Confident Eaters

Weight loss Drugs
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Georgie: [00:00:00] Welcome to the Confident Eaters Podcast, where you get proven methods to end overeating, emotional eating, and stressing about food. We are heading for harmony between your body, food and feelings, hosted by me, Georgie Fear, and my team at Confident Eaters.

So today we are going to learn about the newest class of weight loss drugs. Now, everybody has heard of Wegovy and Ozempic.

You may also have heard of Mounjaro. These are brand names for compounds that are used for weight loss and type 2 diabetes management. And they've generated a lot of excitement because they have really promising results. Previous weight loss drugs would at best get people like 5 10 percent of body weight lost.

And so that wasn't super exciting, like nobody wants to take a drug that potentially has side effects. to [00:01:00] lose five percent of their body weight. They also had a lot of side effects, and as I'll go a little bit more into, they've had some checkered history of safety. So the reason that these are getting so much attention is because they're more effective than previous weight loss or diabetes drugs have been, which is exciting considering a lot of people are dealing with those conditions. They also have generated massive profits, which puts a lot of things into the news, as well as increases the amount of advertising that you see for them, and they also arouse suspicions and concerns for a lot of people. So they're an interesting topic that people like to discuss. I guess the 1st question is.

Do they work? It appears that they do work quite effectively. Patients can usually expect to lose 12 to 15 percent of their body weight on average, and then they seem to plateau. Some trials have reported average losses of 20 to 25 percent of somebody's body weight. So if you think about your body weight and subtracting 20 percent or 25 percent, you're [00:02:00] like, wow, that's a significant difference.

and those are averages. So that means that some people will lose less. Some people will lose more, but that means somebody losing 20 percent of their body weight is not the outlier, "results not typical", you know, the one person that had tons of success on this juice cleanse. That's actually the average.

So on average, they do produce pretty significant weight losses, and because weight loss isn't the only thing we're interested in, they do also improve cardiovascular health, metabolic health, they reduce diabetes symptoms, and then the consequences of long term diabetes probably are improved as well.

So it seems like there's some really good stuff there. There are some concerns specifically that to maintain the weight loss, it appears that a person needs to stay on these medications. It's not like you can take this to jumpstart your new lifestyle and then come off of it. You can't fiddle with it for a period of time, get [00:03:00] to your goal weight and then expect that you'll stop taking it.

I think it's more reasonable to consider it a lifelong commitment. There have been a number of trials about discontinuing it or tapering it. And people do seem to gain back the weight that they've lost quite rapidly. And in fact, frighteningly rapid in some of the trials. So if someone is considering this or someone you love is considering it, keep that in mind.

It's probably something to be continued long term. So I wanted to ask you two, if you have experience with your clients and weight loss drugs, have any of them tried them? Or asked you about them and what have their experiences been? So Christina, why don't you tell us first?

Christina: Sure I have three clients who have been taking it. Well let's see, they all three have been struggling with binge eating. One of them took it for two months and was experiencing. Some negative side effects that he just decided it was not worth it for him to [00:04:00] continue. The way he put it was he had to be very close to a bathroom at all times, and it just was too constrained for him. The other two found it super helpful with dealing with the food noise that a lot of our clients talk about having, like they just didn't think about food anymore. It helped their appetite go way down, which is what we hear about and read about. But specifically for them, it was these foods that used to bring comfort or they would go to like the fast food line. They just didn't get that same pleasure. They didn't crave it anymore. And if they did end up eating it. They didn't feel great and just didn't give them the benefit that they were seeking, the habit they had developed with the binge eating. So that helped them a lot, just not to think about food all the time. It was just like a big relief for both of those. And they're, they're still on it to this day, but the other client, he just decided to stop taking [00:05:00] it.

But that's kind of my experience from what I've heard. But the main thing that both of the clients who continue to take it is that they recognize that they need the behavior change still to happen. It's not just like this magical fix. They have to develop other ways of coping. If food was like a thing that they use to cope and they need those emotional regulation skills that we help clients develop. So it helps with the appetite. It helps with the food noise, but then the other stuff still needs to be dealt with is the the consensus that I've heard with my clients,

Georgie: Yeah. How about you, Marie Claire?

Maryclaire: Almost identical. There's 2 clients in particular that I think about. Both of them in this case had type 2 diabetes. So it was extra important for them, I think, and helpful for them to be on the medication. It did lower their blood sugar numbers. They did lose weight. It seemed like, again, it just made things easier for them.

like Christina was saying, it was less of a [00:06:00] struggle. So, Less chatter in their heads, less urges less interest. I will say with one person that they can still kind of blow past those signals and still reach for food for comfort. So we're still working together on some of those same sorts of skills, like Christina was saying, it doesn't replace them, but it certainly is an aid and perhaps gives people more of an opportunity even to practice those skills with less of a challenge.

Georgie: Awesome. Thank you both for sharing that. So in my clients, I've seen really diverse experiences, which is kind of fascinating to me. So the first experience I had, or the first client I had was reaching out to me after a period of not doing coaching. So she had, you know, sort of graduated or taken a break and then wanted to come back.

And when she said she wanted to come back, she was like, I've taken this weight loss medication, and I believe she obtained it through a friend, so it wasn't necessarily prescribed directly to her, and she did it for a month or two, lost the [00:07:00] weight that she wanted to lose, this was on the order of 10 or 15 pounds, and came off of it, and she said the binging was uncontrollable.

She's like, I stopped. And it was like, I needed air. That was how much I needed massive quantities of food. So it was very upsetting to her. She gained back all the weight quite rapidly. And so her experience was, I'll say, very positive and then very negative, because she didn't anticipate taking it for a long time.

She had a friend who had sort of like stockpiled a little bit of it. My second experience was with a client who received it as a prescription from a doctor's office specializing in weight loss, and he was financially advantaged enough that he could pay for it out of pocket. So he was receiving his medication and he was able to basically fill the prescription at multiple pharmacies.

And accumulate a freezer or refrigerator backlog for months of medication, in addition to what he was actually taking. So that created, for [00:08:00] me, somewhat of an ethical dilemma, because there are lots of people with prescriptions for this that can't obtain it. So I was somewhat uncomfortable with the fact that one of my clients was hoarding it in his kitchen.

For him, he said it was fantastically helpful. He went on to lose 100 plus pounds. So it definitely was helpful for him. He did say that there was pretty dramatic negative gastrointestinal side effects if you overate, but he seemed to be able to comfortably exist on a shockingly small amount of food.

So for him, it was definitely very helpful for his success. And I haven't heard from him, like after he hit about the a hundred pound mark, I haven't heard from him since. Apparently he doesn't need me anymore, so, I presume he's going to stay on it if it's been that helpful for him. That's what I would recommend, not that anyone's asked me.

the third person on my clients that has been prescribed this has been using it and has [00:09:00] found that it has had an impact in terms of there's more negative payback if they overeat, they feel very full, like it's just not sinking in, it's not settling and because these medications slow the movement of food through the digestive system, that makes sense, like your food is going to stay in your stomach longer before emptying into your small intestine.

So if you overeat, that could potentially mean several hours of being quite uncomfortable. It has not been able to put a huge dent. in emotionally driven eating for this client. It's been it's really clarified that it's not hunger behind you know, his particular overeating incidents. So, obviously, we still have work to do.

He is still continuing on the medication and I do think it's a benefit for him. But it has not been the greater part of the solution for him. And the fourth client that I have who has been prescribed this medication has not been able to obtain it due to shortages. So he has played the game of calling around to every [00:10:00] pharmacy within a reasonable and unreasonable radius of his home and just can't obtain it.

He's also had a lot of back and forth with his insurance company because at first they said they wouldn't cover it and he had to try weight loss counseling first, and he was like excuse me, I've been working with Georgie for two years. I wrote a letter on his behalf and sent it to his insurance company saying, I think it would really benefit him.

He is the case You know, a perfect example of somebody who would benefit from this. So yes, it's been a frustrating series of red tape for that client who has not actually been able to obtain it yet. So, yeah, so that's been my first hand experience. People do agree that they feel something.

Nobody has taken these to my knowledge and been like, Didn't notice that, couldn't tell the difference. Might have been a sugar pill. That hasn't happened. Everybody has felt something. Oh, you know, I forgot one. I have one client that took one of these weight loss medications for, I want to say four or six weeks and said that she felt nauseous every single day and was just like, it's not worth it.

It's just absolutely not worth it. This, even if this helps me lose weight, I want nothing to do with it. It's [00:11:00] horrible. The side effects were really, really bad for her, So she never even made it to the higher dose just the entry level dose was too much for her. So, as we can see, some people have more positive experiences, some people have more negative experiences, some people have a lot of both, and then some people get caught in red tape and can't even afford or obtain these medications.

So, what actually happens when somebody takes one of these medications? most of these medications that we're talking about are what we would call incretin mimetics or GLP 1 agonists. what that means is that GLP 1 is a hormone that is secreted in the digestive system in response to food intake, and it circulates up to the brain and is part of the body.

That feeling of, okay, I've had enough to eat. I'm going to stop now. It's part of moving food through the digestive system. Some hormones actually slow the digestion of food through the digestive system. And then there's [00:12:00] other hormones in addition to GLP 1. And some of these drugs mimic other hormones.

You may have heard of GIP or glucagon. These are the three main targets right now that are commonly impacted by these drugs. So what these drugs do is that they bind to cell receptors and cell receptors are little proteins, almost always on the surface of cells. And the way that your body's neurotransmitters and hormones work is they bind to the receptor and that causes the signal to be passed into the cell, which makes other stuff happen.

So if you think of the hormones you've heard of insulin binds to the insulin receptor. Serotonin binds to serotonin receptors, estrogen to estrogen receptors, and so on. Now, sometimes there's different forms of the receptor. So dopamine, for example, has D1 and D2 receptors, but we're not going to get into that much detail.

So the new crop of weight loss drugs primarily binds to [00:13:00] receptors for hormones that control hunger, fullness, and glucose management, which is why they're also helpful for diabetes. I won't get into the exact molecules, but the three ones that we're talking about are GLP 1, GIP, and glucagon, also known as the three G's.

some of the most prevalent drugs right now in this class would be Wegovy and Ozempic, which are both actually the same drug in different forms. And they both are GLP 1 agonists, meaning that they hit the GLP 1 receptor and they Act like GLP 1 does. So they sort of like fake their way in posing as GLP 1 to the receptor. So you may also hear more and more in the future about dual agonists. And what these are are drug formulations that bind to multiple receptors. So for example, the GLP 1 receptor and the GIP receptor, which is for a completely different hormone. so GIP and GLP are [00:14:00] both satiety and blood sugar regulating hormones.

So they can sort of have a synergistic effect. So Mounjaro is one example of an approved dual agonist. And currently I don't think there are any approved triple agonists. I don't Which hit those two and the glucagon receptor. But there are a lot of them in clinical trials. There are a lot of them in pipelines because every pharmaceutical company in the world wants to get on this train.

So there's a lot of publications about double and triple agonists out there. So the result is that a person feels less hungry. More full from a given amount of food and that the food moves through their system more slowly so that they retain that feeling of fullness a lot longer, but there's also some impact on perception of food.

So, many people report as your client, Christina did that food doesn't have the same appeal as it did before. It can even be distasteful, like, I'm actually turned [00:15:00] off from thoughts of eating. And that can be a really new thing for somebody who has always felt really, really drawn to food.

And it shows just how powerful our biology is in shaping our perceptions and opinions and wants of things. So Side effects. We already talked briefly about nausea, vomiting, diarrhea, and constipation are the most common. Those happen in 20 40 percent of people who take these drugs. So it's not a rare effect.

A rare occurrence. to have digestive related side effects. There are some rare ones that are more severe, like pancreatitis, liver, or kidney dysfunction. Those would happen in less than 1 percent of people, but it's important to know that they do happen. The cost of these is another thing that's worth talking about.

They cost about 1, 000 a month. And so if one also considers that this is a long term commitment. That's like another mortgage. That's like paying rent for some [00:16:00] people. A thousand dollars a month puts these way out of reach for a lot of people. A lot of insurance companies don't cover them, and coverage is somewhat better for people taking them for diabetes, but many people will not have any insurance coverage if they just want to take this to reduce their weight.

So this is Not a perfect world, and sometimes doctors will say things that are not 100 percent truthful on their client's records to help them obtain this medication, such as indicating that somebody does have diabetes you know, I won't say those things don't happen, but at this point, if it's only approved for Diabetes care, then theoretically people wouldn't be able to get coverage just for weight loss. So, the cost is significant. Many people's insurance won't cover it, which simply means it's not accessible to them. The availability, as I mentioned, has also been a problem. There's shortages of these medications. And as you would expect, people who are very wealthy or have other advantages may be able to [00:17:00] obtain the medication when other people can't.

So, it's definitely not a fair game. That way I don't know what else to say about the availability, except that it, it varies. It seems like there's been periods of greater shortage, and then they seem to have a little more available and then greater shortage and then more available. I expect in the next year or so, we're going to see that improve because this is a big money maker. I mean, these companies are going to be cranking out these drugs as fast as they can produce them. So hopefully those shortages are going to be only temporary. One of the biggest questions that everybody has when they're considering taking one of these medications is, What about the long term side effects?

Okay, so maybe I get a little queasy, maybe I gotta hang out near the bathroom for the first couple weeks, but is this going to have a negative impact on me 5, 10, 12, 20 years from now? The answer to that is we kinda have to wait and see, which is a somewhat scary prospect. The long term side effects of a drug can't really be seen just through the clinical trials that Drugs have to undergo [00:18:00] before they're FDA approved.

So, we do have safety on the time scale of months, but we simply haven't had enough time of these drugs being used to know what happens if somebody takes them for a decade or longer. A little historical perspective here, some context. In 1996, the FDA approved a drug called dexfenfluramine, and then reports of heart valve damage started accumulating.

Doctors are supposed to report when people have negative effects after taking prescribed drugs. So just one year later, the FDA pulled the drug. because of those negative impacts on people's heart valves. Also that same year, they approved a drug called Meridia, which is sibutramine. except they withdrew that one from the market in 2010 because turned out to have cardiac side effects.

So we've got two drugs that have been introduced and withdrawn for very serious things. We don't want to mess with people's hearts. There is also a drug called rimonabant, the first blocker of [00:19:00] cannabinoid receptor one for weight loss. Cannabinoid receptors, as you might figure out from the sound of the word, are the receptors that THC binds to.

So the active compounds that are in cannabis some of their impacts are due to Binding the cannabinoid receptor, you've heard of getting the munchies. You can see how appetite is related in here. So if we block that cannabinoid receptor 1, people have lowered appetite. So it was approved in Europe in 2006, lasted only two years before being pulled because it was linked to thoughts of suicide. Another drug known as Belvik, is a small molecule that stimulates a serotonin receptor, was also tried for weight loss, but pulled after 8 years on the market because it increased the risk of cancer. So, what we can see, taking this sort of historical context, into account is, it's hardly the case that once something's approved, it's just a green light that it's going to be safe long term.

The [00:20:00] FDA has a big job. They require a lot of safety data prior to approving a new drug. But sometimes these health effects simply can't be detected until you have millions of people taking a drug for years. So they don't withhold drugs from the marketplace until they have decades of data because they could potentially have positive impacts on people.

So the best they can do is try to stay as on top of adverse effects as they can and withdraw them when that seems to be the smart thing to do. So separate from the potential for long term health consequences, which really none of us can know right now, there's the question of whether the body develops resistance over time.

This has been known to happen with some other drugs that they work initially, but slowly over months to years of use, the body adjusts the receptors themselves down regulate, and the effect of the drug can diminish. Again, we don't know if this happens with these drugs. It's just a potential concern that we may want to look out [00:21:00] for. One of the interesting Discussions that I found when I was looking at this online is You know, when you search for something in Google, it'll sort of auto fill in or what other people have asked some of those questions.

And so one of the things that I spotted on that was, is it cheating to take ozempic? I was like, that's very interesting. Is it cheating? Now, this is such a subjective question. I think you both can probably intuit, knowing me very well, that I'd say no, it's not cheating. I don't think there is a way to cheat at weight loss, but it reminds me of the same question being asked about bariatric surgery about 20 years ago.

I know a lot of people who were talking about this or knew somebody that lost a significant amount of weight would sort of say, but they had surgery. Implying that somehow it was invalid or not earned the hard way or the proper way because they had surgery. I saw a a statistic that there was a study following [00:22:00] 30 people who had weight loss surgery and more than half of them decided they didn't want to tell anybody other than their close family.

So more than half of people are like, I'm not telling anybody I have weight loss surgery. So clearly they're worried about being stigmatized or shamed for it. Of those people who did speak openly about it, more than 90 were told by at least one person in their social network that they were cheating at weight loss.

I was shocked when I saw that. That's why I'm reading it like verbatim. More than 90 percent had somebody tell them they're cheating at weight loss. Floored. personally, I don't think it's at all fair to call it cheating or imply that it's an easy way out. Injecting yourself with a drug, first of all, is not something that most people want to do just for, you know, giggles.

It's not fun giving yourself shots. Especially if somebody's had to go through a significant financial outlay to obtain this. they've had to, you know, maybe jump through loopholes trying to obtain this medication. This is not an [00:23:00] easy solution. And as we've discussed, people also have to change their habits.

It's not like the take a weight loss injection and your weight just falls off. You also have to eat less. Many people also begin exercising more. This is just one tool that is helping people, many of whom have been working hard at weight loss for the majority of their lives. So if you call that cheating or an easy way to weight loss, it's sort of distorted if you ask me.

I don't know. Any thoughts from you guys on that?

Maryclaire: I've had that expressed to me that clients were considering it and feeling maybe negatively because it was somehow taking quote unquote, the easy way out. And you know, I feel similar to Georgie. I've seen people really struggle with this and maybe not get the results they've wanted for a very long time.

And when something like this comes along, that can be really helpful, especially with the health benefits. Why not, right? Like I, that's kind of my feeling. Like if your weight is negatively impacting your health your wellbeing and you've tried many things, it's like this can help you.

I mean, at this point, obviously with all the caveats and concerns we've raised so [00:24:00] far, I certainly don't view it as cheating and it may be an excellent option.

Georgie: Yeah. How about you, Christina? Any thoughts on that one?

Christina: I think most of the time when I hear people talking about it being cheating is related to celebrities who are accessing it, you know, like you said, it's an expensive thing. So they have the means to do that. And I've heard people express it. Towards celebrities, but it's interesting, even like you bringing up the bariatric thing, it's like pretty sure people don't casually go through major surgery.

Like yeah, I think it's interesting how people respond to things like this, but yeah, it's, it's kind of dehumanizing when you put it that way, but I like the perspective you offered. this is expensive. This is not just a casual thing. It can be a really big life change to inject these drugs,

Georgie: Yeah. I can understand people feeling like Disapproval when someone who has a lot of [00:25:00] money has the option of taking it simply for vanity purposes.

Christina: Right.

Georgie: Meanwhile, somebody who genuinely needs it in more of a health protective role can't access it. Like the, I think the, the unfairness about that makes a lot of us itch.

Christina: Yeah.

Georgie: I did see a lot of discussions about celebrities, like, is so and so taking Ozempic? Is so and so taking Wigowi? How did so and so lose that weight? And everybody has their own sense of like, how much do celebrities deserve privacy? My personal opinion, like, it's none of your damn business.

Christina: Yeah.

Georgie: I don't know

Christina: There's some discussions about Oprah because I think Weight Watchers is starting to promote Ozempic or something. And, you know, she's been a big part of that. Proponent of Weight Watchers. And she's had a very long struggle, weight loss and been very open about that. But I think there is some criticism going towards her because now it's like, obviously a money [00:26:00] making thing. And, she has that access and then it kind of makes people question. Who trust her, you know, and who have followed her

for a long time. I think there's a little bit of a burden on, on her and what she promotes because of the role that she's played in a lot of people's lives, but I wouldn't want that responsibility, but yeah,

Georgie: I think it's pretty awesome that she said, yes, I've used these medications. They were a great help to me. I mean, I think that goes a long way toward reducing the stigma. Like it's fair for people to expect stigma because unfortunately that's a reality. So the more that people say like, yes, I've taken this.

Yes, I do this. I think it helps normalize it in the same way that we want to de stigmatize Disordered eating or taking antidepressants. Like we wouldn't think twice before saying like, Oh yeah, I wear contact lenses. But we would think twice before saying I take weight loss medication, or I take diabetes medication. And so I like that she was willing to speak [00:27:00] openly about it.

I believe she is actually like sort of divested and separated from Weight Watchers. And is no longer at least financially connected to them. Because I could see absolutely how if she were still connected to Weight Watchers, Weight Watchers is moving in the direction where they will be including medications as part of their program.

That her coming out and saying her piece it could be framed less as a genuine openness and more as like, oh, this is, you know, a marketing angle. Look at that. Yeah. So it's easy also for me to say, yeah, people should talk about it because I'm not taking it. You know, but I do take antidepressants and I say that because I don't want anybody else out there who's like, Oh yeah, if I start taking that, does that mean this, does that mean that?

I'm like, no, it doesn't. It's just a support. And I think when we're all having trouble with something in our lives and. Weight loss certainly is a trouble for a lot of people if there's something out there that can support you or be part of the solution, not availing yourself of it is [00:28:00] just, it doesn't fit in with my logic system, though.

I recognize some people, it doesn't make them comfortable and that's okay because there's other options. So, we've established they're not a quick fix. We've established they're not an easy cure. I'd say they're one option in the complex management of a complex problem. So some individuals don't like the idea of taking medications and that along with the cost makes them really just not want to consider these medications.

And in fact, I've read some accounts of people who are becoming irritated with doctors that kept recommending it to them or kept asking them if they wanted to try that. And I can completely understand that. If you feel strongly that this is not a road you want to take. Nobody, in my opinion, should be you know, coerced into trying to take a medication.

They just don't want to put in their bodies. There's so many options for how someone can get healthier and lose weight. I do think the cost prohibitive nature and the unequal access is an unfortunate thing. There's [00:29:00] already this unlevel landscape of health disparities with people who are at lower socioeconomic levels.

Status already being more afflicted by diabetes, obesity, cardiac disease, and lots of other problems. So it's unfortunate if the cost of effective weight loss medications further stratifies so that the people who are on the top, not only have a lower burden of disease, but can also get better care. You know, I, I would really like to see that change in the next few years.

So that brings me to what do we think we will see in the future? Georgie's crystal ball comes out. And here's what I think we're going to see more of in the future. One, we're going to see more of those double and triple agonists. I can't even tell you how many clinical trial papers I found when I was looking for all this stuff.

Like every company's got a compound that they're testing. So I think there's going to be a lot of new drugs, potentially. I don't think they're all going to be safe. I expect we're going to see some reach the marketplace. And get withdrawn from the [00:30:00] marketplace, so I would expect that to happen. There is already one approved Oral form.

So currently, a lot of the drugs are given through once weekly injections, but now there's some that you can take as a once a day tablet. So the active ingredient in Wigovi Endozempic is currently available in tablets. It still costs 1, 000 a month, but now that some companies have been able to combat the bioavailability challenges of getting a drug into people orally I think we'll see more and more of that because people don't like giving themselves shots.

I'm sure if there's a way around it, people are going to want a way around it. Hopefully we'll see more insurance coverage for these. And given the cost of covering somebody who has higher body weights, unmanaged diabetes. And other cardiovascular problems that potentially can be improved with these drugs.

I think insurance companies are going to realize that it's in their best interest to cover these for people, keep them [00:31:00] healthier and prevent paying for a lot of care down the road. So I think that is the way things will go. So, some interesting questions that we talked about prior to the meeting. Do they impact binge eating? I haven't seen too much direct research on this. I found one trial that reported a decrease in binge eating episodes. With a once a week injection of the active ingredient in Wegovy and Ozempic I believe it wasn't a single treatment. It was a combination of the drug and some lifestyle counseling.

So it's really tough to say how much was, was one or the other, but they did have a control group that just had the lifestyle counseling. And so there was a greater impact of having them both. There's not a lot of research on it, so I don't think we can really say comfortably like, oh yeah, this is a good thing for binge eating disorder and people should seek it for that.

I don't think we have enough evidence to say that. I think there's a big person to person difference here. And we know already, because we work with binge [00:32:00] eating disorder all the time, not every individual with BED is the same. Some people's, symptoms are really strongly intertwined with food restriction and under eating between binge episodes. For other people that's not playing as large of a role and other theoretical frameworks like experiential avoidance or avoiding self critical emotional states are much more pertinent.

So for people whose binges are being caused by more emotional things. It doesn't seem like the incretin mimetic drugs are going to have as big of a role. If you ask me, does that make sense?

Maryclaire: Yeah, I think we're seeing that already. Right. Yeah. With some of the clients we've had. Sure.

Georgie: Yeah. Yeah. So Mary Claire, you told me that you heard protein is important, but also that the medication can make protein unappealing. And that is 100 percent true. Like it is really important when somebody has a decreased food [00:33:00] intake. It becomes really important to have high quality, nutritious food.

And we learned a lot about this when gastric bypass and gastric sleeve operations, you know, first became widespread and we could see in large numbers of people, like what happens when someone can only eat an ounce of food at a time. And that is that if you don't focus on getting protein and focus on getting a lot of vitamins and minerals.

you can develop dietary deficiencies pretty dramatically. So when somebody takes one of these medications that significantly reduces their drive to eat and increases their fullness, yes, it may be less appealing to eat chicken and more appealing to just, eat some candy or sweets or something just for fun and not really focus on eating vegetables and fruits and high nutrient foods.

So When somebody is realizing that they're having a hard time eating protein, or that protein feels unappealing, thinking about the reasons why we need it can really help. I mean, if somebody says, Yeah, I don't need protein. I just need to eat less calories. And then they're likely to not eat [00:34:00] enough. But if somebody is receiving some coaching or guidance or encouragement, then they can look for what foods still might be palatable to them. I know a lot of times pregnant women will have really strong taste aversions to like spicy or savory foods. Mary Claire's got this look on her face like, Oh, hell yeah. So we

Maryclaire: still remember.

Georgie: Yes.

I have found for women in that situation when they need protein, but meat is just stomach turning to think about looking at dairy foods like Greek yogurt or cottage cheese egg whites because they don't have a lot of aroma or taste, you know, kind of like blander things, or things that you can take in the direction of a sweet flavor profile.

Like a whey protein shake, or a soy protein shake, or yogurt with berries. Often go down a little more easily than like, a hamburger. I don't know, does that fit with your experience?

Maryclaire: I actually had an aversion to pizza.

Georgie: How?

Maryclaire: Yeah Well, I, you know, I actually went to a place where they had really poor quality cheese. Like it was disgusting. Because of that combined with the pregnancy, I [00:35:00] couldn't eat it for years afterwards. So, But I got over it.

Georgie: good. You got

Maryclaire: I worked on it and I got over it. Yes.

Georgie: Hashtag goals.

Maryclaire: The struggle is real.

Georgie: Yeah, that's going to be your next book. It'll be like how I got over my aversion to pizza.

Christina: Yeah.

Maryclaire: My life story. Yeah.

Georgie: So it is definitely important for people to take in adequate protein. It's also really important to encourage strength training among our clients or other people who are taking these medications. They have been associated with a rapid and significant loss of lean mass, and we're looking at about 10% or around six kilograms which is comparable to a decade or more of aging, you would expect to see that sort of muscle loss in about 10 years of aging and somebody that's not exercising or strength training. You start to lose about 10 percent of your muscle mass per decade. So considering that even a short time on these medications.

can produce a really fast decline in lean mass is [00:36:00] concerning. If people weight cycle, that all too familiar game of like lose weight and regain, unfortunately what tends to happen is that people lose a mixture of lean mass and fat mass, but the regain is almost exclusively fat mass. So over several cycles of weight cycling, you may be at the same weight you were Prior to all the cycling, but at a much higher body fat percentage, and that has a lot of negative outcomes in terms of somebody's lifespan prediction, protecting them from osteoporosis and falls and all sorts of other things.

Maintaining muscle mass is really, really crucial. As people get older. We can also support our clients by being supportive and understanding. I think as we recognize, not everybody's comfortable talking to their friends or their colleagues or the public about their considering taking weight loss aiding drugs or their decision to take them.

And so for professionals out there who work with clients who do take these medications, I think we offer something really valuable. In that we can just offer this nonjudgmental space. Like, [00:37:00] let's talk about the pros and cons. Like, how is this impacting you? How do you expect this to impact you in the future?

And just having somebody to talk about where they know we're not going to turn around and be like, Oh, so you're going to cheat at weight loss. Definitely. We can also support our clients through helping promote exercise, sleep. And the habits that lead to adequate nutrient intake, sometimes we can lose sight of the amount of vitamins and minerals and fiber aspect of our clients diets, because we're so focused on helping them reduce they're energy intake enough to see weight loss, but it is really important that if somebody takes these drugs and all of a sudden has much lower appetite, we may want to look at, are you still getting vegetables in? Are you getting your fiber in? Especially if somebody is having constipation as a result of the medications. You may want to start looking at, like, are you eating some whole grains? Are you eating beans, And then we also want to make sure people are getting enough of the vitamins and minerals, like iron and calcium and B vitamins. And for many people, I [00:38:00] would refer them to ask their doctor about supplementation.

Some doctors are more of a fan of it. Some are less of a fan of it. When I worked in a bariatric clinic, and most of my patients were having surgeries the sort of standard recommendation was to take two one a day multivitamins that would provide, usually a single dose, would provide 100%. of the RDA of vitamins and minerals, and we would recommend they take two of them because of their decreased absorption.

So these drugs don't cause that decreased absorption, but it still may be advisable to take a supplement that offers 100 percent of your daily needs, but you would definitely want to run that by your doctor. Just taking supplements casually can be a bit dangerous. Don't listen to what a podcast hosts recommend above what your doctor recommends, because even multivitamins can interact with some of your prescription medications.

I don't know you, and I would hate to recommend taking a multivitamin and then Causing you not to attain all the benefit from one of your prescriptions. But ask your doctor if you should be taking a [00:39:00] multivitamin in addition to trying to eat lots of whole and varied foods. So that wraps up all of the stuff that I have to update on these new weight loss drugs, also known as Incretin mimetics or GLP agonists.

If you have any other questions, if you want to know more about them, fire me an email and we will talk about it. My email is Georgiefear@gmail.com and on behalf of all of us at Confident Eaters, thanks for joining.