like border-line eating disorder or chemo patient appearance.

Are there side effects? Is it worth it to use Ozempic to lose 20 lbs? Are we going to see some unintended consequences cropping up? As a comparison, I think amphetamines were legal until 1969, and a lot of people did themselves a lot of harm.

Youre not seeing people in the 20+ lb overweight range using any GLPs

Youre likely seeing people who actually want to lose 75+ lbs to be back to where they were as a freshman in college coupled with morbidly obese who have shed in excess of 100 pounds already. They are in way too much of a caloric deficit and are lacking proper nutrition.

The GLPs are all being prescribed incorrectly and excessively in dosage. However, is it better to go from obese to skinny in a year or two? Probably.

Back to OP questions: theres not all that many bad side effects. They are stopping people from eating as much because they are full and even get nauseous from overeating. I'd say there's a direct link to doing one thing too much correlating to doing another thing too much ie GLP

Serena Williams hawking this stuff is pretty scary.

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No way I would use GLP-1's to drop 20 for comsetic reasons. The gaunt look is more than just a look, these people are malnourished and losing muscle mass.

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Had a patient come in last week that was using it to go from 175 to 150. He's 5'8.

We've seen plenty of them in the last year that are trying to use it as the quick 10-20 lb weight loss method

wangus12 said:

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Quote:

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No way I would use GLP-1's to drop 20 for comsetic reasons. The gaunt look is more than just a look, these people are malnourished and losing muscle mass.

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Had a patient come in last week that was using it to go from 175 to 150. He's 5'8.

We've seen plenty of them in the last year that are trying to use it as the quick 10-20 lb weight loss method

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I mean it does work though. Basically fasting without needing to deal with the hunger and discipline (maybe actually a reverse discipline needed to force a person to consume the macros and vitamins necessary for good health). Compare that to prepared meal plan services and it is an interesting paradox

1996 said:

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Agree with wangus... I've seen plenty of patients coming in with bmis below 28 who are on glp1s. I question the ethics of the docs that are prescribing it.

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Agree with KidDoc.

Unfortunately, there are a lot of non-physicians that have infiltrated medicine and have found ways to make a quick buck. And all physicians aren't always perfect either. Direct to patient marketing for everything from GLPs, to testosterone supplements, to ED medication, etc., all typically go back to larger companies that have figured out how to capitalize large scale.

There are some small physician led shops that are also a bit dubious, but it's often the big places. Aesthetics, med spas, and vanity medicine is big business these days. At the end of the day, you can do the right thing and not get paid. The patient will leave you a bad review online, which you can't defend yourself against because of HIPAA, and go somewhere else and get what they want anyways. So do you stick with your morals, or do you make a few extra bucks?


Also, yes. Rapid weight loss is associated with things like temporal wasting and sunken eyes. The fat in your temples, around your eyes, and even around your kidneys usually only gets targetted during rapid weight loss. People also have a hard time getting enough protein with no appetite, and end up losing muscle - especially older patients. Which is really not good. There was a doc whose mom, in her 80s, wanted to get on it to lose a few pounds. At her age, even a few ounces of muscle loss would be a big deal, and something she'd never get back.

Interesting. I hadn't thought about that angle before. Makes sense. Honestly I think any aesthetic procedure can be addictive. I think that's why you see celebrities completely changing over time. A little botox and filler, then a little more, and more, and throw in a facelift, then a nose job, and before you know it they are unrecognizable.

TXTransplant said:

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I firmly believe there is a connection between aesthetic "med" spas marketing and prescribing GLP-1s to women...

Get them to lose weight fast, and then sell them cosmetic filler to make their face look "normal" again. Once they get the filler, they basically are hooked, even if they gain the weight back, because the filler stretches/deforms the skin. Between the GLP injections and the filler, you have a long-term customer who is hooked.

It's marketed as a "one stop shop", all in the name of convenience. No worries, because there is no problem that can't be fixed with a syringe.

I am certainly not against some cosmetic procedures (I've had laser treatments and abdominoplasty), but I see what I've described above, and it's disturbing to me.

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How was the abdominoplasty recovery?

It was not too bad. The hardest part was I'm a stomach sleeper, and I had to sleep on my back semi-upright for a while. That was uncomfortable. Drains were kinda gross, but I got them out within a week or so.

Otherwise I felt great within a few weeks. It's been almost exactly 6 years since the surgery, and the only lingering effect is some occasional numbness/tightness in my abdomen that can feel really weird.

But I had pretty bad abdominal wall separation, and the relief I got from the repair has been amazing. Best $10k I could have spent.

KidDoc said:

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1996 said:

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Agree with wangus... I've seen plenty of patients coming in with bmis below 28 who are on glp1s. I question the ethics of the docs that are prescribing it.

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The online services selling these with video visits have no ethics other than profit. Drug dispensers not docs who actually strive to do the best they can for their patients.

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Same reason all the marketing for ED meds seems to have shifted to the 20 year old population. 20 y/o's shouldn't be having ED problems and don't need the meds, but the marketing using women saying its the best ever is definitely working.

bigtruckguy3500 said:

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1996 said:

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Agree with wangus... I've seen plenty of patients coming in with bmis below 28 who are on glp1s. I question the ethics of the docs that are prescribing it.

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Agree with KidDoc.

Unfortunately, there are a lot of non-physicians that have infiltrated medicine and have found ways to make a quick buck. And all physicians aren't always perfect either. Direct to patient marketing for everything from GLPs, to testosterone supplements, to ED medication, etc., all typically go back to larger companies that have figured out how to capitalize .

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I made the mistake of answering an add to Hone Health for their $45 blood test that supposedly tests a dozen different things. I almost did the impulse buy but after researching it a bit I stopped. It's clear they are just going to push TRT. I am inundated wjth emails and texts now.

How do you know the marketing is working? 20 yr old patients self reporting?

wangus12 said:

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Same reason all the marketing for ED meds seems to have shifted to the 20 year old population. 20 y/o's shouldn't be having ED problems and don't need the meds, but the marketing using women saying its the best ever is definitely working.

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I agree.

That being said, I have also seen a surprising number of men under 30 who are having problems in that department. Even some as young as 21. Who knows if they're lying to just get a prescription. But I think pornography is playing a big role, and maybe stress/mental health/performance anxiety.

But also a lot of young men get it for recreational purposes since it reduces the softening effects of alcohol and marijuana.

https://pubmed.ncbi.nlm.nih.gov/29887595/
https://pubmed.ncbi.nlm.nih.gov/20722788/

MRB10 said:

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How do you know the marketing is working? 20 yr old patients self reporting?

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See links above. But I think they prey on the insecurities of young men. Or really all men, but especially young men that are having a hard time finding relationships, or afraid their significant other will leave them for someone better.

lol! My docs offered it to me yesterday saying I'm a candidate since I have sleep apnea. I'm not "thin" and could lose about 5-10 lbs, but sure as hell don't need some bs weight loss medicine. There are no shortcuts in life.

Is sleep apnea the trick for how everyone is getting this prescribed? My insurance says that they only approve it for type 2 diabetics, otherwise it is $500/month.

Quinn said:

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Is sleep apnea the trick for how everyone is getting this prescribed? My insurance says that they only approve it for type 2 diabetics, otherwise it is $500/month.

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Yeah zepbound got FDA approved specifically for OSA. I don't prescribe so don't have first hand experience but I'm guessing that is often a diagnostic code used to get approval.

Considering how often obesity contributes to apnea and how destructive apnea is to health, it's not the worst thing.

The way I see it, used in proper moderation, these thing can be a great tool to reset people or get the obese into a position where they can ease into a healthier lifestyle without the drug long term.

Unfortunately, my sleep apnea has little do with weight. My pulmonologists told me he knew I had it when he looked in my mouth.

Queso1 said:

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Unfortunately, my sleep apnea has little do with weight. My pulmonologists told me he knew I had it when he looked in my mouth.

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I am not petite but I agree with my mild OSA weight loss doesn't seem to help. Just a big tongue and small airway. I have been a bit lighter than I am now and still had issues.

However, for many obese patients with OSA, weight loss is likely helpful.