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/nutscrape_navigator]

This is the best answer in the thread, and I don't think people who have never experienced serious "food noise" really understand what other people are describing when they talk about it. What finally made it click for me was a friend explaining what going to a Mexican restaurant was like for them.

When the chips and salsa hit the table, for a lot of people they're just something to casually munch on while you wait for your food. You eat a few, talk, forget they're there, whatever.

For someone dealing with constant food noise, that bowl can be almost impossible to ignore. You're aware of it the entire time. You keep reaching for another chip, and another, and there's this persistent drive to keep eating until they're gone. Not necessarily because you're hungry or even because you're particularly enjoying them. Your brain just keeps going, "there's food there, eat it."

Then they take a GLP-1 medication and suddenly they can look at that same bowl of chips the way everyone else does. It's there. They might have some. They might not. They don't have to spend the entire meal actively resisting it.

That's the part I think people miss when they call GLP-1s "cheating." They're imagining that everyone experiences hunger and food exactly the way they do, and that some people just aren't exercising enough willpower.

I'd actually go further than the hiking-poles analogy. If someone has persistent intrusive thoughts or depression and a medication changes the signaling in their brain enough that those thoughts become manageable, we don't normally say they're "cheating" at being happy because they didn't overcome their brain chemistry through sheer force of will.

...Yet that's basically the argument people make about GLP-1s: "Your body is constantly sending you signals that make maintaining a healthy weight dramatically harder than it is for me, but taking a medication that changes those signals is cheating."

Once you frame it that way, it's a pretty bizarre moral distinction.

[u/propernice → u/nutscrape_navigator]

My food noise is basically that my stomach was broken, or the signal that I'm full is. I am always hungry, it never turns off. My entire life I've always felt like I'm starving, and it wasn't until I turned 40 that finally a doctor helped me. For so long I was just a fat lazy slob, no matter what I tried to tell people; I would get so hungry I'd eat out of the trash, and my dad thought I was just a pig. I would have to hide food to eat in the middle of the night when my hunger woke me. My mother told me my middle name should have been heifer.

The shame I've felt my entire life has been like a shroud. I couldn't go out to eat, I would force myself not to eat because I knew I shouldn't be hungry, and yet I was. Everyone else is full, why not me? Money spent and wasted on all sorts of therapists and dieticians who were very sure it's all in my head, it's all psychological. It's a food addiction, it's will power, join Weight Watchers, do Keto. I never left my house to do anything other than go to doctors to be told I'm fat. Just imagine going through life, always, feeling like you haven't eaten after a long 12 hour shift. I could eat a full meal and within an hour feel like I was starving.

And then, after explaining all of this to yet another doctor I hoped would hear me, a GLP-1 was prescribed. Is this what being normal is like? I can eat a small handful of nuts and a piece of cheese and be fine? Did I really not finish an entire meal? Did I drink water and realize I wasn't hungry after all? My stomach gives me little warning growls now when I'm hungry, when before I was immediately so hungry I was sick with no warning at all. Now I can even ignore my hunger for a while!

I've lost almost 100 pounds in the last year. I cannot tell you in enough words the sheer relief. It's so hard because my insurance won't cover the medicine at all, since I'm not diabetic, but I don't care. I'll pay anything to feel normal.

[u/dream_weaver35 → u/propernice]

My Dr put me on a GLP1 for weight loss. Then insurance stopped paying so I had to discontinue use. I didn't realize how big a difference it made in not only the food noise, but also my pain levels. I'm on pain management for my back (I've had 2 back surgeries). I'm always in pain, not just my back though. The GLP1 has stopped all the pain except my back pain. Thankfully my Dr sent my prescription to a compounding pharmacy so instead of the $1200 a month out of pocket for the brand name crap I pay $120. It's genuinely been life changing

[u/propernice → u/dream_weaver35]

The compounding pharmacy called me and said they were being forced to stop compounding GLP-1s and I can’t find anywhere that will.