February 12, 2025 • 44 mins
Unlock the mysteries of weight loss drugs with us, as we inform you about the groundbreaking GLP-1 medications transforming obesity treatment. Joined by Dr. Richard Kennedy, we explore how these diabetes drugs, like Ozempic, have taken center stage in the fight against obesity. From reducing cardiovascular risks to improving sugar metabolism, these injectables are more than just weight loss solutions—they're potential game-changers for health and wellness. Aussie Mike James adds a fitness perspective, while Kettle Hiding delves into the economic dimensions of this pharmaceutical trend.
We tackle the gritty details, discussing potential side effects and the critical need for medical supervision when using these medications. Discover why maintaining muscle mass is crucial and how weight training serves as a powerful ally in preserving it. We question the conventional reliance on BMI as the sole measure of obesity and advocate for a more nuanced assessment of body composition. Our conversation also touches on the controversial idea of micro-dosing these drugs, weighing the pros and cons with a cautious lens.
The broader implications of these medications stretch far beyond individual benefits, reaching into global health landscapes. We discuss the accessibility hurdles for low income people and less affluent nations and how the production of generics might offer solutions. With anecdotes and studies underlining the psychological and societal pressures of weight loss, we underscore the importance of lifestyle changes and a holistic approach to health. As we wrap up, we invite you, our listeners, to join this ongoing conversation, sharing your questions and insights as we navigate these complex issues together.
Through expert insights and personal anecdotes, we explore the interplay between medication, lifestyle changes, and societal attitudes towards obesity.
• Discussion on how GLP-1 medications work
• The dual benefit of managing blood sugar and promoting weight loss
• Importance of muscle preservation while using these drugs
• Cost barriers and insurance implications for accessing weight loss medications
• Societal views on the stigma of using weight loss drugs
• The necessity of medical supervision when using these prescriptions
• Long-term effects and sustainability of weight loss achieved through medication
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Richard Kennedy (00:05):
So these drugs?
Initially they were made forthe treatment of diabetes and
they're in a class we call GLP-1, which is a chemical inside the
body that when you stimulatethis, when you stimulate this,
(00:28):
it actually decreases therelease of sugar from different
parts of our body where it'sstored and helps with the
metabolism of sugar that'scoming into the body.
Incidentally, what they foundwhen they initially started
using these drugs, with Ozempicbeing the classic example is
that not only did it improvepeople's blood sugars, but also
(00:54):
they found that people who mightwork at greater risk for
cardiovascular disease events ieheart attack, things like that,
and strokes, non-fatal strokesthe incidence of those
occurrences in this patientpopulation decreased.
And as a side effect of this,they realized wow, many of these
(01:16):
patients were losing weight.
Aussie Mike James (01:24):
Hello and welcome.
In this episode of the WellnessMusketeers podcast, the
Musketeers explore the complexworld of weight loss drugs from
three unique perspectives.
Dr Richard Kennedy sharesinsights from his experience as
a physician working withpatients using these medications
(01:45):
.
Aussie Mike James discusses howthese drugs intersect with
fitness and long-term wellnessstrategies, while Kettle Hiding
provides an economist's view ofthe financial drivers behind the
obesity epidemic and financialimplications for individuals and
society of these new drugs.
Through personal stories,professional insights and
(02:08):
engaging conversation, the teamtackles key questions what do
weight loss drugs really offer?
Are they accessible andaffordable for all, and what do
they mean for the future ofhealth and wellness?
Whether you're consideringweight loss medications, curious
about their societal impact, orjust love a good discussion on
(02:29):
health and economics, thisepisode offers something for
everyone, and whether you'reseeking practical tips or
exploring big wellness topics,we're glad you're here.
We hope you enjoy today'sepisode.
Please like, share andsubscribe and let us know what
you think.
So let's get right into today'sepisode.
Please like, share andsubscribe and let us know what
you think.
So let's get right into today'sepisode.
Perhaps we could just startwith Dr Kennedy.
(02:50):
The common question, I guess,dr K, is what are these weight
loss drugs and how do theyactually work?
Dr. Richard Kennedy (02:58):
So these drugs are drugs made initially.
They were made for thetreatment of diabetes and
they're almost all of them areinjectable drugs and they're in
a class we call GLP-1, which isa chemical inside the body that
(03:19):
when you stimulate this, whenyou stimulate this, it actually
(03:52):
decreases the release of sugarfrom different parts of our body
.
Did it improve people's bloodsugars?
But also they found that peoplewho might work at greater risk
for cardiovascular diseaseevents ie heart attack, things
like that, and strokes,non-fatal strokes the incidence
of those occurrences in thispatient population decreased.
And as a side effect of thisthey realized wow, many of these
(04:16):
patients were losing weight andthat is where this class of
drugs has taken off to in thelast two to three years for sure
.
And now these drugs arespecifically being prescribed to
treat obesity, meaning a BMIgreater than 30.
(04:38):
And 30 to 35 BMI is what wecall overweight, a greater than
35 is morbid obesity.
And so what they found is bydecreasing the weight of people
(05:02):
again, you improve their healthby getting rid of their diabetes
, which is a major risk factorfor cardiovascular disease,
kidney disease, stroke, etc.
So that's sort of how thisstarted, and now it has become
one of the classic drugs,because it has been proven in
several studies that patientswho take these drugs lose much
(05:25):
more weight than doing lifestylechanges lifestyle modifications
and they maintain that weightloss better than if the person
did lifestyle modification, iediet and exercise.
Aussie Mike James (05:42):
Quick question on that, dr K.
Has there been any side effectsnausea and so forth?
Dr. Richard Kennedy (05:47):
I've heard yes, the most common side
effects are gastrointestinal, sonausea, upset stomach, vomiting
in extreme cases some diarrhea,all of that.
And that's why, when theyinitiate treatment with this in
anybody, they start at the verylower doses.
(06:07):
They continue it for a week tosee if the purpose.
Because, like any drug and it'simportant to understand there
is no drug that has ever beendeveloped, be it prescribed or
an over-the-counter, thatdoesn't have side effects, an
over-the-counter that doesn'thave side effects, and so not
everybody who's going to take itis going to have the side
effect.
But if they do many of the sideeffects, if the patient takes
(06:31):
it consistently enough, the sideeffects will become less
significant and even go away.
Dave Liss (06:39):
Are there issues with loss of muscle mass, strength
or issues affecting bone?
Dr. Richard Kennedy (06:45):
density.
Well, I don't know if it's notreally clear on this, but I
would say that muscle mass mightbe an issue.
And I would say that's atwo-pronged problem to me,
(07:10):
because sometimes when you givea person a drug that you tell
them it's going to help you loseweight, which means you're
going to burn calories, you'regoing to burn fat.
If you are not simultaneouslydoing some kind of workout
regimen, yeah, your muscle masswill decrease.
It's like anything else If youdon't use it, you will lose it.
Ketil Hviding (07:32):
Yeah, so we don't know whether this is worse when
you use the drug relatively.
Dr. Richard Kennedy (07:34):
to just weight loss in general.
I don't think so.
It's possible, but I don't.
Aussie Mike James (07:39):
Okay, that's an interesting perspective.
I know in the fitness industryand I've looked at the position
statements of groups like theAmerican College of Sports
Medicine, american Council ofExercise and the American Health
Clubs Association, whichrepresents the largest
industrial group, if you like,of health clubs throughout the
world.
They all have pretty similarposition statements, if you will
(08:03):
saying that.
One, that the use of them hasto be under medical supervision
and two, they really emphasizeweight training because of the
evidence of muscle loss and it's, I think, reading into that a
little bit more.
I think for a long time thestandard guideline was that you
lost it by one or two pounds aweek over a long term.
(08:23):
Hence you'd have a lot ofpeople drop out because they
couldn't keep that sort ofdiscipline up and they don't see
immediate results.
So I think the groups arerealizing that these drugs are
here to stay.
So you've got to work with thembecause they're not going to be
stopped, going down in usage oranything.
Weight training is an essentialpart of the fitness regimen and
I guess they're reallypromoting that to help the
(08:45):
decrease in muscle loss.
It's been evidence and thatmakes perfect sense.
Yeah, yeah, perfect sense.
I think that's one thing younotice visually from people who
you've seen on it that there'ssort of a look, if you will,
that makes it look like they'velost muscle weight.
Dave Liss (09:00):
Are there different considerations for someone
starting a weight lossmedication like this if they're
a younger person, a middle-agedperson or an older person?
Like what kind of what doessarcopenia?
Is that a relevant drug?
Is that you have an in-depthdiscussion?
Dr. Richard Kennedy (09:27):
with your provider who's going to
prescribe it.
One, the benefits of taking thedrug.
Two, the problems that youmight have taking the drug.
Three, how this drug may affectyour overall wellness in life,
because all drugs have an effect.
So you know, drugs are like nodifferent than exercise, diet,
(09:51):
rest, sleep.
It is part of the formula for aperson becoming healthy.
Ketil Hviding (09:58):
So you know you mentioned overweight, so I am
just overweight a little bit.
Would that be okay to startwith the drug, maybe microdosing
it?
Dr. Richard Kennedy (10:09):
I would probably at least for me, I
probably would then overweight,because to me I think that
there's to me it's the conflictof what we use as the measure of
obesity.
The PMI is essentiallymeasuring your body weight and
your height.
It does not take into accountyour fat, and what we always see
(10:32):
is that you technically couldtake any.
In the United States, anyfootball player.
Ketil Hviding (10:38):
Yes.
Dr. Richard Kennedy (10:39):
Football player, many basketball players.
Basically, by default, they areoverweight and, in some,
morbidly obese, except for thefact that when you look at their
muscle mass compared to theirbody fat content, it's very
(10:59):
different than ever.
So we have to now.
That's because it's hard to youknow.
It's not difficult to measurebody fat.
It takes some effort to do it.
There's some simple tools thatwe can use to measure body fat,
and so all I have to say I havea discussion with your doctor.
(11:21):
I wouldn't with your doctor,knowing as active as you are,
that it would be fool's gold tobe putting you on a medicine to
make you lose 10 pounds.
Ketil Hviding (11:36):
I want to look fitter.
I want to have those six-packs.
Dr. Richard Kennedy (11:40):
Yeah, but being on those medicines is not
going to give you a six-pack.
Ketil Hviding (11:50):
But I can also work out a little bit.
Aussie Mike James (11:51):
I have dave and kia they can kind of, uh,
put me on a strict regimen.
Ketil Hviding (11:53):
Yeah six packs for sure, yeah, and then I get
some fat off.
Dr. Richard Kennedy (11:59):
Then I go yeah, I'm joking, I mean for the
term anything is okay, as theysay, everything in moderation is
okay.
It's the extremes that get usinto trouble.
Ketil Hviding (12:11):
The microdosing.
What do you think about that?
Is that something that'srelevant or can be done?
Dr. Richard Kennedy (12:17):
I'm sure that people are considering it.
I personally wouldn't domicrodosing.
I would tell my patient.
I'd say look, you're prettyclose to be an ideal weight, but
you're no longer 25.
And so the real issue is if youget back to your weight of when
(12:39):
you were, in your mind, mostphysically fit, that might not
be a good weight for you now,because your body has changed,
your metabolism has changed.
You hold on to things a littlebit more now than you did before
.
I have more muscle, yeah so.
So it's not necessary.
(13:00):
And muscle and and muscle massis heavier than fat, so
technically you could actuallybe overweight but be fit.
That's why I say that microdosing would not be what I would
recommend, Unless the personhas told me look, you know, I've
(13:23):
been doing this workout regimenfor the last six months.
I eat like a little rabbit andI still can't, I still can't, I
still can't lower things down.
So I have to be able to work onthat and to get what I need,
(13:43):
what I need best for me.
Dave Liss (13:46):
Do you think that people have a realistic
expectation about what theyshould expect, or that this may
be a lifetime commitment to themedication when they start, or
that they think, well, I'll useit to get through this hump in
my weight situation and thenI'll get off it once I lose my
weight?
Dr. Richard Kennedy (14:05):
I think people do it for different
reasons.
There are going to be thosepeople who I'm going to be in a
wedding in six months.
I need to get into this gown, Ineed to get into this, I need
to get into this.
Yeah, I need to get into this,I need to fit into this tuxedo.
So what I'm going to do is I'mgoing to go talk to my doctor
and say, look, I need to loseweight fast, you know Oil.
Ketil Hviding (14:30):
I mean I think we all know by now people who've
been on this drug and seeingsome of the potential side
effects.
But I wonder whether there'seven more than side effects
because, as you said, it affectsthe metabolism.
I mean, the body goes through abig change because of this
medication.
So it would kind of seemfoolish to have the body going
(14:52):
through all of these things andthen just kind of drop off it
and then go back and forth, thatkind of, so you get this kind
of yo-yo effect again.
That would probably not be goodfor the body.
Dave Liss (15:05):
There's a weight loss program at GW Hospital.
It's sort of like one of thelast places on the bus before
you go to gastric bypass surgeryor something else, or had been
before this.
And I knew a man that you're ona calorie restricted diet less
than a thousand calories a day.
They have a behaviormodification part of the program
.
Well, these people are reallybusy and they don't take
(15:25):
advantage of this.
And I knew a man.
His issue was wine.
Basically he would.
He and his wife would have twoor three bottles of wine a night
.
His wife wouldn't drinkanything.
He and his wife would have twoor three bottles of wine a night
.
His wife wouldn't drinkanything.
And he went on this program allthese holidays and family
events where he was having hissmoothie and a bar and not
(15:46):
eating, and his wife was angrywith him because she didn't
think he'd do it in the firstplace.
And then he did it.
He lost like 60 pounds and thenhe got off of it and he didn't
do any kind of gradualreintroduction of food and then
in a couple of months he drankit all back and he spent
thousands of dollars to be inthis program.
Aussie Mike James (16:04):
Yeah, but turning to personal stories and
real life experiences, guys andI guess we've all got anecdotes,
maybe we could share a few.
But one quick question is itstill?
Is there still reticence in thecommunity to sort of say,
listen, I'm on these drugs.
Are there still a lot of peoplewho go on them without telling
anyone?
(16:25):
We've found that in the fitnessworld that there's quite a few
people will go on these withoutreally telling you.
You know, is it are peoplehappy to share it now or is it
dependent on the individual?
Dr. Richard Kennedy (16:37):
I think there's a little of both.
I think it's become moreacceptable because they
advertise it and I always sayyou have to look at it from the
perspective they stop sort ofusing the providers as the ones
to introduce drugs to patients.
(16:57):
They went straight to theconsumer.
So there isn't, you know, thereisn't a every time you watch a
television show when thecommercial comes on.
There's a Wegovi, there's aRebelsis, there's a Ozempic
commercials, and so what they'redoing is they're advertising it
(17:18):
to the patient.
So, by default, once you do that, you make it acceptable to the
community as a whole that it'san acceptable thing, that it's
not a bad drug it's not that itis and they know how to
highlight and accent this personlost 25% of their body weight,
(17:39):
that this person lost 10% oftheir body weight.
And you know, they show thebefore and the after photos
sometimes.
So with them now.
That being said, yeah, thereare people who don't.
I have patients who clearlydon't tell their family members
that they're on it.
Now it's pretty interesting.
(18:02):
It becomes obvious that youcould have something that you
have to inject all the time.
So, okay, again, once peopleget used to sticking themselves,
because it's not a deep stick,it's a very superficial
injection and you only have todo it once a week.
(18:22):
So there are ways you can dothis and nobody be aware of it.
Then, of course, what they wantis the results Wow, you look
good.
Wow you look good, wow, youlook great.
You know, I have, I've had acouple of patients over the
years who are in the public, inthe public image.
They're in front of the camera,they're public speakers, et
(18:47):
cetera.
For them, it's good business.
Ketil Hviding (18:52):
It takes us a little bit to the whole thing
about image, a body image, aswell as what it means to be thin
, because always this thingabout having the willpower to go
through a regimen that'sconsidered to be good, now we
can do it without the willpower.
Yes, so that changes all ofthat.
Dave Liss (19:14):
It's interesting.
I knew this one woman who didthis same program at GW.
She lost about 100 pounds mayneed to lose 100 more,
unfortunately and she noticedthat she was getting depressed.
And she talked to the peoplethere and she said that it was
very common for people to loseweight and have depression.
And they said the reason wasthat people thought once they
(19:35):
lose the weight, all theproblems in their life will go
away.
Then they realized they've lostweight and they're just thinner
.
Ketil Hviding (19:43):
There might be many explanations, but I think
there could be otherexplanations as well.
We are being constantlybombarded by temptations.
Yeah, the food industry hasincentives to sell us by
tentations.
You know, yeah, and as you know, I mean the industry.
The food industry hasincentives to sell us whatever
we want, and one of the thingswe are primed to eat are sugars.
(20:05):
It's very easy, it's fast, it'ssomething that you know.
When you are hunting and yousee something that's sweet,
you're going to go for itbecause it's going to give you a
lot of energy.
You can fight better,everything.
So we are primed for that.
Refusing and rejecting it isstrenuous for us, it's hard.
It also intervenes in oursocial activities.
(20:26):
Think about all the parties.
It involves I mean, fromchildhood involves sugar in some
way or another.
Then it goes from sugar toalcohol yes, which is another
form of sugar.
Yes, not partaking in this aswell is also hard.
Yes, now this drug comes inthere and I'm not sure we have
really understood how it affectsthe whole thing, because in a
(20:48):
way, maybe now what you probablywill see is that, for instance,
the food, food industry they'regoing to see losing sales of
candies, for instance.
They're going to have to figureout something yeah yeah.
Dr. Richard Kennedy (21:04):
I mean it's interesting like this.
Dave Liss (21:07):
I've known people they had gastric bypass and it
didn't address the craving, andso there were people who managed
to find a way to gain weightwhile having had gastric bypass.
Physical capacity is limitedbut they can't eat a box of
M&M's bag of M&M's in fiveminutes, but they can eat three
in four hours.
And then people I've known thathave taken the drug.
(21:28):
They just don't have thatinterest in eating.
They're done when they're done,and that seems to me to be the
primary distinction between thetwo kinds of treatments.
Aussie Mike James (21:40):
Turning to the real nuts and brass of these
things, as a manager of fitnesscenters in two different
countries, if there was oneconstant I used to see, it was
that scenario we talked aboutbefore about people wanting to
get fit for an event in sixmonths, whether it's be fit into
a wedding dress or somethinglike that, and the amount of
people.
I could almost pick them.
(22:00):
They would come in.
You would see they'd startyawning.
They hadn't eaten breakfast,they hadn't eaten hardly the day
before, their blood sugar's lowand they they faint.
And you just almost.
I could almost catch thembefore they fainted.
I got to see it so often.
So I would think takingsomething like Wegovy would be a
hell of a lot healthier in thelong term.
(22:22):
I mean you wouldn't have thesesort of episodes.
Jumping conclusions is.
Dr. Richard Kennedy (22:26):
Dr K.
No, that makes perfect sense.
Yeah, and again, I would tellyou, there aren't as many people
on these drugs just for theshort term and for short term to
me is six months or lessWhereas this is because these
(22:47):
people have reached a pointwhere they and the medical
establishment has said to themyes, you're overweight, you're
obese, you need to lose weight.
I have an option for you herenow that might be helpful, and
(23:08):
if you can tolerate this, you'llbe able to lose the weight.
And so, for some peopleinitially, particularly for
those who haven't really tried,you know that there are lots of
people who will go on diet.
You know that diet.
And that's the problem.
Diets are, as they say,self-limited by nature.
(23:29):
Even if they work, you have toeventually go back to some form
of a regular eating routine foryou, and I always say that's
mainly the dilemma.
Most diets work because,technically, you are eating less
.
The bottom line is you'reeating less by default.
(23:50):
What happens is remember, thestomach is a big, is a tube that
expands and contracts based onthe amount of substances coming
into it.
If you decrease the amount ofsubstances coming into it, the
stomach will get smaller.
I mean, it's essentially theprinciple of what bypass surgery
(24:11):
is?
They literally make the stomachsmaller.
Principle of what bypass surgeryis they literally make the
stomach smaller.
So therefore, and again, theycut out other things, but they
make the stomach smaller and, bydefault, if you have less, if
the stomach won't expand, but somuch, you get full quicker.
Well then you'll eat less.
And it's why, when they havethe people go through this
(24:38):
bypass surgery, before you gothrough bypass surgery you have
to go through mental healththerapy, you have to go through
exercise programs, you have togo through a diet regimen.
They want to prove that you'remotivated enough because they
(25:05):
know, once the surgery happens,just doing the surgery itself,
when you come out of theoperation, you've lost quite a
bit of weight, almost always.
Ketil Hviding (25:10):
So the question is how do you sustain that going
forward?
So now we found a solution.
This is pretty much the wonderdrug.
No, Even with a solution.
This is pretty much the wonderdrug?
Dr. Richard Kennedy (25:17):
no, even with that solution it serves the
purpose.
And partly because we have infront of us, on the movie screen
, in the theaters, we have thebodies and faces of people who
we saw them when they were inthis role and they were 220
(25:40):
pounds and now they're 107.
Ketil Hviding (25:43):
Yeah, I know they're starting.
There is this influence thatthey said oh, thin is good, yes,
and now, suddenly, you knowthis is less of a problem to
talk that way.
Yeah, you know this is less ofa problem to talk that way, but
I mean, is this, though, alsothe one drug?
Only for the rich, that's thenext point.
Aussie Mike James (26:02):
I thought we should bring up Kettle Cost and
affordability.
I mean how affordable is it forthe average person and discuss
like Medicare and all of this.
I mean how much does it cost,say, for the average person to
undertake a course of Wagovi?
Dr. Richard Kennedy (26:19):
It's expensive.
Ketil Hviding (26:22):
I mean it's in the $1,000 a month.
Dr. Richard Kennedy (26:25):
Without insurance.
$1,200 to $1,400 per month.
Wow, Per month.
So what happened is is, whenthe drugs came out, they knew
(26:49):
that they, so they said theymade they, they, they partnered
with the health insurers andsaid look, okay, we will make
this drug, but you have to beable to give us something back.
And what they do is they giveto the patient.
If you have commercial insurancein the United States, different
in Europe, but commercialinsurance the Aetna's, Blue
(27:10):
Crosses of the world if you havethat, they're going to pay a
percentage of it.
So, based on what your plan isyou're going to pay, it's going
to cover 80% or whatever andwhat the Goldberg Company says.
We're going to give the patienta card that says $25 per month.
(27:33):
We're going to charge you andthat's all.
You're going to pay out ofpocket for the medication for a
year, and so that mitigates thecost.
Now, that doesn't help if youdon't have insurance.
(27:54):
It doesn't help if you haveinsurance and right now,
Medicare not being a commercialinsurance, it wasn't being
covered, being covered.
So the only way you could getit covered is if, okay, this
person needs to take it, notjust for obesity, but because
(28:15):
they happen to be diabetic,because they had a cardiac event
that they survived, and so thisis to promote their wellness
and well-being going forward andwell-being going forward.
Ketil Hviding (28:33):
So then we have a situation where still a certain
percentage of the United Statespopulation is uninsured and
it's towards the lower range ofincome that will not benefit
from this, and these areactually the part of society
where you find more obesity.
They're living in food desertswhere you probably only can get
(28:55):
McDonald's or other kind of fastfood providers and no fresh
food, whereas the rich, thewealthy, can gobble up these
things that are, by the way,also in short supply.
So it's a risk, is risk ofincreasing differences in
society.
Aussie Mike James (29:13):
Is there a possibility of that changing, at
least in the US, so that itbecomes more affordable?
Are there any indications ofthat?
Dr. Richard Kennedy (29:20):
Well, with Medicare being the largest
insurer in the United Stateswith them.
Now it appears that I know theBiden administration has put
into place ways that they can.
Medicare will be able tonegotiate with the drug
(29:41):
companies to be able to get amore affordable price, but we'll
see.
The jury's still out.
It will be better.
Ketil Hviding (29:53):
I don't know how much better and when on the
prices and because the industryhas been pushing back on this
and they've done this only for afew drugs so far.
They might include this andwe'll see whether the new
(30:13):
administration would allow thatto go forward.
Yeah, I mean just looking ateurope, where most countries
have as it was at all, have somekind of national health
insurance and they negotiatewith the companies, and I also
think there is some kind ofpan-European possibility there.
And there are the prices about10 times less, yeah, which is
(30:40):
still expensive here, stillexpensive there too.
And that takes us to the otherissue that, even with reductions
, this is the cost that theinsurance system, however it's
organized, will more or lesshave to bear, and it's going to
(31:00):
affect budgets.
Now, on the other hand, ofcourse, having much less obese
people if that is going to bethe result that get actually
rolled out will save money forthe society.
Yes, so you know, it's going tobe interesting to see how this
pans out.
Dr. Richard Kennedy (31:18):
Well, and from the standpoint that the
drug companies will, they'realways looking at a way to use
their drug as a way to treat acondition, and so if you just
think about these drugs inparticular, how they started out
(31:40):
specifically to treat diabetes,then they found out, wow,
people's cardiac events andstroke events decreased.
So then they had anotherindication to promote it.
Then they found out, oh, wow,obesity is a big disease in the
(32:02):
United States.
We now have a drug regimen thatcan actually help to reduce
that and promote wellness at thesame time.
So they'll you know, because tome the issue is is what's the
end point?
Do you people on on the drugfor the next five?
Ketil Hviding (32:23):
years.
And then there's actuallysomething I think is not
discussed a lot the we aretalking now about the United
States, europe, and the obesityepidemic that you talked about
is also spreading.
It's not only the United States, yes, but you're also having a
large part of the world beingaffected by it.
I mean you can have less.
(32:43):
I mean emerging markets,relatively poor countries where
obesity is also a problem.
Because what are we pushingthem?
Soft drinks, often, okay, softdrinks, for instance, in a lot
of Middle East.
Soft drinks, same in Mexico,for instance.
Obesity is becoming a bigproblem as well, india, but they
(33:07):
don't.
I haven't actually.
Do you know anything about therollout of drugs in these parts
of the world?
Dr. Richard Kennedy (33:14):
No, not off the top of my head, I would
suspect, because, as expensiveas they are, most of the health
insurance plans that do existand again a lot of the
developing world countries don'teven have them there's no way
to ban it out Now.
They'll eventually figure out away when the poorer countries
(33:42):
so that they can benefit from it, like we've done with many
other drugs over the years.
Ketil Hviding (33:48):
We've come with many other drugs over the years
and also I think, if I am notwrong, but I understand that for
instance, in India they wouldbe producing.
India and Brazil in particular,been producing medication.
That is actually not it's stillon patent, but they're
producing it, so I am not sure Ihaven't actually seen that they
actually started with this.
Dave Liss (34:08):
I would expect they're not.
Isn't India, where many drugsare formulated anyway already,
like for global distribution?
Dr. Richard Kennedy (34:15):
Yes, they are.
The problem is is the qualityof the drugs that come out of
there, whether it's real or not.
So a lot of times there aredrugs that come from different
parts, from India and otherplaces, but people are not so
sure that they are as effectivebecause they don't go through
(34:36):
the same scrutiny that theywould in Europe or they would in
North America.
Ketil Hviding (34:44):
There is even in the United States.
Now I understand somepharmacies are compounding the
drugs.
Dr. Richard Kennedy (34:50):
Yes.
Dave Liss (34:51):
I know a woman who's going to a compounding facility
to get her medication startingnext week and because she's a
pretty fluent person.
But it's cheaper for her to getthe formulation than it would
be for her to get a prescription.
Aussie Mike James (35:05):
Look, cheaper is a dove.
Do you know how much cheaper itis prescription?
Does it like cheaper?
Dave Liss (35:09):
as a dove.
Do you know how much cheaper itis?
I don't know what thedifference is, but it's
substantial enough to make thatarrangement.
Ketil Hviding (35:15):
Okay, but if I understand that it can only be
done as long as there's supplyconstraints, because the
companies have patent on this?
Yeah, and I understand thepatent lasts for about 10 years,
is that right?
Yeah, 10, us 10 years.
Dave Liss (35:32):
Well, it's interesting, Like I was in a
prescription study a few yearsago and, as it turns out, what
it was trying to do was for anADD medication, was that the
medication lasted four hours andif they change the formulation
so it lasted six or eight hours,they could extend the patent.
So rather than have an expiryand go generic, by changing the
(35:53):
formulation they could extendthe life of the exclusivity of
the patent.
I don't know if there's similarkind of considerations.
Dr. Richard Kennedy (36:00):
Well, they always are.
They did the same thing withViagra.
The Viagra patent lasted almost20, 25 years.
Ketil Hviding (36:11):
Yeah, there's another one, that's right.
Dave Liss (36:13):
Yeah.
Ketil Hviding (36:14):
So we have Viagra and we have Ozempic.
We are, you know, if you havethe money, you can be a new
person.
Aussie Mike James (36:21):
But what about the long-term?
That's a whole other talk showthere, ketel, sorry.
Ketil Hviding (36:29):
I'm taking on this though Hard to, believe.
Aussie Mike James (36:32):
Turning to the long-term effects, we looked
at the economics sustainabilitybut, dr K, many listeners
wonder about the safety andeffectiveness of these drugs
over time.
Has there been any long-termstudies on, or is there gaps in
research on, these studies aboutlong-term effectiveness and,
well, any side effects?
Dr. Richard Kennedy (36:52):
well, I mean they've done studies that
have gone on for eight years,with the people being on the
drug for eight years they'vebeen pretty effective.
Four-year studies eightfour-year had been pretty
effective and the side effectprofile that you get at the very
beginning of taking the drug ispretty much the same across and
(37:23):
the side effects seem todissipate.
You start out with the, you know, 0.5 milligrams, which would,
depending on the drug or it, or1.3 milligrams I can't remember
what it is let's say as anexample, once a week for four
weeks.
And if the person tolerates itthen, but they're not getting
(37:44):
the desired effect, meaning thatthey haven't really lost much
weight or no weight at all, thenthey'll bump it up to the next
level of the dose of the drugand try that for a month, come
back and measure whateverparameters are they met and
they'll always easy to measuresugar, easy to measure on a
scale what the person's weighthas become.
(38:07):
So you can do that and you cansee along.
And the people who discontinuethe drug because they can't
tolerate it, you know, one ofthe things you tend to always
see is that even though the drugwas helping them to lose weight
, they couldn't tolerate itbecause of the side effects.
(38:27):
So they stopped it and it wouldgo right back to their free
weight, free treatment weights,so they would gain the weight
back that they might have lost.
You know, and this is nodifferent than when you know you
have people on these differentdiets back in the day.
Aussie Mike James (38:47):
Yeah.
And they go back to whatever isnormal and do the same thing,
and if they lasted that long togo through the regimen, that's
the difference.
I think yeah.
Dr. Richard Kennedy (38:57):
And that's been the case.
Yeah, you know, they used tohave this television show Big
Fat Loser.
Aussie Mike James (39:04):
Yes.
Dr. Richard Kennedy (39:06):
Where people would get, there was
incentive.
Yes, where people would getthere was incentive, there were
these intensive programs wherethey got them to cut back on
(39:26):
what they ate, exercise, do allthese other things and they of
their body weight during thecourse of the show.
They would regain the weightwithin a year.
Dave Liss (39:38):
yeah, yeah, I had someone say to me that the whole
thing about weight loss is it'ssort of like mountain climbing,
that people think that thehardest thing is the losing of
the weight, but really, like themost dangerous part of climbing
a mountain often is coming downfrom the mountain and that once
you've lost the weight, findinga way to keep it off is the
most difficult thing.
Dr. Richard Kennedy (39:58):
It still falls back on lifestyle.
Aussie Mike James (40:01):
Yeah, yeah, I think it's not going to change
exercise habits.
I mean, in fact, I guess in thegym culture the people on
Mugabe will be sort of clappingtheir hands because they'll be
saying all the people who wantedto put on muscles that had
steroids for years and they'rewalking around with these
bulging, at least we've got ourown back, you know.
We've got our own drug now.
Dave Liss (40:21):
But I think that sounds trivial, but it's true.
Aussie Mike James (40:25):
People want to get out of the gym.
Dave Liss (40:26):
I mean you.
You want to have the benefit,not have to do the work.
You know, in a way, and yeah,but I think I kind of wonder
about, is I?
Aussie Mike James (40:34):
do say, though, when I alluded before to
the visuals of people have beenon ozempic, I've lost a lot of
muscle.
I always refer to the sydneycarver bridge effect you've got
a big suit.
People have had suits that theypreviously wore.
Yes, they no longer feel like asuit and it's just like a big
suit.
People have had suits that theypreviously wore.
They no longer feel as thoughit's a suit and it's just like a
big hanger sitting off them.
Quite a few of the recentpoliticians who I won't name,
(40:55):
who you can tell with that?
Ketil Hviding (40:58):
As you said before, these drugs don't.
I mean, it's the weight loss,the fast-paced loss problem.
How do you actually deal withthat?
These drugs don't enter a newthing in the equation there, so
they should have a chance tobuild up muscles.
Dr. Richard Kennedy (41:14):
Yes, yeah, yeah, and that's important.
They should be willing to workon it and realizing that they
could, because in many, whatyou'll find is in the people who
do the muscle toning and themuscle building, who happen to
be on these drugs, what willhappen is they'll plateau where
it won't look like they'rereally losing any weight.
(41:36):
But these are the same peoplewho will tell you that their one
or two sizes smaller inclothing because they've reduced
the fat, tone the muscle, sothey've gotten fitter in that
regard, but their weight on thescale may not have changed very
(41:56):
much.
Ketil Hviding (41:58):
You guys.
I have to run out to get toTregno.
Aussie Mike James (42:04):
But run to the gym.
Run to the weight training gymstraight after.
Dr. Richard Kennedy (42:08):
That jiu-jitsu and fencing what are
you talking about.
Aussie Mike James (42:17):
Well, you know, there's this.
Okay, guys, should we I meanedit, should we sort of wrap it
up now?
Ketil Hviding (42:25):
Yeah, I think we'll wrap it up and maybe we
should think about havinganother episode and then take
questions.
Maybe I'll wrap it up with yeah, I think we'll wrap it up, and
maybe we should think abouthaving another episode and then
take questions.
Aussie Mike James (42:31):
Maybe I'll wrap it up with saying that the
three things that we should lookat are doctor supervision,
weight training yes, and generallifestyle modification yes,
yeah, okay.
Dave Liss (42:42):
We'll just wrap it up .
I'm cutting and then when youstart, that's where we'll redo
it.
If you want to do somethingwith questions like I could take
, like family members, like youknow, your spouses and they
could ask questions.
Ketil Hviding (42:54):
I think it would be great to get some questions.
We might even get questionsfrom India, since you have your
biggest podcast in India.
Dave Liss (43:03):
Yeah, we're 130th in the health and wellness space in
India.
Aussie Mike James (43:13):
Well, I think we need to figure out how they
actually are going to get itthere's only 131 in there.
Dave Liss (43:16):
There's over a billion people in India and
we're 130th.
I think that's pretty good.
Ketil Hviding (43:20):
Yeah.
Dave Liss (43:21):
Okay, we're going to go up, I'm leaving Wait wait,
kettle.
Can you just wait till he wrapsit up, then we'll close that
way we don't lose you.
Aussie Mike James (43:30):
Wait, wait, wait.
I'll close it up now and I'lljust finish off with that close.
Well, okay, I guess the realtakeaways from this just to get
verification from you, dr K isthat one, if we take these drugs
, or if you get them prescribed,they should be definitely under
a doctor's supervision.
Weight training should beincluded, or at least some sort
(43:54):
of strength resistance work, andthree, general lifestyle
modification.
It's not just the drug that'sgoing to do the work.
You have to actually work withthe drug, so to speak.
So, on that note, and we'regoing to talk more on this and
we'll get some questions fromour listeners and maybe discuss
this in a future episode.
But thanks for tuning in folks.
(44:15):
We'd love to hear your thoughtsand if you have any comments or
questions, connect with us onour social media with links in
the program notes, or visit ourwebsite at
wellnessmusketeersbuzzsproutcom.
Don't forget to like and sharethis episode.
Subscribe to WellnessMusketeers for more insights.
(44:36):
Your support helps us reachmore listeners, spreading
wellness to everyone.
Stay healthy, stay inspired,and we'll see you for the next
episode of Wellness Musketeerscoming soon.
So these drugs?
Initially they were made forthe treatment of diabetes and
they're in a class we call GLP-1, which is a chemical inside the
body that when you stimulatethis, when you stimulate this,
(00:28):
it actually decreases therelease of sugar from different
parts of our body where it'sstored and helps with the
metabolism of sugar that'scoming into the body.
Incidentally, what they foundwhen they initially started
using these drugs, with Ozempicbeing the classic example is
that not only did it improvepeople's blood sugars, but also
(00:54):
they found that people who mightwork at greater risk for
cardiovascular disease events ieheart attack, things like that,
and strokes, non-fatal strokesthe incidence of those
occurrences in this patientpopulation decreased.
And as a side effect of this,they realized wow, many of these
(01:16):
patients were losing weight.
Aussie Mike James (01:24):
Hello and welcome.
In this episode of the WellnessMusketeers podcast, the
Musketeers explore the complexworld of weight loss drugs from
three unique perspectives.
Dr Richard Kennedy sharesinsights from his experience as
a physician working withpatients using these medications
(01:45):
.
Aussie Mike James discusses howthese drugs intersect with
fitness and long-term wellnessstrategies, while Kettle Hiding
provides an economist's view ofthe financial drivers behind the
obesity epidemic and financialimplications for individuals and
society of these new drugs.
Through personal stories,professional insights and
(02:08):
engaging conversation, the teamtackles key questions what do
weight loss drugs really offer?
Are they accessible andaffordable for all, and what do
they mean for the future ofhealth and wellness?
Whether you're consideringweight loss medications, curious
about their societal impact, orjust love a good discussion on
(02:29):
health and economics, thisepisode offers something for
everyone, and whether you'reseeking practical tips or
exploring big wellness topics,we're glad you're here.
We hope you enjoy today'sepisode.
Please like, share andsubscribe and let us know what
you think.
So let's get right into today'sepisode.
Please like, share andsubscribe and let us know what
you think.
So let's get right into today'sepisode.
Perhaps we could just startwith Dr Kennedy.
(02:50):
The common question, I guess,dr K, is what are these weight
loss drugs and how do theyactually work?
Dr. Richard Kennedy (02:58):
So these drugs are drugs made initially.
They were made for thetreatment of diabetes and
they're almost all of them areinjectable drugs and they're in
a class we call GLP-1, which isa chemical inside the body that
(03:19):
when you stimulate this, whenyou stimulate this, it actually
(03:52):
decreases the release of sugarfrom different parts of our body
.
Did it improve people's bloodsugars?
But also they found that peoplewho might work at greater risk
for cardiovascular diseaseevents ie heart attack, things
like that, and strokes,non-fatal strokes the incidence
of those occurrences in thispatient population decreased.
And as a side effect of thisthey realized wow, many of these
(04:16):
patients were losing weight andthat is where this class of
drugs has taken off to in thelast two to three years for sure
.
And now these drugs arespecifically being prescribed to
treat obesity, meaning a BMIgreater than 30.
(04:38):
And 30 to 35 BMI is what wecall overweight, a greater than
35 is morbid obesity.
And so what they found is bydecreasing the weight of people
(05:02):
again, you improve their healthby getting rid of their diabetes
, which is a major risk factorfor cardiovascular disease,
kidney disease, stroke, etc.
So that's sort of how thisstarted, and now it has become
one of the classic drugs,because it has been proven in
several studies that patientswho take these drugs lose much
(05:25):
more weight than doing lifestylechanges lifestyle modifications
and they maintain that weightloss better than if the person
did lifestyle modification, iediet and exercise.
Aussie Mike James (05:42):
Quick question on that, dr K.
Has there been any side effectsnausea and so forth?
Dr. Richard Kennedy (05:47):
I've heard yes, the most common side
effects are gastrointestinal, sonausea, upset stomach, vomiting
in extreme cases some diarrhea,all of that.
And that's why, when theyinitiate treatment with this in
anybody, they start at the verylower doses.
(06:07):
They continue it for a week tosee if the purpose.
Because, like any drug and it'simportant to understand there
is no drug that has ever beendeveloped, be it prescribed or
an over-the-counter, thatdoesn't have side effects, an
over-the-counter that doesn'thave side effects, and so not
everybody who's going to take itis going to have the side
effect.
But if they do many of the sideeffects, if the patient takes
(06:31):
it consistently enough, the sideeffects will become less
significant and even go away.
Dave Liss (06:39):
Are there issues with loss of muscle mass, strength
or issues affecting bone?
Dr. Richard Kennedy (06:45):
density.
Well, I don't know if it's notreally clear on this, but I
would say that muscle mass mightbe an issue.
And I would say that's atwo-pronged problem to me,
(07:10):
because sometimes when you givea person a drug that you tell
them it's going to help you loseweight, which means you're
going to burn calories, you'regoing to burn fat.
If you are not simultaneouslydoing some kind of workout
regimen, yeah, your muscle masswill decrease.
It's like anything else If youdon't use it, you will lose it.
Ketil Hviding (07:32):
Yeah, so we don't know whether this is worse when
you use the drug relatively.
Dr. Richard Kennedy (07:34):
to just weight loss in general.
I don't think so.
It's possible, but I don't.
Aussie Mike James (07:39):
Okay, that's an interesting perspective.
I know in the fitness industryand I've looked at the position
statements of groups like theAmerican College of Sports
Medicine, american Council ofExercise and the American Health
Clubs Association, whichrepresents the largest
industrial group, if you like,of health clubs throughout the
world.
They all have pretty similarposition statements, if you will
(08:03):
saying that.
One, that the use of them hasto be under medical supervision
and two, they really emphasizeweight training because of the
evidence of muscle loss and it's, I think, reading into that a
little bit more.
I think for a long time thestandard guideline was that you
lost it by one or two pounds aweek over a long term.
(08:23):
Hence you'd have a lot ofpeople drop out because they
couldn't keep that sort ofdiscipline up and they don't see
immediate results.
So I think the groups arerealizing that these drugs are
here to stay.
So you've got to work with thembecause they're not going to be
stopped, going down in usage oranything.
Weight training is an essentialpart of the fitness regimen and
I guess they're reallypromoting that to help the
(08:45):
decrease in muscle loss.
It's been evidence and thatmakes perfect sense.
Yeah, yeah, perfect sense.
I think that's one thing younotice visually from people who
you've seen on it that there'ssort of a look, if you will,
that makes it look like they'velost muscle weight.
Dave Liss (09:00):
Are there different considerations for someone
starting a weight lossmedication like this if they're
a younger person, a middle-agedperson or an older person?
Like what kind of what doessarcopenia?
Is that a relevant drug?
Is that you have an in-depthdiscussion?
Dr. Richard Kennedy (09:27):
with your provider who's going to
prescribe it.
One, the benefits of taking thedrug.
Two, the problems that youmight have taking the drug.
Three, how this drug may affectyour overall wellness in life,
because all drugs have an effect.
So you know, drugs are like nodifferent than exercise, diet,
(09:51):
rest, sleep.
It is part of the formula for aperson becoming healthy.
Ketil Hviding (09:58):
So you know you mentioned overweight, so I am
just overweight a little bit.
Would that be okay to startwith the drug, maybe microdosing
it?
Dr. Richard Kennedy (10:09):
I would probably at least for me, I
probably would then overweight,because to me I think that
there's to me it's the conflictof what we use as the measure of
obesity.
The PMI is essentiallymeasuring your body weight and
your height.
It does not take into accountyour fat, and what we always see
(10:32):
is that you technically couldtake any.
In the United States, anyfootball player.
Ketil Hviding (10:38):
Yes.
Dr. Richard Kennedy (10:39):
Football player, many basketball players.
Basically, by default, they areoverweight and, in some,
morbidly obese, except for thefact that when you look at their
muscle mass compared to theirbody fat content, it's very
(10:59):
different than ever.
So we have to now.
That's because it's hard to youknow.
It's not difficult to measurebody fat.
It takes some effort to do it.
There's some simple tools thatwe can use to measure body fat,
and so all I have to say I havea discussion with your doctor.
(11:21):
I wouldn't with your doctor,knowing as active as you are,
that it would be fool's gold tobe putting you on a medicine to
make you lose 10 pounds.
Ketil Hviding (11:36):
I want to look fitter.
I want to have those six-packs.
Dr. Richard Kennedy (11:40):
Yeah, but being on those medicines is not
going to give you a six-pack.
Ketil Hviding (11:50):
But I can also work out a little bit.
Aussie Mike James (11:51):
I have dave and kia they can kind of, uh,
put me on a strict regimen.
Ketil Hviding (11:53):
Yeah six packs for sure, yeah, and then I get
some fat off.
Dr. Richard Kennedy (11:59):
Then I go yeah, I'm joking, I mean for the
term anything is okay, as theysay, everything in moderation is
okay.
It's the extremes that get usinto trouble.
Ketil Hviding (12:11):
The microdosing.
What do you think about that?
Is that something that'srelevant or can be done?
Dr. Richard Kennedy (12:17):
I'm sure that people are considering it.
I personally wouldn't domicrodosing.
I would tell my patient.
I'd say look, you're prettyclose to be an ideal weight, but
you're no longer 25.
And so the real issue is if youget back to your weight of when
(12:39):
you were, in your mind, mostphysically fit, that might not
be a good weight for you now,because your body has changed,
your metabolism has changed.
You hold on to things a littlebit more now than you did before
.
I have more muscle, yeah so.
So it's not necessary.
(13:00):
And muscle and and muscle massis heavier than fat, so
technically you could actuallybe overweight but be fit.
That's why I say that microdosing would not be what I would
recommend, Unless the personhas told me look, you know, I've
(13:23):
been doing this workout regimenfor the last six months.
I eat like a little rabbit andI still can't, I still can't, I
still can't lower things down.
So I have to be able to work onthat and to get what I need,
(13:43):
what I need best for me.
Dave Liss (13:46):
Do you think that people have a realistic
expectation about what theyshould expect, or that this may
be a lifetime commitment to themedication when they start, or
that they think, well, I'll useit to get through this hump in
my weight situation and thenI'll get off it once I lose my
weight?
Dr. Richard Kennedy (14:05):
I think people do it for different
reasons.
There are going to be thosepeople who I'm going to be in a
wedding in six months.
I need to get into this gown, Ineed to get into this, I need
to get into this.
Yeah, I need to get into this,I need to fit into this tuxedo.
So what I'm going to do is I'mgoing to go talk to my doctor
and say, look, I need to loseweight fast, you know Oil.
Ketil Hviding (14:30):
I mean I think we all know by now people who've
been on this drug and seeingsome of the potential side
effects.
But I wonder whether there'seven more than side effects
because, as you said, it affectsthe metabolism.
I mean, the body goes through abig change because of this
medication.
So it would kind of seemfoolish to have the body going
(14:52):
through all of these things andthen just kind of drop off it
and then go back and forth, thatkind of, so you get this kind
of yo-yo effect again.
That would probably not be goodfor the body.
Dave Liss (15:05):
There's a weight loss program at GW Hospital.
It's sort of like one of thelast places on the bus before
you go to gastric bypass surgeryor something else, or had been
before this.
And I knew a man that you're ona calorie restricted diet less
than a thousand calories a day.
They have a behaviormodification part of the program
.
Well, these people are reallybusy and they don't take
(15:25):
advantage of this.
And I knew a man.
His issue was wine.
Basically he would.
He and his wife would have twoor three bottles of wine a night
.
His wife wouldn't drinkanything.
He and his wife would have twoor three bottles of wine a night
.
His wife wouldn't drinkanything.
And he went on this program allthese holidays and family
events where he was having hissmoothie and a bar and not
(15:46):
eating, and his wife was angrywith him because she didn't
think he'd do it in the firstplace.
And then he did it.
He lost like 60 pounds and thenhe got off of it and he didn't
do any kind of gradualreintroduction of food and then
in a couple of months he drankit all back and he spent
thousands of dollars to be inthis program.
Aussie Mike James (16:04):
Yeah, but turning to personal stories and
real life experiences, guys andI guess we've all got anecdotes,
maybe we could share a few.
But one quick question is itstill?
Is there still reticence in thecommunity to sort of say,
listen, I'm on these drugs.
Are there still a lot of peoplewho go on them without telling
anyone?
(16:25):
We've found that in the fitnessworld that there's quite a few
people will go on these withoutreally telling you.
You know, is it are peoplehappy to share it now or is it
dependent on the individual?
Dr. Richard Kennedy (16:37):
I think there's a little of both.
I think it's become moreacceptable because they
advertise it and I always sayyou have to look at it from the
perspective they stop sort ofusing the providers as the ones
to introduce drugs to patients.
(16:57):
They went straight to theconsumer.
So there isn't, you know, thereisn't a every time you watch a
television show when thecommercial comes on.
There's a Wegovi, there's aRebelsis, there's a Ozempic
commercials, and so what they'redoing is they're advertising it
(17:18):
to the patient.
So, by default, once you do that, you make it acceptable to the
community as a whole that it'san acceptable thing, that it's
not a bad drug it's not that itis and they know how to
highlight and accent this personlost 25% of their body weight,
(17:39):
that this person lost 10% oftheir body weight.
And you know, they show thebefore and the after photos
sometimes.
So with them now.
That being said, yeah, thereare people who don't.
I have patients who clearlydon't tell their family members
that they're on it.
Now it's pretty interesting.
(18:02):
It becomes obvious that youcould have something that you
have to inject all the time.
So, okay, again, once peopleget used to sticking themselves,
because it's not a deep stick,it's a very superficial
injection and you only have todo it once a week.
(18:22):
So there are ways you can dothis and nobody be aware of it.
Then, of course, what they wantis the results Wow, you look
good.
Wow you look good, wow, youlook great.
You know, I have, I've had acouple of patients over the
years who are in the public, inthe public image.
They're in front of the camera,they're public speakers, et
(18:47):
cetera.
For them, it's good business.
Ketil Hviding (18:52):
It takes us a little bit to the whole thing
about image, a body image, aswell as what it means to be thin
, because always this thingabout having the willpower to go
through a regimen that'sconsidered to be good, now we
can do it without the willpower.
Yes, so that changes all ofthat.
Dave Liss (19:14):
It's interesting.
I knew this one woman who didthis same program at GW.
She lost about 100 pounds mayneed to lose 100 more,
unfortunately and she noticedthat she was getting depressed.
And she talked to the peoplethere and she said that it was
very common for people to loseweight and have depression.
And they said the reason wasthat people thought once they
(19:35):
lose the weight, all theproblems in their life will go
away.
Then they realized they've lostweight and they're just thinner
.
Ketil Hviding (19:43):
There might be many explanations, but I think
there could be otherexplanations as well.
We are being constantlybombarded by temptations.
Yeah, the food industry hasincentives to sell us by
tentations.
You know, yeah, and as you know, I mean the industry.
The food industry hasincentives to sell us whatever
we want, and one of the thingswe are primed to eat are sugars.
(20:05):
It's very easy, it's fast, it'ssomething that you know.
When you are hunting and yousee something that's sweet,
you're going to go for itbecause it's going to give you a
lot of energy.
You can fight better,everything.
So we are primed for that.
Refusing and rejecting it isstrenuous for us, it's hard.
It also intervenes in oursocial activities.
(20:26):
Think about all the parties.
It involves I mean, fromchildhood involves sugar in some
way or another.
Then it goes from sugar toalcohol yes, which is another
form of sugar.
Yes, not partaking in this aswell is also hard.
Yes, now this drug comes inthere and I'm not sure we have
really understood how it affectsthe whole thing, because in a
(20:48):
way, maybe now what you probablywill see is that, for instance,
the food, food industry they'regoing to see losing sales of
candies, for instance.
They're going to have to figureout something yeah yeah.
Dr. Richard Kennedy (21:04):
I mean it's interesting like this.
Dave Liss (21:07):
I've known people they had gastric bypass and it
didn't address the craving, andso there were people who managed
to find a way to gain weightwhile having had gastric bypass.
Physical capacity is limitedbut they can't eat a box of
M&M's bag of M&M's in fiveminutes, but they can eat three
in four hours.
And then people I've known thathave taken the drug.
(21:28):
They just don't have thatinterest in eating.
They're done when they're done,and that seems to me to be the
primary distinction between thetwo kinds of treatments.
Aussie Mike James (21:40):
Turning to the real nuts and brass of these
things, as a manager of fitnesscenters in two different
countries, if there was oneconstant I used to see, it was
that scenario we talked aboutbefore about people wanting to
get fit for an event in sixmonths, whether it's be fit into
a wedding dress or somethinglike that, and the amount of
people.
I could almost pick them.
(22:00):
They would come in.
You would see they'd startyawning.
They hadn't eaten breakfast,they hadn't eaten hardly the day
before, their blood sugar's lowand they they faint.
And you just almost.
I could almost catch thembefore they fainted.
I got to see it so often.
So I would think takingsomething like Wegovy would be a
hell of a lot healthier in thelong term.
(22:22):
I mean you wouldn't have thesesort of episodes.
Jumping conclusions is.
Dr. Richard Kennedy (22:26):
Dr K.
No, that makes perfect sense.
Yeah, and again, I would tellyou, there aren't as many people
on these drugs just for theshort term and for short term to
me is six months or lessWhereas this is because these
(22:47):
people have reached a pointwhere they and the medical
establishment has said to themyes, you're overweight, you're
obese, you need to lose weight.
I have an option for you herenow that might be helpful, and
(23:08):
if you can tolerate this, you'llbe able to lose the weight.
And so, for some peopleinitially, particularly for
those who haven't really tried,you know that there are lots of
people who will go on diet.
You know that diet.
And that's the problem.
Diets are, as they say,self-limited by nature.
(23:29):
Even if they work, you have toeventually go back to some form
of a regular eating routine foryou, and I always say that's
mainly the dilemma.
Most diets work because,technically, you are eating less
.
The bottom line is you'reeating less by default.
(23:50):
What happens is remember, thestomach is a big, is a tube that
expands and contracts based onthe amount of substances coming
into it.
If you decrease the amount ofsubstances coming into it, the
stomach will get smaller.
I mean, it's essentially theprinciple of what bypass surgery
(24:11):
is?
They literally make the stomachsmaller.
Principle of what bypass surgeryis they literally make the
stomach smaller.
So therefore, and again, theycut out other things, but they
make the stomach smaller and, bydefault, if you have less, if
the stomach won't expand, but somuch, you get full quicker.
Well then you'll eat less.
And it's why, when they havethe people go through this
(24:38):
bypass surgery, before you gothrough bypass surgery you have
to go through mental healththerapy, you have to go through
exercise programs, you have togo through a diet regimen.
They want to prove that you'remotivated enough because they
(25:05):
know, once the surgery happens,just doing the surgery itself,
when you come out of theoperation, you've lost quite a
bit of weight, almost always.
Ketil Hviding (25:10):
So the question is how do you sustain that going
forward?
So now we found a solution.
This is pretty much the wonderdrug.
No, Even with a solution.
This is pretty much the wonderdrug?
Dr. Richard Kennedy (25:17):
no, even with that solution it serves the
purpose.
And partly because we have infront of us, on the movie screen
, in the theaters, we have thebodies and faces of people who
we saw them when they were inthis role and they were 220
(25:40):
pounds and now they're 107.
Ketil Hviding (25:43):
Yeah, I know they're starting.
There is this influence thatthey said oh, thin is good, yes,
and now, suddenly, you knowthis is less of a problem to
talk that way.
Yeah, you know this is less ofa problem to talk that way, but
I mean, is this, though, alsothe one drug?
Only for the rich, that's thenext point.
Aussie Mike James (26:02):
I thought we should bring up Kettle Cost and
affordability.
I mean how affordable is it forthe average person and discuss
like Medicare and all of this.
I mean how much does it cost,say, for the average person to
undertake a course of Wagovi?
Dr. Richard Kennedy (26:19):
It's expensive.
Ketil Hviding (26:22):
I mean it's in the $1,000 a month.
Dr. Richard Kennedy (26:25):
Without insurance.
$1,200 to $1,400 per month.
Wow, Per month.
So what happened is is, whenthe drugs came out, they knew
(26:49):
that they, so they said theymade they, they, they partnered
with the health insurers andsaid look, okay, we will make
this drug, but you have to beable to give us something back.
And what they do is they giveto the patient.
If you have commercial insurancein the United States, different
in Europe, but commercialinsurance the Aetna's, Blue
(27:10):
Crosses of the world if you havethat, they're going to pay a
percentage of it.
So, based on what your plan isyou're going to pay, it's going
to cover 80% or whatever andwhat the Goldberg Company says.
We're going to give the patienta card that says $25 per month.
(27:33):
We're going to charge you andthat's all.
You're going to pay out ofpocket for the medication for a
year, and so that mitigates thecost.
Now, that doesn't help if youdon't have insurance.
(27:54):
It doesn't help if you haveinsurance and right now,
Medicare not being a commercialinsurance, it wasn't being
covered, being covered.
So the only way you could getit covered is if, okay, this
person needs to take it, notjust for obesity, but because
(28:15):
they happen to be diabetic,because they had a cardiac event
that they survived, and so thisis to promote their wellness
and well-being going forward andwell-being going forward.
Ketil Hviding (28:33):
So then we have a situation where still a certain
percentage of the United Statespopulation is uninsured and
it's towards the lower range ofincome that will not benefit
from this, and these areactually the part of society
where you find more obesity.
They're living in food desertswhere you probably only can get
(28:55):
McDonald's or other kind of fastfood providers and no fresh
food, whereas the rich, thewealthy, can gobble up these
things that are, by the way,also in short supply.
So it's a risk, is risk ofincreasing differences in
society.
Aussie Mike James (29:13):
Is there a possibility of that changing, at
least in the US, so that itbecomes more affordable?
Are there any indications ofthat?
Dr. Richard Kennedy (29:20):
Well, with Medicare being the largest
insurer in the United Stateswith them.
Now it appears that I know theBiden administration has put
into place ways that they can.
Medicare will be able tonegotiate with the drug
(29:41):
companies to be able to get amore affordable price, but we'll
see.
The jury's still out.
It will be better.
Ketil Hviding (29:53):
I don't know how much better and when on the
prices and because the industryhas been pushing back on this
and they've done this only for afew drugs so far.
They might include this andwe'll see whether the new
(30:13):
administration would allow thatto go forward.
Yeah, I mean just looking ateurope, where most countries
have as it was at all, have somekind of national health
insurance and they negotiatewith the companies, and I also
think there is some kind ofpan-European possibility there.
And there are the prices about10 times less, yeah, which is
(30:40):
still expensive here, stillexpensive there too.
And that takes us to the otherissue that, even with reductions
, this is the cost that theinsurance system, however it's
organized, will more or lesshave to bear, and it's going to
(31:00):
affect budgets.
Now, on the other hand, ofcourse, having much less obese
people if that is going to bethe result that get actually
rolled out will save money forthe society.
Yes, so you know, it's going tobe interesting to see how this
pans out.
Dr. Richard Kennedy (31:18):
Well, and from the standpoint that the
drug companies will, they'realways looking at a way to use
their drug as a way to treat acondition, and so if you just
think about these drugs inparticular, how they started out
(31:40):
specifically to treat diabetes,then they found out, wow,
people's cardiac events andstroke events decreased.
So then they had anotherindication to promote it.
Then they found out, oh, wow,obesity is a big disease in the
(32:02):
United States.
We now have a drug regimen thatcan actually help to reduce
that and promote wellness at thesame time.
So they'll you know, because tome the issue is is what's the
end point?
Do you people on on the drugfor the next five?
Ketil Hviding (32:23):
years.
And then there's actuallysomething I think is not
discussed a lot the we aretalking now about the United
States, europe, and the obesityepidemic that you talked about
is also spreading.
It's not only the United States, yes, but you're also having a
large part of the world beingaffected by it.
I mean you can have less.
(32:43):
I mean emerging markets,relatively poor countries where
obesity is also a problem.
Because what are we pushingthem?
Soft drinks, often, okay, softdrinks, for instance, in a lot
of Middle East.
Soft drinks, same in Mexico,for instance.
Obesity is becoming a bigproblem as well, india, but they
(33:07):
don't.
I haven't actually.
Do you know anything about therollout of drugs in these parts
of the world?
Dr. Richard Kennedy (33:14):
No, not off the top of my head, I would
suspect, because, as expensiveas they are, most of the health
insurance plans that do existand again a lot of the
developing world countries don'teven have them there's no way
to ban it out Now.
They'll eventually figure out away when the poorer countries
(33:42):
so that they can benefit from it, like we've done with many
other drugs over the years.
Ketil Hviding (33:48):
We've come with many other drugs over the years
and also I think, if I am notwrong, but I understand that for
instance, in India they wouldbe producing.
India and Brazil in particular,been producing medication.
That is actually not it's stillon patent, but they're
producing it, so I am not sure Ihaven't actually seen that they
actually started with this.
Dave Liss (34:08):
I would expect they're not.
Isn't India, where many drugsare formulated anyway already,
like for global distribution?
Dr. Richard Kennedy (34:15):
Yes, they are.
The problem is is the qualityof the drugs that come out of
there, whether it's real or not.
So a lot of times there aredrugs that come from different
parts, from India and otherplaces, but people are not so
sure that they are as effectivebecause they don't go through
(34:36):
the same scrutiny that theywould in Europe or they would in
North America.
Ketil Hviding (34:44):
There is even in the United States.
Now I understand somepharmacies are compounding the
drugs.
Dr. Richard Kennedy (34:50):
Yes.
Dave Liss (34:51):
I know a woman who's going to a compounding facility
to get her medication startingnext week and because she's a
pretty fluent person.
But it's cheaper for her to getthe formulation than it would
be for her to get a prescription.
Aussie Mike James (35:05):
Look, cheaper is a dove.
Do you know how much cheaper itis prescription?
Does it like cheaper?
Dave Liss (35:09):
as a dove.
Do you know how much cheaper itis?
I don't know what thedifference is, but it's
substantial enough to make thatarrangement.
Ketil Hviding (35:15):
Okay, but if I understand that it can only be
done as long as there's supplyconstraints, because the
companies have patent on this?
Yeah, and I understand thepatent lasts for about 10 years,
is that right?
Yeah, 10, us 10 years.
Dave Liss (35:32):
Well, it's interesting, Like I was in a
prescription study a few yearsago and, as it turns out, what
it was trying to do was for anADD medication, was that the
medication lasted four hours andif they change the formulation
so it lasted six or eight hours,they could extend the patent.
So rather than have an expiryand go generic, by changing the
(35:53):
formulation they could extendthe life of the exclusivity of
the patent.
I don't know if there's similarkind of considerations.
Dr. Richard Kennedy (36:00):
Well, they always are.
They did the same thing withViagra.
The Viagra patent lasted almost20, 25 years.
Ketil Hviding (36:11):
Yeah, there's another one, that's right.
Dave Liss (36:13):
Yeah.
Ketil Hviding (36:14):
So we have Viagra and we have Ozempic.
We are, you know, if you havethe money, you can be a new
person.
Aussie Mike James (36:21):
But what about the long-term?
That's a whole other talk showthere, ketel, sorry.
Ketil Hviding (36:29):
I'm taking on this though Hard to, believe.
Aussie Mike James (36:32):
Turning to the long-term effects, we looked
at the economics sustainabilitybut, dr K, many listeners
wonder about the safety andeffectiveness of these drugs
over time.
Has there been any long-termstudies on, or is there gaps in
research on, these studies aboutlong-term effectiveness and,
well, any side effects?
Dr. Richard Kennedy (36:52):
well, I mean they've done studies that
have gone on for eight years,with the people being on the
drug for eight years they'vebeen pretty effective.
Four-year studies eightfour-year had been pretty
effective and the side effectprofile that you get at the very
beginning of taking the drug ispretty much the same across and
(37:23):
the side effects seem todissipate.
You start out with the, you know, 0.5 milligrams, which would,
depending on the drug or it, or1.3 milligrams I can't remember
what it is let's say as anexample, once a week for four
weeks.
And if the person tolerates itthen, but they're not getting
(37:44):
the desired effect, meaning thatthey haven't really lost much
weight or no weight at all, thenthey'll bump it up to the next
level of the dose of the drugand try that for a month, come
back and measure whateverparameters are they met and
they'll always easy to measuresugar, easy to measure on a
scale what the person's weighthas become.
(38:07):
So you can do that and you cansee along.
And the people who discontinuethe drug because they can't
tolerate it, you know, one ofthe things you tend to always
see is that even though the drugwas helping them to lose weight
, they couldn't tolerate itbecause of the side effects.
(38:27):
So they stopped it and it wouldgo right back to their free
weight, free treatment weights,so they would gain the weight
back that they might have lost.
You know, and this is nodifferent than when you know you
have people on these differentdiets back in the day.
Aussie Mike James (38:47):
Yeah.
And they go back to whatever isnormal and do the same thing,
and if they lasted that long togo through the regimen, that's
the difference.
I think yeah.
Dr. Richard Kennedy (38:57):
And that's been the case.
Yeah, you know, they used tohave this television show Big
Fat Loser.
Aussie Mike James (39:04):
Yes.
Dr. Richard Kennedy (39:06):
Where people would get, there was
incentive.
Yes, where people would getthere was incentive, there were
these intensive programs wherethey got them to cut back on
(39:26):
what they ate, exercise, do allthese other things and they of
their body weight during thecourse of the show.
They would regain the weightwithin a year.
Dave Liss (39:38):
yeah, yeah, I had someone say to me that the whole
thing about weight loss is it'ssort of like mountain climbing,
that people think that thehardest thing is the losing of
the weight, but really, like themost dangerous part of climbing
a mountain often is coming downfrom the mountain and that once
you've lost the weight, findinga way to keep it off is the
most difficult thing.
Dr. Richard Kennedy (39:58):
It still falls back on lifestyle.
Aussie Mike James (40:01):
Yeah, yeah, I think it's not going to change
exercise habits.
I mean, in fact, I guess in thegym culture the people on
Mugabe will be sort of clappingtheir hands because they'll be
saying all the people who wantedto put on muscles that had
steroids for years and they'rewalking around with these
bulging, at least we've got ourown back, you know.
We've got our own drug now.
Dave Liss (40:21):
But I think that sounds trivial, but it's true.
Aussie Mike James (40:25):
People want to get out of the gym.
Dave Liss (40:26):
I mean you.
You want to have the benefit,not have to do the work.
You know, in a way, and yeah,but I think I kind of wonder
about, is I?
Aussie Mike James (40:34):
do say, though, when I alluded before to
the visuals of people have beenon ozempic, I've lost a lot of
muscle.
I always refer to the sydneycarver bridge effect you've got
a big suit.
People have had suits that theypreviously wore.
Yes, they no longer feel like asuit and it's just like a big
suit.
People have had suits that theypreviously wore.
They no longer feel as thoughit's a suit and it's just like a
big hanger sitting off them.
Quite a few of the recentpoliticians who I won't name,
(40:55):
who you can tell with that?
Ketil Hviding (40:58):
As you said before, these drugs don't.
I mean, it's the weight loss,the fast-paced loss problem.
How do you actually deal withthat?
These drugs don't enter a newthing in the equation there, so
they should have a chance tobuild up muscles.
Dr. Richard Kennedy (41:14):
Yes, yeah, yeah, and that's important.
They should be willing to workon it and realizing that they
could, because in many, whatyou'll find is in the people who
do the muscle toning and themuscle building, who happen to
be on these drugs, what willhappen is they'll plateau where
it won't look like they'rereally losing any weight.
(41:36):
But these are the same peoplewho will tell you that their one
or two sizes smaller inclothing because they've reduced
the fat, tone the muscle, sothey've gotten fitter in that
regard, but their weight on thescale may not have changed very
(41:56):
much.
Ketil Hviding (41:58):
You guys.
I have to run out to get toTregno.
Aussie Mike James (42:04):
But run to the gym.
Run to the weight training gymstraight after.
Dr. Richard Kennedy (42:08):
That jiu-jitsu and fencing what are
you talking about.
Aussie Mike James (42:17):
Well, you know, there's this.
Okay, guys, should we I meanedit, should we sort of wrap it
up now?
Ketil Hviding (42:25):
Yeah, I think we'll wrap it up and maybe we
should think about havinganother episode and then take
questions.
Maybe I'll wrap it up with yeah, I think we'll wrap it up, and
maybe we should think abouthaving another episode and then
take questions.
Aussie Mike James (42:31):
Maybe I'll wrap it up with saying that the
three things that we should lookat are doctor supervision,
weight training yes, and generallifestyle modification yes,
yeah, okay.
Dave Liss (42:42):
We'll just wrap it up .
I'm cutting and then when youstart, that's where we'll redo
it.
If you want to do somethingwith questions like I could take
, like family members, like youknow, your spouses and they
could ask questions.
Ketil Hviding (42:54):
I think it would be great to get some questions.
We might even get questionsfrom India, since you have your
biggest podcast in India.
Dave Liss (43:03):
Yeah, we're 130th in the health and wellness space in
India.
Aussie Mike James (43:13):
Well, I think we need to figure out how they
actually are going to get itthere's only 131 in there.
Dave Liss (43:16):
There's over a billion people in India and
we're 130th.
I think that's pretty good.
Ketil Hviding (43:20):
Yeah.
Dave Liss (43:21):
Okay, we're going to go up, I'm leaving Wait wait,
kettle.
Can you just wait till he wrapsit up, then we'll close that
way we don't lose you.
Aussie Mike James (43:30):
Wait, wait, wait.
I'll close it up now and I'lljust finish off with that close.
Well, okay, I guess the realtakeaways from this just to get
verification from you, dr K isthat one, if we take these drugs
, or if you get them prescribed,they should be definitely under
a doctor's supervision.
Weight training should beincluded, or at least some sort
(43:54):
of strength resistance work, andthree, general lifestyle
modification.
It's not just the drug that'sgoing to do the work.
You have to actually work withthe drug, so to speak.
So, on that note, and we'regoing to talk more on this and
we'll get some questions fromour listeners and maybe discuss
this in a future episode.
But thanks for tuning in folks.
(44:15):
We'd love to hear your thoughtsand if you have any comments or
questions, connect with us onour social media with links in
the program notes, or visit ourwebsite at
wellnessmusketeersbuzzsproutcom.
Don't forget to like and sharethis episode.
Subscribe to WellnessMusketeers for more insights.
(44:36):
Your support helps us reachmore listeners, spreading
wellness to everyone.
Stay healthy, stay inspired,and we'll see you for the next
episode of Wellness Musketeerscoming soon.
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