Dr.NephBHM_UK said:SELECT is the trial that changed the framing of this class, because it was an outcome trial rather than a weight trial: about a 20% relative reduction…
Dr.NephBHM_UK said:...we don't know the long-term effects of cardiovascular risk...
This is a fair point, and I think intellectual honesty requires acknowledging it. GLP-1 agonists in their current form have ~8-10 years of human exposure data. That's not nothing, but it's not 30+ years either.
However: the risk-benefit calculation should also consider the KNOWN long-term effects of untreated obesity — diabetes, cardiovascular disease, cancer, joint destruction, reduced lifespan by 5-10 years.
Uncertainty about GLP-1 long-term safety vs certainty about obesity consequences. The calculus seems clear to me, but reasonable people can disagree.
A narrower follow-up, since the general answer is now clear:
What did you change at the same time, and can you separate the two now?
lucas_SP_BR said:Dr.NephBHM_UK said: ...we don't know the long-term effects of cardiovascular risk...
lucas_SP_BR said:...we're creating a generation dependent on cardiovascular risk...
I understand the concern, but consider this analogy: are we "creating a generation dependent on" blood pressure medication? Cholesterol medication? Thyroid medication?
Obesity is a chronic disease with biological drivers. Treating it with medication is no different from treating any other chronic condition. The "dependency" framing implies weakness or moral failure — neither of which is accurate.
If ongoing medication is what keeps someone healthy, that's successful treatment, not dependency.
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View Resultslucas_SP_BR said:Dr.NephBHM_UK said: ...we don't know the long-term effects of cardiovascular risk...
Senior perspective on cardiovascular risk: I'm 65 years old and started this journey skeptically. My geriatrician recommended it after years of failed interventions.
9 months later: down 38 lbs, more mobile, pain reduced, medications simplified. My quality of life has improved dramatically. I wish this existed 20 years ago.
To other older adults hesitating: the SELECT trial proved benefit in our age group. You deserve to feel good in your body regardless of age.
DebRD_ATL said:lucas_SP_BR said: ...we're creating a generation dependent on cardiovascular risk...
DebRD_ATL said:...cardiovascular risk is just another fad...
I understand the skepticism — we've all seen "miracle" weight loss solutions come and go. But consider what makes GLP-1 agonists different:
- Phase 3 RCTs with thousands of participants (not 20-person pilot studies)
- Published in NEJM, JAMA, Lancet (not press releases)
- Replicated across multiple independent research groups
- Proven cardiovascular and renal benefits beyond weight loss
- Biological mechanism fully characterized at the receptor level
This isn't a fad — it's a new drug class supported by the highest level of clinical evidence. The comparison to past fads is understandable but inappropriate.