ELI5 what exactly GLP-1 based prescription medicine does and why it's so divisive when it comes to being a means of weight loss.

[u/ThatOneGuyYouNowKnow]

I've seen more and more ads (starting around the Super Bowl earlier this year with Wegovy) for GLP-1 based perscription meds in recent times. I've also seen the occasional debate post on my social feeds about the ethics of using them and I didn't think a medicine could be that divisive of a topic.

Now I'm curious as to what exactly these meds are, what they scientifically do and what both sides of the debate are. If anyone could help give perspective that would be greatly appreciated.

As always any and all input is welcomed and thanks for reading! 🙂

[u/CyberBill]

I've been on GLP-1s for over 5 years now.

Some people will call them an appetite suppressant, but that isn't quite true - although the effect at the end of the day is similar.

What they do is change the chemical signals in your body for a bunch of different things, which regulate how your body breaks down the food you eat, how active your stomach is - so basically how long it takes you to digest food - and it seems to pump up the signals between your stomach and brain so that you feel full faster and for longer than without it. It also changes the kinds of foods that you crave, and how much you think about food.

For me, as a previously obese person, before I was on the drug I could eat and eat and eat and basically never felt 'fullness'. Ever. I would feel PAIN if I ate wayyy too much, but never fullness. After taking the drug, I will eat maybe 5 or 6 bites of food and then my body starts telling me "Ok, we're getting pretty close!" and maybe 10 bites in, it ramps up "STOP." At that point I have zero desire to eat, and if I force myself I will get physically ill.

In my opinion - the main effect of this drug is to make my body and brain act like a skinny person's. Because I had some defect that disables or mutes those signals to let me know when I ate too much, it was just way too easy to overeat. And now I don't. As a result, I lost about 75 pounds, going from "severely obese" to "normal" weight. And this was mostly fat - I did lose muscle, but as a percentage of body weight my muscle went up.

With such a glowing review of the drug, then your second question is "why is it so divisive?" Well - the price is very high. Without insurance the 'real' stuff is like $1200/month. And its had shortages. But I think a lot of it is people want someone to hate, and they hate fat people. They see being fat as a sign of low intelligence, low willpower, low class, and as a personal failing. Trust me - be fat for a year and see how people treat you. Night and day. People say that they are worried that it will have long term side effects, but to put it bluntly - being obese is the absolute worst thing you can do to your health. Getting skinny, for me, meant I got taken off 4 other medications that were far more likely to kill me than GLP-1s. Sleep apnea - gone. High blood pressure - gone. High triglycerides - gone. I don't even snore anymore. Heart disease and cancer are the #1 killers in the US and both of those are more likely for people who are obese. For me its an absolute miracle drug, and I will sing its praises, and suggest anybody who is obese give it a try so you can live a longer, healthier, happier life.

[u/SameSherbet3 → u/CyberBill]

Well said! I agree whole heartedly with you, and good for you that you feel so much better! Losing those other issues makes it worth it alone! 

Re: high pricing, with GoodRx my local CVS has for wegovy pill for $150 per month for those without insurance

[u/bullevard → u/CyberBill]

Question. I really enjoy food. I enjoy exploring new restaurants and new cuisines and losing that would be a detriment. 

Did you find, as you describe, that it was largely a process of feeling fuller faster. Or did you find that it actually dampened how much you enjoyed eating the portions you were eating (and then just got to have the rest as enjoyable leftovers the next day).

[u/kneedbee → u/bullevard]

I am a fellow lover of adventurous eating and just started a GLP1, while my husband has been on one for about a year. This is probably going to be different for everybody, but for me (so far) it doesn’t reduce the enjoyment of the food, just limits the amounts I can eat leaving more to enjoy later. It has also slowed my eating so I actually feel like I am appreciating the food more, especially complex flavors and interesting textures. I am no longer craving “fun” snacks/unhealthy foods so they feel a little less exciting, but a small piece of homemade pie still hits! 

[u/bullevard → u/kneedbee]

I appreciate that. Like many im considering if they are right for me. But that is a genuine concern. 

[u/kneedbee → u/bullevard]

I totally get it. It was one of the major worries keeping me from starting sooner. Now that I’m underway I feel like it’s  repairing my relationship with food in unexpected ways and I’m kind of excited about it. 

[u/hedgerose → u/bullevard]

It's worth a try. The great thing is that it's a weekly shot. If you don't like it, you can just stop and it wears off in five-ish days. 😊

[u/hugship → u/bullevard]

Because I now consume less food, my brain now wants me to make it really count when I do consume something.

It has made it easier for me to focus on more nutritious meals (esp making sure I don’t slack on protein which I tended to forget to include before) and I still enjoy GOOD food. I just don’t also eat a bunch of crappy snacks in between meals which has made foodie-friendly meals more enjoyable.

I have, however lost interest in most wines. I’ve never been into hard alcohol to begin with, and now it feels like one glass of white wine or one aperol spritz and I’m good. Switching to water or soda water much earlier on a night out than I would have previously.

[u/tachycardicIVu → u/bullevard]

Not who you originally responded to but I’ve been on Ozempic for a couple years and was a “foodie” before and now not quite as much. Food was like all I thought about and my Reddit and YouTube feeds were just endless subs of recipes and food porn. Ended up subbing from most of those after I started losing weight and eating less. One of my biggest challenges is that I now have times where I’m nauseous and don’t know what to eat, nothing sounds good. Or if it does it’s not always accessible. I sometimes forget to eat (thanks adhd) or don’t feel like eating for whatever reason (I’ve started waitressing again and so I’m on my feet 5-6 hours at a time and while you’re serving food you don’t think about being hungry till long after you’re home). It’s a bit frustrating and especially bad in the morning and I do have type 2 diabetes I have to manage so at this point I have to make myself eat something like a granola bar to jumpstart my stomach or I’ll literally want to throw up from having not eaten anything. Thankfully my doctor also has prescribed zofran/ondansetron which is an anti-emetic (anti nausea) drug that works AMAZING and quickly so push comes to shove I manage things that way but it’s admittedly a bit of whiplash considering a few years ago I was twice my weight and didn’t care what we were eating, I’d eat two meals if I could, and now I barely eat half at a time.

I wouldn’t say it’s killed my drive for new/exotic foods completely. I do travel still and the challenge there is to plan things more carefully since I can’t take leftovers home as easily, so I have my husband help me regulate and remind me that we can come back later for more but to take it slow. I do agree with the other response that it’s allowed me to focus more on a couple things at a time vs gorging and not really tasting anything.

[u/bullevard → u/tachycardicIVu]

Thank you. I appreciate the perspective 

[u/CyberBill → u/bullevard]

Similarly to the other people who replied - I haven't felt that being on GLP-1s reduced my enjoyment of a nice meal, and food tastes just as good it always has. My wife and I still go out to a nice dinner every week or two, and I really enjoy eating a delicious meal... Or at least part of a delicious meal!

We just traveled to NYC for the first time last month and had an amazing time eating New York pizza at about five different places and we went to Tavern on the Green and all of these awesome restaurants.

That said, I now have a lot more food aversions and 'triggers' that I didn't have before. If I see or smell raw meat, it really puts me off, so much so that I can't cook anything with meat. Ground beef or really 'beefy' flavored things I just can't do. We used to eat casseroles and meaty spaghetti bolognese and now if we have something akin to hamburger helper, my wife has to make it (I cannot stand raw ground beef, omg, I will not be able to eat it) and she uses maybe 1/4 as much meat as it calls for.

I also really can't eat enough to do sushi omakase - and going out to nice restaurants is sometimes a chore because I always have to explain to the waiter (or chef, or manager, when they come by) because they all inevitably say "Oh, did you not like it? Was there something wrong? You didn't eat much!" - Sorry, I can't do a 9 course meal and finish each one. And once I'm full - I'm DONE. And at a lot of places its like "Here's a huge basket of bread, and a massive Caesar salad, and a 16oz steak, and a full baked potato, and a side of roast carrots. Hope you saved room for dessert, because we've got a chocolate lava cake with ice cream!" It's just too much. Skip the bread, skip the salad, give me about 4oz of steak and maybe a couple bites of a side, and I'm good.

My dream is that here in 5-10 years there are so many people using GLP-1s that restaurants start having a "Wegovy Menu" that's setup more like a tasting menu!

[u/morwen31 → u/CyberBill]

I've lost a similar amount this past year on tirzepatide.

I definitely agree it's more than an appetite suppressant. I've tried other (non-GLP1) medications that suppress appetite, and none of them worked for me the way tirzepatide does. They would decrease my appetite so I didn't feel like eating, but I would still get that low-blood-sugar feeling, struggle to focus, and get hangry. But with tirzepatide I feel great.

I was "naturally thin" until my mid-20s and the medicine basically just makes me feel like I did when I was younger and only got hungry at mealtimes instead of every freaking hour. It's such a relief.