All my immediate family members are obese. I'm not (BMI 24.5, borderline overweight at the high end of normal, highest lifetime BMI was 29.5), but that's through strenuous, exhausting effort over decades. I also exercise regularly, though I've learned over time how disconnected exercise is from weight management.

At my weight, I'm not a candidate for going on a GLP-1. I'm sure I could find an unethical doctor to prescribe it if I looked hard enough, but I don't want to have the downsides hidden from me.

My weight has been steadily ratcheting up over the years, since I don't have as much room in my life as I used to for living with the discomfort of caloric deficit. If that continues, I will probably become a candidate for GLP-1s, like my immediate family members, just after a decade or so of possibly unneeded striving.

Lots of people are in situations far worse than mine, so I don't feel unlucky — but it would be nice if there were a clearer path forward. While lowering risk for Alzheimer's is not a priority for me, other effects of GLP-1s sound extremely enticing — especially reports of reduced food craving.

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jaggederest 5 hours ago | parent [-]

Speaking as someone who had the same kind of reservations, I think you sound exactly like me, and if I had any advice to my past self, it would be "get on it as early as it's available, start much lower than anyone thinks is sane, and never ever stop".

I got a concierge doctor who absolutely evaluates what I ask for skeptically, and pay for my GLP medications out of pocket, so I feel ethically totally comfortable with this position. The downsides are real and significant, it's not a "fun" medication, but just the change in how I feel is worth every penny, let alone the massive reduction in heart attack risk, liver enzyme numbers, and so on.

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Jaygles 4 hours ago | parent [-]

What downsides have you experienced?

	▲	jaggederest 3 hours ago \| parent \| next [-]
		Gastrointestinal - nausea, extreme fullness, paradoxically both rapid and slow transit (I recommend lots of fiber, but that will make you too full too), bloating, all kinds of negative stuff, and obviously if you're on a calorie deficit because you get full off a single bite of food you're going to have low energy and feel pretty garbage on that front (thus ramp slowly), but also some jitteryness, all manner of things. I would call the first week on a tiny dose something like a very mild GI bug or flu, in terms of everything I experienced. That said, I'm extremely prone to side effects, most people I know who have tried them started at maybe half the standard dose and had zero side effects at all. I'm the best possible guinea pig for these things, because if I can tolerate it, almost anyone who isn't frankly allergic or something can. The other downside, obviously, is injections - you will need to learn how to use sterile technique to inject yourself or pay the incredibly high costs for the pens. The pills are also an option but I have no personal experience and their bioavailability is so low I don't know that I fully trust them. They will completely change your relationship with food and alcohol, too. Your tastes will probably shift, nearly everybody I know who is on them has essentially given up booze (maybe a couple drinks a year, more or less)
	▲	cj 2 hours ago \| parent \| prev [-]
		In my experience, basically all downsides can be solved by lowering the dose, and not escalating dosages as fast as the doctors tell you.