People that are doing that are smart enough to know they may not be getting the real thing. They don't care as long as it works.

bam02 said:

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People that are doing that are smart enough to know they may not be getting the real thing. They don't care as long as it works.

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I actually doubt that. It's being marketed heavily as the "generic" version. There is no such thing. Compounding pharmacies don't have the same regulatory oversight as regular pharmacies. And there is a lot of trademark and copyright infringement going on. It's being marketing and sold as the real thing, just cheaper.

There are also "conspiracy theories" being spread with it - basically the drug companies are greedy and charging too much and creating artificial shortages. And these compounding pharmacies are "heroes" for making the cheaper version available.

It's actually even being pushed by MDs who work in the field of bariatric medicine, and I've seen stories in the mainstream media about what a great service this is. I think there is a lot of confusion out there around this one.

The good news is, Teva should be clear to make a legit generic version by the end of this year.

See link below. WWL is a legit CBS affiliate news station.

https://www.wwltv.com/amp/article/news/local/generic-weight-loss-injection-semaglutide-hailed-as-affordable-game-changer-for-patients/289-3c01fba9-83fc-4af8-aa2e-af08e3aa3197

And now I am derailing the thread.

I think we just have different views on what healthy should be, because the examples of quick weight loss from wegovy or a gastric sleeve reinforce to me that they aren't the answer. Your friend nearly died after a sleeve and is now on wegovy, but I'd be willing to bet she never put sustained (years) of effort into truly trying to be healthy before either of these things. I truly believe obesity has ties to mental issues, and they should be dealt with alongside lifestyle changes for weight loss.

The medical and fitness industry push quick fixes for weight loss, yet most people never see long term results. There are numerous examples of people on the weight loss thread that saw significant weight loss on keto, yet put many of them put weight back on. Someone I know lost 120 lbs on keto and looked great, but they put it all back on when they got off the diet and slipped back into old habits. It works but is not sustainable for most. I know numerous people that stretched their gastric sleeve and put most of their weight back on because habits never changed. 2 of the people on wegovy puke their brains out while eating Oreos and chips, but are proud of their 25 lbs lost. You don't eat yourself into obesity in a year, so the expectation to drop all that weight in the same timeframe sets you up for failure. A 5 year plan for weight loss sounds miserable and most don't want to commit to that vs a pill or sleeve that provides instant results, but 5 years of steady improvements is much easier for building habits.

7 years ago I was 50 lbs heavier, in terrible shape, living on a diet of beer and fast food. If you would have told me then to immediately work out 6 days a weeks, eat only fresh cooked healthy meals, drink only water and coffee, and maybe 2 alcohol drinks a month, I would have failed miserably. I incrementally built to that lifestyle, and now feel much better, and those healthy habits are a routine I don't have to think about while doing them.

TXTransplant said:

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bam02 said:

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People that are doing that are smart enough to know they may not be getting the real thing. They don't care as long as it works.

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I actually doubt that. It's being marketed heavily as the "generic" version. There is no such thing. Compounding pharmacies don't have the same regulatory oversight as regular pharmacies. And there is a lot of trademark and copyright infringement going on. It's being marketing and sold as the real thing, just cheaper.

There are also "conspiracy theories" being spread with it - basically the drug companies are greedy and charging too much and creating artificial shortages. And these compounding pharmacies are "heroes" for making the cheaper version available.

It's actually even being pushed by MDs who work in the field of bariatric medicine, and I've seen stories in the mainstream media about what a great service this is. I think there is a lot of confusion out there around this one.

The good news is, Teva should be clear to make a legit generic version by the end of this year.

See link below. WWL is a legit CBS affiliate news station.

https://www.wwltv.com/amp/article/news/local/generic-weight-loss-injection-semaglutide-hailed-as-affordable-game-changer-for-patients/289-3c01fba9-83fc-4af8-aa2e-af08e3aa3197

And now I am derailing the thread.

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That story just talks about the compounding pharmacies. When I search for Tevai just find sandals. What is the generic GLP-1 you are referring to?

That may have been my bad. I saw a blurb about it in another article that I didn't link and assumed it was correct (considering the source), but I probably shouldn't have done that.

It looks like the settlement was over the generic for Victoza, which I guess is also a diabetes drug. The dates line up. I'll let you explain the difference.

https://www.pharmaceutical-technology.com/news/novo-teva-victoza-patent-dispute/

Edit: looks like Victoza us the version approved for diabetes, vs Ozempic, Wegovy, etc, are the formulations approved for weight loss. Please correct me if I'm wrong.

I agree with everything you're saying, and there is no magic cure. And not everyone will be helped by the drugs. But if even a small percentage can jump start their weight loss and then go on to develop sustainable habits over the long term, then it may be worth it. If for no other reason than the strain that will relieve from our health care system.

My friend has actually done really well keeping the weight off. She just found herself in a stressful situation last year and panicked when she put on 15-20. Which pushed her to the injectable. I do worry about her long term ability to keep that 15-20 under control (and the bad habits she may be forming to do it), but I feel confident she won't gain 50-100 back. Her weight loss has just skewed her perception of what her weight should be. We all know those last few lbs are the hardest to lose - which is why I don't think that's what these drugs should be used for.

As far as using these drugs for weight loss is concerned, that genie is out of the bottle. It's just a matter now of who has access to it because of high prices and limited supply.

KidDoc said:

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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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Am I missing something? I didn't see anything in that study that mentioned behavior modifications or controls besides the medication or placebo being administered.

Study was also funded by the drug company that makes Wegovy.

Aggie_Boomin 21 said:

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KidDoc said:

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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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Am I missing something? I didn't see anything in that study that mentioned behavior modifications or controls besides the medication or placebo being administered.

Study was also funded by the drug company that makes Wegovy.

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It is in the first paragraph.

Participants were randomly assigned in a 2:1 ratio to receive once-weekly subcutaneous semaglutide (at a dose of 2.4 mg) or placebo for 68 weeks, plus lifestyle intervention. The primary end point was the percentage change in BMI from baseline to week 68; the secondary confirmatory end point was weight loss of at least 5% at week 68.

It also explains it in the graphic on the right. Of course it was.funded by the manufacturer the vast majority of studies are funded like that unfortunately.

KidDoc said:

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Aggie_Boomin 21 said:

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KidDoc said:

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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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Am I missing something? I didn't see anything in that study that mentioned behavior modifications or controls besides the medication or placebo being administered.

Study was also funded by the drug company that makes Wegovy.

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It is in the first paragraph.

Participants were randomly assigned in a 2:1 ratio to receive once-weekly subcutaneous semaglutide (at a dose of 2.4 mg) or placebo for 68 weeks, plus lifestyle intervention. The primary end point was the percentage change in BMI from baseline to week 68; the secondary confirmatory end point was weight loss of at least 5% at week 68.

It also explains it in the graphic on the right. Of course it was.funded by the manufacturer the vast majority of studies are funded like that unfortunately.

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I saw all that. I guess I misunderstood what you meant by "behavioral modifications." Didn't think you just meant the groups were given drug or placebo, and instead thought you meant they took other actions that were monitored/recorded/prescribed to try to lose weight in addition to the meds.

TXTransplant said:

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That may have been my bad. I saw a blurb about it in another article that I didn't link and assumed it was correct (considering the source), but I probably shouldn't have done that.

It looks like the settlement was over the generic for Victoza, which I guess is also a diabetes drug. The dates line up. I'll let you explain the difference.

https://www.pharmaceutical-technology.com/news/novo-teva-victoza-patent-dispute/

Edit: looks like Victoza us the version approved for diabetes, vs Ozempic, Wegovy, etc, are the formulations approved for weight loss. Please correct me if I'm wrong.

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Victozia is for DM only, it is daily instead of weekly injection and the weight loss data is modest at 5-10%. It is not currently approved for weight loss.

Ozempic is DM only and they accidentally found more impressive weight loss data. Wegovy is the exact same drug just higher dose. It shows 15-20% weight loss. Both are weekly sub-Q injections.

Mounjaro is currently type 2 DM only, weekly injection, 20-25% weight loss. FDA approval for weight loss is pending.

Aggie_Boomin 21 said:

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KidDoc said:

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Aggie_Boomin 21 said:

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KidDoc said:

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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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Am I missing something? I didn't see anything in that study that mentioned behavior modifications or controls besides the medication or placebo being administered.

Study was also funded by the drug company that makes Wegovy.

---

It is in the first paragraph.

Participants were randomly assigned in a 2:1 ratio to receive once-weekly subcutaneous semaglutide (at a dose of 2.4 mg) or placebo for 68 weeks, plus lifestyle intervention. The primary end point was the percentage change in BMI from baseline to week 68; the secondary confirmatory end point was weight loss of at least 5% at week 68.

It also explains it in the graphic on the right. Of course it was.funded by the manufacturer the vast majority of studies are funded like that unfortunately.

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I saw all that. I guess I misunderstood what you meant by "behavioral modifications." Didn't think you just meant the groups were given drug or placebo, and instead thought you meant they took other actions that were monitored/recorded/prescribed to try to lose weight in addition to the meds.

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I signed up for NEJM as that is a great question. From the actual appendix in the study here are the details:

Lifestyle intervention, consisting of healthy nutrition and physical activity counseling provided by a dietician or other qualified healthcare professional, according to local standards, was provided throughout the trial (from the start of the run-in to the end of the follow-up), with the goal of obtaining weight loss. If a BMI corresponding to <85th percentile on sex- and agespecific growth charts was reached during the trial (or if a BMI of <25.0 kg/m2 was reached for participants who had reached 18 years of age during the trial), participants were assigned to a maintenance diet, at the discretion of the investigator. Instruction and advice on physical activity was provided by trained site staff to encourage and reinforce a goal of 60 minutes of moderate-to-high intensity exertion per day. Activity trackers could be provided to support this goal (use was optional). Dietary and physical activity counseling were provided 12 every 2 weeks during the run-in period and up to week 20 of the treatment period, and every 4 weeks thereafter and could be delivered at trial sites or via phone or video call.

ETA: in the AAP guidelines I linked they do specifically state that intensive lifestyle interventions have been proven to decrease BMI but only if > 26 hours of face to face time. The BMI decrease was roughly 1 BMI in a year- rather disappointing for 26 hours of intensive intervention.

KidDoc,

Are you saying generic sites like this are a scam?

https://henrymeds.com/semaglutide/

fc2112 said:

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KidDoc,

Are you saying generic sites like this are a scam?

https://henrymeds.com/semaglutide/

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They are completely unregulated so hard to know how much actual medication is in the concoction or if there are impurities. I would avoid them personally, but I also am not on any weight loss meds at this time since I'm under 30 BMI.

ETA: that is a great price though @ $200 a month. With my insurance I was only paying $25 a month though.

One further - is the idea you go off this once you hit BMI < 30?

fc2112 said:

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One further - is the idea you go off this once you hit BMI < 30?

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Yes. Treat it like every other chronic disease. Like depression-- treat until they improve, then wean off, then if they relapse treat again. Same as hypertension, Type 2 DM, dyslipidemia, etc.

ETA: For kids it is to get to BMI < 95% for age.

Thanks for getting that

You're salaried. Doesn't apply to you.

Some docs learn that strategy on their own. Or maybe in residency or fellowship.

I'm not sure. I haven't ever heard that it was taught in Med school.

Hoosegow said:

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The first rule they teach you in medical school is that the first person you cure is the first customer you lose...

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lol wat

BCOBQ98 said:

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I guess nothing is our fault anymore? I'm glad my cardiologist's philosophy is about pushing me to make lifestyle changes and eliminating medications.

Personally, I know for me being at a healthy weight is 100% about willpower and making good diet and exercise choices.

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It's more nuanced then just will power. Yes, ultimately one needs to know how their particular body reacts to food and the calories that are ingested. And that can change as well with things like age, circumstances and level of athletic training as it is important too (more muscle usually means a better fat burning platform if you will to work with). But given so many factors that do also act on things, like genetics, lifestyle, income level etc, there's never just one thing. Ultimately, it is about about a calorie deficit. And what that looks like for one is different than another. Sure, it should be achievable and if my child were obese I'd try to exhaust every avenue I could before using a drug, as the habits formed are more important. There's also a lot of evidence that the habits/lifestyle is even more important than how much body fat a kid has as long as his vitals are in line with other healthy children. A lot of even obese kids are actually VERY healthy. It's more about how that diminishes over time once they become adults, t which is why I HATE the incorrect narrative of "healthy at any size". Sure, a 13 year old who is obese might be as healthy technically as the skinny 13 year old, but there are very few obese people after the age of 40-50 statistically as most die from complications and health issues brought on by obesity. So I'd rather see lifestyle be the reason for weight loss but I'm a realist too. As a teacher, I see what kids eat. It's mostly junk food. For now, their "health" is probably fine. But long term, the habit of grabbing junk food without thinking to overcome hunger will generally lead to at the least annoying levels of BF and in bad cases becoming overweight or even obese. It's a complicated issue though. Perfect world: everyone would train 3-6 days a week intense and consistently and eat with their body weight/BF% goals in mind (ie be deliberate with their food choices) and almost no one would be obese or overweight. That alone (a world with super fit people) would probably wipe out some diseases or greatly reduce the severity of most illness. Unfortunately, that's never going to be reality. Too many people practically celebrate their unhealthy lifestyles and even in some few instances give us healthy folks grief about our fitness lifestyle choice. I hope this option can help kids get on the right track for their future.

BCOBQ98 said:

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I guess nothing is our fault anymore? I'm glad my cardiologist's philosophy is about pushing me to make lifestyle changes and eliminating medications.

Personally, I know for me being at a healthy weight is 100% about willpower and making good diet and exercise choices.

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Interesting because I'm shopping around for a cardiologist who has experience with athletes as my heart hard stopped me from distance running. My current one is fine but he doesn't have the knowledge to help me craft a plan to exercise and manage afib.

KidDoc said:

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FratboyLegend said:

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KidDoc said:

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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:

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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.

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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.

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Do you know the cash cost of a script? I assume it remains patent protected.

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$1600 a month. It is crazy.

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Oh look a drug that is probably marked up 100x more than what it cost to make

https://www.wsj.com/articles/ozempic-wegovy-stop-weight-loss-ea925ae1

And here's why giving it to a 12 year old is a dumb idea. Some dumb to medicate for life starting that young.

Aggie369 said:

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Kinda sad we "need" this

Put down the soda and pizza....go outside.

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If there is a disease, and even if there isn't, the pharmaceutical companies will find a pill to make it better (but maybe kill you according to the warnings).

Pharmaceutical Companies have done more damage to American's than big tobacco.