Dave Knapp – Decoding GLP-1

Air Date - 24 July 2025

Having just undertaken my own weight loss journey with a GLP-1 drug, I was fascinated to learn of the work of Dave Knapp and his organization, “On The Pen.” Calling upon his personal experience with GLP-1, Dave recognized the need for a source of comprehensive information as well as advocacy for those challenged with Obesity and Type 2 Diabetes.

His website is http://OnThePen.com, and he joins me this week to share his personal journey and book that answers many of the questions surrounding these drugs, Decoding GLP-1: A Guide for Friends and Family of Those On The Pen.

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Episode Transcript

Speaker 1 (00:05):
Vox Novus, the New Voice, Vox Novus, the new Dimension,
Vox Novus thought and movement leaders who will share from
their experience and offer tools to help us navigate our
rapidly changing world. My name is Victor Furman. Welcome to

(00:29):
vox Novus, the New Voice. Having just undertaken my own
weight loss journey with a GLP one drug, I was
fascinated to learn of the work of Dave Knapp and
his organization on the Pen. Calling upon his personal experience

(00:49):
with GLP one, Dave recognized the need for a source
of comprehensive information as well as advocacy for those challenged
with obesity and type two diabetes. His website is ondepen
dot com, and he joins me this week to share
his personal journey and book that answers many of the

(01:09):
questions surrounding these drugs, Decoding GLP one, a guide for
friends and family of those on the Pen. Please join
me in welcoming to Vox Novis. Dave Knapp, Welcome, Dave.

Speaker 2 (01:25):
Thank you, Victor. It's a pleasure to be here. Thank
you for having me.

Speaker 1 (01:28):
Dave, please share with us your personal journey and the
emotional challenges you had to face.

Speaker 3 (01:35):
Yeah, I always appreciate the chance to share my story
because I think it echoes so many other stories that
are out there for people who have lived with obesity.
I started to experience, at least noticing that I was
a little bit different than my siblings and my peers
at a pretty young age, probably early adolescence. I noticed
that I was a little heftier around the midsection than

(01:59):
some of my friends were. And it was the first
time I really started to notice that I that I had,
you know, something that was different about me. It wasn't
completely abnormal, because on either side of my family, I've
got aunts and uncles and grandparents that have struggled with

(02:20):
their weight and some with obesity and type two diabetes
as well, but in my immediate family it was it
was kind of rare, and so I felt a little
bit like a fish out of water at a young age,
and you know, that just sort of progressed until high school,
where you know, I tried to tried to always kind
of watch what I eat, and you know, I had

(02:42):
people in my life too that were trying to encourage
me to watch what I eat and always reminding me
that heart disease ran in the family and all those
things that obesity can impact all well meaning things. But
definitely that's a lot of pressure to feel at that
age when you're already you know, kind of feeling a
little bit different and as things sort of progressed. Victor,

(03:05):
I discovered late in high school. This say is around
the two thousand and two two thousand and three timeframe.
I discovered the Atkins diet, and that will ring a
bell with many of your listeners.

Speaker 2 (03:15):
I'm sure.

Speaker 3 (03:17):
And I embarked on, you know, just kind of controlling
my weight with that, and the thing about it, in hindsight,
the bad thing about.

Speaker 2 (03:26):
It was that it worked. It worked really well. At
that age.

Speaker 3 (03:31):
I was coupling it with a lot of strenuous exercise
as well, you know, running miles and miles a day.
I had. You can imagine what the what you know,
in that time frame two thousand and two, two thousand
and three, I had friends that were enrolling and listing
in the military, and so I had friends that would

(03:51):
run with me that were in the military to train.
So I was I was doing a lot to control
my weight, and it was it was working well. I
was I was down I think at my heavy I
was around two hundred and twenty pounds on a five
to eleven frame, and I got down right around graduation
time to my lowest weight of about one hundred and seventy pounds,
and I was able to keep that up until I wasn't.

(04:15):
Until I wasn't. It just wasn't a long term sustainable lifestyle,
both in terms of how much I was exercising and
the restriction of food that I was eating, and so
really to kind of encapsulate the next around seventeen years
of my life, I sort of chased that success with

(04:39):
that Atkins diet. For about three to five months out
of every year, I would go hard on some form
of a low carbohydrate diet and I would usually be
able to lose about twenty five pounds, but on the upswing,
I'd gained thirty or thirty five pounds. And this ultimately
led to age thirty seven, where I was diagnosed with

(05:02):
type two diabetes. And at that time I weighed in
at three hundred and nineteen pounds, and so not only
was I no, no, not only was I you know, overweight,
and you know having these early early issues with you know,
some elevated blood pressure a little bit of high heart rate.

(05:23):
But I was diagnosed with type two diabetes, and it
was at that moment that my doctor said, Dave, what
do you want to do?

Speaker 2 (05:32):
At this point? I have four kids, and.

Speaker 3 (05:34):
I really, really am, you know, convinced in my mind
that I'm going to do this with more hard work
and grit and determination, and I was just going to
buckle down. He said, well, if you want to stay
off medication, there's basically one thing you can do, Dave.
You can eat low carbohydrate. And so I explained that

(05:55):
I had basically lived that lifestyle off and on, never
been able to sustain it for long periods of time
my entire adult life. But I was willing to with
this type two diabetes diagnosis do whatever I could. Grip
my teeth and do whatever I could to stay off medicine.
And so for the next year, I embarked on a
extremely restrictive car low carbohydrate diet. I wore a continuous

(06:18):
glucose monitor that fed back to my doctor so he
could always see, you know, if I was minding my
p's and q's. Of course, as a diabetic, if you
eat carbohydrates, it's pretty noticeable when you are managing when
you are having your blood glucose monitored in real time
twenty four hours a day. And so I was doing
everything I needed to do. But after one year, I
sat in the doctor's office with a completely normal A

(06:40):
one C, but my weight had only gone from three
hundred and nineteen pounds to three hundred and twelve pounds.
This was, as you can imagine, Victor, quite quite I'm
struggling to even find the word. I mean, I was defeated,
for sure, but that seems to come up short for.

Speaker 2 (07:01):
What I felt. I was crushed.

Speaker 3 (07:04):
By those results, or lack thereof. And it was at
that point that the doctor said, well, we've got two
ways we can go with this. One, you're a candidate
for bariatric surgery since you're non responsive to this program.
Or two, there's basically a new class of medications that

(07:26):
are starting to mimic hormonally what happens to people when
they have bariatric surgery. And I was my curiosity was piqued.
At thirty eight years old, I wasn't too keen on
the idea of getting my biology rearranged to fight the
disease of obesity. I thought a medication sounded maybe preferable

(07:49):
to that, and he said, you know, what they've learned
about these surgeries is that you know, everybody thinks that
they that people lose weight because ultimately they're just eating less,
they have a smaller stomach, etc. And he said, certainly,
that's part of it to begin with, but really what's
happening is there's a restoration of these gut hormones that
are responsible for things like satiety and helping your pancreas

(08:14):
release insulin efficiently, and it's just restoring sort of this homeostasis.
Even on the operating table, they're able to measure some
of these hormones, and now they have medications that can
mimic sort of some of those hormonal effects of bariatric surgery.
And that, Victor, is when I was introduced to the

(08:35):
idea of GLP one medications.

Speaker 1 (08:38):
Your story is very similar to my story, except I'm
a bit older and GLP one came into my life
much later. But I'm going to share this with you
really quickly. As a kid, I grew up in a
family where food was considered a reward, and even though
I have a younger brother and sister who did not

(09:00):
become obese, I became obese, especially at a young age.
In nineteen seventy three, I went into the Air Force
and I weighed about two hundred pounds at the time
five 'ot nine and a half and the training I
had to go through special training to lose weight so
that I could pursue the career in the Air Force

(09:20):
or the enlistment that I had in the Air Force.
I did that. I got down to the way that
they wanted me to be, and I was in the
Air Force, and actually I carried that way pretty well
until I got out of the Air Force in nineteen
seventy nine. When I got out in nineteen seventy nine,
I was weighing one hundred and seventy pounds. As my
life ensued, the weight came back to the extent that

(09:44):
in nineteen and sorry in twenty ten, at the age
of fifty seven, I was weighing close to four hundred
pounds and I had an issue. I had to have
stence put into my heart. I was blessed that I
did not have diabetes, but I had to have stints
put in my heart, and my cardiologist said to me,
you really need to get this weight off of you.

(10:04):
And at that time, the only opportunity I had was
to go under the bariatric surgery, and I had what
they call a sleeve gas strict to me, where they
basically remove most of your stomach and have a little
sleeve shaped stomach left over. I think you've probably heard
of that. And they did that, and I started losing weight,
and I'm feeling better and losing weight, and I got

(10:24):
down to all I leveled off at about two hundred
and forty pounds, and I just couldn't go beyond that,
even though my weight of my food intake was much less.
But I guess for some reason, was stuck at that.
And then I'll share later on my GLP one experience
with you, but I will say, and very happily say
that after that experience, I'm now down to one hundred

(10:45):
and seventy pounds, the same weight I was when I
left the Air Force in nineteen seventy nine, for which
I am grateful.

Speaker 3 (10:52):
Wow, that is an amazing story. And what I find
most fascinating about what you know your whole story there,
and there's probably a lot to unpass, but you struggled
with your weight all the way up until you got
into the military, and then it was as if the
physical demands of a military career were the only thing

(11:16):
that could really keep your weight in check. And I
think that really encapsulates I think the experience that a
lot of people living with the disease of obesity. And
I do say disease. I know some people will struggle
with that, and I'd love to get into that topic
more if you'd like to, But for purposes of this conversation,
I think that that is the big takeaway, because I

(11:37):
think that's what people don't understand. I think that people
living with overweight or obesity are always just lacking willpower,
lacking the ability to just put the fork down right,
put the fork down and move more. And if all
things were created equal, that would be the case. But
that's the big misconception about obesity. Some people simply have
genetic factors that are working against them. They've been exposed

(12:00):
to perhaps different toxins or different you know, foods that
have destroyed their gut microbiome. And really, you know, when
we talk about g LP one, it's not GLP one
is not the name of a drug. GLP one is
the name of a hormone that your body makes in
response to taking in nutrients, and this is one of
the hormones that becomes dysregulated in people living with disease

(12:24):
like obesity.

Speaker 2 (12:24):
And type two diabetes.

Speaker 3 (12:25):
So I just find that fascinating that it was it
took that amount a military career, that amount of physical
activity for someone like you to be able to control
your weight absolutely.

Speaker 1 (12:37):
And I'll share my GLP one experience with you later
on in the interview. What inspired you to write Decoding
GLP one and share your personal experiences?

Speaker 3 (12:47):
Get that question a lot, and really the the the
answer to that question is the fact that I started
to document my journey, ID document a different weight loss,
you know, pinpoints of my journey, so to speak, on YouTube,
and I felt like, you know, I'm not going to
start this medication without knowing everything I can know about

(13:10):
this medication. Like I said, I was a little hesitant
to take any medication right away right and so before
I was going to inject myself with the medication, I
was going to learn everything there was to learn. But
at that time, back in the fall of twenty twenty two,
there was just not a lot out there in terms
of information about GLP one medications. What they were, where
they came from, how they work in the body, et cetera.

(13:32):
And to be honest with you, at that point, I
didn't even buy into the idea that obesity was a disease,
and so I just started to learn. And as I learned,
I started to share on YouTube. And as I started
to share on YouTube, a community started to develop around
around the YouTube channel. And so as that community grew,
what I found is a lot of people would reach

(13:53):
out to me and tell me that I was courageous
or perhaps in their mind, heroic for sharing that I
was on a GLP one, and I simply couldn't understand
that sentiment. It did not track with me that how
could somebody find that element of what I'm doing courageous?

(14:15):
It's just naturally what I do. I like to If
I find something I believe in and am passionate about,
I share about it. But what I quickly found is
that so many people have so much shame and guilt
wrapped up in living with the disease of obesity because culture, society,
family loved ones have placed on us this moral inadequacy
that really cuts to the core I think of where

(14:36):
people find their value and self worth and what I
found is that most my story was uncommon in that
I was willing to share, and more commonly, people did
not want to share that they were on medication. They
did not want to share that they were getting treatment,
and that really impacted me on a personal level. As

(14:57):
a content creator, you have to kind of disassociate sometimes
times from comments and things people say, or things can
be hurtful. But that's one of the things that really
stuck out to me. I just read comment after comment,
and I was personally impacted by the fact that so
many people just felt like they couldn't share this part
of their journey. And I thought one of the things

(15:18):
that I have the ability to do is articulate big
concepts and boil them down into little, bite sized chunks
that people can digest and understand. And I wanted to
take everything that I was learning about glpe's by this point,
by the time I wrote the book, which was last year,
around this time, I was writing the book this time
last year, this summertime of twenty twenty four. By that time,

(15:39):
I had been introduced to some of the most renowned
obesity specialists in the world because my YouTube channel had
grown from me sharing little stories about my injections to
interviewing people, and the community had really grown because really
what we were doing was pioneering a whole genre of

(16:01):
social media content that didn't exist prior to On the Pen,
And so we gave it a name On the Pen,
which is, you know, obviously a play on words, because
these medications primarily come in inject injector pens, so we
call it on the Pen. But the book itself was
written to just simply be a cliffs Notes to GLP one,

(16:22):
something that somebody could pass along to a loved one
and say, hey, I'm on this medication and you know,
it's kind of awkward for me to talk about, but
if you just read this book, you're going to get
everything you need to know. There's a little bit about,
you know, what it's like to live with obesity, all
the way to you know, sort of some of the
ins and outs of the history of the medication and
the future of these medications. And I just wanted it

(16:43):
to be a tool that would open up conversations between
people and their loved ones and so they didn't feel
like they had to hide.

Speaker 2 (16:51):
Under under a rock anymore.

Speaker 3 (16:53):
And in terms of the treatment that they were seeking
out for their obesity.

Speaker 1 (16:58):
You touched upon this before, but can you break down
for our listeners, Uh, the science behind GOLP desh one medications.

Speaker 2 (17:08):
Yes, I'd love to so.

Speaker 3 (17:10):
As I mentioned before, g LP one stands for glucagon
like peptide ones, just a long science y word for
a hormone that is produced in your gut and in
your brain in response to nutrient intakes. So these are
often referred to as nutrient stimulated hormones. In other words,
they're hormones that your body releases in response to nutrient intake.

(17:31):
And the GLP one falls under a specific class of
medication not to lose people, but they're called encritin mimetics
and in cretin hormones fall under this idea of nutrients
stimulated hormones, and GLP one happens to be the most prominent.
Now the the there's some lore and we share this
in the book a little bit. There's some lore around
how they came up with g LP one. I mean, obviously,

(17:54):
the hormone in the body was discovered long ago, but
in terms of mimic it, mimicking it in a pharmaceutical drug,
they were looking at HeLa monster venom, which contained a
peptide in it that it when isolated, brought down blood
sugars in humans, and so they isolated this peptide. It's

(18:15):
called extendant four, and Exendin four would later become the
first GLP one to hit the market, called exendotide, and
the brand name was Baieta. And simply what it did
was it mimic this GLP one hormone, this hormone that
when you eat, your body makes it and it helps
you to feel full in your brain. It helps to
regulate the insulin release in your pancreas, so it actually

(18:39):
acts on the beta cells in your pancreas to say, hey,
there's these types of nutrients, specifically glucose, and you need
to release insulin now so that we can maintain our homeostasis.
And what they had learned previously is that a lot
of times these GLP one, this GLP one signaling the
GLP one levels in the body were disrupted or dysregulated

(18:59):
in the bodies of specifically type two diabetics. And in fact,
one of the medications that came out before GLP one
receptor agonists or GLP one mimetics were called DPP four inhibitors.
And again I'm saying a lot of sciencey things, so
I don't want to lose anybody. But basically, in your gut,

(19:20):
you have bacteria, right, everybody knows that, And there's byproducts
of these bacteria, right, there's waste that they excrete. And
one of the byproducts of some specific gut bacteria is
this DPP four enzyme, which basically lives to destroy GLP
one in similar hormones. And what they found is that
in the guts, in the intestines, in the digestive tract

(19:44):
of people living with type two diabetes, the gut bacteria
that produces DPP four was orders of magnitude higher than
it was in people with let's say a healthy gut.
And so DPP four came around, inhibitors came around as
a treatment for two two diabetes to help your body
preserve that natural GLP one that your body creates, and

(20:06):
that sort of led to this discovery of GLP one analogs,
which just have a much longer half life and they're
sort of impervious. They can't be destroyed as easily by
this DPP four enzyme in your gut, and so you
get that signaling restored for satiation, for insulin release, and
sort of this homeostasis is sort of brought back to

(20:28):
that signaling between your gut and your brain.

Speaker 1 (20:31):
Now there can't be an hour that goes by without
a commercial home television for Ozebic or Truelicity or Munjaro
or Victoza. Are there any differences between these?

Speaker 3 (20:42):
Yeah, So, as I talked earlier, the first GLP one
receptor agonist was Baieta. That was the one that was
sort of derived from this peptide in helo monster venom.

Speaker 2 (20:55):
That evolved right.

Speaker 3 (20:57):
That was a twice daily shot and this all sort
of relates to the half life of the medication. So
with Bayeta, you have a GLP one receptor agonist that
lasts a few hours. Well, the drug companies got to
work and they say, how can we make this last
longer so that people maybe only have to take it
once a day? And then you know, the drug companies

(21:17):
came up with a once a day shot that was
that was Victosa, which became the second GLP one to
hit the market for type two diabetes. Then they realized
there was actually some overlap and people were losing weight
on these medications and Victosa was approved then for obesity
management and it was called sex sendas. So that was
the first once daily and you know, I don't want

(21:38):
to go through the whole evolution of it, but then
you get to your once weekly. That was Trulyicity from
Eli Lilly to manage diabetes. And then after Trulyicity came
another once weekly, a more powerful medication called Ozepic from
Novo Nordisk, and Ozempic was then approved for obesity management
and it's called we go V and that led to

(22:01):
now targeting multiple incrytin hormones. As we talked about earlier.
You have the GLP one, but there are multiple incrton hormones,
and so Eli Lilly brought one to market that not
only focuses on GLP one receptors, but also GIP which
is another incretin hormone and has become a more even
powerful drug yet for both controlling A one C which

(22:23):
is the marker that they determine type two diabetes and
measure type two diabetes with and in obesity, so it
has a more powerful potential for weight loss as well.

Speaker 1 (22:34):
My guest is Dave Knapp. His book is called Decoding
GLP Dash one a guide for friends and family of
those on the Pen. Dave, please share with our listeners
where they can get your book and find out more
about you and your work.

Speaker 3 (22:49):
Yes, so the book is available on Amazon. If you
just search on the pen or decoding GLP one, you'll
be able to find it there. But the gateway to
sort of every thing lives at our website on thepen
dot com. And really where our focus is these days
is we are creating a obesity medicine news platform. All

(23:13):
the information that flows about these medications, you're either going
to get it from the media, and it's basically the
media puts out information about these medications that is designed
for one of two people. It's either designed for doctors
because it came from maybe clinical trials, or it's designed
for investors because there's a lot of money to be
made in treating obesity, a problem that affects an estimated

(23:36):
one hundred million people in the US alone. So there's
there's investor news, and then there's doctor news, and we
seek to bring patients the news that affects them and
empowers them to have better conversations with their doctor and
so on. The pen dot com is the best gateway
to get information about GLP one from the patient perspective,

(23:58):
and we have a podcast, we have have all the
social media channels, and we have interviews with all of
the obesity specialists around the country CEOs of companies that
are working on future medication. So anything you would need
to learn more about these medication is going to be
available there.

Speaker 1 (24:15):
Thank you for your advocacy, sir, Thank you, I appreciate it,
and we'll be back with more of Dave after these
words on the Own Times Radio network.

Speaker 4 (24:26):
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Speaker 1 (24:58):
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(25:22):
eleven a m. Eastern on Old Times Radio back on
vox Novis. My guest this week is Dave Knapp. We're
talking about his book Decoding GLP one, a guide for
friends and family of those on the pen. Dave, what
are some of the common myths and misconceptions surrounding these treatments.

Speaker 3 (25:45):
Oh, I don't know that we have enough time to
unpack all that, but you've seen the headlines ozepic, face, ozempic, butt, ozempic.

Speaker 2 (25:54):
You name it.

Speaker 3 (25:55):
There's a lot of sensational headlines out there, to be sure,
But I think to be serious about it because hopefully
people understand that whenever you lose weight rapidly, there are
a host of issues that can come with losing weight rapidly,
And of course those sort of side effects are associated
with the medication. But oftentimes the side effects that people

(26:18):
feel on these medications or may experience that become sensational
headlines are more a result of rapid weight loss than
anything else. But let's talk about maybe the biggest concern
that people have these with these medications that I think
is completely warranted. So all GLP one medications or anchorton
memetics come with a black box warning, which is a
warning for medullary thyroid cancer. And so this is the

(26:40):
one that I get the most from people who look
at taking these medications, is like, there's a warning about
thyroid cancer on here, should I be concerned? And We've
interviewed doctors and specialists around the country. We've interviewed scientists
and researchers, and here is the rub on the black
box warning on GLP once. So when rod are given

(27:01):
an exorbitantly high amount of these medications, they have had
rodents in rodent models, they've seen a specific type of
thyroid cancer called medullary thyroid cancer, and so what they've
seen is an increase, and so they put that warning
on the medication because they've seen it in rodents. It
has yet to be seen or shown in these medications

(27:25):
that it actually causes this same thing in humans. A
couple of really great studies have been done in the
recent past, including one just a couple of weeks ago
that came out and forgive me, I don't have it
in front of me, but you can look it up.
You can find it at obesity dot News, which is
our sub stack. We do articles on this stuff all
the time. But type obesity period news into your browser

(27:45):
and use the search tool. But basically what they've done
is they've done post marketing studies. So everybody knows about
clinical trials.

Speaker 2 (27:52):
You have a phase.

Speaker 3 (27:53):
One which is usually in animals, and then if it's safe,
and they'll move it to phase two, phase three and
then it's approved. But phase four trials are less talked about.
And these are the studies that they look at using
electronic medical records, so they're able to aggregate data from
millions and millions of patients and cross reference data about
patients who are on GLP ones versus patients who are

(28:14):
not and basically say, you know, is there an increased
risk of medullary thyroid cancer. And they've looked specifically at
diabetics and the most recent study was looking at diabetics
who were taking a GLP one receptor agonist versus any
other of the frontline treatments for diabetes. And there was
after I believe it was a they looked at a
four year window. There was no increased risk over any

(28:37):
other diabetes medication for developing medullary thyroid cancer than with
the GLP one receptor agonists versus any other diabetes medication.
And so that was a really long study and it
was looking at millions of patients, and so you can
you're hard pressed to come up with better data than
that in a post marketing study. And so it's just

(28:58):
it's yet to be own or proven that this exists
in humans the way that it does in mice. But
I think that's the biggest one that people sort of
flinch when they when they see that black box warning.
But it's good to put it in perspective of what
we've actually seen in the real world.

Speaker 1 (29:15):
There was a point when there were news reports of
shortages of GLP one medications.

Speaker 3 (29:22):
Yeah, the obviously, as one can imagine, when you have
a problem facing the United States, and actually obese has.

Speaker 2 (29:30):
Become a global problem.

Speaker 3 (29:33):
The demand for these drugs because of their effectiveness is exponential,
and people are willing to pay a very high price
tag to get these medications. So even though for obesity
there's a very low insurance adoption rate as of current
people are willing to pay the sticker price to get
effective treatment. And because that's the case, these medications have

(29:58):
been in shortage because the drug manufacturers have been unable
to keep up with demand. Novo Nordisk had the first
really effective obesity drug when we talk about Saxenda.

Speaker 2 (30:12):
But Saxenda I believe was around nine.

Speaker 3 (30:16):
Percent body weight loss over the over the clinical trial,
and that was that was a game changer. But we Govi,
which is the obesite version of ozepic, hit the market
at almost sixteen percent fifteen percent and change weight loss.

Speaker 2 (30:30):
Over sixty eight weeks.

Speaker 3 (30:32):
That is an exponentially larger jump from Saxenda even and
then when ter zeppetide, Munjaro and zep bound hit the market,
it got all the way up to twenty two percent.
So they've become very effective medications for treating obesity, and
you've basically got two companies that make them. You have
Novo Nordisk and Eli Lilly. Now both have scrambled to

(30:56):
increase their manufacturing capacity. In fact, last year, at the
end of the year year a deal was consummated between
Novo Nordisk or Novo Holdings, the parent company, which is
one of the largest companies in the world, and a
company called Catalan, which was once the law once one
of the largest generics manufacturer in the world, and Novo
Nordis acquired them and acquired all their finish and fill

(31:17):
capacity to be able to convert that basically to GLP
one manufacturing. ELI Lilly, for their part of it, have
invested almost thirty billion dollars in the last five years
in expanding manufacturing capacity in these drugs in the United States,
so they have scrambled to increase capacity to meet demand,

(31:38):
and only recently have they really been able to catch up.
So these were very hard to find. It actually impacted
my own journey early on. There's a titration, a very
specific titration process to starting these medications and getting up
to the highest dose, which is the most effective dose
in the clinical trials, and I had to skip several
of them because they just weren't anywhere to be found

(32:00):
during the early days of being on these medications.

Speaker 1 (32:03):
How many patients and their families best navigate this complex
world of GLP one medications.

Speaker 3 (32:10):
Well, it obviously starts with great open conversations with your
medical provider. These providers are becoming more aware and more
educated on the topic of GLP one medication, certainly much
more so than two years ago or three years ago
when we started making content about this. So start with
your primary care doctor, and I would really encourage folks.

(32:31):
If your primary care doctor has reservations about these medications,
try to speak to an obesity specialist, right because they're
certainly going to be well versed in all of the
areas of not only how these medications work, how they
might benefit you, but also the insurance side of it,
because again, obtaining these medications is extremely expensive, especially if

(32:52):
you're taking them for obesity management. Diabetes has a great
adoption rate from the insurance company. So if you have diabetes,
if you have the good for of being a type
two diabetic like myself, they're rather easy to get through
through commercial insurance. But if you're treating obesity with them,
as I mentioned earlier, the insurance adoption rates are terrible
on OBCC medicine right now, and we're working on that

(33:14):
and working with organizations and working on Capitol Hill to
change that. But start with your primary care if they're
not open to it or uneducated on this topic, speak
to an obesity specialist and honestly, going to ondipin dot
com going to obesity dot News, one of.

Speaker 2 (33:33):
Our resources out there.

Speaker 3 (33:34):
We talk all the time about different ways that you
can get these medications covered. Manufacture savings cards are a
big topic of conversations because if your insurance doesn't cover
these drug, companies provide a way for you to get
them more affordably. You have a list price, and then
they'll have a savings card that'll bring that list price

(33:55):
down almost in half. There are direct options now through
both Eli Lilly and novo Ortics through their own pharmacies
to do a cash pay version that circumvents the insurance altogether,
which allows you to get these medications for less money
than the sticker price. And so there are options out there,
and we cover all of that on the PEN.

Speaker 2 (34:15):
It's a huge topic that we.

Speaker 1 (34:16):
Cover without mentioning any names. There are many organizations companies
that you see advertising on television that are offering a
free consultation by phone to determine your need and then
issuing these medications to you under their brand. Are these reliable?

Speaker 3 (34:37):
Yeah, So I believe you're speaking about telehealth companies. Telehealth
companies which would essentially provide a stable of providers that
they'll connect you with that you can visit for an
appointment and get these medications prescribed when medically necessary. I
would say buyer beware always applies. Right. Not all of

(34:58):
these companies are going to be created equal there. You
want to do your homework and your due diligence on
what company you're working with. Because, as we alluded to
the idea of shortages earlier, this sort of spawned this
whole industry of what's called compounded medications. In other words,
when a drug is in shortage, patents sort of go

(35:20):
by the wayside for a little bit, and generics I'm
using the term loosely, but copies of these medications are
allowed to be made by pharmacies that hold the property designation.
Now that has spawned a whole industry of basically knockoff
versions of these medications that are sold and prescribed by
these telehealth companies. So understanding the differences between both the

(35:43):
branded medications and compounded medications are very important a topic
that we cover in the book. It's a topic that
we cover online quite frequently. Basically, they're not FDA regulated
when they're compounded. Are these compound pharmacies have FDA oversight
to some degree, But these are going to be copies
that are made in times of shortage. Now that the

(36:04):
shortage is over, things have moved to this idea of
a personalized medication, sort of a legal loophole that allows
them to continue to offer these at scale. But definitely
it's a buyer beware situation, and you want to follow
good people online, good resources like on the pen where
we can point you to reputable organizations that can help

(36:25):
you get access to safe medication.

Speaker 1 (36:28):
In your book, you share how well intended family and
friends may actually say things to those using GLP one
that are inappropriate. Please share some examples of this and
how we can address the stigma surrounding obesity and diabetes.

Speaker 3 (36:45):
I appreciate the question because I think this is one
of the most universal experiences that people living with obesity have,
and that's these people in our lives, whether well intentioned
or malicious intent, we hear things and things are said
to us about our weight or about the way that
we try to manage our weight, and even well meaning
comments for example like hey, you're looking good, have you

(37:09):
lost weight? Oftentimes somebody living with obesity hears that, and
for some they might find it and take that for
what it's worth.

Speaker 2 (37:18):
Hey, I guess I'm looking good. That's great. That makes
me feel good.

Speaker 3 (37:21):
But for many others, myself included, when I hear that,
I start to consciously or subconsciously ascribe my value with
that person being based upon how my physical appearance looks,
and that can drive all sorts of behaviors because because
thoughts lead to behaviors, and when these kind of ideas

(37:44):
of our self worth get wrapped up in our weight
or the size of pants or shirt that we wear,
I can be a very dangerous and slippery slope and
lead to some behaviors that may not be great for
that person. So I would always one of the things
that we do in our books is towards the backside
of it. We give some ideas about how you might
start a conversation with somebody that you love about being

(38:08):
on a weight loss journey, and you know some of
the things that you can do to start that conversation.
But also conversely, on the other side of it, if
you love someone who may benefit from a GLP one
or you just love someone who lives with obesity and
want to understand them more, there's some tips for how
to support them and how to avoid comments about their appearance,

(38:31):
how to acknowledge the complexity of obesity as a disease
and not a choice that somebody has chosen for themselves.
Offers support without judgment or advice. So there's some good
tips and tricks towards the back of just knowing how
to maybe gently approach those conversations in a way that
is not going to be harmful for the person that

(38:52):
you love.

Speaker 1 (38:53):
In the beginning, I started sharing my personal journey, and
I had mentioned that in twenty ten I had a
sleeve guts strictomy. I eventually settled down to a weight
of about two hundred and forty pounds, which was still
too heavy for my physical size of five foot nine
and a half. I do have a wide frame. In
twenty twenty four, my orthopedic surgeon said it's time to
replace your left me and I was having a great

(39:15):
deal of difficulty walk and couldn't navigate steps for more
than a couple of steps, And in preparation for that,
he worked with my primary physician prescribing me one of
the GLP one drugs, and by the time I had
the surgery in September, I had actually lost twenty five
pounds and subsequent to the surgery, staying on the GLP one,

(39:41):
I am now down to one hundred and seventy pounds.
And remember this journey in the second part of my
life started at four hundred pounds, so I had lost
a tremendous amount of weight. I'm grateful for this because
at seventy two years of age, right now my energy
level is like through the roof, and I can go
out and do things that I hadn't been able to
do in years. I can run, I can do many

(40:03):
many things. By the way, if anyone else has a
knee replacement, if you want to run, talk to your
doctor first. I'm not going to say go out and
run right away. But in my case I can, and
I feel very blessed in that way, and I'm just
grateful for the entire process. The one thing, the one
hitch for me was that when the prescription, I'm on Medicare.
I have been on Medicare for several years. When the

(40:24):
prescription was issued, Medicare and my supplemental insurance covered it
until this year, until January of this year, and then
they said because I didn't have diabetes, they couldn't cover me. Anymore. So,
I was actually paying out of pocket on a monthly
basis for this, and you, as you alluded to, the
expense on this can be rather extensive. I find that

(40:45):
I truly want to do that now that I'm at
my settled weight of one seventy. I'm having another appointment
with my primary at the end of this month to
see whether or not he thinks I should continue, and
we'll talk talk about that in the next segment. But
I'm very grateful for everything that happened this process.

Speaker 3 (41:02):
Yeah, that's an amazing that's an amazing story.

Speaker 2 (41:05):
I'm glad.

Speaker 3 (41:05):
You're very fortunate being on Medicare to have gotten coverage
for these GLP one medications without a type two diabetes diagnosis,
especially given that you've been taking them for some time.
Because going back, that's the whole the whole thing about
Medicare is what people don't understand is that it's actually illegal.

Speaker 2 (41:24):
I'm not saying that wrong.

Speaker 3 (41:25):
It's illegal. It's against the law for Medicare to cover
obesity medicine. Now, this stems back to some legislation that
was designed to protect the elderly population from previous generations
of OBEs. Medications that were stimulants. Obviously, the older population

(41:46):
is at risk for more, you know, typically core morbidities
associated with heart and they didn't want to go around
feeding a bunch of elderly folks who were on beta
blockers and blood pressure medicaid with things that we're going
to amp their heart rate up. And so it's old,
archaic legislation that pre existed.

Speaker 2 (42:07):
GLP one treatments.

Speaker 3 (42:09):
And so what we're working on right now at on
the PEN as part of our advocacy push, is working
with organizations to get that legislation changed. That would be
it's now introduced in the House and the Senate as
a bill called the Treat and Reduce Obesity Act, and
part of this legislation would change the Medicare approach to

(42:31):
obesity management and open up the opportunity for weight loss
medications to be covered. But you are very fortunate to
be one who got that coverage through Medicare supplementary plans.

Speaker 1 (42:42):
Absolutely. My guest is Dave Mapp. We'll be back with
more after these words on the Own Times Radio network.

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Speaker 1 (46:02):
Back on Box Novis, my guest this week is Dave Knapp.
We've been talking about his book Decoding GLP Dash one,
a guide for friends and family of those on the pen. Dave,
do people taking these medicines require constant maintenance even after
their weight loss goal is achieved.

Speaker 3 (46:22):
It's a great question and one that many people weigh
out before they start these medications.

Speaker 2 (46:29):
So the first thing that I think.

Speaker 3 (46:30):
That we have to understand is that obesity is a
chronic relapsing disease. So if you've ever lived with obesity
and tried to treat it with let's just use the
word that gets thrown around a lot, the natural way, right.
Most of us have lived that experience where we have
gone down and gone up and gone down and gone

(46:51):
up and gone down and gone up and gone down.
Very few people have better gone down or very few
people are able to go down and stay down for
their whole entire life because those living with obesity, including
some of the metabolic disfunction that goes along with that,
some of the dysregulation of these hormones, if you stop
treating it, you stop getting the advantages of treating it.

(47:11):
Much similar to the way that you would treat high
blood pressure. Most people don't expect to take a blood
pressure medication, get their blood pressure down, and say, Okay,
we're good, we're coming off of it. Obesity medicines are
no different because it is a chronic relapsing disease, and
the clinical trials for both some of glue tide, the
select trials, the surmount trials. Forture Zeppetite is the main

(47:34):
two drugs that are out there right now. Both have
pretty good clinical evidence that once the medication is stopped,
the benefit goes away and the weight does come back.
Not all the weight in all the cases, but for
most people going off the treatment will experience some form.

Speaker 2 (47:55):
Of weight regain. A maintenance dose is typically what the
goal is.

Speaker 3 (48:00):
When people get to a goal weight and they're done
with their losing weight, they want to be able to
then maintain that weight loss with the lowest amount of
medication possible. And that's really going to be a back
and forth with you and your provider to try to
find what is that ideal dose.

Speaker 4 (48:17):
Now.

Speaker 3 (48:18):
For some of the people in the community, that may
mean taking the same dose they're on today less frequently.
So for some people that may be appealing because then
you don't have to buy as much medication. For others,
that may be just reducing the dose. Maybe you're on
five milligrams now and you're still losing a little bit
of weight. You want to slow the weight loss down,

(48:38):
and you move down to two point five milligrams. That
typically seems to be the track that people in the
community follow, But the data definitely does show us that
there is a pretty significant amount of weight regain when
the treatment is removed.

Speaker 1 (48:52):
What are your thoughts on the future of GLP one
research and its potential impact?

Speaker 3 (48:58):
As one of the questions, Victor, that I love answering
the most. I really am hopeful for the future of
obesity medication because, as we talked about early on in
our discussion, GLP one is one of many incretin hormones.
And now what they're doing with these future medications in

(49:20):
early stage and some in late stage clinical trials, is
they're combining these hormones. So where we had again their
early stage GLP ones and then when Manjaro chrezeppetide zet bound,
those are all interchangeable, right. Trezepetide the active ingredient in
Manjaro the diabetes medication, terzepetide the active ingredient in zet Bound,

(49:40):
the obese medicine. They targeted two hormones. Now Eli Lilly's
next project that they'll release in a once weekly shot
is called retatratide. And Retatratide is a GLP one hormone agonist,
it's a GP hormone agonist, and it's a glucagon hormone agonists,

(50:01):
and so you've got three targeted there. In what early
stage clinical trials they're showing us everything from best in
class weight loss twenty five plus percent weight loss over
seventy two weeks or sorry, those are some of the
earlier clinical trials, predicted to be about between twenty five
and thirty when that data drops later this year. Perhaps

(50:26):
that data drops late next year or early next year,
I can't remember the exact timeline, but soon that data drops,
expected to be between twenty five and thirty percent weight loss,
It eviscerates liver fat, it reverses liver fibrosis, it's being
shown to shrink tumors. There's all sorts of data that
will be coming fast and furious, and so targeting multiple

(50:47):
hormones because there's likely dysregulation in many hormones where there's
dysregulation with one, if you're talking about a gut that's
out of whack and out of balance. The future this medication,
these medications is bright. I think it's really going to
change the way that we look at things like bariatric
surgery and medicine. You're going to see a blend of two.
One of the things I'm most excited about is a

(51:09):
company called Fractal Health, and we've interviewed their CEO on
on the pen but they they've been looking at more
of like root cause, why does your body become dysregulated
in GLP one, Why does the nutrient sensing get dysregulated?
And so they actually have like minor outpatient endoscopic procedures
that you know, perform like a small oblation on the

(51:31):
surface of your gut lining and it helps to restore
the sensitivity to the nutrients that you take and so
you're endogenous or naturally occurring hormones are rebalanced and reset.
And so they're looking at trials where they get people
down to their ideal weight with a drug like terzepetide

(51:51):
or semaglutide and then they have this procedure done and
then they maintain their weight loss with that procedure instead
of more medication.

Speaker 2 (51:59):
And so.

Speaker 3 (52:01):
I'm just very very encouraged. The more I learn, the
more I believe that we will see perhaps in my lifetime,
this idea of disease as a very treatable, curable, preventable
disease and all of the cascading comorbidities that go along
with it, whether we're talking about heart health, cardiac health,
whether we're talking about cancer, where you know there are

(52:23):
thirteen different cancers associated with obesity alone. Imagine if we
can can get to the bottom of this obesity problem,
we solve a lot of the cancer problems that we have,
We solve a.

Speaker 2 (52:31):
Lot of the heart issues that we have.

Speaker 3 (52:33):
And So while people look at these medications and the
current price tag of them and say this is going
to bankrupt our healthcare system, I look at it and say,
these medications are going to save our healthcare system.

Speaker 1 (52:44):
How may individuals and organizations support GLP one advocacy and
education efforts.

Speaker 3 (52:52):
There are a whole host of them out there that
support the advocacy for these and things like to treat
and reduce obesiae. The act we talked about four I
would point a couple to a couple of them. The
first would be the Obese Action Coalition. Now, this is
a sort of like a trade organization. Is how how
it operates. The you know, they do like the industry

(53:16):
trade shows, and they have you know, some pharmaceutical backing,
et cetera. But it's really designed to be patient centric.
I'll be actually attending a Your Weight Matters conference just
next week in Washington, d C. And people will be
learning how to you know, talk to their representatives and
advocate for obesc treatment. So the Obese the Action Coalition

(53:36):
is one and the Obese Medicine Association would be another
one that I would point people in the direction of
just some great advocacy groups helping to rewrite the narrative
about obesity in this country and helping people get access
to care.

Speaker 1 (53:50):
What would you like readers to take away from Decoding
g LP One.

Speaker 3 (53:55):
I would just like to see more people feeling like
they can have an intelligent conversation with a loved one,
to educate them and to just have a more open relationship.
At the end of the day, this book wasn't designed
to do the work of getting people to understand everything
there is to understand about these medications. It was designed
as a conversation starter's starter to allow people to have

(54:17):
better conversations with the people they love in their life,
so that they didn't feel like they had to hide
this part of their life. Now, imagine Victor being somebody
who had gone from four hundred pounds to one hundred
and seventy pounds and never saying a word about how
you did it to your mom, to your dad, to
your even some folks in the community don't share with
their spouse that they're on these medications. So imagine the

(54:41):
shame that is wrapped up in living with obesity for
somebody who is not sharing with their spouse that they're
on a medication to treat their disease. My hope and
prayer for this book is that it opens up conversations
for people to just have better conversations with their loved ones.

Speaker 1 (54:55):
Absolutely. My guest Dave Knapp his book Decoding golp one,
a guide for friends and family of those on the pen. Dave,
one more time, please share with our listeners where they
can get your wonderful book and find out more about
you and your organization.

Speaker 3 (55:11):
Thank you, Victor on theepen. Dot com is the gateway
to all the things, whether you're looking for social media connection,
whether you're looking for a podcast, if you're looking for
news like a newsletter. A lot of people just like, hey,
I don't like to watch videos, but I do like
to read. If that is more what you prefer. We
have a new domain called obesity dot news. So people

(55:34):
are used to typing in dot com, but if you
just type in your browser obesity period news, it's going
to take you to our substack, which is what our
newsletter is, and so you just put your email in,
you'll sign up there and directly to your inbox. Just
about every day, you're going to get a new update
on virtually every topic that we talked about today and
then some.

Speaker 1 (55:54):
Dave, thank you so much for joining us and sharing
this amazing and valuable information with our listeners.

Speaker 2 (56:01):
My pleasure. Thank you for having me Victor.

Speaker 1 (56:03):
And thank you for joining us on Vox Novus. I'm
Victor the Voice Ferman. Have a wonderful week.