Latest / Flourish- A Prisma Health Podcast / If You Can’t Get a GLP-1 for Weight Loss — What Are Your Options?

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If You Can’t Get a GLP-1 for Weight Loss — What Are Your Options? · Flourish- A Prisma Health Podcast

• 0:03
  Joey Wahler (Host): There are a hot topic right now, so we're
• 0:06
  discussing GLP One Medications.
• 0:08
  Our guest is Dr.
• 0:09
  Eva Wolf.
• 0:10
  She's an internal medicine physician and board-certified in Obesity Medicine.
• 0:15
  This is Flourish, a podcast from Prisma Health.
• 0:19
  Thanks so much for joining us.
• 0:20
  I'm Joey Wahler.
• 0:21
  Hi, Dr.
• 0:22
  Wolf.
• 0:22
  Welcome.
• 0:23
  Dr Eva Wolf: Hello.
• 0:23
  Thank you.
• 0:25
  Joey Wahler (Host): Thank you.
• 0:25
  We appreciate the time.
• 0:26
  So first, as you well know, GLP ones are everywhere in the news these days,
• 0:32
  but who are they actually intended for, And what do we mean by correct
• 0:37
  use of a GLP one, medically speaking.
• 0:40
  Dr Eva Wolf: Well these medicines first came around as a treatment
• 0:43
  for type two diabetes, and they're widely used for that indication.
• 0:47
  when we hear Ozempic and Manjaro, those names fall in that category,
• 0:51
  but under different brand names for those active ingredients, they have FDA
• 0:56
  approval for treating excess weight.
• 0:57
  And so that would be people who have a BMI of 30 or more, or people with A BMI
• 1:01
  of 27 with one or more weight-related health conditions Those have the same
• 1:06
  ingredients as the diabetes medicines, but they have different doses, And so
• 1:10
  they're increased as needed to control hunger, not increased for a glucose
• 1:14
  target like the diabetes formula.
• 1:18
  Wegovy also has an approval for treating fatty liver and preventing further heart
• 1:23
  or stroke events in people with a personal history of stroke or heart attack.
• 1:28
  And Zet Bound has an approval for moderate to severe sleep apnea
• 1:32
  in people who also have obesity.
• 1:35
  Joey Wahler (Host): And when we talk about the reasons someone might be
• 1:38
  unable to access or use a GLP one medication, what would some of those be?
• 1:44
  Dr Eva Wolf: Those indications I talked about earlier, those
• 1:46
  drive the insurance coverage.
• 1:48
  Your insurance company can decide to include or exclude those medicines
• 1:53
  and they decide which indications they'll cover the medicines for.
• 1:56
  They may choose to cover ozempic, but if you do not have type two diabetes,
• 2:01
  they won't cover the medicine for you.
• 2:03
  They may fully exclude wegovy or Zet bound for treating obesity, but they
• 2:07
  may cover it for sleep apnea or fatty liver, or history of heart indications.
• 2:14
  Joey Wahler (Host): Gotcha.
• 2:14
  And so naturally if someone isn't fully insured, then
• 2:19
  cost becomes an issue, right?
• 2:21
  Dr Eva Wolf: That's right, so people can cash pay for these medicines, but
• 2:24
  that's not affordable for many people.
• 2:27
  Joey Wahler (Host): How about side effects?
• 2:28
  How much of an issue can that be?
• 2:30
  Dr Eva Wolf: Certainly some people just don't tolerate those medicines
• 2:33
  because they do have some side effects of nausea or constipation, And that
• 2:37
  can be variable in each person.
• 2:39
  So, it may be a good fit for some people, but for some people
• 2:42
  they don't tolerate it well.
• 2:44
  Joey Wahler (Host): How about medical incompatibility with an existing med or
• 2:48
  condition that a patient is dealing with?
• 2:52
  Dr Eva Wolf: You're right.
• 2:52
  If someone has a history of pancreatitis or a family history of a rare type of
• 2:57
  cancer, medullary, thyroid carcinoma, they can't use these medicines.
• 3:02
  Joey Wahler (Host): And then supply issues are sometimes a factor too, right?
• 3:06
  Dr Eva Wolf: You are right.
• 3:07
  And that can be tricky because these medicines need to be dosed appropriately.
• 3:11
  We don't want to stagnate at a dose that's too low or we don't want a gap between
• 3:17
  doses where someone might get more side effects when they get the medicine back.
• 3:22
  So it's a tricky balance.
• 3:24
  These are good medicines, but there are some things that could
• 3:27
  get in the way of using them.
• 3:29
  Joey Wahler (Host): Yeah, balance is definitely a good word there on your part.
• 3:32
  So if a GLP one 30.
• 3:34
  P is not available.
• 3:36
  What would you say the first step is that patient's should take when seeking real
• 3:41
  evidence-based medical weight loss care?
• 3:45
  Dr Eva Wolf: The first step is to get a workup to find out if you
• 3:47
  actually do have any of those health conditions we talked about earlier.
• 3:52
  Many people have diabetes, sleep apnea, or fatty liver disease, but if they haven't
• 3:57
  been tested yet, you may have no idea.
• 4:00
  Joey Wahler (Host): How about other FDA approved anti-obesity medications
• 4:05
  that are available, and how do clinicians decide like yourself,
• 4:09
  which is the best fit for a patient?
• 4:12
  Dr Eva Wolf: There are a couple, so Qia.
• 4:15
  Is a brand name that's a Combination of phentermine and topiramate.
• 4:20
  It combines an older weight loss drug you may be familiar with called Aex.
• 4:24
  That's a stimulant and it combines with another medicine
• 4:27
  to help the aex work better.
• 4:29
  That combinations approved for chronic weight management and does
• 4:32
  not have the prescription time constraints like the adex does alone.
• 4:37
  That one works like an appetite suppressant.
• 4:39
  It helps with cravings as well, but because it increases your heart rate,
• 4:45
  can increase your blood pressure, could cause insomnia or dry mouth.
• 4:49
  It may not be a good fit for all people and, we can't use it in
• 4:52
  people with certain heart conditions.
• 4:54
  And women of childbearing, potential need to be using a reliable birth control
• 4:58
  method if they want to use that medicine.
• 5:00
  Another FDA approved anti-obesity medicine would be contrave.
• 5:05
  That's a combination of an antidepressant, Wellbutrin, bupropion, and an opi.
• 5:10
  Opioid receptor antagonist, naltrexone, that helps reduce appetite and cravings.
• 5:16
  Bupropion Wellbutrin works so well for cravings.
• 5:19
  We also use that to help people quit smoking.
• 5:21
  The Naltrexone component that works so well for cravings, we'll
• 5:25
  use that for people who even struggle with stopping alcohol.
• 5:28
  Joey Wahler (Host): So how do medical weight loss clinics personalize
• 5:32
  treatment plans beyond medication?
• 5:35
  Because in the big picture, there's more to it than just that.
• 5:38
  Right.
• 5:39
  Dr Eva Wolf: We always start by taking a detailed history, all the questions we
• 5:43
  ask, help discover those weight-related conditions you may have, or what issues
• 5:47
  we need to target with medication.
• 5:50
  Is your problem, excess hunger or cravings?
• 5:53
  What time of day are they troubling you?
• 5:55
  We have different tools for each of those targets, but many times the
• 5:59
  issue is gaps in nutritional knowledge.
• 6:01
  So attending nutrition classes or working directly with a dietician can help guide
• 6:06
  dietary choices while building confidence.
• 6:10
  And we screen nearly everyone for sleep apnea because it's wildly underdiagnosed.
• 6:16
  We encourage everyone to aim for an ideal sleep duration and quality because
• 6:20
  that impacts our hunger signaling.
• 6:23
  . For physical activity, step tracking is an accessible first step.
• 6:27
  We discuss any barriers to increased movement and
• 6:30
  troubleshoot alternative movements.
• 6:33
  I also refer to a formal exercise program where patient's can work
• 6:36
  with a trainer in a small group setting to safely initiate exercise.
• 6:41
  Joey Wahler (Host): So what role do older or non GLP one medications still play
• 6:47
  these days in modern obesity treatment?
• 6:50
  And who would you say tends to respond well to those?
• 6:53
  Dr Eva Wolf: Those stimulant medicines like Phentermine, AEX,
• 6:57
  that's great for that younger, otherwise healthy patient who hasn't.
• 7:01
  Develop the complications of weight yet.
• 7:03
  So that person who does not have hypertension and just needs help
• 7:06
  controlling daytime hunger and cravings, then Metformin, which is an old medicine
• 7:12
  for type two diabetes, is fabulous for those with insulin resistance.
• 7:16
  So that may look like a woman with PCOS or someone entering menopause and having
• 7:21
  new weight challenges in this life change.
• 7:24
  Joey Wahler (Host): Doctor, since we're talking about doing this all properly
• 7:28
  as a patient, how can they avoid unsafe or ineffective weight loss trends
• 7:34
  when GLP one meds are out of reach?
• 7:37
  Dr Eva Wolf: I definitely advise against using what they call
• 7:40
  compounded GLP one medications because you have no idea of their origin
• 7:45
  And the dosing can be incorrect.
• 7:48
  And I definitely recommend talking to a trusted weight management specialist
• 7:51
  before embarking on any type of fad diet, just to know if that's safe for you.
• 7:57
  And not all providers have extra training in weight management, so your PCP may
• 8:02
  need to refer you out to one who does.
• 8:04
  Joey Wahler (Host): When should someone consider escalating from medical weight
• 8:09
  loss to metabolic or bariatric surgery?
• 8:13
  If medications, including these GLP one alternatives are ine effective.
• 8:18
  Dr Eva Wolf: Metabolic and bariatric surgery is a good tool for those
• 8:21
  who have significant weight to lose to improve their health.
• 8:25
  That surgery works to control hunger and craving signals, so you're
• 8:29
  able to stick to a healthier diet.
• 8:31
  It even helps quickly control type two diabetes even before
• 8:35
  the weight loss kicks in.
• 8:38
  That's why they call it metabolic and bariatric.
• 8:40
  That procedure raises your natural GLP levels.
• 8:43
  So more about surgery.
• 8:45
  It's recommended for individuals with A BMI over 35, and it can even
• 8:51
  be considered for individuals in a lower BMI category with severe
• 8:55
  obesity-related conditions like type two diabetes, hypertension, fatty liver.
• 9:00
  some don't know that gastric bypass is actually very helpful for reflux
• 9:04
  and can even reverse a precancerous condition called Barrett's esophagus.
• 9:09
  Joey Wahler (Host): And so in summary here, doctor, you've done a great
• 9:11
  job breaking down all the details.
• 9:13
  What's the main message for those joining us about non GLP one options here?
• 9:20
  What should people keep in mind?
• 9:21
  Dr Eva Wolf: I'd say don't give up hope if you can't get a GLP one.
• 9:24
  There are many options out there.
• 9:26
  And remember, these medicines are just tools to help you
• 9:29
  manage hunger and cravings.
• 9:31
  So you make.
• 9:31
  some serious lifestyle changes and getting a certain medicine doesn't hold
• 9:36
  you back from starting those steps.
• 9:38
  We just wanna make one healthy choice every day and keep building on that.
• 9:43
  Joey Wahler (Host): It's definitely just a piece of improving your
• 9:46
  overall lifestyle moving forward.
• 9:49
  Folks, we trust you are now more familiar with GLP one Options, Dr.
• 9:54
  Wolf.
• 9:55
  Great advice indeed.
• 9:56
  Thanks so much again.
• 9:58
  Dr Eva Wolf: Thank you.
• 9:59
  Joey Wahler (Host): Stand for more information, please visit
• 10:01
  prisma health.org/flourish.
• 10:05
  If you found this podcast helpful, please do share it on your social media.
• 10:09
  I'm Joey Wahler, and thanks so much again for being part of Flourish.
• 10:13
  A podcast from Prisma Health.