Ep #312: Ozempic, Wegovy, and Other Newer Weight Loss Medications

Welcome to the Weight Loss for Busy Physicians podcast. I'm your host, master certified life and Weight Loss coach Katrina Ubel, M.D. This is the podcast where busy doctors like you come to learn how to lose weight for the last time by harnessing the power of your mind. If you're looking to overcome your stress, eating and exhaustion and move into freedom around food, you're in the right place. Well, hello there, my friend. Happy New Year. How are you? Welcome to 2023. For better or for worse, here we are. Right. The start of a new year. It's so fun. It always feels like just kind of like some freshness, right? Like I'm one of those people who, as soon as it turns a new year, I like to get all the Christmas decorations put away and just start out fresh and clean. And off we go. I've got my two younger kids in ski racing this year, and so this can be a very busy time of year for us, for better or for worse. Again, it's great for them. It's a very short season for us, so it's just kind of intense and squished into a couple of months. But it's also a good time and a good way to spend the winter months in Wisconsin, that is for sure. Now, I wanted to talk today about something that is coming up more and more, more and more people are hearing about this. There's ads about this. As a doctor, you might be getting patients coming in and talking to you about this and asking about it.

Maybe you've had pharmaceutical reps come in to talk to you about it. And so the question comes up, is this maybe something for you to where does this fit in the broad scheme of permanent weight loss? And what I'm talking about are the GLP one agonists. So I'm talking about Ozempic and Weatherby Wegovy. I think it's what Govee most notably, but basically Semaglutide and which is an injectable medication. And what do we think about this? Basically, how does it fit in with what we're doing? So just a little bit more information. These medications were really initially created for people who were at high risk and really needed to lose weight more quickly or needed help with that. So really, people with type two diabetes in order to lower their blood sugar and to regulate their insulin. And what they found is that weight loss was just a positive side effect of this. So they found like, oh, you know, that's super helpful. And then they kind of changed it and went to, well, what if we create a medication that we really used for weight loss? So that's where more people are now interested. And so what's happened is on TikTok and other forms of social media, people are talking like crazy about this, that they've been using it and they've been getting great weight loss results. And so people start thinking, oh my gosh, maybe I'm missing the boat here.

What if I, you know, like I know this person who did it or someone online got these great results and maybe I should do this, too. Now, technically, what it's approved for is for people who have a BMI greater than 30 or a BMI greater than 27, in addition to at least one weight related condition. And so that's really who it's for. But a lot of people are using an off label. And definitely there are doctors who are like, Well, I got some samples. And so I just started to try it or myself. You know, as so often we end up doing that and people have gotten some really good results. Overall, the largest trial for Wegovy showed that people lost 13% of their initial body weight. So that works really well. But like with anything, there's no free lunch, right? So what do we find with this? Well, first of all, what does it do for you? So it helps to lower your appetite, helps you to feel fuller faster and help you to feel fuller longer because it slows gastric emptying and it can also create fewer sugar cravings. And so a lot of people are interested in this. They're like, Yeah, this is what I've been dreaming for. This is that magic bullet that I've always hoped would come for me. And what's happening now is that it's actually in short supply and it's been really actually pretty tough for a lot of the people with diabetes and who really need it because people end up taking it ongoing.

So a lot of people are saying, you know, just like people will take ongoing medication to lower their blood pressure or lower their cholesterol at taking these injectables. These are shots taking these injectables ongoing, you know, possibly for the rest of your life could be a way for people to manage their weight. It's kind of an interesting thing, right? You know, we did a study on our weight loss for doctors only program. We actually had several cohorts go through. And what we found is with coaching, with working on your thoughts and your feelings in addition to some lifestyle changes, right. Changing how you eat and possibly how you move your body, that our program works almost as well as Semaglutide, almost as well as these medications with some lifestyle changes. So it's important to note that when you take these medications, you can't just eat total garbage and never move. Like there's a whole sort of like protocol that's supposed to go along with it where you're eating well and exercising and some things like that. And because I guess what people are doing is they're finding this off label somehow on the Internet, just putting themselves on it. And I don't know how these things work on the Internet, but apparently you can do that. And that's not so great because people aren't getting really that guidance and advice.

And so there's some real side effects, too, that can come. That's the no free lunch part nausea, dehydration, fatigue, some significant GI issues like diarrhea or severe constipation, like needing to go to the ER level for constipation. So sometimes you have to take additional medication to help with some of the side effects. Pancreatic. This is a real issue and gallbladder problems as well. So like anything, there's always possibilities that it isn't working out so well. So here's the other thing that I think is just really interesting is like I have had several clients now who have been doing coaching and doing all that work and have had good results, but still find themselves struggling somewhat and have decided to experiment with Ozempic and have found that it really has helped them. It made it easier for them to kind of get connected to their hunger. It's sort of like it took the edge off enough so that they could actually do some of the work that they've been trying to do in terms of connecting to their bodies, in terms of understanding their hunger and fullness signals and things like that. And it's amazing. I do also just want to point out that the placebo effect is real, folks. I know you know that, but it is really real. So when someone comes to you and goes like, Oh my gosh, this could be amazing when we believe it could make a really big difference for us, we will often subconsciously approach things differently, right? When we believe that this will work.

It can work, right? I mean, here's what's interesting is do we believe in it lasting, the results lasting. And, you know, overall, it's a pretty new drug. There's really not a lot of evidence on what happens for people who fall outside of the FDA's criteria. I mean, everything I was reading is like ultimately these medications were not created for people who have a few pounds they want to lose so that they can become really thin. But that's what you're seeing. You're seeing celebrity trainers talking about what it does and Elon Musk and different people, you know, talking about all that stuff. And so, of course, it makes sense that everybody would be totally interested and curious and wondering what it could do for them. And so the kind of the question has come to me like, what do we think about this and how do we want to approach this? How does this fit in when it comes to weight loss coaching and more importantly, how does it fit in when it comes to permanent weight loss? The first thing to note is that I am not your doctor and I'm not even a doctor for adults, so I have no business telling you what you should be doing with your health. And I would never pretend to have any business doing that. So ultimately, this is going to be a decision that you should be making with your doctor.

Now, when samples come across your desk and you decide to just try it on your own, even when your doctor like, I don't love that for you to be 100% honest, I don't think that that's a great way of approaching this. To me, that's coming from a place of like fear and scarcity and pressure and rushing, and I just want it off right away. And I don't want to even take the time to actually get legitimate help, which like in applying it, which is so interesting because then as doctors, when our patients do that, we often are not pleased with them for doing that. But then here we are wanting to do it. So we just have to look at like, what is it that we're trying to solve for here? Now, if you have a significant health problem, if you have type two diabetes that you're struggling to manage, if you are fitting into the FDA's criteria, I have no problem at all. I mean, I am a fan of using all the things that can help you. It's certainly not like a just there's one thing that's going to do it or only one thing can help you or only one way is the right way. You know, it kind of think about it like, you know, when people are like, you know, a vaginal birth is better than a C-section. Like, literally, there's no award for how your baby came out of you.

There's no award for that. Right. So there's not an award for like you fixed your type two diabetes without medication versus someone who did. I think we just have to meet ourselves where we're at. You know, for some people, the momentum that we gained from getting going with some medication, I mean, amazing, like if that helps you to keep going, if that helps you to do the thing that you've always struggled to do. I mean, why would we say no? Like, I don't see any problem in doing that at all. But I do think of it kind of like training wheels, you know? Sure. You know, you might have no problem, you know, taking some pills for the rest of your life and maybe you don't have a problem taking a shot for the rest of your life. What we don't know is just a lot of stuff like you come off of that medication, say, for any number of reasons, it's not the right thing for you anymore. Then what happens? We don't really know. Like, how do you gain the way back? Does it come back fast? Is your hunger come back with a vengeance? Do you feel like, you know, like the empty pit in your stomach that you'll never be able to fill? Like what ends up happening? Do you just go back to the old way? Does it change you in another way? We just don't know is what it comes down to, right? So what I find that when people are just so like throw caution in the wind and just like, go and do it, I just have a feeling there's going to be some people who are going to regret that, you know, later.

And I just, you know, hearken back to the many other medical weight loss interventions that have helped, definitely help significant numbers of people, but have really been a flash in the pan for a lot of others. I'm just thinking back to in the 2000s, when it was like everyone in their sister was getting Lap-Band surgery or gastric sleeve or, you know, like it was really like the bariatric surgery was going to be the way to go. And, you know, I know there's still people who are doing that, but in terms of who's really eligible, who it's really the right thing for, that's really changed a lot. It's not really the thing that everybody kind of had thought or hoped that it would be. A lot of people got those procedures done and found that they gained the way back, that it didn't actually solve the problem that help for a while and then it didn't anymore after that. And even going back to other medications, like thinking of like fen, fen and things like that, like it worked really well, you know, you stop taking it, you gain the way back. And of course, there were all these other really serious and dangerous side effects which made it be pulled off the market.

So. Right. Sometimes, I mean, I know a lot of people love to be early adopters when it comes to your health. You know, I don't know. I think you just have to really understand what the risks and benefits are. And there are many people where I think the benefits definitely outweigh the risks for sure. But for the person who doesn't qualify and is just kind of frustrated with everything and just wants to do something else, you know how we really approach things with coaching? Like have we really looked at our brain? Have we really thoroughly explored the problem that food solves for you? Because the thing is, is that no medication is going to solve the. Problem for you that food solves I mean, food solves your hunger issues. So maybe you need less food to solve that hunger. But when you're an emotional eater, when you struggle with your weight, there are a lot of times you're eating where being hungry has nothing to do with it, right? And so maybe you feel more full and it's easier to say no to things, maybe for a while because you're excited and it's fun. What's coming off? And here's my hunch, and I don't have data to support it, but I'm kind of going on record as saying that I think over the course of time, six months, a year or two years, three years, five years, right, We're still giving ourselves these shots, but life is still being leafy.

You know, things are still coming up. There's still challenges. If we haven't changed our brains, then food is still what we turn to to solve those problems. We you know, if we don't know how to deal with our anxiety and we eat or drink to feel less anxious, this medication won't make you feel less anxious. It might make you feel less anxious in the short term about your weight because you're doing something about it and you're arguably hopefully getting some results. But in the long term, it's still not solving that problem. So really it could turn into a bit of a fad type of a thing. Who knows, five, ten years from now, we might be like, oh my gosh, remember when everyone was on Ozempic and that was like totally a thing? Or maybe not. But I think a bigger question is, do you want to be on training wheels for the rest of your life? You know, is that the way you want to approach it? Maybe some people do. I know for me, though, I just I'm thinking to myself, like, you know, about midway through my life, hopefully a little less than midway through my life, what I really want to take a shot forevermore. I don't know when I know there's other options out there. The other thing that's kind of tricky is how to get people off.

You know, some people do successfully come off of it, but some people really find that they can't come off of it. And so I think that's something to be aware of. Right. And if you can't, that's fine. But still, do yourself a favor, working on managing your mind, learning how to solve the actual problem. Why were you over eating food to begin with? Why were you using maybe more alcohol than you had wanted? Because that's the other thing, right? Maybe we're not hungry anymore, or maybe we're not even using food anymore. But when we don't know how to manage our emotions, guess what happens? We just look for another way to cope, another way to numb ourselves out. And I have always said this and I still maintain it. I don't want to switch problems. Like if I am going to have a way that I'm going to try to avoid feeling my emotions and I'll just stick with food. I don't want to switch it to like other substances. I don't want to switch it to spending or gambling or like reacting over exercising spending, you know, like shopping too much, watching shows, like all the ways that we overdo stuff. Like you'll just find a new way if you don't work on your brain, you know? And I want to just remind you, because it's really easy to forget this, that there are a lot of people, lots, millions, arguably, possibly billions of human beings who are at a normal weight for them and are still not happy.

They're not feeling like they're living their best lives. They have their own struggles and issues and miseries and all the things that they have to deal with. So I don't want to take away anyone's excitement. And if it's working for you, it's amazing. I'm so happy for you. That's so amazing. I just want to shine a light on the fact that the bigger problem remains unsolved. And so if this is a way to get maybe to a place where you can maintain maybe this is a way where you can actually dig in and do some of that work, kind of similarly to how, you know, medications can help people with depression or anxiety actually be able to participate effectively in therapy. Right. It's not like those medications like solve your anxiety or depression for you. For most people, there's other work that still needs to be done as well. And so I would just look at this in a similar way where there's not like a magic pill or magic shot or magic surgery. There's still always going to be work to do for the people who are willing to do it, who are really looking for that peace and freedom around food, and to just be able to live their lives how they want to live it. And like I said, I'm not going to make an assumption that people don't want to take a shot for the rest of the life.

I just personally, to me, it's this the same thing as counting points or, you know, putting food in a box or like anything like that, which for me wasn't the right thing. So it's not something that I'm interested in doing, but I definitely support people where it's the right fit for them. And also just want to highlight that we can't skip the part where we have to look at our brains. I just don't think that it's possible. And and even when you look into things like lots of doctors who are specialists in this are are saying similar things, you know, it's really a godsend for people who are in a health crisis, you know, for people whose their. Literal, you know, physical health is at risk because of what's going on with their weight or with their diabetes and things like that. That's not really meant for the person who just has those last £20 or something, you know, that they want to or like, you know, those couple of COVID pounds that they gained. It's not really what it's for. So I'm very, very interested and curious to see what ends up happening, like what kind of the arc is of this and how this ends up working out. I can't blame people for being excited. You know, I share in that excitement. I don't want to take the wind out of their sails at all.

It's more of a yes and right like yes, that's awesome. Hopefully you don't have much of the side effects. Hopefully your body responds to it really, really well. And there's still other work that we need to do. And of course, that's what we do in the weight loss for doctors only program and in our continuation programs, Masters and VIP as well. So, you know, maybe you use that as a little way to get a few pounds off, get the motivation going, get the wheels turning, and then you dive into the work that really needs to be done so that you can really experience that peace and freedom, right? Having a full belly never stopped an emotional eater from eating. That's what I know. All right, my friend. Well, happy New Year again. I am so glad you're here listening to this. I've actually got a really, really exciting series of podcast episodes that I'm planning for the rest of January. So I invite you to come back and listen through the rest of this month and of course, onward as well. But I'm going to have some really fun episodes planned for you, so can't wait to connect with you next time. Take care. I wish you nothing but the best for you and your family this year and hopefully we'll be working together very soon. Take care. Have a great week. Bye bye. Ready to start making progress on your weight loss goals for lots of free health. Go to Catrina, UBL, M.D., and click on Free Resources.