[00:00:00] Welcome to the vibrant MD podcast, where we discuss weight loss, women's health and food. I'm your host, Dr. Heather, a family doctor and certified weight loss coach. This podcast is informational, but it's not meant as medical advice. Anything you want to change after listening should be discussed with your own doctor and personal medical team. I'm so glad that you're here with me today
Hello, my vibrant friends. Thanks for joining me today. I'm really excited. We're talking about weight loss medications. Now, people that work with me, we generally do lifestyle changes for weight loss. So I have invited a friend of mine, Lina Qazi, who is a doctor on the East Coast to talk about weight loss medications, because this is what she does all day long.
So welcome, dr. Qazi.
Thank you so much for having me. I'm so excited to [00:01:00] talk about this. This is one of my favorite subject areas to talk about.
Great. Why don't you tell the audience a little bit about yourself?
Sure. So I am a board certified family medicine physician who specializes in obesity and lifestyle medicine.
So I combine both medications and lifestyle changes to help patients optimize weight loss. And this is I have a practice in Virginia, and I've been practicing for about a year now, and it's amazing seeing my patients lose weight, especially on some of these newer medications that I want to talk about.
Great. And people actually can see you, so they can see you in person, and then do you also do some telemedicine for follow ups?
I do, I do. I have my patients come, you know, into the office for the initial visit and it's typically an hour to an hour and a half long so we can get a really good history and go over all the treatment options and then yeah, it's weekly tele visits.
Great. Great. All right. Well, let's jump in. I did title this Ozempic, Wegovy, Mounjaro, oh my!, [00:02:00] because there's so many names, right?
Yeah. Anytime someone says I'm taking some medication, everyone jumps up and says, are you on Ozempic?
So let's talk about You know what these are, which ones are the same, which ones are not the same.
Sure, sure. So it can get a bit confusing because there are so many of them out there and, and what we're talking about are there are GLP 1 agonists. That's the actual mechanism of how these medications are working. So I'll start with semaglutide. That's the generic name for Ozempic and Wegovy. So Ozempic and Wegovy, they're actually the exact same medication.
They're both weekly injectables. Ozempic was released in 2017, I believe. And then a few years later, Wegovy was released because they had been studying Ozempic in looking at weight loss for patients who do not have [00:03:00] type 2 diabetes and saw that it was safe to use so they released it as Wegovy to be used in patients who do not have type 2 diabetes but need to lose some weight. Now, Ozempic is FDA approved. It was FDA approved initially for type 2 diabetes and, and is currently used to manage type 2 diabetes. But the great thing about it is when we're looking at patients who have this chronic disease, a lot of them are overweight or have obesity. So by using Ozempic, they're not only losing weight, but it's helping control the blood sugar as well, which is part of how this medication works. The GLP 1 molecule actually had, we have receptors throughout our body for these GLP 1 molecules- so they're working in multiple ways to both reduce the blood, blood glucose levels, the average blood glucose levels, as well as giving a boost to our metabolism, slowing gastric [00:04:00] emptying, you may have heard that phrase, but basically as you're eating, our bodies tend to digest and churn and, and eliminate the food at a specific rate. So when this is slowed down, you're going to be eating less food and you will be feeling fuller faster. So you end up eating smaller portions of food. And that's a great benefit for, for these GLP 1 agonists. When it comes to let's talk about Ozempic and Wegovy and why they have two separate names, it is the vaccine medication. Basically, one is marketed towards type 2 diabetes and the other is marketed towards obesity management. So, Wegovy is marketed towards obesity management, and this basically means that the FDA has approved Ozempic for type 2 diabetes and Wegovy for weight management. So when it comes to, you know, your doctor prescribing these medications your insurance company and your insurance plan is going to take a look and see, okay, does this patient meet certain [00:05:00] criteria to for us to cover Ozempic or Wegovy? So if you have type 2 diabetes, then there's a greater chance that Ozempic will be covered for you. And on the other hand, if you are overweight or obese, then there's a good chance Wegovy will be covered. And this varies insurance company to insurance company. I was going to go ahead and talk about the third medication, the newest medication that's out there, which is Mounjaro.
Now, Mounjaro is really exciting. It has both GLP 1 activity as well as another molecule, which is a GIP. And both work very similarly. As I mentioned, it's going to work on delaying gastric emptying, increasing the metabolism. There is some effect on the hypothalamus as well, which is going to decrease your wanting to eat a lot of food or eating in between meals it'll decrease cravings. So many patients feel pretty amazing on these medications because they're just not thinking about food all the time, which [00:06:00] is also known as food noise. You may have heard that term. So this is another reason why so many people love these medications. So once a week injection and they're not constantly bothered about thinking about what they're going to eat next.
Okay, great. And let's talk a little bit about injections. I mean, people get worried. I don't want to give myself a shot. Can we talk a little bit about that?
Yes, I have so many people who freak out when I tell them that it's a once a week injection and that you're going to be doing it yourself at home.
And I tell all of them that the anticipation is worse than the actual shot. These are, they've developed the thinnest needle possible and shortest needle to help you give these shots. And it's very easy to do at home. Most of these injectable pens, it's a one time use pen, and basically you push a button, wait a couple seconds, and you're done. Most people do it on the belly area. It's just less painful than other areas of the body. [00:07:00] And I've had so many people who will call me and say, Dr. Qazi, I don't know if the medication went in. I just didn't feel a thing. And, and it's such a common kind of call I get because it's just, it's that painless.
Now some people will feel a little poke, but again, it's really like the anticipation is worse than the actual shot itself. On top of that, with Mounjaro being a once a week shot, it's, it's really, you know, a small, tiny little bump, tiny little hill to overcome when you're looking at the benefit from these medications.
So this isn't anything like getting a vaccination in your arm muscle or some of the other things. It's not like when they've pricked your finger to check your blood count or anything like that. Those things are definitely painful.
Absolutely, absolutely. Yes. I mean, I would say it would be a fraction of a fraction of what you feel when you get some pricking your finger for testing your blood sugar.
So [00:08:00] just, just to let people know that if that's what's holding you back, you know, it's, it may be different than you expect.
Well, what are common side effects of these medications?
So some of the common side effects are GI related stomach related, so nausea, vomiting, constipation, diarrhea. Some patients do have mild flu like symptoms which is basically your body getting used to this type of shot, so minor body aches, headaches. Most of these side effects are resolved by the second or third day, and in general, they decrease after each shot. So, after that initial injection, you may have pretty significant side effects, but it's not nearly as bad after the second or third shot. And by the time you've taken the fourth or fifth dose, a lot of my patients just haven't felt anything at all in terms of side effects. I do tell my patients just, you know, be careful with what you're eating when you're [00:09:00] taking the shot and make sure you're eating lighter meals, smaller meals, because if you decide to eat a burger or a pizza and then inject yourself with something that's slowing down that gastric emptying, there's a good chance that you're going to throw it up. So it's just being mindful of what you're eating which will really help mitigate some of these side effects.
And do you feel like people get used to this pretty quickly as they get into it?
In general, yes. In general, yes. For the most part, people have gotten used to it. If, you know, for whatever reason, maybe, maybe your body's very sensitive to the medication and you're noticing significant side effects even four or five days after you've taken that initial shot, then it's definitely worth having a conversation with your physician to see if there's some alternative, if they can switch you over to a different medication. Because it's not It should not persist more than, I would say three to four days.
Okay. Now, you know, we talked about kind of coverage. So, these are usually covered for people with [00:10:00] diabetes, sometimes covered for people with obesity. You know, I have heard of some people just getting it covered because they have high, a high blood sugar without, you know, actually getting diagnosed with diabetes.
Correct, correct. It, it's definitely sort of trial and error when it comes to seeing what indications will allow coverage and, and what will be kind of thrown back at you and, and basically told that no, we're not going to cover it for, for this situation. As I mentioned before, in general, if you have type 2 diabetes, then there's a great chance that the medication will be covered.
Now, there's a caveat to that. It may be it may not be a preferred drug, so they may ask that you try something else and fail it before you even, before they consider covering Ozempic or Mounjaro, but a lot of insurances do allow do cover it as a first line therapy for type 2 diabetes, and I think it's because of how they [00:11:00] incredible the results are from these medications.
So, there are certain insurance companies will cover it for diagnoses related to weight gain, obesity, and and or type 2 diabetes. So, yes, like you had mentioned, the elevated blood sugar insulin resistance, PCOS, liver disease. What else have I seen coverage for? In some patients, they have had it covered for for high cholesterol and high blood pressure because, you know, these are risk factors for developing worsening chronic diseases. So I do believe that insurances are taking that into consideration and are allowing coverage based on these diagnoses to, to help their patients get better and prevent, you know, like a future hospitalization or, or multiple medications.
Great, great. Are there any other medicines that we should know about, or, or, have heard about or think about? [00:12:00]
Yeah, yeah. So let's say, you know, let's say you go to your doctor and you're interested in Ozempic, Mounjaro, or Wegovy, and for whatever reason your, your insurance company just says, no, we're not going to cover any of them. There are a couple of other GLP 1 agonists that are on the market right now. One of them is called Saxenda, and it is FDA approved for weight loss. It's a daily injection, but it is quite effective. I've seen patients lose 20 to 30 pounds on Saxenda, and in conjunction with diet and exercise. So that is one choice that, that you can ask your doctor to look into.
Another option is Rybelsus. Now, Rybelsus is an oral GLP 1 agonist. So it is semaglutide. It's basically Ozempic and Wegovy in oral form. You can take up to, it starts at a 3mg dose and it goes up to 14mg a day. And it is a daily tablet. It does help with [00:13:00] appetite control and it is helping with insulin resistance as well. So you're seeing less inflammation in the body and in conjunction with that you're eating less and that does allow your body to lose weight more easily. Rybelsus is FDA approved for type 2 diabetes management. It is not currently approved for weight management, but it is something that you can talk to your doctor about to see if this is something that you can try.
Why would, why do people pick the shots versus the oral one?
So definitely when it comes to the weekly injectables, it's just the ease and convenience of it. When it comes to, let's say, Rybelsus, which is daily, and Saxenda, which is also a daily, Rybelsus is an oral tablet, and then Saxenda is the daily injection, we do tend to see less GI side effects or stomach side effects from the Saxenda injection versus the Rybelsus. Since you're taking Rybelsus by mouth, you are going to see more of an upset [00:14:00] stomach some nausea, more significant than you would with the injectables. But again, those side effects do tend to subside after that third or fourth dose.
Okay, great. Now, what should people expect? You know, people talk about them kind of like miracle drugs, of course so what would you say, what would you say about that? Are these, are these a miracle for everybody?
So they definitely, they definitely are game changers, I would say that. And I would say 90, 90 percent of my patients have done incredibly on these medications. I've seen patients lose 50 plus pounds in, within a year. Using these medications and, and watching their, watching what they're eating and exercising regularly. Now, I do have that 10%, and this was shown in the studies as well, of patients who are basically, they're termed as non responders. And for whatever reason they just don't feel any change from these [00:15:00] medications. My, my theory myself is just that maybe the receptors are displayed differently in their body.
And so these little molecules aren't hitting those receptors like they do in some of the other patients. But I have tried, you know. The maximum dose of Ozempic and Mounjaro and we'll go beyond some of these patients, but they just don't have any of the appetite suppression and, and minimal weight loss.
So it is good to keep in mind that although these medications are, are quite phenomenal, they may, they may not work for everybody. And, and don't, you know, don't be dismayed if it doesn't work. There are other options available. Some of the medications that have been out for years that do help with weight loss. So if you, you know, let's say someone, you go to your doctor and you get prescribed Wegovy Mounjaro and you find that it doesn't work for you at all, don't lose hope. There are other options that you can talk to your doctor about if your goal is weight loss.
Great. And do some people lose just a little bit of weight and not 50 [00:16:00] plus pounds on these?
Yes. Yes, absolutely. So what it really depends on how much weight you need to lose to reach that healthy sort of happy weight. And with the lower doses, you know, we can, I tend to see obviously less weight loss more in the 10 to 15 pound range. And as we increase the strength of the medication, we're seeing more and more significant weight loss.
So, in general, from what I've seen in my practice, and I believe the studies are pretty similar, it's about 30 to 50 pounds around the six month mark up to one year mark. And of course, every single person is different, you know even genetically everyone is different. And so that rate of weight loss is going to vary significantly. You'll also have to take into consideration your diet and exercise. So there's a lot that plays into how much weight you're going to lose and how quickly you're [00:17:00] going to lose that weight.
And most people that start this, will they, let's say they don't need it for diabetes. Will they, once they lose the weight, do they stop the medication then or do they keep going?
So the vast majority of cases will need to take this medication regularly for life. We are now categorizing obesity as a chronic disease and as with any chronic disease, such as diabetes, hypertension, high cholesterol, medications that you're taking are typically lifelong medications. And these medications are safe to take for a long period of time, as long as you're being monitored regularly with your physician. I have had a very few patients who have been able to maintain off the medications, but these are the ones who have a very strict diet and, and they've made very significant lifestyle changes. So they're eating very clean,[00:18:00] eating lots of fruits and vegetables, maybe a little bit of white meat and complex carbs, and they exercise regularly as well. And this is both cardio and weightlifting. So there's a very small portion of patients that yes, as long as they are making those lifestyle changes, they can come off the medication, but vast majority of people will need to take the medication lifelong.
Okay, that's good to know from the, from the outset. Are there new medications coming down the pipeline?
Yeah, yeah, there are, there are actually a couple of medications that they are studying right now. Now, I talked about Mounjaro, it contains the GLP 1 agonist and the GIP agonist. I believe they are creating, they are studying one that contains both of those plus I believe it's a glucagon agonist. So, by using all three of those agonists, it's mimicking exercise as well as increasing the metabolism and decreasing the appetite. So I mean that really sounds like a miracle drug to [00:19:00] me. I think I think so one of the concerns right now is they are seeing a significant increase increase in patients heart rates. So it'll be interesting to see what happens with that medication in particular. They are also studying monthly injections. So instead of taking it every week, you just have a once a month shot, and, and, you know, that's, it can't get more convenient than that. And then they do have a couple of more oral GLP 1 agonists that they're studying for people who just really, for whatever reason, just do not, cannot take the shots. So there are a couple of oral medications that are in the pipeline. And all of these medications are still a couple of years out. So we're still keeping an eye on the studies, kind of looking and seeing what sort of effects we're seeing on patients, both the positive and the negative sort of side effects. But I do think that it's, [00:20:00] it's really the future of medicine in what we're seeing and it's really exciting and I can't wait to see what comes out next and, and how what the studies show.
Yeah, yeah, that's very, it's a very exciting field, definitely. Very cool. How about an old drug like Metformin that was used for diabetes and also shows the benefits?
I love Metformin. Metformin is amazing. So what I do in my practice is I do check my patient's insulin levels and then I'll do a calculation to see if there's any signs of insulin resistance. Because although their diabetes number, the A1C number may be normal, their blood glucose may be normal, you may not see any signs of anything before you see that change in insulin levels. So if there's an increase in that insulin, level more than likely you're going to develop pre diabetes and then diabetes. So, when I measure that, if I see there's elevated insulin in the blood, that tells [00:21:00] me there are signs of insulin resistance, and that's where Metformin comes in. Metformin is a fantastic medication that helps reduce that insulin resistance, and in turn, it's reducing overall inflammation in the body, allowing our bodies to lose weight more easily.
Me personally, I've been combining metformin with some of the other medications, as long as it's safe in my patient because that combination of reducing that insulin resistance, plus using another medication that may be using another that, that follows a different mechanism it's a very powerful combination to help people lose weight, especially those who have been trying to lose weight for years and, and, you know, women who are in their 40s and 50s, they're hitting that perimenopause and menopause kind of stages in their lives. That's when we start seeing this insulin resistance and they're doing everything. They're exercising, they're dieting, they're doing everything they need to do, but the weight just won't come off. And a lot of times the culprit is insulin [00:22:00] resistance, and many times that metformin just does the trick. It's also used frequently in PCOS, so PCOS, which stands for polycystic ovarian syndrome. And, and in case, you know, someone doesn't know what it is, it's basically your body is churning out an excess amount of hormones, and that can result in significant insulin resistance and many side effects, including weight gain. That's where Metformin can really come in and help reduce that resistance, reduce that inflammation, and help with weight loss.
Well, thank you so much for all this. I know people are really interested and will continue to be interested as this as these more medications come and, and we get more studies on these. So thank you for sharing all this.
Absolutely. Thank you so much for having me here. I, I, I love what you do and, you know, I just I'm so impressed by how significant lifestyle changes are on people and, and on their chronic diseases. So, you know, [00:23:00] I, I just, lifestyle medicine is just the way of the future and I think it's the, it's a way to help alleviate the burden on our healthcare system.
Yeah, definitely. Great. Well, I will make sure that all of your contact information is in the show notes, but please tell people where they can remind them where they can find you in the real world and in the virtual world.
Yes, absolutely. So my website is www. thrivelifemedicine. com and you can also find me on Instagram and my handle is @thrivelifemedicine.
Great, great. Well, thank you so much for being here again. And it's just been a terrific conversation. I, I know the people listening have gotten a lot out of it.
Thank you so much for having me. I really appreciate you.