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Exciting times for Pediatric Obesity treatment!

7,598 Views | 99 Replies | Last: 1 yr ago by agracer
The Lost
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I only quickly skimmed, but does this actually solve any problem, or is it just masking them?

These people are probably not changing their habits so things like diabetes will still be an issue and they'll either become hooked on the drug which is money for your investment/big pharma (and hilarious you mentioned you invested in this which makes it feel even more for profit/slimy) or it does what a fad diet does and short term fixes a problem just to go back to where they were. Starting another cycle.

All I see is $$$ for pharma, and kids docs/pushing investing in it. Not actually long term healthy kids.
KidDoc
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AG
The Lost said:

I only quickly skimmed, but does this actually solve any problem, or is it just masking them?

These people are probably not changing their habits so things like diabetes will still be an issue and they'll either become hooked on the drug which is money for your investment/big pharma (and hilarious you mentioned you invested in this which makes it feel even more for profit/slimy) or it does what a fad diet does and short term fixes a problem just to go back to where they were. Starting another cycle.

All I see is $$$ for pharma, and kids docs/pushing investing in it. Not actually long term healthy kids.
Valid questions for sure. The guidelines address everything you ask about but yes it is a paradigm shift to treat obesity like any other chronic disease with ups and downs and needing intermittent treatments when it worsens. Much like depression, anxiety, hypertension, diabetes, dyslipidemia--- you treat with medicine when the illness is out of control then stop the medication when they are doing well and restart as needed.

It is to be used as a last resort with lifestyle changes but for me personally it was dramatic and life changing almost immediately.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Pepper Brooks
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AG
I worry the second order effects of giving people, especially impulsive kids, an easy out are going to cause more long term issues than letting them struggle through food addiction.

Exhibit A: https://news.yahoo.com/happens-stop-taking-ozempic-remi-230101405.html

Quote:

Bader said her doctor had recommended the drug shortly after it was approved by the Food and Drug Administration in 2020 to help with pre-diabetic insulin issues and weight gain.

"They said I need this. And I had a lot of mixed feelings," she said.

But Bader explained her binge eating disorder almost immediately returned once she stopped taking the medication.

"I saw a doctor, and they were like, it's 100% because I went on Ozempic," she said. "It was making me think I wasn't hungry for so long, I lost some weight. I didn't want to be obsessed with being on it long term. I was like, 'I bet the second I got off I'm going to get starving again.' I did, and my binging got so much worse. So then I kind of blamed Ozempic. I gained double the weight back after."


I'm speaking as a kid who was 5'6" and 190lbs going into high school. The ridicule I received was an incredibly powerful motivator to get in shape. Freshman year was a tough year… but I was 6'1" and 180 by the end of my sophomore year and had developed exercise habits that have stuck with me into my mid-30s.

I completely understand the willpower challenges mentioned in this thread as most people who grew up like me are trying to reverse years of conditioning and bad habits. I still struggle with, and feel like I'm constantly trying to quit, my sugar cravings. But, I don't see this as the answer.
KidDoc
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AG
Pepper Brooks said:

I worry the second order effects of giving people, especially impulsive kids, an easy out are going to cause more long term issues than letting them struggle through food addiction.

Exhibit A: https://news.yahoo.com/happens-stop-taking-ozempic-remi-230101405.html

Quote:

Bader said her doctor had recommended the drug shortly after it was approved by the Food and Drug Administration in 2020 to help with pre-diabetic insulin issues and weight gain.

"They said I need this. And I had a lot of mixed feelings," she said.

But Bader explained her binge eating disorder almost immediately returned once she stopped taking the medication.

"I saw a doctor, and they were like, it's 100% because I went on Ozempic," she said. "It was making me think I wasn't hungry for so long, I lost some weight. I didn't want to be obsessed with being on it long term. I was like, 'I bet the second I got off I'm going to get starving again.' I did, and my binging got so much worse. So then I kind of blamed Ozempic. I gained double the weight back after."


I'm speaking as a kid who was 5'6" and 190lbs going into high school. The ridicule I received was an incredibly powerful motivator to get in shape. I was 6'1" and 180 by the end of my sophomore year and had developed exercise habits that have stuck with me into my mid-30s.
Yeah binge eating disorder is a whole other level of dysfunction and likely would need treatment long term.

I've been off Wegovy since 11/2022 and have gained 0 lbs- I do exercise nearly every day and IF until lunch and eat salad + protein + fruit for lunch daily. I'm 50, was chubby as a kid, great shape for high school and college, got up to 280 after medical school and residency, 230-240 most of my 40's.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
htxag09
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AG
Weren't you the one also posting studies around a biological clock that goes off during puberty, setting a persons metabolic baseline? I could also see that as a valid reason for this drug. At least help them maintain a good baseline until they do mature and make changes.
Pepper Brooks
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AG
Did you have the mentioned exercise habits in the few years prior to starting wegovy? The weight fluctuations you describe read like an on/off again exercise and healthy eating habit that you let get interrupted by life and career obligations. I apologize if my wording comes across as offensive or blunt.
KidDoc
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AG
Pepper Brooks said:

Did you have the mentioned exercise habits in the few years prior to starting wegovy? The weight fluctuations you describe read like an on/off again exercise and healthy eating habit that you let get interrupted by life and career obligations. I apologize if my wording comes across as offensive or blunt.
yes my exercise and eating have not changed at all in about 10 years. In my 20s I had no exercise and poor diet related to poverty and working >100 hours a week.

No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
94chem
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Pepper Brooks said:

I worry the second order effects of giving people, especially impulsive kids, an easy out are going to cause more long term issues than letting them struggle through food addiction.

Exhibit A: https://news.yahoo.com/happens-stop-taking-ozempic-remi-230101405.html

Quote:

Bader said her doctor had recommended the drug shortly after it was approved by the Food and Drug Administration in 2020 to help with pre-diabetic insulin issues and weight gain.

"They said I need this. And I had a lot of mixed feelings," she said.

But Bader explained her binge eating disorder almost immediately returned once she stopped taking the medication.

"I saw a doctor, and they were like, it's 100% because I went on Ozempic," she said. "It was making me think I wasn't hungry for so long, I lost some weight. I didn't want to be obsessed with being on it long term. I was like, 'I bet the second I got off I'm going to get starving again.' I did, and my binging got so much worse. So then I kind of blamed Ozempic. I gained double the weight back after."


I'm speaking as a kid who was 5'6" and 190lbs going into high school. The ridicule I received was an incredibly powerful motivator to get in shape. Freshman year was a tough year… but I was 6'1" and 180 by the end of my sophomore year and had developed exercise habits that have stuck with me into my mid-30s.

I completely understand the willpower challenges mentioned in this thread as most people who grew up like me are trying to reverse years of conditioning and bad habits. I still struggle with, and feel like I'm constantly trying to quit, my sugar cravings. But, I don't see this as the answer.


Kudos on your willpower to grow 7".
94chem,
That, sir, was the greatest post in the history of TexAgs. I salute you. -- Dough
Aggie369
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AG
Here is one of the problems

Overweight and out of shape doesn't happen because of poverty and 100 hour work weeks

Those two things may make it harder to be in shape
Pepper Brooks
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AG
Thanks. I was trying to get to 6'3" and couldn't get there.
TXTransplant
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Aggie369 said:

Here is one of the problems

Overweight and out of shape doesn't happen because of poverty and 100 hour work weeks

Those two things may make it harder to be in shape


There have been many studies that have correlated poverty to obesity. Just go to the grocery and look at what the cheapest foods are - highly processed carbs and low quality fats and oils. There is also the phenomenon of "food deserts" in rural areas. One could argue that's a chicken and egg problem, but no one can deny it's more expensive to eat high quality protein and fresh foods. Probably now more than ever (just look at what's happened to the price of eggs).

Add on top of that the American mindset of quantity vs quality when it comes to food.
Aggie369
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AG
Studies can show anything

If you want to eat healthy and cheap you can 100% do it if it's a priority.

I'd say the bigger correlation in poverty/unhealthy studies is poor choices and poor priorities over extended periods of time
bam02
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AG
100% truth.
TXTransplant
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Aggie369 said:

Studies can show anything

If you want to eat healthy and cheap you can 100% do it if it's a priority.

I'd say the bigger correlation in poverty/unhealthy studies is poor choices and poor priorities over extended periods of time


You're exactly supporting my point. A family who is poor financially is going to make poor choices at the grocery store, at least in part due to financial constraints (agree that may not be the only reason). And kids obviously have little control over what's given to them to eat by the adults in their life.

Why do you think school lunches are so bad, from a nutritional standpoint? Because it's cheap!

Not to mention, it's easy to love and over eat junk food. You can't expect a child to have the willpower to avoid unhealthy foods that taste good when that's what is right in front of them.

Dieting and weight loss is a multi-BILLION dollar industry. If it was as easy as you say it is for most people, we wouldn't have diets, books, fitness apps, tv shows, podcasts, therapists, coaches, supplements, etc.

I have my own personal feelings about medical and pharmaceutical interventions for weight loss, but when it comes to someone who has 100 lbs or more to lose, I don't think anyone who hasn't been through it should be critical of what someone in that position chooses to do to lose the weight.

And I still come back to the point that obese kids who could potentially benefit from this treatment probably don't have supportive parents and/or the money to allow them to even obtain it.
Aggie369
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AG
My response wasn't directed to kids

It was directed at OP and other adults

Poverty and long work hours doesn't make you over weight

It's easy to blame other external factors for where we are or arent instead of blaming our cumulative choices....being in shape/healthy doesn't require money or a lot of time it requires discipline and consistent good choices.

People make money off of consumers by selling to them that "its not your fault" this pill will fix it. People don't like admitting they made a lot of poor choices so they take the pill. The circle is then taught to their kids because no one is held accountable if you can't hold yourself accountable. Some things require medication.....a lot of things dont.
TXTransplant
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Your point about medication is an interesting one. These medications started out as treatments for diabetes and a "side effect" was weight loss". Obesity is the major cause of type 2 diabetes.

If an obese person was diabetic, we wouldn't think twice about giving this medication to get that under control. But there is a different viewpoint if the person is only obese and not diabetic. There is a case to be made that these meds can be used to stimulate weight loss in obese patients BEFORE they become diabetic.

I do think it has to come with coaching or supervision when it comes to teaching and maintaining good eating and exercise habits after losing the weight. There is a reason why so many medical weight loss interventions fail - people go back to their old habits after some time.
Aggie369
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AG
If u eat yourself into being a diabetic I have little sympathy for you.

The thread is becoming derailed. Apologies
Stringfellow Hawke
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AG
KidDoc said:

FratboyLegend said:

KidDoc said:

If your teens are struggling with weight, Wegovy was just approved for 12+ yesterday for weight loss 12+. The data is very promising and it is exciting to finally have something beyond diet & exercise to manage this very common problem.

Quote:


Finally, there remains "ongoing weight bias and stigma among the public, and in particular, among healthcare providers, with the misconception that obesity is a personal failing or matter of willpower, or ultimately a fault of the child and parent," Armstrong said.

However, that is simply not the case, she noted, pointing out that obesity needs to be treated via the same model as other chronic diseases, accounting for remissions, relapses, monitoring, and ongoing care.


AAP Guidelines: 'Watchful Waiting' No Longer the Right Call for Child Obesity | MedPage Today

Executive Summary: Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity | Pediatrics | American Academy of Pediatrics (aap.org)

Wegovy was life changing to me as a 50 year who was a fat little kid. I believe in this treatment so much I bought stock in Novo nordisk. Now the big fight will be getting the price down and getting insurance to cover it. Right now medicare/medicaid refuse to cover any medication for weight loss period as they think it is cosmetic only. Commercial insurance is hit or miss depending on the details of each policy.


Do you know the cash cost of a script? I assume it remains patent protected.
$1600 a month. It is crazy.



Not to derail, but my Dad was recently prescribed Sprycel and initially the medication cost was $600 monthly but now we are at $5,000 and climbing. So screw Medicare/Medicaid/Aetna/Caremark and their sliding scale model of pricing. All those A-holes are doing is sitting around and blaming each other while transferring you to a supervisor.
KidDoc
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AG
How do you guys who think all obese kids need is behavioral modification explain this 2 year study where all the families had behavioral interventions but half of them got Wegovy and half got placebo but only the treatment group lost weight?

Once-Weekly Semaglutide in Adolescents with Obesity | NEJM
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TXTransplant
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Aggie369 said:

If u eat yourself into being a diabetic I have little sympathy for you.

The thread is becoming derailed. Apologies


Your sympathy (or anyone else's) is irrelevant. Standard of medical care is to treat diabetes with medication, regardless of the cause. If the patient loses weight and the condition resolves, that's great. But many just continue on the meds, and no doctor would deny diabetes medication in favor of weight loss.

So, it's not a derail. Using this medication for weight loss is diabetes prevention. In the grand scheme of the medical expenses, hospitalizations, and complications that come with diabetes, that's huge.
bam02
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AG
I don't think anybody is surprised that a $1600/month magic pill is more effective than difficult lifestyle changes. I believe most of us are just frustrated that we all pay for all of this. We pay kajillions for T2DM care and potentially zillions for this drug that pharma companies and stockholders profit off of. Sucks that we are a nanny welfare state either way.

It is harsh, but we need more austerity and self-reliance and more and more people will figure it out or suffer the consequences. Sucks that children suffer from their parents bad choices (and I know these things become endemic and carry on from one generation to the next) but you just have to feel like eventually personal responsibility must take over.
KidDoc
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AG
bam02 said:

I don't think anybody is surprised that a $1600/month magic pill is more effective than difficult lifestyle changes. I believe most of us are just frustrated that we all pay for all of this. We pay kajillions for T2DM care and potentially zillions for this drug that pharma companies and stockholders profit off of. Sucks that we are a nanny welfare state either way.

It is harsh, but we need more austerity and self-reliance and more and more people will figure it out or suffer the consequences. Sucks that children suffer from their parents bad choices (and I know these things become endemic and carry on from one generation to the next) but you just have to feel like eventually personal responsibility must take over.
As someone who has practice medicine for over 20 years this data is absolutely shocking and unexpected at any price. It is literally unprecedented in human history to have a safe and effective medication for obesity.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
bam02
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AG
My response was from the standpoint of assuming the medicine is efficacious. Not disputing that at all, so assuming it's the "miracle pill" that people have long hoped for, it would actually be shocking if diet and exercise arm had comparable results at all. People want the easy way out. That's all the study proves.

Every single person in the diet/exercise arm is 100% capable of weight loss without a $1600/month pill that our tax dollars and insurance premiums are gonna pay for.
KidDoc
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AG
bam02 said:

My response was from the standpoint of assuming the medicine is efficacious. Not disputing that at all, so assuming it's the "miracle pill" that people have long hoped for, it would actually be shocking if diet and exercise arm had comparable results at all. People want the easy way out. That's all the study proves.

Every single person in the diet/exercise arm is 100% capable of weight loss without a $1600/month pill that our tax dollars and insurance premiums are gonna pay for.
But you are not understanding the results of that study. Both groups had the same diet and exercise. Placebo gained BMI over 2 years, Wegovy lost 16% BMI.

No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
boredatwork08
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AG
Yeah, y'all's feelings about the moral failings of a minor don't really play into this at all.

If the insurance companies would think long-term (yeah, right) they would realize that covering this medication along with other interventions for a couple of years would significantly reduce the lifetime cost of an insured individual.
bam02
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AG
Oh ok. I didn't read the study. My bad! I assumed diet and exercise was prescribed but didn't know it was supervised and documented.
The Lost
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KidDoc said:

bam02 said:

I don't think anybody is surprised that a $1600/month magic pill is more effective than difficult lifestyle changes. I believe most of us are just frustrated that we all pay for all of this. We pay kajillions for T2DM care and potentially zillions for this drug that pharma companies and stockholders profit off of. Sucks that we are a nanny welfare state either way.

It is harsh, but we need more austerity and self-reliance and more and more people will figure it out or suffer the consequences. Sucks that children suffer from their parents bad choices (and I know these things become endemic and carry on from one generation to the next) but you just have to feel like eventually personal responsibility must take over.
As someone who has practice medicine for over 20 years this data is absolutely shocking and unexpected at any price. It is literally unprecedented in human history to have a safe and effective medication for obesity.

So that doesn't make you skeptical at all?
KidDoc
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AG
The Lost said:

KidDoc said:

bam02 said:

I don't think anybody is surprised that a $1600/month magic pill is more effective than difficult lifestyle changes. I believe most of us are just frustrated that we all pay for all of this. We pay kajillions for T2DM care and potentially zillions for this drug that pharma companies and stockholders profit off of. Sucks that we are a nanny welfare state either way.

It is harsh, but we need more austerity and self-reliance and more and more people will figure it out or suffer the consequences. Sucks that children suffer from their parents bad choices (and I know these things become endemic and carry on from one generation to the next) but you just have to feel like eventually personal responsibility must take over.
As someone who has practice medicine for over 20 years this data is absolutely shocking and unexpected at any price. It is literally unprecedented in human history to have a safe and effective medication for obesity.

So that doesn't make you skeptical at all?
How can you be skeptical when faced with an outstanding study (double blind, placebo controlled, for 2 years) showing very clear results? You cannot deny actual hard data.

And in my data set of 1(me lost 40 lbs) + one of my MAs (who has lost over 100 lbs on it) I can say it made a rapid and tremendous difference immediately.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
CenterHillAg
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AG
I'm skeptical of the study because you have a bunch of overweight kids that are given an appetite suppressant and begin losing weight immediately, thereby giving them and their parents motivation to try harder and lose significant weight/BMI. Meanwhile a control group probably took everything seriously initially, and when they saw little-to-no results, they lost motivation and mailed in the diet and lifestyle change effort. I couldn't find an explanation of all the methodology in the paper, I'd be curious to see what it says.

I've struggled with weight all my life, and have had only had significant success in the past 5 or so years. It took a true lifestyle change, exercise, and a focus on healthy eating I could sustain with a busy work schedule. I purposely avoided popular diets or exercise routines I can't maintain for the rest of my life. I wanted a true reset in how I live, it wasn't easy and took years. Hit walls and setbacks, but learned to mentally push through them. I can cook a healthy meal in about 15 mins after a 17 hr work day that costs $4, half the price of the fast food junk I used to get. Anybody can do the same with a real focus on changing. I know several people on wegovy, and while they have lost weight, they're in no way healthy or learning how to make lifestyle changes. They just eat smaller portions of junk. To me, this is just another band-aid that works until it doesn't, and the person is back to square 1, with no idea in how to cope other than get another pill.
The Lost
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KidDoc said:

The Lost said:

KidDoc said:

bam02 said:

I don't think anybody is surprised that a $1600/month magic pill is more effective than difficult lifestyle changes. I believe most of us are just frustrated that we all pay for all of this. We pay kajillions for T2DM care and potentially zillions for this drug that pharma companies and stockholders profit off of. Sucks that we are a nanny welfare state either way.

It is harsh, but we need more austerity and self-reliance and more and more people will figure it out or suffer the consequences. Sucks that children suffer from their parents bad choices (and I know these things become endemic and carry on from one generation to the next) but you just have to feel like eventually personal responsibility must take over.
As someone who has practice medicine for over 20 years this data is absolutely shocking and unexpected at any price. It is literally unprecedented in human history to have a safe and effective medication for obesity.

So that doesn't make you skeptical at all?
How can you be skeptical when faced with an outstanding study (double blind, placebo controlled, for 2 years) showing very clear results? You cannot deny actual hard data.

And in my data set of 1(me lost 40 lbs) + one of my MAs (who has lost over 100 lbs on it) I can say it made a rapid and tremendous difference immediately.


How can I be skeptical? Oh let's see, opioid crisis, all sorts of failed drugs, companies paying for studies, you writing it up like a cheap sales person, literally one study. Do you know all the things in human history that sounded good once but didn't work?

I work in data, give me a data set and I can make it sing for you however you want.
bam02
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fc2112
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Gotta admit I'm torn on this one as well. As someone who was obese up until age 55, then made diet and exercise changes and lost close to a hundred pounds - yeah, I know it's more than just will power, but kids can lose weight so easily with just minor adjustments.
TXTransplant
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CenterHillAg said:

I'm skeptical of the study because you have a bunch of overweight kids that are given an appetite suppressant and begin losing weight immediately, thereby giving them and their parents motivation to try harder and lose significant weight/BMI. Meanwhile a control group probably took everything seriously initially, and when they saw little-to-no results, they lost motivation and mailed in the diet and lifestyle change effort. I couldn't find an explanation of all the methodology in the paper, I'd be curious to see what it says.

I've struggled with weight all my life, and have had only had significant success in the past 5 or so years. It took a true lifestyle change, exercise, and a focus on healthy eating I could sustain with a busy work schedule. I purposely avoided popular diets or exercise routines I can't maintain for the rest of my life. I wanted a true reset in how I live, it wasn't easy and took years. Hit walls and setbacks, but learned to mentally push through them. I can cook a healthy meal in about 15 mins after a 17 hr work day that costs $4, half the price of the fast food junk I used to get. Anybody can do the same with a real focus on changing. I know several people on wegovy, and while they have lost weight, they're in no way healthy or learning how to make lifestyle changes. They just eat smaller portions of junk. To me, this is just another band-aid that works until it doesn't, and the person is back to square 1, with no idea in how to cope other than get another pill.


Your concerns about the study actually make a compelling case for using this drug to jump start weight loss. When you are truly obese, losing weight can seem like an overwhelming, daunting task. And many people do give up because they don't see results.

People are motivated by success. Get people down 15-20 lbs, and they may be motivated to make the lifestyle changes necessary to continue losing weight and maintain it long-term, eventually without the drug.

But as another poster said, you have to concurrently train people to have better eating and exercise habits. I have a friend going through this now. She lost 100+ lbs years ago with a gastric sleeve. She recently put on another 15-20 lbs, and she's so terrified she's going to end up obese again that she went on Wegovy. And now she just doesn't eat. An eating disorder caused her to gain the wait, and now she's developing another eating disorder to lose it.

Food is a powerful drug. Telling an obese person to eat less and exercise more is like telling an alcoholic to stop drinking. Sure, there will be a few who have the willpower to do it on their own, but most will fail over and over and ultimately succumb to the health effects of their addiction.

As far as the side and/or long-term effects of the drug are concerned, they can't be measured in a vacuum and should be considered in comparison to the "side effects" and long term complications of being obese. Similar to how we look at gastric bypass surgery as a tool for weight loss. My same friend almost died after her surgery and was in the hospital for weeks, but I'm 100% certain she'd tell you it was worth the risk.

What I personally do have a problem with is this drug being used by the Kim Kardashians of the world to lose 10-15 lbs to fit in a dress that was custom made for someone else. I'm seeing this in my own circle of upper middle-class friends. People want to lose a few lbs and they are using these meds for purely vanity-related reasons. They are getting cheaper, "generic" versions from functional medicine doctors and compounding pharmacies, which is a whole other issue, since these drugs are still patent protected.
fc2112
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TXTransplant said:

People want to lose a few lbs and they are using these meds for purely vanity-related reasons. They are getting cheaper, "generic" versions from functional medicine doctors and compounding pharmacies, which is a whole other issue, since these drugs are still patent protected.
Horrible! Terrilbe!

Where and how do people do this?
TXTransplant
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fc2112 said:

TXTransplant said:

People want to lose a few lbs and they are using these meds for purely vanity-related reasons. They are getting cheaper, "generic" versions from functional medicine doctors and compounding pharmacies, which is a whole other issue, since these drugs are still patent protected.
Horrible! Terrilbe!

Where and how do people do this?


Seems to be functional medicine doctors, compounding pharmacies, and "wellness" or "med" spas. The problem with it is they are compounding the injections themselves with no testing or oversight. So they might be mixing the semaglutide in with ingredients that have not been tested or approved by the FDA. There is also concern that they may be buying the active ingredient (semaglutide) from places like China, where quality control and purity may be an issue. As you can imagine that might cause different side effects, or even reduce the efficacy of the drug. In some cases, they might be outright ripping people off by knowingly selling diluted or placebo injections. In the meantime, the people taking it think they are getting the "real" thing.
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