November 19, 2024 • 33 mins
Discover why the future of weight management lies beyond the realm of traditional diet and exercise as we welcome Dr. Cortina, a leading internal medicine specialist focused on obesity management. Challenge your assumptions about Ozempic and other weight loss medications as we unravel their dual purpose beyond diabetes treatment. Dr. Cortina enlightens us on the critical role of GLP-1, a gut hormone mimicked by these medications, which offers a scientific approach to managing appetite and obesity-related health conditions like prediabetes. We dig into the complexities of assessing who qualifies for these treatments, stressing the importance of evaluating obesity-related risks. Dr. Cortina also takes on the problematic nature of the diet industry, likening it to "weight loss cartels" that often exploit vulnerable individuals. We conclude with a hopeful vision for a future where informed medical guidance prevails over diet culture, and we invite you to explore more of Dr. Cortina's insights on Instagram.
About Dr. Cortina
Dr. Sandra Cortina is an internal medicine specialist and diplomate of the American Board of Obesity Medicine who practices obesity medicine in British Columbia, Canada. She has a special interest in ADHD and Binge Eating Disorder as well as managing the multifactorial causes of obesity that help ensure long-term treatment success. Her previous training includes a bachelors in Kinesiology, a masters in Public Health and a bachelors in Nursing with prior nursing practice experience in mental health, harm reduction and addiction medicine. She currently holds active memberships with the Canadian ADHD Resource Alliance and Eating Disorders Association of Canada. She is passionate about helping patients unlearn diet culture myths, and to replace them with evidence-based approaches to clinically important weight loss. As an advocate for scientific communication, she actively shares accurate weight loss information on social media and works to debunk misleading trends.
Takeaways
- Weight loss medications should be reframed as anti-obesity medications, as their goal is to reduce the burden of excess fat tissue that leads to other health issues.
- Weight loss medications work by mimicking gut hormones that control appetite and help individuals feel full.
- Weight loss medications should be used in conjunction with lifestyle changes, such as reducing processed foods and engaging in physical activity.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:25):
Okay, welcome back to the Elegoo podcast.
My name is Lisa, I am your host, and today's guest is Dr
Cortina.
Dr Cortina, thank you forcoming to the show.
Oh, thanks for having me.
So why don't you tell us alittle bit about what you do?
Speaker 2 (00:42):
For sure, yeah, so I am an internal medicine
specialist, which basicallymeans I do adult medicine, but
my specialty training is inobesity management.
So I am American boardcertified in obesity medicine
and I do community obesitymedicine essentially here in New
Westminster Canada.
Speaker 1 (01:03):
Okay.
So I found you on Instagram andI was like oh, wow, okay, she's
dropping bombs and gems.
Because I saw the comments andI'm like woo Okay.
And obviously there is thiswhole talk about weight loss
medications with Ozempic.
(01:24):
There is this whole talk aboutweight loss medications with
Ozempic and I'm going to be realhonest with you, I don't know a
lot about those medications,which I'm probably going to
guess a lot of people don't knowa lot about these medications.
When I look at your comments,I'm seeing that.
So let's start with what's thebiggest misconception with
weight loss medications.
Speaker 2 (01:46):
Yeah, the biggest misconception has to be that
they're weight loss.
No, they're called weight lossmedications.
I think if we were to justreframe the narrative and call
them anti-obesity medications,it might be a bit different.
But because we always call themweight loss medications and so
we always think that this isabout a number on a scale, when
(02:09):
the whole purpose and the goalof using these medications is to
reduce the burden of excess fattissue that is leading to other
health issues.
I think that's the biggestthing.
Speaker 1 (02:20):
Okay, yeah, yeah, for sure, okay.
So what are the most commonlyprescribed weight loss
medications?
Like, I even mentioned theOzempic, and then there's
another one out there and how dothey work in the body?
Because, honestly, when I thinkabout the weight loss
medications, as they call them,I mean back in the day there
(02:46):
were a lot of ones that werealready out there.
I don't even think peoplerealize that there are a lot out
there, but now, because of Idon't know if it's because of
social media or just the way weare in the world everybody knows
the names of these medications.
So what are the ones that aremost commonly prescribed?
Speaker 2 (03:07):
Hands down, it has to be Ozempic and of course it's
prescribed off-label becauseit's intended for diabetes.
But as physicians we canprescribe things off-label.
And what really made Ozempicpopular among everyone is that
it's the most cost-effectivemedication, or it's the most
cost effective medication, orit's the most affordable one on
the market.
(03:27):
And so when you look at, whenyou look at just the anti
obesity medications, the onesthat are approved for obesity,
let's say like will go be thesame medication, but it's they
charge more for it samemedication.
And so what?
What, as doctors have beendoing is we don't want patients
to take on that burden of theextra costs when we know it's
the same medication.
(03:48):
So we prescribe the Ozempic offlabel because it ends up being
the, you know, most costeffective one, at least.
Speaker 1 (03:55):
So was it around like cause it's for cause that's the
thing I heard that it's fordiabetes.
So has this been around for awhile.
Speaker 2 (04:03):
It's been around for some time.
Yes, it's been around sinceabout 2018.
Ozempic I was certainlyprescribing it back then off
label and I was probably beggingpeople to just even consider it
at that time.
It's a different landscape now,but it has been around.
(04:24):
So Ozempic's been around forsome time.
When you look at just the classof the medications because we
call them GLP-1s, which standsfor glucagon-like peptide 1,
it's a long name.
It's the name of the hormone init or the copy of the hormone
in it these classes, this classof medications, have been around
since 2007.
So we're talking 17 years.
(04:44):
They've been around.
Speaker 1 (04:46):
Okay, so let's talk about what exactly do they do
Like?
How are these people losingweight?
What's going on?
Speaker 2 (04:55):
Yeah.
So what's really interesting orat least how I explain it to my
patients is this is a copy of agut peptide and they've copied
the peptide really well.
Ozepic mimics our natural GLP-1by 96%.
It's a very close copy with itand basically what I explain to
(05:19):
patients is that this is anappetite hormone.
It helps us feel full when weeat food.
Normally, okay, food travelsdown the gut right and it'll hit
the gut wall and when it hitsthe gut wall, our gut will
secrete.
There's actually a slew ofdifferent hormones, but one of
them is GLP-1, and it has a lotof jobs.
But for our purposes, itcontrols our appetite when we
(05:41):
eat.
So it goes to the brain and itsays, hey, food is here, feel
full?
Okay.
So that's that's thepredominant way I would say.
It works and people will say,yes, there's reduced gastric
emptying, yada, yada.
Yes, but remember, obesity is adisease of the brain and that's
where this thing is working,okay.
Well, why is that even important?
Because we know that whenpeople start to carry extra
(06:04):
weight, the extra weight leadsto prediabetes, diabetes.
This is the same same guys.
This is the same disorder.
The question is, where are youon this spectrum?
Because we already know acrossthe spectrum whether it's excess
weight to diabetes.
The functioning of GLP-1, it'snot as robust when we compare it
to people without extra weightor without type 2 diabetes, et
(06:26):
cetera.
So that's a whole idea aboutwhy we give this hormone back.
Speaker 1 (06:31):
Wow Okay.
Speaker 2 (06:32):
I didn't know that.
Speaker 1 (06:33):
So I didn't realize that it is something that's
natural, that we already have.
So let me ask you this, becauseI'm sure people are listening
and they're thinking the samething Okay, we already have it.
Why, what?
Why are we giving more of it?
I don't get it.
Speaker 2 (06:51):
Cause it doesn't.
It doesn't work as well, it'snot as robust, and so we have.
We have studies.
At least it correlates with BMI.
The higher the BMI, the lessrobust or the lower levels of
this hormone people with higherBMIs will have.
I think probably the next mostnatural question that always
(07:11):
comes up is well, can't we testit Right?
Why don't?
Can we test the levels to knowfor sure?
We can't.
Because our natural GLP-1, itgets released after a meal.
It's gone after about eightminutes.
Glp-1.
It gets released after a meal.
It's gone after about eightminutes.
Wow, the half-life of thismedication is a week, so it
(07:32):
makes it last a long time.
So you're feeling full, fuller,faster, longer after you eat
consistently.
Speaker 1 (07:36):
Okay, all right, so you mentioned two of them, so of
course I only know Ozempic.
And then there's a what is it?
Wagozi, or?
Speaker 2 (07:44):
Wagovi yeah.
Speaker 1 (07:46):
Wagovi.
Okay, what's the difference?
Speaker 2 (07:48):
They're the same.
It's the same.
It's the same.
It has to do with marketing,basically.
So the drug company who makesit is Novo Nordisk, and when
they speak to the medication fora certain audience for the
diabetes audience they want touse a specific brand, and that's
(08:09):
Ozempic.
But when they want to speak tothe different audience, for
weight management, that's wherethey package the same medication
just in a different color penthan they go and write Wagovi on
it.
But it's the same medication.
So they're the same,essentially Ozempic the.
They're the same, essentiallyOsempic diabetes.
Wagovi is for weight management.
Speaker 1 (08:30):
Okay.
Speaker 2 (08:31):
But there's a newer medication on the market that
maybe you've heard of is Manjaro.
Yes, yes.
There's Manjaro and then thereis the weight management version
cousin.
Again, this is going to be thesame medication, right, which is
called Zepbound, and thatmedication is called weight
management version.
Cousin.
Again, this is going to be thesame medication, right, which is
called Zepbound, and thatmedication is called Terzepatide
.
So when they brand it fordiabetes, sponjaro, when they
(08:53):
brand it for weight management,zepbound, that is a very
interesting medication.
So, if you remember, withOzempic it has a copy of
glucagon-like peptide 1.
With manjaro it has two hormonecopies, so it has that glp1,
but it has a second hormone, haseven longer name.
(09:14):
We call it gip for short.
Okay, but it's glucosedependent insulin tropic peptide
c really long, so it's gip forshort.
What gip does is it blocks theside effect profile of glp1 that
you would otherwise experiencewith just Ozempic alone.
So everyone hears about thoseside effects, right, and so what
(09:35):
you get with this newer one isyou actually get more weight
loss because there's twohormones, but you get a much
lower side effect profile, like50% lower the rate of side
effects.
Speaker 1 (09:45):
Okay, all right, yeah , okay.
Yeah, that's the other one I'mhearing about.
All right.
So, yes, the side effects iswhat we're hearing about a lot,
and especially you know you said.
You said I don't want to saythis the wrong way, but you said
delayed gastric emptying.
(10:07):
So can you just say a littlebit about what that exactly
means?
Speaker 2 (10:14):
So delayed gastric emptying basically means when
your gastrointestinal system isprocessing food and it's going
down at a rate like a regularrate, so food has to travel down
our gastrointestinal tract,gets digested, moves along, the
nutrients get absorbed, all thatstuff.
With delayed gastric emptyingthat is slowed down and if it's
(10:39):
slowed down there's more food inour gut.
And remember, when there's foodin our gut it's stimulating
those fullness hormones, right?
Because when it's stimulatingthe gut, those fullness hormones
, right?
Because when it's signaling inthe gut, those fullness hormones
are constantly getting secretedand so that helps with that
fullness feeling.
So that's what I meant by the,or that's what's meant by the
gastric emptying piece.
Speaker 1 (11:01):
Okay, so a lot of the words or the terms that I hear
a lot is also gastroparesis aspart of the side effects.
So what is that?
Gastroparesis as part of theside effects?
So what is that?
Speaker 2 (11:15):
And okay, let me start with that.
What is that?
Yeah, no, that's great, yeah,and probably you were hearing a
stomach paralysis too, I'd throwin there, right, so, so, yeah,
so we know that, um, we know,like we already know, that the
medication causes delayedgastric emptying, and the Latin
(11:36):
medical term for that isgastroparesis.
Okay, paresis means slowingdown, and gastro well, you know,
it's gastro, right, so it kindof makes sense Gastroparesis,
same same, okay.
What's happened, though, is, inmedia, they've really they've
started to confuse, in myopinion, paresis with paralysis.
That's not the same thing.
(11:57):
Paralysis is like halting,right, this is slowing, and so
when they use the terms theparalysis, people of course can
get a bit freaked out, butwhat's happening is it's paresis
, it's the slowing down ofgastric emptying out, but what's
happening is it's paresis, it'sthe slowing down of gastric
emptying.
Speaker 1 (12:14):
Okay, so, with the side effects, which you know,
with every drug there's sideeffects, right, and it's kind of
like a toss up whether you'regoing to be the one that's going
to have that.
I mean, isn't it really likethat's how it is, like you might
(12:36):
have more of?
Speaker 2 (12:38):
those side effects than somebody else.
Is there any reason for that?
I mean, what?
What is your take on that?
The side effects are.
So the side effects, all theside effects, are a result of
the gastroparesis.
They're a result of the gastricemptying.
Okay, so everyone gets a bitspooked with the word
gastroparesis.
Stomach paralysis and it's notstomach paralysis.
Right, it's slowing, but whenthere is slowing, what happens
(13:00):
is people get acid reflux.
That's a more relatable sideeffect, right, okay, that makes
sense.
Constipation right, slowingdown, that makes sense.
More relatable side effectNausea it's also because of the
slowing down.
So, all of the known sideeffects, the underlying
physiological reason for all theside effects that have been
(13:22):
listed for this medication isdue to gastroparesis.
The word gastroparesis is newto the public, not new to me.
I knew about that already.
I know it causes gastroparesisand that's why the list of side
effects looks like this.
I don't know if that helps.
Speaker 1 (13:41):
No, that helps, but I guess it's not new to people
who've been around, the peoplewho have it.
But yeah, I guess you're right,not a lot of people are aware
of that terminology.
Okay, so let's get into.
How do you determine if apatient is a good candidate for
(14:02):
weight loss medication?
Speaker 2 (14:03):
Yes, so the drug companies do have a, you know, a
list of what we callindications.
Indications meaning this is whoyou can prescribe it to and
this is who you don't.
And the biggest, you know, whatwe're looking for is does this
person have obesity and willthey benefit from weight loss?
(14:25):
And you know they, they sort itout and they base it on BMI.
But it does get a bit morecomplex than that.
Really.
You're looking to see if theyhave excess fat tissue really
around their abdomen and ifthat's going to help reduce
other things like do they havehigh cholesterol?
Yeah, reducing their weight isgoing to help Diabetes.
Yeah, do they have pain attheir joints, at their knees?
(14:47):
Yeah, that's who you want toprescribe it to.
When they have excess weightaround their abdomen, that's
leading to other medical issues.
Okay, really, really, how youdetermine.
Speaker 1 (15:00):
Okay, let me take a step back.
So most people are thinking,okay, you know, if you're
overweight, then why don't youjust do it the natural way?
And then there are people whoare extremely like obese and I'm
thinking, yeah, they need help.
Like the, the, the um, themlike, right now, we need to save
(15:20):
them.
Like there's you know what I'msaying?
Because, like, there's the, thecholesterol, the potential of a
heart attack.
I mean, we're talking lifethreatening things that could
potentially happen to thisindividual.
And then, um, you know, a lotof people are like, well then, I
, you know, I can understandthem taking these weight loss
medications.
But then you see people likethe Kardashians, supposedly, you
(15:42):
know, we think, okay, theymight, they might, are they on
it?
They're not on it, we don'tknow.
I mean we suspect.
And then there's tons ofcelebrities.
I mean we suspect.
And then there's tons ofcelebrities who are not obese
that are taking this medication.
So, like, what is?
What are your thoughts?
Speaker 2 (15:59):
on that?
Yeah, it's, yeah, there's.
It's a loaded question, isn'tit there is sometimes it's hard
to know if they, if they shouldor should not be on it, like,
sometimes, like you, you don'tknow what their lab tests are
doing.
So it's it's, it is hard.
But then there's some casesyou're like, oh, I don't know
about this one person, like theyweren't you know, I don't know.
(16:21):
I think I came across somethingabout ice spice on on it, yes,
yes, okay, uh, so that I can't.
I can't fault them.
I actually have to fault theperson who's prescribing them.
Like, who is this personprescribing it to?
This person who probablydoesn't have the indication?
(16:43):
Because every time we prescribesomething as a physician, you
always have to weigh.
Okay, the patient has to havemore benefits than downsides,
more benefits than risks.
If you're going to prescribethis thing, or else you're not
practicing first, do no harm.
And if you do prescribe it tosomebody with just a little bit
of extra weight, you run therisk of more side effects or
(17:07):
disadvantages.
People lose muscle loss andthat's significant.
When you're in a lower BMIcategory, I would argue.
But people don't alsoappreciate this is they'll lose
their hair, they'll grow back,but when you don't have that
much extra weight to lose andyou throw on something like that
that causes you to lose weightwhen you really didn't have that
(17:27):
much.
You will lose hair.
It grows back, but that can bedistressful, which I don't think
people appreciate.
Speaker 1 (17:36):
That makes a lot of sense.
That makes a lot of sense.
So the other thing that I'veheard people say well, you know,
these medications are expensiveand they're taking it away from
the people who really need it,Like those aren't diabetic.
Speaker 2 (17:51):
Sorry, I'm throwing this at you.
Speaker 1 (17:54):
What are your thoughts on that?
Speaker 2 (17:56):
Yeah, during the whole shortage and everything,
yeah, yeah.
So it's like, who deserves tobe on this medication at the end
of the day, right?
So what if I put it this way?
What if I had two medication?
Or I had a medication, ittreated both, uh, let's say,
multiple sclerosis andrheumatoid arthritis, right,
(18:18):
okay, and it went to shortage.
We wouldn't be having aconversation.
Who deserves to have themedication more?
So that comes down to weightbias.
For one, okay, here's the otherweight bias.
Okay, so I've got somebody withdiabetes.
We can use Ozempic, I can useit off label for somebody for
weight management, okay, and itgoes into shortage.
(18:40):
Who deserves it?
Okay, how many treatments do Ihave in obesity?
One, two, three.
How many medications do peoplewith diabetes have?
They got like 20 medications.
So why are we saying that theyget first priority?
You know they've got 20 othermedications, and so you're.
(19:00):
Are we saying that, um, it'sokay to leave one population
just completely untreated, right?
And so that's another exampleof the weight bias that happens.
At the end of the day,semaglutide is semaglutide,
zampic, wogovie.
I don't care what rules thedrug companies have made.
(19:22):
They're a business.
Speaker 1 (19:24):
I know what the medication is, it's the same
right, okay, all right, let'stalk about the amount of weight
loss, like what's realistic, andyou know, then, taking these
medications, I mean I reallydon't know, like if when I see
somebody obviously thesecelebrities I don't see them
(19:44):
every day, so it's not like I'mlike, oh my God, they lost all
that in one week, like I can'tsay that because it's not like
we see them every day.
But then it's like you know,you see them maybe six months
ago, and then you're like whatHoly crap?
But realistically, speaking.
Speaker 2 (20:00):
What should they be expecting?
So it depends on the medication.
If I was to talk about Wagovi,let's say what I quote.
Everybody is expect to loseabout 15% of your body weight,
maybe up to 17,.
But expect that over the courseof a year, a year and a half.
So it happens slowly, and sohow you calculate that percent
(20:28):
is well, whatever your currentweight is 15%, that's how much
weight you would lose.
Speaker 1 (20:32):
Okay, Should they be doing other things besides that?
I mean, like, what are yourrecommendations?
I mean, should they also beworking out eating?
Speaker 2 (20:45):
healthy like, or are they just, you know, getting
this medication?
Yeah, that's, yeah, what awonderful question.
Yeah, of course.
So what I tell everyone isreduce your intake of processed
foods and do 150 minutes of,like, moderate intensity
physical activity if you can.
Some people have limitations,right, um, but those
recommendations are no differentthan the recommendations for
(21:08):
the general public people Peoplewith obesity don't get special
recommendations that aredifferent from the general
public.
Speaker 1 (21:19):
Wow, really no, okay, yeah, I know.
Speaker 2 (21:22):
It's very shattering.
Speaker 1 (21:24):
This kind of goes into the question I was going to
ask you and the question washow do these medications compare
with diet and exercise alone interms of effectiveness?
Because, like I said, a lot ofpeople are going to say, well,
why can't they do it the naturalway and working out and eating
healthy, versus taking themedications?
(21:44):
What is your answer to that?
Speaker 2 (21:47):
Sure.
So to answer that, we're goingto have to go over what happens
in obesity, I guess.
How does obesity even happen?
So when we think about obesity,you have to remember that this
is a disease of the brain, ourbrain, that controls weight, and
(22:09):
it's subconscious.
Okay, so it's subconscious, butit likes to pick the best
weight it goes.
I like this weight.
We call it the set point, butreally it's like a range of, I
don't know, plus or minus 10 or20 pounds.
So as long as you're in thisweight range, your brain thinks
you're happy, safe, whatnot?
Okay.
When we gain weight, though, andfor whatever reason is, this
(22:31):
range will go, shifts up, shiftsup, and this process naturally
does not go in this direction onits own, because if it does,
what are we worried about?
We're about cancer or somethingright?
Why is this person just losingweight, not doing anything?
So, from an evolutionary basis,this thing is going up, because
we would have survived longeras a species going this way, and
(22:54):
what happens in the disease ofobesity is this thing gets stuck
at an inappropriately highweight set point or set range.
Okay, it's stuck here.
Your brain thinks this is thebest weight for you to be here,
while the rest of your body'slooking up, going right.
It's like the one thing.
The brain gets wrong.
And so when we're talking abouthow do we get the weight down
(23:17):
and why not use diet andexercise over medications,
because they work completelydifferently.
Let's say I diet, okay, and Iremember I said just got to
reduce processed foods.
Okay, let's say we do that.
What happens is your weightwill probably drop 5% in the
longterm.
It goes from here to here, butI know that's sustainable and
that's what matters.
And people are like I couldlose more.
(23:39):
I can lose more than 5%, forsure I can.
I've done it before becausethey probably have.
They've done something reallyrestrictive and that's true.
So I could start using myconscious brain and I could
force my weight out of here.
Right, I force it here.
But dieting doesn't changewhere this doesn't.
It doesn't change where thislives.
This is still here.
And because you left the safetyzone, your subconscious brain
(24:00):
thinks you're in trouble, likeyou're in the famine.
Has no idea.
You got a fridge full of food.
Thinks you're in the famine andyou're in trouble Like you're
in the famine.
Has no idea.
You got a fridge full of food.
Thinks you're in the famine andyou're down here, and what it
does to counteract this is itmakes you tired, lowers your
metabolic rate, makes you hungry.
All of a sudden, all you wantis McDonald's and ice cream.
Can't stop thinking about it,and it's not sustainable.
(24:21):
So what happens as soon as youlet go back here?
Okay, this is what obesity is.
Okay, it's stuck here.
Okay, well, what aboutmedications then?
So medications change this,they alter this, so it's a
treatment.
Medications will take thisrange, move it down Okay,
(24:45):
depending like how much you knowit, depending on the medication
, how much down, but it holds ithere, holds it here and your
new weight range is here, and itstays here for as long as
you're on the medication.
Because if you stop it, comparethat to bariatric surgery.
Bariatric surgery is a hormonalsurgery.
(25:05):
I know this is a hormonalsurgery.
Okay, I know this is a littlebit off topic, but we should
compare it.
Bariatric surgery permanentlymoves this all the way down here
, and then you can let go right,because it's a solution.
Right, it's a treatment.
Yeah, so those are the mainthree treatment options, and
that's why Diets are not goingto treat obesity, the disease.
Speaker 1 (25:31):
I'm speechless because that is probably the
best way to explain that, andI'm like like mind blown.
I mean, do I know this?
Yes, but the way you explainedit just makes so much sense and
it is with your brain.
Of course it's with the brain.
(25:52):
You could do all the fancystuff, but if you're not doing
this, it's 100% you let go.
You're going to go back to thatsafe place.
The way you explain that isjust right on point.
My God, okay.
Safe place.
The way you explain that isjust right on point.
My God, okay.
Now you just answered myquestion because I was going to
ask you what happens when thepatient stops taking the
(26:14):
medication.
Is there a risk of regainingthe weight?
Speaker 2 (26:20):
Yeah.
So I tell everyone yes, yes,yes, yes.
We think that there is okay.
When you look at the data, wethink that there's about
probably 5% of the populationthat can keep the weight off
after stopping the medication,which is diet and exercise alone
(26:40):
.
But we also think those are thesame people who would have lost
the weight anyways without themedication.
And if that's the case, theydon't have obesity and they're
able to sustain it.
Because there are some peoplewho they've gained the weight,
ok, but their weight range isn't.
(27:02):
So it's not so narrow as what Isaid, right, it's probably a
weight range, but it's likegoing up, but it's like a big
weight range and they so it'snot so narrow as what I said,
right, it's probably like aweight range, but it's like
going up, but it's like a bigweight range and they'd make
these diet changes and it'sstill here to here, but because
their diet was so poor in thebeginning, they can keep it off
because this thing was so big,right, and this is genetically
determined or whatnot.
(27:22):
So so what I guess what I'mtrying to say is there is the
people who can do this getsignificant weight down, keep it
off lifelong without medication.
They don't have obesity.
Okay, obesity is when this isstuck.
This is when you're stuck.
Speaker 1 (27:43):
You can't get this down.
I think that's one of the.
That's the biggestmisconception, because I don't.
They don't get that that.
This is first of all.
I'm going to be honest with you.
When people used to say it wasa disease, I was like, how is
that?
Speaker 2 (27:56):
But when how is it?
Speaker 1 (27:58):
a disease.
But you're right, you're soright about the minds, the brain
.
You're so right about the brainputting you in that spot and
when people think about, well,just do their organic way.
Oh my God, why is the dietculture, the diet industry is
booming?
Because you go back.
(28:18):
Hello, because you go back.
It's a good business model, I'mtelling you, you go back to.
How many times do people dothat?
They lose the way, theyeventually go back and that's
why it's a big moneymaker.
I got to say you pretty muchopened up my eyes today.
(28:39):
I didn't know if I could beopened up any further, but it is
.
And you explaining it the wayyou did really makes a lot of
sense.
And let me ask you this onequestion what do you see as a
change as far as all thesemedications coming up, as far as
the diet culture, the dietindustry?
(29:01):
What do you foresee happeningin the future with all this?
Speaker 2 (29:06):
Oh, what I foresee, I I hope I will.
What I foresee and what I hopeI guess is different.
I think, slowly, though I thinkdiet culture will start to
(29:27):
whittle, you know, whither awaya bit.
If you follow me on Instagram,I will talk about like the diet
culture and diet culturecompanies as weight loss cartels
, and that's how.
That's exactly what they are.
They prey on people who arevulnerable, desperate, right,
and they're charging people with, you know, stuff that is not
going to treat your obesity.
(29:47):
I'm talking about like diets orwhatever.
It's not going to treat obesity.
I just said obesity, is thisokay?
And they're nothing more thanweight loss cartels.
At the end of the day, peopleneed to see it.
They need to see somebody whocan like a health professional.
At the end of the day, I thinkit will start to wither away.
(30:10):
I think it'll take some timefor people to appreciate the
double standards, but I think,over time, we'll start to see it
.
And and the double standardmeaning, if you know, we don't
see this with other diseases.
So, um, let's say, somebody hasheart disease.
I don't see Weight Watchersdoing a uh, uh, comes to our
(30:32):
cardiology clinic, right, it'sall.
It's like comical, really,right, and that comes down to
that bias piece.
That weight bias thing is westill don't believe obesity is a
disease because we would neverdo that to other diseases, we
just wouldn't.
Speaker 1 (30:48):
Yeah, yeah, right, I again.
I just thank you so much forproviding all this information.
I'm going to urge everyone tocheck her out on her Instagram.
I'm sure she's like battingeverybody as she's looking at
the comments, but I mean, you'reproviding education and I'm
(31:11):
sure people are gettingtriggered by that because it's
completely opposite of whatthey're thinking.
But I want to thank you so muchfor literally giving us the
basics of these medications andtalking about this disease,
because it is a disease and youknow again I go back to you know
the risk, the risk of thoseother risks of heart disease and
(31:35):
stroke, and I mean we just sithere and talk about all the
other risks from being obese.
You know that is the reason whythese medications are being
given, because we want to savethese people.
So, um, again, dr Cortina,thank you for being a part of
this.
Speaker 2 (31:54):
Oh, you're very welcome, very, very welcome.
Speaker 1 (31:57):
Spread the word always, so where can we find you
?
Speaker 2 (32:02):
Yeah, so you can find me on on Instagram.
So my handle is yeah, so youcan find me on Instagram.
So my handle is Cortina WeightMedicine and yeah, that's where
I post all my content on socialmedia.
Speaker 1 (32:16):
I just post it on my Instagram.
Speaker 2 (32:17):
there she hasn't gone to the TikTok land.
I did have TikTok, but it wastoo many impersonators.
I had a TikTok until maybe liketwo weeks ago, when I had these
impersonator accounts andTikTok wouldn't take them down.
Oh my God.
So I deleted my TikTok.
Oh my God, it's really bizarre,tiktok.
(32:37):
Be better.
What is wrong with you?
Be better.
Speaker 1 (32:40):
What is wrong with you?
Okay, all right, I didn't know.
I think I saw a post youtalking about that, so I think I
did.
I'm like she's talkingimpersonators.
Anyways, follow her onInstagram, get educated, listen
to what she's saying.
But, yes, I'll put all thelinks to get ahold of her on the
(33:01):
show notes.
And again, dr Cortina, thankyou for being a part of this.
I really appreciate it.
All right, awesome, verywelcome.
Okay, and until next time, byeyou.
Okay, welcome back to the Elegoo podcast.
My name is Lisa, I am your host, and today's guest is Dr
Cortina.
Dr Cortina, thank you forcoming to the show.
Oh, thanks for having me.
So why don't you tell us alittle bit about what you do?
Speaker 2 (00:42):
For sure, yeah, so I am an internal medicine
specialist, which basicallymeans I do adult medicine, but
my specialty training is inobesity management.
So I am American boardcertified in obesity medicine
and I do community obesitymedicine essentially here in New
Westminster Canada.
Speaker 1 (01:03):
Okay.
So I found you on Instagram andI was like oh, wow, okay, she's
dropping bombs and gems.
Because I saw the comments andI'm like woo Okay.
And obviously there is thiswhole talk about weight loss
medications with Ozempic.
(01:24):
There is this whole talk aboutweight loss medications with
Ozempic and I'm going to be realhonest with you, I don't know a
lot about those medications,which I'm probably going to
guess a lot of people don't knowa lot about these medications.
When I look at your comments,I'm seeing that.
So let's start with what's thebiggest misconception with
weight loss medications.
Speaker 2 (01:46):
Yeah, the biggest misconception has to be that
they're weight loss.
No, they're called weight lossmedications.
I think if we were to justreframe the narrative and call
them anti-obesity medications,it might be a bit different.
But because we always call themweight loss medications and so
we always think that this isabout a number on a scale, when
(02:09):
the whole purpose and the goalof using these medications is to
reduce the burden of excess fattissue that is leading to other
health issues.
I think that's the biggestthing.
Speaker 1 (02:20):
Okay, yeah, yeah, for sure, okay.
So what are the most commonlyprescribed weight loss
medications?
Like, I even mentioned theOzempic, and then there's
another one out there and how dothey work in the body?
Because, honestly, when I thinkabout the weight loss
medications, as they call them,I mean back in the day there
(02:46):
were a lot of ones that werealready out there.
I don't even think peoplerealize that there are a lot out
there, but now, because of Idon't know if it's because of
social media or just the way weare in the world everybody knows
the names of these medications.
So what are the ones that aremost commonly prescribed?
Speaker 2 (03:07):
Hands down, it has to be Ozempic and of course it's
prescribed off-label becauseit's intended for diabetes.
But as physicians we canprescribe things off-label.
And what really made Ozempicpopular among everyone is that
it's the most cost-effectivemedication, or it's the most
cost effective medication, orit's the most affordable one on
the market.
(03:27):
And so when you look at, whenyou look at just the anti
obesity medications, the onesthat are approved for obesity,
let's say like will go be thesame medication, but it's they
charge more for it samemedication.
And so what?
What, as doctors have beendoing is we don't want patients
to take on that burden of theextra costs when we know it's
the same medication.
(03:48):
So we prescribe the Ozempic offlabel because it ends up being
the, you know, most costeffective one, at least.
Speaker 1 (03:55):
So was it around like cause it's for cause that's the
thing I heard that it's fordiabetes.
So has this been around for awhile.
Speaker 2 (04:03):
It's been around for some time.
Yes, it's been around sinceabout 2018.
Ozempic I was certainlyprescribing it back then off
label and I was probably beggingpeople to just even consider it
at that time.
It's a different landscape now,but it has been around.
(04:24):
So Ozempic's been around forsome time.
When you look at just the classof the medications because we
call them GLP-1s, which standsfor glucagon-like peptide 1,
it's a long name.
It's the name of the hormone init or the copy of the hormone
in it these classes, this classof medications, have been around
since 2007.
So we're talking 17 years.
(04:44):
They've been around.
Speaker 1 (04:46):
Okay, so let's talk about what exactly do they do
Like?
How are these people losingweight?
What's going on?
Speaker 2 (04:55):
Yeah.
So what's really interesting orat least how I explain it to my
patients is this is a copy of agut peptide and they've copied
the peptide really well.
Ozepic mimics our natural GLP-1by 96%.
It's a very close copy with itand basically what I explain to
(05:19):
patients is that this is anappetite hormone.
It helps us feel full when weeat food.
Normally, okay, food travelsdown the gut right and it'll hit
the gut wall and when it hitsthe gut wall, our gut will
secrete.
There's actually a slew ofdifferent hormones, but one of
them is GLP-1, and it has a lotof jobs.
But for our purposes, itcontrols our appetite when we
(05:41):
eat.
So it goes to the brain and itsays, hey, food is here, feel
full?
Okay.
So that's that's thepredominant way I would say.
It works and people will say,yes, there's reduced gastric
emptying, yada, yada.
Yes, but remember, obesity is adisease of the brain and that's
where this thing is working,okay.
Well, why is that even important?
Because we know that whenpeople start to carry extra
(06:04):
weight, the extra weight leadsto prediabetes, diabetes.
This is the same same guys.
This is the same disorder.
The question is, where are youon this spectrum?
Because we already know acrossthe spectrum whether it's excess
weight to diabetes.
The functioning of GLP-1, it'snot as robust when we compare it
to people without extra weightor without type 2 diabetes, et
(06:26):
cetera.
So that's a whole idea aboutwhy we give this hormone back.
Speaker 1 (06:31):
Wow Okay.
Speaker 2 (06:32):
I didn't know that.
Speaker 1 (06:33):
So I didn't realize that it is something that's
natural, that we already have.
So let me ask you this, becauseI'm sure people are listening
and they're thinking the samething Okay, we already have it.
Why, what?
Why are we giving more of it?
I don't get it.
Speaker 2 (06:51):
Cause it doesn't.
It doesn't work as well, it'snot as robust, and so we have.
We have studies.
At least it correlates with BMI.
The higher the BMI, the lessrobust or the lower levels of
this hormone people with higherBMIs will have.
I think probably the next mostnatural question that always
(07:11):
comes up is well, can't we testit Right?
Why don't?
Can we test the levels to knowfor sure?
We can't.
Because our natural GLP-1, itgets released after a meal.
It's gone after about eightminutes.
Glp-1.
It gets released after a meal.
It's gone after about eightminutes.
Wow, the half-life of thismedication is a week, so it
(07:32):
makes it last a long time.
So you're feeling full, fuller,faster, longer after you eat
consistently.
Speaker 1 (07:36):
Okay, all right, so you mentioned two of them, so of
course I only know Ozempic.
And then there's a what is it?
Wagozi, or?
Speaker 2 (07:44):
Wagovi yeah.
Speaker 1 (07:46):
Wagovi.
Okay, what's the difference?
Speaker 2 (07:48):
They're the same.
It's the same.
It's the same.
It has to do with marketing,basically.
So the drug company who makesit is Novo Nordisk, and when
they speak to the medication fora certain audience for the
diabetes audience they want touse a specific brand, and that's
(08:09):
Ozempic.
But when they want to speak tothe different audience, for
weight management, that's wherethey package the same medication
just in a different color penthan they go and write Wagovi on
it.
But it's the same medication.
So they're the same,essentially Ozempic the.
They're the same, essentiallyOsempic diabetes.
Wagovi is for weight management.
Speaker 1 (08:30):
Okay.
Speaker 2 (08:31):
But there's a newer medication on the market that
maybe you've heard of is Manjaro.
Yes, yes.
There's Manjaro and then thereis the weight management version
cousin.
Again, this is going to be thesame medication, right, which is
called Zepbound, and thatmedication is called weight
management version.
Cousin.
Again, this is going to be thesame medication, right, which is
called Zepbound, and thatmedication is called Terzepatide
.
So when they brand it fordiabetes, sponjaro, when they
(08:53):
brand it for weight management,zepbound, that is a very
interesting medication.
So, if you remember, withOzempic it has a copy of
glucagon-like peptide 1.
With manjaro it has two hormonecopies, so it has that glp1,
but it has a second hormone, haseven longer name.
(09:14):
We call it gip for short.
Okay, but it's glucosedependent insulin tropic peptide
c really long, so it's gip forshort.
What gip does is it blocks theside effect profile of glp1 that
you would otherwise experiencewith just Ozempic alone.
So everyone hears about thoseside effects, right, and so what
(09:35):
you get with this newer one isyou actually get more weight
loss because there's twohormones, but you get a much
lower side effect profile, like50% lower the rate of side
effects.
Speaker 1 (09:45):
Okay, all right, yeah , okay.
Yeah, that's the other one I'mhearing about.
All right.
So, yes, the side effects iswhat we're hearing about a lot,
and especially you know you said.
You said I don't want to saythis the wrong way, but you said
delayed gastric emptying.
(10:07):
So can you just say a littlebit about what that exactly
means?
Speaker 2 (10:14):
So delayed gastric emptying basically means when
your gastrointestinal system isprocessing food and it's going
down at a rate like a regularrate, so food has to travel down
our gastrointestinal tract,gets digested, moves along, the
nutrients get absorbed, all thatstuff.
With delayed gastric emptyingthat is slowed down and if it's
(10:39):
slowed down there's more food inour gut.
And remember, when there's foodin our gut it's stimulating
those fullness hormones, right?
Because when it's stimulatingthe gut, those fullness hormones
, right?
Because when it's signaling inthe gut, those fullness hormones
are constantly getting secretedand so that helps with that
fullness feeling.
So that's what I meant by the,or that's what's meant by the
gastric emptying piece.
Speaker 1 (11:01):
Okay, so a lot of the words or the terms that I hear
a lot is also gastroparesis aspart of the side effects.
So what is that?
Gastroparesis as part of theside effects?
So what is that?
Speaker 2 (11:15):
And okay, let me start with that.
What is that?
Yeah, no, that's great, yeah,and probably you were hearing a
stomach paralysis too, I'd throwin there, right, so, so, yeah,
so we know that, um, we know,like we already know, that the
medication causes delayedgastric emptying, and the Latin
(11:36):
medical term for that isgastroparesis.
Okay, paresis means slowingdown, and gastro well, you know,
it's gastro, right, so it kindof makes sense Gastroparesis,
same same, okay.
What's happened, though, is, inmedia, they've really they've
started to confuse, in myopinion, paresis with paralysis.
That's not the same thing.
(11:57):
Paralysis is like halting,right, this is slowing, and so
when they use the terms theparalysis, people of course can
get a bit freaked out, butwhat's happening is it's paresis
, it's the slowing down ofgastric emptying out, but what's
happening is it's paresis, it'sthe slowing down of gastric
emptying.
Speaker 1 (12:14):
Okay, so, with the side effects, which you know,
with every drug there's sideeffects, right, and it's kind of
like a toss up whether you'regoing to be the one that's going
to have that.
I mean, isn't it really likethat's how it is, like you might
(12:36):
have more of?
Speaker 2 (12:38):
those side effects than somebody else.
Is there any reason for that?
I mean, what?
What is your take on that?
The side effects are.
So the side effects, all theside effects, are a result of
the gastroparesis.
They're a result of the gastricemptying.
Okay, so everyone gets a bitspooked with the word
gastroparesis.
Stomach paralysis and it's notstomach paralysis.
Right, it's slowing, but whenthere is slowing, what happens
(13:00):
is people get acid reflux.
That's a more relatable sideeffect, right, okay, that makes
sense.
Constipation right, slowingdown, that makes sense.
More relatable side effectNausea it's also because of the
slowing down.
So, all of the known sideeffects, the underlying
physiological reason for all theside effects that have been
(13:22):
listed for this medication isdue to gastroparesis.
The word gastroparesis is newto the public, not new to me.
I knew about that already.
I know it causes gastroparesisand that's why the list of side
effects looks like this.
I don't know if that helps.
Speaker 1 (13:41):
No, that helps, but I guess it's not new to people
who've been around, the peoplewho have it.
But yeah, I guess you're right,not a lot of people are aware
of that terminology.
Okay, so let's get into.
How do you determine if apatient is a good candidate for
(14:02):
weight loss medication?
Speaker 2 (14:03):
Yes, so the drug companies do have a, you know, a
list of what we callindications.
Indications meaning this is whoyou can prescribe it to and
this is who you don't.
And the biggest, you know, whatwe're looking for is does this
person have obesity and willthey benefit from weight loss?
(14:25):
And you know they, they sort itout and they base it on BMI.
But it does get a bit morecomplex than that.
Really.
You're looking to see if theyhave excess fat tissue really
around their abdomen and ifthat's going to help reduce
other things like do they havehigh cholesterol?
Yeah, reducing their weight isgoing to help Diabetes.
Yeah, do they have pain attheir joints, at their knees?
(14:47):
Yeah, that's who you want toprescribe it to.
When they have excess weightaround their abdomen, that's
leading to other medical issues.
Okay, really, really, how youdetermine.
Speaker 1 (15:00):
Okay, let me take a step back.
So most people are thinking,okay, you know, if you're
overweight, then why don't youjust do it the natural way?
And then there are people whoare extremely like obese and I'm
thinking, yeah, they need help.
Like the, the, the um, themlike, right now, we need to save
(15:20):
them.
Like there's you know what I'msaying?
Because, like, there's the, thecholesterol, the potential of a
heart attack.
I mean, we're talking lifethreatening things that could
potentially happen to thisindividual.
And then, um, you know, a lotof people are like, well then, I
, you know, I can understandthem taking these weight loss
medications.
But then you see people likethe Kardashians, supposedly, you
(15:42):
know, we think, okay, theymight, they might, are they on
it?
They're not on it, we don'tknow.
I mean we suspect.
And then there's tons ofcelebrities.
I mean we suspect.
And then there's tons ofcelebrities who are not obese
that are taking this medication.
So, like, what is?
What are your thoughts?
Speaker 2 (15:59):
on that?
Yeah, it's, yeah, there's.
It's a loaded question, isn'tit there is sometimes it's hard
to know if they, if they shouldor should not be on it, like,
sometimes, like you, you don'tknow what their lab tests are
doing.
So it's it's, it is hard.
But then there's some casesyou're like, oh, I don't know
about this one person, like theyweren't you know, I don't know.
(16:21):
I think I came across somethingabout ice spice on on it, yes,
yes, okay, uh, so that I can't.
I can't fault them.
I actually have to fault theperson who's prescribing them.
Like, who is this personprescribing it to?
This person who probablydoesn't have the indication?
(16:43):
Because every time we prescribesomething as a physician, you
always have to weigh.
Okay, the patient has to havemore benefits than downsides,
more benefits than risks.
If you're going to prescribethis thing, or else you're not
practicing first, do no harm.
And if you do prescribe it tosomebody with just a little bit
of extra weight, you run therisk of more side effects or
(17:07):
disadvantages.
People lose muscle loss andthat's significant.
When you're in a lower BMIcategory, I would argue.
But people don't alsoappreciate this is they'll lose
their hair, they'll grow back,but when you don't have that
much extra weight to lose andyou throw on something like that
that causes you to lose weightwhen you really didn't have that
(17:27):
much.
You will lose hair.
It grows back, but that can bedistressful, which I don't think
people appreciate.
Speaker 1 (17:36):
That makes a lot of sense.
That makes a lot of sense.
So the other thing that I'veheard people say well, you know,
these medications are expensiveand they're taking it away from
the people who really need it,Like those aren't diabetic.
Speaker 2 (17:51):
Sorry, I'm throwing this at you.
Speaker 1 (17:54):
What are your thoughts on that?
Speaker 2 (17:56):
Yeah, during the whole shortage and everything,
yeah, yeah.
So it's like, who deserves tobe on this medication at the end
of the day, right?
So what if I put it this way?
What if I had two medication?
Or I had a medication, ittreated both, uh, let's say,
multiple sclerosis andrheumatoid arthritis, right,
(18:18):
okay, and it went to shortage.
We wouldn't be having aconversation.
Who deserves to have themedication more?
So that comes down to weightbias.
For one, okay, here's the otherweight bias.
Okay, so I've got somebody withdiabetes.
We can use Ozempic, I can useit off label for somebody for
weight management, okay, and itgoes into shortage.
(18:40):
Who deserves it?
Okay, how many treatments do Ihave in obesity?
One, two, three.
How many medications do peoplewith diabetes have?
They got like 20 medications.
So why are we saying that theyget first priority?
You know they've got 20 othermedications, and so you're.
(19:00):
Are we saying that, um, it'sokay to leave one population
just completely untreated, right?
And so that's another exampleof the weight bias that happens.
At the end of the day,semaglutide is semaglutide,
zampic, wogovie.
I don't care what rules thedrug companies have made.
(19:22):
They're a business.
Speaker 1 (19:24):
I know what the medication is, it's the same
right, okay, all right, let'stalk about the amount of weight
loss, like what's realistic, andyou know, then, taking these
medications, I mean I reallydon't know, like if when I see
somebody obviously thesecelebrities I don't see them
(19:44):
every day, so it's not like I'mlike, oh my God, they lost all
that in one week, like I can'tsay that because it's not like
we see them every day.
But then it's like you know,you see them maybe six months
ago, and then you're like whatHoly crap?
But realistically, speaking.
Speaker 2 (20:00):
What should they be expecting?
So it depends on the medication.
If I was to talk about Wagovi,let's say what I quote.
Everybody is expect to loseabout 15% of your body weight,
maybe up to 17,.
But expect that over the courseof a year, a year and a half.
So it happens slowly, and sohow you calculate that percent
(20:28):
is well, whatever your currentweight is 15%, that's how much
weight you would lose.
Speaker 1 (20:32):
Okay, Should they be doing other things besides that?
I mean, like, what are yourrecommendations?
I mean, should they also beworking out eating?
Speaker 2 (20:45):
healthy like, or are they just, you know, getting
this medication?
Yeah, that's, yeah, what awonderful question.
Yeah, of course.
So what I tell everyone isreduce your intake of processed
foods and do 150 minutes of,like, moderate intensity
physical activity if you can.
Some people have limitations,right, um, but those
recommendations are no differentthan the recommendations for
(21:08):
the general public people Peoplewith obesity don't get special
recommendations that aredifferent from the general
public.
Speaker 1 (21:19):
Wow, really no, okay, yeah, I know.
Speaker 2 (21:22):
It's very shattering.
Speaker 1 (21:24):
This kind of goes into the question I was going to
ask you and the question washow do these medications compare
with diet and exercise alone interms of effectiveness?
Because, like I said, a lot ofpeople are going to say, well,
why can't they do it the naturalway and working out and eating
healthy, versus taking themedications?
(21:44):
What is your answer to that?
Speaker 2 (21:47):
Sure.
So to answer that, we're goingto have to go over what happens
in obesity, I guess.
How does obesity even happen?
So when we think about obesity,you have to remember that this
is a disease of the brain, ourbrain, that controls weight, and
(22:09):
it's subconscious.
Okay, so it's subconscious, butit likes to pick the best
weight it goes.
I like this weight.
We call it the set point, butreally it's like a range of, I
don't know, plus or minus 10 or20 pounds.
So as long as you're in thisweight range, your brain thinks
you're happy, safe, whatnot?
Okay.
When we gain weight, though, andfor whatever reason is, this
(22:31):
range will go, shifts up, shiftsup, and this process naturally
does not go in this direction onits own, because if it does,
what are we worried about?
We're about cancer or somethingright?
Why is this person just losingweight, not doing anything?
So, from an evolutionary basis,this thing is going up, because
we would have survived longeras a species going this way, and
(22:54):
what happens in the disease ofobesity is this thing gets stuck
at an inappropriately highweight set point or set range.
Okay, it's stuck here.
Your brain thinks this is thebest weight for you to be here,
while the rest of your body'slooking up, going right.
It's like the one thing.
The brain gets wrong.
And so when we're talking abouthow do we get the weight down
(23:17):
and why not use diet andexercise over medications,
because they work completelydifferently.
Let's say I diet, okay, and Iremember I said just got to
reduce processed foods.
Okay, let's say we do that.
What happens is your weightwill probably drop 5% in the
longterm.
It goes from here to here, butI know that's sustainable and
that's what matters.
And people are like I couldlose more.
(23:39):
I can lose more than 5%, forsure I can.
I've done it before becausethey probably have.
They've done something reallyrestrictive and that's true.
So I could start using myconscious brain and I could
force my weight out of here.
Right, I force it here.
But dieting doesn't changewhere this doesn't.
It doesn't change where thislives.
This is still here.
And because you left the safetyzone, your subconscious brain
(24:00):
thinks you're in trouble, likeyou're in the famine.
Has no idea.
You got a fridge full of food.
Thinks you're in the famine andyou're in trouble Like you're
in the famine.
Has no idea.
You got a fridge full of food.
Thinks you're in the famine andyou're down here, and what it
does to counteract this is itmakes you tired, lowers your
metabolic rate, makes you hungry.
All of a sudden, all you wantis McDonald's and ice cream.
Can't stop thinking about it,and it's not sustainable.
(24:21):
So what happens as soon as youlet go back here?
Okay, this is what obesity is.
Okay, it's stuck here.
Okay, well, what aboutmedications then?
So medications change this,they alter this, so it's a
treatment.
Medications will take thisrange, move it down Okay,
(24:45):
depending like how much you knowit, depending on the medication
, how much down, but it holds ithere, holds it here and your
new weight range is here, and itstays here for as long as
you're on the medication.
Because if you stop it, comparethat to bariatric surgery.
Bariatric surgery is a hormonalsurgery.
(25:05):
I know this is a hormonalsurgery.
Okay, I know this is a littlebit off topic, but we should
compare it.
Bariatric surgery permanentlymoves this all the way down here
, and then you can let go right,because it's a solution.
Right, it's a treatment.
Yeah, so those are the mainthree treatment options, and
that's why Diets are not goingto treat obesity, the disease.
Speaker 1 (25:31):
I'm speechless because that is probably the
best way to explain that, andI'm like like mind blown.
I mean, do I know this?
Yes, but the way you explainedit just makes so much sense and
it is with your brain.
Of course it's with the brain.
(25:52):
You could do all the fancystuff, but if you're not doing
this, it's 100% you let go.
You're going to go back to thatsafe place.
The way you explain that isjust right on point.
My God, okay.
Safe place.
The way you explain that isjust right on point.
My God, okay.
Now you just answered myquestion because I was going to
ask you what happens when thepatient stops taking the
(26:14):
medication.
Is there a risk of regainingthe weight?
Speaker 2 (26:20):
Yeah.
So I tell everyone yes, yes,yes, yes.
We think that there is okay.
When you look at the data, wethink that there's about
probably 5% of the populationthat can keep the weight off
after stopping the medication,which is diet and exercise alone
(26:40):
.
But we also think those are thesame people who would have lost
the weight anyways without themedication.
And if that's the case, theydon't have obesity and they're
able to sustain it.
Because there are some peoplewho they've gained the weight,
ok, but their weight range isn't.
(27:02):
So it's not so narrow as what Isaid, right, it's probably a
weight range, but it's likegoing up, but it's like a big
weight range and they so it'snot so narrow as what I said,
right, it's probably like aweight range, but it's like
going up, but it's like a bigweight range and they'd make
these diet changes and it'sstill here to here, but because
their diet was so poor in thebeginning, they can keep it off
because this thing was so big,right, and this is genetically
determined or whatnot.
(27:22):
So so what I guess what I'mtrying to say is there is the
people who can do this getsignificant weight down, keep it
off lifelong without medication.
They don't have obesity.
Okay, obesity is when this isstuck.
This is when you're stuck.
Speaker 1 (27:43):
You can't get this down.
I think that's one of the.
That's the biggestmisconception, because I don't.
They don't get that that.
This is first of all.
I'm going to be honest with you.
When people used to say it wasa disease, I was like, how is
that?
Speaker 2 (27:56):
But when how is it?
Speaker 1 (27:58):
a disease.
But you're right, you're soright about the minds, the brain
.
You're so right about the brainputting you in that spot and
when people think about, well,just do their organic way.
Oh my God, why is the dietculture, the diet industry is
booming?
Because you go back.
(28:18):
Hello, because you go back.
It's a good business model, I'mtelling you, you go back to.
How many times do people dothat?
They lose the way, theyeventually go back and that's
why it's a big moneymaker.
I got to say you pretty muchopened up my eyes today.
(28:39):
I didn't know if I could beopened up any further, but it is
.
And you explaining it the wayyou did really makes a lot of
sense.
And let me ask you this onequestion what do you see as a
change as far as all thesemedications coming up, as far as
the diet culture, the dietindustry?
(29:01):
What do you foresee happeningin the future with all this?
Speaker 2 (29:06):
Oh, what I foresee, I I hope I will.
What I foresee and what I hopeI guess is different.
I think, slowly, though I thinkdiet culture will start to
(29:27):
whittle, you know, whither awaya bit.
If you follow me on Instagram,I will talk about like the diet
culture and diet culturecompanies as weight loss cartels
, and that's how.
That's exactly what they are.
They prey on people who arevulnerable, desperate, right,
and they're charging people with, you know, stuff that is not
going to treat your obesity.
(29:47):
I'm talking about like diets orwhatever.
It's not going to treat obesity.
I just said obesity, is thisokay?
And they're nothing more thanweight loss cartels.
At the end of the day, peopleneed to see it.
They need to see somebody whocan like a health professional.
At the end of the day, I thinkit will start to wither away.
(30:10):
I think it'll take some timefor people to appreciate the
double standards, but I think,over time, we'll start to see it
.
And and the double standardmeaning, if you know, we don't
see this with other diseases.
So, um, let's say, somebody hasheart disease.
I don't see Weight Watchersdoing a uh, uh, comes to our
(30:32):
cardiology clinic, right, it'sall.
It's like comical, really,right, and that comes down to
that bias piece.
That weight bias thing is westill don't believe obesity is a
disease because we would neverdo that to other diseases, we
just wouldn't.
Speaker 1 (30:48):
Yeah, yeah, right, I again.
I just thank you so much forproviding all this information.
I'm going to urge everyone tocheck her out on her Instagram.
I'm sure she's like battingeverybody as she's looking at
the comments, but I mean, you'reproviding education and I'm
(31:11):
sure people are gettingtriggered by that because it's
completely opposite of whatthey're thinking.
But I want to thank you so muchfor literally giving us the
basics of these medications andtalking about this disease,
because it is a disease and youknow again I go back to you know
the risk, the risk of thoseother risks of heart disease and
(31:35):
stroke, and I mean we just sithere and talk about all the
other risks from being obese.
You know that is the reason whythese medications are being
given, because we want to savethese people.
So, um, again, dr Cortina,thank you for being a part of
this.
Speaker 2 (31:54):
Oh, you're very welcome, very, very welcome.
Speaker 1 (31:57):
Spread the word always, so where can we find you
?
Speaker 2 (32:02):
Yeah, so you can find me on on Instagram.
So my handle is yeah, so youcan find me on Instagram.
So my handle is Cortina WeightMedicine and yeah, that's where
I post all my content on socialmedia.
Speaker 1 (32:16):
I just post it on my Instagram.
Speaker 2 (32:17):
there she hasn't gone to the TikTok land.
I did have TikTok, but it wastoo many impersonators.
I had a TikTok until maybe liketwo weeks ago, when I had these
impersonator accounts andTikTok wouldn't take them down.
Oh my God.
So I deleted my TikTok.
Oh my God, it's really bizarre,tiktok.
(32:37):
Be better.
What is wrong with you?
Be better.
Speaker 1 (32:40):
What is wrong with you?
Okay, all right, I didn't know.
I think I saw a post youtalking about that, so I think I
did.
I'm like she's talkingimpersonators.
Anyways, follow her onInstagram, get educated, listen
to what she's saying.
But, yes, I'll put all thelinks to get ahold of her on the
(33:01):
show notes.
And again, dr Cortina, thankyou for being a part of this.
I really appreciate it.
All right, awesome, verywelcome.
Okay, and until next time, byeyou.
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