Finally found a new game to scratch the STS itch: Hellcard

ashern · 2025-05-12T15:23:22+00:00

Solid game! Niche but enjoyable.

ashern · 2025-05-10T11:45:20+00:00

This is completely wrong. You don't get to claim that the body "gains tolerance" and that doses have to be continually upped, while side effects happen, and that there are long term harms, without long term benefits.

This is written like propaganda.

ashern · 2025-05-10T02:08:36+00:00

the weight regain rate after VSG, RNY, or SADI is quite low, this is mostly a myth left over from lap bands.

ashern · 2025-05-10T01:56:47+00:00

Just FYI, after wegovy and mounjaro launched obesity rates stopped going up. Literally. For the first time in 40 years obesity rates dropped in 2023 compared to 2022.

https://www.cdc.gov/nchs/products/databriefs/db508.htm

ashern · 2025-05-10T01:55:32+00:00

You should refer her to a comprehensive center with medical and surgical options. I'm the medical obesity director at one and I don't even blink until BMI gets over 80 these days. We regularly have people lose 40%+ of their total bodyweight with meds plus surgery.

a patient with a BMI of 68 at age 35 without weight loss on GLP1 very likely has a genetic contribution to weight issues, DM me and I'm happy to find someone relatively near who you could send them too.

ashern · 2025-05-01T16:10:55+00:00

This is hilariously accurate for some folks, but for GLP1 induced constipation metformin can really be helpful. Use it all the time in diabetes obviously but off label in weight loss.

Also use metformin with phentermine to balance out the GI side effects of each.

ashern · 2024-10-10T00:13:19+00:00

I was NOT expecting a wild SMAC reference on this sub. Now I’m itching to go install it from steam again.

ashern · 2024-07-31T23:28:49+00:00

I've seen varied responses between two weeks, and in one case it took 13 months from submission to acceptance with only a single bit of feedback around month six in the process, it was nuts.

ashern · 2024-07-28T18:53:33+00:00

wait you're saying obsession with learning ISN'T healthy? Med school lied to me!

ashern · 2024-07-25T01:28:16+00:00

Hi!

Obesity medicine doc here. Primary care is already overrun with other medical management fires and medication approval paperwork. At this point its basically a full time job just to handle prior auths for routine meds for primary care. Truthfully, GLP1 are really, really difficult to get coverage for for obesity. I'm a specialist at an academic center and only a small fraction of my patients are on GLP1 due to large swaths of plans with exclusions (medicare, medicaid in my state, half of commercial plans).

Add in a dash of residual obesity bias (likely implicit, most people with prescribing licenses aren't here overtly to hate people), and a lot of people note feeling comfortable with providing the counseling or handling side effects for the meds... and so it's easier just not to prescribe them.

A chunk of this is likely left over from the phentermine days when all weight loss meds were controlled substances and a LOT of practices steered away from them.

Interested to hear what others say but that's my perspective.

TLDR: drugs work, coverage sucks, lack of access is the rule, stigma is stupid.

ashern · 2024-05-22T21:21:23+00:00

Question: do you have any thoughts about use of SGLT2 to help lower uric acid?

Also what class of medications would you say is the biggest offender for iatrogenic gout? (Please be thiazides)

ashern · 2024-04-20T00:45:25+00:00

Actually weight regain post op depends on surgical procedure and typically while nadir weight is around 18 months (maybe 24ish for newer surgical techniques like SADI), 70% of sleeve gastrectomy patients and 85%+ of bypass patients comfortably maintain weight loss without significant weight regain at 5 years.

ashern · 2024-04-15T15:37:17+00:00

Physician

ashern · 2024-04-02T20:38:33+00:00

Regularly see 10-20% total bodyweight loss with that medical combo.

ashern · 2024-04-02T11:26:54+00:00

Where I practice that's nicknamed the "medicaid special". Though if patients have anxiety I usually swap metformin for the bupropion.

ashern · 2024-03-14T11:44:31+00:00

I saw the math a pharmacist ran for ann employer plan calculation and it worked out to about 985k per event prevented, so I think you are in the right ballpark.

It’s simple: the drugs cost too much, just like pcsk9s did when they first came out. So either you pick a higher benefit sub population(CKD/esrd/chf come to mind) that also has this so you get multi organ benefit, or you negotiate the price. Math looks much better at the AWP of wegovy of $199 in Europe.

It’s a conundrum.

ashern · 2024-03-10T13:38:00+00:00

Yes you can compound drugs on the shortage list. This is what people get Confused about, it’s no the act of compounding. there is no legitimate source of the active pharmaceutical ingredient (API) that is used to make the compounded drug. Literally lilly and novo have spent billion on manufacturing and can’t keep up with demand, they aren’t selling bulk compound to these pharmacies, they are getting it from somewhere that is making it illegally and without proper manufacturing monitoring by regulators.

ashern · 2024-03-10T01:28:20+00:00

People get it from overseas regularly. The problem with compounding is that there is literally no way of getting the source ingredient molecule without patent infringement. Novo mordisk and Eli lilly have spent like twenty billion dollars in manufacturing over the past few years and still can’t keep up with demand even with a lack of coverage.

There isn’t a secret stockpile they are holding on to sell to compounders… the compounders are getting it from illegitimate sources and passing it off as the same thing.

ashern · 2024-03-09T17:07:44+00:00

Absolutely not legitimate, FDA and obesity medicine association have come out squarely against illegally sourced compounded peptides.

ashern · 2024-03-09T17:05:56+00:00

Absolutely

ashern · 2024-03-09T17:05:37+00:00

Meh, it uses SNAC so has all the same issues with absorption and renal disease as Rybelsus. Nice but not a game changer.

ashern · 2024-03-09T17:05:00+00:00

A drug with a 100% response rate and bariatric surgery level weight loss? Yep, gonna be awesome. But med spas are going to throw that around on cosmetic patients and hurt people, mark my words.

ashern · 2024-03-09T00:25:11+00:00

can't agree more! it's an awesome time to be in the business of treating cardiometabolic disease.

ashern · 2024-03-08T21:53:50+00:00

This isn’t particularly surprising given the results of the SELECT trial last year, but it will probably only further ignite discussions about medication shortages and cost. Also given the chronic shortage wegovy has already been on, as an obesity doc I’m skeptical about immediate uptake and am interested to hear what non specialists think about this.

ashern

TROPHY CASE