January 5, 2024 • 50 mins
In this episode of "The Middle with Jeremy Hobson," we're kicking off the new year and asking you: are drugs like Ozempic, Wegovy and Mounjaro changing everything we know about weight loss? Jeremy is joined by two leading obesity physicians - Dr. Fatima Cody Stanford at Massachusetts General Hospital and Dr. Disha Narang at Endeavor Health System in Illinois. The Middle's house DJ Tolliver joins as well, plus callers from around the country.
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Episode Transcript
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Speaker 1 (00:05):
Welcome to the middle. I'm Jeremy Hobson. This week we
welcome the listeners of Spokane Public Radio in Washington State
and WOSU in Columbus, Ohio, and Tolliver is here as always. Hi, Tolliver.
Happy New Year.
Speaker 2 (00:17):
Right back at to Jeremy. So, how you doing with
your New Year's resolution?
Speaker 1 (00:20):
I mean, I'm not doing as well as I would
like because I wanted to do less social media, but
your TikTok videos are just too good.
Speaker 2 (00:26):
All a part of my plans stay away, you know.
Speaker 1 (00:29):
Before we get on with the show, Tolliver, I just
mentioned we are now airing on Spokane Public Radio. As
you know, last week we asked listeners what the most
important stories were in twenty twenty three in their communities,
and so many calls came into on our voicemail. But
here's one that came from a new listener in Spokane.
Speaker 3 (00:46):
Hi.
Speaker 4 (00:47):
This is Lynn calling from Spokane, Washington. The biggest news
in our county this year was of two large fires,
lots of physical damage, but very few lives lost. So
we feel very, very fortunate this year to have such
(01:08):
a great community that comes together and cares for people
to have kept all of these people safe.
Speaker 1 (01:16):
What a great point. And as you can hear, we
do listen to the voicemails if you happen to call
at a time other than when we are live again.
Our number is eight four four four six four three
three five three. That is eight four four four middle
you know, Tolliver. Lately, I have been doing something I
do every year around this time, which is I try
to watch the movies that are going to be nominated
for an oscar. Okay, And it was at the Oscars
(01:37):
last year when host Jimmy Kimmel made this.
Speaker 5 (01:40):
Joke, everybody looks so great When I look around this room,
I can't help but wonder is ozempic.
Speaker 6 (01:46):
Right for me?
Speaker 1 (01:48):
So the thing about that joke is that a year
ago a zempic and Wigov, which is very similar, weren't
really a part of the popular culture like they are now.
Now there's a shortage of the drugs for people who
need them for diabetes, and there's an estimate from Morgan
Stanley that seven percent of the US population will be
on one of these drugs in the next ten years.
Speaker 7 (02:10):
Wow.
Speaker 1 (02:11):
So this hour we're asking listeners what do you think
of medications like Ozepic, Mount Jarro, and Wagovi. Are you
using them to lose weight? Is this a revolution for
weight loss or just another fad? I can't wait to
hear the calls, Tolliver.
Speaker 2 (02:24):
Yeah, me either. Our number is eight four four four Middle.
That's eight four four four six four three three five three.
You can also email us by going to Listen to
the Middle dot com.
Speaker 1 (02:33):
Let's meet our panel. Doctor Fatima Cody Stanford practices obesity
medicine at Massachusetts General Hospital and is a professor at
Harvard University. Doctor Stanford, welcome.
Speaker 8 (02:45):
Thank you for having me. It's a delight to be here.
Speaker 1 (02:47):
And doctor Deshonnrang is incoming director of Obesity at Endeavor
Health North Shore in Chicago. Welcome to the Middle, doctor.
Speaker 7 (02:55):
Norang, thank you so much for having me.
Speaker 1 (02:58):
Well, before we get to the phones, let's start with
the base. Most of these drugs are slightly different from
one another, but they all seem to have the same effect,
which is pretty rapid weight loss, like fifteen or twenty
percent of body fat in some cases in a year.
Doctor Stafford, how did they work?
Speaker 3 (03:13):
Briefly?
Speaker 5 (03:14):
Yeah, well, actually I want to just kind of get
rid of a little few myths that we've kind of
stated at the outset of the show.
Speaker 8 (03:19):
They actually are the same drugs.
Speaker 5 (03:21):
So some magnetide is the agent that is exactly the
same drug ozimpic and will go be their identical drug.
They're the exact same drug, so it's the exact same compound.
These are what we call GLP one receptor agonists, and
I know that some fancy language that we have to
throw out there, but that's exactly what they are. They're
called glucagon like peptide one receptor agonists, and they really
(03:42):
work on the brain and the gut.
Speaker 8 (03:44):
They work to upregulate a part.
Speaker 5 (03:45):
Of the brain that tells us to eat less, and
they work to really help us store us out a
post or fat. So they do work in the brain
and the gut to really regulate how our brains think
and how we store fat. There's a lot of complicated
science behind how they work, but it's really important to
recognize that in our bodies, our bodies already produce gop one.
(04:09):
A lot of people don't know that in our bodies,
we already produce gop one within our gut. Some of
us produce more of it than others. So for those
of us that produce more of it. We already have
in our bodies, this ability to regulate how our bodies,
you know, have this sense of satiety, the sense of
fullness better than those of us that don't produce as
(04:31):
much of it. So I just want to kind of
throw that out there right now. The FDA has approved
ozempic for the for the purpose of treating diabetes diabetes
right gov for treating obesity, and.
Speaker 1 (04:44):
They're exactly the same thing. You say, they're exactly the
same thing.
Speaker 5 (04:47):
Fact drug, the exact identical, exact same drug. And then
for manduro that's a dual agonist that has kind of
two different types of things in it, the gop one
we just talked about, and something called a GI that's
a glucose insulinotropic polypeptide.
Speaker 8 (05:03):
Say that five times fast.
Speaker 5 (05:05):
And it's a dual agonist, and it's it's a little
bit of a you know, kind of a step above
what we see in that kind of single agent. That's
the Manjurro that you talked about, but it was approved
by the FDA on November eighth for the treatment of
patients with obesity under the trade name of zet bound.
So that is the same agent mondurro and zet bound,
(05:26):
same drug approved by the FDA initially to treat diabetes,
then approved to treat patients with obesity. I don't like
this idea of us taking one drug from one population
to treat another population, because many of the patients that
have type two diabetes also happen to have obesity. About
actually eighty percent of patients that have type two diabetes
(05:46):
also have obeses. So not necessarily taking one from one
another to treat another population, both patients, both sets of
patients actually happened. Yeah, it's not that one is better
or worse than the other. I think both warn't treatment
and so I don't like for us to think of
it that way, and so I really want to kind
of get rid of that dimorphism. So I just want
(06:08):
to throw those things out there and I'll be quiet after.
Speaker 1 (06:10):
Well, let me just I'll just bring doctor during in.
Do you think that these drugs are as revolutionary as
so many people think, or are they comparable to any
other existing weight loss tool?
Speaker 7 (06:21):
So these are amazing resources and it has really changed
the landscape of weight management.
Speaker 3 (06:27):
Right.
Speaker 9 (06:27):
So, as weight management.
Speaker 7 (06:28):
Specialists, we have had medications in the past approved for
weight management right and weight loss. However, these medications in
the trials have shown upwards of twenty percent or more
weight loss in the groups that have been on the
highest doses. So truly, yes, this has really changed the
landscape of.
Speaker 9 (06:47):
Medical weight management.
Speaker 7 (06:49):
However, within this whole conversation about you know, these revolutionary medications,
we really need to emphasize that these are, at the
end of the day, recent sources for weight loss.
Speaker 4 (07:02):
Right.
Speaker 7 (07:02):
So in the trials, patients went through rigorous lifestyle changes
in addition to taking these medications in order to achieve
that long term weight loss. So you know, just from
a clinical standpoint, I have had patients on these medications
who have not lost weight. I've also had patients on
(07:23):
these medications who have changed their lives and lost a
very significant amount of weight, and you know, their entire
life is different than it was a few years ago.
And so you know, we don't necessarily need to tout
these medications as magic bullets or revolutionary things. However, yes
we are. They're excellent resources and we're excited to have
them as a resource, but they're not a magic bullet.
Speaker 1 (07:46):
Well, but anybody who has tried to lose weight for
their whole life and then suddenly does with one of
these drugs. Probably does feel like it's a bit of
a magic bullet. We have a lot of people calling
in on the phones. Let's get to one of them.
Wes is calling from soft Center. Minister Wes, welcome to
the middle, Go ahead.
Speaker 3 (08:03):
Yes.
Speaker 10 (08:04):
So I take oz empic myself, and I have for
three years and my doctor had encouraged me to take
it against you know, my what I wanted to do.
But I started taking it. You know, I was sick
for about six to eight months just with you know,
you throw up, you know, you have terrible bawel movements
(08:25):
and you kind of get through it. But you learn
what you can eat and what you can eat and
it and it changes your mind on what you put
in your body just because you don't want to be sick.
But I lost about one hundred and twenty pounds wow
after taking ozempic. Yeah, and changed my life. I mean
I had to buy three wardrobes because I lost so
(08:45):
much weight, and you know, and I just changed my appetite,
It changed my mood. I came off of all my
blood pressure meds.
Speaker 7 (08:54):
Wo.
Speaker 10 (08:55):
I came off of all Yeah, and it and it.
I mean I came off of I was on my
nine meds and I got down to three.
Speaker 1 (09:02):
And Wes, do you think that you're going to take
it for the rest of your life or do you
think you'll eventually wean yourself off of it?
Speaker 10 (09:09):
I think I would, you know, Honestly, the way it's
changed my mind as far as what I eat and
how I eat, it's mentally made me think about, Wow,
I used to eat a lot of this and I
don't any more because I don't want to be sick.
But you know, the biggest problem I run into now
is that I can come.
Speaker 3 (09:26):
Off of it.
Speaker 10 (09:26):
I mean, I know what, I what my body needs.
I know how to how I feel. I don't have
chronic foot pain. I don't have I can run, I
can run upstairs.
Speaker 3 (09:36):
Wow, you know.
Speaker 10 (09:38):
And yeah, it's it's it's crazy to think that's a
drug could do that. And it's very you know, and
I listened to your show that it's very upsetting to
see like these celebrities have ozembic parties. Uh and uh
you know, and well because they run out there's such
a short supply. I've had to wait a month before. Uh,
a few quite a few times to get the medication
(10:00):
and the dose I need, and uh, you know, then
I have to start over again and I gets six
for a few months again because you know, not because
of what I'm eating, but just because my body's trying
to readjust again.
Speaker 3 (10:11):
Right.
Speaker 1 (10:11):
Well, yeah, Wes.
Speaker 10 (10:12):
Celebrising people miss using it.
Speaker 1 (10:15):
Let me take that to the panel. Thank you so
much for the call, doctor Stanford. He brought up a
couple of points I want to get to. Let's start
with one of them, the side effects. There are some
people have been reporting, you know that some of the
things that Wes was talking about there.
Speaker 5 (10:26):
Yeah, so the key side effects from these medications. Number
one is the one that he brought up, which is nausea.
So forty to forty five percent of patients will experience
nausea on these medications, and it's usually a dose effect.
So you tight trate up on the doses of these medicines.
If you're looking at smagluti, there five key doses for
semaglutie point two five melograms point five miligrams, one miligram
(10:50):
one point seven and then two point four miligrams.
Speaker 8 (10:52):
What he mentioned to.
Speaker 5 (10:53):
You at the very end of his call was that
if he misses a dose or it's missing several doses,
he needs to restart and ret trade up the dosing
of what he's saying is and so then he has
to kind of restart his plan and then that he
has to go back up the dosing titration, which then
makes him have to go back through his body getting
adjusted to the medication. So he brought up some really
(11:14):
key points there. So nausea is by far the number
one side effect, and he brought that up as a
key side effect. He talked about diarrhea, constipation. Constipation is
a key side effect, and so he thought about these things.
These are really the gi side effects, are the key
side effects that we hear from these medications, and that's
what we saw in the trials.
Speaker 1 (11:32):
Well, and we'll see if we'll see if other listeners
bring that up as well. I want to just remind
our listeners we are available as a podcast in partnership
with iHeart Podcasts on the iHeart app or wherever you
listen to podcasts.
Speaker 2 (11:43):
You know, Jeremy, one industry that might be more than
a bit scared of these drugs is the weight loss industry.
Weight Watchers has been around for sixty years. Wow, here's
an ad from the nineteen eighties.
Speaker 1 (11:53):
Surprise, Jessica, I'm home.
Speaker 8 (11:57):
It's not what it looks like.
Speaker 1 (11:58):
It looks like I thought we were on a diet.
Speaker 3 (12:01):
We still are.
Speaker 1 (12:03):
Weight watchers, Jessica, don't try to fool me.
Speaker 11 (12:07):
Finally, nineteen new meals that are so much saucier, so
much chunkier, and so much zestier, you won't believe they're
weight watchers.
Speaker 2 (12:16):
Well, if you can't beat them, to join them. Rather
than trying to compete with those, Zimpi and Agovie and
Mujaro weight watches are now offering special plans for people
who are on the drugs, and even about a telehealth
company to prescribe the drugs themselves.
Speaker 1 (12:27):
That is amazing. By the way, if you're listening to
this podcast and you love it, go and rate it
please wherever you listen to your podcast five stars, tell
us why you like it so much, and we'll be
right back with more calls in a minute. This is
the Middle. I'm Jeremy Hobson. If you're just tuning. In
the Middle is a national call in show. We're focused
on elevating voices from the middle geographically, politically, and philosophically,
(12:51):
or maybe you just want to meet in the middle.
This hour, we're asking you what do you think of
medications like a zempic, mount jarro and Withgovie that are
being used by a growing numnumber of people to lose weight.
Are you using them? Do you think they're revolutionary or
just another diet fad? Tolliver, what is that number to
call it?
Speaker 2 (13:08):
It's eight four four four Middle. That's eight four four
four six four three three five three. You can also
write to us at Listen to the Middle dot com
or on social media.
Speaker 1 (13:16):
I'm joined by doctor Fatima Cody Stanford, an obesity physician
at Massachusetts General Hospital, and doctor Desha Orang, incoming director
of Obesity at Endeavor Health North Shore in Chicago. Before
we get back to the phones, let's just talk about
a potential downside. We just heard about some of the
side effects that people have talked about. But doctor Nrang,
(13:37):
another criticism I've heard about this is people who've been
trying their whole lives to lose weight and not feel
shame about their bodies now feel like a whole movement
toward body positivity has been upended. I'm sure you've heard that.
What are you hearing? And do you think that that's
that's real?
Speaker 7 (13:55):
Yeah, you know, I think one of the things is
that anyone who may be coming into doctor Stanford's clinic
or mine, they've probably been shamed for decades at that
point for their weight, right, and so to have a
resource to be able to treat that is immense, right.
And so one thing is that you know, obesity nationally
(14:17):
is seen or just worldwide, is seen as a disease
of vanity, that it's your fault or it was your
will power that caused you to.
Speaker 9 (14:23):
Be at this certain weight. But that's not true.
Speaker 7 (14:26):
Their obesity and weight gain weight loss, it's very much
a neuro hormonally mediated disease. So your hormones talk to
your brain, talk to your gut. They determine how full
or you know, and hungry you are and your environment
and that means you know, the food around you, where
you live, what your access to food might be, may
(14:49):
exacerbate that or may not affect that. And so that's
the environment that we live in. That's the disease of obesity.
And so when we add these medications in you know
what doctor stanf Or was saying earlier. The medication works,
you know, the GLP one agonist. When we add the
gip on, it works to suppress the hunger hormone, so
it shuts off the noise in your head to you know,
(15:12):
have those cravings for food. So when someone is on
these medications and loses that weight, it's like one of
those things where you know, people are judged for being
at a certain weight, then they are judged for being
on medication to lose that weight. And I want to
kind of turn that conversation to say that, well, no
one's judging you for having heart disease or taking medication
for that. We aren't, you know, judging people for being
(15:35):
on a cholesterol or blood pressure medication.
Speaker 9 (15:37):
This is no different.
Speaker 7 (15:39):
And so you know, it's great to have that body positivity.
But I feel like a lot of my patients who
are on these medications feel like they can't win because
they've been judged either way.
Speaker 1 (15:48):
Well, and by the way, the number one prescribed medication
in America is a tour of statin, which is a
cholesterol medication that so many people take, including me. Let's
go to the phone's. Diana in Michigan is with us. Diana,
Welcome to the middle. Go ahead, Hi there, Hi, go
ahead with your comment.
Speaker 12 (16:10):
Hi, so, and I apologize you got me right as
sunchtime is hearing. So, I have started taking I thought
out manjaro as a way to sort of combat fertility
treatment I have inful and resistant pcos. And I continued
(16:31):
to hear from doctors that if I would just lose weight,
that maybe I could get pregnant in a second pregnancy.
And so I sought out ozepic and my doctor said,
why don't we try manjaro instead as a better option,
And it's been a complete game changer for me. So
(16:52):
I think it's really important to look at the hormonal
and fertility aspect of these drugs, and it's not something
everybody's talking about.
Speaker 1 (17:00):
Dana, thank you for that call. Doctor Stanford. Your thoughts
on that well, first.
Speaker 5 (17:04):
Of all, thanks so much for calling in. I think
this is a very important, overlooked issue. I've published widely
on this issue. I think a lot of the fertility
conversation is missing this issue, the issue with hormone and
balance and how it's impacting fertility treatment, and how many
of our fertility docs are really not trained to look
at this issue of hormone imbalance and how this can
(17:28):
be impacting infertility with either first or second or even
third or however many pregnancies that we're looking at, and
how this can play a major role. And I thank
her for calling in and bring up this important issue
that is very much overlooked. I've, like I said, I've
published on this. I find that about a third of
my female patients that are of reproductive of age or
coming in with this exact issue, many of whom I
(17:50):
am trying on medications, whether it be some maglutide, whether
it be truseeppetide or other of our more historic agents
that I've utilized. And I've gotten sign gnificant success among
these using these medications and helping them to achieve pregnancy
in the midst of being told that this was really
an impossible feat. So I thank her so much for
(18:11):
sharing her story, being brave enough to share this story.
I think it's an important overlooked conversation in the fertility world.
And like I said, I just want to thank her
for sharing her story.
Speaker 1 (18:21):
Especially as the kids were crying in the background.
Speaker 5 (18:23):
Yeah, she was brave in that sense, so brave all around.
Speaker 8 (18:28):
Thank you so much for sharing her story.
Speaker 1 (18:30):
Anthony is with us from Atlanta, Georgia. Anthony, I go ahead,
Welcome to the Middle, Y.
Speaker 13 (18:36):
Thank you. So yes, I just started taking Olympic in October.
Prior to that, I was on the highest postage of
me foreman never you know, was not seeing results. My
last agllency I had dropped you know, three or four
points within three or four month period. So it's been
(18:58):
a game changer for me. I'm you know, thirty nine
active and just a combination of exercising and strength training
has helped tremendously.
Speaker 1 (19:09):
So you've been You've been taking it in collaboration with
also an exercise routine. That's helpful.
Speaker 14 (19:17):
Absolutely.
Speaker 13 (19:18):
I play tennis, work out at a gym, and so
I think for me, I'm actually I feel like I'm
doubling the results, you know, with my a W and
sy reducing. I got back said doctor next month and
we're going to see if we need to produce the
dosa since it's working so well in my body.
Speaker 1 (19:34):
Anthony, thank you for that call. Let's get to another one.
Will is with us from Houston. Will go ahead, Welcome
to the Middle.
Speaker 15 (19:42):
Hi, good to be on Love the Show. So my
point is basically a little bit personal. But I've been
on ADHD meds for the majority of my life, and
with ADHD meds it really suppresses your hunger and I
haven't had the best relationship with you know, I was
not trouble losing weight, but gaining weight. And you know,
(20:05):
with that in mind, I don't think relying upon pills
to gain or lose weight is a healthy way at all.
I think it's a tool, and by all means you
can use tools to your advantage, but if you're relying
upon a wonder drug to help you lose all this weight,
it's not going to laugh. And you know, lately, getting
(20:27):
off of ADHD meds and being able to regain a
healthy relationship with food has been really helpful in gaining
muscle and gaining healthy weight. And that's really my point
that I wanted to make, because it's a tool, not
a crutch.
Speaker 1 (20:40):
I appreciate your comment, Doctor Nuring. Let me go to
you on that. What about that view? I'm sure you've
heard it before.
Speaker 9 (20:46):
Yeah, I actually completely agree with you.
Speaker 7 (20:49):
I think that it is a tool, and as I
said earlier, that it's an excellent resource, but it is
not the magic bullet.
Speaker 9 (20:55):
And so you know the caller before that.
Speaker 7 (20:58):
You know, is doing a regimented exercise program. You know,
it has an entire lifestyle built around this. That's where
you tend to see success. So you know, of course
there's camps where people say, you know, you only do
lifestyle modifications. The other camps may just you know, rely
on medication. Well, we truly see long term success when
(21:19):
we marry the two, when we marry lifestyle, when we
and medication together, that's where we see long term success. However, yes,
I agree that we cannot be using this as a crutch,
and especially in the setting of medication shortages and insurance denials.
We don't have you know, readily available medication for folks
every single month.
Speaker 9 (21:38):
I wish we did.
Speaker 13 (21:40):
We do not.
Speaker 9 (21:41):
And this this is also not a treatment.
Speaker 7 (21:44):
For eating disorders, and this is exactly where long term
weight management becomes essential. We cannot just dole out the
medication like candy.
Speaker 9 (21:52):
There's a lot of counseling that goes into it.
Speaker 7 (21:55):
And you know, someone is struggling with an eating disorder,
whether that might be restricted or you know, the opposite.
We really need to be able to make sure is
this patient a good candidate for medication to lose weight.
You know, is it going to trigger the eating disorder?
My bigger concern is that are you going to continue
to have a positive relationship with food, because it really
(22:18):
does come down to, you know, we need to make
sure that we have a healthy relationship with food, and
because think about the next twenty five years of your life,
right like, we have to make sure that this is not,
you know, a temporary fix.
Speaker 9 (22:30):
And so that's where it really comes.
Speaker 7 (22:32):
Down to the food environment and how we're thinking about,
you know, day to day what we're eating.
Speaker 1 (22:37):
Yeah, Tolliver, we're getting some comments in online at Listen
to the Middle dot com.
Speaker 2 (22:41):
Yeah, Christy and Hazlitt. Michigan says, as a pharmacist, I
see people struggling with weight and always looking for the
quick fix. These new drugs are working for people and
getting a lot of good press. They do work. However,
I hear from my patients that as soon as they
can get the medication, their former appetite and former habits
come right back. I'm not sure we have made it
clear that these are lifelong meds and not the quick fix.
There seeing in the media. Bottom line, if I thought
(23:01):
it was the magic bullet, I'd be using it since
I'm two hundred plus pounds.
Speaker 1 (23:05):
Doctor Stanford, What about that that these are drugs you'd
have to take your whole life.
Speaker 5 (23:10):
That is absolutely true. These are a lifetime commitment. I
tell my patients whenever they're starting any medication that we're
using to treat the chronic disease that is obesity, if
they do work, and notice I said, if they do work,
if you are a responder, this is a lifetime commitment
to these medications. For many of my patients, they've been
with me for at least ten years. So this isn't
(23:32):
a short term commitment. If you're looking for something that
you're going to just breeze on bube, start it, stop it,
and hope that everything is going to be solved, you
have picked the wrong thing. This is not something that
you're going to just start and stop. Like I said,
people have been with me for ten, fifteen, twenty plus
years and they're looking this is going to be a
(23:53):
long term commitment. If they work, you do need to
be on these for the rest of your life.
Speaker 16 (23:59):
So you have a patient that they don't work for
for that if they don't work, then we need to
pick another agent, something that works in a different pathway
of the brain, or maybe even look at other types
of treatments.
Speaker 5 (24:11):
Metabolic and bariatric surgery is still the best treatment that
we have available, particularly for those with moderate to severe obesity.
And for many of my patients, they're in combination therapy.
What do I mean by that? They have undergone bariatric surgery,
They're on medications, they're doing lifestyle modifications, they're working with
psychiatrists and psychologists. They're truly using all of the forms
(24:33):
of therapy available for them to get the best possible outcome.
Speaker 1 (24:37):
Let's go back to the phones. Beth is with us
from Nashville, Tennessee. Beth, welcome to the middle. How is
ozempic working for you or one of the drugs like it?
Speaker 14 (24:48):
Well, I took ozempic for eighteen months through a program
at my work, and for me, it was really kind
of the brain piece that I was not expecting. And
I w learned that cemeglatide goes through the blood brain barrier.
But as someone who all my life has I sake,
I would secret eat and I binge ate. And I
(25:11):
know one of the doctors mentioned about eating disorders and
this not necessarily being a great treatment for it. But
for the first time in my life, within a couple
of weeks of starting ozimpic, I felt like I understood
what the majority of the population feels like about food.
I wasn't that that food noise and food chatter was
(25:32):
not always in my head and I was not just
constantly trying to think of, you know, what food's going
to be available, and is it food I'm going to
want to eat in front of people? And am I
going to want to eat before or after? And is
there going to be enough food or not enough? And
not even just like craving things, but just having a
healthy outlook on eating or you know, going to a
(25:54):
restaurant and thinking about what everyone else is going to
order and just feeling full. That was something I had
never really even experienced. I was like a bottomless pit.
And when I started taking the ozempic, it was like, Oh,
I don't have to eat the entirety of that. I
can have a stopping point. And I just wasn't expecting
that brain piece to come into play so quickly.
Speaker 1 (26:16):
Let me ask you. Let me ask you that question,
which is when you were taking it, when you started
taking ozepich, did you tell other people that you were
taking it, because I've read a lot of people who've
been taking it they feel a little uncomfortable about talking
about taking it.
Speaker 14 (26:30):
Yeah. So I had several friends who were in the
same work weight loss program that we were in at
the same time. But there were people, even like close
friends and relatives who I still have never told because
they have said in the past. You know, well, if
you wanted to lose weight, you just you know, exercise
and eat, you know, eat some spinach and stop you know,
(26:51):
having junk food or whatever. And for me, it wasn't
even just the weight loss, like my body image issues
still exist, like we were talking about the body movement,
but it was it was that brain piece for me.
But for people who never experienced that brain piece, they
don't understand where I'm coming from.
Speaker 1 (27:10):
Well, let me take your comment to doctor Nrang your
thoughts on that.
Speaker 7 (27:16):
Yeah, you know, if it was as easy as eating
some salad and losing weight, we would have all been
able to do that.
Speaker 4 (27:22):
Right.
Speaker 7 (27:23):
As of twenty thirty, fifty percent of our population is
predicted to have obesity. So this is not just about
the fact that you may not have eaten enough salad
in the last you know, however, many decades.
Speaker 6 (27:34):
Of your life.
Speaker 7 (27:35):
This goes way way beyond that. And you know, as
I said earlier, it's not a question of willpower. This
is very much our brain chemistry. This is very much
you know, the genetics we were dealt and and part
of it is, you know, we can't change our genetics,
but we can change the environment around us. We can
be on you know, therapeutic medications that can alter part
(27:58):
of that interaction of hormone between our brain and our gut.
And that's the situation that we're in right now, right
And I think people, you know, like she was mentioning
those who may not necessarily understand that chatter going on
in the brain, those people finally feel seen because they
have a resource to actually.
Speaker 9 (28:16):
Calm that chatter down.
Speaker 7 (28:18):
Which and that's why, you know, these medications are remarkable
because for the first time, and probably you know, decades
of dealing with this.
Speaker 9 (28:26):
They have something that can you know, help them.
Speaker 7 (28:29):
Right And I'm telling you everyone who may have come
into my clinic, they've tried every diet.
Speaker 9 (28:34):
In the book right right there.
Speaker 7 (28:36):
There is not a diet they have not tried so
that it's not a question of eating more greens.
Speaker 1 (28:41):
Well, but just as it's not a question of eating
more greens. And you mentioned the amount of people that
may be obese. Almost three quarters of adults older than
twenty in the US are already living with obesity or overweight,
Doctor Stanford. There are probably some listeners saying to themselves,
what about the food industry? Is this just? Is this
just a way to counteract the kinds of things that
(29:02):
the food industry markets to us and has for decades.
Speaker 5 (29:06):
Well, I mean, I definitely think the food industry plays
a role, But I think that we make it just
about the food industry, and it's so much more complex
than that. It's about our sleep quality and duration. It's
about other issues that play a large role. I mean,
let's look at how our environment has changed over the
last fifty years. Let's look at the one demand ability
to get food at anytime, at any hour, at any
(29:28):
minute of any day. That's part of it. But let's
look at how our circadian rhythms have changed. Just the
timing of when we eat has plays a large role.
Those things play a large role. Medications that we take
play a large role in how much we weigh. Do
you know that twenty percent of our obesity has to
do with medications that we take for other issues? Did
you know that that twenty percent of obesity is caused
(29:50):
by other medications? What medications cause obesity? Medications like beta blockers,
lithium depicode, medication that are antipsychotics, insulin, these medications that
we have to take for other issues that lead to waggain.
We can't like not take those medications, but guess what
they cause weight gain?
Speaker 8 (30:10):
So there's a lot of other issues that lead to obesity.
Speaker 1 (30:13):
All right, Well, stand by a reminder that The Middle
is also available as a podcast in partnership with iHeart
Podcasts on the iHeart app or wherever you listen to podcasts. Tolliver,
I have to say, when I first heard about ozembek,
I thought of Fenfenn, which was a hit weight loss
drug in the nineties, called a miracle drug at the time.
Speaker 2 (30:28):
Yep, until it turned into a nightmare. Listen to this
nineteen ninety seven clip from the Fox affiliate in my
home city of Chicago.
Speaker 11 (30:34):
The first Illinois lawsuit's been filed against the makers of
fen Fenn. A Chicago law firm filed a class action
suit today. It comes after the Food and Drug Administration
last week urged the recall of fen fenn because of
studies that link it to heart problems.
Speaker 1 (30:48):
And by the way, the drug combination that made fenfenn
was never approved by the FDA, whereas the drugs were
talking about today have been approved by the FDA. We
are going to be back with more in just a minute.
On the middle. This is the Middle. I'm Jeremy Hobson.
We're talking about drugs like ozepic and Wogovi that have
grown so popular for weight loss that there's now a
shortage in some cases. So what do you think of
(31:10):
these drugs? Are you using them? Do you have concerns?
We want to hear from you at eight four four
four Middle or at listen toothemiddle dot com. I'm joined
by doctor Fatima Cody Stanford, an obesity physician at Massachusetts
General Hospital, and doctor Disha Nerang, incoming director of Obesity
at Endeavor Health North Shore in Chicago. Before we go
back to the phones, I want to ask both of you,
(31:32):
our guests, about two things. One, the cost if it's
not covered by insurance, it's around one thousand dollars a month.
Medicare does not cover it for weight loss, so for
most people the cost would be prohibitive. Do you expect
that to change anytime soon, Doctor Norang.
Speaker 7 (31:53):
Not in the near future. I think one of the
things is that there are more agents in the pipeline
coming out, So I do think that potentially having multiple
agents that are as powerful as you know, the current
agents that we have, may help to decrease the prices.
Speaker 9 (32:09):
That's just conjecture.
Speaker 7 (32:10):
Though we do have coupons available, you know, for all
of these medications. However, even after the coupons, they are
quite pricey. So in the near future, unfortunately, I do
not see the price coming down.
Speaker 1 (32:23):
Doctor Stamford. The other thing I'm wondering about, and we've
heard about, is that ozebic, what it does for cravings, addictions,
and desires, goes beyond hunger. Can it be used for
you know, alcoholism or impulse shopping.
Speaker 5 (32:38):
Even so, those studies are being now conducted by the NIH,
so the data is still very preliminary. There are some
people that will anecdotally say that, you know, I do
feel that I'm not having those strong alcohol, you know,
cravings that I've had before. I've had some patients, although
just a few, that say that I no longer have
(32:59):
those issues, but the data is very scarce, and so
I would be a little bit pro you know, cautious
in terms.
Speaker 8 (33:07):
Of making these really sweeping.
Speaker 5 (33:08):
Statements to say that those are what we're getting from
these drugs, although there are some patients that would tell
you that definitively they've seen major shifts in those One
thing that I do want to add, however, to what
doctor Mringe stated earlier, is that one of the drugs
that is a golp one that's a daily injection, that
was the first drug approved that was a golp one.
That's the ragletide. That was Victoza, which was the one
(33:31):
treat the treat diabetes and sex cinda. That is set
to come off patent in twenty twenty four. So when
that does come off patent, that will be a generic
drug which will be available to the public. Now, on average,
the weight loss is significantly less, but it still works
in the same pathways of the brain and was quite
effective for many patients and still quite effective for several patients.
(33:52):
So that will improve some of the equity issues that
we've seen in access issues when that comes off patent
this year, and so I do think that that will
help improve some of the equity and access issues when
that comes off patent in twenty twenty four.
Speaker 8 (34:05):
Thank year.
Speaker 1 (34:06):
Let's go back to the phone. Sarah is joining us
from Pennsylvania. Sarah, Welcome to the middle.
Speaker 17 (34:10):
Go ahead, Hi, thank you. I caught this show accidentally
and it has been so informative and great to hear,
so thank you, thank you. I heard one of the callers,
a gentleman, talking about how he's been on the medication
for add or ADHD, and his statement kind of challenged
(34:32):
me about you know, we're looking for the weight loss,
the magic bullet, the magic pill here, and I think
that's the biggest thing, one of the biggest things that
gets me with this. I too have taken add orall
for my add over the years, I've taken Fennermine. I
actually took Finton before it was banned for a short time,
(34:52):
which helped me and I was able to be off
of it for a number of years. And then I
did revisit Centerman itself years ago. It actually helped me
more with my add than the weight loss, so that
was interesting. And then here comes Wagovi and I started
that earlier this year. And the mental component, the brain opponent,
like one of the other callers mentioned, it is amazing
(35:15):
what it does and it's hard to put to words.
And I just wish that people would understand that Nobody
goes into the store and says, you know what, I'll
take a box to add actually give me a double dose.
And while you're at it, why don't you add some
obesity to it and make that a triple dose. Nobody
wants any of this. Nobody's looking for an easy way out.
(35:35):
It's exactly like the doctor said that, you know, there's
no judgments because you're taking medication for your heart or
insolence or because of whatever. So it just really I
guess struck my number when he was like, you know, hey,
change your live stuff. I've done everything like like has
been mentioned on the show. I've done the lifestyle change,
(35:56):
I've done the eating change, and I still gain weight
and being a bottomless pit of hunger hungry all the time. Yeah,
to the point of being physically sick is mind blowing
of like what is going on with my body? And
so w GOVI it is a game changer and and
it was just like, yeah, whatever it did to the mentalness.
I was like, whoa wait a minute, because I know
(36:17):
what Funerman does.
Speaker 1 (36:18):
Well, Sarah, we've got it. Let me take it to
our panel, doctor Dourng. Why is there such judgment about
about not just weight, but about people trying to lose
the weight.
Speaker 7 (36:31):
Yeah, So, going back to my earlier comment, obesity is
seen as the disease of vanity. It is seen as
a disease that was your fault because you ate too
much or whatever the situation may have been, that it
was your fault. We need to turn this conversation around.
This is a chronic disease. We're not seeing this conversation
around blood pressure, polesterol, heart disease, diabetes, sleep apnea, joint disease.
(36:55):
All of these are actually complications of obesity. And so
this conversation needs to change. Even our insurance companies, you know,
deny these medications left and right, or if someone didn't
lose enough weight on the medication, they'll stop coverage for
the medication. Well, they're putting blame on the patient. They're
making this disease their fault, and this is precisely why
(37:17):
we need to treat this as a long term chronic
illness that needs to be treated long term with the
medication potentially. And so this is exactly you know what
this caller was saying. She's tried all these medications and
you know this finally worked for her, that mental chatter
came down. She's doing well on it. Well, that's what
(37:37):
we want to see, right, because when we do well
on it, then all these other things get better. Our diabetes,
blood pressure, cholesterol, heart disease, sleep apnea, ad joint disease,
risk of cancer, like you name it right, all of
these things get better. So we need to change this conversation.
Speaker 1 (37:53):
Let's go to Nick, who's calling from Michigan. Nick, Welcome
to the Middle.
Speaker 3 (38:00):
Hello. My question to your panel was I was just
that actually at my doctor recently, and he was commenting
that they were seeing or maybe in the lab animal
aspect of when they test drugs, that they were seeing
increased rates of thyroid cancer. But I don't know that
(38:20):
that necessarily translated to the human I guess trials and
now that it's been on market, if we've seen an
uptick in instances of thyroid cancer.
Speaker 1 (38:31):
Well, let me take that to doctor Stanford. Have you
heard about that.
Speaker 5 (38:35):
So yeah, so I think that what he's saying is
that some of the earlier troup particularly in the WRAP models,
did show a slight increase in thyroid cancer. We haven't
really seen this translate into the human models, and so
I appreciate Nick for bringing.
Speaker 8 (38:49):
This to the attention.
Speaker 5 (38:50):
So there has been some fear associated with this, but
long term studies have not seen this translate into human studies.
And what I want to also let the call early
people that are listening to the show, not that gop
ones have been on the market here in the United
States for almost twenty years, so we have almost twenty
years of data to look at with regards to the
gop ones, and we just really haven't seen that play
(39:11):
out in the almost twenty years of data that we've
seen in terms of thyroid disease. There was one study
that was conducted in Europe that showed a slight increase
in the European population with regards to thyroid disease in
one study that was conducted there. We have not seen
that we're out in the American population. So I have
(39:32):
not been cautious in that way. Within my patient population.
I have over treated over three thousand patients with gop
ones in my own personal patient population, and so I
can tell you that I'm always very cautious of thinking
about this. I will say a contra indication to use
of this medication. If you have a personal or family
(39:53):
history of medullary thyroid cancer, you cannot use this medication.
This is completely a contra indication to use. Or any
fit patient that has a history of multiple intercaneoplasia type
two complete contra indication to the use of these medications.
So those patient populations completely excluded from the use of medication.
But thanks so much for calling in with that concern.
Speaker 1 (40:14):
Let's go to Eva, who's in the Chicago area.
Speaker 3 (40:17):
Hi.
Speaker 1 (40:18):
Eva, Welcome to the middle.
Speaker 18 (40:21):
Hi, I was beginning to lose hope.
Speaker 1 (40:27):
Your prayers have been answered.
Speaker 4 (40:28):
Go ahead.
Speaker 18 (40:29):
Yes, I never had weight problems.
Speaker 15 (40:33):
I'm bushed.
Speaker 6 (40:34):
I guess.
Speaker 18 (40:35):
My daughter, however, was born Finn was thin through school
and through high school, went away to college and started
getting weight and then gaining more and more and more
and more, and she was clinically obese, which of course
worries her mother. But I wasn't allowed to talk about
(40:56):
it or ask her question because then I would be
that shaming her. So all I could do is bite
my lips and hope she has used the medication and
lost almost one hundred pounds, and it's like, oh my god,
(41:17):
that's the person you know I saw growing up. That's
and it's it's wonderful. But I have three concerns. Number One,
there was no research being done for weight control for
the medication because it was for diabetics. Is the medica
is research going on now? Number two? Are people who
(41:39):
are taking it for weight control taking a higher dosage
or different dosage when people are taking it for diabetes?
And number three, do we have any idea of what
happens when people stop taking it?
Speaker 1 (41:52):
Okay, my life. Yeah, those are great questions. Let me
take Let me take that to our panel, Doctor Muring,
you're give answers to those questions.
Speaker 9 (42:02):
Yes.
Speaker 7 (42:03):
So the answer to the first question, whether there has
been research on long term weight management, I think that
was the question. We have research and so with stamaglatide,
we're seeing about twenty percent to give or take at
the highest dose. With turzeppatide, we're seeing even more than that,
up to twenty five percent in patients who have taken
(42:26):
it for over a year, and so we do have
actually data to support you know, long term weight maintenance
and weight loss. Right now, remind me of the.
Speaker 1 (42:36):
Other Do people have to take a higher dose if
they're using it for weight loss?
Speaker 7 (42:40):
Well, so the way that the medications have been dose
so stamaglatide for diabetes goes up to two milligrams, some
maglatide for that is indicated for the for weight management
goes up to two point four milligrams. So there's not
too much of a difference, but it's a very slight
difference for turzeppatide for both diabetes management and weight management,
(43:01):
it's the exact same dosing and so you know, when
these studies were done, there were studies done for people
who have obesity without diabetes, and there are separate studies
for patients who do have diabetes. So we actually have
very concrete data on this, and as doctor Stanford said,
we have twenty years almost experience with these sorts of agents,
(43:22):
and so for long term management now you know, we
have ongoing trials to understand if we go down on
the dose, do we maintain our weight if we come
off of the dose. Though, especially anecdotally patients, do you know,
regain some of that appetite, some of that food noise,
and some of that weight. And so when when we
say that obesity is a chronic disease, we're expecting patients
(43:45):
to be on these medications long term. And so the
trade off is that hopefully you know your diabetes and
blood pressure issues, cholesterol issues, those all get better, so
hopefully you do get to come off of other medications
as a trade off.
Speaker 1 (44:00):
Let's get in another call here. Weston is joining us
from Boise, Idaho.
Speaker 6 (44:05):
Weston, go ahead, I guess to get my thesis. I
think we're starting to. Sorry, I'm actually a lot of
risks to at the gym. My thesis is ultimately nice.
We're trying to address a broken food system with pills.
(44:27):
And the reason I say that is that our food
systems designed to be addictive, at least the commercialized food system.
So people from a very young age are eating food
that's mentally and physically addictive, and then as they grow
up that's all their body knows. They haven't gotten good
(44:48):
eating habits near their wife. So then we're at a
point where now Eli Lillings make billions up the drugs
because of the food system being broaking, and I guess
we just I think we need a radical look at
like how societies where and how people are becoming unhealthy
because of society.
Speaker 1 (45:05):
All right, well, Wesson, thank you for that call. And
I think it's very appropriate that we got a call
from somebody who's at the gym, clearly on a piece
of exercise equipment during this show about this. But doctor Stanford,
this is something we just talked about a few moments ago.
But the food industry and the food that we eat.
Speaker 5 (45:20):
Yeah, I think that Wesson brings up a certain point,
but I think that he's missing the fact that this
is a global pandemic. There's not one country in the
world that isn't affected by obesity, and there's been a
global increase and the rates of obesity in every single
country in the world. And so if we're talking about
this and we're looking at food and food systems throughout
(45:41):
the world, we've seen this as an increase even in
those countries that don't have the same food systems that
we have here in the US. And so if we
think about this as a multifactorial disorder where genetics, development, environment,
and behavior all play a role in a person's likelihood of.
Speaker 8 (45:56):
Developing this disease.
Speaker 5 (45:58):
Where food does play a role, we have to look
at the role of genetics, development, environment, and behavior and
all of those components playing a role in the likelihood
of a person's development of obesity. I encourage him to
watch my lecture that I recorded Obesity. It's much more
complex than you think. It is one hour and eleven minutes,
and you can go watch it for free. It's available
(46:20):
for you to watch, and it is great.
Speaker 8 (46:23):
It's not behind a paywall.
Speaker 5 (46:24):
But I think that if you go watch that, you'll
recognize that this is not just about the food system.
And while that does play a role, it is much
more complex than you think.
Speaker 1 (46:32):
And doctor Durang, you are a nutritionist as well.
Speaker 9 (46:35):
Correct, I have a license in culinary medicine.
Speaker 1 (46:38):
Okay, do you have thoughts on this?
Speaker 7 (46:41):
You know I do. I agree with doctor Stanford. Food
is certainly a large part of this. We are in
a different world than we were in nineteen fifty, right.
We rely on our cars, our physical activity is much different,
you know, the way we live, the way we work,
the places we live and work.
Speaker 9 (46:59):
It's just it's a different world.
Speaker 7 (47:00):
Right, And so when we I agree, right, when we
add in the processed food industry and and all of
those things.
Speaker 9 (47:09):
It all contributes.
Speaker 7 (47:11):
We're more stressed, we don't sleep enough. Like it's a whole,
you know, combination of issues.
Speaker 1 (47:17):
We have to leave it there in terms of the
calls for now, but Tolliver, we do have time for
a quiz.
Speaker 2 (47:23):
Shout out to Weston for setting this question up perfectly. Okay, okay,
So the quiz question is what's the US food banned
most in other countries? Some of the name for foods Okay,
instant mashed potatoes, Skittles, twinkies, or pills Berry biscuits. Feel
free to jump in when you got it. It's instant
mashed potatoes, Skittles, twinkies, or Pillsberry biscuits, Twinkies.
Speaker 9 (47:45):
I say twinkies too.
Speaker 2 (47:47):
You know I would have said the exact same thing.
It's instant mashed potatoes.
Speaker 8 (47:50):
Wow, that's that's kind of disgusting. I think this should
be really I.
Speaker 1 (47:54):
Just want the real mashed potatoes. They don't want the
inst the issue.
Speaker 2 (48:00):
At it, I just sather.
Speaker 1 (48:01):
Third, Yeah, I want to thank my guest doctor Fatima
Cody Stanford, an obesity medicine physician at Massachusetts General Hospital
professor at Harvard, Doctor Stanford, thank you so much for
joining us.
Speaker 8 (48:12):
Thank you for having me and.
Speaker 1 (48:14):
Doctor tishen Orang, incoming director of Obesity at Endeavor Health
North Shore in Chicago, Doctor Irang, thank you so much
for joining us.
Speaker 9 (48:22):
Thank you so much.
Speaker 13 (48:23):
It was an honor.
Speaker 1 (48:24):
And by the way, our next show will be the
last one before Iowa Republicans have their say in the
presidential nomination process. One of the top issues for them,
according to a Des Moines registered poll, is immigration and
border security.
Speaker 2 (48:37):
That's right, Jeremy. So we're asking listeners all over the country,
not just in Iowa, what do you want the government
to do about immigration and border security?
Speaker 1 (48:44):
That's going to be an interesting one. You can call
us at eight four four four six four three three
five three or write in at listen to them Middle
dot com. And while you're there, you can sign up
for our weekly news letter. The Middle is brought to
you by Long Nook Media, distributed by Illinois Public Media
in Urbana, Illinois, and produced by joe Ane Jennings, Harrison Patino,
John Barth, and Danny Alexander. Our technical director is Jason Croft.
(49:08):
Our theme music was composed by Andrew Haigu. Thanks also
to Nashville Public Radio, iHeartMedia, and the now more than
three hundred and eighty public radio stations that are making
it possible for people across the country to listen to
the Middle. I'm Jeremy Hobson, and I'll talk to you
next week
Welcome to the middle. I'm Jeremy Hobson. This week we
welcome the listeners of Spokane Public Radio in Washington State
and WOSU in Columbus, Ohio, and Tolliver is here as always. Hi, Tolliver.
Happy New Year.
Speaker 2 (00:17):
Right back at to Jeremy. So, how you doing with
your New Year's resolution?
Speaker 1 (00:20):
I mean, I'm not doing as well as I would
like because I wanted to do less social media, but
your TikTok videos are just too good.
Speaker 2 (00:26):
All a part of my plans stay away, you know.
Speaker 1 (00:29):
Before we get on with the show, Tolliver, I just
mentioned we are now airing on Spokane Public Radio. As
you know, last week we asked listeners what the most
important stories were in twenty twenty three in their communities,
and so many calls came into on our voicemail. But
here's one that came from a new listener in Spokane.
Speaker 3 (00:46):
Hi.
Speaker 4 (00:47):
This is Lynn calling from Spokane, Washington. The biggest news
in our county this year was of two large fires,
lots of physical damage, but very few lives lost. So
we feel very, very fortunate this year to have such
(01:08):
a great community that comes together and cares for people
to have kept all of these people safe.
Speaker 1 (01:16):
What a great point. And as you can hear, we
do listen to the voicemails if you happen to call
at a time other than when we are live again.
Our number is eight four four four six four three
three five three. That is eight four four four middle
you know, Tolliver. Lately, I have been doing something I
do every year around this time, which is I try
to watch the movies that are going to be nominated
for an oscar. Okay, And it was at the Oscars
(01:37):
last year when host Jimmy Kimmel made this.
Speaker 5 (01:40):
Joke, everybody looks so great When I look around this room,
I can't help but wonder is ozempic.
Speaker 6 (01:46):
Right for me?
Speaker 1 (01:48):
So the thing about that joke is that a year
ago a zempic and Wigov, which is very similar, weren't
really a part of the popular culture like they are now.
Now there's a shortage of the drugs for people who
need them for diabetes, and there's an estimate from Morgan
Stanley that seven percent of the US population will be
on one of these drugs in the next ten years.
Speaker 7 (02:10):
Wow.
Speaker 1 (02:11):
So this hour we're asking listeners what do you think
of medications like Ozepic, Mount Jarro, and Wagovi. Are you
using them to lose weight? Is this a revolution for
weight loss or just another fad? I can't wait to
hear the calls, Tolliver.
Speaker 2 (02:24):
Yeah, me either. Our number is eight four four four Middle.
That's eight four four four six four three three five three.
You can also email us by going to Listen to
the Middle dot com.
Speaker 1 (02:33):
Let's meet our panel. Doctor Fatima Cody Stanford practices obesity
medicine at Massachusetts General Hospital and is a professor at
Harvard University. Doctor Stanford, welcome.
Speaker 8 (02:45):
Thank you for having me. It's a delight to be here.
Speaker 1 (02:47):
And doctor Deshonnrang is incoming director of Obesity at Endeavor
Health North Shore in Chicago. Welcome to the Middle, doctor.
Speaker 7 (02:55):
Norang, thank you so much for having me.
Speaker 1 (02:58):
Well, before we get to the phones, let's start with
the base. Most of these drugs are slightly different from
one another, but they all seem to have the same effect,
which is pretty rapid weight loss, like fifteen or twenty
percent of body fat in some cases in a year.
Doctor Stafford, how did they work?
Speaker 3 (03:13):
Briefly?
Speaker 5 (03:14):
Yeah, well, actually I want to just kind of get
rid of a little few myths that we've kind of
stated at the outset of the show.
Speaker 8 (03:19):
They actually are the same drugs.
Speaker 5 (03:21):
So some magnetide is the agent that is exactly the
same drug ozimpic and will go be their identical drug.
They're the exact same drug, so it's the exact same compound.
These are what we call GLP one receptor agonists, and
I know that some fancy language that we have to
throw out there, but that's exactly what they are. They're
called glucagon like peptide one receptor agonists, and they really
(03:42):
work on the brain and the gut.
Speaker 8 (03:44):
They work to upregulate a part.
Speaker 5 (03:45):
Of the brain that tells us to eat less, and
they work to really help us store us out a
post or fat. So they do work in the brain
and the gut to really regulate how our brains think
and how we store fat. There's a lot of complicated
science behind how they work, but it's really important to
recognize that in our bodies, our bodies already produce gop one.
(04:09):
A lot of people don't know that in our bodies,
we already produce gop one within our gut. Some of
us produce more of it than others. So for those
of us that produce more of it. We already have
in our bodies, this ability to regulate how our bodies,
you know, have this sense of satiety, the sense of
fullness better than those of us that don't produce as
(04:31):
much of it. So I just want to kind of
throw that out there right now. The FDA has approved
ozempic for the for the purpose of treating diabetes diabetes
right gov for treating obesity, and.
Speaker 1 (04:44):
They're exactly the same thing. You say, they're exactly the
same thing.
Speaker 5 (04:47):
Fact drug, the exact identical, exact same drug. And then
for manduro that's a dual agonist that has kind of
two different types of things in it, the gop one
we just talked about, and something called a GI that's
a glucose insulinotropic polypeptide.
Speaker 8 (05:03):
Say that five times fast.
Speaker 5 (05:05):
And it's a dual agonist, and it's it's a little
bit of a you know, kind of a step above
what we see in that kind of single agent. That's
the Manjurro that you talked about, but it was approved
by the FDA on November eighth for the treatment of
patients with obesity under the trade name of zet bound.
So that is the same agent mondurro and zet bound,
(05:26):
same drug approved by the FDA initially to treat diabetes,
then approved to treat patients with obesity. I don't like
this idea of us taking one drug from one population
to treat another population, because many of the patients that
have type two diabetes also happen to have obesity. About
actually eighty percent of patients that have type two diabetes
(05:46):
also have obeses. So not necessarily taking one from one
another to treat another population, both patients, both sets of
patients actually happened. Yeah, it's not that one is better
or worse than the other. I think both warn't treatment
and so I don't like for us to think of
it that way, and so I really want to kind
of get rid of that dimorphism. So I just want
(06:08):
to throw those things out there and I'll be quiet after.
Speaker 1 (06:10):
Well, let me just I'll just bring doctor during in.
Do you think that these drugs are as revolutionary as
so many people think, or are they comparable to any
other existing weight loss tool?
Speaker 7 (06:21):
So these are amazing resources and it has really changed
the landscape of weight management.
Speaker 3 (06:27):
Right.
Speaker 9 (06:27):
So, as weight management.
Speaker 7 (06:28):
Specialists, we have had medications in the past approved for
weight management right and weight loss. However, these medications in
the trials have shown upwards of twenty percent or more
weight loss in the groups that have been on the
highest doses. So truly, yes, this has really changed the
landscape of.
Speaker 9 (06:47):
Medical weight management.
Speaker 7 (06:49):
However, within this whole conversation about you know, these revolutionary medications,
we really need to emphasize that these are, at the
end of the day, recent sources for weight loss.
Speaker 4 (07:02):
Right.
Speaker 7 (07:02):
So in the trials, patients went through rigorous lifestyle changes
in addition to taking these medications in order to achieve
that long term weight loss. So you know, just from
a clinical standpoint, I have had patients on these medications
who have not lost weight. I've also had patients on
(07:23):
these medications who have changed their lives and lost a
very significant amount of weight, and you know, their entire
life is different than it was a few years ago.
And so you know, we don't necessarily need to tout
these medications as magic bullets or revolutionary things. However, yes
we are. They're excellent resources and we're excited to have
them as a resource, but they're not a magic bullet.
Speaker 1 (07:46):
Well, but anybody who has tried to lose weight for
their whole life and then suddenly does with one of
these drugs. Probably does feel like it's a bit of
a magic bullet. We have a lot of people calling
in on the phones. Let's get to one of them.
Wes is calling from soft Center. Minister Wes, welcome to
the middle, Go ahead.
Speaker 3 (08:03):
Yes.
Speaker 10 (08:04):
So I take oz empic myself, and I have for
three years and my doctor had encouraged me to take
it against you know, my what I wanted to do.
But I started taking it. You know, I was sick
for about six to eight months just with you know,
you throw up, you know, you have terrible bawel movements
(08:25):
and you kind of get through it. But you learn
what you can eat and what you can eat and
it and it changes your mind on what you put
in your body just because you don't want to be sick.
But I lost about one hundred and twenty pounds wow
after taking ozempic. Yeah, and changed my life. I mean
I had to buy three wardrobes because I lost so
(08:45):
much weight, and you know, and I just changed my appetite,
It changed my mood. I came off of all my
blood pressure meds.
Speaker 7 (08:54):
Wo.
Speaker 10 (08:55):
I came off of all Yeah, and it and it.
I mean I came off of I was on my
nine meds and I got down to three.
Speaker 1 (09:02):
And Wes, do you think that you're going to take
it for the rest of your life or do you
think you'll eventually wean yourself off of it?
Speaker 10 (09:09):
I think I would, you know, Honestly, the way it's
changed my mind as far as what I eat and
how I eat, it's mentally made me think about, Wow,
I used to eat a lot of this and I
don't any more because I don't want to be sick.
But you know, the biggest problem I run into now
is that I can come.
Speaker 3 (09:26):
Off of it.
Speaker 10 (09:26):
I mean, I know what, I what my body needs.
I know how to how I feel. I don't have
chronic foot pain. I don't have I can run, I
can run upstairs.
Speaker 3 (09:36):
Wow, you know.
Speaker 10 (09:38):
And yeah, it's it's it's crazy to think that's a
drug could do that. And it's very you know, and
I listened to your show that it's very upsetting to
see like these celebrities have ozembic parties. Uh and uh
you know, and well because they run out there's such
a short supply. I've had to wait a month before. Uh,
a few quite a few times to get the medication
(10:00):
and the dose I need, and uh, you know, then
I have to start over again and I gets six
for a few months again because you know, not because
of what I'm eating, but just because my body's trying
to readjust again.
Speaker 3 (10:11):
Right.
Speaker 1 (10:11):
Well, yeah, Wes.
Speaker 10 (10:12):
Celebrising people miss using it.
Speaker 1 (10:15):
Let me take that to the panel. Thank you so
much for the call, doctor Stanford. He brought up a
couple of points I want to get to. Let's start
with one of them, the side effects. There are some
people have been reporting, you know that some of the
things that Wes was talking about there.
Speaker 5 (10:26):
Yeah, so the key side effects from these medications. Number
one is the one that he brought up, which is nausea.
So forty to forty five percent of patients will experience
nausea on these medications, and it's usually a dose effect.
So you tight trate up on the doses of these medicines.
If you're looking at smagluti, there five key doses for
semaglutie point two five melograms point five miligrams, one miligram
(10:50):
one point seven and then two point four miligrams.
Speaker 8 (10:52):
What he mentioned to.
Speaker 5 (10:53):
You at the very end of his call was that
if he misses a dose or it's missing several doses,
he needs to restart and ret trade up the dosing
of what he's saying is and so then he has
to kind of restart his plan and then that he
has to go back up the dosing titration, which then
makes him have to go back through his body getting
adjusted to the medication. So he brought up some really
(11:14):
key points there. So nausea is by far the number
one side effect, and he brought that up as a
key side effect. He talked about diarrhea, constipation. Constipation is
a key side effect, and so he thought about these things.
These are really the gi side effects, are the key
side effects that we hear from these medications, and that's
what we saw in the trials.
Speaker 1 (11:32):
Well, and we'll see if we'll see if other listeners
bring that up as well. I want to just remind
our listeners we are available as a podcast in partnership
with iHeart Podcasts on the iHeart app or wherever you
listen to podcasts.
Speaker 2 (11:43):
You know, Jeremy, one industry that might be more than
a bit scared of these drugs is the weight loss industry.
Weight Watchers has been around for sixty years. Wow, here's
an ad from the nineteen eighties.
Speaker 1 (11:53):
Surprise, Jessica, I'm home.
Speaker 8 (11:57):
It's not what it looks like.
Speaker 1 (11:58):
It looks like I thought we were on a diet.
Speaker 3 (12:01):
We still are.
Speaker 1 (12:03):
Weight watchers, Jessica, don't try to fool me.
Speaker 11 (12:07):
Finally, nineteen new meals that are so much saucier, so
much chunkier, and so much zestier, you won't believe they're
weight watchers.
Speaker 2 (12:16):
Well, if you can't beat them, to join them. Rather
than trying to compete with those, Zimpi and Agovie and
Mujaro weight watches are now offering special plans for people
who are on the drugs, and even about a telehealth
company to prescribe the drugs themselves.
Speaker 1 (12:27):
That is amazing. By the way, if you're listening to
this podcast and you love it, go and rate it
please wherever you listen to your podcast five stars, tell
us why you like it so much, and we'll be
right back with more calls in a minute. This is
the Middle. I'm Jeremy Hobson. If you're just tuning. In
the Middle is a national call in show. We're focused
on elevating voices from the middle geographically, politically, and philosophically,
(12:51):
or maybe you just want to meet in the middle.
This hour, we're asking you what do you think of
medications like a zempic, mount jarro and Withgovie that are
being used by a growing numnumber of people to lose weight.
Are you using them? Do you think they're revolutionary or
just another diet fad? Tolliver, what is that number to
call it?
Speaker 2 (13:08):
It's eight four four four Middle. That's eight four four
four six four three three five three. You can also
write to us at Listen to the Middle dot com
or on social media.
Speaker 1 (13:16):
I'm joined by doctor Fatima Cody Stanford, an obesity physician
at Massachusetts General Hospital, and doctor Desha Orang, incoming director
of Obesity at Endeavor Health North Shore in Chicago. Before
we get back to the phones, let's just talk about
a potential downside. We just heard about some of the
side effects that people have talked about. But doctor Nrang,
(13:37):
another criticism I've heard about this is people who've been
trying their whole lives to lose weight and not feel
shame about their bodies now feel like a whole movement
toward body positivity has been upended. I'm sure you've heard that.
What are you hearing? And do you think that that's
that's real?
Speaker 7 (13:55):
Yeah, you know, I think one of the things is
that anyone who may be coming into doctor Stanford's clinic
or mine, they've probably been shamed for decades at that
point for their weight, right, and so to have a
resource to be able to treat that is immense, right.
And so one thing is that you know, obesity nationally
(14:17):
is seen or just worldwide, is seen as a disease
of vanity, that it's your fault or it was your
will power that caused you to.
Speaker 9 (14:23):
Be at this certain weight. But that's not true.
Speaker 7 (14:26):
Their obesity and weight gain weight loss, it's very much
a neuro hormonally mediated disease. So your hormones talk to
your brain, talk to your gut. They determine how full
or you know, and hungry you are and your environment
and that means you know, the food around you, where
you live, what your access to food might be, may
(14:49):
exacerbate that or may not affect that. And so that's
the environment that we live in. That's the disease of obesity.
And so when we add these medications in you know
what doctor stanf Or was saying earlier. The medication works,
you know, the GLP one agonist. When we add the
gip on, it works to suppress the hunger hormone, so
it shuts off the noise in your head to you know,
(15:12):
have those cravings for food. So when someone is on
these medications and loses that weight, it's like one of
those things where you know, people are judged for being
at a certain weight, then they are judged for being
on medication to lose that weight. And I want to
kind of turn that conversation to say that, well, no
one's judging you for having heart disease or taking medication
for that. We aren't, you know, judging people for being
(15:35):
on a cholesterol or blood pressure medication.
Speaker 9 (15:37):
This is no different.
Speaker 7 (15:39):
And so you know, it's great to have that body positivity.
But I feel like a lot of my patients who
are on these medications feel like they can't win because
they've been judged either way.
Speaker 1 (15:48):
Well, and by the way, the number one prescribed medication
in America is a tour of statin, which is a
cholesterol medication that so many people take, including me. Let's
go to the phone's. Diana in Michigan is with us. Diana,
Welcome to the middle. Go ahead, Hi there, Hi, go
ahead with your comment.
Speaker 12 (16:10):
Hi, so, and I apologize you got me right as
sunchtime is hearing. So, I have started taking I thought
out manjaro as a way to sort of combat fertility
treatment I have inful and resistant pcos. And I continued
(16:31):
to hear from doctors that if I would just lose weight,
that maybe I could get pregnant in a second pregnancy.
And so I sought out ozepic and my doctor said,
why don't we try manjaro instead as a better option,
And it's been a complete game changer for me. So
(16:52):
I think it's really important to look at the hormonal
and fertility aspect of these drugs, and it's not something
everybody's talking about.
Speaker 1 (17:00):
Dana, thank you for that call. Doctor Stanford. Your thoughts
on that well, first.
Speaker 5 (17:04):
Of all, thanks so much for calling in. I think
this is a very important, overlooked issue. I've published widely
on this issue. I think a lot of the fertility
conversation is missing this issue, the issue with hormone and
balance and how it's impacting fertility treatment, and how many
of our fertility docs are really not trained to look
at this issue of hormone imbalance and how this can
(17:28):
be impacting infertility with either first or second or even
third or however many pregnancies that we're looking at, and
how this can play a major role. And I thank
her for calling in and bring up this important issue
that is very much overlooked. I've, like I said, I've
published on this. I find that about a third of
my female patients that are of reproductive of age or
coming in with this exact issue, many of whom I
(17:50):
am trying on medications, whether it be some maglutide, whether
it be truseeppetide or other of our more historic agents
that I've utilized. And I've gotten sign gnificant success among
these using these medications and helping them to achieve pregnancy
in the midst of being told that this was really
an impossible feat. So I thank her so much for
(18:11):
sharing her story, being brave enough to share this story.
I think it's an important overlooked conversation in the fertility world.
And like I said, I just want to thank her
for sharing her story.
Speaker 1 (18:21):
Especially as the kids were crying in the background.
Speaker 5 (18:23):
Yeah, she was brave in that sense, so brave all around.
Speaker 8 (18:28):
Thank you so much for sharing her story.
Speaker 1 (18:30):
Anthony is with us from Atlanta, Georgia. Anthony, I go ahead,
Welcome to the Middle, Y.
Speaker 13 (18:36):
Thank you. So yes, I just started taking Olympic in October.
Prior to that, I was on the highest postage of
me foreman never you know, was not seeing results. My
last agllency I had dropped you know, three or four
points within three or four month period. So it's been
(18:58):
a game changer for me. I'm you know, thirty nine
active and just a combination of exercising and strength training
has helped tremendously.
Speaker 1 (19:09):
So you've been You've been taking it in collaboration with
also an exercise routine. That's helpful.
Speaker 14 (19:17):
Absolutely.
Speaker 13 (19:18):
I play tennis, work out at a gym, and so
I think for me, I'm actually I feel like I'm
doubling the results, you know, with my a W and
sy reducing. I got back said doctor next month and
we're going to see if we need to produce the
dosa since it's working so well in my body.
Speaker 1 (19:34):
Anthony, thank you for that call. Let's get to another one.
Will is with us from Houston. Will go ahead, Welcome
to the Middle.
Speaker 15 (19:42):
Hi, good to be on Love the Show. So my
point is basically a little bit personal. But I've been
on ADHD meds for the majority of my life, and
with ADHD meds it really suppresses your hunger and I
haven't had the best relationship with you know, I was
not trouble losing weight, but gaining weight. And you know,
(20:05):
with that in mind, I don't think relying upon pills
to gain or lose weight is a healthy way at all.
I think it's a tool, and by all means you
can use tools to your advantage, but if you're relying
upon a wonder drug to help you lose all this weight,
it's not going to laugh. And you know, lately, getting
(20:27):
off of ADHD meds and being able to regain a
healthy relationship with food has been really helpful in gaining
muscle and gaining healthy weight. And that's really my point
that I wanted to make, because it's a tool, not
a crutch.
Speaker 1 (20:40):
I appreciate your comment, Doctor Nuring. Let me go to
you on that. What about that view? I'm sure you've
heard it before.
Speaker 9 (20:46):
Yeah, I actually completely agree with you.
Speaker 7 (20:49):
I think that it is a tool, and as I
said earlier, that it's an excellent resource, but it is
not the magic bullet.
Speaker 9 (20:55):
And so you know the caller before that.
Speaker 7 (20:58):
You know, is doing a regimented exercise program. You know,
it has an entire lifestyle built around this. That's where
you tend to see success. So you know, of course
there's camps where people say, you know, you only do
lifestyle modifications. The other camps may just you know, rely
on medication. Well, we truly see long term success when
(21:19):
we marry the two, when we marry lifestyle, when we
and medication together, that's where we see long term success. However, yes,
I agree that we cannot be using this as a crutch,
and especially in the setting of medication shortages and insurance denials.
We don't have you know, readily available medication for folks
every single month.
Speaker 9 (21:38):
I wish we did.
Speaker 13 (21:40):
We do not.
Speaker 9 (21:41):
And this this is also not a treatment.
Speaker 7 (21:44):
For eating disorders, and this is exactly where long term
weight management becomes essential. We cannot just dole out the
medication like candy.
Speaker 9 (21:52):
There's a lot of counseling that goes into it.
Speaker 7 (21:55):
And you know, someone is struggling with an eating disorder,
whether that might be restricted or you know, the opposite.
We really need to be able to make sure is
this patient a good candidate for medication to lose weight.
You know, is it going to trigger the eating disorder?
My bigger concern is that are you going to continue
to have a positive relationship with food, because it really
(22:18):
does come down to, you know, we need to make
sure that we have a healthy relationship with food, and
because think about the next twenty five years of your life,
right like, we have to make sure that this is not,
you know, a temporary fix.
Speaker 9 (22:30):
And so that's where it really comes.
Speaker 7 (22:32):
Down to the food environment and how we're thinking about,
you know, day to day what we're eating.
Speaker 1 (22:37):
Yeah, Tolliver, we're getting some comments in online at Listen
to the Middle dot com.
Speaker 2 (22:41):
Yeah, Christy and Hazlitt. Michigan says, as a pharmacist, I
see people struggling with weight and always looking for the
quick fix. These new drugs are working for people and
getting a lot of good press. They do work. However,
I hear from my patients that as soon as they
can get the medication, their former appetite and former habits
come right back. I'm not sure we have made it
clear that these are lifelong meds and not the quick fix.
There seeing in the media. Bottom line, if I thought
(23:01):
it was the magic bullet, I'd be using it since
I'm two hundred plus pounds.
Speaker 1 (23:05):
Doctor Stanford, What about that that these are drugs you'd
have to take your whole life.
Speaker 5 (23:10):
That is absolutely true. These are a lifetime commitment. I
tell my patients whenever they're starting any medication that we're
using to treat the chronic disease that is obesity, if
they do work, and notice I said, if they do work,
if you are a responder, this is a lifetime commitment
to these medications. For many of my patients, they've been
with me for at least ten years. So this isn't
(23:32):
a short term commitment. If you're looking for something that
you're going to just breeze on bube, start it, stop it,
and hope that everything is going to be solved, you
have picked the wrong thing. This is not something that
you're going to just start and stop. Like I said,
people have been with me for ten, fifteen, twenty plus
years and they're looking this is going to be a
(23:53):
long term commitment. If they work, you do need to
be on these for the rest of your life.
Speaker 16 (23:59):
So you have a patient that they don't work for
for that if they don't work, then we need to
pick another agent, something that works in a different pathway
of the brain, or maybe even look at other types
of treatments.
Speaker 5 (24:11):
Metabolic and bariatric surgery is still the best treatment that
we have available, particularly for those with moderate to severe obesity.
And for many of my patients, they're in combination therapy.
What do I mean by that? They have undergone bariatric surgery,
They're on medications, they're doing lifestyle modifications, they're working with
psychiatrists and psychologists. They're truly using all of the forms
(24:33):
of therapy available for them to get the best possible outcome.
Speaker 1 (24:37):
Let's go back to the phones. Beth is with us
from Nashville, Tennessee. Beth, welcome to the middle. How is
ozempic working for you or one of the drugs like it?
Speaker 14 (24:48):
Well, I took ozempic for eighteen months through a program
at my work, and for me, it was really kind
of the brain piece that I was not expecting. And
I w learned that cemeglatide goes through the blood brain barrier.
But as someone who all my life has I sake,
I would secret eat and I binge ate. And I
(25:11):
know one of the doctors mentioned about eating disorders and
this not necessarily being a great treatment for it. But
for the first time in my life, within a couple
of weeks of starting ozimpic, I felt like I understood
what the majority of the population feels like about food.
I wasn't that that food noise and food chatter was
(25:32):
not always in my head and I was not just
constantly trying to think of, you know, what food's going
to be available, and is it food I'm going to
want to eat in front of people? And am I
going to want to eat before or after? And is
there going to be enough food or not enough? And
not even just like craving things, but just having a
healthy outlook on eating or you know, going to a
(25:54):
restaurant and thinking about what everyone else is going to
order and just feeling full. That was something I had
never really even experienced. I was like a bottomless pit.
And when I started taking the ozempic, it was like, Oh,
I don't have to eat the entirety of that. I
can have a stopping point. And I just wasn't expecting
that brain piece to come into play so quickly.
Speaker 1 (26:16):
Let me ask you. Let me ask you that question,
which is when you were taking it, when you started
taking ozepich, did you tell other people that you were
taking it, because I've read a lot of people who've
been taking it they feel a little uncomfortable about talking
about taking it.
Speaker 14 (26:30):
Yeah. So I had several friends who were in the
same work weight loss program that we were in at
the same time. But there were people, even like close
friends and relatives who I still have never told because
they have said in the past. You know, well, if
you wanted to lose weight, you just you know, exercise
and eat, you know, eat some spinach and stop you know,
(26:51):
having junk food or whatever. And for me, it wasn't
even just the weight loss, like my body image issues
still exist, like we were talking about the body movement,
but it was it was that brain piece for me.
But for people who never experienced that brain piece, they
don't understand where I'm coming from.
Speaker 1 (27:10):
Well, let me take your comment to doctor Nrang your
thoughts on that.
Speaker 7 (27:16):
Yeah, you know, if it was as easy as eating
some salad and losing weight, we would have all been
able to do that.
Speaker 4 (27:22):
Right.
Speaker 7 (27:23):
As of twenty thirty, fifty percent of our population is
predicted to have obesity. So this is not just about
the fact that you may not have eaten enough salad
in the last you know, however, many decades.
Speaker 6 (27:34):
Of your life.
Speaker 7 (27:35):
This goes way way beyond that. And you know, as
I said earlier, it's not a question of willpower. This
is very much our brain chemistry. This is very much
you know, the genetics we were dealt and and part
of it is, you know, we can't change our genetics,
but we can change the environment around us. We can
be on you know, therapeutic medications that can alter part
(27:58):
of that interaction of hormone between our brain and our gut.
And that's the situation that we're in right now, right
And I think people, you know, like she was mentioning
those who may not necessarily understand that chatter going on
in the brain, those people finally feel seen because they
have a resource to actually.
Speaker 9 (28:16):
Calm that chatter down.
Speaker 7 (28:18):
Which and that's why, you know, these medications are remarkable
because for the first time, and probably you know, decades
of dealing with this.
Speaker 9 (28:26):
They have something that can you know, help them.
Speaker 7 (28:29):
Right And I'm telling you everyone who may have come
into my clinic, they've tried every diet.
Speaker 9 (28:34):
In the book right right there.
Speaker 7 (28:36):
There is not a diet they have not tried so
that it's not a question of eating more greens.
Speaker 1 (28:41):
Well, but just as it's not a question of eating
more greens. And you mentioned the amount of people that
may be obese. Almost three quarters of adults older than
twenty in the US are already living with obesity or overweight,
Doctor Stanford. There are probably some listeners saying to themselves,
what about the food industry? Is this just? Is this
just a way to counteract the kinds of things that
(29:02):
the food industry markets to us and has for decades.
Speaker 5 (29:06):
Well, I mean, I definitely think the food industry plays
a role, But I think that we make it just
about the food industry, and it's so much more complex
than that. It's about our sleep quality and duration. It's
about other issues that play a large role. I mean,
let's look at how our environment has changed over the
last fifty years. Let's look at the one demand ability
to get food at anytime, at any hour, at any
(29:28):
minute of any day. That's part of it. But let's
look at how our circadian rhythms have changed. Just the
timing of when we eat has plays a large role.
Those things play a large role. Medications that we take
play a large role in how much we weigh. Do
you know that twenty percent of our obesity has to
do with medications that we take for other issues? Did
you know that that twenty percent of obesity is caused
(29:50):
by other medications? What medications cause obesity? Medications like beta blockers,
lithium depicode, medication that are antipsychotics, insulin, these medications that
we have to take for other issues that lead to waggain.
We can't like not take those medications, but guess what
they cause weight gain?
Speaker 8 (30:10):
So there's a lot of other issues that lead to obesity.
Speaker 1 (30:13):
All right, Well, stand by a reminder that The Middle
is also available as a podcast in partnership with iHeart
Podcasts on the iHeart app or wherever you listen to podcasts. Tolliver,
I have to say, when I first heard about ozembek,
I thought of Fenfenn, which was a hit weight loss
drug in the nineties, called a miracle drug at the time.
Speaker 2 (30:28):
Yep, until it turned into a nightmare. Listen to this
nineteen ninety seven clip from the Fox affiliate in my
home city of Chicago.
Speaker 11 (30:34):
The first Illinois lawsuit's been filed against the makers of
fen Fenn. A Chicago law firm filed a class action
suit today. It comes after the Food and Drug Administration
last week urged the recall of fen fenn because of
studies that link it to heart problems.
Speaker 1 (30:48):
And by the way, the drug combination that made fenfenn
was never approved by the FDA, whereas the drugs were
talking about today have been approved by the FDA. We
are going to be back with more in just a minute.
On the middle. This is the Middle. I'm Jeremy Hobson.
We're talking about drugs like ozepic and Wogovi that have
grown so popular for weight loss that there's now a
shortage in some cases. So what do you think of
(31:10):
these drugs? Are you using them? Do you have concerns?
We want to hear from you at eight four four
four Middle or at listen toothemiddle dot com. I'm joined
by doctor Fatima Cody Stanford, an obesity physician at Massachusetts
General Hospital, and doctor Disha Nerang, incoming director of Obesity
at Endeavor Health North Shore in Chicago. Before we go
back to the phones, I want to ask both of you,
(31:32):
our guests, about two things. One, the cost if it's
not covered by insurance, it's around one thousand dollars a month.
Medicare does not cover it for weight loss, so for
most people the cost would be prohibitive. Do you expect
that to change anytime soon, Doctor Norang.
Speaker 7 (31:53):
Not in the near future. I think one of the
things is that there are more agents in the pipeline
coming out, So I do think that potentially having multiple
agents that are as powerful as you know, the current
agents that we have, may help to decrease the prices.
Speaker 9 (32:09):
That's just conjecture.
Speaker 7 (32:10):
Though we do have coupons available, you know, for all
of these medications. However, even after the coupons, they are
quite pricey. So in the near future, unfortunately, I do
not see the price coming down.
Speaker 1 (32:23):
Doctor Stamford. The other thing I'm wondering about, and we've
heard about, is that ozebic, what it does for cravings, addictions,
and desires, goes beyond hunger. Can it be used for
you know, alcoholism or impulse shopping.
Speaker 5 (32:38):
Even so, those studies are being now conducted by the NIH,
so the data is still very preliminary. There are some
people that will anecdotally say that, you know, I do
feel that I'm not having those strong alcohol, you know,
cravings that I've had before. I've had some patients, although
just a few, that say that I no longer have
(32:59):
those issues, but the data is very scarce, and so
I would be a little bit pro you know, cautious
in terms.
Speaker 8 (33:07):
Of making these really sweeping.
Speaker 5 (33:08):
Statements to say that those are what we're getting from
these drugs, although there are some patients that would tell
you that definitively they've seen major shifts in those One
thing that I do want to add, however, to what
doctor Mringe stated earlier, is that one of the drugs
that is a golp one that's a daily injection, that
was the first drug approved that was a golp one.
That's the ragletide. That was Victoza, which was the one
(33:31):
treat the treat diabetes and sex cinda. That is set
to come off patent in twenty twenty four. So when
that does come off patent, that will be a generic
drug which will be available to the public. Now, on average,
the weight loss is significantly less, but it still works
in the same pathways of the brain and was quite
effective for many patients and still quite effective for several patients.
(33:52):
So that will improve some of the equity issues that
we've seen in access issues when that comes off patent
this year, and so I do think that that will
help improve some of the equity and access issues when
that comes off patent in twenty twenty four.
Speaker 8 (34:05):
Thank year.
Speaker 1 (34:06):
Let's go back to the phone. Sarah is joining us
from Pennsylvania. Sarah, Welcome to the middle.
Speaker 17 (34:10):
Go ahead, Hi, thank you. I caught this show accidentally
and it has been so informative and great to hear,
so thank you, thank you. I heard one of the callers,
a gentleman, talking about how he's been on the medication
for add or ADHD, and his statement kind of challenged
(34:32):
me about you know, we're looking for the weight loss,
the magic bullet, the magic pill here, and I think
that's the biggest thing, one of the biggest things that
gets me with this. I too have taken add orall
for my add over the years, I've taken Fennermine. I
actually took Finton before it was banned for a short time,
(34:52):
which helped me and I was able to be off
of it for a number of years. And then I
did revisit Centerman itself years ago. It actually helped me
more with my add than the weight loss, so that
was interesting. And then here comes Wagovi and I started
that earlier this year. And the mental component, the brain opponent,
like one of the other callers mentioned, it is amazing
(35:15):
what it does and it's hard to put to words.
And I just wish that people would understand that Nobody
goes into the store and says, you know what, I'll
take a box to add actually give me a double dose.
And while you're at it, why don't you add some
obesity to it and make that a triple dose. Nobody
wants any of this. Nobody's looking for an easy way out.
(35:35):
It's exactly like the doctor said that, you know, there's
no judgments because you're taking medication for your heart or
insolence or because of whatever. So it just really I
guess struck my number when he was like, you know, hey,
change your live stuff. I've done everything like like has
been mentioned on the show. I've done the lifestyle change,
(35:56):
I've done the eating change, and I still gain weight
and being a bottomless pit of hunger hungry all the time. Yeah,
to the point of being physically sick is mind blowing
of like what is going on with my body? And
so w GOVI it is a game changer and and
it was just like, yeah, whatever it did to the mentalness.
I was like, whoa wait a minute, because I know
(36:17):
what Funerman does.
Speaker 1 (36:18):
Well, Sarah, we've got it. Let me take it to
our panel, doctor Dourng. Why is there such judgment about
about not just weight, but about people trying to lose
the weight.
Speaker 7 (36:31):
Yeah, So, going back to my earlier comment, obesity is
seen as the disease of vanity. It is seen as
a disease that was your fault because you ate too
much or whatever the situation may have been, that it
was your fault. We need to turn this conversation around.
This is a chronic disease. We're not seeing this conversation
around blood pressure, polesterol, heart disease, diabetes, sleep apnea, joint disease.
(36:55):
All of these are actually complications of obesity. And so
this conversation needs to change. Even our insurance companies, you know,
deny these medications left and right, or if someone didn't
lose enough weight on the medication, they'll stop coverage for
the medication. Well, they're putting blame on the patient. They're
making this disease their fault, and this is precisely why
(37:17):
we need to treat this as a long term chronic
illness that needs to be treated long term with the
medication potentially. And so this is exactly you know what
this caller was saying. She's tried all these medications and
you know this finally worked for her, that mental chatter
came down. She's doing well on it. Well, that's what
(37:37):
we want to see, right, because when we do well
on it, then all these other things get better. Our diabetes,
blood pressure, cholesterol, heart disease, sleep apnea, ad joint disease,
risk of cancer, like you name it right, all of
these things get better. So we need to change this conversation.
Speaker 1 (37:53):
Let's go to Nick, who's calling from Michigan. Nick, Welcome
to the Middle.
Speaker 3 (38:00):
Hello. My question to your panel was I was just
that actually at my doctor recently, and he was commenting
that they were seeing or maybe in the lab animal
aspect of when they test drugs, that they were seeing
increased rates of thyroid cancer. But I don't know that
(38:20):
that necessarily translated to the human I guess trials and
now that it's been on market, if we've seen an
uptick in instances of thyroid cancer.
Speaker 1 (38:31):
Well, let me take that to doctor Stanford. Have you
heard about that.
Speaker 5 (38:35):
So yeah, so I think that what he's saying is
that some of the earlier troup particularly in the WRAP models,
did show a slight increase in thyroid cancer. We haven't
really seen this translate into the human models, and so
I appreciate Nick for bringing.
Speaker 8 (38:49):
This to the attention.
Speaker 5 (38:50):
So there has been some fear associated with this, but
long term studies have not seen this translate into human studies.
And what I want to also let the call early
people that are listening to the show, not that gop
ones have been on the market here in the United
States for almost twenty years, so we have almost twenty
years of data to look at with regards to the
gop ones, and we just really haven't seen that play
(39:11):
out in the almost twenty years of data that we've
seen in terms of thyroid disease. There was one study
that was conducted in Europe that showed a slight increase
in the European population with regards to thyroid disease in
one study that was conducted there. We have not seen
that we're out in the American population. So I have
(39:32):
not been cautious in that way. Within my patient population.
I have over treated over three thousand patients with gop
ones in my own personal patient population, and so I
can tell you that I'm always very cautious of thinking
about this. I will say a contra indication to use
of this medication. If you have a personal or family
(39:53):
history of medullary thyroid cancer, you cannot use this medication.
This is completely a contra indication to use. Or any
fit patient that has a history of multiple intercaneoplasia type
two complete contra indication to the use of these medications.
So those patient populations completely excluded from the use of medication.
But thanks so much for calling in with that concern.
Speaker 1 (40:14):
Let's go to Eva, who's in the Chicago area.
Speaker 3 (40:17):
Hi.
Speaker 1 (40:18):
Eva, Welcome to the middle.
Speaker 18 (40:21):
Hi, I was beginning to lose hope.
Speaker 1 (40:27):
Your prayers have been answered.
Speaker 4 (40:28):
Go ahead.
Speaker 18 (40:29):
Yes, I never had weight problems.
Speaker 15 (40:33):
I'm bushed.
Speaker 6 (40:34):
I guess.
Speaker 18 (40:35):
My daughter, however, was born Finn was thin through school
and through high school, went away to college and started
getting weight and then gaining more and more and more
and more, and she was clinically obese, which of course
worries her mother. But I wasn't allowed to talk about
(40:56):
it or ask her question because then I would be
that shaming her. So all I could do is bite
my lips and hope she has used the medication and
lost almost one hundred pounds, and it's like, oh my god,
(41:17):
that's the person you know I saw growing up. That's
and it's it's wonderful. But I have three concerns. Number One,
there was no research being done for weight control for
the medication because it was for diabetics. Is the medica
is research going on now? Number two? Are people who
(41:39):
are taking it for weight control taking a higher dosage
or different dosage when people are taking it for diabetes?
And number three, do we have any idea of what
happens when people stop taking it?
Speaker 1 (41:52):
Okay, my life. Yeah, those are great questions. Let me
take Let me take that to our panel, Doctor Muring,
you're give answers to those questions.
Speaker 9 (42:02):
Yes.
Speaker 7 (42:03):
So the answer to the first question, whether there has
been research on long term weight management, I think that
was the question. We have research and so with stamaglatide,
we're seeing about twenty percent to give or take at
the highest dose. With turzeppatide, we're seeing even more than that,
up to twenty five percent in patients who have taken
(42:26):
it for over a year, and so we do have
actually data to support you know, long term weight maintenance
and weight loss. Right now, remind me of the.
Speaker 1 (42:36):
Other Do people have to take a higher dose if
they're using it for weight loss?
Speaker 7 (42:40):
Well, so the way that the medications have been dose
so stamaglatide for diabetes goes up to two milligrams, some
maglatide for that is indicated for the for weight management
goes up to two point four milligrams. So there's not
too much of a difference, but it's a very slight
difference for turzeppatide for both diabetes management and weight management,
(43:01):
it's the exact same dosing and so you know, when
these studies were done, there were studies done for people
who have obesity without diabetes, and there are separate studies
for patients who do have diabetes. So we actually have
very concrete data on this, and as doctor Stanford said,
we have twenty years almost experience with these sorts of agents,
(43:22):
and so for long term management now you know, we
have ongoing trials to understand if we go down on
the dose, do we maintain our weight if we come
off of the dose. Though, especially anecdotally patients, do you know,
regain some of that appetite, some of that food noise,
and some of that weight. And so when when we
say that obesity is a chronic disease, we're expecting patients
(43:45):
to be on these medications long term. And so the
trade off is that hopefully you know your diabetes and
blood pressure issues, cholesterol issues, those all get better, so
hopefully you do get to come off of other medications
as a trade off.
Speaker 1 (44:00):
Let's get in another call here. Weston is joining us
from Boise, Idaho.
Speaker 6 (44:05):
Weston, go ahead, I guess to get my thesis. I
think we're starting to. Sorry, I'm actually a lot of
risks to at the gym. My thesis is ultimately nice.
We're trying to address a broken food system with pills.
(44:27):
And the reason I say that is that our food
systems designed to be addictive, at least the commercialized food system.
So people from a very young age are eating food
that's mentally and physically addictive, and then as they grow
up that's all their body knows. They haven't gotten good
(44:48):
eating habits near their wife. So then we're at a
point where now Eli Lillings make billions up the drugs
because of the food system being broaking, and I guess
we just I think we need a radical look at
like how societies where and how people are becoming unhealthy
because of society.
Speaker 1 (45:05):
All right, well, Wesson, thank you for that call. And
I think it's very appropriate that we got a call
from somebody who's at the gym, clearly on a piece
of exercise equipment during this show about this. But doctor Stanford,
this is something we just talked about a few moments ago.
But the food industry and the food that we eat.
Speaker 5 (45:20):
Yeah, I think that Wesson brings up a certain point,
but I think that he's missing the fact that this
is a global pandemic. There's not one country in the
world that isn't affected by obesity, and there's been a
global increase and the rates of obesity in every single
country in the world. And so if we're talking about
this and we're looking at food and food systems throughout
(45:41):
the world, we've seen this as an increase even in
those countries that don't have the same food systems that
we have here in the US. And so if we
think about this as a multifactorial disorder where genetics, development, environment,
and behavior all play a role in a person's likelihood of.
Speaker 8 (45:56):
Developing this disease.
Speaker 5 (45:58):
Where food does play a role, we have to look
at the role of genetics, development, environment, and behavior and
all of those components playing a role in the likelihood
of a person's development of obesity. I encourage him to
watch my lecture that I recorded Obesity. It's much more
complex than you think. It is one hour and eleven minutes,
and you can go watch it for free. It's available
(46:20):
for you to watch, and it is great.
Speaker 8 (46:23):
It's not behind a paywall.
Speaker 5 (46:24):
But I think that if you go watch that, you'll
recognize that this is not just about the food system.
And while that does play a role, it is much
more complex than you think.
Speaker 1 (46:32):
And doctor Durang, you are a nutritionist as well.
Speaker 9 (46:35):
Correct, I have a license in culinary medicine.
Speaker 1 (46:38):
Okay, do you have thoughts on this?
Speaker 7 (46:41):
You know I do. I agree with doctor Stanford. Food
is certainly a large part of this. We are in
a different world than we were in nineteen fifty, right.
We rely on our cars, our physical activity is much different,
you know, the way we live, the way we work,
the places we live and work.
Speaker 9 (46:59):
It's just it's a different world.
Speaker 7 (47:00):
Right, And so when we I agree, right, when we
add in the processed food industry and and all of
those things.
Speaker 9 (47:09):
It all contributes.
Speaker 7 (47:11):
We're more stressed, we don't sleep enough. Like it's a whole,
you know, combination of issues.
Speaker 1 (47:17):
We have to leave it there in terms of the
calls for now, but Tolliver, we do have time for
a quiz.
Speaker 2 (47:23):
Shout out to Weston for setting this question up perfectly. Okay, okay,
So the quiz question is what's the US food banned
most in other countries? Some of the name for foods Okay,
instant mashed potatoes, Skittles, twinkies, or pills Berry biscuits. Feel
free to jump in when you got it. It's instant
mashed potatoes, Skittles, twinkies, or Pillsberry biscuits, Twinkies.
Speaker 9 (47:45):
I say twinkies too.
Speaker 2 (47:47):
You know I would have said the exact same thing.
It's instant mashed potatoes.
Speaker 8 (47:50):
Wow, that's that's kind of disgusting. I think this should
be really I.
Speaker 1 (47:54):
Just want the real mashed potatoes. They don't want the
inst the issue.
Speaker 2 (48:00):
At it, I just sather.
Speaker 1 (48:01):
Third, Yeah, I want to thank my guest doctor Fatima
Cody Stanford, an obesity medicine physician at Massachusetts General Hospital
professor at Harvard, Doctor Stanford, thank you so much for
joining us.
Speaker 8 (48:12):
Thank you for having me and.
Speaker 1 (48:14):
Doctor tishen Orang, incoming director of Obesity at Endeavor Health
North Shore in Chicago, Doctor Irang, thank you so much
for joining us.
Speaker 9 (48:22):
Thank you so much.
Speaker 13 (48:23):
It was an honor.
Speaker 1 (48:24):
And by the way, our next show will be the
last one before Iowa Republicans have their say in the
presidential nomination process. One of the top issues for them,
according to a Des Moines registered poll, is immigration and
border security.
Speaker 2 (48:37):
That's right, Jeremy. So we're asking listeners all over the country,
not just in Iowa, what do you want the government
to do about immigration and border security?
Speaker 1 (48:44):
That's going to be an interesting one. You can call
us at eight four four four six four three three
five three or write in at listen to them Middle
dot com. And while you're there, you can sign up
for our weekly news letter. The Middle is brought to
you by Long Nook Media, distributed by Illinois Public Media
in Urbana, Illinois, and produced by joe Ane Jennings, Harrison Patino,
John Barth, and Danny Alexander. Our technical director is Jason Croft.
(49:08):
Our theme music was composed by Andrew Haigu. Thanks also
to Nashville Public Radio, iHeartMedia, and the now more than
three hundred and eighty public radio stations that are making
it possible for people across the country to listen to
the Middle. I'm Jeremy Hobson, and I'll talk to you
next week
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