Latest / Hurdle with Emily Abbate / 278. Weight Loss Medications: Dr. Spencer Nadolsky Answers Your GLP-1 Questions

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278. Weight Loss Medications: Dr. Spencer Nadolsky Answers Your GLP-1 Questions · Hurdle with Emily Abbate

• 0:00
  Speaker 1: It's going to be similar to I would say, like
• 0:02
  Speaker 1: mental health before it was taboo and people didn't understand,
• 0:05
  Speaker 1: and it's like just pull yourself up on your bootstraps
• 0:07
  Speaker 1: and put a smile on, just cheer up. It's going
• 0:10
  Speaker 1: to be the same with obesity. Instead of just like hey,
• 0:12
  Speaker 1: you need to put the fork down, they're going to
• 0:14
  Speaker 1: understand the biological underpinnings of it. And this doesn't mean
• 0:17
  Speaker 1: we shouldn't be working on our environment too. Yeah, we
• 0:19
  Speaker 1: should be working on the environment. We need to prevent
• 0:21
  Speaker 1: obesity before it occurs, but we also need tools to
• 0:25
  Speaker 1: help treat the obesity once it occurs too.
• 0:42
  Speaker 2: What is happening everyone, I'm only a body here.
• 0:45
  Speaker 3: You are listening to episode two hundred and seventy eight
• 0:48
  Speaker 3: of Hurdle, a wellness focused podcast reconnect with everyone from
• 0:51
  Speaker 3: your favorite athletes to top experts and industry CEOs about
• 0:55
  Speaker 3: their highest highs, toughest moments, and everything in between. We
• 0:59
  Speaker 3: all go through hurdles in life, and my goal through
• 1:02
  Speaker 3: these discussions is to empower you to better navigate yours
• 1:05
  Speaker 3: and move with intention so that you can stride towards
• 1:09
  Speaker 3: your own big potential and of course have some fun
• 1:13
  Speaker 3: along the way. First and foremost, I'll address my voice.
• 1:17
  Speaker 3: It's been better, but the show must go on. Literally,
• 1:21
  Speaker 3: So today I am bringing you my conversation with doctor
• 1:25
  Speaker 3: Spencer and Dadolski. He is the medical director of WW
• 1:31
  Speaker 3: and Sequence. He is also an obesity and lipid specialist physician.
• 1:37
  Speaker 3: Say that five times fast. Today we are talking all
• 1:41
  Speaker 3: about GLP one medications and extremely controversial topic, something that
• 1:47
  Speaker 3: we've been talking about now as a society for a
• 1:50
  Speaker 3: greater part of the past year. For those of you
• 1:53
  Speaker 3: that do not know, GLP one medications are what we
• 1:58
  Speaker 3: commonly hear to be zempic legovi medicines that are injected
• 2:04
  Speaker 3: and used as a tool for weight loss. As someone
• 2:08
  Speaker 3: who personally has a history of weight loss, and doctor
• 2:11
  Speaker 3: Nadolski and I talk about that in today's episode. It
• 2:14
  Speaker 3: was really interesting to me when these came on the scene.
• 2:18
  Speaker 3: I I'll just give you my stance. I feel like,
• 2:20
  Speaker 3: if you can speak with a physician you qualify every
• 2:23
  Speaker 3: one of these medications and it is something that you
• 2:26
  Speaker 3: are interested in going on, going on and using it in
• 2:29
  Speaker 3: a safe way, then you're entirely entitled to do whatever
• 2:33
  Speaker 3: you feel is right for you and your body. There
• 2:35
  Speaker 3: are two things that concern me. One that we don't
• 2:38
  Speaker 3: know the long standing effects of something like this because
• 2:41
  Speaker 3: they are so new to the market. And also when
• 2:44
  Speaker 3: individuals abuse these medications, maybe they obtained something like this
• 2:48
  Speaker 3: from a concierge doctor who may not always play by
• 2:52
  Speaker 3: the rules. So we talk about both of those things today,
• 2:55
  Speaker 3: and I really appreciate doctor Nadolski's expertise on the top.
• 3:00
  Speaker 3: We cover everything you need to know what these medications do,
• 3:04
  Speaker 3: what they are, how they interact with the body, what
• 3:07
  Speaker 3: the side.
• 3:07
  Speaker 2: Effects could be.
• 3:09
  Speaker 3: Who could be a good candidate to go on a
• 3:11
  Speaker 3: medication like this, Why it's important to be conscious of
• 3:15
  Speaker 3: your environment, whether or not you are interested in this
• 3:18
  Speaker 3: type of treatment if you are interested in weight loss,
• 3:22
  Speaker 3: And of course we talk about the controversy around these drugs,
• 3:26
  Speaker 3: and doctor Nadalski, as I mentioned, the medical director over
• 3:30
  Speaker 3: at Weight Watchers, talks about their decision to acquire Sequence
• 3:35
  Speaker 3: as well as they're first of its kind GLP one program,
• 3:39
  Speaker 3: which offers specialized behavioral support focusing on nutrition and activity
• 3:44
  Speaker 3: program formation to support those who are already on their
• 3:48
  Speaker 3: own GLP one journey. Like I've said before, it's so
• 3:53
  Speaker 3: important for me to have big conversations like this on
• 3:57
  Speaker 3: the show. So I hope that you find this insight
• 4:01
  Speaker 3: valuable and if you have any additional questions, feel free
• 4:05
  Speaker 3: to ask it by leaving me a voice message. The
• 4:08
  Speaker 3: link to do that is in the show notes at
• 4:11
  Speaker 3: Emily Abodi at Hurdle Podcast.
• 4:14
  Speaker 2: With that, let's get to hurtling today.
• 4:21
  Speaker 3: I'm sitting down with doctor Spencer Nadolski. He's a Board
• 4:25
  Speaker 3: certified family physician specializing in obesity, medicine, and lipidology. He's
• 4:30
  Speaker 3: also the medical director of WW and Sequence.
• 4:33
  Speaker 2: How are you doing today, Spencer doing great.
• 4:36
  Speaker 1: I'm in Michigan. It's getting cold here, but I went
• 4:39
  Speaker 1: for a run before this podcast. I'm good.
• 4:42
  Speaker 2: I know.
• 4:42
  Speaker 3: I need to make sure that we let the hurdlers
• 4:45
  Speaker 3: my audience what I call them in on the intel
• 4:47
  Speaker 3: that you also are a podcaster yourself. You have a
• 4:51
  Speaker 3: podcast with your brother called Docs Who Lift.
• 4:54
  Speaker 2: I love this.
• 4:55
  Speaker 1: Yeah, that's right. We promote exercises medicine, obviously lifting weights,
• 4:59
  Speaker 1: but you know we do a lot of aerobic training
• 5:02
  Speaker 1: as well.
• 5:02
  Speaker 3: Also, two doctors in the family have pretty fun for
• 5:05
  Speaker 3: your parents, I'm sure.
• 5:07
  Speaker 1: Yeah, yeah, they're proud of us. Of course.
• 5:11
  Speaker 2: Well, I'm so happy to have you on the show today.
• 5:14
  Speaker 3: We are getting together to talk about GLP one medication.
• 5:18
  Speaker 3: It's something that has certainly made its fair share of
• 5:22
  Speaker 3: headlines over the last three sixty five and beyond. Now,
• 5:26
  Speaker 3: before we get into all of the faqes, I want
• 5:29
  Speaker 3: to make sure that I learn a little bit about you,
• 5:31
  Speaker 3: especially because getting into the field of obesity medicine libidology
• 5:37
  Speaker 3: definitely a niche interest. So what inspired you to get
• 5:40
  Speaker 3: onto this side of medicine.
• 5:43
  Speaker 1: Yeah, I grew up in a very athletically and academically
• 5:46
  Speaker 1: minded family. Both parents were school teachers. My brothers obviously
• 5:52
  Speaker 1: into athletics and academics as well, and so got into
• 5:56
  Speaker 1: science to be good at athletics, did really well, and
• 6:00
  Speaker 1: to wrestle at UNC Chapel Hill. I was their heavyweight,
• 6:03
  Speaker 1: did pretty well there. And when I went into medical school,
• 6:05
  Speaker 1: everybody it's like, you're gonna be a sports medicine doctor.
• 6:07
  Speaker 1: You're going to help athletes get better. And I was like,
• 6:09
  Speaker 1: I don't want to help athletes get better. It's like,
• 6:12
  Speaker 1: to me, it's just kind of boring. I know. Sorry,
• 6:13
  Speaker 1: there's a lot of other people that liked doing that.
• 6:15
  Speaker 1: But what I thought was more fulfilling was actually helping
• 6:20
  Speaker 1: people become athletes, like people that didn't move at all,
• 6:24
  Speaker 1: people that were having type two diabetes and chronic disease,
• 6:27
  Speaker 1: and helping them either prevent those things from happening or
• 6:31
  Speaker 1: actually reversing or putting those things into remission, giving them
• 6:35
  Speaker 1: a fraction of the passion or the obsession I have
• 6:38
  Speaker 1: with diet and exercise, nutrition and exercise, just giving them
• 6:41
  Speaker 1: a little bit and preventing and treating those chronic diseases. So,
• 6:46
  Speaker 1: as I went through medical school, it was kind of
• 6:48
  Speaker 1: a specialty. Back then, there were some people doing it,
• 6:53
  Speaker 1: and they didn't have that greade of medicines back then,
• 6:54
  Speaker 1: and bioatric surgery is of course another thing. But as
• 6:59
  Speaker 1: I went through medical school and then residency, it was
• 7:02
  Speaker 1: starting to become these newer drugs and these newer technologies
• 7:06
  Speaker 1: were starting to come out, and the specialty really gained
• 7:09
  Speaker 1: some traction, and they actually created this Board of Obesity
• 7:12
  Speaker 1: Medicine right at the end of my residency, so I
• 7:15
  Speaker 1: was able to get that certification right after residency. So
• 7:18
  Speaker 1: for anybody listening, you go through four years of medical
• 7:20
  Speaker 1: school and then you do something called residency, which is
• 7:23
  Speaker 1: where you choose your specialty. I chose to do a
• 7:25
  Speaker 1: very broad one called family medicine. You can do internal medicine,
• 7:29
  Speaker 1: which is just adults, pediatrics, could do obgyn surgeries, all
• 7:34
  Speaker 1: sorts of different things. So I chose the broadest of
• 7:36
  Speaker 1: them all and then decided to specialize off of that.
• 7:40
  Speaker 1: So the other thing is I really think that our
• 7:43
  Speaker 1: current medical system is so archaic. So I was really
• 7:46
  Speaker 1: passionate about different ways of delivering healthcare that weren't the
• 7:50
  Speaker 1: same traditional fifteen minutes with a patient. I would do
• 7:53
  Speaker 1: Facebook lives at lunchtime, and I feel like I was
• 7:56
  Speaker 1: helping more people during my quick little live than I did,
• 8:00
  Speaker 1: like in a whole day of seeing people in the clinic.
• 8:03
  Speaker 1: It was really interesting. So that's kind of where I
• 8:05
  Speaker 1: got to today.
• 8:06
  Speaker 3: Yeah, you know, it's it's interesting, and I can relate
• 8:09
  Speaker 3: to that concept of feeling really fulfilled with your opportunity
• 8:13
  Speaker 3: to help people at a larger scale seeing those one
• 8:17
  Speaker 3: on one patients, there's so much value in that. But
• 8:19
  Speaker 3: when you can really utilize the knowledge that you have
• 8:22
  Speaker 3: to help a wider group of people, it's exciting.
• 8:25
  Speaker 1: Yeah, Yeah, that's exactly that's exactly. It. It was just
• 8:28
  Speaker 1: like and I felt like I was still getting that
• 8:30
  Speaker 1: deep meaningful help with them, not just superficial help, but
• 8:35
  Speaker 1: it was like deep, meaningful and wider, a larger net.
• 8:38
  Speaker 1: So that's why now that we're doing telemedicine and all
• 8:42
  Speaker 1: sorts of different ways of delivering care.
• 8:44
  Speaker 3: Yeah, so when it comes to we talked about obviously
• 8:47
  Speaker 3: the or you mentioned the four years of medical school
• 8:50
  Speaker 3: and the residency program. When it comes to then specializing
• 8:54
  Speaker 3: in the fields that you specialize, what does obtaining that
• 8:57
  Speaker 3: specialization look like.
• 8:59
  Speaker 1: Yeah, so currently, because it's so new, you just you
• 9:01
  Speaker 1: have to go get what's called the continuing medical education.
• 9:04
  Speaker 1: You have to go to conferences and things, and then
• 9:06
  Speaker 1: you take a board exam. What usually it ends up
• 9:10
  Speaker 1: is they you eventually have to take a one year
• 9:12
  Speaker 1: fellowship where you go from residency which is usually three
• 9:16
  Speaker 1: or so years, and then you go one more or
• 9:19
  Speaker 1: two more years in an actual setting where you keep
• 9:22
  Speaker 1: learning that right now, because it's so new, they they
• 9:26
  Speaker 1: have it set up to where you go to different
• 9:28
  Speaker 1: lectures and all these things. Then you take an exam
• 9:32
  Speaker 1: after about a year. But eventually that's that's that's the
• 9:35
  Speaker 1: idea of that's a lot of all this. A lot
• 9:37
  Speaker 1: of specialties have started that way and then moved over
• 9:40
  Speaker 1: into like a legit fellowship type of situation.
• 9:43
  Speaker 3: Okay, and then just a little bit more context before
• 9:46
  Speaker 3: we dive into the meat and potatoes of our discussion today.
• 9:49
  Speaker 3: Where along this journey for you in this specialization did
• 9:54
  Speaker 3: you come into connection with WW and sequence.
• 9:59
  Speaker 1: Yeah. So I graduated residency in twenty fourteen, got my
• 10:05
  Speaker 1: board certification obesity. Shortly after, went to private practice, worked
• 10:11
  Speaker 1: with a few different groups, actually jumped into a telemedicine
• 10:16
  Speaker 1: group in twenty sixteen and really started exploring these new
• 10:20
  Speaker 1: ways of delivering care, doing obesity medicine online, lipidology online,
• 10:25
  Speaker 1: and just lifestyle medicine online in general. And then in
• 10:28
  Speaker 1: twenty twenty one is when we go VI or some
• 10:30
  Speaker 1: maglutide was approved for obesity or weight management specifically. And
• 10:35
  Speaker 1: there were a couple of these engineers who found me
• 10:38
  Speaker 1: on Twitter and just said, hey, have you ever thought
• 10:41
  Speaker 1: about doing like an obesity medicine program online. I'm like, yeah,
• 10:44
  Speaker 1: That's what I've always wanted to do. I'm not a
• 10:46
  Speaker 1: startup guy, so if you guys are startup guys, let's
• 10:49
  Speaker 1: do it. And what we did is we these guys
• 10:52
  Speaker 1: were smart engineers. They developed a whole like electronic medical
• 10:57
  Speaker 1: records system kind of how I just told them to
• 11:00
  Speaker 1: do it based on what I think would be efficient
• 11:02
  Speaker 1: for both the provider, the doctor or nurse practitioner, whoever,
• 11:06
  Speaker 1: and then also for the patient, give them good care,
• 11:09
  Speaker 1: make them have a good experience, while also giving the
• 11:11
  Speaker 1: clinician a good experience. And I knew we were going
• 11:15
  Speaker 1: to do really well because other programs that were out there,
• 11:19
  Speaker 1: I didn't see them as much on social media and
• 11:21
  Speaker 1: I'm very good at social media. And we delivered great
• 11:26
  Speaker 1: care while also doing great job at marketing. And within
• 11:30
  Speaker 1: it was within a year we blew up. We had,
• 11:32
  Speaker 1: you know, thousands and thousands of patients started with just
• 11:36
  Speaker 1: me as the physician. Then we had I don't know
• 11:40
  Speaker 1: how many dozens of clinicians that were under me. And
• 11:44
  Speaker 1: what happened was Weight Watchers wanted me to be a
• 11:49
  Speaker 1: scientific advisor and they hadn't heard of our program yet,
• 11:53
  Speaker 1: but they were interested in getting into the clinical space,
• 11:58
  Speaker 1: and so we started talking YadA YadA YadA. They said, hey,
• 12:02
  Speaker 1: we want to add this clinical arm to our program.
• 12:06
  Speaker 1: When it was a perfect fit because they're you know,
• 12:08
  Speaker 1: the number, here's the number one behavioral commercial weight loss
• 12:12
  Speaker 1: program in the world, and we at the time, you know,
• 12:17
  Speaker 1: we're the top what I would consider the top telemedicine
• 12:20
  Speaker 1: obesity program. But you know still that that is in
• 12:23
  Speaker 1: its infancy, the whole you know, that whole niche is
• 12:26
  Speaker 1: in its infancy, but we're the top top ones, and
• 12:28
  Speaker 1: we're going to kind of combine and make this work
• 12:31
  Speaker 1: for everybody, kind of hit this whole what i'd call
• 12:34
  Speaker 1: the spectrum of what would call weight health. So there's
• 12:36
  Speaker 1: behavioral and then once people need more help than that,
• 12:39
  Speaker 1: they need to get into medical and even surgical tools
• 12:43
  Speaker 1: to help them with losing weight and keeping it off.
• 12:46
  Speaker 2: Got it.
• 12:46
  Speaker 3: So for those that aren't completely in the loop on Sequence,
• 12:50
  Speaker 3: you did just kind of give a rundown on how
• 12:53
  Speaker 3: it works.
• 12:53
  Speaker 2: But I do want to make sure that we really.
• 12:57
  Speaker 3: Dial into the specifics of how it works, because I
• 13:00
  Speaker 3: think there is a lot of questions around perhaps the
• 13:04
  Speaker 3: safety of something like this. So let's start first and
• 13:08
  Speaker 3: foremost with what it might look like for someone who
• 13:12
  Speaker 3: goes to SEQUENCE, which, as you mentioned, is a clinical
• 13:16
  Speaker 3: arm now of WW seeking perhaps a weight loss drug
• 13:22
  Speaker 3: like a semaglue tide, which we'll get into that in
• 13:24
  Speaker 3: just a second as well.
• 13:26
  Speaker 1: Yeah, so my biggest thing is I need to make
• 13:29
  Speaker 1: sure we are doing this safe. We cannot start giving
• 13:32
  Speaker 1: this medicine out to those who don't qualify. That was
• 13:35
  Speaker 1: like a big push of mine, because you know a
• 13:38
  Speaker 1: lot of people start these startup companies, and you know
• 13:40
  Speaker 1: you've seen these places in the media and all sorts
• 13:44
  Speaker 1: of all sorts of things are happening. So I wanted
• 13:46
  Speaker 1: to make sure it's safe. I want to make sure
• 13:48
  Speaker 1: we're doing appropriate prescribing. So the way we set it
• 13:51
  Speaker 1: up is basically you can't even get through the intake
• 13:54
  Speaker 1: quiz unless on paper you would qualify before you even
• 13:58
  Speaker 1: see a clinician. So you go through this intake quiz
• 14:00
  Speaker 1: that would make sure that sure you have a BMI
• 14:04
  Speaker 1: so that for anybody listening, these drugs are only approved
• 14:07
  Speaker 1: for those with it from an FDA guideline standpoint, for
• 14:10
  Speaker 1: those who have a BMI body mass index. And say
• 14:13
  Speaker 1: what you want about BMI, it's just it's what they
• 14:15
  Speaker 1: had to have at the time. Right now. It will
• 14:18
  Speaker 1: get better in the future with how to diagnose obesity,
• 14:20
  Speaker 1: but BMI of thirty and above or a BMI body
• 14:25
  Speaker 1: mass index of twenty seven and above plus what's called
• 14:28
  Speaker 1: a comorbidity. A comorbidity is anything related to obesity or
• 14:32
  Speaker 1: weight that is a medical problem. So think about hypertension,
• 14:36
  Speaker 1: high blood pressure, hyperglycemia, you know, pre diabetes, type two diabetes,
• 14:41
  Speaker 1: higher blood sugars, those types of things. Even things like
• 14:44
  Speaker 1: an obstructive sleepaptiam, maybe osteoarthritis in your knees, those types
• 14:47
  Speaker 1: of things. So if you have a thirty and above,
• 14:50
  Speaker 1: you technically qualified via FDA guidelines. If you have a
• 14:54
  Speaker 1: twenty seven plus one of these other weight related things,
• 14:58
  Speaker 1: you would also qualify. So you have to have that
• 15:01
  Speaker 1: at first. But then there's there's a there's a few
• 15:04
  Speaker 1: other things that you want to make sure that you're
• 15:07
  Speaker 1: not missing. You want to make sure people aren't pregnant, breastfeeding,
• 15:09
  Speaker 1: those types of things. These drugs you don't want to
• 15:12
  Speaker 1: use while people are pregnant or breastfeeding. There are some
• 15:16
  Speaker 1: other black box warnings like family history of medullary thyroid cancer.
• 15:20
  Speaker 1: It's a type of a very rare type of thyroid cancer.
• 15:22
  Speaker 1: But and we can get into why that is later.
• 15:25
  Speaker 1: And then you also want to see what medicines are on,
• 15:27
  Speaker 1: you know, do they have a primary care doctor, all
• 15:30
  Speaker 1: sorts of things. So you want to make sure that
• 15:31
  Speaker 1: these people are having a like should appropriately at least
• 15:35
  Speaker 1: get through because what you will see if you don't
• 15:38
  Speaker 1: have those things, and there's a lot of people wanting
• 15:40
  Speaker 1: to use these drugs just for vanity what i'd call
• 15:43
  Speaker 1: vanity weight loss. They don't have health problems. They're metabolically healthy.
• 15:47
  Speaker 1: You know, they may be in what's considered this normal
• 15:50
  Speaker 1: BMI range, which I don't like that term, but like
• 15:54
  Speaker 1: their weight, they're healthy for their weight, and they might
• 15:58
  Speaker 1: want to lose five to ten pounds and they want
• 16:00
  Speaker 1: these drugs, but like, not appropriate to prescribing these medicines
• 16:03
  Speaker 1: and those types of patients at least right now, and
• 16:06
  Speaker 1: it's not studied at this time, so we wanted to
• 16:09
  Speaker 1: stay away from that. And then once you get through
• 16:12
  Speaker 1: the intake quizz everything looks good, then you are then
• 16:14
  Speaker 1: evaluated by a clinician because then certain things you might
• 16:19
  Speaker 1: chat through the chat, they can do it what's it
• 16:21
  Speaker 1: called asynchronously, which may seem odd because people are used
• 16:25
  Speaker 1: to seeing somebody face to face when they see a doctor.
• 16:28
  Speaker 1: But because of scheduling and people people work, they don't
• 16:33
  Speaker 1: want to take an hour off of work to do
• 16:36
  Speaker 1: a telemedicine, so you might be able to chat back
• 16:37
  Speaker 1: and forth. There are some states that allow that. Some
• 16:40
  Speaker 1: states you have to be seen face to face synchronously
• 16:43
  Speaker 1: via video. But through that evaluation, then the clinician decides
• 16:50
  Speaker 1: whether that person is the right fit. And then after
• 16:53
  Speaker 1: that it's sounds more complicated than is, but there's what's
• 16:56
  Speaker 1: called a prior authorization, So then the insurance companies they
• 17:00
  Speaker 1: also want to make sure this is an appropriate patient.
• 17:02
  Speaker 1: So then we have a whole team, which is one
• 17:05
  Speaker 1: of the secret sauces we have is that we have
• 17:07
  Speaker 1: a whole team that does these prior authorizations. And it's
• 17:12
  Speaker 1: actually what's actually really a big reason why we do
• 17:14
  Speaker 1: well is because when you go to a primary care doctor,
• 17:18
  Speaker 1: they're inundated from patients wanting to get these medicine. These
• 17:21
  Speaker 1: medicines are in high demand, and the prior authorization process
• 17:25
  Speaker 1: and filling out it's a real pain. It's a burden
• 17:28
  Speaker 1: to the back office who's like they've already got a
• 17:31
  Speaker 1: lot of other stuff they got to do, and so
• 17:33
  Speaker 1: now they have to fill out this long prior authorization.
• 17:35
  Speaker 1: We have a whole team that does it for people.
• 17:37
  Speaker 1: In fact, I was just one with a patient who
• 17:40
  Speaker 1: specifically said, like, Hey, the reason we chose you is
• 17:43
  Speaker 1: because you guys are known to be good at these
• 17:46
  Speaker 1: prior authorizations. So for anybody listening, insurance, it's like, they
• 17:49
  Speaker 1: don't want to pay for these medicines. They want to
• 17:51
  Speaker 1: put you through hoops, and we help the patients jump
• 17:54
  Speaker 1: through those hoops basically to get the medicine.
• 17:57
  Speaker 3: Now, someone listening to this might add, Okay, why is
• 18:01
  Speaker 3: it that they want you to jump through these hoops?
• 18:04
  Speaker 2: Why do you think that that is?
• 18:06
  Speaker 1: Yeah, these medicines are expensive. They're extremely expensive, and there's
• 18:10
  Speaker 1: a whole list of reasons why that is. And you know,
• 18:14
  Speaker 1: we could get into big pharma, these PBMs and the
• 18:19
  Speaker 1: middlemen that start negotiating rates. But the gist is that
• 18:22
  Speaker 1: these medicines are expensive, insurances don't want to cover them,
• 18:27
  Speaker 1: and you know, I could understand that. I think in
• 18:30
  Speaker 1: the future of what we're going to see at the
• 18:32
  Speaker 1: prices are going to come down. There is only one
• 18:35
  Speaker 1: player in the market, one manufacturer. Now there are two
• 18:38
  Speaker 1: manufacturers in this world, and there's a whole list of
• 18:42
  Speaker 1: manufacturers seeing you know, i'd say dollar scigns if you
• 18:47
  Speaker 1: really want to see. But they're seeing like, hey, this
• 18:49
  Speaker 1: class of drug is somewhat miraculous and works extremely well.
• 18:54
  Speaker 1: And if we can prove that we have another similar
• 18:57
  Speaker 1: type of like peptides is what they are, these one
• 19:00
  Speaker 1: agonists we have, we can have one that's similar with
• 19:03
  Speaker 1: about similar efficacy amount of weight loss and safety and
• 19:07
  Speaker 1: improving health, then why not jump in and we can
• 19:10
  Speaker 1: make it cheaper. And then all of a sudden they
• 19:11
  Speaker 1: start competing a bunch of different options than the prices
• 19:15
  Speaker 1: should come down.
• 19:16
  Speaker 2: Got it?
• 19:17
  Speaker 3: Okay, so we've said these buzzwords a few times now.
• 19:21
  Speaker 3: Some of glue tides GLP one agonists. For those that
• 19:25
  Speaker 3: are really just diving into the shallow end and news
• 19:29
  Speaker 3: to understanding what we're even talking about here, why don't
• 19:33
  Speaker 3: we give a brief overview and set the table so
• 19:36
  Speaker 3: they can understand how some of glue tide interacts with
• 19:41
  Speaker 3: the body.
• 19:42
  Speaker 1: Yeah, so these are GLP one agonists glucagun like peptide one.
• 19:47
  Speaker 1: It's it's you don't need to know much more than that,
• 19:49
  Speaker 1: but GLP one agonists we have naturally occurring GLP one
• 19:54
  Speaker 1: that's released from our intestines. Now we may say, well then,
• 19:57
  Speaker 1: like do we have GLP one deficient? Is that why
• 20:00
  Speaker 1: we start gaining weights? It's no, that's not true at all.
• 20:04
  Speaker 1: We know as we gain weight, our GLP one works
• 20:07
  Speaker 1: quite well in our own body. The thing is is
• 20:10
  Speaker 1: that our own GLP one is broken down very quickly
• 20:12
  Speaker 1: within minutes, So we can't just even make natural GLP
• 20:16
  Speaker 1: one and start injecting it or find different foods to
• 20:19
  Speaker 1: hopefully boost our own GLP one. It's broken down so quickly.
• 20:23
  Speaker 1: So what these researchers, just brilliant researchers did back in
• 20:28
  Speaker 1: the late nineties early two thousands, they actually found a
• 20:31
  Speaker 1: little lizard and they're trying to find ways to mimic
• 20:35
  Speaker 1: this GLP one because they start seeing the actions of
• 20:38
  Speaker 1: it in the body. And they found ways to then
• 20:41
  Speaker 1: have this GLP one, a different type of GLP one,
• 20:45
  Speaker 1: not our own natural something similar that hit the receptors,
• 20:48
  Speaker 1: but that didn't break down as quickly. So the first
• 20:51
  Speaker 1: one was that exenotide or biatos, the brand name came
• 20:55
  Speaker 1: out in two thousand and five. So people thinking these
• 20:56
  Speaker 1: are brand new drugs and scary because we don't know
• 20:59
  Speaker 1: much about them. They're not they've been out for almost
• 21:02
  Speaker 1: two decades, not completely yet but definitely studied for two
• 21:06
  Speaker 1: decades now. But the first one was an injectable twice
• 21:10
  Speaker 1: a day. Then they got smarter researchers getting better at
• 21:14
  Speaker 1: making these little peptides since they found a once a
• 21:16
  Speaker 1: day more effective one. Then it got into then they
• 21:20
  Speaker 1: found they found ways to make it once a week.
• 21:24
  Speaker 1: They're a couple out back in the twenty tens. Then samaglutide,
• 21:30
  Speaker 1: So samaglutide was the newer one in twenty seventeen. That
• 21:34
  Speaker 1: was ozempic was is the name everybody hears about. That's
• 21:37
  Speaker 1: the type two diabetes branded version, somaglutide. Though then they
• 21:41
  Speaker 1: upped the dose because in ozempic it only went up
• 21:44
  Speaker 1: to one milligram at the time. It goes up to
• 21:45
  Speaker 1: two milligrams now, but they studied it in two point
• 21:49
  Speaker 1: four milligrams, a much higher dose, and they found it
• 21:52
  Speaker 1: this works extremely well for weight loss. In fact, older
• 21:57
  Speaker 1: drugs like we would the the standard of care was
• 22:01
  Speaker 1: looking at like if David look like can a lot
• 22:03
  Speaker 1: of people lose at least five percent of their weight
• 22:05
  Speaker 1: from a weight loss medicine or weight management medicine. The
• 22:08
  Speaker 1: reason they picked five percent is because that's where you
• 22:10
  Speaker 1: start seeing pretty good improvements in your health. But the
• 22:14
  Speaker 1: thing is, once you get to ten percent, fifteen, twenty percent,
• 22:16
  Speaker 1: you get many more and more massive improvements in your health.
• 22:21
  Speaker 1: You don't start seeing improvements in sleep apnea obstructive sleep
• 22:24
  Speaker 1: apnea until you hit like ten percent or more. But
• 22:26
  Speaker 1: the marker they used before was five percent. And so
• 22:29
  Speaker 1: the older drugs, you know that we had something called
• 22:32
  Speaker 1: cusimia that was okay, it combined fenturemine until piramide that
• 22:35
  Speaker 1: was around you know, ten percent, but some maglutide in
• 22:39
  Speaker 1: the dose of two point four milligrams off we govi.
• 22:42
  Speaker 1: That's when twenty one hit. This first study that came
• 22:46
  Speaker 1: out looking at obesity. In this one it was around
• 22:49
  Speaker 1: fifteen percent. So now all of a sudden, the average
• 22:52
  Speaker 1: weight loss jumped up from this five to ten percent
• 22:55
  Speaker 1: range now up to fifteen percent, which was massive. It
• 22:59
  Speaker 1: was a it was a you know what they said
• 23:02
  Speaker 1: said in the newspaper, a game changer. And you know,
• 23:05
  Speaker 1: why didn't the drug why didn't ozempic go crazy back
• 23:08
  Speaker 1: in twenty seventeen or you know, before the two thousand
• 23:11
  Speaker 1: and twenties. It's because nobody really knew about it. We
• 23:15
  Speaker 1: all knew as a clinician, we knew. I was like,
• 23:17
  Speaker 1: you know, we're prescribing it back then, but not until
• 23:20
  Speaker 1: this week GOV came out to where there's a big
• 23:23
  Speaker 1: study and then people are like, hey, this stuff really
• 23:24
  Speaker 1: works for for weight loss and losing weight, keeping it
• 23:27
  Speaker 1: off and it seems to be safe and those with
• 23:29
  Speaker 1: type two diabetes at the time of reducing risks of
• 23:33
  Speaker 1: heart attacks and all sorts of stuff like that.
• 23:35
  Speaker 3: And I know that the study that you're mentioning this
• 23:37
  Speaker 3: was during a time period that was a little bit
• 23:40
  Speaker 3: more than a year compared to you said that fifteen
• 23:43
  Speaker 3: percent ish baseline of weight loss versus people that were
• 23:47
  Speaker 3: using a placebo, which was closer to something like two
• 23:49
  Speaker 3: point four percent. So really big difference here when it
• 23:53
  Speaker 3: comes to assisted weight loss using the Semaglue tide versus
• 23:58
  Speaker 3: no Semaglue tide.
• 23:59
  Speaker 1: Yeah, that's that's the other thing. Because people are like, well,
• 24:01
  Speaker 1: of course they're injecting themselves. It's probably because the diet
• 24:04
  Speaker 1: and exercise. It's like, no, they had a placebo where
• 24:07
  Speaker 1: they gave the exact same lifestyle advice too, and they
• 24:11
  Speaker 1: only lost a few percent. So yeah, massive, massive improvements.
• 24:14
  Speaker 1: And then to jump on top of that research, the
• 24:18
  Speaker 1: technology is just getting better and better. The newest one,
• 24:22
  Speaker 1: which is called tur Zeppetide, is actually a gluca gun
• 24:24
  Speaker 1: like peptide one GLP one slash gip, what they call
• 24:28
  Speaker 1: a coagonist. It's hitting two different receptors in the body,
• 24:32
  Speaker 1: and that one is now hitting over twenty percent. So
• 24:35
  Speaker 1: we went from five to ten percent and then fifteen percent,
• 24:38
  Speaker 1: which is great. Now we're hitting over twenty percent and
• 24:40
  Speaker 1: maybe maybe the longer you take it, and we're getting
• 24:43
  Speaker 1: into twenty know, mid twenty percents, And then there's drugs
• 24:46
  Speaker 1: coming down the pipeline. They're not out yet, we're probably
• 24:49
  Speaker 1: going to hit that thirty percent range. And for people,
• 24:52
  Speaker 1: just to put that in perspective, bariatric surgery is that
• 24:55
  Speaker 1: thirty percent range. So we're now we're getting just massive
• 24:59
  Speaker 1: amounts of weight loss. And also to put into perspective,
• 25:03
  Speaker 1: because we start talking about a percentage of weight, it's like,
• 25:07
  Speaker 1: what does that even mean? I just want to lose
• 25:08
  Speaker 1: thirty pounds or what? You know what I mean? So
• 25:11
  Speaker 1: let's just say you are, you know, two hundred pounds.
• 25:13
  Speaker 1: Let's say you qualify for the medicine. You know, ten
• 25:16
  Speaker 1: percent would be twenty pounds, right of two hundred pounds.
• 25:20
  Speaker 1: Fifteen percent would would be you know, thirty thirty pounds,
• 25:23
  Speaker 1: and you know, and twenty percent would be forty pounds.
• 25:26
  Speaker 1: So that's average. By the way, you see a spectrum
• 25:30
  Speaker 1: of some people don't respond super well these medicines. That's rare,
• 25:34
  Speaker 1: but you do see it. And then some people are
• 25:37
  Speaker 1: what we call like hyper responders. They'll respond extremely well
• 25:40
  Speaker 1: to the medicine. So you see a big range. It's
• 25:42
  Speaker 1: just at that average fifteen percent for some magnetide and
• 25:46
  Speaker 1: twenty or so percent for zeppetide, the newest one. It's
• 25:51
  Speaker 1: pretty interesting to see.
• 25:52
  Speaker 3: For those that are on the semaglutide what happens within
• 25:58
  Speaker 3: the body.
• 25:59
  Speaker 1: Yeah, so how this drug works now, they made it
• 26:03
  Speaker 1: for type two diabetes originally because of the way that
• 26:05
  Speaker 1: it helped the pancreas release more insulin. It reduces another
• 26:10
  Speaker 1: hormone called glucagon, which it increases your blood sugar, so
• 26:13
  Speaker 1: it helps you lower your blood sugar, but over long run,
• 26:16
  Speaker 1: with your losing weight, it also improves your blood sugar.
• 26:18
  Speaker 1: The way this works for those without type two diabetes. Ooh,
• 26:21
  Speaker 1: and just for losing weight. These GLP one hits receptors
• 26:27
  Speaker 1: in the brain that helps with appetite, and you know,
• 26:31
  Speaker 1: it's like, oh, I don't need something to make me
• 26:33
  Speaker 1: less hungry. But like, people talk about this term called
• 26:36
  Speaker 1: food noise. I don't know if you've heard of this term,
• 26:39
  Speaker 1: but it's a pretty good term to describe intrusive thoughts
• 26:43
  Speaker 1: about food. So I always talk about it, like, you
• 26:46
  Speaker 1: might eat a super healthy meal just let's just be
• 26:49
  Speaker 1: like cliche, and you're like chicken breast and roccoli and
• 26:53
  Speaker 1: brown rice. You know, so like so cliche. But let's
• 26:57
  Speaker 1: just say you're eating a high volume of of low calorie,
• 27:01
  Speaker 1: high protein, high fiber healthy foods. Let's say, but afterwards,
• 27:06
  Speaker 1: you're like, I'm I feel full, but I'm not like
• 27:09
  Speaker 1: necessarily like you call satiated, So your stomach's kind of full,
• 27:13
  Speaker 1: and you're like, I should be full, but I'm like
• 27:15
  Speaker 1: I still want to I want to eat some potato chips.
• 27:17
  Speaker 1: I want to eat some pie, some cookies, some like those.
• 27:21
  Speaker 1: The food noise, you're still thinking about food. You're thinking
• 27:24
  Speaker 1: about your next meal, you're thinking about having another serving
• 27:27
  Speaker 1: despite like, you know, like I should be fine right now.
• 27:31
  Speaker 1: These medicines what the patients literally tell me, they say,
• 27:35
  Speaker 1: they make it make them feel like what someone who's
• 27:38
  Speaker 1: never had to worry about their weight must feel like
• 27:40
  Speaker 1: after a normal meal. It's that's about as It's about
• 27:43
  Speaker 1: as good of a description as you could give it,
• 27:44
  Speaker 1: because you know, you see people that they can apparently
• 27:50
  Speaker 1: eat whatever they want, and what happens in those cases,
• 27:52
  Speaker 1: people are like, oh, they must burn it off. It's like, well, no,
• 27:54
  Speaker 1: they're in those cases a lot of times, not all
• 27:57
  Speaker 1: the times, but in a lot of times they're actually
• 27:59
  Speaker 1: not eating as much throughout the day. They can eat
• 28:01
  Speaker 1: pizza and eat all these other things and their bodies satisfied,
• 28:06
  Speaker 1: while other people will eat that same food and their
• 28:09
  Speaker 1: their minds, the wires, I call them, like they're kind
• 28:12
  Speaker 1: of afraid. There might be some short circuits in the
• 28:14
  Speaker 1: brain and the appetite centers, they still will seek more food.
• 28:19
  Speaker 1: And these these were these drugs basically hit receptors in
• 28:22
  Speaker 1: the brain that dampen that signal to a point where
• 28:27
  Speaker 1: they say, like, I can't explain it, but I don't
• 28:30
  Speaker 1: I'm not thinking about food all the time. And in fact,
• 28:32
  Speaker 1: their anxiety and relationships with food all improve as well.
• 28:37
  Speaker 1: I can't say for everybody, but for most people that we.
• 28:40
  Speaker 3: See, someone hears these things reduced food noise, I get
• 28:44
  Speaker 3: to eat pizza and still lose weight, and they're like,
• 28:47
  Speaker 3: oh my god, this sounds awesome. But also I worry
• 28:52
  Speaker 3: about the concepts of I can eat all these things
• 28:57
  Speaker 3: and still lose weight and then get to a point
• 28:59
  Speaker 3: where maybe you go off of this medication and you've
• 29:01
  Speaker 3: learned actually nothing about nourishing yourself. What do you say
• 29:07
  Speaker 3: to people that are a little unsure on that front.
• 29:11
  Speaker 1: Yeah, this, I mean, this is where we step in
• 29:13
  Speaker 1: with our behavioral component because we also think the same way.
• 29:16
  Speaker 1: We want to make sure that people are nourishing their body,
• 29:19
  Speaker 1: and there's what I would say quality of weight loss.
• 29:22
  Speaker 1: And also it's not just about weight loss, it's about
• 29:26
  Speaker 1: the improvement of their health while they're doing it. So
• 29:29
  Speaker 1: anybody could just lose weight, like if we could just
• 29:32
  Speaker 1: give these medicines out like candy and people lose weight
• 29:35
  Speaker 1: and if their weight improves, their health could improve, but
• 29:38
  Speaker 1: there could be all there. It's not optimal. We want
• 29:41
  Speaker 1: to make sure people aren't just eating non nourishing foods
• 29:45
  Speaker 1: while just losing weight. Because as you said, some people
• 29:48
  Speaker 1: will come off the medicines. These medicines are meant to
• 29:50
  Speaker 1: be taken long term. I just want to mention that,
• 29:53
  Speaker 1: like we think of obesity as a chronic disease, just
• 29:55
  Speaker 1: like we think of type two diabetes or hypertension. And
• 29:58
  Speaker 1: in those cases like high pretension, people they're doing everything
• 30:02
  Speaker 1: they can from a lifestyle standpoint, and they'll have to
• 30:05
  Speaker 1: get on what's called like an ACE inhibitor or some
• 30:07
  Speaker 1: blood pressure medicine. Their blood pressure will go down and
• 30:09
  Speaker 1: get into a good range. It would be like stopping
• 30:12
  Speaker 1: that blood pressure medicine only to watch their blood pressure
• 30:17
  Speaker 1: jump back up. The same happens with obesity. Not everybody,
• 30:20
  Speaker 1: by the way, but most people. When you stop the medicine,
• 30:24
  Speaker 1: their weights start going out. Because we think of obesity
• 30:27
  Speaker 1: more of the chronic, relapsing, remitting type of disease. Now
• 30:33
  Speaker 1: in terms of like trying to help with behavior, because
• 30:36
  Speaker 1: these drugs work so well, that's where we jump in.
• 30:39
  Speaker 1: This is what our GLP one companion program does. We're
• 30:43
  Speaker 1: seeing this with people. If you don't give any behavior
• 30:45
  Speaker 1: with it, they'll lose weight. Like the medicine, they'll just
• 30:48
  Speaker 1: eat less of what they're doing, right, and if it's
• 30:51
  Speaker 1: pizza or whatever, they'll just eat less of it. However,
• 30:55
  Speaker 1: they could get side effects eating those types of things
• 30:58
  Speaker 1: because sometimes when you eat heavier, very fatty, kind of
• 31:02
  Speaker 1: greasy foods, it doesn't sit well. So what we are
• 31:06
  Speaker 1: doing is we're making sure that you're having some behavior
• 31:10
  Speaker 1: change and eating more of the nutrient dense types of foods,
• 31:14
  Speaker 1: getting enough protein. There's a worry of muscle loss with
• 31:17
  Speaker 1: these because people lose massive amounts of weight. If you
• 31:19
  Speaker 1: don't eat anything, you lose muscle. If you don't lift weights,
• 31:22
  Speaker 1: if you don't do any type of exercise, you can
• 31:25
  Speaker 1: lose muscle along with us. So we put a big
• 31:29
  Speaker 1: emphasis on making sure you're getting those micronutrients, the vitamins
• 31:32
  Speaker 1: and minerals that you should be getting, because if you're
• 31:34
  Speaker 1: not eating enough, you won't be getting enough of those.
• 31:36
  Speaker 1: So we want to make sure that people are getting those.
• 31:38
  Speaker 1: We want to make sure people are getting enough protein,
• 31:40
  Speaker 1: and we want to make sure people are getting enough
• 31:42
  Speaker 1: physical activity. And the truth is some people will want
• 31:46
  Speaker 1: to come up despite we call, you know, even if
• 31:48
  Speaker 1: we call obesity chronic disease, and these medicines are meant
• 31:50
  Speaker 1: to be taken long term. There will be people that
• 31:54
  Speaker 1: want to come off these medicines, and you do have
• 31:56
  Speaker 1: to give the behaviors that hopefully they can stain when
• 32:01
  Speaker 1: they come off. And then there will be people there
• 32:04
  Speaker 1: will be insurances that might not cover it long term
• 32:06
  Speaker 1: unfortunately too, and so we want to give them their
• 32:09
  Speaker 1: best shot at that. But ultimately we do want to
• 32:11
  Speaker 1: improve what we'd call non scale health measures because again,
• 32:17
  Speaker 1: you take somebody who has a what I call like
• 32:19
  Speaker 1: a poor quality diet versus someone who's exactly the same,
• 32:22
  Speaker 1: because there's just a twin. They have everything else the same,
• 32:25
  Speaker 1: except their quality of diet is more like the highly processed,
• 32:30
  Speaker 1: very low nutrient dense types of foods. And it's probable,
• 32:34
  Speaker 1: at least there's good evidence to say that the person
• 32:37
  Speaker 1: with the poor quality of diet is probably going to
• 32:40
  Speaker 1: have worse health outcomes over the long run. So regardless
• 32:44
  Speaker 1: of weight loss, we do want to make sure that
• 32:46
  Speaker 1: these people are improving their lifestyle.
• 32:55
  Speaker 3: Taking a break from today's episode to give some love
• 32:58
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  Speaker 3: lmnt dot com slash hurdle. What I'm hearing you say
• 36:08
  Speaker 3: is that a lot of the people that are on
• 36:11
  Speaker 3: a sea glue tide will basically eat the way that
• 36:15
  Speaker 3: they would or could eat on WW without the food noise.
• 36:21
  Speaker 3: So I'm likening this to my experience with WW. I
• 36:26
  Speaker 3: lost about seventy pounds back in college. At the time,
• 36:29
  Speaker 3: some of glue Tide was obviously not on my radar.
• 36:32
  Speaker 3: But it beckons the question for those individuals that maybe
• 36:38
  Speaker 3: in this higher BMI category as we spoke about, but
• 36:42
  Speaker 3: haven't tried a conventional weight loss program, what are the
• 36:46
  Speaker 3: pros versus the cons of then immediately jumping to something
• 36:51
  Speaker 3: like a Sema glue tide instead of simply trying to
• 36:54
  Speaker 3: follow something like WW or being more cognizant of portion, size,
• 36:59
  Speaker 3: what you're putting in your body.
• 37:00
  Speaker 2: More traditional weight loss methods.
• 37:02
  Speaker 1: Yeah, most people should. I mean most people usually try
• 37:06
  Speaker 1: to do some sort of weight loss diet and exercise before.
• 37:12
  Speaker 1: So a lot of my patients they have already done
• 37:15
  Speaker 1: some sort of behavioral program, but it's if they hadn't.
• 37:18
  Speaker 1: It basically helps people do what they know they should
• 37:20
  Speaker 1: do they just can't do. Does that make sense? So
• 37:23
  Speaker 1: like let's say they do Weight Watchers our core program
• 37:25
  Speaker 1: and they're like they have some success, and we see
• 37:28
  Speaker 1: it all the time. There's some people that would just
• 37:30
  Speaker 1: have success and it's like great, and they just keep
• 37:32
  Speaker 1: doing it and they keep the weight off. Great. But
• 37:35
  Speaker 1: there you know, there's going to be some people that
• 37:36
  Speaker 1: their body starts fighting back and they're going to feel it.
• 37:39
  Speaker 1: It's like it's the food noise, it's the appetite drivers,
• 37:43
  Speaker 1: it's the energy, and it's really difficult for a lot
• 37:47
  Speaker 1: of people to stick to that lifestyle. So basically, add
• 37:49
  Speaker 1: in these medicines boom boom hits these receptors in the brain.
• 37:52
  Speaker 1: It's like, oh, it helps them then calm down all
• 37:56
  Speaker 1: that food noise, calm all those other signals from their
• 37:59
  Speaker 1: body helps them basically do the lifestyle that we're recommending.
• 38:03
  Speaker 1: They just their body wouldn't allow them to do it,
• 38:05
  Speaker 1: if that makes sense.
• 38:07
  Speaker 3: I want to talk about side effects. You said this
• 38:09
  Speaker 3: buzzword early in our conversation. Definitely a concern for many
• 38:13
  Speaker 3: who are contemplating going the route of being on one
• 38:15
  Speaker 3: of these medications.
• 38:17
  Speaker 2: What do we know so far?
• 38:18
  Speaker 1: Yeah, most common side effect is nausea and GI side effects,
• 38:23
  Speaker 1: So nausea's number one. It's mild to moderate for most people,
• 38:28
  Speaker 1: and for most people it resolves over time. You'll see
• 38:31
  Speaker 1: it in the beginning when you start the medicine, and
• 38:33
  Speaker 1: you might see it every time what we call tit
• 38:35
  Speaker 1: trade up, go up in a dose, and then you
• 38:38
  Speaker 1: get to what's called your maintenance dose at some point,
• 38:41
  Speaker 1: and for most people, the side effect of nausea resolves.
• 38:46
  Speaker 1: One thing about our GLP one companion program. So this
• 38:51
  Speaker 1: is the program that you can do, whether you get
• 38:54
  Speaker 1: the medicine through our ww clinic versus getting it from
• 38:58
  Speaker 1: your primary care doctor. We've basically made the dietary changes
• 39:04
  Speaker 1: in a program like fashion too. Hopefully lesson now we
• 39:09
  Speaker 1: can't you know, we can't make that claim and whatever,
• 39:12
  Speaker 1: But it should. The way we set it up is
• 39:13
  Speaker 1: should decrease the risk of certain side effects because the
• 39:17
  Speaker 1: way you eat actually does. Like I said, if somebody
• 39:20
  Speaker 1: eats pizza, they'll know the next day, like I probably
• 39:23
  Speaker 1: shouldn't have done that because now I'm feeling really nauseous.
• 39:25
  Speaker 1: The food's kind of sitting in their stomach. So the
• 39:28
  Speaker 1: way you eat does have an effect there. But for
• 39:32
  Speaker 1: most people mild to moderate results. For most there will
• 39:35
  Speaker 1: be a subset of people that get more moderate to
• 39:38
  Speaker 1: severe nausea. It's a risk. You know, most people don't
• 39:42
  Speaker 1: start vomiting and have to go to the hospital, but
• 39:44
  Speaker 1: it does happen from time to time. The reason our
• 39:47
  Speaker 1: WW clinic, the reason I think is great as opposed
• 39:50
  Speaker 1: to like going to a primary care doctor or someone
• 39:52
  Speaker 1: you see once a month. We have very proactive care,
• 39:57
  Speaker 1: so like the doctor and our care teams always right there.
• 40:01
  Speaker 1: So if you start getting side effects, first of all,
• 40:03
  Speaker 1: we want to minimize we want to even prevent them
• 40:05
  Speaker 1: from happening. That's why we have our GLP one Companion
• 40:08
  Speaker 1: nutrition program and we have dietitians and to make sure
• 40:11
  Speaker 1: that hey eat in a way that we know is
• 40:13
  Speaker 1: going to reduce risk. Of side effects. However, not, there's
• 40:18
  Speaker 1: still going to be people that have side effects. So
• 40:19
  Speaker 1: what we do is jump in. We can jump in
• 40:21
  Speaker 1: with you know, does this person need to go to
• 40:24
  Speaker 1: the hospital. No, hopefully we can jump in with anti
• 40:26
  Speaker 1: nausea medicines. There are anti nausea medicines, and no, not
• 40:30
  Speaker 1: everybody should be taking these medicines to have nausea, only
• 40:33
  Speaker 1: to take another medicine to combat the nausea. And one
• 40:36
  Speaker 1: of the common questions that we get is like, Okay,
• 40:38
  Speaker 1: so people are just nauseous all the time and that's
• 40:40
  Speaker 1: why they're not eating. It's no, They've done studies on this.
• 40:43
  Speaker 1: It's not the nausea that makes people lose it. In fact,
• 40:45
  Speaker 1: the nausea resolves in the satiety and all that food
• 40:48
  Speaker 1: noise is down, so it's not the nausea. But unfortunately,
• 40:51
  Speaker 1: some people do still get nausea. But that's what I
• 40:54
  Speaker 1: really like about our proactive approach because we prevent it
• 40:57
  Speaker 1: and then we can jump in if we need to. You,
• 41:00
  Speaker 1: whereas other places it's I can't even get a hold
• 41:03
  Speaker 1: of my doctor. I'm gonna have to go to the
• 41:05
  Speaker 1: er and get some fluids to make sure that I
• 41:08
  Speaker 1: don't get dehydrated or some type of thing.
• 41:10
  Speaker 3: Outside of the nausea. What are other possible sidefacts constipation.
• 41:15
  Speaker 1: We see constipation. It slows down your GI track, so
• 41:18
  Speaker 1: you do see some constuppation. Again, being proactive in our program,
• 41:23
  Speaker 1: we make sure people are drinking enough fluid that obviously
• 41:26
  Speaker 1: helps with consumpation, enough fiber, and then physical activity even
• 41:29
  Speaker 1: just even just going for more walks and more steps
• 41:32
  Speaker 1: during the day should help your GI transit getting the
• 41:35
  Speaker 1: food through your system. So preventing the constipation is very important.
• 41:40
  Speaker 1: And then of course on top of that, you can
• 41:42
  Speaker 1: take cilium husk, you can do magnesium and other types
• 41:45
  Speaker 1: of things to improve the constipation. Sometimes we see diarrhea
• 41:51
  Speaker 1: resolves pretty quickly. Reflux is another thing because again you
• 41:55
  Speaker 1: slow down the gastric emptying how well your stomach releases
• 41:58
  Speaker 1: food through the intestine, and so sometimes we see people who,
• 42:03
  Speaker 1: especially if they have a history of reflux, it can
• 42:05
  Speaker 1: it can worsen acutely. But sometimes we do see fatigue
• 42:09
  Speaker 1: and people think that it's from not eating enough, but
• 42:12
  Speaker 1: there's something about the drug that may that we're saying
• 42:14
  Speaker 1: may cause fatigue. But again it resolves for anybody that
• 42:19
  Speaker 1: gets it. It resolves for pretty much everybody that gets that.
• 42:22
  Speaker 1: Other there's there's some other very rare side effects, but bye,
• 42:26
  Speaker 1: by far the most common one is nausea. Then there's
• 42:30
  Speaker 1: reflux and constipation.
• 42:33
  Speaker 3: And sometimes and what you mentioned about ramping up on
• 42:37
  Speaker 3: this medication, I would like in it maybe to ramping
• 42:40
  Speaker 3: up on some sort of anxiety medication. Right, what does
• 42:44
  Speaker 3: that process look like? Because you said that as a
• 42:47
  Speaker 3: byproduct of that ramp up, some of the side effects
• 42:50
  Speaker 3: that someone could experience with these may lessen over time
• 42:53
  Speaker 3: as the body gets used to it.
• 42:55
  Speaker 2: Is that the right language there?
• 42:56
  Speaker 1: Yeah? Yeah, So you know there's some patients that are like,
• 42:59
  Speaker 1: just throw me on the high dose, and it's like no.
• 43:02
  Speaker 1: You hear stories like that. Sometimes a pharmacist will dispense
• 43:06
  Speaker 1: the wrong medicine, unfortunately the wrong dose, and a lot
• 43:10
  Speaker 1: of those people end up in the hospital because it's
• 43:12
  Speaker 1: their body's not used to it and it comes as
• 43:14
  Speaker 1: a big shock. They're not used to to this type
• 43:18
  Speaker 1: of physiological effect or super physiological effect. I should say. So, yeah,
• 43:24
  Speaker 1: it's very important to start a low dose. Body gets
• 43:26
  Speaker 1: used to it. Okay, let's go up. Body gets used
• 43:28
  Speaker 1: to it. Okay, let's go up. And so for we
• 43:31
  Speaker 1: go V specifically, you start at point twenty five milligrams,
• 43:35
  Speaker 1: you go up too point five milligrams, and you go
• 43:37
  Speaker 1: to one milligrams, and you go to one point seven
• 43:39
  Speaker 1: then two point four. For the newest one called zep bound,
• 43:41
  Speaker 1: which is the ter zeppetide stuff, you start at two
• 43:44
  Speaker 1: point five milligrams, you go to five milligrams, and you
• 43:46
  Speaker 1: go to seven and a half, then ten, then twelve
• 43:48
  Speaker 1: and a half then fifteen right, and you know it's
• 43:53
  Speaker 1: because of the shortages that we saw on in a while.
• 43:55
  Speaker 1: It's possible that some people may skip around in doses,
• 43:59
  Speaker 1: but it that can increase your risk of getting these
• 44:03
  Speaker 1: side effects because when you jump up too quickly, too fast,
• 44:07
  Speaker 1: your body's not used to it. So that's exactly how
• 44:11
  Speaker 1: it works.
• 44:11
  Speaker 3: The other thing that I want to make sure that
• 44:13
  Speaker 3: we double click on is how we're making sure that
• 44:16
  Speaker 3: the right people are getting their hands on this. I
• 44:20
  Speaker 3: know you talked extensively about the vetting process for someone
• 44:23
  Speaker 3: to get this through sequence in the WW clinic, but
• 44:27
  Speaker 3: what's not to say that someone could give their phone
• 44:30
  Speaker 3: to someone else who's obese and have them put in
• 44:33
  Speaker 3: all their information and then end up with something harmful.
• 44:38
  Speaker 1: Yeah, it's you know, those things are really tough to
• 44:41
  Speaker 1: get by because like even in the clinic, you could
• 44:43
  Speaker 1: have your friend go in get them the prescription, and
• 44:46
  Speaker 1: then afterwards they can be like, all right, here you go,
• 44:48
  Speaker 1: here's the prescription for you. But we have some safeguards
• 44:51
  Speaker 1: in place. We make sure we have them take a picture.
• 44:54
  Speaker 1: We have them take a picture on a scale to
• 44:56
  Speaker 1: start off with, just to verify their weight. We get
• 45:00
  Speaker 1: medical records, we get labs and all these different things.
• 45:04
  Speaker 1: There's no you know, complete foolproof way to say like,
• 45:07
  Speaker 1: but I would say, out of anybody doing it out there,
• 45:11
  Speaker 1: I'm pretty sure I can say this. We're we have
• 45:15
  Speaker 1: to be one of the safe safest if not, that
• 45:19
  Speaker 1: was my thing. I want to make sure that we're
• 45:21
  Speaker 1: not putting this in the wrong hands. I mean, you know,
• 45:23
  Speaker 1: when we it's funny because some patient will flag and
• 45:27
  Speaker 1: we'll look at as a team like is this there's
• 45:29
  Speaker 1: something going on here? You know, and you'll see you'll
• 45:32
  Speaker 1: see all sorts of all sorts of things, and we
• 45:34
  Speaker 1: want to make sure that only the correct people are
• 45:37
  Speaker 1: are getting is. We're very serious about it. We don't
• 45:41
  Speaker 1: want to become known as someone who's just increasing diet
• 45:45
  Speaker 1: culture or doing this for just vanity weight loss purposes.
• 45:49
  Speaker 1: We want to do this for true health purposes from
• 45:51
  Speaker 1: a physician standpoint, like we really want to hone in
• 45:55
  Speaker 1: on improving health from a true indication of the medicine.
• 45:58
  Speaker 1: You want to make sure that we're doing this for
• 46:00
  Speaker 1: health purposes, not for just vanity purposes.
• 46:03
  Speaker 3: Yeah, and I want to reiterate that obviously, all this
• 46:06
  Speaker 3: is extremely interpretive, right, So one person may feel completely
• 46:09
  Speaker 3: happy in a place like where I was back in
• 46:12
  Speaker 3: college that I mentioned I lost a lot of weight,
• 46:14
  Speaker 3: and that's so fine, But I would be remiss if
• 46:16
  Speaker 3: I didn't say that there were things about me at
• 46:18
  Speaker 3: that time before the weight loss that were extremely unhealthy
• 46:21
  Speaker 3: biomarkers that I needed to be concerned about. You said
• 46:25
  Speaker 3: the words diet culture, So I do want to make
• 46:28
  Speaker 3: sure that we also talk a little bit about that. Clearly,
• 46:31
  Speaker 3: this whole Semaglue tie situation, there's been so many people
• 46:36
  Speaker 3: across the United States that have somehow gotten their hands
• 46:40
  Speaker 3: on this, and now people have a really big negative stereotype,
• 46:44
  Speaker 3: oftentimes with the buzzword ozebic, with the buzzword Wagov. I
• 46:49
  Speaker 3: want to know what your stance is on the people
• 46:52
  Speaker 3: that are maybe shaming others who have leaned into these
• 46:56
  Speaker 3: drugs because of the negativity that we've seen from Hollywood,
• 47:00
  Speaker 3: A listers, et cetera.
• 47:02
  Speaker 1: Yeah, I think that, you know, it's hard to get
• 47:05
  Speaker 1: around the people with a lot of money are going
• 47:07
  Speaker 1: to find a way to get these drug I mean,
• 47:09
  Speaker 1: whether it's their concierge doctor or they're they're going to
• 47:13
  Speaker 1: go get it from a compounding pharmacy, which we don't do.
• 47:16
  Speaker 1: We don't we only do FDA approved versions. But yeah,
• 47:19
  Speaker 1: you go to a concierge doctor, you're paying them thousands
• 47:23
  Speaker 1: of dollars a year. The concierge doctor is probably going
• 47:26
  Speaker 1: to follow what you what you want, unfor Unfortunately, you know,
• 47:30
  Speaker 1: people are like, but aren't doctors supposed to be? Yeah,
• 47:32
  Speaker 1: you know, we should, we should be prescribing it according
• 47:35
  Speaker 1: to the label, but you know, I don't know. People
• 47:37
  Speaker 1: are human, I guess. So it's it's just it's it's
• 47:41
  Speaker 1: really unfortunate about the whole Hollywood thing, but it's it's
• 47:44
  Speaker 1: hard to stop them from doing so. All I can
• 47:46
  Speaker 1: do my big messaging is like, forget the vanity weight
• 47:50
  Speaker 1: loss thing like, it's not I strongly strongly discourage that
• 47:55
  Speaker 1: use the people that are upset that people are you know,
• 47:59
  Speaker 1: take in this easy way out. It's it's a little
• 48:03
  Speaker 1: bit of ignorance. They don't understand what we call like
• 48:05
  Speaker 1: the pathophysiology of the disease of obesity. What they they
• 48:10
  Speaker 1: see in those who have obesity is a lack of
• 48:13
  Speaker 1: real power and discipline and they just can't stop eating,
• 48:16
  Speaker 1: like just push yourself away from the table, put your
• 48:19
  Speaker 1: fork down. And what they don't see are the internal
• 48:22
  Speaker 1: cues biological cues. Mind you, this isn't disciplined cues. It's
• 48:26
  Speaker 1: it's think of it as like an itch that that
• 48:30
  Speaker 1: like just don't just don't scratch it, and it's just
• 48:32
  Speaker 1: getting stronger and stronger and stronger. I have a I've
• 48:36
  Speaker 1: heard some other good analogies, like think of it like
• 48:38
  Speaker 1: you just didn't sleep last night, and somebody else had
• 48:41
  Speaker 1: the greatest sleep of their life, and the person wants
• 48:44
  Speaker 1: to fall asleep, it's like, just don't be tired. Well,
• 48:47
  Speaker 1: it's it's same as telling somebody with that pathophysiological disease
• 48:50
  Speaker 1: of obesity, like just stop eating so much. I don't understand,
• 48:54
  Speaker 1: why can't you just stop eating? And it's it's because
• 48:56
  Speaker 1: they just haven't felt it, this internal drive to just
• 48:59
  Speaker 1: like thinking about food. And so when someone is just like,
• 49:04
  Speaker 1: I don't understand, why don't you just use DIAGNEXTI I
• 49:06
  Speaker 1: posted a tweet yesterday about it. There's people always posting
• 49:10
  Speaker 1: about it. It's good, it's good fodder for social media
• 49:13
  Speaker 1: because it gives me a chance to talk about this.
• 49:16
  Speaker 1: But like, it shows ignorance and also a clear bias
• 49:20
  Speaker 1: and stigma against those with obesity, just a complete misunderstanding
• 49:25
  Speaker 1: of it. Because if if it were just a discipline issue,
• 49:28
  Speaker 1: then then you're telling me that every like most of
• 49:31
  Speaker 1: the population has a discipline issue, and it's just not true.
• 49:36
  Speaker 1: And then they're going to say, well, did you are
• 49:38
  Speaker 1: you saying genetics have changed? It's like, no, genetics are
• 49:40
  Speaker 1: a part of it, but obviously our environment has changed.
• 49:44
  Speaker 1: It's just that those who have a susceptibility and a
• 49:47
  Speaker 1: wiring to to eating more calories than we burn, it's
• 49:52
  Speaker 1: a it's a passive thing, despite despite their their frontal
• 49:56
  Speaker 1: cortex and them trying to fight against it, whereas like
• 50:00
  Speaker 1: someone like me, I'm naturally leaner, my body you know,
• 50:03
  Speaker 1: I can go eat whatever, and my body tends to
• 50:05
  Speaker 1: just stay leaner. And I understand that, and so I
• 50:10
  Speaker 1: think other people think that, like, well, if I can
• 50:13
  Speaker 1: do it, then other people should be able to do it.
• 50:15
  Speaker 1: But they don't know what's going on in that other
• 50:16
  Speaker 1: person's body. It's just that's that's all it is. It's
• 50:19
  Speaker 1: a lack of understanding. And so I used to get
• 50:22
  Speaker 1: really mad about it, and now I'm just like, well,
• 50:25
  Speaker 1: they don't get it, so let me see if I
• 50:26
  Speaker 1: can try to like teach them. And then if they
• 50:28
  Speaker 1: hear enough patient stories, and the stories are the same
• 50:32
  Speaker 1: over and over, they all say the same thing like
• 50:36
  Speaker 1: I just I can't I can't explain it when especially
• 50:38
  Speaker 1: when they start the medicine, they just all say, like
• 50:40
  Speaker 1: I feel what it must feel like to be someone
• 50:44
  Speaker 1: that doesn't struggle with weight.
• 50:45
  Speaker 2: Yeah, yeah, yeah.
• 50:48
  Speaker 3: So before when we were giving that example of a
• 50:50
  Speaker 3: two hundred pound person and maybe they'll lose fifteen percent,
• 50:54
  Speaker 3: maybe they'll lose up to thirty percent eventually using a
• 50:57
  Speaker 3: medication like this, who is to say via the medical
• 51:02
  Speaker 3: intervention when this person then comes off of this medication.
• 51:06
  Speaker 3: If someone loses something like forty to sixty pounds and
• 51:09
  Speaker 3: they're now in a normal quote unquote BMI range, although
• 51:12
  Speaker 3: you and I have already discussed the problems that come
• 51:14
  Speaker 3: hand in hand with that, but they're in a healthier
• 51:17
  Speaker 3: weight range. They're seeing a lot of the benefits that
• 51:19
  Speaker 3: come with that percentage of overall fat loss. Who's to
• 51:24
  Speaker 3: then modify that prescription? Should they need to come off
• 51:27
  Speaker 3: of it or is that something that they would just
• 51:29
  Speaker 3: stay on?
• 51:30
  Speaker 1: Yeah, great question. There's unfortunately a false I would call
• 51:33
  Speaker 1: it a false dichotomy that's occurring. So there's one group
• 51:37
  Speaker 1: of people who say these are a short term thing
• 51:39
  Speaker 1: to lose the weight and then they got to come off.
• 51:41
  Speaker 1: There's another group of mostly physicians, who are saying obese
• 51:44
  Speaker 1: is a chronic disease. They go on this medicine, why
• 51:47
  Speaker 1: would they ever stop? Well, the truth is is that
• 51:49
  Speaker 1: patients have autonomy, and we don't have autonomy over insurances
• 51:54
  Speaker 1: and whatnot either. But like there will be a subset
• 51:59
  Speaker 1: of patients, I will say most people will likely need
• 52:01
  Speaker 1: to take some form of fashion or fashion of a
• 52:06
  Speaker 1: therapy of biological therapy. It may not be a GLP one,
• 52:09
  Speaker 1: It may be a lower dose, it may be a
• 52:11
  Speaker 1: spread out like for example, let's just use let's use
• 52:16
  Speaker 1: URRs appetite zep bound as for an example. They may
• 52:19
  Speaker 1: get up to fifteen milligrams and they're they're like, they
• 52:23
  Speaker 1: lost one hundred pounds and they want they want to
• 52:28
  Speaker 1: wean off of it. So you start weaning them down.
• 52:31
  Speaker 1: You get them down to the lowest dose of two
• 52:33
  Speaker 1: and a half, and they're still keeping the weight off.
• 52:36
  Speaker 1: And now they go from every seven days to every
• 52:39
  Speaker 1: you know, twelve to fourteen days, like every other week,
• 52:42
  Speaker 1: and it's still keeping the weight off. And then they
• 52:44
  Speaker 1: stop and then they notice that their weight starts creeping up.
• 52:47
  Speaker 1: So those people may need to still stay on a
• 52:49
  Speaker 1: low dose, but a very low dose and spread out,
• 52:51
  Speaker 1: not even according to the package insert, which again, like
• 52:56
  Speaker 1: I just have to say, we're supposed to follow a
• 52:58
  Speaker 1: package insert, but patients. We're going to find that patients
• 53:01
  Speaker 1: respond so differently to these that we're going to start
• 53:03
  Speaker 1: having to really individualize, and that's what we do. Not
• 53:07
  Speaker 1: everybody needs to stay in the medicine long term. Most
• 53:10
  Speaker 1: people will have to be on some form or fashion
• 53:13
  Speaker 1: of it. But there are a subset of people that
• 53:15
  Speaker 1: will be able to come off of it and This
• 53:17
  Speaker 1: is kind of understanding that what we call the heterogeneity
• 53:20
  Speaker 1: of obesity, meaning that people are different. Different people are different.
• 53:24
  Speaker 1: We all have i don't know, different physiologies and different
• 53:28
  Speaker 1: environments and genetics, and so people need to have individualized care.
• 53:33
  Speaker 3: When someone gets a renewal for their prescription, would there
• 53:39
  Speaker 3: become a point if they're doing this through telehealth, that
• 53:44
  Speaker 3: someone would say, okay, you're at this weight now, which
• 53:47
  Speaker 3: means that we are going to lower the dose for you,
• 53:51
  Speaker 3: even if they want to maybe keep it at where
• 53:54
  Speaker 3: it's at.
• 53:55
  Speaker 1: We don't force people to come off. We offer We
• 54:01
  Speaker 1: offer it if they want, and we'll be there if
• 54:02
  Speaker 1: we want. But people are very sensitive to that because
• 54:08
  Speaker 1: other doctors in the past have forced people to come
• 54:10
  Speaker 1: off and it can be quite triggering, like you don't
• 54:13
  Speaker 1: understand I've done everything my whole life to try to
• 54:16
  Speaker 1: lose weight and keep it off and this is the
• 54:18
  Speaker 1: first time i feel free from that burden. And so like,
• 54:23
  Speaker 1: we don't force it, we say, look, you're at a
• 54:26
  Speaker 1: good weight. What we do have, though, we have a
• 54:28
  Speaker 1: safety check in place like these newer metzepetite specifically zet bound.
• 54:34
  Speaker 1: It is so powerful that some people will they'll keep
• 54:38
  Speaker 1: losing weight, and if you keep them on the highest
• 54:40
  Speaker 1: they'll go, they'll go into what I would consider a
• 54:43
  Speaker 1: weight such a low weight that it's not healthy. So
• 54:46
  Speaker 1: that becomes less about health and more about like this
• 54:49
  Speaker 1: person's BMI. Like, so I set the cutoff of the
• 54:52
  Speaker 1: BMI at twenty two. You know, eighteen eighteen is considered
• 54:58
  Speaker 1: you know, underweight, but like really twenty two. If they're
• 55:02
  Speaker 1: getting below twenty two, it's it comes. It's you're not
• 55:05
  Speaker 1: going to get any health benefit below that, right, So.
• 55:08
  Speaker 3: Yeah, I guess, but that was my that's my question
• 55:11
  Speaker 3: or my concern really is that who's checking in to
• 55:14
  Speaker 3: make sure that this isn't going to a dangerous place forals?
• 55:18
  Speaker 1: So yeah, I set the protocol there to where basically
• 55:20
  Speaker 1: it I call it like landing a plane. So like
• 55:23
  Speaker 1: if they are rapidly losing weight and they're getting you know,
• 55:26
  Speaker 1: under twenty five BMI they're getting, they're gonna they're gonna
• 55:29
  Speaker 1: look like they're going to shoot past that twenty two BMI.
• 55:32
  Speaker 1: Then we start rapidly, not rapidly, but we start titrating
• 55:35
  Speaker 1: down the dose to make sure they don't shoot past that.
• 55:38
  Speaker 1: So we're we're very careful there, and then that's kind
• 55:41
  Speaker 1: of the basement BMI. We could go to twenty one
• 55:43
  Speaker 1: or so if you know, some people lose weight just
• 55:46
  Speaker 1: even if we didn't calculate it in their rate necessarily.
• 55:49
  Speaker 1: But like we try not to go past that. We
• 55:52
  Speaker 1: have that in our safety protocols.
• 55:54
  Speaker 3: Right, And I again, I have an understanding that on
• 55:56
  Speaker 3: your side, you do the best you can in this situation.
• 55:59
  Speaker 3: Understanding that telehealth they're not actually there physically by their
• 56:02
  Speaker 3: side all the time. I would assume there's also an
• 56:04
  Speaker 3: instance where someone might not actually be accurately reporting their weight,
• 56:09
  Speaker 3: which could bring other issues to the forefront.
• 56:12
  Speaker 1: Yeah, it's it's very possible. We recognize that that's kind
• 56:16
  Speaker 1: of one of the drawbacks of telemedicine as opposed to
• 56:20
  Speaker 1: bringing them in person, looking at them right on the scale,
• 56:23
  Speaker 1: making sure they're not holding a forty five pound weight
• 56:28
  Speaker 1: on their chest or you know, something like something silly
• 56:31
  Speaker 1: like that, so that you know those things are you know,
• 56:35
  Speaker 1: are concerned and we find ways to minimize that type
• 56:39
  Speaker 1: of situation. But I will say that tellymedicine, like the
• 56:43
  Speaker 1: stigma around obese people have been traumatized from having to
• 56:47
  Speaker 1: go in being sitting in chairs that weren't made for
• 56:51
  Speaker 1: their bodies, around a bunch of other people that might
• 56:54
  Speaker 1: be coughing and sputtering because they're because they're coming in
• 56:57
  Speaker 1: for some cold or whatever. And then you're sitting around
• 57:00
  Speaker 1: these other people, not in a comfortable chair to be
• 57:02
  Speaker 1: brought in maybe weighed in in front of other people.
• 57:06
  Speaker 1: It's it can be very traumatized. And then you sit
• 57:08
  Speaker 1: there and the doctors behind a computer. The first thing
• 57:11
  Speaker 1: he says is that like, hey, you know, you need
• 57:13
  Speaker 1: to lose weight, right And they're not even looking at you.
• 57:17
  Speaker 1: The person doesn't even realize that you lost fifty pounds
• 57:19
  Speaker 1: despite your BMI being still in this kind of higher range.
• 57:23
  Speaker 1: And I hear these stories all the time. The reason
• 57:25
  Speaker 1: I bring this up. I hear these stories the trauma
• 57:27
  Speaker 1: that's been done, and people just want to have a
• 57:31
  Speaker 1: non stigmatizing, non biased type of weight health care visit.
• 57:38
  Speaker 1: They just they just want to be heard. They don't
• 57:40
  Speaker 1: want everything, including their cough and sickness to be attributed
• 57:44
  Speaker 1: to their weight. They you know, if you hear about
• 57:47
  Speaker 1: the person that had has obesity to have back pain,
• 57:51
  Speaker 1: it's rare, but you see the doctor like it's just wait,
• 57:53
  Speaker 1: go lose weight. They didn't even do the exam because
• 57:55
  Speaker 1: they're they clearly have a bias. They just think everything's
• 57:57
  Speaker 1: due to their weight. And the person had a tumor
• 57:59
  Speaker 1: in their fine, again, it doesn't happen. That's that's rare.
• 58:02
  Speaker 1: But those are like the cases you hear. So yeah,
• 58:06
  Speaker 1: in terms of telemedicine, like removing that barrier of in
• 58:10
  Speaker 1: the stigma away from it to where people feel comfortable
• 58:13
  Speaker 1: to finally have those discussions where you don't have to
• 58:16
  Speaker 1: go wige in front of a whole group of people
• 58:21
  Speaker 1: and be kind of chastised by the system. Anyway, that's
• 58:25
  Speaker 1: just my that's my little I'm going off on a
• 58:27
  Speaker 1: thing because I've thought about it very much and I've
• 58:29
  Speaker 1: talked with so many patients, thousands of patients, and they
• 58:32
  Speaker 1: you know, some people do still prefer that in person,
• 58:35
  Speaker 1: of course, and there is a strong role for that,
• 58:37
  Speaker 1: and I agree there is. But like telemedicine especially, I
• 58:43
  Speaker 1: would say, I say chronically monitoring. I was on Good
• 58:45
  Speaker 1: Morning American, Like, can you say continuously and people don't
• 58:48
  Speaker 1: know what chronically monitoring is, so continuously monitoring where it's
• 58:52
  Speaker 1: like they can message in, they can have a team
• 58:54
  Speaker 1: right then and there, proactively helping in between what you
• 58:58
  Speaker 1: usually do or like month to month visits with like
• 59:01
  Speaker 1: a normal doctor. But with us, it's like we're there
• 59:04
  Speaker 1: all the time with you, with you on the journey.
• 59:07
  Speaker 1: So anyway, sorry, I'm going off.
• 59:08
  Speaker 2: Oh you are so fine. You are so fine.
• 59:10
  Speaker 3: What would you say your hopes are for the future
• 59:13
  Speaker 3: of this type of treatment?
• 59:16
  Speaker 1: Yeah, so technology is just going to keep getting better
• 59:18
  Speaker 1: and better. We need to keep improving our ways of
• 59:24
  Speaker 1: delivering care through telemedicine. I think the future is going
• 59:28
  Speaker 1: to be a hybrid though, of both. So we need
• 59:30
  Speaker 1: to find ways to do good in person. We can't
• 59:34
  Speaker 1: just get rid of in person. You need to be
• 59:35
  Speaker 1: seen in person from time to time. Right now, we're
• 59:38
  Speaker 1: you know, people still have their primary care doctors and
• 59:40
  Speaker 1: they use us and we try to communicate with their
• 59:42
  Speaker 1: primary care doctors. But I think eventually the future is
• 59:45
  Speaker 1: a hybrid version of this. I think technology though online
• 59:50
  Speaker 1: people have their people have their phones in their pocket
• 59:53
  Speaker 1: at all time. Imagine having your care team in your
• 59:55
  Speaker 1: pocket at all time, like a dietasan a strength coach.
• 59:58
  Speaker 1: And then your apps. So for us, it's like our app,
• 1:00:02
  Speaker 1: you know, you can't always have a person always there,
• 1:00:04
  Speaker 1: you know, within minutes. But our app to help people
• 1:00:07
  Speaker 1: through this journey to make sure they're eating the right things,
• 1:00:09
  Speaker 1: to make sure they're doing the right physical activity. Even
• 1:00:12
  Speaker 1: if you don't use us for a prescription, you can
• 1:00:14
  Speaker 1: still use our app that helps you through this. So
• 1:00:17
  Speaker 1: I think I think the future is making sure that
• 1:00:20
  Speaker 1: people have a safe journey through it, a better quality
• 1:00:24
  Speaker 1: of life through the journey. People stop the medicines. Oftentimes
• 1:00:27
  Speaker 1: you see these articles like people don't even stay on
• 1:00:29
  Speaker 1: these medicines because of the side effects. It's like, well,
• 1:00:31
  Speaker 1: we have a good track record of keeping people on
• 1:00:33
  Speaker 1: the medicines because if you minimize the side effects and
• 1:00:36
  Speaker 1: make sure you're not increasing the dose when they're having
• 1:00:38
  Speaker 1: side effects, because that's what you see in other instances though,
• 1:00:41
  Speaker 1: they're going to be having side effects and like whatever,
• 1:00:44
  Speaker 1: just keep going up on your dose. It's like, who, well,
• 1:00:46
  Speaker 1: maybe not go up on the dose. Maybe you still
• 1:00:47
  Speaker 1: got to get used to this. Maybe we need to
• 1:00:49
  Speaker 1: adjust the way you're eating and that type of thing
• 1:00:52
  Speaker 1: before we start thinking about going up in a dose.
• 1:00:55
  Speaker 1: So I think the future is you really utilizing good technology,
• 1:01:01
  Speaker 1: good programming to make sure people can safely use this
• 1:01:05
  Speaker 1: new technological drug. And the drugs are just going to
• 1:01:08
  Speaker 1: get better and better, like they're just the things that
• 1:01:11
  Speaker 1: are coming out are just they're crazy people. People don't
• 1:01:15
  Speaker 1: realize what's coming down the pipeline. It's it's going to
• 1:01:17
  Speaker 1: be quite different in five to ten years of what
• 1:01:21
  Speaker 1: we're going to see.
• 1:01:22
  Speaker 2: What does better mean to you?
• 1:01:24
  Speaker 1: So fewer side effects, better weight loss, fewer, fewer times
• 1:01:30
  Speaker 1: you have to inject, like all the pain points that
• 1:01:33
  Speaker 1: you see. So like before when I talked about it
• 1:01:35
  Speaker 1: is like twice a day injection. Then it went to
• 1:01:36
  Speaker 1: once a day, then it went to once a week,
• 1:01:39
  Speaker 1: and then it went from this amount of weight loss
• 1:01:42
  Speaker 1: up to this amount of weight loss. So we're going
• 1:01:44
  Speaker 1: to see better weights and then and then there's a
• 1:01:45
  Speaker 1: concern of like well how much of it's fat, how
• 1:01:48
  Speaker 1: much of it's muscle and bone. There are gonna be
• 1:01:51
  Speaker 1: ways where they're going to decrease the nausea. They're going
• 1:01:53
  Speaker 1: to find ways to hit the receptors in the brain
• 1:01:56
  Speaker 1: differently to where you don't cause nausea at all. Like
• 1:01:58
  Speaker 1: there's think about that, Like all those little pain points
• 1:02:01
  Speaker 1: are going to just be refined through the years, and
• 1:02:04
  Speaker 1: I see our rule as just improving the journey while
• 1:02:09
  Speaker 1: they take these medicines, because the medicines are inevitable unless
• 1:02:13
  Speaker 1: there's a smoking gun that we don't know but we
• 1:02:15
  Speaker 1: haven't seen it. There's just piles of data to show
• 1:02:18
  Speaker 1: the safety of these medicines. I see our role as
• 1:02:21
  Speaker 1: a facilitating the best quality of life and journey while
• 1:02:24
  Speaker 1: people are taking these because I think there's going to
• 1:02:26
  Speaker 1: be a lot of people taking these regardless.
• 1:02:29
  Speaker 3: So yeah, I anticipate I'm curious to know your thoughts
• 1:02:32
  Speaker 3: on this. I anticipate that as these quote unquote get
• 1:02:36
  Speaker 3: better your words, more and more people are going to
• 1:02:40
  Speaker 3: get onto a GLP one medication. Do you anticipate that
• 1:02:45
  Speaker 3: there will be a wider acceptance of these medications as
• 1:02:50
  Speaker 3: we move forward versus the kind of flack that they're
• 1:02:53
  Speaker 3: getting now.
• 1:02:54
  Speaker 1: Yeah, it's inevitable. And this is what I'm up against
• 1:02:57
  Speaker 1: on social media all the time. And what's going to
• 1:03:01
  Speaker 1: happen is that it's going to be similar to I
• 1:03:03
  Speaker 1: would say, like mental health and things like that. Before
• 1:03:07
  Speaker 1: it was you know, taboo and people didn't understand it.
• 1:03:10
  Speaker 1: It's like, just pull yourself up in your bootstraps. You know, smile,
• 1:03:14
  Speaker 1: put your smile on, you have depression, whatever, put a
• 1:03:16
  Speaker 1: smile on, just cheer up. It's going to be the
• 1:03:18
  Speaker 1: same with obesity. Instead of just like, hey, you need
• 1:03:21
  Speaker 1: to put the fork down. They're going to understand the
• 1:03:23
  Speaker 1: biological underpinnings of it. And this doesn't mean we shouldn't
• 1:03:26
  Speaker 1: be working on our environment too. People I'll get chastise
• 1:03:30
  Speaker 1: on Twitter with this kind of straw man false dichotomy,
• 1:03:34
  Speaker 1: whatever you want to call it. They're like, but shouldn't
• 1:03:35
  Speaker 1: we be working on the environment and not just working
• 1:03:37
  Speaker 1: on these drugs? Is like, yeah, we should be working
• 1:03:39
  Speaker 1: on the environment too. We need to prevent obesity before
• 1:03:42
  Speaker 1: it occurs, but we also need tools to help treat
• 1:03:46
  Speaker 1: the obesity once it occurs too. And by the way,
• 1:03:49
  Speaker 1: there was just a press or release. There are companies,
• 1:03:51
  Speaker 1: all sorts of companies working on how to prevent the
• 1:03:54
  Speaker 1: obesity in the first place, because again, once people develop
• 1:03:58
  Speaker 1: the obesity, that's where some physiological changes can happen in
• 1:04:02
  Speaker 1: the brain, and that's where it's like the food noise,
• 1:04:05
  Speaker 1: those biological drivers. It's really hard to just will power
• 1:04:09
  Speaker 1: yourself out of that.
• 1:04:10
  Speaker 3: Yeah, and you're really talking about what I think so
• 1:04:13
  Speaker 3: many advocate now, it's what can we do from the
• 1:04:17
  Speaker 3: get go, especially if you're in a position where you're
• 1:04:19
  Speaker 3: raising children, to keep a healthier environment around because we
• 1:04:24
  Speaker 3: are truly a product of our environment, and having important
• 1:04:28
  Speaker 3: conversations about what eating well might look like, what you
• 1:04:32
  Speaker 3: can do to move your body regularly, so many different
• 1:04:35
  Speaker 3: things that we take on as a responsibility to hopefully
• 1:04:38
  Speaker 3: live a healthier and happier life. And also be honest
• 1:04:41
  Speaker 3: that there are going to be situations that feel as
• 1:04:43
  Speaker 3: though they are beyond our control, and that just because
• 1:04:46
  Speaker 3: someone may want to lose weight doesn't mean that they
• 1:04:49
  Speaker 3: should be demonized for it. I think that's a really
• 1:04:53
  Speaker 3: tough point point that we're at now in our society.
• 1:04:55
  Speaker 3: I as someone who's lost weight herself, I know how
• 1:04:59
  Speaker 3: difficult it can be to have other people have an
• 1:05:01
  Speaker 3: opinion on your body. And when someone has an opinion
• 1:05:04
  Speaker 3: on your body, when you know personally that you don't
• 1:05:06
  Speaker 3: feel healthy in your body, it should be your decision
• 1:05:08
  Speaker 3: on what you want to do moving forward, not the
• 1:05:11
  Speaker 3: decision of the other.
• 1:05:12
  Speaker 1: Yeah. Right, So you shouldn't feel forced to lose like that.
• 1:05:15
  Speaker 1: That's the other So I I deal with a lot
• 1:05:17
  Speaker 1: of those people online and it's like, look, I'm not
• 1:05:19
  Speaker 1: going to tell you to lose like force you to
• 1:05:22
  Speaker 1: lose weight. I'm not going to chastise you. If you
• 1:05:24
  Speaker 1: want to lose weight or if you don't want to
• 1:05:25
  Speaker 1: lose weight, the options there. You have autonomy over your body.
• 1:05:31
  Speaker 1: But the thing is people are jerks. Like you know,
• 1:05:34
  Speaker 1: people will say all sorts of things to me, mean
• 1:05:38
  Speaker 1: from different angles. You. If you can't lose weight, you
• 1:05:43
  Speaker 1: lack the discipline. If you lose weight using trying to
• 1:05:46
  Speaker 1: do behavior, then you use the you know, one of
• 1:05:48
  Speaker 1: these new medicines. Then you're taking the easy way out.
• 1:05:51
  Speaker 1: It's like, just can I just like live my own
• 1:05:52
  Speaker 1: life and do what I need to do now. Unfortunately,
• 1:05:55
  Speaker 1: people are just not not nice people out there. But
• 1:05:58
  Speaker 1: I think, I honestly think the perception, the paradigm will shift.
• 1:06:02
  Speaker 1: We're at that turning point though, where I'd say, over
• 1:06:05
  Speaker 1: the next decade or so, it's going to be thinking
• 1:06:08
  Speaker 1: very differently about this.
• 1:06:10
  Speaker 3: Well, Doctor Nandolski, I'm so happy that we are able
• 1:06:13
  Speaker 3: to have this really in depth conversation about GLP one medication.
• 1:06:17
  Speaker 3: I know that so many individuals are really trying to
• 1:06:20
  Speaker 3: figure out what's right for them. And I just want
• 1:06:23
  Speaker 3: to close this off by personally saying that no one
• 1:06:26
  Speaker 3: should should you into what you do for your body.
• 1:06:29
  Speaker 3: So make sure that if this is something that you're
• 1:06:32
  Speaker 3: interested in, you really are taking ownership of your health.
• 1:06:35
  Speaker 3: You're getting informed, You're not just listening to a podcast
• 1:06:37
  Speaker 3: like this, but you're talking to an expert one on
• 1:06:40
  Speaker 3: one to make decisions that are right for you and
• 1:06:42
  Speaker 3: your body, knowing that those decisions and what's right might
• 1:06:46
  Speaker 3: change over time. For those that want to follow up
• 1:06:49
  Speaker 3: with you, that want to listen to more of what
• 1:06:51
  Speaker 3: you have to say, keep up with you.
• 1:06:52
  Speaker 2: How do they do that? Doctor Nadolski, Yeah, you.
• 1:06:55
  Speaker 1: Can do it on so Instagram. I'm at doctor Nandolski,
• 1:06:58
  Speaker 1: Dr nad oil Usky. I'm on TikTok at doctor Spencer,
• 1:07:03
  Speaker 1: d R sp and c R at Doctor and Adult
• 1:07:07
  Speaker 1: Scan Twitter and then doctor Spencer ADL Scan Facebook. You
• 1:07:11
  Speaker 1: can listen to our docs who Lift podcast. It's me
• 1:07:13
  Speaker 1: and my brother. We we get a little goofy on there,
• 1:07:16
  Speaker 1: kind of giving each other, uh crap, but we go
• 1:07:18
  Speaker 1: over all the new studies and all the new stuff
• 1:07:21
  Speaker 1: to think about when it comes to these drugs or
• 1:07:23
  Speaker 1: anything else related to obesity and health. And of course,
• 1:07:26
  Speaker 1: like if you are interested in our whether you're on
• 1:07:29
  Speaker 1: a GLP one and you you know from your own
• 1:07:31
  Speaker 1: doctor you want to join our GLP one companion program
• 1:07:33
  Speaker 1: through weight Watchers, we'd love to have you there. And
• 1:07:37
  Speaker 1: if you are thinking about these new medicines and you
• 1:07:38
  Speaker 1: don't want to go through your own doctor, we'd love
• 1:07:40
  Speaker 1: to have you in our WW or weight Watchers clinic,
• 1:07:43
  Speaker 1: so you can go to weight watchers dot com to
• 1:07:46
  Speaker 1: get all that information.
• 1:07:47
  Speaker 3: Beautiful, Thanks so much for your time today. I'm over
• 1:07:50
  Speaker 3: at Emily a Body and at Hurdle Podcast another hurdle conquered.
• 1:07:54
  Speaker 2: Catch you guys next time