August 15, 2024 • 26 mins
Can psychiatric medications really lead to dramatic weight gain? Does your socioeconomic status really determine if you’ll end up obese? And is there anything you can do about weight loss plateaus? Join us for an eye-opening episode of the Pound of Cure Weight Loss Podcast.
In today’s episode, we touch on a few key topics related to weight gain and weight loss challenges. First off, we dive into the role of medications that can actually cause weight gain. Things like antidepressants, mood stabilizers, and even birth control can seriously impact your body’s ability to maintain or lose weight. It’s not uncommon for people to be doing everything right with their diet and exercise, but these medications still push their weight up.
We also talk about frustrating weight loss plateaus. Everyone hits them at some point, and the key is not to freak out. Reverting back to only drinking protein shakes, is not going to solve the problem. Small changes—like adjusting your veggie intake or swapping out processed foods for whole foods—can make a big difference. And remember, plateaus are totally normal, so don’t feel like you're failing.
Finally, we touch on how socioeconomic status plays a major role in weight gain. People from lower-income backgrounds often have a harder time losing weight, partly because of limited access to healthier foods. Living in areas where fresh produce is hard to come by (hello, food deserts!) makes sticking to a healthy lifestyle that much tougher.
So, it’s a mix of factors outside your control like medications, hitting plateaus, and even where you live that can affect your weight loss journey.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Weiner (00:00):
Bilify, geodon, clozapine, olanzapine, lithium,
seroquel, risperidone.
These are stronger medicationsusually used more for bipolar
disease, but are also used nowI'm seeing them being used for
depression.
These things cause 10%, 15%.
I mean I've seen 50, 60, 70pounds of weight gain from these
(00:20):
meds, from these meds.
Zoe (00:25):
Welcome back to the Pound of Cure.
Weight Loss Podcast, episode 38, a dose of dilemma.
Dr. Weiner (00:36):
which antidepressants cause the most
weight gain?
Yeah, I mean we've talked aboutthis a lot, yeah, yeah, so
we're doing something a littledifferent.
Zoe (00:40):
I know it's exciting.
Dr. Weiner (00:41):
We're shortening up these episodes.
Deidre, who's been on the show,she is quite a commute, she
lives a little bit, you know,outside of Tucson and she said
she came in one day and she saidmy drive is 45 minutes and I
couldn't finish your podcastepisode.
It's too long, you have toshorten it.
And about eight other peoplealso told us our podcasts were
(01:02):
too long.
And we get it.
We both talk a lot, so there'sa lot to say.
Zoe (01:06):
There's a lot of nuance we need to discuss.
Dr. Weiner (01:08):
Yeah, I mean, we have a lot to say about this and
it's an interesting topic toboth of us for sure.
So, anyway, we're shorteningthese things up and we're going
to kind of break it up.
This is going to be really justkind of the segments are in of
obesity, and we'll have thepatient stories a separate
episode and we'll bring moreexperts in, which I think is
(01:29):
going to allow us to have someinteresting conversations, and
then we're going to take the Q&Aand that's going to be another
episode.
So that'll mix things up andwe'll adjust the dose.
We'll adjust the rate of releaseand let us know what you think
about this.
Please comment if you thinkit's a better way of doing it,
if maybe you want two hourepisodes.
Zoe (01:50):
I've heard one person tell us that I wish your episodes
were longer, because she takesher baby out for a walk in the
stroller and that's her time tolisten to us.
Dr. Weiner (01:59):
So okay, well, so you can do multiple.
Yeah, now you get to be.
Zoe (02:01):
Cue them up.
All right.
So what do we have for in thenews?
Dr. Weiner (02:06):
So this is a New York Times article.
The name of the article is theNew Study Shows which
Antidepressants May Cause theMost Weight Gain.
We've been talking about this,you know.
I've been talking about thisfor probably a decade about the
weight gaining effect ofmedications, and I was really
happy to see it make it into thepopular press and I think we're
finally starting to.
You know, with the GLP-1s andthe popularity, people are
(02:29):
starting to look at obesity forwhat it is a metabolic disease.
And so when you're looking atthis as a metabolic disease,
obesity caused by weight-gainingmedications makes total sense.
So they looked at SSRIs.
So these are kind of, you know,the usual drugs that people are
prescribed as a first-lineagent for depression.
So they looked at Lexapro,which is also known as
isopalipram, paxil, cymbalta,effexor, these things we see,
(02:54):
you know, I'd say probably athird to even, you know, 40% of
my patients in the office are onone of these medications and I
would bet about 60, 70% of theUS population has taken one of
these medications and I wouldbet about 60, 70% of the US
population has taken one ofthese at one time.
And so what they found is thatand they looked at, I think
183,000 records.
So we have such a rich databasenow with all these EMRs and we
(03:16):
can say, okay, which drugs wereprescribed?
And let's look at the weightsfor the six months after.
And that's exactly what theydid.
They found that by beingprescribed Lexapro, paxil,
cymbalta or Effexor, you had amuch higher chance of gaining 5%
or more of your weight.
Zoe (03:32):
So that's a lot.
Yeah, that's real weight gain.
Dr. Weiner (03:36):
And Zoloft and Welbutrin.
Zoloft is also Sertraline, andWelbutrin caused less weight
gain but still cause weight gain, which is interesting because
Welbutrin is part of Contrave,which is a weight loss medicine,
but yet with Welbutrin alone westill saw weight gain in these
patients.
So here's the thing that theydidn't mention in the article,
(03:58):
but it's important.
These are the first line agents.
We're seeing more commonlypatients on these second line
agents.
These are things like Abilify,geodon, clozapine, olanzapine,
lithium, seroquel, risperidone.
These are stronger medications,usually use more for bipolar
disease but are also used nowI'm seeing them being used for
(04:20):
depression.
These things cause 10%, 15%.
I mean I've seen 50, 60, 70pounds of weight gain from these
meds and you know, when you'reworking with someone on
nutrition, it's like impossibleto get someone on one of these
meds to lose weight.
Right Like no matter what you do.
Zoe (04:34):
Yeah, I'm interested.
Do you know any more about,like the mechanism of action and
why it causes weight gain?
Dr. Weiner (04:39):
You know, I think we're starting to understand
GLP-1s work centrally and thesemeds also work centrally.
By centrally I mean on yourbrain, and so these meds work on
your brain and you know thebrain is such a complicated
organ and these are such bluntinstruments.
When we're giving thesemedications that modify the
(05:02):
receptors in the brain and theneurotransmitters, we're just
opening up Pandora's box to somedegree, right, I mean, it's
really very blunt.
This is at some point we'lllook.
People will look back on thesemedications the way we might
look back on like medieval times, weapons and chivalry and
knights and spears and joustingas like warfare, you know, like
(05:23):
it's just so.
It's just so much lesssophisticated than the way the
brain works and I don't knowthat we know the exact, exact
mechanism of action.
They're probably, it's probablyknown.
I can say I don't know theexact mechanism I hear it's.
Zoe (05:37):
You know, hunger just that, that insatiable hunger, just
like with the, as you're saying,with the GLP-1s, like well,
that makes the hunger go away.
And so if this is workingcentrally, you know just that,
that overproduction of hunger itreally gets down to the set
point right.
Dr. Weiner (05:53):
These medications cause your set point to go up.
Glp-1 medications, bariatricsurgery, nutritional change,
building muscle cause your setpoint to go down.
These medications cause yourset point to go up, and so once
that set point goes up, if yourweight's at 200 and your set
point is going up to 210 or 220,your weight's going to follow.
You're almost powerless toprevent that, and so I think
(06:17):
that's what we're seeing withthese medications, and I think
this really speaks to the ideathat treating obesity
effectively, getting long-term,durable weight loss, requires a
very comprehensive approach.
It's not just a here's our dietor let's do surgery.
We have to look at this.
I just saw a patient todaywho'd been on a medication for a
(06:39):
long time and I was like youknow, this med causes weight
gain, and he was like no idea,had no idea, and we tracked it
back and he had gained asignificant amount of weight
since starting that medication.
Zoe (06:52):
And how frustrating, too, to feel like you don't why am I
gaining this weight?
And to not have that answer.
Wow.
Dr. Weiner (06:59):
Yeah.
So I can't tell you how manytimes I've kind of found that
where someone comes in and it'slike they're like I don't know
why I'm gaining weight and I'mlike, oh, it's the medicine
you're on, and they're like what?
Yeah, like, yeah, it's reallyit's.
It's kind of earth shatteringand I think this really speaks
to this.
And so an important messagehere is don't stop this med if
(07:21):
you're taking it, because firstof all especially something like
Paxil you can't just stop Paxil.
You've got to wean off of itand that medicine particularly
can be very difficult to comeoff of.
You have to work with yourpsychiatrist or the prescribing
physician.
Don't take this, as you shouldstop this medicine if you're
trying to lose weight.
(07:41):
Take this as.
Go back to your prescribingphysician, have a conversation
and discuss alternativetreatments which may be more
weight neutral, particularly ifyou're not getting a lot of
benefit of the med.
Zoe (07:52):
Right.
Dr. Weiner (07:52):
And a lot of times we're like you come in for your
five minute appointment andhere's your prescription on your
way and then you take that medfor the next four years.
Zoe (07:59):
Yeah.
Dr. Weiner (07:59):
I mean, that's pretty common.
Zoe (08:00):
You know, what got my gears turning is we see all of this
new emerging research about howthe glp1s are having a benefit
with depression and these othermental health conditions.
So it's it's almost like Iwonder if somebody who is
struggling with weight gain fromtheir, their mental health
medications, the ozempic likewould it?
(08:22):
I, you know it might help withthe weight loss and them I don't
know.
Dr. Weiner (08:25):
It's kind of we're not there yet but, we're gonna
be.
Yeah, that's exactly.
I think you're exactly rightthat we're going to start
looking at glp1s potentially asa first-line agent for
depression, particularly inpeople who would also like to
lose a little bit of weight.
Right, the problem is, too alot of people's mood is linked
to their weight that's true, andthat food noise at a constant
preoccupation.
So you know, if we can start tohelp people with weight loss and
(08:48):
quieting the food noise andimproving your mood, that's
going to be a lot moreattractive to most people than
an SSRI.
Totally so I think we're.
You know, there was a saying Ilearned very early in medical
school, which is that newphysicians have 10 different
drugs for each problem andexperienced physicians have one
(09:11):
drug for 10 different problems,and I think I've learned that,
like you.
Just kind of start to learnover the years.
Hey, this drug works, thisdrug's kind of crap Like
metformin, yeah.
Zoe (09:22):
Yeah.
Dr. Weiner (09:22):
Doesn't really do much.
I've never really seen thatwork for pretty much anything.
So you just kind of learn overthe years like hey, some meds
are worth it and some are not.
Zoe (09:32):
Yeah, and this might be one of those that becomes one of
those.
Dr. Weiner (09:36):
I think we're seeing that for sure.
Glp-1 is the one med for 10different problems, For sure.
So what do we have for ournutrition segment today?
Zoe?
Zoe (09:44):
Well, I wanted to talk about what to do when you're
experiencing a weight lossplateau, partly because I think
it's somewhat related to whatwe're talking about today, but
also because I have a lot ofpeople who struggle with this
and we have a support group forit breaking through plateaus.
So you know you definitely joinin on that.
(10:05):
For it breaking throughplateaus.
So you know you definitely joinin on that.
But for today, I wanted to havethe focus mostly when you're on
your weight loss journey, whenyou're having that medical tool
to help, right, the GLP-1 orsurgery.
Now, first off, we have tounderstand that a weight loss
plateau is not, if it's going tohappen, it's when it's going to
happen.
(10:25):
Right, and as we like to talkabout, no journey is completely
linear.
Whether you're on a weight lossjourney, a career journey, you
know, anything in life it'syou're going to have those ups
and those downs and thoseplateaus, just like this
beautiful painting that yourwife just hung up in our in our
conference room.
You guys can't see it, but itbut a continuation of the
(10:46):
beautiful Tucson mountains.
That is representative of aweight loss journey.
But the reality is is that it'snot going to be perfectly linear
.
You're not going to lose thesame amount of weight every
single week.
It's going to go up, it's goingto go down, it's going to stay
the same.
What we do not want to do issomething super extreme, right?
I hear so many people talkabout well, I want to reset my
(11:08):
pouch.
So the idea of going back toonly drinking protein shakes,
like immediately after surgery,and that's not what we want to
do.
First off, I always like I'mtalking with my hands a lot, as
you know.
Dr. Weiner (11:22):
I do too.
I keep hitting the mic.
Zoe (11:25):
So I always like to visualize like bring yourself
out of the like zoom out lookobjectively about what's going
on.
Where can you honestly make someroom for improvement, right,
and it's not.
I don't want to take theapproach of what do I need to
take away?
What do I need to restrict?
What do I need to restrict,what do I need to cut back on?
(11:47):
It's always what can we add?
Can we add more steps?
Can we add more veggies?
Can we add more protein?
And if you're like, oh, zoe,I'm doing everything right, I
don't know what to do, well,taking maybe a food log actually
, and creating some awarenessthrough that can be very
beneficial.
But if we're thinking aboutwhether it's surgery or meds,
(12:10):
there is that opportunity toexplore if we need to tweak that
tool a little bit.
So do you want to talk a littlebit about what you see with
some of these plateaus and what?
Dr. Weiner (12:20):
you might do medically.
Yeah, I mean, I think, first ofall, you're dead on, Like it's
when it's going to happen, notif it's going to happen.
And I think, first of all,you're dead on, like it's when
it's going to happen, not ifit's going to happen.
And you and I think and I wantyour opinion on this in a second
is this idea of how often youweigh yourself and I think you
know like, and I think thatchanges too from like right when
you start the med or rightafter surgery to you know months
(12:40):
later.
But the GLP-1s, the kind ofstandard FDA recommendations,
are like month one, 2.5, monthtwo, 5, and this kind of very
aggressive increase of the doseand especially with the
shortages, we saw people jumpingaround quite a bit with this.
I've never quite subscribed tothat theory and I think over
(13:02):
time we'll recognize that thatactually causes more side
effects to that theory.
And I think over time we'llrecognize that that actually
causes more side effects,probably doesn't cause more
weight loss and I think as westart to see the self-pay market
and the cost of these meds kindof be directly linked to the
dose, not the injector pen,which is how they're linked now,
which is how many times youtake it.
That's what the cost comes frominstead of the amount of
(13:23):
medicine you take.
I think over time we'll start tosee some opportunity for people
to, at lower doses pay lessthan at higher doses.
And if that's the case and weactually have a lot of patients
in our practice or dosingstrategies.
They pay less when the dose isless.
So I think that there's a lotof value in keeping the dose low
(13:43):
, which means you're going tohit those plateaus, and that's
okay.
It kind of allows you to, like,fully explore that dose, get
everything you can out of it,make sure you've plateaued and
really focus on the nutritionand it and it, and it really
emphasizes the importance ofjust nutrition and the
medication together.
Yeah, um, and then we go up onthe dose, right and, and this
(14:06):
kind of slow, progressive we'vetalked about you're going to be
on this for a long time.
We're not in a rush to get tothe highest dose.
It doesn't necessarily makethings better, and the worst
thing that can happen is youhave pancreatitis or some
terrible side effect and we haveto stop the med.
That's the real risk here, andso we want to prevent that by
keeping the dose low.
Zoe (14:27):
Well, and if someone's seeing results at a lower dose,
that's the whole point of havingindividualized strategies and
care, because if you're losingweight on 2.5 and your neighbor
is losing weight at five, thatdoesn't mean you have to go up.
If your body is responding wellto that lower dose, milk it for
(14:48):
everything you can.
Dr. Weiner (14:49):
Absolutely, absolutely.
So talk to us about weighingyourself.
Zoe (14:52):
Oh yeah, Great, great, great.
Segue.
So I there are very few peoplethat I recommend weigh
themselves every day.
Dr. Weiner (15:02):
Yeah.
And the people who I tell yourpatients well, yeah, yeah.
Zoe (15:05):
And the people who I tell your patients well, yeah, but
specifically in terms of weightloss, people who can view that
number on the scale strictly asdata.
Very few people can Again,removing yourself emotionally
from the situation, looking atthis as objective, logical data
that you can track and look attrend over time.
Because we know that, thosedaily fluctuations.
(15:27):
I literally had somebody comein for the weigh-in and
accountability group today whereshe's like, oh, yesterday I was
two pounds lighter.
I was like I promise that thosetwo pounds of weight on the
scale were not two pounds ofbody fat that you just gained
overnight.
There are so many things outsideof our control playing into
(15:48):
that daily fluctuation number onthe scale that most people
drive themselves insane, right,you have this obsessive
relationship.
So, unless you can strictlyview it as data, take your
average for the week and trackthat trend over time.
Don't weigh yourself every day,I'd say once a week.
I have plenty of patients whoare very is impacted emotionally
(16:12):
by that number on the scale andit becomes very triggering.
And so for those patients, manyof them have had their husband
hide the scale and guess what?
There are so many other waysthat we can measure progress
that do not have to be sotraumatic.
Dr. Weiner (16:27):
Totally.
Yeah, I think, kind of just asa follow-up to what you said,
the more a bad number on thescale ruins your day, ruins your
mood, kind of puts you in a badheadspace, the less often you
should weigh yourself, and Ithink that's another way of kind
of stating what you exactlysaid, which is how much it
impacts you.
Zoe (16:47):
Just shorter.
Dr. Weiner (16:48):
Yeah, all right, that's a surprise for me to say
something short.
I usually find the long way tosay it.
Zoe (16:56):
So what do we have for economics of obesity?
Dr. Weiner (16:59):
So this is interesting and to me, kind of a
little bit of a heartbreakingdiscussion.
So obesity is a socioeconomicdisease, which means that,
depending on your socioeconomicstanding in life, you are more
or less likely to developobesity, and so that's been
borne out in a bunch ofdifferent studies.
But I'm just going to talk alittle bit about one that I saw.
(17:20):
It's about childhood obesity,which we don't talk about.
We actually don't treatchildhood obesity in our
practice, but anyway, I thinkthere's a lot that can be drawn
from this.
So this is a study in Germany,in rural Germany, and, like the
US, there's areas in Germanywhere there's a lot of money and
there's areas in Germany wherethere's not a lot of money, and
so this was in more of a ruralarea, less money, and so they
(17:42):
looked at high school age kidsin rural Germany.
They also looked at middleschool kids and what they found
were 76% were normal weight, 11%had pre-obesity and 10% had
obesity, and the last little 3%were underweight.
There was no difference betweenboys and girls.
The older kids, the high schoolage kids, had a higher rate of
(18:03):
obesity compared to the middleschool kids.
That's not surprising.
What I think?
First, the first kind of tragicpiece of this is that 39% of the
children or adolescents withobesity had mental health
problems that were requiringactual treatment in therapy on
medication.
So 39%, that's a lot.
You know, I don't know thatmuch about child psychiatry, but
(18:26):
actually my guess would be, inthe US, that might be the number
of kids, if not more, who arecurrently being treated more,
who are, yeah, who are, who arecurrently, you know, being
treated.
So when they they then lookedat these kids and looked at they
, put the, stratified them into,you know, the coming from a
family of lower income, middleincome or upper income.
So if we look at the obesityrate for the normal weight kids,
(18:49):
29% of the normal weight kidscame from lower income.
If we looked at the kids withobesity, 38% came from lower
income.
If we looked at the kids withobesity, 38% came from lower
income.
So if you're lower income,you're more likely to suffer
from obesity and, interestingly,there were no children in the
high income bracket categorizedas obese.
None, none, wow it wasn't a hugestudy, but still.
Zoe (19:13):
Yeah, yeah, you know.
I mean, I don't know the exactnumber but it wasn't five.
Dr. Weiner (19:15):
still, you know.
I mean it was I don't know theexact number, but it was.
It wasn't five kids, you know,it was 60, 70, 80 kids, so there
wasn't a single kid from thehigh income bracket who had
obesity.
And so they they talked withkids who had obesity.
They were much more likely tohave psychological stress.
A lot of their stress wasrelated to their weight, and,
and so I think there's twothings to talk about with this.
(19:36):
I think the first is this ideaof food deserts, and I don't
know about the German foodsupply, but I know in the US
there are certain neighborhoodswhere you can't get fruits and
vegetables.
What do you know about this?
I mean, what do you know aboutfood deserts?
And you must have studied someof that in your certainly yeah,
in your training, what's goingon, what's being done for them.
(19:57):
You know how do you, how do youmanage people who are living in
food deserts?
Zoe (20:00):
right, well, yeah, let's just kind of, like you said,
define food deserts, and I thinkwe see a lot of food deserts in
arizona yeah um, just becauseof the rural nature absolutely
and so.
So it's the lack of, not lackof of access to food, lack of
access to nutrient-dense freshwhole, nutritious foods.
(20:22):
And so in these cases we reallywant to capitalize on what is
available.
Can we stock up on frozenvegetables and fruit?
What about canned?
Maybe making a monthly trip towhere there is maybe some more
accessibility or, you know,working with some of those
(20:43):
community partners such as thepowwow or the market on the move
, those sorts of things, youknow.
I think it really does boildown to trying to strategize and
making the best choices you canin those certain situations and
then also doing a lot of yourown prep work and freezing it
and that kind of thing whichtakes time and energy and and
(21:04):
you know a lot, a lot of fooddeserts are in those lower
socioeconomic.
Dr. Weiner (21:09):
They're only in lower right.
You do not have food deserts inwealthy areas, true, true, you
just don't.
Absolutely, there's no question.
This is binary.
I challenge you to find a upperincome zip code that is a food
desert.
Yeah, they're only lower income, right.
Can you follow the metabolicreset diet in a food desert?
Zoe (21:29):
It's tough.
Dr. Weiner (21:30):
It's really hard.
Zoe (21:31):
Yeah, I've worked with a couple of people who live in
food deserts and we've tried ourbest to implement some of these
strategies right the cannedvegetables, the frozen, the bags
of beans, the dried beans.
So not ideal, definitely hardto do, canned tuna, fish, like
(21:53):
those sorts of things, but it'sjust, it's not nearly as you
know, easy to do, I think themetabolic reset diet.
Dr. Weiner (22:00):
It's not an impossible diet to follow by any
means.
I think a lot of people find itvery comfortable and easy to do
, but it's not something thatjust comes without effort, right
, and so you know, to make iteven harder by not having access
to fresh fruits and vegetablesis tough.
Even harder by not havingaccess to fresh fruits and
vegetables is tough.
I think food deserts is kind ofthe first thing that makes me
(22:21):
worried, because I think fooddeserts increase this disparity
between an increase of frequencyof obesity in lower people from
lower socioeconomic classes.
I think we're actually going tosee this problem get much worse
before it gets better, and thereason is because, especially
with childhood obesity, glp-1meds are going to become the de
facto treatment for childhoodobesity.
There was this movement foradolescent bariatric surgery.
(22:43):
I was never into it.
I've never operated on anybodyunder 18.
I think it just doesn't quitefeel right for a lot of us.
Yeah, even 18, 19 year oldsdon't always feel right to me,
but anyway, I think there wasthis move.
That move has quieted downquite a bit with the success
(23:05):
rate of GLP-1s, but we knowthese meds go to the wealthier
zip codes, right?
I mean, when we look at ourpractice, who's on GLP-1 meds?
It tends to be the people ofupper income.
There's exceptions, of course,and there are insurance plans
and some people who can get onthem, but if you look at the
average out-of-pocket cost, it's$100, $200, sometimes $400,
(23:25):
$500 a month.
It's real money and it's anamount that a lot of families
can't afford.
And so I think my concern isthat we're going to see that
again.
Kids in the upper incomebracket are being treated and
are, you know, don't have to gothrough through childhood
obesity.
Kids in the lower incomebracket aren't going to have
access to these meds and aregoing to suffer, and I think
(23:47):
that's really unfortunate and Idon't know what the solution is.
But, but, but, yeah, I thinkthat's, that's something, that
that something that we're goingto see more of.
Yeah, so that was a cheeryeconomic and obesity segment.
Zoe (24:01):
Right, yeah, I was going to try to say something, but I
don't know what to say.
Dr. Weiner (24:05):
I don't know that there is much to say, but I
think it's important that whenyou do see someone who's
overweight and I think we'repreaching to the choir here with
this podcast but we understandthat it's a complex disease,
right, it's caused by psych meds, it's caused by socioeconomic
status, and that you can'tnecessarily look at someone and
say, oh, this person just can'tget control, they're eating and
(24:28):
doesn't really respectthemselves and that's why
they're overweight.
It's a complicated disease.
Zoe (24:32):
Yeah, so much deeper than that, absolutely.
Dr. Weiner (24:35):
All right.
Well, I think this was ourgreat first shortened episode.
Yes, we'd like to thank Benfrom Bloom House Media for his
camera work and his editing, andwe will see you next time.
Bilify, geodon, clozapine, olanzapine, lithium,
seroquel, risperidone.
These are stronger medicationsusually used more for bipolar
disease, but are also used nowI'm seeing them being used for
depression.
These things cause 10%, 15%.
I mean I've seen 50, 60, 70pounds of weight gain from these
(00:20):
meds, from these meds.
Zoe (00:25):
Welcome back to the Pound of Cure.
Weight Loss Podcast, episode 38, a dose of dilemma.
Dr. Weiner (00:36):
which antidepressants cause the most
weight gain?
Yeah, I mean we've talked aboutthis a lot, yeah, yeah, so
we're doing something a littledifferent.
Zoe (00:40):
I know it's exciting.
Dr. Weiner (00:41):
We're shortening up these episodes.
Deidre, who's been on the show,she is quite a commute, she
lives a little bit, you know,outside of Tucson and she said
she came in one day and she saidmy drive is 45 minutes and I
couldn't finish your podcastepisode.
It's too long, you have toshorten it.
And about eight other peoplealso told us our podcasts were
(01:02):
too long.
And we get it.
We both talk a lot, so there'sa lot to say.
Zoe (01:06):
There's a lot of nuance we need to discuss.
Dr. Weiner (01:08):
Yeah, I mean, we have a lot to say about this and
it's an interesting topic toboth of us for sure.
So, anyway, we're shorteningthese things up and we're going
to kind of break it up.
This is going to be really justkind of the segments are in of
obesity, and we'll have thepatient stories a separate
episode and we'll bring moreexperts in, which I think is
(01:29):
going to allow us to have someinteresting conversations, and
then we're going to take the Q&Aand that's going to be another
episode.
So that'll mix things up andwe'll adjust the dose.
We'll adjust the rate of releaseand let us know what you think
about this.
Please comment if you thinkit's a better way of doing it,
if maybe you want two hourepisodes.
Zoe (01:50):
I've heard one person tell us that I wish your episodes
were longer, because she takesher baby out for a walk in the
stroller and that's her time tolisten to us.
Dr. Weiner (01:59):
So okay, well, so you can do multiple.
Yeah, now you get to be.
Zoe (02:01):
Cue them up.
All right.
So what do we have for in thenews?
Dr. Weiner (02:06):
So this is a New York Times article.
The name of the article is theNew Study Shows which
Antidepressants May Cause theMost Weight Gain.
We've been talking about this,you know.
I've been talking about thisfor probably a decade about the
weight gaining effect ofmedications, and I was really
happy to see it make it into thepopular press and I think we're
finally starting to.
You know, with the GLP-1s andthe popularity, people are
(02:29):
starting to look at obesity forwhat it is a metabolic disease.
And so when you're looking atthis as a metabolic disease,
obesity caused by weight-gainingmedications makes total sense.
So they looked at SSRIs.
So these are kind of, you know,the usual drugs that people are
prescribed as a first-lineagent for depression.
So they looked at Lexapro,which is also known as
isopalipram, paxil, cymbalta,effexor, these things we see,
(02:54):
you know, I'd say probably athird to even, you know, 40% of
my patients in the office are onone of these medications and I
would bet about 60, 70% of theUS population has taken one of
these medications and I wouldbet about 60, 70% of the US
population has taken one ofthese at one time.
And so what they found is thatand they looked at, I think
183,000 records.
So we have such a rich databasenow with all these EMRs and we
(03:16):
can say, okay, which drugs wereprescribed?
And let's look at the weightsfor the six months after.
And that's exactly what theydid.
They found that by beingprescribed Lexapro, paxil,
cymbalta or Effexor, you had amuch higher chance of gaining 5%
or more of your weight.
Zoe (03:32):
So that's a lot.
Yeah, that's real weight gain.
Dr. Weiner (03:36):
And Zoloft and Welbutrin.
Zoloft is also Sertraline, andWelbutrin caused less weight
gain but still cause weight gain, which is interesting because
Welbutrin is part of Contrave,which is a weight loss medicine,
but yet with Welbutrin alone westill saw weight gain in these
patients.
So here's the thing that theydidn't mention in the article,
(03:58):
but it's important.
These are the first line agents.
We're seeing more commonlypatients on these second line
agents.
These are things like Abilify,geodon, clozapine, olanzapine,
lithium, seroquel, risperidone.
These are stronger medications,usually use more for bipolar
disease but are also used nowI'm seeing them being used for
(04:20):
depression.
These things cause 10%, 15%.
I mean I've seen 50, 60, 70pounds of weight gain from these
meds and you know, when you'reworking with someone on
nutrition, it's like impossibleto get someone on one of these
meds to lose weight.
Right Like no matter what you do.
Zoe (04:34):
Yeah, I'm interested.
Do you know any more about,like the mechanism of action and
why it causes weight gain?
Dr. Weiner (04:39):
You know, I think we're starting to understand
GLP-1s work centrally and thesemeds also work centrally.
By centrally I mean on yourbrain, and so these meds work on
your brain and you know thebrain is such a complicated
organ and these are such bluntinstruments.
When we're giving thesemedications that modify the
(05:02):
receptors in the brain and theneurotransmitters, we're just
opening up Pandora's box to somedegree, right, I mean, it's
really very blunt.
This is at some point we'lllook.
People will look back on thesemedications the way we might
look back on like medieval times, weapons and chivalry and
knights and spears and joustingas like warfare, you know, like
(05:23):
it's just so.
It's just so much lesssophisticated than the way the
brain works and I don't knowthat we know the exact, exact
mechanism of action.
They're probably, it's probablyknown.
I can say I don't know theexact mechanism I hear it's.
Zoe (05:37):
You know, hunger just that, that insatiable hunger, just
like with the, as you're saying,with the GLP-1s, like well,
that makes the hunger go away.
And so if this is workingcentrally, you know just that,
that overproduction of hunger itreally gets down to the set
point right.
Dr. Weiner (05:53):
These medications cause your set point to go up.
Glp-1 medications, bariatricsurgery, nutritional change,
building muscle cause your setpoint to go down.
These medications cause yourset point to go up, and so once
that set point goes up, if yourweight's at 200 and your set
point is going up to 210 or 220,your weight's going to follow.
You're almost powerless toprevent that, and so I think
(06:17):
that's what we're seeing withthese medications, and I think
this really speaks to the ideathat treating obesity
effectively, getting long-term,durable weight loss, requires a
very comprehensive approach.
It's not just a here's our dietor let's do surgery.
We have to look at this.
I just saw a patient todaywho'd been on a medication for a
(06:39):
long time and I was like youknow, this med causes weight
gain, and he was like no idea,had no idea, and we tracked it
back and he had gained asignificant amount of weight
since starting that medication.
Zoe (06:52):
And how frustrating, too, to feel like you don't why am I
gaining this weight?
And to not have that answer.
Wow.
Dr. Weiner (06:59):
Yeah.
So I can't tell you how manytimes I've kind of found that
where someone comes in and it'slike they're like I don't know
why I'm gaining weight and I'mlike, oh, it's the medicine
you're on, and they're like what?
Yeah, like, yeah, it's reallyit's.
It's kind of earth shatteringand I think this really speaks
to this.
And so an important messagehere is don't stop this med if
(07:21):
you're taking it, because firstof all especially something like
Paxil you can't just stop Paxil.
You've got to wean off of itand that medicine particularly
can be very difficult to comeoff of.
You have to work with yourpsychiatrist or the prescribing
physician.
Don't take this, as you shouldstop this medicine if you're
trying to lose weight.
(07:41):
Take this as.
Go back to your prescribingphysician, have a conversation
and discuss alternativetreatments which may be more
weight neutral, particularly ifyou're not getting a lot of
benefit of the med.
Zoe (07:52):
Right.
Dr. Weiner (07:52):
And a lot of times we're like you come in for your
five minute appointment andhere's your prescription on your
way and then you take that medfor the next four years.
Zoe (07:59):
Yeah.
Dr. Weiner (07:59):
I mean, that's pretty common.
Zoe (08:00):
You know, what got my gears turning is we see all of this
new emerging research about howthe glp1s are having a benefit
with depression and these othermental health conditions.
So it's it's almost like Iwonder if somebody who is
struggling with weight gain fromtheir, their mental health
medications, the ozempic likewould it?
(08:22):
I, you know it might help withthe weight loss and them I don't
know.
Dr. Weiner (08:25):
It's kind of we're not there yet but, we're gonna
be.
Yeah, that's exactly.
I think you're exactly rightthat we're going to start
looking at glp1s potentially asa first-line agent for
depression, particularly inpeople who would also like to
lose a little bit of weight.
Right, the problem is, too alot of people's mood is linked
to their weight that's true, andthat food noise at a constant
preoccupation.
So you know, if we can start tohelp people with weight loss and
(08:48):
quieting the food noise andimproving your mood, that's
going to be a lot moreattractive to most people than
an SSRI.
Totally so I think we're.
You know, there was a saying Ilearned very early in medical
school, which is that newphysicians have 10 different
drugs for each problem andexperienced physicians have one
(09:11):
drug for 10 different problems,and I think I've learned that,
like you.
Just kind of start to learnover the years.
Hey, this drug works, thisdrug's kind of crap Like
metformin, yeah.
Zoe (09:22):
Yeah.
Dr. Weiner (09:22):
Doesn't really do much.
I've never really seen thatwork for pretty much anything.
So you just kind of learn overthe years like hey, some meds
are worth it and some are not.
Zoe (09:32):
Yeah, and this might be one of those that becomes one of
those.
Dr. Weiner (09:36):
I think we're seeing that for sure.
Glp-1 is the one med for 10different problems, For sure.
So what do we have for ournutrition segment today?
Zoe?
Zoe (09:44):
Well, I wanted to talk about what to do when you're
experiencing a weight lossplateau, partly because I think
it's somewhat related to whatwe're talking about today, but
also because I have a lot ofpeople who struggle with this
and we have a support group forit breaking through plateaus.
So you know you definitely joinin on that.
(10:05):
For it breaking throughplateaus.
So you know you definitely joinin on that.
But for today, I wanted to havethe focus mostly when you're on
your weight loss journey, whenyou're having that medical tool
to help, right, the GLP-1 orsurgery.
Now, first off, we have tounderstand that a weight loss
plateau is not, if it's going tohappen, it's when it's going to
happen.
(10:25):
Right, and as we like to talkabout, no journey is completely
linear.
Whether you're on a weight lossjourney, a career journey, you
know, anything in life it'syou're going to have those ups
and those downs and thoseplateaus, just like this
beautiful painting that yourwife just hung up in our in our
conference room.
You guys can't see it, but itbut a continuation of the
(10:46):
beautiful Tucson mountains.
That is representative of aweight loss journey.
But the reality is is that it'snot going to be perfectly linear
.
You're not going to lose thesame amount of weight every
single week.
It's going to go up, it's goingto go down, it's going to stay
the same.
What we do not want to do issomething super extreme, right?
I hear so many people talkabout well, I want to reset my
(11:08):
pouch.
So the idea of going back toonly drinking protein shakes,
like immediately after surgery,and that's not what we want to
do.
First off, I always like I'mtalking with my hands a lot, as
you know.
Dr. Weiner (11:22):
I do too.
I keep hitting the mic.
Zoe (11:25):
So I always like to visualize like bring yourself
out of the like zoom out lookobjectively about what's going
on.
Where can you honestly make someroom for improvement, right,
and it's not.
I don't want to take theapproach of what do I need to
take away?
What do I need to restrict?
What do I need to restrict,what do I need to cut back on?
(11:47):
It's always what can we add?
Can we add more steps?
Can we add more veggies?
Can we add more protein?
And if you're like, oh, zoe,I'm doing everything right, I
don't know what to do, well,taking maybe a food log actually
, and creating some awarenessthrough that can be very
beneficial.
But if we're thinking aboutwhether it's surgery or meds,
(12:10):
there is that opportunity toexplore if we need to tweak that
tool a little bit.
So do you want to talk a littlebit about what you see with
some of these plateaus and what?
Dr. Weiner (12:20):
you might do medically.
Yeah, I mean, I think, first ofall, you're dead on, Like it's
when it's going to happen, notif it's going to happen.
And I think, first of all,you're dead on, like it's when
it's going to happen, not ifit's going to happen.
And you and I think and I wantyour opinion on this in a second
is this idea of how often youweigh yourself and I think you
know like, and I think thatchanges too from like right when
you start the med or rightafter surgery to you know months
(12:40):
later.
But the GLP-1s, the kind ofstandard FDA recommendations,
are like month one, 2.5, monthtwo, 5, and this kind of very
aggressive increase of the doseand especially with the
shortages, we saw people jumpingaround quite a bit with this.
I've never quite subscribed tothat theory and I think over
(13:02):
time we'll recognize that thatactually causes more side
effects to that theory.
And I think over time we'llrecognize that that actually
causes more side effects,probably doesn't cause more
weight loss and I think as westart to see the self-pay market
and the cost of these meds kindof be directly linked to the
dose, not the injector pen,which is how they're linked now,
which is how many times youtake it.
That's what the cost comes frominstead of the amount of
(13:23):
medicine you take.
I think over time we'll start tosee some opportunity for people
to, at lower doses pay lessthan at higher doses.
And if that's the case and weactually have a lot of patients
in our practice or dosingstrategies.
They pay less when the dose isless.
So I think that there's a lotof value in keeping the dose low
(13:43):
, which means you're going tohit those plateaus, and that's
okay.
It kind of allows you to, like,fully explore that dose, get
everything you can out of it,make sure you've plateaued and
really focus on the nutritionand it and it, and it really
emphasizes the importance ofjust nutrition and the
medication together.
Yeah, um, and then we go up onthe dose, right and, and this
(14:06):
kind of slow, progressive we'vetalked about you're going to be
on this for a long time.
We're not in a rush to get tothe highest dose.
It doesn't necessarily makethings better, and the worst
thing that can happen is youhave pancreatitis or some
terrible side effect and we haveto stop the med.
That's the real risk here, andso we want to prevent that by
keeping the dose low.
Zoe (14:27):
Well, and if someone's seeing results at a lower dose,
that's the whole point of havingindividualized strategies and
care, because if you're losingweight on 2.5 and your neighbor
is losing weight at five, thatdoesn't mean you have to go up.
If your body is responding wellto that lower dose, milk it for
(14:48):
everything you can.
Dr. Weiner (14:49):
Absolutely, absolutely.
So talk to us about weighingyourself.
Zoe (14:52):
Oh yeah, Great, great, great.
Segue.
So I there are very few peoplethat I recommend weigh
themselves every day.
Dr. Weiner (15:02):
Yeah.
And the people who I tell yourpatients well, yeah, yeah.
Zoe (15:05):
And the people who I tell your patients well, yeah, but
specifically in terms of weightloss, people who can view that
number on the scale strictly asdata.
Very few people can Again,removing yourself emotionally
from the situation, looking atthis as objective, logical data
that you can track and look attrend over time.
Because we know that, thosedaily fluctuations.
(15:27):
I literally had somebody comein for the weigh-in and
accountability group today whereshe's like, oh, yesterday I was
two pounds lighter.
I was like I promise that thosetwo pounds of weight on the
scale were not two pounds ofbody fat that you just gained
overnight.
There are so many things outsideof our control playing into
(15:48):
that daily fluctuation number onthe scale that most people
drive themselves insane, right,you have this obsessive
relationship.
So, unless you can strictlyview it as data, take your
average for the week and trackthat trend over time.
Don't weigh yourself every day,I'd say once a week.
I have plenty of patients whoare very is impacted emotionally
(16:12):
by that number on the scale andit becomes very triggering.
And so for those patients, manyof them have had their husband
hide the scale and guess what?
There are so many other waysthat we can measure progress
that do not have to be sotraumatic.
Dr. Weiner (16:27):
Totally.
Yeah, I think, kind of just asa follow-up to what you said,
the more a bad number on thescale ruins your day, ruins your
mood, kind of puts you in a badheadspace, the less often you
should weigh yourself, and Ithink that's another way of kind
of stating what you exactlysaid, which is how much it
impacts you.
Zoe (16:47):
Just shorter.
Dr. Weiner (16:48):
Yeah, all right, that's a surprise for me to say
something short.
I usually find the long way tosay it.
Zoe (16:56):
So what do we have for economics of obesity?
Dr. Weiner (16:59):
So this is interesting and to me, kind of a
little bit of a heartbreakingdiscussion.
So obesity is a socioeconomicdisease, which means that,
depending on your socioeconomicstanding in life, you are more
or less likely to developobesity, and so that's been
borne out in a bunch ofdifferent studies.
But I'm just going to talk alittle bit about one that I saw.
(17:20):
It's about childhood obesity,which we don't talk about.
We actually don't treatchildhood obesity in our
practice, but anyway, I thinkthere's a lot that can be drawn
from this.
So this is a study in Germany,in rural Germany, and, like the
US, there's areas in Germanywhere there's a lot of money and
there's areas in Germany wherethere's not a lot of money, and
so this was in more of a ruralarea, less money, and so they
(17:42):
looked at high school age kidsin rural Germany.
They also looked at middleschool kids and what they found
were 76% were normal weight, 11%had pre-obesity and 10% had
obesity, and the last little 3%were underweight.
There was no difference betweenboys and girls.
The older kids, the high schoolage kids, had a higher rate of
(18:03):
obesity compared to the middleschool kids.
That's not surprising.
What I think?
First, the first kind of tragicpiece of this is that 39% of the
children or adolescents withobesity had mental health
problems that were requiringactual treatment in therapy on
medication.
So 39%, that's a lot.
You know, I don't know thatmuch about child psychiatry, but
(18:26):
actually my guess would be, inthe US, that might be the number
of kids, if not more, who arecurrently being treated more,
who are, yeah, who are, who arecurrently, you know, being
treated.
So when they they then lookedat these kids and looked at they
, put the, stratified them into,you know, the coming from a
family of lower income, middleincome or upper income.
So if we look at the obesityrate for the normal weight kids,
(18:49):
29% of the normal weight kidscame from lower income.
If we looked at the kids withobesity, 38% came from lower
income.
If we looked at the kids withobesity, 38% came from lower
income.
So if you're lower income,you're more likely to suffer
from obesity and, interestingly,there were no children in the
high income bracket categorizedas obese.
None, none, wow it wasn't a hugestudy, but still.
Zoe (19:13):
Yeah, yeah, you know.
I mean, I don't know the exactnumber but it wasn't five.
Dr. Weiner (19:15):
still, you know.
I mean it was I don't know theexact number, but it was.
It wasn't five kids, you know,it was 60, 70, 80 kids, so there
wasn't a single kid from thehigh income bracket who had
obesity.
And so they they talked withkids who had obesity.
They were much more likely tohave psychological stress.
A lot of their stress wasrelated to their weight, and,
and so I think there's twothings to talk about with this.
(19:36):
I think the first is this ideaof food deserts, and I don't
know about the German foodsupply, but I know in the US
there are certain neighborhoodswhere you can't get fruits and
vegetables.
What do you know about this?
I mean, what do you know aboutfood deserts?
And you must have studied someof that in your certainly yeah,
in your training, what's goingon, what's being done for them.
(19:57):
You know how do you, how do youmanage people who are living in
food deserts?
Zoe (20:00):
right, well, yeah, let's just kind of, like you said,
define food deserts, and I thinkwe see a lot of food deserts in
arizona yeah um, just becauseof the rural nature absolutely
and so.
So it's the lack of, not lackof of access to food, lack of
access to nutrient-dense freshwhole, nutritious foods.
(20:22):
And so in these cases we reallywant to capitalize on what is
available.
Can we stock up on frozenvegetables and fruit?
What about canned?
Maybe making a monthly trip towhere there is maybe some more
accessibility or, you know,working with some of those
(20:43):
community partners such as thepowwow or the market on the move
, those sorts of things, youknow.
I think it really does boildown to trying to strategize and
making the best choices you canin those certain situations and
then also doing a lot of yourown prep work and freezing it
and that kind of thing whichtakes time and energy and and
(21:04):
you know a lot, a lot of fooddeserts are in those lower
socioeconomic.
Dr. Weiner (21:09):
They're only in lower right.
You do not have food deserts inwealthy areas, true, true, you
just don't.
Absolutely, there's no question.
This is binary.
I challenge you to find a upperincome zip code that is a food
desert.
Yeah, they're only lower income, right.
Can you follow the metabolicreset diet in a food desert?
Zoe (21:29):
It's tough.
Dr. Weiner (21:30):
It's really hard.
Zoe (21:31):
Yeah, I've worked with a couple of people who live in
food deserts and we've tried ourbest to implement some of these
strategies right the cannedvegetables, the frozen, the bags
of beans, the dried beans.
So not ideal, definitely hardto do, canned tuna, fish, like
(21:53):
those sorts of things, but it'sjust, it's not nearly as you
know, easy to do, I think themetabolic reset diet.
Dr. Weiner (22:00):
It's not an impossible diet to follow by any
means.
I think a lot of people find itvery comfortable and easy to do
, but it's not something thatjust comes without effort, right
, and so you know, to make iteven harder by not having access
to fresh fruits and vegetablesis tough.
Even harder by not havingaccess to fresh fruits and
vegetables is tough.
I think food deserts is kind ofthe first thing that makes me
(22:21):
worried, because I think fooddeserts increase this disparity
between an increase of frequencyof obesity in lower people from
lower socioeconomic classes.
I think we're actually going tosee this problem get much worse
before it gets better, and thereason is because, especially
with childhood obesity, glp-1meds are going to become the de
facto treatment for childhoodobesity.
There was this movement foradolescent bariatric surgery.
(22:43):
I was never into it.
I've never operated on anybodyunder 18.
I think it just doesn't quitefeel right for a lot of us.
Yeah, even 18, 19 year oldsdon't always feel right to me,
but anyway, I think there wasthis move.
That move has quieted downquite a bit with the success
(23:05):
rate of GLP-1s, but we knowthese meds go to the wealthier
zip codes, right?
I mean, when we look at ourpractice, who's on GLP-1 meds?
It tends to be the people ofupper income.
There's exceptions, of course,and there are insurance plans
and some people who can get onthem, but if you look at the
average out-of-pocket cost, it's$100, $200, sometimes $400,
(23:25):
$500 a month.
It's real money and it's anamount that a lot of families
can't afford.
And so I think my concern isthat we're going to see that
again.
Kids in the upper incomebracket are being treated and
are, you know, don't have to gothrough through childhood
obesity.
Kids in the lower incomebracket aren't going to have
access to these meds and aregoing to suffer, and I think
(23:47):
that's really unfortunate and Idon't know what the solution is.
But, but, but, yeah, I thinkthat's, that's something, that
that something that we're goingto see more of.
Yeah, so that was a cheeryeconomic and obesity segment.
Zoe (24:01):
Right, yeah, I was going to try to say something, but I
don't know what to say.
Dr. Weiner (24:05):
I don't know that there is much to say, but I
think it's important that whenyou do see someone who's
overweight and I think we'repreaching to the choir here with
this podcast but we understandthat it's a complex disease,
right, it's caused by psych meds, it's caused by socioeconomic
status, and that you can'tnecessarily look at someone and
say, oh, this person just can'tget control, they're eating and
(24:28):
doesn't really respectthemselves and that's why
they're overweight.
It's a complicated disease.
Zoe (24:32):
Yeah, so much deeper than that, absolutely.
Dr. Weiner (24:35):
All right.
Well, I think this was ourgreat first shortened episode.
Yes, we'd like to thank Benfrom Bloom House Media for his
camera work and his editing, andwe will see you next time.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!