Bali 9: Nine very different drug mules and the two painful traits they sharedUnlike scores of people who scrambled for the blockbuster drugs Ozempic and Wegovy to lose weight in recent years, Danielle Griffin had no trouble getting them. The 38-year-old information technology worker from New Mexico had a prescription. Her pharmacy had the drugs in stock. And her health insurance covered all but $25 to $50 of the monthly cost. For Griffin, the hardest part of using the new drugs wasn’t access. It was finding out that the much-hyped medications didn’t really work for her. “I have been on Wegovy for a year and a half and have only lost 13 pounds,” said Griffin, who watches her diet, drinks plenty of water and exercises regularly. “I’ve done everything right with no success. It’s discouraging.” In clinical trials, most participants taking Wegovy or Mounjaro to treat obesity lost an average of 15% to 22% of their body weight — up to 50 pounds or more in many cases. But roughly 10% to 15% of patients in those trials were “nonresponders” who lost less than 5% of their body weight. Now that millions of people have used the drugs, several obesity experts told The Associated Press that perhaps 20% of patients — as many as 1 in 5 — may not respond well to the medications. It's a little-known consequence of the obesity drug boom, according to doctors who caution eager patients not to expect one-size-fits-all results. “It's all about explaining that different people have different responses,” said Dr. Fatima Cody Stanford, an obesity expert at Massachusetts General Hospital The drugs are known as GLP-1 receptor agonists because they mimic a hormone in the body known as glucagon-like peptide 1. Genetics, hormones and variability in how the brain regulates energy can all influence weight — and a person's response to the drugs, Stanford said. Medical conditions such as sleep apnea can prevent weight loss, as can certain common medications, such as antidepressants, steroids and contraceptives. “This is a disease that stems from the brain,” said Stanford. “The dysfunction may not be the same” from patient to patient. Despite such cautions, patients are often upset when they start getting the weekly injections but the numbers on the scale barely budge. “It can be devastating,” said Dr. Katherine Saunders, an obesity expert at Weill Cornell Medicine and co-founder of the obesity treatment company FlyteHealth. “With such high expectations, there’s so much room for disappointment.” That was the case for Griffin, who has battled obesity since childhood and hoped to shed 70 pounds using Wegovy. The drug helped reduce her appetite and lowered her risk of diabetes, but she saw little change in weight. “It’s an emotional roller coaster,” she said. “You want it to work like it does for everybody else.” The medications are typically prescribed along with eating behavior and lifestyle changes. It’s usually clear within weeks whether someone will respond to the drugs, said Dr. Jody Dushay, an endocrine specialist at Beth Israel Deaconess Medical Center. Weight loss typically begins right away and continues as the dosage increases. For some patients, that just doesn't happen. For others, side effects such as nausea, vomiting and diarrhea force them to halt the medications, Dushay said. In such situations, patients who were counting on the new drugs to pare pounds may think they’re out of options. “I tell them: It's not game over,” Dushay said. Trying a different version of the new class of drugs may help. Griffin, who didn't respond well to Wegovy, has started using Zepbound, which targets an additional hormone pathway in the body. After three months of using the drug, she has lost 7 pounds. “I'm hoping it's slow and steady,” she said. Other people respond well to older drugs, the experts said. Changing diet, exercise, sleep and stress habits can also have profound effects. Figuring out what works typically requires a doctor trained to treat obesity, Saunders noted. “Obesity is such a complex disease that really needs to be treated very comprehensively,” she said. “If what we’re prescribing doesn’t work, we always have a backup plan.”Brainy, 'normal guy': the suspect in US insurance CEO's slayingDAMASCUS, Syria — Syria's prime minister said Monday that most cabinet ministers were back at work after rebels overthrew President Bashar Assad, but some state workers failed to return to their jobs, and a United Nations official said the country's public sector came "to a complete and abrupt halt." Meanwhile, streams of refugees crossed back into Syria from neighboring countries, hoping for a more peaceful future and looking for relatives who disappeared during Assad's brutal rule. The rebel alliance now in control of much of the country is led by a former senior al-Qaida militant who severed ties with the extremist group years ago and promises representative government and religious tolerance. The rebel command said Monday they would not tell women how to dress. Syrian citizens stand on a government forces tank that was left on a street Monday as they celebrate in Damascus, Syria. "It is strictly forbidden to interfere with women's dress or impose any request related to their clothing or appearance, including requests for modesty," the command said on social media. Nearly two days after rebels entered the capital, some key government services shut down after state workers ignored calls to go back to their jobs, the U.N. official said, causing issues at airports and borders and slowing the flow of humanitarian aid. Rebel leader Ahmad al-Sharaa, who was long known by his nom de guerre Abu Mohammed al-Golani, also met for the first time with Prime Minister Mohammad Ghazi Jalali, who stayed in Syria when Assad fled. Israel said it carried out airstrikes on suspected chemical weapons sites and long-range rockets to keep them from falling into the hands of extremists. Israel also seized a buffer zone inside Syria after Syrian troops withdrew. Syrians wait to cross into Syria from Turkey on Monday at the Oncupinar border gate near the town of Kilis, southern Turkey. In northern Syria, Turkey said allied opposition forces seized the town of Manbij from Kurdish-led forces backed by the United States, a reminder that even after Assad's departure, the country remains split among armed groups that have fought in the past. The Kremlin said Russia granted political asylum to Assad, a decision made by President Vladimir Putin. Kremlin spokesperson Dmitry Peskov declined to comment on Assad's specific whereabouts and said Putin did not plan to meet with him. Damascus was quiet Monday, with life slowly returning to normal, though most shops and public institutions were closed. In public squares, some people still celebrated. Civilian traffic resumed, but there was no public transport. Long lines formed in front of bakeries and other food stores. There was little sign of any security presence, though in some areas small groups of armed men were stationed in the streets. Syrian citizens celebrate Monday during the second day of the takeover of the city by the insurgents in Damascus, Syria. Across swathes of Syria, families are now waiting outside prisons, security offices and courts, hoping for news of loved ones who were imprisoned or who disappeared. Just north of Damascus in the feared Saydnaya military prison, women detainees, some with their children, screamed as rebels broke locks off their cell doors. Amnesty International and other groups say dozens of people were secretly executed every week in Saydnaya, and they estimate that up to 13,000 Syrians were killed between 2011 and 2016. "Don't be afraid," one rebel said as he ushered women from packed cells. "Bashar Assad has fallen!" In southern Turkey, Mustafa Sultan was among hundreds of Syrian refugees waiting at border crossings to head home. He was searching for his older brother, who was imprisoned under Assad. "I haven't seen him for 13 years," he said. "I am going to go see whether he's alive." Jalali, the prime minister, sought to project normalcy since Assad fled. "We are working so that the transitional period is quick and smooth," he told Sky News Arabia TV on Monday, saying the security situation already improved from the day before. Israeli soldiers sit on top of a tank Monday along the so-called Alpha Line that separates the Israeli-annexed Golan Heights from Syria, in the town of Majdal Shams. At the court of Justice in Damascus, which was stormed by the rebels to free detainees, Judge Khitam Haddad, an aide to the justice minister in the outgoing government, said Sunday that judges were ready to resume work quickly. "We want to give everyone their rights," Haddad said outside the courthouse. "We want to build a new Syria and to keep the work, but with new methods." But a U.N. official said some government services were paralyzed as worried state employees stayed home. The public sector "has just come to a complete and abrupt halt," said U.N. Resident and Humanitarian Coordinator for Syria Adam Abdelmoula, noting, for example, that an aid flight carrying urgently needed medical supplies was put on hold after aviation employees abandoned their jobs. "This is a country that has had one government for 53 years and then suddenly all of those who have been demonized by the public media are now in charge in the nation's capital," Abdelmoula told The Associated Press. "I think it will take a couple of days and a lot of assurance on the part of the armed groups for these people to return to work again." People wave Syrian opposition flags at City Hall Square in Copenhagen, Denmark, Sunday, Dec. 8, 2024. (Emil Nicolai Helms/Ritzau Scanpix via AP) People attend a rally celebrating the fall of Syrian President Bashar Assad's government, at central Syntagma square, in Athens, Greece, Sunday, Dec. 8, 2024. (AP Photo/Yorgos Karahalis) People wave Syrian opposition flags at City Hall Square in Copenhagen, Denmark, Sunday, Dec. 8, 2024. (Emil Nicolai Helms/Ritzau Scanpix via AP) People gather to react following the fall of Syrian president Bashar Assad’s government, in Trafalgar Square, in London, Sunday, Dec. 8, 2024. (AP Photo/Alberto Pezzali) People wave Syrian opposition flags at City Hall Square in Copenhagen, Denmark, Sunday, Dec. 8, 2024. (Emil Nicolai Helms/Ritzau Scanpix via AP) People gather to react following the fall of Syrian president Bashar Assad’s government, in Trafalgar Square, in London, Sunday, Dec. 8, 2024. (AP Photo/Alberto Pezzali) People attend a rally celebrating the fall of Syrian President Bashar Assad's government, at central Syntagma square, in Athens, Greece, Sunday, Dec. 8, 2024. (AP Photo/Yorgos Karahalis) Members of the Syrian community in Finland wave a Syrian flag and celebrate in Helsinki, Finland, Dec. 8, 2024. (Roni Rekomaa/Lehtikuva via AP) People attend a rally celebrating the fall of Syrian President Bashar Assad's government, at central Syntagma square, in Athens, Greece, Sunday, Dec. 8, 2024. (AP Photo/Yorgos Karahalis) Syrians wave opposition flags and give out sweets during a spontaneous rally in Wuppertal, Germany, Sunday, Dec. 8, 2024, following the fall of Syrian president Bashar Assad’s government. (Christoph Reichwein/dpa/dpa via AP) Syrians celebrate the fall of the Assad regime in Syria at a demonstration in Stockholm, Sweden, Sunday, Dec. 8, 2024. (Jonas Ekstroemer/TT News Agency via AP) A Syrian man waves a flag during a spontaneous demonstration celebrating the fall of the Assad regime, in Nicosia, Cyprus, Sunday, Dec. 8, 2024. (AP Photo/Petros Karadjias) People gather to celebrate the Syrian government fall at Faith mosque in Istanbul, Turkey, Sunday, Dec. 8, 2024. (AP Photo/Emrah Gurel) Syrians wave Syrian opposition flags at a rally in Wuppertal, Germany, Sunday, Dec. 8, 2024, following the fall of Syrian president Bashar Assad’s government. (Christoph Reichwein/dpa/dpa via AP) People wave Syrian opposition flags at City Hall Square in Copenhagen, Denmark, Sunday, Dec. 8, 2024. (Emil Nicolai Helms/Ritzau Scanpix via AP) Syrians living in France gather on Republique square after the Syrian government fell early today in a stunning end to the 50-year rule of the Assad family, Sunday, Dec. 8, 2024 in Paris. (AP Photo/Aurelien Morissard) People gather to celebrate the Syrian government fall at Faith mosque in Istanbul, Turkey, Sunday, Dec. 8, 2024. (AP Photo/Emrah Gurel) People gather to celebrate the Syrian government fall at Faith mosque in Istanbul, Turkey, Sunday, Dec. 8, 2024. (AP Photo/Emrah Gurel) People gather to celebrate the Syrian government's fall, in Istanbul, Turkey, Sunday, Dec. 8, 2024. (AP Photo/Emrah Gurel) Syrians living in France hug during a rally on Republique square after the Syrian government fell early today in a stunning end to the 50-year rule of the Assad family, Sunday, Dec. 8, 2024 in Paris. (AP Photo/Aurelien Morissard) People gather to react following the fall of Syrian president Bashar Assad’s government, in Trafalgar Square, in London, Sunday, Dec. 8, 2024. (AP Photo/Alberto Pezzali) People gather to celebrate the Syrian government fall at Faith mosque in Istanbul, Turkey, Sunday, Dec. 8, 2024. (AP Photo/Emrah Gurel) People attend a rally celebrating the fall of Syrian President Bashar Assad's government, at central Syntagma square, in Athens, Greece, Sunday, Dec. 8, 2024. (AP Photo/Yorgos Karahalis) A Syrian man waves a flag during a spontaneous demonstration celebrating the fall of the Assad regime in Nicosia, Cyprus, Sunday, Dec. 8, 2024. (AP Photo/Petros Karadjias) Get local news delivered to your inbox!
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