May 20, 2025 • 56 mins
Why is it so hard for women to lose weight? Did you know it is harder today than ever before? There is a biological and a hormonal reason for this. Dr. Alexandra Sowa tells patients the real facts and knows how to help them lose weight and keep it off. She specializes in internal medicine and obesity medicine with a holistic, evidence-based approach for success. She teaches at the NYC School of Medicine. Central to this episode is an exploration of why weight loss remains a formidable challenge for women, especially in contemporary society. Dr. Alexandra Sowa, an esteemed authority in the fields of obesity and internal medicine, emphasizes the intricate biological and hormonal dynamics that complicate weight management for women. She is passionate about combating the stigma and blame game often given to patients who can’t lose weight. She views obesity as a medical condition and stresses that GLP-1s like Ozempic can help. These drugs have gotten a bad rap lately with misinformation. Dr. Sowa says they also provide multiple health benefits for our heart, kidneys, and can even help with addiction. She dispels the misconceptions about these drugs. Her new book THE OZEMPIC REVOLUTION is a Guide for people on GLP-1s and tells you what your doctor isn't. Tune into this episode of Women Road Warriors with Shelley Johnson and Kathy Tuccaro as Dr. Sowa clears up the myths, along with powerful facts and tips you need to combat and lose weight, and if products like Ozempic are right for you.
#GLP1 #Ozempic #DrAlexandraSowa #WeightLoss #WeightGain #Health #ShelleyJohnson #ShelleyMJohnson #KathyTuccaro #WomenRoadWarriors
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:02):
This is Women Road warriorswith Shelly Johnson and Kathy Tucaro.
From the corporate office tothe cab of a truck, they're here
to inspire and empower womenin all professions.
So gear down, sit back and enjoy.
(00:24):
Welcome.
We're an award winning showdedicated to empowering women in
every profession throughinspiring stories and expert insights.
No topics off limits.
On our show, we power women on.
The road to success withexpert and.
Celebrity interviews andinformation you need.
I'm Shelley.
And I'm Kathy.
(00:44):
When it comes to weight loss,doctors have quite often played the
blame game with their patients.
They've regarded obesity as alack of willpower.
Too many have even regardedpatients as victims of their own
sloth or ignorance.
Shocking, isn't it?
These are terribleperspectives that marginalize patients.
Dr.
Alexandra Soa is an obesityspecialist whose patients have had
(01:07):
great and successful outcomes.
She doesn't buy into these perspectives.
She says obesity is a fact ofbiology and is a disease state.
There's no blame to be assigned.
Dr.
Soa is up on the latest weightloss breakthroughs and techniques.
Through over 10 years ofpractice and as a clinical instructor
at NYU School of Medicine, Dr.
Soa has developed a profoundunderstanding of the biology of obesity
(01:31):
and how to treat it with toolslike GLP1 agonist medications.
She says products like GLP1meds like Ozempic are game changers
and can also have health benefits.
Her new book, the OzempicRevolution offers answers and clears
up any confusion people mayhave about GLP1s, which many people
don't totally understand.
(01:52):
Dr.
So has been interviewed bymajor media outlets, most recently
on Good Morning America.
Dr.
Soa is with us today toeducate us.
Welcome Dr.
Soa.
Thank you so much for being onthe show with us.
Thank you so much for having me.
Absolutely.
It's great to have you.
Are you kidding me?
Awesome.
This is going to be so enlightening.
(02:12):
Before we cover your tips onhow to successfully lose weight and
keep it off, as well aseducate us on GLP1 medications, I
wanted listeners to know moreabout you, what's your background
and what exactly do you do?
So, as you so nicelydescribed, I am a dual board certified
doctor of internal medicineand of obesity medicine.
(02:34):
So I am a pretty niche doctorand for the past 10 years, I've been
helping people to achievehealth through weight loss.
And I take a very scientificapproach to this.
And this all started from myundergraduate degree at Johns Hopkins
and then through my medicaltraining at nyu.
I always wanted to be anevidence based doctor, but what I
(02:58):
wanted to do was to preventdisease, not just treat end stage
disease, which is often somuch of our medical care in the United
States is really focused onend stage disease management.
And I was like, there has tobe a better way.
So as I was really coming tofind what specialty I was going to
pursue, I found this verynascent early stage field called
(03:20):
obesity medicine.
And I was so fortunate tobecome an early adopter in this field.
And that has led me to beusing GLP1 medications and all of
the most modern techniques forweight management over the past 10
years and has really allowedme to kind of emerge as someone who
says, hey, these meds aren't new.
(03:42):
I've been using them for along time and here is my framework.
And that's how this book cameto be.
It's super informative and Ithink it's going to be a game changer
for a lot of people whofinally can lose weight and keep
it off.
Your first chapter says tryharder is terrible medical advice.
Is this the typical banter of doctors?
(04:02):
I mean, that could be superdiscouraging to patients who really
are trying?
Oh, yes.
I mean, I think every singleperson who is listening right now
who has ever had any weight tolose knows that they had weight to
lose.
And to go into the doctor'soffice and to say, hey, I've put
on £15 and I don't know why,and I'm trying and to be met with
(04:25):
just, you know, eat less,exercise more, it is so disheartening.
And unfortunately, that'sreally what we were taught in medical
school Even up to 15, 20 yearsago, you know, that was just what
we learned.
It was the patient wasn'tdoing the right things, they must
be overeating calories,they're not moving their body enough.
(04:46):
So just give them this adviceto try harder and hopefully it works.
And we just know that that'snot true.
Because when you look aroundand doctors are struggling with their
weight and everybody isstruggling with their weight, it
can't be that we're just abunch of, you know, slovenly people
if that's just not it.
Weight loss is very, very complicated.
(05:07):
And it's taken quite a fewdecades for us to translate the research
of obesity and understandingthat it is disease to the wider public
and in turn, even to medicine.
Medicine is very slow to adopt.
Actually, what we know to betrue, there is a widely cited study
that says it takes about 17years for medicine and doctors to
(05:32):
give the most updated advice.
So we've known for a whilethat Obesity is a disease and we
actually had effectivemedications to help manage the disease.
But instead, so many of ushave heard and continue to hear,
just, you know, try harder.
And it really doesn't work.
No.
And people get caught up inthis vicious cycle.
(05:55):
They go to every kind ofweight loss program they can think
of, they spend thousands andthousands of dollars and they lose
it, and then they gain it back.
And of course, then you'rehearing on the news the obesity percentages
in North America.
Is it true that there are morepeople who have an obesity issue
today than say, 50 years ago?
(06:15):
Absolutely.
So about 50 years ago, about1980, we started to have a very significant
inflection point of the ratesof obesity in this country.
And steadily every year theywould climb.
Only recently have, just thisyear, probably in thanks to these
(06:36):
new medications, have westarted to see a decline, subtly
and not across all groups, butin some.
But since 1980, we have gonefrom a population that had about
15% obesity to nearly 50.
Wow.
Yes.
Yes.
So why is that?
Well, I talk about this in the book.
It is complex and there is noone answer.
(07:00):
What did happen around thattime is we started to have big changes
in our environment and what wewere eating.
So we started having a lotmore packaged food.
The government came in andstarted subsidizing corn, and that
corn byproduct made its wayinto a lot of our packaged food.
(07:21):
We were trying to solve for aproblem of how do we feed everybody,
like, how do we feed people?
And processed foods andpackaged foods became some of that
solution.
So that was one part of it.
Our environment started to change.
Instead of walking two milesto the bus stop, you started driving
more widely.
Our jobs shifted from jobs inwhich we were more active to ones
(07:45):
in which we were more sedentary.
And then this problem has onlygotten worse and worse and worse
as we all sit on our computersand we have telehealth.
And, you know, that's what Ido now instead of working in a clinic
and our screens and ourdevices and we started to move out
to the burbs and we were lessurban centric.
So a lot going on, a lot.
(08:07):
And we really can't pinpointit on one thing.
Something that has alsohappened, and I talk about this in
the book, is our geneticscan't change over one to two generations,
but the genes that sit on topof our genes do, the epigenetics.
And so as we get heavier, ournext generations also get heavier
(08:29):
by what we pass down to them.
So even in utero, what we'reexposed to.
If our mothers are carryingmore weight than they did in previous
generations and we're set tocarry more weight, it's.
It's pretty remarkable.
So it's kind of been thissnowball effect.
That's interesting.
I'd not heard of that.
Epigenetics.
Epigenetics.
(08:49):
Epigenetics.
Interesting.
You know, I think a lot ofpeople trying to lose weight feel
like they're, they're so muchalone with that many people who are
struggling.
It is not a minority.
People everywhere are fightingweight loss and trying to keep it
off.
Why is it so many people can'tlose weight and keep it off?
(09:10):
What are the biggest reasons?
Well, I think kind of comingback to this idea that it's biology
and even this concept, I justtold you about this, it's fascinating.
Epigenetics or genetics or theenvironment and all of these reasons
of what, why this hashappened, they're big systemic problems
and they're not somethingthat's easily solvable on an individual
(09:31):
level.
And I said this, I think it'sreally important for people to understand
why weight loss is so complicated.
And if you're consideringgoing on a GLP1 medication to really
understand the whole process.
And so in the book the OICRevolution, I really discuss this
and I move people through thescience of obesity, the science of
these drugs, before we get tohow do you make yourself successful?
(09:54):
Because it's so complicated.
And I want people to know thatthis is not a failure of you as an
individual.
This is a much bigger problem.
The, the answer to yourquestion of why is it so hard?
Is that our body is workingagainst us to constantly get back
up to its highest set point weight.
(10:16):
So even if we start in a nicelean style state, if every year we're
putting on five pounds andthen in between we take off seven
and then put on ten and thentake off two, we constantly, our
body wants to put more weighton and this comes down to hormones.
And we discuss this in the book.
But really, obesity, yes, ithas something to do with what we've
(10:41):
done in our lifetime, youknow, what we've eaten and if we've
moved or not, but much biggerthan that, it's a balance of hormones.
And as weight comes on and theenvironment around us encourages
the weight to come on through,the foods we eat and the things we
do, our hormones in our bodythat talk to our brain and our gut
and our fat cells, they becomevery dysregulated and it becomes
(11:05):
almost nearly impossible toLose significant excess weight on
your own.
Of course, we do know, wemight know somebody who's lost significant
weight and kept it off, or yousee the social media picture.
But on average, very, very fewpeople, less than 5% of people, are
successful at losingsignificant weight and keeping it
off.
(11:26):
When you're talking abouthormones, women have constant hormone
fluctuations.
They have, after havingbabies, they have the pregnancy weight
that they have a hard time losing.
Would you say that hormonescreate more of a problem for women
and maybe that they have aharder time losing weight?
Oh, that's such a good question.
(11:48):
As a whole population, studiesshow that men and women will have
similar rates of obesity.
Women will have morefluctuations over the course of their
lifetime.
And it does get harder.
I, I shared with you bothright before the call that I, I just
had my first fourth child.
So I intimately know thisdance of weight gain through pregnancy,
(12:10):
trying to get the weight, theweight off after.
And our body does change.
And every time that we havethese big changes and every time
we put on more fat, it doesbecome harder for our body to let
go of that.
One of the other things thathappens with women specifically is
through all of these lifechanges, specifically in the midlife,
changes in the perimenopauseand the menopause changes, our estrogen
(12:33):
decline will make it so thatour body composition changes.
And when body compositionchanges and we put on more fat, mass
over muscle, which alsohappens in with every year that we
age, that makes it harder tolose weight because muscle is much
more metabolically active andwill help our hormones stay in balance.
(12:56):
And so it can be a reallysignificant struggle.
The other thing that happenswith women is through our hormonal
states, such as pcos,polycystic ovary syndrome, or pregnancy,
with the fluctuations inestrogen and progesterone, it can
be very easy to put onsignificant weight.
(13:20):
And that is a scenario I'veoften found.
My patients will tell me thatevery other doctor under the sun
has just said, you're doingsomething wrong.
They're like, I'm literallynot doing anything wrong.
I've changed nothing, zero, zilch.
And I'm doing all the rightthings and my body is just working
against me.
So, yes, I think that women inthe, on the individual level just
(13:41):
have a much harder time intheir lifetime because of all of
the changes we're constantly experiencing.
Lucky us, huh?
I'm going through thatcurrently myself, I'm going through
menopause.
I sit in equipment for 14 daysstraight, 13 hours a day.
My thyroid quit working about10 years ago.
And so it's very difficult, Ifind, or I should say it's very easy
(14:05):
to gain weight.
It's almost like I look atfood and it just jumps on my body.
And there's a lot of women whoI work with who are in the same predicament.
And I haven't changed anything.
Like, I feel, you know, Idon't eat gluten.
I'm, I'm gluten, I'm a severeallergy to gluten.
I don't have dairy.
I don't eat meat.
I'm, you know, I go to the gymand it's still, it's like, oh.
My God, like, the battle is unreal.
(14:26):
Yes, yes.
And I hear that a lot.
And, and it does happen inthese transitions of life.
One of the other things thatoften I'll identify regardless of
where you are in life, is ifsomeone says to me, the weight's
just coming on and nothing has changed.
I really like to do aholistic, deep dive into their metabolic
health.
And I, I, I lay out thisframework in the book.
(14:48):
But I think it's reallyimportant just to go back to basics
with labs and really look atwhat defines metabolic health.
Because one of the things thatdevelops is often insulin resistance.
And very subtly, it willdevelop before you start seeing pre
diabetes or before you seereal blood sugar imbalances.
And that's something thatoccurs in peri and menopause.
(15:12):
And it's one of the thingsthat really makes it hard for people
to lose weight even thoughthey've shifted nothing else in their
lives.
And I make a case for reallytesting for fasting insulin and comparing
it to your fasting blood sugar.
And it's not something thatmost traditional primary care doctors
do.
And it really gives insight.
You also mentioned that youhave hypothyroidism.
(15:33):
We'll see this a lot, too,because when we start to see autoimmune
or other endocrine diseasescome on, really does interfere with
metabolism.
And it can make it very hardto move the needle on the scale.
And that's where when we say,okay, we'll treat your hypothyroidism,
well, we also might need totreat weight in the same way we might
(15:56):
need to use a medication.
And that's where these GLP1medications really have become a
game changer, because it's notjust you going into your doctor's
office and us saying, okay,well, work out harder.
I'll see you next year.
Yeah, what a frustrating thing.
It's like here we keep raisingthe bar for you.
Keep, keep trying.
Keep trying.
See ya.
Nobody wants to hear that.
(16:20):
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We want to help as many womenas possible.
For way too long, the medicalworld has kind of failed folks who
are dealing with problemslosing weight.
Many doctors have blamed theirpatients treating obesity like it's
just about laziness or a lackof willpower.
(18:34):
That mindset totally outdatedand honestly, pretty harmful and
outrageous.
Enter Dr.
Alexandra Soa.
She's an internal medicine andobesity medicine specialist who's
flipping that narrative on its head.
Dr.
Soa views obesity as a medicalcondition, a disease, not a character
flaw.
(18:54):
She's been in the game forover a decade, teaches at NYU School
of Medicine, and stays sharpon the latest science and Treatment
options.
One of the biggest breakthroughs.
She talks.
GLP1 medications like Ozempic,these aren't just buzzwords.
They're real tools that arechanging the way people approach
weight loss and even improvingother health markers.
(19:16):
If you're curious or confusedabout these meds, Dr.
Soa's new book, the OzempicRevolution, breaks it all down.
It's an honest, science backedguide to understand how these treatments
work and why the old blamegame is finally being shown the door.
Dr.
Soa, we are hearing a lotabout GLP1 meds like Ozempic and
(19:37):
people have different opinions.
Some are just giving it a badrap and some are saying, hey, it's
a game changer.
What are the misconceptions orurban myths about GLP1 medications?
Well, the first one is, isthat it is just a magic shot and
people are taking the easy wayout or you, if you take it, that
(19:59):
you don't have to do anything else.
And it couldn't be fartherfrom the truth.
And that is why I wrote thebook, because I laid out the holistic
framework that I have mypatients follow, which is how to
change habits, how to eat, howto think, how to exercise.
It's really not just here's ashot and then nothing else changes.
In fact, the medication reallydoes help trans people's behaviors.
(20:23):
They want to eat differently,they need to eat differently, they
want to start moving andexercising for the first time in
20 years.
And so there's a lot of workthat does still need to go into thriving
on these medications.
So that's really, I think, thebiggest misconception I see.
It is not the easy way out.
I think anyone who isstruggling with their weight would
(20:46):
so have preferred to haveeither the genetic genetics or the
fortune in life or thecircumstances in life that they never
had to deal with, deal withtheir weight.
So I really, really wish thatthat narrative would go away.
I think the other bigmisconception I see is that these
medications are new and wedon't know what the long term side
(21:06):
effects are.
And that is actually very false.
These medications have beenaround in use, FDA approved for almost
no at this point, 20 years.
They were released.
The first GLP1 medication wasreleased in 2005.
The evidence and the nowbacklog of 20 years of being able
(21:28):
to study patients on thesemedications for this long is so robust
and the safety profile ofthese medications is incredibly robust.
And so when people say we justdon't know what will happen when
you're on these meds, we doand you're, you'll do well.
And in fact what we now knowis that for people who are on these
(21:49):
medications, their risk of 16types of cancer is down.
They're all cause mortality isdecreased by 20%.
So is risk of stroke and heartattack and kidney disease and type
2 diabetes and sleep apneacomplications and osteoarthritis.
And honestly the list goes onand on.
Wow.
Yes.
So, so that's the big one I hear.
And I can just kind of comeright back and say that you're absolutely
(22:12):
wrong.
This is good because you heara lot of fear mongering and I think
that there's a lack ofunderstanding and people are skeptical
if they don't understand something.
What exactly do GLP1medications do with the body?
That's a great question.
So they have.
So just to take it back a step further.
(22:33):
So our body makes GLP1hormone, that's one of the hormones
that I was referencing thatbecome dysregulated over time.
So a few of the big ones thatI talk about in the book, Insulin
becomes dysregulated, wedevelop insulin resistance, we develop
something called leptinresistance that becomes dysregulated
and GLP1 also becomes dysregulated.
(22:56):
So we make this naturally inour body and we have GLP1 receptors
all over our body.
The medication is a syntheticversion of the protein of the hormone.
What makes it different thanthe version that we produce in our
bodies is that the versionthat we get through an injection
lasts much, much, much, much longer.
(23:18):
So instead of having an effectin the order of minutes on our body,
it has an effect for weeks.
And that's what has made itsuch an effective tool for us.
And how it works is it worksat the level of our brain and it
talks to our brain to quietfood noise, to not be hungry when
(23:39):
it's not necessary to be full.
What is food noise?
Oh, that's a great question.
So that's like I ever heardthat one.
So you know that littlecreeping feeling where you really
shouldn't be hungry but you'rethinking about your next snack or
you sit down to watch TV andyou can't, you know, you see the
(24:00):
ad for chips and your brainjust keeps telling you to go to the
kitchen and get chips?
Uh huh, yes.
So it's not a scientific term,but I think.
But it's a term that's beencoined by the Internet and I think
it so appropriately describeswhat this medication does, which
is just to stop that everpresent noise.
That tells you to snack andeat and constantly think about food.
(24:21):
Ah, yeah, okay.
Yeah.
It stops food cravings, essentially.
It does it very, very dramatically.
And it's not like previousanti appetite medications that we've
had.
It's even more profound than that.
It doesn't just curb your appetite.
It actually stops from a highlevel of thought of constantly thinking
(24:43):
about it.
And so this has been very effective.
Also, outside of weight andblood sugar management, these medications
are being studied fortreatment of alcohol use and opioid
and drug abuse disorder too,because it's the same part of the
brain that keeps telling youto think about alcohol or drugs or
food.
It's all connected.
(25:05):
So super interesting.
So that's the first place thatit works.
And the second place it worksis in the gut, and it slows down
our stomach emptying time.
So food sits in our stomach longer.
So in effect, it's almost asif you've had a bariatric surgery
where your stomach is smallerand the food feels more, you're fuller,
longer.
(25:25):
It really does sit there longer.
And so you just don't wantyour next meal as soon.
So that's the next way.
And then the final big waythat it works is at the level of
the pancreas.
And pancreas secretes insulin,whose job it is to scoop up blood
sugar and to take it where itneeds to go in the body.
And it really makes thisprocess very seamless.
(25:48):
And we had briefly mentionedsomething called insulin resistance.
And that's where your bodyisn't very good at regulating blood
sugar and responding quicklywith the right levels of insulin.
And.
And this medication helpsregulate that.
And when our blood sugarsremain stable, not only does that
become an effective treatmentfor things like type 2 diabetes,
but it actually becomes aneffective treatment for weight loss
(26:10):
because a stable blood sugarwill allow our body to burn its own
fat stores.
So Those are the three big superpowers.
We have GLP1 receptors allover our body.
So we are seeing even bigger benefits.
Cardiac benefits, kidneybenefits that are independent of
weight or blood sugar regulation.
But that's really kind of the short.
(26:32):
It's not so short, but that'sthe shortest I can make an answer
about what these drugs do.
You've really helped usunderstand this.
And I think that it's going toquell some of the fears out there,
because I think there's somepeople that are like, ooh, I've never
heard of this.
This doesn't sound right.
And anytime people haveacronyms that they hear, they think
it's really scary, you know, tlp.
What does that mean?
(26:53):
You know?
Yes.
So it shouldn't be scary.
I talk through this in the book.
I think that there's anappropriate level of fear around
medications.
You know, anyone who'sprobably old enough to be losing
weight does remember thingslike fen phenomen.
Right.
I call that the fen phen fiasco.
(27:14):
We had a drug released in the90s that did cause actual heart damage.
That changed the game for howwell controlled the studies needed
to be and how long and big thestudies needed to be for weight management
drugs.
And it became actually a lotharder to create and distribute and
(27:34):
to get these drugs out to market.
So I think.
I think it's appropriate tocome with a little level of skepticism.
I will say.
What makes drugs for themanagement of obesity probably different
than other diseases is thatthe thing we have to be honest about
is that there's a lot ofweight bias in the world.
And so a lot of people,whether they want to admit it or
(27:56):
not, think that a medicationor weight is.
Is cheating and it's taking aneasy way out, and it inherently must
be wrong.
And I think we've been sold awhole society that's built on selling
us programs and gym membershipand try harder and January starts
(28:17):
that it's really hard tounravel the way that our brain has
been trained over the past.
Our past lifetime.
Sure.
Who's a good candidate forGLP1 meds?
So it's pretty broad right now.
The FDA says for weightmanagement specifically, there are
two things to qualify for, andwe go by body mass index, bmi, and
(28:43):
that just takes into accountyour height and your weight.
And so anyone with a BMIgreater than 30, which puts people
into an obesity category,qualify for this medication or a
BMI of 27 with one healthcondition that would be improved
by weight loss.
And generally, if you'recarrying excess weight, I can generally
(29:04):
find one other healthcondition, whether it's this slightly
high blood pressure or backpain, sleep apnea.
And people think that obesitylooks a certain way.
But I will say that BMI of 27looks pretty normal, and so does
a BMI of 30.
And it really doesn't.
(29:24):
It doesn't matter how someone looks.
It's really about theirmetabolic health.
Haven't they changed BMIparameters over the years too?
Well, I think that there'sbeen an appropriate amount of skepticism
about bmi.
They really haven't changed parameters.
They're constantly kind ofrenaming what we call things.
Yeah, that makes it confusing, too.
(29:46):
It does make it confusing.
Body mass index does not tellus anything about someone's health.
It really just tells us therelationship between height and weight.
And it's a good screeningtool, but it doesn't get to the root
of it.
So like a bodybuilder couldhave a BMI of 27 and have truly no
body fat on them and there'snothing to lose and there are just
(30:08):
a hunk of muscle.
And then someone could have anormal BMI and have no muscle tone.
And that's not healthy either.
So really, while the FDA kindof sets these clear guidelines there,
there, we really need to lookat the person as an individual and
a better predictor.
And this is where we'll movetoward over the next, I don't know,
(30:28):
probably take medicine a while.
But the way that we're goingto move is about body composition.
So instead of looking at bmi,we should be looking really more
at body fat composition and,and your metabolic health as a predictor.
So those would be differenttests that.
The doctors would have to do then.
Yeah, yeah.
(30:49):
And it's, I don't know, thereare, there are special scales.
They're expensive and I thinkwe need to bring the costs down and
just kind of make it more accessible.
But there are actually, thereare cheaper ways to do this too.
We can use a simple oldfashioned soft measuring tape to
look at the ratio between yourbelly and your hip.
(31:09):
And that can tell us a lot,actually, about where we're carrying
our fat.
When people hear that, though,I'll tell you, even I say it out
loud and I'm kind of like, oh,I got a pit in my stomach.
People are listening to it andthey're like, you want me to measure
myself?
Is this like the 1950s?
Are you trying to give me aneating disorder?
But it can tell us a littlebit about kind of where we're carrying
(31:30):
our weight, because we do knowthat the belly fat is the type of
fat that we want to workagainst and it's not well distributed
body fat.
So BMI gives us a cutoff, butreally we need to look at the individual.
And the other part of theconversation here is that these medications
are approved for, for a few uses.
(31:50):
Now, one of them is weightmanagement, but the other, the first
FDA approval they garnered wasfor the management of type 2 diabetes.
So anyone who has type 2diabetes, regardless of weight, is
a good candidate for these medications.
Okay, so what are some of thegood habits and behaviors for patients
who want to lose weight andkeep it off?
You've had great success withyour patients.
(32:11):
So I have.
What do you recommend to them?
I would imagine it differswith every patient, but it does.
But I found after treatingthousands of patients truly on these
medications, that theframework to kind of guarantee success
has remained the same.
And I never felt great ever, ever.
(32:32):
Even when I had to do.
When I was started off mycareer and kind of more general internal
medicine, I never felt greatabout just handing someone a prescription
for any disease and saying,see you six months.
It just never felt right in my soul.
And especially when I wentexclusively into the field of weight
management, I knew my patientsneeded a lot more.
So what do they need to do?
(32:54):
I put the framework andeverything that I teach my patients
into this book, the Ozempic Revolution.
And fundamentally, theframework is habit foundations.
It's a food foundations.
It's knowing how to eat, notgoing on a diet, but knowing how
to eat to fuel yourself.
And then the third category offoundations is actually your thought
and mental foundations.
(33:15):
This is the part that I thinkis most overlooked in our society.
Weight is complicated, and theweight that we carry with us brings
emotions and trauma andhistory and a whole lifetime.
And if you aren't prepared todo some of the mental work along
this journey, I find that itcan be very difficult and unsuccessful
(33:37):
for some.
So in the book I lay out these foundations.
I think if I were to say thenumber one thing to ask yourself,
if you're listening to this,this conversation, is, is this right
for me?
I want everyone to askyourself, why would you want to do
this?
Like, why do you want to go ona weight loss journey?
Why would you want to considerthis medication?
(34:00):
And I really want you to thinkabout health and life improvements,
not vanity.
And if you can only come upwith one reason, that's vanity related,
this probably isn't right foryou because this will.
This is a lifetime that wewant to look at changing our behaviors,
not just for a singular eventor getting back into an article of
(34:21):
clothing.
And I've found that mypatients who do amazingly and are
so thrive and are so happy,their motivations were always rooted
in something that made theirlife better.
I want to be able to get onthe ground and play with my kids.
I want to avoid the diseasethat my grandparents had.
I want to be able to hike up amountain, you know, things that made
(34:41):
their life better.
Not I want to be skinny.
Makes sense.
Yeah, I got.
I have a really weird question.
Why do you call fat an organ?
Oh, because it is.
It's so powerful.
It's not Just a nuisance.
It's.
It talks to every part of yourbody, and that's actually why it's
(35:02):
so.
It causes so much disease andwhy it's so hard to get rid of and
stay off.
Because fat is a very dynamicorgan that controls hundreds of hormones
and.
Yeah, so we.
I don't think people reallyhave ever.
I've never heard it like that,and I've never really thought about
it like that.
And I think.
You know what?
You're right.
(35:24):
Well, Dr.
Soa, isn't fat also an insulator?
Yes, we need it.
So.
And like, let's say a heart asan organ, like we.
We need a heart, but you can't just.
We're not trying to get rid ofour heart.
Right.
So that's where I think peopleget a little confused about fat is.
Yes, we need fat.
And fat nourishes us, keeps uswarm, it protects us.
(35:47):
There are very healthy fats inour body, but in excess, it becomes
this dysregulated, powerfulorgan that talks to all of our other
organs, and we do want to getrid of some of it.
What does cholesterol.
How does that interact with fat?
For those that don't know?
Well, that's a good question.
So our cholesterol is in ourbloodstream and dietary.
(36:09):
This is all very confusing.
It's a good question becausedietary cholesterol is different
than the cholesterol that ourbody makes and breaks down.
And we need it.
We need cholesterol forreally, for.
To keep functioning.
It becomes a problem when wemake cholesterol and package cholesterol
in excess and it starts tobuild up in parts of our body.
(36:33):
One of my favorite componentsof cholesterol to look at that gets
so overlooked is somethingcalled triglycerides.
And triglycerides, no one everreally talks about them in the doctor's
office, but they are a part ofa fat that floats around in our bloodstream
that is actuallyrepresentative of the amount of fat
and excess calories we have,specifically from carbohydrates that's
(36:54):
floating around.
So it can be a marker kind of,of our whole metabolic health.
And there is a relationshipbetween our fat, really, because
it's an organ and it's talkingto the rest of our body of how to
process and package things andour blood cholesterol.
So as we lose weight, weactually see dynamic changes in our
cholesterol.
Some that you might.
(37:14):
That might surprise you.
In fact, as we're losingweight, our.
Our blood cholesterol cansometimes go up.
Not because we're doinganything wrong, but because we're
actually releasing fat storesand we can see a translation of higher
ldl temporarily.
It's not harmful, but we'llwe'll see it.
And so there is a relationship.
Interesting.
(37:38):
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Welcome back to Women Roadwarriors with Shelly Johnson and
Kathy Tucaro.
Try harder is not what apatient who has trouble losing weight
needs to hear.
The medical community hasblamed patients for way too long.
Dr.
Alexandra Soa knows thistreatment modality is not the way
(39:06):
to help people.
She says weight loss is verycomplicated and it's taken many decades
to adopt effective treatment regimens.
Dr.
Soa views obesity as a medicalcondition, a disease, not a character
flaw.
Part of the problem, she says,is how people have been eating and
processed and packaged foods,along with driving, more walking,
(39:27):
less and more sedentary jobshave created part of the problem.
We're a product of all of thatand obesity is a disease, not a lifestyle
or a choice.
As Dr.
Soa says, Our epigenetics havechanged and this means future generations
are carrying more weight.
The reason we can't loseweight is systemic and it's biology
(39:47):
and dysregulated hormones.
Women have more fluctuationsof that over their lifetimes.
The newest medications likeOzempic have helped with weight loss
significantly.
Dr.
Soa says they have many healthbenefits like improving longevity
and even helping with addictions.
There are too manymisconceptions about these drugs,
which have been around for 20 years.
(40:08):
Dr.
Soa knows the benefits ofGLP1s, which are what our bodies
produce naturally and have GLP receptors.
She teaches at NYU School ofMedicine and stays on top of the
latest science that helps herpatients lose weight and improve
their health.
One of the biggestbreakthroughs she talks about are
GLP1 medications like ozempicand dispels the myths and misconceptions
(40:29):
about them.
Dr.
Soa's new book, the OzempicRevolution, is super educational.
She's been educating Kathy andI with some amazing facts.
Dr.
Soa, I was watching one of.
Your interviews and you hadsome recommendations for people when
they're taking GLP1 meds.
And I don't know if it alsoapplies to people who may not be
(40:49):
taking that.
But as you talked abouthabits, food and thought, prioritizing
protein, minimizing muscleloss, focusing on hydration and don't
skipping meals.
Are these some fundamentals orare there some others that you could
add for people who are tryingto really get a handle on their weight
gain?
Yes.
(41:10):
Well, even if without thesemedications, I think following the
framework that I set out inthe book is very helpful.
I've used this framework forpatients on other medications.
I've now perfected this forpatients on GLP1 medications.
But also the, the truths of itremain true even without the medications.
(41:31):
So things like logging yourfood and making sure you're actually
hungry and making sure you'rehonoring your hunger and we're not
just eating for emotion.
That's a habit I'll go throughin the book that can be helpful on
or off these meds.
Same for my food foundations.
Protein is a very overlookedmacronutrient and we really need
(41:53):
to prioritize thatspecifically when you're on these
medications because yourappetite is down.
And we need to make sure youget the right nutrients to really
sustain, sustain you tominimize muscle loss.
But protein will help in anyweight loss plan.
I talk about a, a reallyinteresting study that came out of
Cornell a few years ago thatlooked at the order in which we eat
(42:13):
our food.
And if you just change theorder of food, you'll have big blood
sugar benefits.
And in turn, if you remember,if you keep your blood sugar more
normal and stabilized, youwill lose, you will lose weight.
So if you eat your proteinfirst and then your vegetable and
then your carb, you'll have amuch lower blood sugar than if you
(42:34):
ate the traditional meal ofthe carb first and then the vegetable
and then the protein.
So simple things of likereordering our food can really help
and yes, I think checking inwith your mental health is a big
part of it, too.
I teach a cognitive behavioraltherapy framework model in the book
which allows us to just stayhonest and true to how we're feeling
(42:56):
and making sure our brainisn't talking us out of our habit
changes.
And whether you're on a GLP1or not, you'll.
You guys will.
Will appreciate this, but ourbrain can often tell us, well, you
know, I thought today wasgoing to be a day I ate well, but
then I had a bad lunch, so Imight as well throw it out the window
and have a bad dinner, andthen I'm going to have three drinks
and a dessert, and then I'llstart tomorrow.
(43:17):
Right?
Because our brain just getsahead of us and says nothing was
worth it.
And now you might all justthrow in the towel.
Right?
Yeah, our.
Our brain has that.
You get that nasty littlevoice saying, ah, what the heck,
just do it.
Too late now.
Right.
So I think that, you know, alot of the things, and I say this
honestly in the book, a lot ofthe recommendations I give might
(43:41):
feel familiar.
The thing about being on aGLP1 medication is, is it gives people
a new lens in which to.
To execute on some of thesebehaviors, and so we can all learn
something from it.
Even if you're just curiousabout the medications, the book will
still be a helpful tool, butit really is crafted to help people
(44:01):
thrive on these medications.
Because so often the story youhear is one of, I didn't feel well
on them, or they didn't workfor me, or my sister went on them
and lost too much weight, andnow she's not eating anything.
You know, and we want to dothis in a very healthy and controlled
manner.
Why do people have those kindof outcomes where they didn't feel
good?
What's going on there?
Are they not doing what theyneed to do in.
(44:23):
In concert with the meds?
I think that there's.
I think that there are a lotof prescriptions being written in
the country either with goodintentions or not so great intentions.
You know, I think we've allprobably seen our Facebook ads pop
up with all these companiesthat are like, just log in and we'll
send you the meds.
Oh, yeah, take this simple pill.
Yeah, yeah.
And you have to be reallycareful about those because those
(44:45):
aren't nest, those aren't FDA approved.
But, but even if you aregetting the medication, I just think
traditional doctor's officesaren't set up to give you any knowledge
and information.
And also I will be honest,most doctors just don't know.
We don't learn this in medical school.
And even as an expert in thisfield, it's taken me 10 years to
really perfect exactly how Ipatient, I help patients.
(45:07):
And that's one of the reasonsI wrote this book.
Because doctors just don'thave the time, knowledge, bandwidth
to educate.
And so when it comes to sideeffects, we can really help people
get ahead of side effects,manage them, and understand how to
minimize them.
The side effects are abyproduct of how the medication works.
It is not the way that thedrug should work.
(45:29):
And if you're not feelingwell, something is off with your
dose, how you're eating andhow you're responding to the medication.
Aside from the book, Iactually created a whole product
line called so well for GLP1users because I realized that my
patients all needed product.
They needed an electrolyte,they needed a protein, they needed
(45:50):
a fiber, and they needed about15 other individual ingredients that
were based in evidence.
But I couldn't find anywhereelse there.
So I created it for them.
And, and just having theroutine of waking up and making sure
you're getting in yourelectrolyte and then even if you're
not hungry, you're getting inyour protein shake.
And then, gosh, I really can'teat my vegetables yet because they
(46:10):
don't have a very big appetite.
But I'm going to make sure toget in my fiber.
So I keep the nausea and theconstipation and the diarrhea at
bay.
Because if you don't know thatthose things are coming and you don't
know that you have to stay ontop of them, they can take over and
make the experience really complicated.
So, you know, I've even hadpatients come to me who say, I don't
think I can do this again.
(46:31):
Like, I tried it once withanother doctor.
You know, I've heard you'regreat, so I'm going to listen to
you, but I don't think so.
And just with the rightplanning of what to eat and how to
stop before you're full andhow to think about this process and
understanding how themedications work, they do great.
So it's very, very, very rare.
(46:52):
Someone really can't toleratethese meds.
Does the water intake stay the same?
About two liters a day?
That's a great question.
So you should keep up yourwater intake.
But here's the problem is thatnot only does GLP1 tell your brain
to not be hungry, it alsoquiets your Thirst mechanism, which
(47:13):
are very much related.
And so that is one of my foodrules, is that not only do you have
to make sure you're getting inprotein throughout the day, even
if you're not really hungry,you must also drink success.
64 ounces of water.
And electrolytes become a keypart of this because we get a lot
of our salt through processedfood and just food.
(47:35):
And we need salts to actuallyget water into the right parts of
our body.
So even if you're not eating alot, you can still continue to feel
well if you get enoughhydration with a solute or a salt.
And that's why I'm a bigproponent of electrolytes on this
journey.
It's a complicated process,but when you think about it, we're
nothing but a petri dish.
(47:56):
We're nothing but chemistry ina petri dish.
It's true.
And we just have to kind ofbiohack it in the right way in order
to feel well.
Absolutely.
So how much weight canpatients actually lose on a gld?
That was gonna be my next question.
Yep, that's a good one.
And people really wanna know that.
So, 1.
It depends on the individual,but on population averages.
(48:21):
Medications like Ozempic andWegovy, which are the same drug,
just have two different names.
One's for type 2 diabetesmanagement, and one is for weight
loss management.
People, on average, will loseabout 15% of their total body weight
with the newest class ofdrugs, called Tirzepatide, which
is Manjaro or Zepbound.
(48:42):
Patients will lose up to 23 to25% of their total body weight.
Okay.
It really depends on the individual.
In my practice, people get alot higher percentages because they
are doing the holistic work.
And then it's sometimesimpossible for me to know who will
(49:04):
respond to which medication better.
But really, on average, withthe newer versions, we're seeing
even more weight loss.
I do want to say one caveat tothis, is that people sometimes think
that if they go on thesemedications, that they'll achieve
truly, like, a.
Just a different body.
Like.
Like they'll be so thin orthey'll get back to high school,
(49:26):
even if high school is 50years ago.
And that's one thing that I'malways talking to my patients about.
That again, this isn't even ifwe have these big percentage of numbers.
We're doing this for health,not for thinness.
And we have to be realistic inour expectations of what they can
do.
Yeah, that's where people are.
They're seeing Stuff on socialmedia, it's like, hey, I want to
look like her.
You know, it's like, if youdidn't have an hourglass figure to
(49:50):
begin with.
You probably won't now.
Right, Right.
And every year that we age,our body changes.
Even if we were to stay at thesame weight where our breasts are
and our fat distribution andwe age, we age.
And so people need to, to berealistic, I talk about this in the
(50:10):
book, but sometimes, sometimespeople need to actually work with
a therapist toward the end oftheir weight loss journey, because
even though they've achievedeverything that they could possibly
achieve through health andweight loss, they're still.
They still need to workthrough some of that kind of what,
disappointment, and makingsure that we're not fostering any
(50:31):
sort of body dysmorphia, whichis where we're not enjoying our body
because it doesn't look aparticular way.
And we have a lot of work on asociety to still do there.
Oh, yeah.
Unrealistic expectations, for sure.
Now, is this covered by insurance?
And how do patients get theirinsurance company to cover it?
Because that's always aproblem, too.
Yes.
So this is a great andexcellent question.
(50:53):
And right now, there is a billsitting in Congress, actually, not
a bill.
It's a proposed rule that willallow Medicare and Medicaid to cover
these medications, which is avery big deal.
And if that passes, we'regoing to see a pretty profound decrease
in the cost of thesemedications for everyone.
And so I'm really pulling for that.
(51:14):
And you have an opportunity asa listener to let your Congress people
know that you are in supportof this and your senators and anyone
who will listen that you're insupport of it.
Really?
That's, in my opinion, whereit needs to start.
Insurance companies,unfortunately, have a little bit
too much power right now inthe fact that, that they both set
(51:35):
the prices for the medicationsand dictate coverage for them.
I am surprised they're allowedto do that, and they really should
be.
And it's a really big problemthat needs reform.
And unfortunately, this is thebiggest problem right now I have
with these medications is thatthey are for the.
Approved for the use ofchronic disease management, meaning
(51:58):
once you start them, we knowthat you, you will likely need to
cover them.
We didn't, we didn't talkabout that on this podcast, but that
is the truth.
And right now, unfortunately,insurance companies, they're.
They're really playing Godhere where they're giving coverage
and then they're taking it away.
Oh, yeah.
And that's just true malpractice.
And if I did that as a doctorand just willy nilly took it away,
(52:19):
that's just.
We know that that leads toworse outcomes.
And so I.
That's the biggest problem I have.
So these meds are expensive.
In Europe, they are about afifth to a sixth of the price per
month than what we establish here.
So we know costs can come downand we all need to continue to put
pressure on the government,the pharma companies, but really
the insurance companies, in myopinion right now are playing with
(52:43):
us.
Many commercial plans willhave coverage of these and some state
and federal plans will.
But unfortunately, there'sjust a big gap right now.
And I can't.
I can't tell you which ones.
People come to me all the time.
They're like, I have Blue Cross.
Will it cover it?
And I'm like, I don't know.
It's so complicated.
Oh, it really is.
You have to take a collegecourse to understand the coverages.
(53:05):
And they can change all the time.
It's really a nightmare.
It is, it is.
And that discourages good healthcare.
And it's wrong.
So, I mean, that's another subject.
You don't want me getting onthat soapbox, trust me.
I was like, I totally agreewith you, Dr.
Soa.
Where do people find your book?
I mean, you cover everything.
You even have some reciperecommendations, which is simple,
(53:27):
easy meals when you don't feellike eating, that kind of thing,
as well as a guide to dining out.
That's a godsend, too.
Well, I really, I puteverything in here that I've given
to my patients.
Again, this framework that Iknew people needed.
It just wasn't out in theworld yet.
So I wrote this book with HarperCollins.
You can buy it wherever booksare sold, always.
I encourage you to supportyour independent bookseller, but
(53:50):
you can also get it on Amazon.
I love hearing from peoplewhen they get it.
So you can find me on socialmedia too, @AlexandroSoamd.
And I love seeing pictures ofthe book out in the wild.
I love this.
You have been so educational.
You've changed my opinion onsome things, too.
I mean, I didn't have the knowledge.
Now I'm convinced.
Okay.
This makes sense, you know, itreally is.
(54:11):
Yeah.
Thank you.
That's.
So, that's, that's the bestthing I can do is just to provide
education and support to avery complicated issue that a lot
of people grapple with.
So thank you for that.
This is.
This is great.
This is absolutely great.
Yes.
People need to go out and getyour book the Ozempic Revolution.
Can they also get it onAmazon, places like that?
(54:33):
Yes, go go to Amazon and youcan get Kindle or or Audible.
I narrated.
So if my voice on this podcastwas enjoyable to you, you can go
find my.
You can go listen to me in my book.
And I really enjoyed thatprocess too, because again, I think
that this is just a complexemotional journey and if I could
(54:54):
be the doctor in your earhelping you along, I'm very happy
to do so.
That's excellent.
You have been a wealth of knowledge.
Thank you so much.
What a great guest.
Thank you so much.
Yes, thank you Dr.
Soa.
We hope you've enjoyed thislatest episode.
And if you want to hear moreepisodes of Women Road warriors or
learn.
More about our show, be sureto check out womenroadwarriors.com
(55:18):
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And don't forget to subscribeto our.
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You've been listeningListening to Women Road warriors
with Shelly Johnson and Kathy Tucaro.
(56:03):
If you want to be a guest onthe show or have a topic or feedback,
email us@sjohnsonomenroadwarriors.com.
This is Women Road warriorswith Shelly Johnson and Kathy Tucaro.
From the corporate office tothe cab of a truck, they're here
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So gear down, sit back and enjoy.
(00:24):
Welcome.
We're an award winning showdedicated to empowering women in
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No topics off limits.
On our show, we power women on.
The road to success withexpert and.
Celebrity interviews andinformation you need.
I'm Shelley.
And I'm Kathy.
(00:44):
When it comes to weight loss,doctors have quite often played the
blame game with their patients.
They've regarded obesity as alack of willpower.
Too many have even regardedpatients as victims of their own
sloth or ignorance.
Shocking, isn't it?
These are terribleperspectives that marginalize patients.
Dr.
Alexandra Soa is an obesityspecialist whose patients have had
(01:07):
great and successful outcomes.
She doesn't buy into these perspectives.
She says obesity is a fact ofbiology and is a disease state.
There's no blame to be assigned.
Dr.
Soa is up on the latest weightloss breakthroughs and techniques.
Through over 10 years ofpractice and as a clinical instructor
at NYU School of Medicine, Dr.
Soa has developed a profoundunderstanding of the biology of obesity
(01:31):
and how to treat it with toolslike GLP1 agonist medications.
She says products like GLP1meds like Ozempic are game changers
and can also have health benefits.
Her new book, the OzempicRevolution offers answers and clears
up any confusion people mayhave about GLP1s, which many people
don't totally understand.
(01:52):
Dr.
So has been interviewed bymajor media outlets, most recently
on Good Morning America.
Dr.
Soa is with us today toeducate us.
Welcome Dr.
Soa.
Thank you so much for being onthe show with us.
Thank you so much for having me.
Absolutely.
It's great to have you.
Are you kidding me?
Awesome.
This is going to be so enlightening.
(02:12):
Before we cover your tips onhow to successfully lose weight and
keep it off, as well aseducate us on GLP1 medications, I
wanted listeners to know moreabout you, what's your background
and what exactly do you do?
So, as you so nicelydescribed, I am a dual board certified
doctor of internal medicineand of obesity medicine.
(02:34):
So I am a pretty niche doctorand for the past 10 years, I've been
helping people to achievehealth through weight loss.
And I take a very scientificapproach to this.
And this all started from myundergraduate degree at Johns Hopkins
and then through my medicaltraining at nyu.
I always wanted to be anevidence based doctor, but what I
(02:58):
wanted to do was to preventdisease, not just treat end stage
disease, which is often somuch of our medical care in the United
States is really focused onend stage disease management.
And I was like, there has tobe a better way.
So as I was really coming tofind what specialty I was going to
pursue, I found this verynascent early stage field called
(03:20):
obesity medicine.
And I was so fortunate tobecome an early adopter in this field.
And that has led me to beusing GLP1 medications and all of
the most modern techniques forweight management over the past 10
years and has really allowedme to kind of emerge as someone who
says, hey, these meds aren't new.
(03:42):
I've been using them for along time and here is my framework.
And that's how this book cameto be.
It's super informative and Ithink it's going to be a game changer
for a lot of people whofinally can lose weight and keep
it off.
Your first chapter says tryharder is terrible medical advice.
Is this the typical banter of doctors?
(04:02):
I mean, that could be superdiscouraging to patients who really
are trying?
Oh, yes.
I mean, I think every singleperson who is listening right now
who has ever had any weight tolose knows that they had weight to
lose.
And to go into the doctor'soffice and to say, hey, I've put
on £15 and I don't know why,and I'm trying and to be met with
(04:25):
just, you know, eat less,exercise more, it is so disheartening.
And unfortunately, that'sreally what we were taught in medical
school Even up to 15, 20 yearsago, you know, that was just what
we learned.
It was the patient wasn'tdoing the right things, they must
be overeating calories,they're not moving their body enough.
(04:46):
So just give them this adviceto try harder and hopefully it works.
And we just know that that'snot true.
Because when you look aroundand doctors are struggling with their
weight and everybody isstruggling with their weight, it
can't be that we're just abunch of, you know, slovenly people
if that's just not it.
Weight loss is very, very complicated.
(05:07):
And it's taken quite a fewdecades for us to translate the research
of obesity and understandingthat it is disease to the wider public
and in turn, even to medicine.
Medicine is very slow to adopt.
Actually, what we know to betrue, there is a widely cited study
that says it takes about 17years for medicine and doctors to
(05:32):
give the most updated advice.
So we've known for a whilethat Obesity is a disease and we
actually had effectivemedications to help manage the disease.
But instead, so many of ushave heard and continue to hear,
just, you know, try harder.
And it really doesn't work.
No.
And people get caught up inthis vicious cycle.
(05:55):
They go to every kind ofweight loss program they can think
of, they spend thousands andthousands of dollars and they lose
it, and then they gain it back.
And of course, then you'rehearing on the news the obesity percentages
in North America.
Is it true that there are morepeople who have an obesity issue
today than say, 50 years ago?
(06:15):
Absolutely.
So about 50 years ago, about1980, we started to have a very significant
inflection point of the ratesof obesity in this country.
And steadily every year theywould climb.
Only recently have, just thisyear, probably in thanks to these
(06:36):
new medications, have westarted to see a decline, subtly
and not across all groups, butin some.
But since 1980, we have gonefrom a population that had about
15% obesity to nearly 50.
Wow.
Yes.
Yes.
So why is that?
Well, I talk about this in the book.
It is complex and there is noone answer.
(07:00):
What did happen around thattime is we started to have big changes
in our environment and what wewere eating.
So we started having a lotmore packaged food.
The government came in andstarted subsidizing corn, and that
corn byproduct made its wayinto a lot of our packaged food.
(07:21):
We were trying to solve for aproblem of how do we feed everybody,
like, how do we feed people?
And processed foods andpackaged foods became some of that
solution.
So that was one part of it.
Our environment started to change.
Instead of walking two milesto the bus stop, you started driving
more widely.
Our jobs shifted from jobs inwhich we were more active to ones
(07:45):
in which we were more sedentary.
And then this problem has onlygotten worse and worse and worse
as we all sit on our computersand we have telehealth.
And, you know, that's what Ido now instead of working in a clinic
and our screens and ourdevices and we started to move out
to the burbs and we were lessurban centric.
So a lot going on, a lot.
(08:07):
And we really can't pinpointit on one thing.
Something that has alsohappened, and I talk about this in
the book, is our geneticscan't change over one to two generations,
but the genes that sit on topof our genes do, the epigenetics.
And so as we get heavier, ournext generations also get heavier
(08:29):
by what we pass down to them.
So even in utero, what we'reexposed to.
If our mothers are carryingmore weight than they did in previous
generations and we're set tocarry more weight, it's.
It's pretty remarkable.
So it's kind of been thissnowball effect.
That's interesting.
I'd not heard of that.
Epigenetics.
Epigenetics.
(08:49):
Epigenetics.
Interesting.
You know, I think a lot ofpeople trying to lose weight feel
like they're, they're so muchalone with that many people who are
struggling.
It is not a minority.
People everywhere are fightingweight loss and trying to keep it
off.
Why is it so many people can'tlose weight and keep it off?
(09:10):
What are the biggest reasons?
Well, I think kind of comingback to this idea that it's biology
and even this concept, I justtold you about this, it's fascinating.
Epigenetics or genetics or theenvironment and all of these reasons
of what, why this hashappened, they're big systemic problems
and they're not somethingthat's easily solvable on an individual
(09:31):
level.
And I said this, I think it'sreally important for people to understand
why weight loss is so complicated.
And if you're consideringgoing on a GLP1 medication to really
understand the whole process.
And so in the book the OICRevolution, I really discuss this
and I move people through thescience of obesity, the science of
these drugs, before we get tohow do you make yourself successful?
(09:54):
Because it's so complicated.
And I want people to know thatthis is not a failure of you as an
individual.
This is a much bigger problem.
The, the answer to yourquestion of why is it so hard?
Is that our body is workingagainst us to constantly get back
up to its highest set point weight.
(10:16):
So even if we start in a nicelean style state, if every year we're
putting on five pounds andthen in between we take off seven
and then put on ten and thentake off two, we constantly, our
body wants to put more weighton and this comes down to hormones.
And we discuss this in the book.
But really, obesity, yes, ithas something to do with what we've
(10:41):
done in our lifetime, youknow, what we've eaten and if we've
moved or not, but much biggerthan that, it's a balance of hormones.
And as weight comes on and theenvironment around us encourages
the weight to come on through,the foods we eat and the things we
do, our hormones in our bodythat talk to our brain and our gut
and our fat cells, they becomevery dysregulated and it becomes
(11:05):
almost nearly impossible toLose significant excess weight on
your own.
Of course, we do know, wemight know somebody who's lost significant
weight and kept it off, or yousee the social media picture.
But on average, very, very fewpeople, less than 5% of people, are
successful at losingsignificant weight and keeping it
off.
(11:26):
When you're talking abouthormones, women have constant hormone
fluctuations.
They have, after havingbabies, they have the pregnancy weight
that they have a hard time losing.
Would you say that hormonescreate more of a problem for women
and maybe that they have aharder time losing weight?
Oh, that's such a good question.
(11:48):
As a whole population, studiesshow that men and women will have
similar rates of obesity.
Women will have morefluctuations over the course of their
lifetime.
And it does get harder.
I, I shared with you bothright before the call that I, I just
had my first fourth child.
So I intimately know thisdance of weight gain through pregnancy,
(12:10):
trying to get the weight, theweight off after.
And our body does change.
And every time that we havethese big changes and every time
we put on more fat, it doesbecome harder for our body to let
go of that.
One of the other things thathappens with women specifically is
through all of these lifechanges, specifically in the midlife,
changes in the perimenopauseand the menopause changes, our estrogen
(12:33):
decline will make it so thatour body composition changes.
And when body compositionchanges and we put on more fat, mass
over muscle, which alsohappens in with every year that we
age, that makes it harder tolose weight because muscle is much
more metabolically active andwill help our hormones stay in balance.
(12:56):
And so it can be a reallysignificant struggle.
The other thing that happenswith women is through our hormonal
states, such as pcos,polycystic ovary syndrome, or pregnancy,
with the fluctuations inestrogen and progesterone, it can
be very easy to put onsignificant weight.
(13:20):
And that is a scenario I'veoften found.
My patients will tell me thatevery other doctor under the sun
has just said, you're doingsomething wrong.
They're like, I'm literallynot doing anything wrong.
I've changed nothing, zero, zilch.
And I'm doing all the rightthings and my body is just working
against me.
So, yes, I think that women inthe, on the individual level just
(13:41):
have a much harder time intheir lifetime because of all of
the changes we're constantly experiencing.
Lucky us, huh?
I'm going through thatcurrently myself, I'm going through
menopause.
I sit in equipment for 14 daysstraight, 13 hours a day.
My thyroid quit working about10 years ago.
And so it's very difficult, Ifind, or I should say it's very easy
(14:05):
to gain weight.
It's almost like I look atfood and it just jumps on my body.
And there's a lot of women whoI work with who are in the same predicament.
And I haven't changed anything.
Like, I feel, you know, Idon't eat gluten.
I'm, I'm gluten, I'm a severeallergy to gluten.
I don't have dairy.
I don't eat meat.
I'm, you know, I go to the gymand it's still, it's like, oh.
My God, like, the battle is unreal.
(14:26):
Yes, yes.
And I hear that a lot.
And, and it does happen inthese transitions of life.
One of the other things thatoften I'll identify regardless of
where you are in life, is ifsomeone says to me, the weight's
just coming on and nothing has changed.
I really like to do aholistic, deep dive into their metabolic
health.
And I, I, I lay out thisframework in the book.
(14:48):
But I think it's reallyimportant just to go back to basics
with labs and really look atwhat defines metabolic health.
Because one of the things thatdevelops is often insulin resistance.
And very subtly, it willdevelop before you start seeing pre
diabetes or before you seereal blood sugar imbalances.
And that's something thatoccurs in peri and menopause.
(15:12):
And it's one of the thingsthat really makes it hard for people
to lose weight even thoughthey've shifted nothing else in their
lives.
And I make a case for reallytesting for fasting insulin and comparing
it to your fasting blood sugar.
And it's not something thatmost traditional primary care doctors
do.
And it really gives insight.
You also mentioned that youhave hypothyroidism.
(15:33):
We'll see this a lot, too,because when we start to see autoimmune
or other endocrine diseasescome on, really does interfere with
metabolism.
And it can make it very hardto move the needle on the scale.
And that's where when we say,okay, we'll treat your hypothyroidism,
well, we also might need totreat weight in the same way we might
(15:56):
need to use a medication.
And that's where these GLP1medications really have become a
game changer, because it's notjust you going into your doctor's
office and us saying, okay,well, work out harder.
I'll see you next year.
Yeah, what a frustrating thing.
It's like here we keep raisingthe bar for you.
Keep, keep trying.
Keep trying.
See ya.
Nobody wants to hear that.
(16:20):
Stay tuned for more of WomenRoad warriors coming up.
Dean Michael, the tax doctor here.
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(17:28):
Welcome back to Women Roadwarriors with Shelly Johnson and
Kathy Tak.
If you're enjoying thisinformative episode of Women Road
Warriors, I wanted to mentionKathy and I explore all kinds of
topics that will power you onthe road to success.
We feature a lot of expert interviews.
Plus we feature celebritiesand women who've been trailblazers.
(17:52):
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(18:12):
We're on Twitter, Facebook,Instagram, Pinterest, LinkedIn, YouTube
and other sites and tellothers about us.
We want to help as many womenas possible.
For way too long, the medicalworld has kind of failed folks who
are dealing with problemslosing weight.
Many doctors have blamed theirpatients treating obesity like it's
just about laziness or a lackof willpower.
(18:34):
That mindset totally outdatedand honestly, pretty harmful and
outrageous.
Enter Dr.
Alexandra Soa.
She's an internal medicine andobesity medicine specialist who's
flipping that narrative on its head.
Dr.
Soa views obesity as a medicalcondition, a disease, not a character
flaw.
(18:54):
She's been in the game forover a decade, teaches at NYU School
of Medicine, and stays sharpon the latest science and Treatment
options.
One of the biggest breakthroughs.
She talks.
GLP1 medications like Ozempic,these aren't just buzzwords.
They're real tools that arechanging the way people approach
weight loss and even improvingother health markers.
(19:16):
If you're curious or confusedabout these meds, Dr.
Soa's new book, the OzempicRevolution, breaks it all down.
It's an honest, science backedguide to understand how these treatments
work and why the old blamegame is finally being shown the door.
Dr.
Soa, we are hearing a lotabout GLP1 meds like Ozempic and
(19:37):
people have different opinions.
Some are just giving it a badrap and some are saying, hey, it's
a game changer.
What are the misconceptions orurban myths about GLP1 medications?
Well, the first one is, isthat it is just a magic shot and
people are taking the easy wayout or you, if you take it, that
(19:59):
you don't have to do anything else.
And it couldn't be fartherfrom the truth.
And that is why I wrote thebook, because I laid out the holistic
framework that I have mypatients follow, which is how to
change habits, how to eat, howto think, how to exercise.
It's really not just here's ashot and then nothing else changes.
In fact, the medication reallydoes help trans people's behaviors.
(20:23):
They want to eat differently,they need to eat differently, they
want to start moving andexercising for the first time in
20 years.
And so there's a lot of workthat does still need to go into thriving
on these medications.
So that's really, I think, thebiggest misconception I see.
It is not the easy way out.
I think anyone who isstruggling with their weight would
(20:46):
so have preferred to haveeither the genetic genetics or the
fortune in life or thecircumstances in life that they never
had to deal with, deal withtheir weight.
So I really, really wish thatthat narrative would go away.
I think the other bigmisconception I see is that these
medications are new and wedon't know what the long term side
(21:06):
effects are.
And that is actually very false.
These medications have beenaround in use, FDA approved for almost
no at this point, 20 years.
They were released.
The first GLP1 medication wasreleased in 2005.
The evidence and the nowbacklog of 20 years of being able
(21:28):
to study patients on thesemedications for this long is so robust
and the safety profile ofthese medications is incredibly robust.
And so when people say we justdon't know what will happen when
you're on these meds, we doand you're, you'll do well.
And in fact what we now knowis that for people who are on these
(21:49):
medications, their risk of 16types of cancer is down.
They're all cause mortality isdecreased by 20%.
So is risk of stroke and heartattack and kidney disease and type
2 diabetes and sleep apneacomplications and osteoarthritis.
And honestly the list goes onand on.
Wow.
Yes.
So, so that's the big one I hear.
And I can just kind of comeright back and say that you're absolutely
(22:12):
wrong.
This is good because you heara lot of fear mongering and I think
that there's a lack ofunderstanding and people are skeptical
if they don't understand something.
What exactly do GLP1medications do with the body?
That's a great question.
So they have.
So just to take it back a step further.
(22:33):
So our body makes GLP1hormone, that's one of the hormones
that I was referencing thatbecome dysregulated over time.
So a few of the big ones thatI talk about in the book, Insulin
becomes dysregulated, wedevelop insulin resistance, we develop
something called leptinresistance that becomes dysregulated
and GLP1 also becomes dysregulated.
(22:56):
So we make this naturally inour body and we have GLP1 receptors
all over our body.
The medication is a syntheticversion of the protein of the hormone.
What makes it different thanthe version that we produce in our
bodies is that the versionthat we get through an injection
lasts much, much, much, much longer.
(23:18):
So instead of having an effectin the order of minutes on our body,
it has an effect for weeks.
And that's what has made itsuch an effective tool for us.
And how it works is it worksat the level of our brain and it
talks to our brain to quietfood noise, to not be hungry when
(23:39):
it's not necessary to be full.
What is food noise?
Oh, that's a great question.
So that's like I ever heardthat one.
So you know that littlecreeping feeling where you really
shouldn't be hungry but you'rethinking about your next snack or
you sit down to watch TV andyou can't, you know, you see the
(24:00):
ad for chips and your brainjust keeps telling you to go to the
kitchen and get chips?
Uh huh, yes.
So it's not a scientific term,but I think.
But it's a term that's beencoined by the Internet and I think
it so appropriately describeswhat this medication does, which
is just to stop that everpresent noise.
That tells you to snack andeat and constantly think about food.
(24:21):
Ah, yeah, okay.
Yeah.
It stops food cravings, essentially.
It does it very, very dramatically.
And it's not like previousanti appetite medications that we've
had.
It's even more profound than that.
It doesn't just curb your appetite.
It actually stops from a highlevel of thought of constantly thinking
(24:43):
about it.
And so this has been very effective.
Also, outside of weight andblood sugar management, these medications
are being studied fortreatment of alcohol use and opioid
and drug abuse disorder too,because it's the same part of the
brain that keeps telling youto think about alcohol or drugs or
food.
It's all connected.
(25:05):
So super interesting.
So that's the first place thatit works.
And the second place it worksis in the gut, and it slows down
our stomach emptying time.
So food sits in our stomach longer.
So in effect, it's almost asif you've had a bariatric surgery
where your stomach is smallerand the food feels more, you're fuller,
longer.
(25:25):
It really does sit there longer.
And so you just don't wantyour next meal as soon.
So that's the next way.
And then the final big waythat it works is at the level of
the pancreas.
And pancreas secretes insulin,whose job it is to scoop up blood
sugar and to take it where itneeds to go in the body.
And it really makes thisprocess very seamless.
(25:48):
And we had briefly mentionedsomething called insulin resistance.
And that's where your bodyisn't very good at regulating blood
sugar and responding quicklywith the right levels of insulin.
And.
And this medication helpsregulate that.
And when our blood sugarsremain stable, not only does that
become an effective treatmentfor things like type 2 diabetes,
but it actually becomes aneffective treatment for weight loss
(26:10):
because a stable blood sugarwill allow our body to burn its own
fat stores.
So Those are the three big superpowers.
We have GLP1 receptors allover our body.
So we are seeing even bigger benefits.
Cardiac benefits, kidneybenefits that are independent of
weight or blood sugar regulation.
But that's really kind of the short.
(26:32):
It's not so short, but that'sthe shortest I can make an answer
about what these drugs do.
You've really helped usunderstand this.
And I think that it's going toquell some of the fears out there,
because I think there's somepeople that are like, ooh, I've never
heard of this.
This doesn't sound right.
And anytime people haveacronyms that they hear, they think
it's really scary, you know, tlp.
What does that mean?
(26:53):
You know?
Yes.
So it shouldn't be scary.
I talk through this in the book.
I think that there's anappropriate level of fear around
medications.
You know, anyone who'sprobably old enough to be losing
weight does remember thingslike fen phenomen.
Right.
I call that the fen phen fiasco.
(27:14):
We had a drug released in the90s that did cause actual heart damage.
That changed the game for howwell controlled the studies needed
to be and how long and big thestudies needed to be for weight management
drugs.
And it became actually a lotharder to create and distribute and
(27:34):
to get these drugs out to market.
So I think.
I think it's appropriate tocome with a little level of skepticism.
I will say.
What makes drugs for themanagement of obesity probably different
than other diseases is thatthe thing we have to be honest about
is that there's a lot ofweight bias in the world.
And so a lot of people,whether they want to admit it or
(27:56):
not, think that a medicationor weight is.
Is cheating and it's taking aneasy way out, and it inherently must
be wrong.
And I think we've been sold awhole society that's built on selling
us programs and gym membershipand try harder and January starts
(28:17):
that it's really hard tounravel the way that our brain has
been trained over the past.
Our past lifetime.
Sure.
Who's a good candidate forGLP1 meds?
So it's pretty broad right now.
The FDA says for weightmanagement specifically, there are
two things to qualify for, andwe go by body mass index, bmi, and
(28:43):
that just takes into accountyour height and your weight.
And so anyone with a BMIgreater than 30, which puts people
into an obesity category,qualify for this medication or a
BMI of 27 with one healthcondition that would be improved
by weight loss.
And generally, if you'recarrying excess weight, I can generally
(29:04):
find one other healthcondition, whether it's this slightly
high blood pressure or backpain, sleep apnea.
And people think that obesitylooks a certain way.
But I will say that BMI of 27looks pretty normal, and so does
a BMI of 30.
And it really doesn't.
(29:24):
It doesn't matter how someone looks.
It's really about theirmetabolic health.
Haven't they changed BMIparameters over the years too?
Well, I think that there'sbeen an appropriate amount of skepticism
about bmi.
They really haven't changed parameters.
They're constantly kind ofrenaming what we call things.
Yeah, that makes it confusing, too.
(29:46):
It does make it confusing.
Body mass index does not tellus anything about someone's health.
It really just tells us therelationship between height and weight.
And it's a good screeningtool, but it doesn't get to the root
of it.
So like a bodybuilder couldhave a BMI of 27 and have truly no
body fat on them and there'snothing to lose and there are just
(30:08):
a hunk of muscle.
And then someone could have anormal BMI and have no muscle tone.
And that's not healthy either.
So really, while the FDA kindof sets these clear guidelines there,
there, we really need to lookat the person as an individual and
a better predictor.
And this is where we'll movetoward over the next, I don't know,
(30:28):
probably take medicine a while.
But the way that we're goingto move is about body composition.
So instead of looking at bmi,we should be looking really more
at body fat composition and,and your metabolic health as a predictor.
So those would be differenttests that.
The doctors would have to do then.
Yeah, yeah.
(30:49):
And it's, I don't know, thereare, there are special scales.
They're expensive and I thinkwe need to bring the costs down and
just kind of make it more accessible.
But there are actually, thereare cheaper ways to do this too.
We can use a simple oldfashioned soft measuring tape to
look at the ratio between yourbelly and your hip.
(31:09):
And that can tell us a lot,actually, about where we're carrying
our fat.
When people hear that, though,I'll tell you, even I say it out
loud and I'm kind of like, oh,I got a pit in my stomach.
People are listening to it andthey're like, you want me to measure
myself?
Is this like the 1950s?
Are you trying to give me aneating disorder?
But it can tell us a littlebit about kind of where we're carrying
(31:30):
our weight, because we do knowthat the belly fat is the type of
fat that we want to workagainst and it's not well distributed
body fat.
So BMI gives us a cutoff, butreally we need to look at the individual.
And the other part of theconversation here is that these medications
are approved for, for a few uses.
(31:50):
Now, one of them is weightmanagement, but the other, the first
FDA approval they garnered wasfor the management of type 2 diabetes.
So anyone who has type 2diabetes, regardless of weight, is
a good candidate for these medications.
Okay, so what are some of thegood habits and behaviors for patients
who want to lose weight andkeep it off?
You've had great success withyour patients.
(32:11):
So I have.
What do you recommend to them?
I would imagine it differswith every patient, but it does.
But I found after treatingthousands of patients truly on these
medications, that theframework to kind of guarantee success
has remained the same.
And I never felt great ever, ever.
(32:32):
Even when I had to do.
When I was started off mycareer and kind of more general internal
medicine, I never felt greatabout just handing someone a prescription
for any disease and saying,see you six months.
It just never felt right in my soul.
And especially when I wentexclusively into the field of weight
management, I knew my patientsneeded a lot more.
So what do they need to do?
(32:54):
I put the framework andeverything that I teach my patients
into this book, the Ozempic Revolution.
And fundamentally, theframework is habit foundations.
It's a food foundations.
It's knowing how to eat, notgoing on a diet, but knowing how
to eat to fuel yourself.
And then the third category offoundations is actually your thought
and mental foundations.
(33:15):
This is the part that I thinkis most overlooked in our society.
Weight is complicated, and theweight that we carry with us brings
emotions and trauma andhistory and a whole lifetime.
And if you aren't prepared todo some of the mental work along
this journey, I find that itcan be very difficult and unsuccessful
(33:37):
for some.
So in the book I lay out these foundations.
I think if I were to say thenumber one thing to ask yourself,
if you're listening to this,this conversation, is, is this right
for me?
I want everyone to askyourself, why would you want to do
this?
Like, why do you want to go ona weight loss journey?
Why would you want to considerthis medication?
(34:00):
And I really want you to thinkabout health and life improvements,
not vanity.
And if you can only come upwith one reason, that's vanity related,
this probably isn't right foryou because this will.
This is a lifetime that wewant to look at changing our behaviors,
not just for a singular eventor getting back into an article of
(34:21):
clothing.
And I've found that mypatients who do amazingly and are
so thrive and are so happy,their motivations were always rooted
in something that made theirlife better.
I want to be able to get onthe ground and play with my kids.
I want to avoid the diseasethat my grandparents had.
I want to be able to hike up amountain, you know, things that made
(34:41):
their life better.
Not I want to be skinny.
Makes sense.
Yeah, I got.
I have a really weird question.
Why do you call fat an organ?
Oh, because it is.
It's so powerful.
It's not Just a nuisance.
It's.
It talks to every part of yourbody, and that's actually why it's
(35:02):
so.
It causes so much disease andwhy it's so hard to get rid of and
stay off.
Because fat is a very dynamicorgan that controls hundreds of hormones
and.
Yeah, so we.
I don't think people reallyhave ever.
I've never heard it like that,and I've never really thought about
it like that.
And I think.
You know what?
You're right.
(35:24):
Well, Dr.
Soa, isn't fat also an insulator?
Yes, we need it.
So.
And like, let's say a heart asan organ, like we.
We need a heart, but you can't just.
We're not trying to get rid ofour heart.
Right.
So that's where I think peopleget a little confused about fat is.
Yes, we need fat.
And fat nourishes us, keeps uswarm, it protects us.
(35:47):
There are very healthy fats inour body, but in excess, it becomes
this dysregulated, powerfulorgan that talks to all of our other
organs, and we do want to getrid of some of it.
What does cholesterol.
How does that interact with fat?
For those that don't know?
Well, that's a good question.
So our cholesterol is in ourbloodstream and dietary.
(36:09):
This is all very confusing.
It's a good question becausedietary cholesterol is different
than the cholesterol that ourbody makes and breaks down.
And we need it.
We need cholesterol forreally, for.
To keep functioning.
It becomes a problem when wemake cholesterol and package cholesterol
in excess and it starts tobuild up in parts of our body.
(36:33):
One of my favorite componentsof cholesterol to look at that gets
so overlooked is somethingcalled triglycerides.
And triglycerides, no one everreally talks about them in the doctor's
office, but they are a part ofa fat that floats around in our bloodstream
that is actuallyrepresentative of the amount of fat
and excess calories we have,specifically from carbohydrates that's
(36:54):
floating around.
So it can be a marker kind of,of our whole metabolic health.
And there is a relationshipbetween our fat, really, because
it's an organ and it's talkingto the rest of our body of how to
process and package things andour blood cholesterol.
So as we lose weight, weactually see dynamic changes in our
cholesterol.
Some that you might.
(37:14):
That might surprise you.
In fact, as we're losingweight, our.
Our blood cholesterol cansometimes go up.
Not because we're doinganything wrong, but because we're
actually releasing fat storesand we can see a translation of higher
ldl temporarily.
It's not harmful, but we'llwe'll see it.
And so there is a relationship.
Interesting.
(37:38):
Stay tuned for more of WomenRoad warriors coming up.
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(38:46):
Welcome back to Women Roadwarriors with Shelly Johnson and
Kathy Tucaro.
Try harder is not what apatient who has trouble losing weight
needs to hear.
The medical community hasblamed patients for way too long.
Dr.
Alexandra Soa knows thistreatment modality is not the way
(39:06):
to help people.
She says weight loss is verycomplicated and it's taken many decades
to adopt effective treatment regimens.
Dr.
Soa views obesity as a medicalcondition, a disease, not a character
flaw.
Part of the problem, she says,is how people have been eating and
processed and packaged foods,along with driving, more walking,
(39:27):
less and more sedentary jobshave created part of the problem.
We're a product of all of thatand obesity is a disease, not a lifestyle
or a choice.
As Dr.
Soa says, Our epigenetics havechanged and this means future generations
are carrying more weight.
The reason we can't loseweight is systemic and it's biology
(39:47):
and dysregulated hormones.
Women have more fluctuationsof that over their lifetimes.
The newest medications likeOzempic have helped with weight loss
significantly.
Dr.
Soa says they have many healthbenefits like improving longevity
and even helping with addictions.
There are too manymisconceptions about these drugs,
which have been around for 20 years.
(40:08):
Dr.
Soa knows the benefits ofGLP1s, which are what our bodies
produce naturally and have GLP receptors.
She teaches at NYU School ofMedicine and stays on top of the
latest science that helps herpatients lose weight and improve
their health.
One of the biggestbreakthroughs she talks about are
GLP1 medications like ozempicand dispels the myths and misconceptions
(40:29):
about them.
Dr.
Soa's new book, the OzempicRevolution, is super educational.
She's been educating Kathy andI with some amazing facts.
Dr.
Soa, I was watching one of.
Your interviews and you hadsome recommendations for people when
they're taking GLP1 meds.
And I don't know if it alsoapplies to people who may not be
(40:49):
taking that.
But as you talked abouthabits, food and thought, prioritizing
protein, minimizing muscleloss, focusing on hydration and don't
skipping meals.
Are these some fundamentals orare there some others that you could
add for people who are tryingto really get a handle on their weight
gain?
Yes.
(41:10):
Well, even if without thesemedications, I think following the
framework that I set out inthe book is very helpful.
I've used this framework forpatients on other medications.
I've now perfected this forpatients on GLP1 medications.
But also the, the truths of itremain true even without the medications.
(41:31):
So things like logging yourfood and making sure you're actually
hungry and making sure you'rehonoring your hunger and we're not
just eating for emotion.
That's a habit I'll go throughin the book that can be helpful on
or off these meds.
Same for my food foundations.
Protein is a very overlookedmacronutrient and we really need
(41:53):
to prioritize thatspecifically when you're on these
medications because yourappetite is down.
And we need to make sure youget the right nutrients to really
sustain, sustain you tominimize muscle loss.
But protein will help in anyweight loss plan.
I talk about a, a reallyinteresting study that came out of
Cornell a few years ago thatlooked at the order in which we eat
(42:13):
our food.
And if you just change theorder of food, you'll have big blood
sugar benefits.
And in turn, if you remember,if you keep your blood sugar more
normal and stabilized, youwill lose, you will lose weight.
So if you eat your proteinfirst and then your vegetable and
then your carb, you'll have amuch lower blood sugar than if you
(42:34):
ate the traditional meal ofthe carb first and then the vegetable
and then the protein.
So simple things of likereordering our food can really help
and yes, I think checking inwith your mental health is a big
part of it, too.
I teach a cognitive behavioraltherapy framework model in the book
which allows us to just stayhonest and true to how we're feeling
(42:56):
and making sure our brainisn't talking us out of our habit
changes.
And whether you're on a GLP1or not, you'll.
You guys will.
Will appreciate this, but ourbrain can often tell us, well, you
know, I thought today wasgoing to be a day I ate well, but
then I had a bad lunch, so Imight as well throw it out the window
and have a bad dinner, andthen I'm going to have three drinks
and a dessert, and then I'llstart tomorrow.
(43:17):
Right?
Because our brain just getsahead of us and says nothing was
worth it.
And now you might all justthrow in the towel.
Right?
Yeah, our.
Our brain has that.
You get that nasty littlevoice saying, ah, what the heck,
just do it.
Too late now.
Right.
So I think that, you know, alot of the things, and I say this
honestly in the book, a lot ofthe recommendations I give might
(43:41):
feel familiar.
The thing about being on aGLP1 medication is, is it gives people
a new lens in which to.
To execute on some of thesebehaviors, and so we can all learn
something from it.
Even if you're just curiousabout the medications, the book will
still be a helpful tool, butit really is crafted to help people
(44:01):
thrive on these medications.
Because so often the story youhear is one of, I didn't feel well
on them, or they didn't workfor me, or my sister went on them
and lost too much weight, andnow she's not eating anything.
You know, and we want to dothis in a very healthy and controlled
manner.
Why do people have those kindof outcomes where they didn't feel
good?
What's going on there?
Are they not doing what theyneed to do in.
(44:23):
In concert with the meds?
I think that there's.
I think that there are a lotof prescriptions being written in
the country either with goodintentions or not so great intentions.
You know, I think we've allprobably seen our Facebook ads pop
up with all these companiesthat are like, just log in and we'll
send you the meds.
Oh, yeah, take this simple pill.
Yeah, yeah.
And you have to be reallycareful about those because those
(44:45):
aren't nest, those aren't FDA approved.
But, but even if you aregetting the medication, I just think
traditional doctor's officesaren't set up to give you any knowledge
and information.
And also I will be honest,most doctors just don't know.
We don't learn this in medical school.
And even as an expert in thisfield, it's taken me 10 years to
really perfect exactly how Ipatient, I help patients.
(45:07):
And that's one of the reasonsI wrote this book.
Because doctors just don'thave the time, knowledge, bandwidth
to educate.
And so when it comes to sideeffects, we can really help people
get ahead of side effects,manage them, and understand how to
minimize them.
The side effects are abyproduct of how the medication works.
It is not the way that thedrug should work.
(45:29):
And if you're not feelingwell, something is off with your
dose, how you're eating andhow you're responding to the medication.
Aside from the book, Iactually created a whole product
line called so well for GLP1users because I realized that my
patients all needed product.
They needed an electrolyte,they needed a protein, they needed
(45:50):
a fiber, and they needed about15 other individual ingredients that
were based in evidence.
But I couldn't find anywhereelse there.
So I created it for them.
And, and just having theroutine of waking up and making sure
you're getting in yourelectrolyte and then even if you're
not hungry, you're getting inyour protein shake.
And then, gosh, I really can'teat my vegetables yet because they
(46:10):
don't have a very big appetite.
But I'm going to make sure toget in my fiber.
So I keep the nausea and theconstipation and the diarrhea at
bay.
Because if you don't know thatthose things are coming and you don't
know that you have to stay ontop of them, they can take over and
make the experience really complicated.
So, you know, I've even hadpatients come to me who say, I don't
think I can do this again.
(46:31):
Like, I tried it once withanother doctor.
You know, I've heard you'regreat, so I'm going to listen to
you, but I don't think so.
And just with the rightplanning of what to eat and how to
stop before you're full andhow to think about this process and
understanding how themedications work, they do great.
So it's very, very, very rare.
(46:52):
Someone really can't toleratethese meds.
Does the water intake stay the same?
About two liters a day?
That's a great question.
So you should keep up yourwater intake.
But here's the problem is thatnot only does GLP1 tell your brain
to not be hungry, it alsoquiets your Thirst mechanism, which
(47:13):
are very much related.
And so that is one of my foodrules, is that not only do you have
to make sure you're getting inprotein throughout the day, even
if you're not really hungry,you must also drink success.
64 ounces of water.
And electrolytes become a keypart of this because we get a lot
of our salt through processedfood and just food.
(47:35):
And we need salts to actuallyget water into the right parts of
our body.
So even if you're not eating alot, you can still continue to feel
well if you get enoughhydration with a solute or a salt.
And that's why I'm a bigproponent of electrolytes on this
journey.
It's a complicated process,but when you think about it, we're
nothing but a petri dish.
(47:56):
We're nothing but chemistry ina petri dish.
It's true.
And we just have to kind ofbiohack it in the right way in order
to feel well.
Absolutely.
So how much weight canpatients actually lose on a gld?
That was gonna be my next question.
Yep, that's a good one.
And people really wanna know that.
So, 1.
It depends on the individual,but on population averages.
(48:21):
Medications like Ozempic andWegovy, which are the same drug,
just have two different names.
One's for type 2 diabetesmanagement, and one is for weight
loss management.
People, on average, will loseabout 15% of their total body weight
with the newest class ofdrugs, called Tirzepatide, which
is Manjaro or Zepbound.
(48:42):
Patients will lose up to 23 to25% of their total body weight.
Okay.
It really depends on the individual.
In my practice, people get alot higher percentages because they
are doing the holistic work.
And then it's sometimesimpossible for me to know who will
(49:04):
respond to which medication better.
But really, on average, withthe newer versions, we're seeing
even more weight loss.
I do want to say one caveat tothis, is that people sometimes think
that if they go on thesemedications, that they'll achieve
truly, like, a.
Just a different body.
Like.
Like they'll be so thin orthey'll get back to high school,
(49:26):
even if high school is 50years ago.
And that's one thing that I'malways talking to my patients about.
That again, this isn't even ifwe have these big percentage of numbers.
We're doing this for health,not for thinness.
And we have to be realistic inour expectations of what they can
do.
Yeah, that's where people are.
They're seeing Stuff on socialmedia, it's like, hey, I want to
look like her.
You know, it's like, if youdidn't have an hourglass figure to
(49:50):
begin with.
You probably won't now.
Right, Right.
And every year that we age,our body changes.
Even if we were to stay at thesame weight where our breasts are
and our fat distribution andwe age, we age.
And so people need to, to berealistic, I talk about this in the
(50:10):
book, but sometimes, sometimespeople need to actually work with
a therapist toward the end oftheir weight loss journey, because
even though they've achievedeverything that they could possibly
achieve through health andweight loss, they're still.
They still need to workthrough some of that kind of what,
disappointment, and makingsure that we're not fostering any
(50:31):
sort of body dysmorphia, whichis where we're not enjoying our body
because it doesn't look aparticular way.
And we have a lot of work on asociety to still do there.
Oh, yeah.
Unrealistic expectations, for sure.
Now, is this covered by insurance?
And how do patients get theirinsurance company to cover it?
Because that's always aproblem, too.
Yes.
So this is a great andexcellent question.
(50:53):
And right now, there is a billsitting in Congress, actually, not
a bill.
It's a proposed rule that willallow Medicare and Medicaid to cover
these medications, which is avery big deal.
And if that passes, we'regoing to see a pretty profound decrease
in the cost of thesemedications for everyone.
And so I'm really pulling for that.
(51:14):
And you have an opportunity asa listener to let your Congress people
know that you are in supportof this and your senators and anyone
who will listen that you're insupport of it.
Really?
That's, in my opinion, whereit needs to start.
Insurance companies,unfortunately, have a little bit
too much power right now inthe fact that, that they both set
(51:35):
the prices for the medicationsand dictate coverage for them.
I am surprised they're allowedto do that, and they really should
be.
And it's a really big problemthat needs reform.
And unfortunately, this is thebiggest problem right now I have
with these medications is thatthey are for the.
Approved for the use ofchronic disease management, meaning
(51:58):
once you start them, we knowthat you, you will likely need to
cover them.
We didn't, we didn't talkabout that on this podcast, but that
is the truth.
And right now, unfortunately,insurance companies, they're.
They're really playing Godhere where they're giving coverage
and then they're taking it away.
Oh, yeah.
And that's just true malpractice.
And if I did that as a doctorand just willy nilly took it away,
(52:19):
that's just.
We know that that leads toworse outcomes.
And so I.
That's the biggest problem I have.
So these meds are expensive.
In Europe, they are about afifth to a sixth of the price per
month than what we establish here.
So we know costs can come downand we all need to continue to put
pressure on the government,the pharma companies, but really
the insurance companies, in myopinion right now are playing with
(52:43):
us.
Many commercial plans willhave coverage of these and some state
and federal plans will.
But unfortunately, there'sjust a big gap right now.
And I can't.
I can't tell you which ones.
People come to me all the time.
They're like, I have Blue Cross.
Will it cover it?
And I'm like, I don't know.
It's so complicated.
Oh, it really is.
You have to take a collegecourse to understand the coverages.
(53:05):
And they can change all the time.
It's really a nightmare.
It is, it is.
And that discourages good healthcare.
And it's wrong.
So, I mean, that's another subject.
You don't want me getting onthat soapbox, trust me.
I was like, I totally agreewith you, Dr.
Soa.
Where do people find your book?
I mean, you cover everything.
You even have some reciperecommendations, which is simple,
(53:27):
easy meals when you don't feellike eating, that kind of thing,
as well as a guide to dining out.
That's a godsend, too.
Well, I really, I puteverything in here that I've given
to my patients.
Again, this framework that Iknew people needed.
It just wasn't out in theworld yet.
So I wrote this book with HarperCollins.
You can buy it wherever booksare sold, always.
I encourage you to supportyour independent bookseller, but
(53:50):
you can also get it on Amazon.
I love hearing from peoplewhen they get it.
So you can find me on socialmedia too, @AlexandroSoamd.
And I love seeing pictures ofthe book out in the wild.
I love this.
You have been so educational.
You've changed my opinion onsome things, too.
I mean, I didn't have the knowledge.
Now I'm convinced.
Okay.
This makes sense, you know, itreally is.
(54:11):
Yeah.
Thank you.
That's.
So, that's, that's the bestthing I can do is just to provide
education and support to avery complicated issue that a lot
of people grapple with.
So thank you for that.
This is.
This is great.
This is absolutely great.
Yes.
People need to go out and getyour book the Ozempic Revolution.
Can they also get it onAmazon, places like that?
(54:33):
Yes, go go to Amazon and youcan get Kindle or or Audible.
I narrated.
So if my voice on this podcastwas enjoyable to you, you can go
find my.
You can go listen to me in my book.
And I really enjoyed thatprocess too, because again, I think
that this is just a complexemotional journey and if I could
(54:54):
be the doctor in your earhelping you along, I'm very happy
to do so.
That's excellent.
You have been a wealth of knowledge.
Thank you so much.
What a great guest.
Thank you so much.
Yes, thank you Dr.
Soa.
We hope you've enjoyed thislatest episode.
And if you want to hear moreepisodes of Women Road warriors or
learn.
More about our show, be sureto check out womenroadwarriors.com
(55:18):
and please follow us on social media.
And don't forget to subscribeto our.
Podcast on our website.
We also have a selection ofpodcasts Just for Women.
They're a series of podcastsfrom different podcasters, so if
you're in the mood.
For women's podcasts, justclick the Power network tab on womenroadwarriors.com
youm'll have a variety ofshows to listen to anytime you want
(55:40):
to.
Podcasts Made For Women WomenRoad warriors.
Is on all the major podcastchannels like Apple, Spotify, Amazon,
Audible, YouTube and others.
Check us out and please followus wherever you listen to podcasts.
Thanks for listening.
You've been listeningListening to Women Road warriors
with Shelly Johnson and Kathy Tucaro.
(56:03):
If you want to be a guest onthe show or have a topic or feedback,
email us@sjohnsonomenroadwarriors.com.
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