Latest / Daxko Fitness Forward / From Prescription to Gym Floor: The GLP-1 Opportunity | Fitness Forward Ep. 07

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From Prescription to Gym Floor: The GLP-1 Opportunity | Fitness Forward Ep. 07 · Daxko Fitness Forward

• EP 07 Dr Lou x Dr Catherine x JVD 1: Yeah. This is Fitness Forward, conversations shaping the future of fitness. All right, welcome everyone to the next episode of Daxco's Fitness Forward Podcast. today we are touching on an incredible topic, I think that is transforming our industry, and we're all trying to figure out how to how to how to navigate this as gym owners around GLP1s and peptides. And today we are fortunate to have two experts who are not only experts on the medications, but also experts in terms of how does this intersect with our industry. And so I am very excited. to have with us today Dr. Lou Atkinson and Dr. Katherine Isaac. So welcome and and thank you for participating today. Thank you. It's a pleasure. Yeah, so alright. So I'm I want to I want you all to introduce yourselves and talk a little bit about your history and so you know how you ended up where you're at now. So Dr. Atkinson, I know you know you're you're living in the UK. you've done a lot of work over the years in terms of you know, I think some studies around weight management and pregnancy, and then I think that's morphed into, you know, here we are today, and now you're consulting groups like the David Lloyd Clubs on how to navigate. Overall, you know, kind of health and wellness as a part of your new company. So, yeah, tell us a little bit more about that. Yeah, absolutely. So, I mean, my my brief history is that I've worked in the fitness industry for almost 30 years now as a trainer, as an educator, and as you say, now more as a strategic advisor. I'm also a behavioral scientist, so for the last 20 years or so, I have been working across academia, public health, health. care, health tech, looking at how we integrate the beh behavioral science evidence into sort of practical and often sort of business-related practices. So really how do we leverage what we understand about the determinants of people's behaviour into something that means that we can make people make it easier for people to live healthier lives. So in terms of the sort of space we're going to be talking about today I've done, as you say, a lot of research around obesity, including maternal obesity, childhood obesity, for the last 20 years, really understanding primarily the lived experience of what obesity is like to live with as a complex condition. I have designed, delivered and evaluated a whole broad range of weight management programs. So when GLP1s were licensed for Prescription for obesity as a primary condition, it was a really exciting space for me because I know how desperate a lot of people living with obesity have been. They've tried everything else and it doesn't work and it's not their fault and the society blames them for it. So this feels like something new and exciting. And having worked in the fitness sector for so long, I was really keen to make sure that quite frankly, we didn't mess it up. So we've been working, as you say, with operators and with industry bodies as well to try and develop a better understanding of the individuals who are hopefully going to become the members of the clubs out there who are going to combine GLP1 medication or other therapies for obesity but also for wider health and longevity. alongside of course all the benefits that physical activity and exercise can bring too. Yeah. That's actually amazing. I mean, like the fact that this happened kind of as a culmination of all your work, yeah, it must have been like, wow, you're living in a just a fascinating time to see, you know, this this now, you know, medical advancement and how it impacts, you know, the work you've been doing your your entire life. Absolutely. And and what's really Interesting and concerning to watch as well is how fast the societal shift is happening as well. So while there's lots to be positive about with this as an advancement in medical science, there's also a lot of caution retales here around where it could potentially go wrong. And I'm sure we're gonna delve into conversations about how people might use these drugs in a way that's not health positive, and also how you know, individuals are being judged for their use of the drugs and and you know, as a psychologist, these things are really fascinating and interesting to me. It's amazing. Well thanks for thanks for being on today. Dr. Isaac, so you have spent most of your career as an an MD, and then y you've had a a transition here, you know, and I and I think started as bionic health and now thrive. So yeah, tell just tell the audience you know, how you ended up where you're at and You know, what's you know, kinda what's your role now, in helping, you know, people like us that are in the field navigate this new world of GLP ones and peptides and all the things that are happening. Absolutely. So I'm an internal medicine physician, which means I take care of adults and I've been in practice now for it'll be fifteen s years at least. I've always been interested in primary prevention, so preventative health. and was trained as a primary care physician during my residency training. And I worked in primary care for a number of years and it's a grueling space to work in. So we're seeing people who have you know so many complicated medical conditions, oftentimes that are downstream effects of obesity, diabetes, hypertension, osteoarthritis, liver disease, et cetera. And taking care of these patients is very challenging and super important and difficult to do in a 15 minute space as is often designed in the primary care space. So I was also very interested in in physician wellness and ways to kind of optimize the the you know sort of practice of medicine. And so that's what brought me to Bionic Health, which is now Thrive, which is a company that was formed kind of with two unique missions. The first mission, our founder, Dr. Jared Pellow was very interested in developing a company that really focused on preventative health after he lost a very close family member who was seemingly quite healthy, actually, was like super active. exercise fitness space and had a sudden heart attack and passed away in his fifties. So felt there was this whole space where we really could be more proactive in helping people understand what their health risks were. The other was how to integrate AI into electronic health records to make just our work flow a lot easier for us so we could help patients more be more present and not be doing all of the paperwork, the charting. Yeah. So utilize utilize all the best of that. So that is the mission of our company. And as we've transitioned into Thrive and now have more of a connection with fitness space, we have kind of diversified how we take care of our patients. So preventative health is super important to us still. We have our health span program, which is where we do Kind of a broad evaluation of cardiometabolic risk, cancer screening, and provide sort of like a consultative program to say, hey, this is what we found. These are the things that we think are high level important and that you want to target. And with that, we do health coaching as well. And then we also have medical weight loss, testosterone therapy, and menopause hormone treatment, which we provide for patients. who meet those criteria. Yeah, no, and and we're we're excited to be partnering with you all at Thrive and we're gonna could be continuing to roll out, you know, I think this in important information on how do club operators navigate this world, right? And obviously having that medical background and what Thrive does is critical. So as a part of our Elevate Wellness program, we're excited to be partnering with you at Thrive. So Thank you. Yeah, we're excited too. All right, so we're gonna we're gonna get into the meat of this. so you've got a a large audience here. We service about nineteen thousand customers that are in the field every day. They're in clubs, they're working with you know, members, and they're trying to navigate this. So I would love to get each of your perspectives and you know, Dr. Isaac, we could start with you. You know, what it like on one hand we'll we'll hear, you know, our customers saying, you know, GLP ones are not a great thing because it means people aren't going to come to the gym anymore, right? we're starting to see that not be the case as much. and then on the other hand, it's like, wow, this is something that may be a tailwind or industry, but how do we navigate it? You know, what should we be offering to this client base? So that was a lot, but yeah, I'd love for you just to walk through what you're seeing. And then Dr. Atkinson, obviously, you're you're in the heart of this as well. But what is what is the message to our audience in terms of how they should be embracing or working alongside, you know, kind of these new medications? Absolutely. Well, I think number one, we all understand that GLP one agonists are are actually quite effective. They really do work. People see results, which is wonderful. and I think there may be a subset of people who are taking them and just wanna lose some pounds, only interested in the number on the scale, and are that's the only sort of thing that they're interested in. If someone is approaching this from a health perspective and hopefully, you know, in partnership with their provider, they're being educated that yes, this can help lose weight, but you want to sustain that weight loss when you use it in conjunction with making dietary changes and of course implementing exercise and strength training. Even beyond just that basic education, What the data tells us is that there is the risk of muscle loss as you lose weight, especially if you lose weight too rapidly. So it's actually quite important to implement strength training while on this treatment in order to minimize that muscle loss. So I think there's a lot of opportunity for clubs when you have such a huge population of people in in the United States, right? I mean so many patients fall into the obese or over overweight category that there's going to actually be a larger number of people who are interested in coming to the gym. And I think probably Dr. Atkinson might be able to speak to this, but sometimes just a barrier to coming into the gym is feeling like you're not healthy enough to be in the gym. And a a GLP one agonist can sort of be a Kickstarter for those patients. Wow, actually I'm down ten, fifteen pounds. I want to see how far I can I'm motivated now. Yeah. Now maybe I can actually get into the gym and feel like I deserve to be there with other people. And so I think just putting out that positive message of like let's help you achieve your goal and let's help you maintain your goal while you're on these therapies. So you know, not in any kind of shaming way. Like we're here to support you so that you can reach your your ultimate goal of feeling healthy and moving well. Yeah. Absolutely. So we've heard that anecdotally, but Dr. Atkinson, I'd love to hear what is the data on that, you know, in terms of kind of that motivator to now go to a gym or to a Y or wherever. And then I'd also love you if you i if you could just touch on What type programming are you seeing that's effective? You know, Dr. Isaac talked about, you know, strength training. We've heard, you know, some pretty interesting stats on the amount of muscle that's lost also and the importance of strength training. What kind of programming are you coaching, you know, you know, fitness and gym and you know, operators out there? Fascinating. so yeah, we on the first question, in terms of what was the data showing, we we don't have enough studies yet. On the real experience of GLP ones in the real world. I think it's also always really important to emphasize every single one of the clinical trials of every single one of these drugs, they were prescribed alongside dietary advice, and people were encouraged to do their 150 minutes of moderate intensity exercise plus two straight training sessions. We don't know whether people changed their behavior and did those things because nobody measured that in the clinical trials, so we don't know whether that had Or not, but we do know it was part of the protocol. So we almost need to come at this from the perspective of anyone who's prescribed these drugs, you know, if the guidance is clear, they should also be advised to eat a healthy diet and to do physical activity to meet the recommended guidance. and so where the clubs fit in is is simple quite simplistic in that, in that the clubs should be there to provide. the opportunity and the support for those people to do at least the physical activity part of the treatment because it's part of the treatment. Now we know the reality is there's a broad range of providers out there and how much they're emphasizing the behaviour change or not is going to vary, right? But we definitely know that it's part of the treatment program and so it should be recommended. In ter but as I said, we don't have the data. The data we do have where we have a very small amount of lived experience studies, so qualitative studies where people actually talk about their experience of taking the drugs in the real world, so outside of clinical trials, and I'm a huge fan of real world evidence because clinical trials are completely different. Yeah. you know, they do talk about how the drugs give them a release. It gives them hope. They give them optimism. And that's what facilitates them trying new things or going back to things that they did before. So lots of individuals who are taking GLP ones were active in a past life, may even have tried to be active even as unfortunately they were gaining weight and unable to lose the weight. So we're not necessarily dealing with people who've never been active, but the drugs as as you said, Doctors, it was r is about giving them that starting point to say, actually now I feel differently about myself. So now I am gonna go and try this thing that maybe I've tried before and and not have a great experience. in terms of programming, and this is why I say it's really fascinating, so I want to make a few key points here. Absolutely, the studies are clear, you will lose tons of muscle loss if you lose a ton of weight, right? If you look at the studies that have measured things like physical function and muscle quality, they don't indicate a detrimental effect, even if you lose fifty or a hundred pounds. So we need to be very cautious about this message that Muscle loss is something that is scary. And we have to be particularly cautious because as a health psychologist, it's really clear that fear-based messages can be very counterproductive. So if we want people to be active, what we don't want to do is go out there with lots of messages that say, if you don't do this, your muscles will fade away and your bones will crumble into dust. Because we don't have the evidence to support that. The muscle loss we see. We don't know enough about what that's made up of and how that affects function. But like I said, the sm the small studies we do have that have actually measured those things indicate oftentimes there's an improvement in physical function and muscle quality. So we need to be a bit cautious about this blanket message that everyone must strength train because not only are fear-based messages ineffective, but we know from studies of people living with obesity who are on a weight loss programme. And their experience of exercise and structured exercise is that resistance training is the one thing that they feel the least motivated towards. It's the most scary, most intimidating part. So again, it's like, why would we send out that message to a bunch of people who already feel a little bit wary about stepping into a club? Yeah. Why don't we instead say, Hey guys, movement is great? Again, the guidelines with in the clinical trials were not Come and do four strength training sessions a week. It was the national guidelines, international guidelines. 150 minutes of moderate intensity, aerobic exercise, two strength training sessions a week. So if we stick with the basics, then in terms of programming, you know, we wouldn't necessarily do anything differently than we would do with any other member, which is the first thing is have a conversation. What do you like? What don't you like? Because if I give you a program full of the things that you find uncomfortable or difficult or challenging, I'm not going to see you again. If I give you a program based on, well, hey, I used to do I you know, I used to play a little bit of tennis. Okay, great. Well, let's do a little skills tennis session with you once a week. Or, I used to enjoy running. Okay, well maybe you don't feel confident to run, but maybe we get you on the treadmill and we start you on a programme that works towards you becoming new again. you know, so I think we have to be really cautious about taking a set of good data and interpreting that, you know, taking a few little mental leaps and saying, Okay, we need to start programming strength training. Strength training is important for everybody and most people don't do enough of it. So I'm not saying don't encourage strength training. But again, I think if we think about the individuals who might be stepping into the club after a break. Or who've never felt comfortable in that space, yeah. If we can encourage them to do activities that are resistance training, but don't involve them using barbells and dumbbells and give complicated grey machines that, you know, nowadays look like you know, a tech nightmare. so yeah, let's go back to basics is what I'm saying. Yeah. I love it. Dr. Isaac, so like just just to add on to that, obviously, you know, you guys are doing telehealth and prescribing, you know, medications and like yeah, how how would you want a health and wellness operator to engage with people that are taking GLP ones? Well I actually love that this conversation because as you were talking, I'm thinking about so many of the patients that I would see that would be developing bursitis. as they're trying to start their exercise regimen and they're they haven't been active or they have knee injury or shoulder injuries because they're trying to do too much right off right out the gate. And then that that is like a catch 22 because they get an injury and they're they're back out of the gym and then they're hesitant ev even more so to get back. So as you were talking Dr. Atkinson I was thinking about the importance of mobility and stability training and just even, you know, body weight bearing type exercises and kind of thinking of how wonderful it would ha would be to have programming that says, hey, let's introduce you to these basics first so that we can help to minimize injury and you know move you along on this nice health trajectory. because a lot of the patients are getting on in their decades of life at this point who are seeing success with these medications and they're more prone to injury. So yeah, I I think having that kind of messaging would be amazing. Yeah. I like it. It th this is a good so I I also own clubs and and I think I get excited like, let's you know like let's go fast, you know, here here's there's some momentum here. And I think it's it's really good advice and thank you both for like, hey, let's just slow this down a little bit, right? And introduce people the right way and build up and build a foundation. and I I would imagine there's also people who are overly excited about maybe going too fast as well. and so as club operators sometimes it's like, hey, let's slow this down a little bit for your own safety and your own health, you know? Mm-hmm. So absolutely. I think the the encouragement to do a little bit less is really important. I'm really glad you brought that up, Doctor Isaac, because We see it in the clubs all the time. People get that newfound enthusiasm and they go too hard too soon. And a lot of the the marketing and the sort of training programs that we have do reward sort of continuously increasing what people are doing. Whereas actually, you know, we know that getting the basic skills right and building that confidence to move well i is a worthwhile investment. So I think it's a really good point. Yeah, I was just I actually love that and rewarding consistency I think would be amazing as opposed to rewarding, you know, heavier weight or, you know, accelerating to a harder program. I think consistency is tremendous. because especially again, people who are getting into their fourth, fifth, sixth decade of life, they're gonna have little things that set them back. So they're just not gonna see the steady incremental gains that you would typically see in your Twenties or early thirties. So that that I think is a wonderful, wonderful thing. And then also a number of these patients who are now seeing success with GLP ones, they may not even have the basics of the nutritional component either. And so something that I've actually see a decent amount more than I would like to see is people under fueling their activity level. And they don't really understand that that can impact their energy level, like impact how they feel in terms of recovery. And so also implementing some of that basic education, I think would be super, super helpful. Yeah. Yeah. It's really interesting and and I think so obviously we see a lot of data and information at clubs given kind of the the kind of the breadth that we see across all of health and wellness. And we've known we've known this. now we have AI and we can really look at a lot of data. So Dr. Isaac, it was interesting listening to you talk about data and analyzing data and what we know is if someone connects with an individual, whether it be in a class, a personal training, a small group training, their likelihood of continuing just exponentially goes up. You know, so I think the thing I'm excited about this is what I'm hearing you all say is like, hey, professionals are very important inside the gym of coaching people to do this the right way. And so you know, I I think our hope and and what I'm excited about is it it's showing the value of the customers we have and the way they're serving, you know, people, their members. and there is gonna be more opportunity and and should be more growth in you know, I would say small group training and things like that. So Yeah, absolutely. And I think you know the the conversations I'm having with trainers and coaches who are out there, you know, on on the floor is they are desperately seeking guidance and information around how how to work with these clients. You know, they do want to do the right thing, but unfortunately I think, you know, we do have to unpick some of our older ways of of working. And again, not that these people have never been active, you know, ar aren't even active. We're seeing a A lot of people now who have been consistent exercises, consistent members for many, many years haven't lost any weight, even though that was their primary goal, because their biology isn't playing ball and the GLP ones and all of the new dr newer drugs are helping with the biology. So there's just a shift in identity. But I do think it's a great reset opportunity for us as professionals in this industry to move ourselves more towards you know, a a health focused profession rather than a pure exercise and fitness profession because this is what this new audience wants. They want someone who is gonna be there, is gonna understand the journey that they're on. I love what you said, Dr. Isaac, about, you know, this this isn't a linear journey. I talk about that all the time. you know, there are gonna be these setbacks and they want someone who isn't in it just for a a six week transformation program or a you know a twelve week weight loss program. This is they want professionals who have the empathy, have the compassion, understand the challenges, understand the journey. but genuinely those members could be your absolutely most loyal members because as you say, Jeff they once they make that connection and once they find that community Exactly. That's what keeps them coming to your club. It's nothing to do with the number on the scales. Yeah. No, I love that. All right. So I'm gonna shift into what I think for me at least is a little more complicated topic. and hopefully, you know, you guys can shed some light on this. and I think Dr. Isaac, this is a good one to to send your way. peptides. All right, so big topic. Yes. I'd love for you to maybe just distill it down for us a little bit, like what is happening with peptides. What's good about it? What's not so good about it? Like what should clubs and club owners and trainers and people that are working with clients know about peptides and be thinking about? A hundred percent. This is it's definitely a hot topic. And I'll kind of approach it from a couple of different perspectives. So number one, what is a peptide? A peptide is a series of amino acids that are joined together by peptide bonds. So insulin is a peptide. GLP1s are peptides. it's a very generic term. It's like saying do do exercise. You should do exercise. What does that mean? What type of exercise should I do? What's good for my body? so saying taking peptides or using peptides is a very generic term. And so it's important to understand that because I think there's this blanket idea out in the community that peptides are a really good idea and peptides are effective. and people may have heard that there are some peptides that have FDA approval and then a large amount of them that do not do not currently have FDA approval. And so when we're talking about the peptides that people are kind of interested in, there are things that they're getting in the gray market. They're not FDA approved, they're not coming out with with really any regulation in terms of safety or quality. and people are purchasing them off the internet. I think you know it it's really interesting to me as a clinician. I get the I have the privilege of seeing thousands of patients and and pattern recognition over the years. And what's super interesting to me is where I'll I'll talk to people about the health benefits and the cardiovascular benefits of taking a statin and statin drugs have hundreds of thousands of patients that have been studied over years and years and years and inevitably there's a ton of resistance. I don't like taking drugs. I don't want to take anything. I don't want to be on this medication. Even though there's clear data to support the value of these medications and there are trackable biomarkers. You you start someone at statin, you see their LDL cholesterol go from one forty down to a hundred. You take the test later on and you see the change. but yet there is a very low bar for people to start taking random peptides that they're purchasing on the internet. And there's also a paucity of data for safety. So whenever you're taking a drug whether it's an herbal supplement or you know like saw palm meadow or you're gonna start taking, let's say, testosterone, these things impact our biology and they have some desirable impacts and they have some undesirable impacts. And because we do not have enough data, we don't really understand a variety of things about each of these peptides that people are purchasing on the internet. Number one, what is the best form of absorption? Do how do how do we take this drug? If we take it orally, does our body even absorb it? if we inject it subcutaneously, does it go where we're hoping it's going to go? We don't know anything about dosages in terms of human studies. We don't have that information. This is the optimal dosage. This is a super therapeutic dose, meaning I'm getting way more than my body needs. this is too low of a dose, so I'm injecting something and I'm putting myself at risk by injecting needles. But I'm not actually getting the impact that I'm hoping for. and how does our body metabolize that, or what are the downstream byproducts of the metabolism? Does it impact my liver? Does it impact my kidney? We we have none of this information. And and I'm speaking generically, right? I'm speaking about all peptides. Again, that's like saying all exercise. So there are some peptides that we have data on. such as SMORin and Tesimoralin, which are were FDA-approved drugs that are growth hormone releasing hormone analogues. And then there's things like BPC 157, which people are using for recovery and injury. And we have very limited human data on the impact of these peptides. So I think what I would say to club owners and to fitness professionals is know some of the basics, know that these things are out there, people are asking for them. why are they asking for them? I think that's the important question. What is going on? Is it because they had an injury? Are they overtraining? W what is going on? How can you you know, just analyze it from the perspective of you know, Are we putting our effort where we're gonna get the most output? And that's what I'm often kind of trying to redirect the conversation to when I'm when I'm talking to patients. Like, have you been eating well? Are you exercising? Are you doing all the basics before we go down the line and start taking some random thing on the internet that we think is going to help us? So I think it's very important to just understand where that person is coming from and making sure that they have all the essentials first before they start talking about these other peptides. So it's important in my field and at our company, we really value being a trusted voice. And a trusted voice is going to tell you, hey, we don't have the information. And because we don't have the information, I can't tell you how it's going to impact you. and and that's important. I think that there is also this belief out there among the community that we're trying to withhold information. We're trying to not provide, you know, they won't pass this because people can't make money off of it or something like that. But actually there are a lot of people making money off these petals without any data whatsoever. So I would also say, Hey, like look at the you know, look at the data for other types of therapies like acupuncture or other alternative therapies and and compare to what you're injecting off the internet. So as to try to try to encourage people to evaluate their own mindset before they make these choices for themselves. Yeah, it it's really fascinating and I think that's why at Daxco, you know, I obviously we service a really large group of people out in the field and part of the reason we started elevated wellness and then are connecting to thrive is how do we try to get this information out, you know what I mean, and do this in a really healthy way. And not to plug Thrive. but so if I if I'm a trainer, you know, and I'm working with someone and they say, Hey, I'm I've been reading a lot about peptides, I'm interested 'cause I've read this and I'm thinking about going on the internet and buying this, what do you think? Like, what should they do? Like should they and maybe it's Thrive, maybe it's someone else and Dr. Atkinson if you have like some direction here too, like where should they send someone to get I would say expert advice here? I mean I I think everything you said, Dr. Isaac, is is so important about having that conversation about what are you trying to achieve, and getting the basics in place because I think we need to recognize that, you know, wanting to to find sort of low effort, high reward solutions isn't laziness, you know, that's how we've evolved as human beings, right? You know, we we that's how we became top of the food chain because we're efficient. You know, we're we're able to preserve our energy and and get the biggest bang for our buck. So I I think you're absolutely right about not trying to judge people or stigmatize them because that shuts the conversation down. And I think from the GLP one space this is where I'm working with a lot of trainers to say, yeah, we need to yes, we need to have the conversations 'cause we need to know what our clients, our members are thinking and what they're considering and what they're actually doing so that we can be fully informed. But I think absolutely I would always say from a scope of practice point of view, you know, personal trainers, club operators, fitness trainers, none of us are medically qualified. i or I'm sure there are a few out there, sorry, who are both of course, but the majority are not medically qualified. So we can't be offering any kind of clinical advice. And I think the the advice I always offer is to yeah, find it send someone to a credible source, someone who's regulated. So again, we have regulatory bodies in place for a reason. and I don't know Thrive, I'm gonna make sure I know you from now on, but I have no doubt the second I go to your website I'm gonna see a whole bunch of badges for the regulatory bodies that you need to be involved in. So and again in in on the UK side of things, when it comes to providers, you know, anyone who is signed up to the relevant codes of practice, the the people who are paying the fees to be regulated, the people who contract. what they're providing, the source of it, can give you the all the evidence about where it's come from, how it's repaired, all of those kinds of things. These are the the important things. So you know, definitely don't ask your favorite AI chatbot for advice. go to someone who's qualified to provide that advice. So for trainers it's either to a regulated provider or to a medical professional. Yeah. All right, Doctor Atkinson, you actually touched on a really interesting point and a great question. I'm so gonna Piggyback that, Dr. Isaac, if you could talk about, okay, kind of my first question: what should people do? Where should they go? is AI a legitimate source or not? So that's good, that's great. So, number one, where should people go? I think it's important to gather a couple of different sources of information just to put people's minds at ease. So, what I mean by that is definitely talk to your regular provider, your physician. Your nurse practitioner and say, hey, this is something that I'm interested in, and I this is why. This is why I'm interested in in taking this. So just redirecting people to their specialist or their primary provider is super important. Now they may feel like they're that they're not speaking to someone who is informed, and so if you're interested in finding More information, yes, you could come to a company like Thrive. We do our health span consult, and as part of that, we would have a conversation with patients if they're saying, Hey, I'm interested in X, Y, and Z, talking to them about risks, benefits of each of these different compounds, substances, etc. One thing you want to be wary of is if the company that you're going to is making money off of the peptide. Right. So if they have financial gain, there's always conflict of interest. So you just have to be aware of that. And you you have to know your source. I teach my son, know your judge. Know your judge. No know the source that you're going to. And so you can go them go to that source to access information, but to just remember that that that is not necessarily an unbiased resource that I'm accessing. So If you're going to a company or a provider and they say, this really helped my uncle, my brother, my next door neighbor's father's son, okay, well that's an N of one. And yes, anecdotal information is important and interesting, but in in no way equals evidence for success. And so you have to be cautious about that. And people are very happy to come forward with their stories of success of I used this and it helped and I feel great. The people who don't see benefit, they don't they don't shout that from the rooftops. I spent, you know, a thousand dollars on this for two months and didn't help. I feel like yeah, I feel like that's kinda like the stock market. Everyone tells you about the great stock they picked and it went crazy and not the ones that was a loser. So so so it and again, you know, kind of maybe crystal ball going forward. Doctor Isaac, how long is it gonna take or how long do you think it'll be until there are more peptides and kinda FDA approved, there'll be a little more more data, in in terms of like not just kind of the anecdotal personal experience, but real clinical data to show some results. Yeah, again, that's I mean it's very th similar to thinking about like the exercise space and the data on that. It it takes time. Yeah. And and it's different depending on what you're studying. you know, like you have to look at phase one, two, three clinical trials. Like they're looking for pure safety data first, in very small, healthy people, then they expand that to looking at the treatment, the condition that you're actually looking to treat. So that that takes time. and I I definitely would caution against people taking anything that there's no human data on. And I was watching a recent podcast about peptides where the person was explaining some of the data around I think it was BPC one fifty seven and they were talking about how there's data in interstitial stystitis, which is painful bladder syndrome, yeah, which women can experience. And I think the treatment arm was like twelve patients. This is extremely small. And it was not a randomized trial. This is extremely small. And so just keeping that in mind, it this is so nuanced. I mean, people spend years going to school to understand clinical data and statistics. so for the average trainer, the average person out there just saying like, you know, understanding, they looked at twelve people and normally when you're wanting to clear a drug, we have thousands of patients that we're looking at. So there's there's just such a minimal amount of information that we can use. say whether or not this is safe or is actually effective, right? Because placebo is a real thing. Yeah. So yeah, it's it's challenging, but I would say, you know, it's there there are some that are in the pipeline, like many people have heard of Reditrutide, which is a new drug that's gonna be in the GLP one, GIP, glucagon, you know, in a space of its own or but you know, other things that people are injecting, it's not in the pipeline for them yet. Yeah. So Dr. Atkinson, this has been your career, right? Studying data and understanding this. So how how l let's just take this from how much data and how much time are we going to need to understand the impact on people's behavior and, you know, take maybe even just outside even the medical like FDA approval side of it. So I mean it it's gonna take a long time. Like the same with clinical trials, you know, understanding shifts in behaviour takes pretty much just as long. because it again it it changes. So, you know, s how someone perceives their own health and any conditions they're dealing with and the the the the treatments that are on offer, all of those things translate into what sort of behaviours they will undertake, whether it's taking a a a drug, whether it's doing some exercise, whether it's changing their diet, getting more sleep, whatever it is, taking supplements, all these different behaviours. So what I would say is I will always shout out some great work that Dr. Rene Rogers is doing if you haven't caught her work. I wanna say she's University of Kansas but I might have got that wrong. but she's phenomenal and she's doing some of the first real studies of the experience of both exercise and GLP one treatments and understanding how those two things work together. so we have we need to generate the data around the interaction between behaviour and the drugs first of all. And that is gonna take time because we've got to do it well, like you say, Doctor Isaac. Yeah. Anyone can go along and do a small sample study and that's useful. It's really useful data. That's what informs those bigger trials. but until we have a proper randomized controlled trial with different conditions, we won't really understand the interaction between those things. But what I would say is in the real world, I think we've already seen a massive behavioral shift and a massive shift in the cognitions that drive that behaviour. So first of all As we mentioned at the start, a shift in the perception of what it takes to achieve a sort of socially desirable body, and what it takes to achieve a medically, you know, healthy weight. you know, now there's a whole other dimension. and so people are having to change their beliefs around what's possible and what's not possible. we're also seeing a a a slight shift, I believe, from the conversations I've had. Again, my N of One study, but all the conversations I've had over the last two years, I'm starting to see a a really positive shift amongst fitness professionals, operators, whose initial response was most definitely, this is a threat to my business. And also because the majority of people who work in this sector are people who enjoy physical activity, find it re relatively easy and enjoyable. and have typically lived in a socially acceptable body size. So there it's not their fault, but they have a bias, they have a stigma, and so their initial response was, This is the easy way out, the lazy way out. you know, why would anyone not just eat less, move more? Completely not understanding the biology of obesity. And I think we're really starting to see a positive change in that now. Yes. which I'm you know, I'm really delighted about. I think we've got a long way to go in terms of understanding how best to serve individuals who are not the traditional fitness customer. And that's a lot of the work that I'm doing, along with colleagues to support clubs who wanna understand where are we at, what are we doing, what are the signals that we're putting out. That might be actively repelling people away from my door, that actually they're the people that we want to help. Every fitness professional I speak to has a genuine desire and passion to support individuals, to to get moving more and be healthier and achieve a better quality of life. The problem is they're not able to do that because the spaces and the cultures and the programmes and the services that are being offered out to those individuals are not the right ones, they're not appealing. So I think once we can start to design better offers, and that means changing the shape the the the space that we're in, it means changing the membership models, it means changing the education of our workforce, you know, it means changing the data that we're collecting and the way that we're using it so we under better understand that type of behaviour. you know, then we'll start to develop that understanding of how behavior is shifting in this new era. Yeah, Dr. X, I I could not agree with you more in terms of the shift in mentality. You know, we've seen that in terms of feeling like a threat to like, this is a tailwind, right? So it leads me to our f my final question. I think, you know, you touched on it in terms of, you know, health providers, fitness center operators need need to be thinking about their business a little bit differently, you know, or their offerings differently. and but if you were to if you were each to distill this back to, all right, so I'm listening to this podcast, lots of information, it's helped a little bit, I'm still a little bit overwhelmed. What do I do? Like w what would be the all right, tomorrow, start doing these things, you know, whether that be from a programming standpoint or Dr. Isaac from you know, how they're you know recommending or talking to their members and prospective members. about, you know, GLP1s and peptides. So I mean there there are there's a whole there's a whole lot of things that people could do and it and it definitely is just a case of start with one. Like don't try to change the world. But I do think we all need to recognise the need to change. One of the things that I always encourage trainers and and operators to do is to walk the gym as a person living with obesity. Literally walking through the front door and understand what that experience is like because a lot of spaces the vast majority of spaces have as I said a lot of things that are gonna actively repel someone who wants to get into that space but has never traditionally felt comfortable there so from the first interaction on the front desk like I said we have to all be honest with ourselves about the bias that we hold it's not our fault but it is there and that means that people with obesity tend to get less friendly greetings, tend to, you know, people don't learn their names as often, they don't make eye contact with them as often. So what is that first interaction with the front desk like as someone with obesity? When they have to walk to the changing rooms, do they have to walk past a whole bunch of mirrors? Or when they get into the changing rooms, do they feel like their body is on display? When they walk onto the gym floor, is there a full-length window onto the street so the world can see them in the clothes that they don't feel comfortable in. You know, what are the messages? I see a lot of like mottos on the wall that use words like results, goals, transformation, you know, pain. none of these things are appealing to someone who has spent their whole life feeling like they're failing, feeling like they're not worthy. And constantly being in pain. Pain to someone with obesity is not a positive thing. But if you've lived your whole life being active and pushing yourself physically, pain is a positive thing. So I would say number one is put on your pair of specs and really try and get into the heart of what it's like to live with obesity and walk through that floor. And even broader than obesity, someone with a chronic condition, someone who is always in pain, someone who finds exercise difficult, walk the floor from the start to the end of that journey and understand what are the things I could do to change how safe, psychologically safe someone feels in that space. That's a great start. That's great. Thank you. Doctor Isaac? Yeah, I love that. And I think kind of similar to what I was saying earlier is just preaching the motto of consistency and and to keep coming back. That is super important and kind of like you were talking about having what's what is it, what are the messages on the wall? less so about results and more so about consistency and you know, continuing to build on that foundation. And I'm seeing a lot of advertising these days about GLP one support, like here's your GLP one nutritional support. You need to take this supplement while you're on a GLP one. what is the GL GLP one support? program that the that the gyms and the clubs can design that say, we're here for you. Maybe you're new to the gym. Maybe you've never been here before. Let's help you. And let's come at this from a different perspective than as you were describing, Dr. Atkinson, what it's like for someone who's who's found it easy to be fit in their life. It's it's a completely different perspective. But thinking about movement, mobility, flexibility And like what that person's goals are. Their goals might be just to feel comfortable moving around, getting in and out of the car, you know, playing with the kids, getting up and down off the floor. These are essential things that that are not important just for people with obesity, but they're also important for the aging population. So this is it's a huge number of customers, right? Like being yeah, being able to continue those important activities and how can we support that? And I think it also sends the message that like people at the clubs, the fitness industry cares. We care. We want you to continue to do well and and you create a sense of community for people to come to. And that's a lovely thing. Yeah. It's actually one of the most compelling things to having been in this industry, you know, owning clubs and then obviously being in technology now and getting to be in a lot of facilities, the community is just so powerful. And, you know, we're seeing that more and more and hopefully this just broadens the community of people that feel comfortable, you know, to to be a part of what's happening. And so thank you both for joining today. This is a a complicated topic, in some ways. and and I think both of you mentioned this, you know, the the people we serve are passionate about changing people's lives and are trying to figure this out. So I think your perspective today was really helpful. It's also, you know, why we've started Elevate wellness and are partnering with you know, people like you, Dr. Isaac and and and Thrive and and trying to get the right information out to people and because again the the intent is all really good but how do you how do you navigate this on a day to day basis, you know, with your members and your prospective members. So so thank you both. I really appreciate your time. Very insightful. have a great day. Thank thank you so much. Bye.