Nolan Alexander (Host): We're diving into a crucial topic today. Do weight loss medications work, and should they be part of long-term weight management? Welcome

to the Health Headlines podcast series. I'm Nolan Alexander, and joining me today is Dr. Kiff Anwar from Capital Health. Dr. Anwar, how are you?

Dr Kashif Anwar: I'm doing pretty good today. Thanks for having me, Nolan.

Nolan Alexander (Host): Oh, it's a pleasure to have you on, and there's some popular names out there. What are these GLP one medications like Wegovy, Ozempic, Manjaro, and Zep. And why have they become so popular?

Dr Kashif Anwar: Yeah, great question, Nolan, about the GLP one agonist and. A lot of these names are very much everywhere, as we've seen in various media. They've become fairly popular because of their effectiveness. not to get too in the weeds, but GLP as a receptor in the body that works in a lot of different pathways in your body, to manage both your sugar levels and your weight as well.

And we're learning more and more about these as time goes on. But they've become the safest, most effective medications we we've ever had when it comes to treating obesity.

Nolan Alexander (Host): Can you explain how these medications work differently than other weight loss treatments? Including other prescription medications?

Dr Kashif Anwar: Yeah, these medications definitely work differently compared to what we've had so far for weight loss, non-medication and medication. these medications. Work on receptors in your body, as I mentioned the GLP one. that leads to two main things I like to tell patients. One, it slows down your gastrointestinal tract, giving you a sensation of satiety, faster than before.

They also make your body more sensitive to insulin. You're a natural insulin that your body makes to help regulate blood sugars. That is what we think about, but insulin's. A important hormone in our bodies for many biochemical pathways. And by making our body more sensitive to insulin, it helps to promote less fat storage in general.

The other older medications that are very effective as well, which overall maybe not quite as effective, include medications such as Contrave, EMIA, Orlistat, Orca Ali, also known as. The first two work on other receptors and other neurotransmitters in your body to basically make you feel fuller. more and neurologically, focused.

the last one that I mentioned, the or less stat that functions by blocking your gastrointestinal tracts, ability to absorb fat, and has some frozen cons in that regard. and in terms of effectiveness, as I mentioned earlier, overall in newer studies, maybe not quite as effective in the overall population, and you have a different set of side effects by working on these different targets in your body compared to GLP ones.

The other thing I was gonna mention though is that for certain patients, some of those medications would actually be more effective than the GLP ones, but again, on a broad population basis. That's why there's all this buzz about the GLP one.

Nolan Alexander (Host): Certainly a lot of buzz. Are these medications accessible to everyone right now?

Dr Kashif Anwar: Yes, these medications are accessible to everyone right now, but also very difficult, in terms of getting it. And like other medications that we deal with here in the United States, there's a lot dealing with cost. insurance coverage for, the medications, for the treatment of obesity. Can be, difficult to get.

and also doctor's willingness to prescribe these medications, especially for the obesity indication. And just taking a moment, a step back to what we were originally talking about when we named the more popular GLP ones, you, you named four earlier Wego via Ozempic, Majaro and Zeep Pound. I think most people sometimes get confused as to what the differences are between.

the four, but basically there are two pairs. Ozempic and Wegovy are both the same chemical. They're both glide. One has indication for the treatment of diabetes and the other has indication for the treatment of obesity. And this is due to whatever strategy the, pharmaceutical company the manufacturer decided to do when pursuing approval.

with the regulatory bodies. Similarly, Manjaro and Zep bound also are the same chemical. They're both known as Tirzepatide. And again, Manjaro has the indication of the treatment of diabetes and zep bound for the indication of, the treatment of obesity. And again, same chemical. but because of regulatory reasons, insurance reasons, the manufacturer for those drugs went that route as well.

Nolan Alexander (Host): I appreciate that clarification, doctor.

Dr Kashif Anwar: I just realized something I more why I was bringing it up is that makes a big issue with access in terms of what the insurance coverage may be like for patients and for getting it for the treatment of just obesity. That can be a little bit more difficult at times for coverage, because it hasn't been used as long as it has been for the treatment of diabetes.

And so in terms of. Everyone, warming up that idea and showing the cost benefits for it, that still has to shake out.

Nolan Alexander (Host): So building off of that, how does a medical professional determine if someone should start using these types of medications, and how do you decide which one is the most appropriate for the patient?

Dr Kashif Anwar: So how a medical professional would determine. whether their patients should start these medications and which is gonna be the most appropriate. There's a lot of different factors involved as you can imagine. Medically speaking, most medical societies, have come to the consensus that medications are appropriate for the treatment of obesity.

When someone has a body mass index greater than 30 or a body mass index greater than 27.5 plus, certain comorbidities, meaning things like hypertension. Diabetes, sleep apnea, hyperlipidemia and a few others that may fall under it. medical speaking wise. And I like to make that distinction between, that's the kind of known understanding of when to, prescribe medications and then what's actually happens in practice in terms of, having different criteria in order to make sure, it's available at a accessible cost to.

The, sickest patients, I should say. the more obese or the more severe diabetes in that regard. And so that's one indication that we look at for sure. And Body Mass Index has its own kind of worms in terms of using as a measurement, but we don't have hours and hours to discuss that today.

The other things I would look at too is what other comorbidities, what other conditions does the patient have? I mentioned earlier that the GLP ones themselves have been used for the indication of the treatment of diabetes. and they also, some of them have gotten additional indications since, such as one of them for the treatment of sleep apnea.

One of them for the treatment of, what we call, M-A-F-L-D, colloquially known as fatty liver. I, I don't like using the F word, but that's what most people know that condition as. and also for the treatment of significant cardiovascular diseases such as coronary artery disease, history of strokes, history of, cardiac stents placed peripheral artery disease.

So if patients have some of these conditions, that should be a clue to think about, but also not just focusing on the GLP ones. For a second. The other medications I mentioned earlier, somewhat older, they have their own place. There can be advantages, mood wise, more so for those.

some of them. such as contrary I mentioned earlier is a brand name. It's a combination of Naltrexone and Bupropion and some solicitors may know. Bupropion on its own, is a treatment for, some mental health conditions such as depression. And there can be that benefit, especially if a patient has more emotional eating, that's the root of their, concerns with, the obesity.

Likewise. QC I mentioned earlier, that's a combination pill also of two medications, phentermine and Topiramate. And give that example because Topiramate is a medication that's been used for many decades for the treatment of, headaches, for example, seizures as well, a lot of other neuropsychiatric conditions. And if a patient has chronic headaches, that might be a nice option to consider depending on the cause of their headaches.

And if a patient has. a mood issue, uh, specifically more depression. Something like chore may be a good option to consider. So other comorbidities, and what the major driver is for, why they have the obesity.

Nolan Alexander (Host): So Dr. Anwar, that's everything that you are looking at from the patient's perspective. What are some key questions patients should ask their doctors about these medications?

Dr Kashif Anwar: yeah. Some key questions that patients should ask doctors about these medications. well before they even get into the doctor's office, I would say talk to insurance company because the other thing I also look at when I prescribe is what is the insurance coverage going to be? Like, what is, the cost of what I might be looking at?

And fortunately in this, day and age that it's a very realistic concern. And, I'd love to have the pie in the sky idea of I write for anything and the patient gets it. No problem. Easy peasy. but we have to consider that as well. So. Patients could really help if they do the legwork and check with their insurance carrier, in terms of what coverage is like for anti BC medications and for some of these different medications that we've discussed.

also they should be asking their physicians what else they can be doing, before considering medications and also in conjunction with medications. I would say this to my patients, without the. Uh, changes in diet, exercise, and behavioral support to help have those changes stay long term medications are going to be less effective than if they were used in the environment of those types of changes.

And so starting to put those steps in place is going to be beneficial, both for the patient's health and also for, the physician as well, and their comfort level in terms of prescribing the medication. additionally, the other thing that patients should ask about these medications include side effects include, and whether it would be appropriate for them.

and also they should talk to their physicians about whether these medications, have any interactions with the current medications that they're on. and I can go on, but I think the last thing I wanted to bring up too is. If there are certain conditions a patient has that precludes them from being on medication, that they need to have a frank discussion with their physicians about it and be open to the idea that just because it seems like everyone in the world is taking one of these medications, that it's okay that if you are not able to take it and it is nothing that you did wrong.

And sometimes patients have a lot of guilt, that why can't I tolerate this? I just looked at. Joe Schmoe over there who's getting all this weight loss on this medication. I haven't been able to get this medication or I got this medication and it's not doing anything for me.

And that's where humans are very different. Humans have many different genes, many different environmental reasons, many different factors that go into this. And that reflects the, multiple kind of causes to obesity that we deal with in this space. So not to feel. Guilt or shame if they're not able to get on these medications.

And so having that frank discussion, and I, that was a little long-winded, but the example I was thinking of in my head was, for example, if a person has significant, gastroparesis or other significant gastrointestinal motility issues, the GLP ones may be higher risk. May not be the right option to consider.

Similarly, if patients have uncontrolled hypertension or do have a history of coronary artery disease to any medications with stimulants such as the one I mentioned earlier, emia, which has phentermine in it, phentermine itself is an antib C medication will. Those medications patients should try to avoid and be okay with avoiding.

Nolan Alexander (Host): Can these medications be part of a long-term weight management plan? And how should patients approach this?

Dr Kashif Anwar: Yes, these medications can be part of a long-term weight management plan. as I mentioned earlier, a patient should approach this with a clear mind in terms of, both being open to being on medications and not just for the short term potentially, long term, and I don't mean lifetime with that.

But with a lot of these medications, simply getting up to therapeutic doses. And what I mean by that is you have to titrate patients up slowly on these medications until you get to therapeutic doses. so just the time it takes just for that can be up to six months just to get up to the highest dose of any one of these medications.

And so understanding that this is going to be a long-term commitment of at least six months to a year, if all things, stay. I'm pretty okay with the patient in terms of tolerating the medication, in terms of affording the medication. The other things that, patients should consider an approach is thinking of how to integrate those type of lys cell changes that I mentioned, and we all talk about diet and exercise.

There's no one diet that works for every patient and every person, so that's something that they need to have constant. evaluation and treatment of, and that's where meeting with a nutritionist regularly is going to have the greatest benefit. Also, in terms of exercise, there are different types of exercise, different exercise ideas, intensities, durations that have differences in a patient, whether it's a cardiovascular based, exercise or whether it's a strength training based exercise, both of which are very important.

Additionally, this is something that's very much overlooked by everybody. but sleep. Making sure that a person's getting seven to eight hours, at least I usually recommend, I think recommendations say even more, but seven to eight hours of uninterrupted good quality sleep. And there's a lot of caveats in there.

I think one of the conditions that I deal with a lot that is underdiagnosed is, obstruct of sleep apnea. And if there are concerns about obstructive sleep apnea, to have those evaluated and looked at as well, because poor sleep also leads to more weight gain amongst many other health problems.

So patients, a lot of times end up sacrificing sleep, end up having poor diets, end up not having the energy or the time for, exercise because of other life factors as well. And so reevaluating, those type of, other factors, time commitments, family commitments, and how best to manage and juggle those, to keep everyone happy.

Nolan Alexander (Host): Very interesting and, and you cannot neglect sleep. What are the most important things listeners should. Remember about GLP one agonists for weight loss?

Dr Kashif Anwar: some of the most important things listeners really should remember about GLP one agonist, is particularly for weight loss, is that, like I was saying earlier, not to feel that I'm missing out on something. in our society, the concept of fomo, fear of missing out. And the ideas of, I need to jump on this.

I've never weighed this much before and I really need to be on this. And you'll have patients on one end of the spectrum who may not actually need something as significant as a GLP one for the treatment of excess weight. On the other end of the spectrum, having an open discussion, understanding that.

The GLP one agonists are the most effective and safest things we've had so far, and that though there are a lot of things that are thrown around about side effects and whatnot to come talk to your physician about those and seeing if they are appropriate. Lastly, the other thing that I would say, to remember about the GLP one agonist for patients is to talk to your.

Primary physician or someone who specializes in dealing with obesity medicine, particularly because of how many, copycat, formulations we have of these medications. And what I mean by that is compounding pharmacies and compounding, versions of these medications. what I mean by that compounding. is basically taking the ingredients for any medication.

It's used very often for a variety of medications, but taking the ingredients for any one medication and putting it together to have a copycat version. And these are regulated, by the governments. and so there is some level of safety there for sure. But officially, most medical societies agree that these molecules, these newer medications are such complex peptides that there is a significant risk in using these copycat versions at compounding pharmacies.

So that's where I would say to talk to your physician, and if you're going to go ahead and start the GLP one, definitely doing under the guidance of a physician trying to get on the official brand version. And lastly, keep good communication with the prescribing physician in terms of what, dose you're on and how you're going with it.

These medications need to be titrated closely and carefully to monitor for side effects. They also need to be consistent use of them and not have significant gaps or elapses in terms of taking these medications. Otherwise, patients can end up having significant. Side effects that land them into the emergency room.

Nolan Alexander (Host): And lastly, where can listeners learn more about weight loss medications and get reliable information?

Dr Kashif Anwar: You know, listeners can learn a lot more about their weight loss medications and get that information, in many ways. But what I think should happen is they should start by discussing their weight loss options with their primary care providers. And if they are ready for the next step, they can reach out to the capital health, metabolic, and weight loss center.

By calling 6 0 9 5 3 7 6 7 7 7 or visit capital health.org/weightloss, W-E-I-G-H-T-L-O-O-S-S.

Nolan Alexander (Host): Wow. Dr. Kiff Anwar, thank you so much for equipping us with great information today. We really appreciate it.

Dr Kashif Anwar: Thanks Nolan for having me and thanks again for listening.

Nolan Alexander (Host): Uh, it has been our pleasure. And for more information or to make an appointment at the Capital Health, metabolic and Weight Loss Center, please call 6 0 9 5 3 7 6 7 7 7 or visit capital health.org/weightloss. I am Nolan Alexander, and this has been the Health Headlines podcast series.

Thank you for listening.