Oprah and Yale Researcher Break Down How Weight Loss Drugs Affect the Brain

whether you are listening on the Oprah. podcast or watching on YouTube I. appreciate you being with us last year. Millions tuned into to my special on ABC. shame blame and the weight loss. Revolution it's now streaming on Hulu if. you want to check it out we're. continuing the conversation around. weight loss medications like OIC and. Manjaro people still don't understand it. is it the easy way out it's absolutely. the opposite I'm joined on this podcast. by Dr Ana yasto an endocrinologist and.

associate professor at the Yale School. of Medicine she has been studying glp1. medications for more than 20 years. obesity is not a choice it is about. biology we are diving into the latest. research on these medications that. roughly 15 million Americans are now. using can you set the record straight on. side effects Dr Ana is here to answer a. lot of your common questions is this. something I could taper off of you may.

remember Amy who I met on the ABC. special she had lost 160 lb after. starting a prescription of M jarro she's. zooming in with an update hello hello. good to see you again it's so good to. see you a quick note my guests on this. podcast asked us to show their before. and after weight loss pictures because. they believe the photos are a vital part. of their life's. journey it's wonderful to talk to you. and you know that new study says that.

nearly. 75% of American adults are overweight or. obese so what determines obesity versus. overweight just being overweight okay so. in terms of that first question right. now there aren't really great. definitions yeah so we used to use. definitions of BMI but BMI is really a. screening tool it's not something that. um was actually ever designed to be a d.

agnostic tool so technically overweight. was defined as a BMI of greater than 25. and obesity as a BMI of greater than 30. and that's bass uh body index yes body. mass index bmi's body mass index now. we're really starting to rethink what. that means what does it mean to have. obesity and the indications for the. medications were based on these. initially and now that's also evolving. and changing as well because we're. really trying to understand what is. obesity how does it affect our health.

because ultimately when we're treating. obesity the point is not just weight. reduction it's improving and optimizing. overall health that's the goal yeah the. focus has been on weight reduction but. the real truth is and we're going to. hear from some people today who tell you. that what has happened to them in terms. of their physical health their emotional. health the way they see themselves the. way the rest of the world sees them. including their family members is the. big uh bonus for this is is is is is why.

life changing it's absolutely. life-changing and I know the term. lifechanging gets thrown around a lot. but this really is okay so let's talk. about why is this is the. thing I recognize this probably now it's. almost going on two years that I. realized that obesity was a disease. having a discussion like this can you. share with our audience with every. person who's listening who has doubts. who's heard I saw on Tik Tock and yeah. why is obesity a disease yeah and that.

is such an important and critical. question so as you said so many people. have obesity now and two-thirds of. Americans and half of the world. population did not wake up one morning. and decide to have obesity obesity is. not a choice it is about biology so what. is obesity and and why do so many people. have it and why is it so difficult not. just to lose weight but to maintain that. weight loss and so our body is amazing.

it has this amazing beautiful biology. and basically what it was designed to do. is to make sure that we stored enough. energy or enough fat because we store. energy as we by storing fat I'm tracking. that yeah and so it said okay how are we. going to do this well there're these. hormones they're stimulated when we eat. food they're called nutrient stimulated. nutrient stimulated hormones and they. communicate with our brain how hungry. are we how full are we how much energy. do we have and so this beautiful biology.

so hormones inform the brain and this is. in every person's body in every person's. body every person's body and so. basically it says okay this is how much. energy you're storing this is how much. fat you're storing and so you would. think ah we have this beautiful biology. wonderful then why do so many people. have obesity if this is so carefully. regulated well it turns out that our. obesogenic environment an environment. that is filled with ultra-processed food. lack of sleep lack of physical activity.

all this stress on a population level. that obesogenic environment that. developed so much more quickly than the. biology it basically pushes up how much. energy or how much fat our body wants to. store so our body ends up defending a. higher amount of fat the defended fat. mass or the set point these are terms. that you may have heard but that's. exactly what our body's doing so our. body's doing what it needs to be doing. what it should be doing but a little bit.

too much in this environment so why does. it do it for some people and not for. others yeah and that's a really great. question and one that we're trying to. sort out and figure out what we do know. is that for most people maybe you know. over centuries and Millennia we evolved. in this way where basically you wanted. to make sure that you didn't starve. right so you wanted to store enough. energy so that if there was a famine you. would not starve but if you think about. this this is actually very very tightly. regulated so we all eat.

incredibly we all eat a lot more than. what we actually need so our body. actually figured out how to burn extra. but after a while with this obesogenic. environment it actually says no store it. maybe I need it for later right so when. we try and lose it our body fights back. and it says no no no no no okay but. that's that's in some bodies and not in. others that's true and so is that. because in my body because I obviously.

have uh an issue with obesity in in my. body and people who are prone to be. overweight as I have been um is is that. because my hormones are different than. the other person they may be or your. brain it's the because it obesity is a. neurom metabolic disease so or. neuroendocrine hormones inform the brain. so maybe in your body your body is like. I'm really good at holding on to that. energy I'm really good at holding on to. some extra fat just in case I need it. later and somebody else's body says no I.

don't need that but for most people to. you know where we started the. conversation for most people we want to. store more we want to store extra and. that is where our body is happy and that. is what our body defends and it's. because of the environment we live in. and that tells us two things one is we. have to change the obesogenic. environment we have to because if we. don't we're not going to what do you. mean by obesogenic environment an. obesogenic environment so one that that. is filled with ultr processed food uh.

lots of stress lack of sleep lack of. physical activity all these things are. built into our environment right now but. but when I'm listen I've done every diet. as we're going to talk to people today. who have also done every diet and even. when I'm not when I'm not quote dieting. I considered myself eating healthy meals. and yes you know I'm not a person who. you know goes to fast food restaurants. or you know I do eat a lot of potato. chips but uh I'm not that's what your.

brain craves your brain is craving that. craves those potato chips it craves a. chip or something that's crunchy or. salty that's right and it's my go-to if. there is any discomfort in my life. whatsoever a bad phone call I have to do. all of my builds it helps with your. stress yeah yeah absolutely I don't know. why a pretzel calms me down but it does. but it does and and here's the thing so. those Pathways is that my hormones it's. your hormones and your brain and my. brain and your brain so for example for.

you it's maybe it's potato chips when. you consume those Foods when you eat. those foods that signals to your brain. something positive so these hormones. they don't they communicate with all. sorts of areas of our brain including. reward motivation areas of the brain so. we find these Foods highly rewarding our. brain does and the thing is again we. were designed to function this way. because let's say that we some people. find them rewarding I know other people. potato chips don't turn them on exact.

it's something and and that is actually. why I started doing the research that I. do because I thought to myself well why. is it that some people crave potato. chips and other people want the. cheesecake um or the Crispy Cream or. crispy creams so so why is that and and. and the answer is right now we don't. know um but initially I was doing these. brain studies to really try and. understand what that was about and what. reward region of the brain were actually.

responding if let's say you saw a. picture of a potato chip how would your. brain respond differently than somebody. else's and again that has to do with I. see a bag of Ruffles or I see a Ruffles. commercial I am listen I've gotten up. and left my house to go get a bag of. Ruffles and that's and this is the thing. and we you know maybe we'll talk about. food noise but that's what it is if. there is a bowl of brownies on the table. I would not be able to focus on you I'd. be like I want the ice cream and the. brownies yeah and and the thing is is. it's but that wouldn't affect me a. brownie wouldn't you right but the.

potato chips then that's what I would. not if there were potato chips here it. would it would be a battle for not to. not have one yeah and I know that if I. had one yes because I have an addict's. brain I would not be able to you would. eat all the yeah when lay did that you. nobody can eat just one I think they. knew what they were doing they knew they. knew what they were doing they they had. called you but to your point about the. fact that you're eating very healthfully. and you have for a majority of your life. um again the amount that we eat and. again our body crav a larger amount of.

food the amount that we eat is a lot. more than what we actually need so our. body actually Burns a lot it's just that. different people may hold on to less of. that food than others so you know one of. the the the big breakthrough for me a. couple of years ago when I was doing. having this discussion the state of. weight on oily the big breakthrough for. me was understanding oh the AHA for me. was like oh this is like the years in. the early 80s mid mid mid to late ' 80s.

this was like the years of the mid to. late ' 80s we started the Oprah show in. 1986 and I remember doing a show on. alcoholism in 1987 on a whole family of. Alcoholics and generations passing it on. and people were outraged that you would. call alcoholism a disease in 1987 like. how dare you they just need to put the. bottle down and they're really just. drunks and so forth and over time. through education through information.

through people looking at other people. in their family through corporations. understanding what it was people came to. understand that it actually is an. addiction born of disease yes and I. think that's where we are now with. obesity yeah people still don't. understand it they want to blame other. people for it they want to say just put. your fork down and quit you know eating. those brownies or those potato chips and. what's wrong with you and one of the.

reasons why I was reluctant to use them. in the beginning uh when I was trying to. lose weight after my um knee surgery. because I also felt it's cheating it's. the easy way out I've got to prove this. one last time I could do it by myself. and I don't want people saying I took. the easy way out and I think that that's. one of the major issues that people who. are now open to using the drugs are.

experiencing from their their their. their friends their colleagues their. families and also within themselves is. it the easy way out yeah I mean I. couldn't agree with you more and your. story is one first of. all I'm so sorry that you went through. all this and in such a public way oh my. goodness when I think about it I just. you're so. strong and to have that so publicly and. you just I thank you for that yeah cuz.

now that I look back on it I I've said. this on on other occasions that I was. publicly humiliated for 25 years every. week exploited by the tabloids every. time any comedian wanted to make fun or. make a joke about it they could make a. joke about it and I accepted it because. I thought I deserved it I accepted it I. was shamed by it and I received it. because I thought well they're right.

right and they were wrong and they were. wrong now I know they were so now I know. why they were wrong when you're living. it it is so hard of course you blame. yourself so hard it's so and any person. who's watching or listening to us right. now who has suffered from obesity or. being overweight you know exactly what. I'm talking about you do not have to be. on television every day to experience. the same level of Shame and. embarrassment and why can't I do this. and I'm so good at so many other things.

and I can take charge of my life I can. do all of this and why can't I so the. outside world telling you that's right. that you are less than that you should. be shamed that's right uh feels like the. punishment you deserve and it's it's and. it's absolutely the opposite it's. absolutely the opposite and none of this. is in our control somehow in society we. think that how much we weigh is in our. control and it's not it's it's not it's. in our brain is inol it's like an.

alcoholic finally realizing that it's. not my willpower that caused me to not. to be able to pick up the next drink and. just like with alcohol those reward. motivation Pathways those regions in the. brain really respond in a certain way. when someone who has alcohol use. disorder is drinking alcohol in terms of. obesity those are the the same brain. Pathways now obesity is not an addiction. um the the the the thoughts of of of.

food and the wanting of food that is. something different and again that's. food noise it's the bi it's a. manifestation of the biology it's bi. people who don't have obesity disease. don't even know what we're talking about. you don't know even know we're talking. about because one of the things that I. realized the very first time I took a. gp1 was that all these years I thought. that thin people those people were just. had more willpower they ate Foods they. were able to stick to it longer they.

never had a potato chip and then I. realized the very first time I took the. gp1 that oh they're not even thinking. about it that's right they're only. eating when they're hungry and they're. stopping when they're full that's right. there was a there was a guy named Bob. Schwarz who had a diet called diets. don't work and the whole principle was. to eat when you're hungry stop when. you're full did multiple seminars three. times with him on that and the principal. is great mhm except if you have obesity.

it doesn't work that's right that's. absolutely right and and to get to your. question of well is this the easy way. out is taking medications the easy way. out it's not think about it think about. when we treat someone who has let's say. high blood pressure yes and they come to. see us and lots of Americans Americans. have high blood pressure black people. have high blood pressure ex exactly so. we say Okay low salt diet is very. helpful and here are some medications. that can treat the disease biology yes.

and we need to do the same for obesity. we need to say yes healthy diet and. exercise are critical and they're very. important for optimizing health and to. treat the biology the biology of obesity. here's a medicine or medicines or. surgery or what have you that will help. actually treat that biology we do the. same thing for diabetes my mother was a. diabetic she was an insulin shooting. diabetic for most of her life and she. would be told to stay off of sweets and.

every now and then because people in the. South just uh a lot of people in the. South not generalizing but a lot of. people that come from my family in the. South think that having a little bit of. coconut cake is okay or cuz they they. used to call it sugar diabetes yes sugar. I have a touch of sugar have a touch of. sugar and they call it a touch of sugar. and never realized how uh how really. definitively yes bad it is for you to. have a little bit of sugar when you have.

diabetes until you end up going blind or. end up having to have you know your leg. amputated and all the things that happen. exactly and so diabetes is another. perfect example we say we recommend a. low glycemic index diet so less sugar. less sugar and here are the medicines. and for your mom if it was insulin right. and here are the medicines so we pair. them together to to help that person's. health whether it's to help prevent all. those Downstream uh complications that.

can develop or whether it's to treat. that disease in and of itself so if you. have high blood pressure which a lot of. people do you are recommended not to. have salt and here's a blood pressure. medication DASH diet and here's a. medicine and everybody's out there. taking their blood pressure medications. and not once do they think boy this is. the easy way out that's right that's. exactly right and and with obesity for. whatever reason we have this different. perspective and we need to change that. because we don't understand we don't. understand why do you believe it's so.

important to tell your patients that. obesity is a disease it's critical it's. absolutely critical and when I approach. this so when I see a patient the first. thing I do is one I set the stage and I. say this is a no judgment Zone yeah and. the first thing I asked them after that. is tell me about your weight Journey. tell me about your struggles tell me. just tell me tell me and then I listen. and as I listen to them lot of Tears for. that a lot of I mean they cry I cry it's.

and the thing is is there's something. that happens in that moment where people. begin that journey of understanding that. it's not their fault and it's not. something that they chose and we're here. to help them to treat that biology. because why why would you choose it and. why wouldn't you change it if you could. that's right that's absolutely right you. why would you change it if you could can. have the the you know the healthy foods.

and still our body is so smart it's so. smart that it's like no I some people. your body is going to hold on to the fat. yeah and you're just built that way. you're just built that way and if you if. you you know begin the discussion of. this is really about biology and that. your body's smart and that the hormones. are communicating with your brain and. all these organs and your body and your. body is doing exactly what it was meant. to do. exactly what it was meant to do and then.

again patients start to start to let go. and there's something magical that. happens in that moment because they. become curious curious about the disease. of obesity and open to treatment that's. right cuz you're no longer blaming. yourself that's right you're no longer. blaming yourself okay can you explain. why these glp. medications have been a game Cher for so. many people so as we talked about.

hormones nutrient stimulated hormones. they communicate with our brain to let. our brain know how much energy to store. how much fat to store the medicines they. target the same receptors as these. nutrient stimulated hormones in your. brain in your brain and those receptors. are all over the brain including reward. motivation regions of the brain people. are thinking it's targeting your stomach. because I know some people take their. shots shots in the. stomach it's not targeting your stom no. obesity is a neurom metabolic or a.

neuroendocrine disease it's literally a. disease yes and so what happens in. obesity is that there's something that. is disregulated or broken in terms of. the set point in terms of how much. energy we want to store and the. medicines what we think that they do is. that they re-regulate that set point. they decrease that set point so as you. start taking a medicine during that. first phase when you're losing weight. what happens is your body is trying to. chase a lower defendant fat Mass a lower. set point and so that's why people eat.

less in that first phase then once they. Plateau once their weight plateaus out. um then some of the hunger and cravings. and things can return but the weight. does not and we have to reassure our. patience that that's exactly what's. supposed to happen because once you get. to a new weight Plateau you're not. chasing a new defended fat Mass so the. medicines lower or reset the defended. fat mass or the set point and then. basically they reregulate it to a new. place so as you increase the dose so.

let's say you start out your 200 lb and. then you start taking the medications Y. and you start to lose weight and when. you say it's chasing another set point. it it means what specifically what give. me an example of what that number might. be so let and it's different for every. person this is a really because there's. more than one type of obesity there's. many different types of obesities we. just haven't defined them yet but let's. say so somebody starts at 200 lb and. let's say they start one of these. medicines. maybe with the first or the second dose.

that set point goes down to um let's see. let's say 180 lbs right and then they. keep on taking the medicine and after. some time their doctor increases the. dose and then their set point decreases. let's say to 170 lbs so with every dose. escalation you're chasing a new lower. reset defended fat mass or set point. okay so many of you might remember. remember Amy from the ABC special I did.

back in the spring feels like years ago. now shame blame and the weight loss. Revolution what what happened after you. went on majo immediately almost within. days that voice that I've had in my head. since I always say my earliest memor is. 5 years old I remember thinking about. food when I'm going to eat food how much. I'm going to eat food where I'm going to. what I just ate how many calories was it. and all of a sudden I took this. medication and and it felt like I was. free like I literally felt like I'd been.

trapped and it felt like I don't have to. think about this all the time anymore. and Amy is zooming in from neille. Illinois Amy hello hello good to see you. again it's so good to see you uh I. remember you telling us where highest. weight was around 300 lb and you found. out that you had diabetes and your A1C. number were dangerously off the chart. and then you went on monjaro in March of. 2023 I recall right and you.

lost 160 lbs in one year what has. happened since we last. spoke so much has happened um the one. thing that's remained the same is that. I've now maintained the weight loss for. about a year now um and in that period. of time that is in itself is huge right. it's wonderful that's wonderful yeah I. mean that I always say that it wasn't. about losing weight for me I knew how to. lose weight it was how to maintain the. weight loss so for me now um having. maintained for a year is is pretty great.

uh and I'm pretty proud of myself for. that um and during that time I have sort. of established this sort of community of. people on social media who are kind of. feeling the same as you and I where it's. all about uh you know I am so tired of. feeling bad about my weight and I'm so. tired of being shamed for my weight and. and it's not my fault and and I'm not. alone in this yes and I'm ashame and I'm. tired of people shaming me for being on. a zic or being another gp1 medication so.

it's been kind of a whirlwind uh since. we last chatted and I I hear you're. getting messages hundreds of messages. every week from people online what is. the number one question that people are. asking you or comments that are coming. to. you people want this time to be. different like I said before I knew how. to lose weight I didn't know how to. sustain it because often when I was. losing weight I would feel that I was. starving myself I wasn't giving myself. the right nutrients I wasn't allowing. myself to have a piece of my daughter's.

birthday cake at her party because if I. ate carbohydrates I was going to gain. weight and so this time around people. want to know how to do it differently so. they might be on a gp1 medication or. maybe they're not yet or they're. thinking about it but they want to know. how can I heal my relationship with food. how can I heal my relationship with my. body it goes so beyond the exercise. regimen and the diet changes but how can. I really heal that part that well I just.

want to applaud you because you took. what was one of your greatest pains and. shames and have now turned it into a. powerful movement for yourself and to. help other people what are the B biggest. misconceptions that people are sharing. with you about the glp1 weight loss. drugs what are they saying oh my gosh. it's all day long. unfortunately um on social media. platforms people uh continue to say.

you're lazy if you're on a gp1. medication you're lacking motivation you. should just be able to go to the gym. it's only for diabetes you shouldn't. take it if it's for weight loss um. people don't even know that there's a. drug that's been created specifically. for weight loss and so. absolutely a couple of years ago people. were saying oh you're taking drugs away. from the diabetics that is no longer. true because there is a specific drug. for diab diabetics and the specific. drugs for people who are trying to lose.

weight and what else are what else are. they saying to you uh the you know I I. think people just assume that glp1. medications often they'll just phrase it. as well all it does is make you starve. yourself that's all it does there's not. more to it and when you get off the. medication you're going to gain all the. weight right back and uh I mean so much. shaming around these meds to the point. of uh your face looks a certain way if. you're on these medications or your. bodys a certained way OIC face and OIC.

butt yeah what exactly I'm told I have. OIC face and OIC butt and in reality. it's just blue skin from significant. weight loss uh it has nothing to do with. the medication but uh you know. medications like OIC and Manjaro are in. my opinion a perfect sort of scapegoat. for the continuation of shaming people. in larger bodies yeah I I I mean I can't. agree more it's it's you literally can't. win you you cannot not win you're. ashamed if you have obesity you're.

ashamed if you don't have if you if you. don't try and lose weight you're ashamed. if you lose weight you're ashamed if you. use the medicines if you don't use the. medicines there's literally no winning. so you know I wholeheartedly agree you. are sharing your story so vulnerably and. bravely online and you're fighting for. what's right and what's right is to stop. shaming and blaming people just let. people do what they do you're taking. care of your health yeah and people ask. me all the time how I how I kind of deal.

with a lot of the negativity that comes. my way and to me I mean so many people. when I talk about food noise or when I. talk about obesity being a disease. they're like I thought I was the only. person that had these thoughts up here. and that that out outweighs the no pun. intended that outweighs the the the. other stuff the negativity that you know. comes my way well you know what else I. realized too Amy and Dr Anya is that the. people who are. shaming uh often times have never.

experienced the food noise themselves. they don't even know what you're talking. about when you're saying food noise and. so I that it brings us to the point of. uh I interviewed Mel Robbins recently. who has a great book out call let them. you just have to let them say what they. say do what they do and let. yourself understand the power of what. you're doing by creating community and. building connection with people who. experienced some of the same things and. are looking to improve their health I'm.

so happy to know first of all you were. telling me that uh back in March when we. talked that you were still trying to. adjust to buying the right size for. yourself because you were still thinking. that you needed to get larger sizes has. that eased itself it's definitely gotten. better you know even though I've now. been on this medication for about two. years now I've been on this weight loss. Journey so to speak for about two years. I have to remind myself that this was.

decades I mean since I was a little girl. of thinking one way about my body and. about food and so lots of progress has. been made but there's still times where. I look at I'm folding laundry and I look. at a pair of pants and I'm like whose. pants are these there's no way these are. these these still fit your these fit. your body um but I'm coming to terms. with it I challenge myself I take. pictures of myself now um I had no. pictures of myself with my children from. when they were little I take pictures. that kind of thing. challenges some of that thinking but I.

think it's going to still take more time. yeah uh yeah on another conversation Dr. Anya and I were talking to a woman who. said she's kept herself out of every. picture yeah in her. entire life with her family wearing dark. colors weing dark colors or standing. behind other people or standing to the. side or trying to avoid the picture. we're glad you're putting yourself in. the picture now thank you so much thanks. Amy good to see you again you too keep. up the great work you're doing where do.

we find you online what is your uh on. Tic Tac and Instagram it's Amy in half. okay great great keep it up thank you. thank you next Amina is a mom of two. young children zooming in from Lee. Summit Missouri hi Amina how are you hi. ala how are you thanks so much for. having me today well thank you I heard. that the ABC special that we did um the. same one that Amy was on inspired Ed you. to make a change in your life so tell us.

what happened you were watching the. special and you saw Amy you heard her. story yes I I was watching the special. and you know I had actually quietly. started the medication uh in January of. that year earlier that year but I you. know I just didn't want to share it with. anyone but hearing the personal stories. that were shared about how you know gp1s. were really helping people take control. of their health and really just you know. changing their relationship with food it.

really motivated me to really give it a. really true shot and and hopefully you. know it would work out for me too I had. great hope wow and so do you have a. question for us today or do you want to. share something yeah yes so um you know. as someone who has struggled with weight. for most of my life um and emotional. eating as well you know food was always. an escape for me um just from deep. emotional pain from anxiety you know and. the journey for to my health didn't.

really start until after the birth of my. two children and in between that um two. miscarriages as well and so you know. experiencing that level of physical and. emotional trauma was something I was. unprepared for and I knew that I needed. to take control of my health and make a. change and you know I started the. traditional way as well Oprah in terms. of diet and exercise and all of those. things but I found after the birth of my. son uh the weight just wouldn't drop and. my health markers were not improving and.

so gp1s gave me you know a second chance. to really take control of my health and. start again and so I started in January. of this year and have lost 50 pounds. which uh it's been incredible you know. just my energy everything that I have. and the food noise stopped right the. food noise and the food noise stopped. the constant cravings for sugar and. carbs and always thinking about the next. meal all of that one away and it's. something I've I've never experienced.

before it's been incredible what's your. question what's your question today uh. so um I'm wondering if it's if I will. still need to stay on this medication. for the rest of my life or is this. something I could taper off of yeah I. mean I think that's a great question. it's probably one of the top questions. if not the most uh commonly asked. questions that my patients come to me. with right now you know what we do know. is that obes is a chronic disease it's a. chronic disease so let's say that you.

had high blood pressure and you started. taking a blood pressure medicine what. would happen if you were to stop taking. that blood pressure medicine your blood. pressure would go back up same thing. with diabetes if you were taking insulin. if you stopped taking the insulin your. blood sugars would go back up and what. we're seeing in in not just in clinic. but also in Trials um we just conducted. a trial it was 3 years uh with one one. of the medications is that the weight.

was completely maintained while people. were taking the medicine and then when. the medicine was stopped people started. gaining back the weight now what I can. say is we see the same thing in clinic. um so that is the case with most of my. patients what I usually do when patients. say well I really like to see what. happens when I stop is I decrease the. dose I go down on the dose by just a. little bit by one step and then I say. come back and see me in 2 three months. and they come back and see me and we see. how they're doing if they're maintaining.

their weight and the food noise isn't. back and they're not struggling then. great we stay on that dose but if their. weight is starting to Trend up or if. that food noise is coming back and. they're having a really hard time um. then we go back up on the dose and I do. think that just as there's differences. in how much weight people lose we will. see differences in terms of how much. people gain back so we'll see. variability in that weight regain but. right now for Mo most patients on.

average what we see and in the studies. we've seen this as well most people yes. you have to continue taking the medicine. because it's targeting your biology it's. targeting your your obesity biology I. think it's such a crucial thing and I. actually this I've heard you say this. before but this is I just had an aha. moment and my aha is we think because. you've lost the weight you've solved the. problem because in the past. every time you went on a diet once you.

lost the weight you thought now this is. it I've done it I've succeeded and we. think and I'm sure you're you're feeling. the I'm saying we assuming that you feel. the same way that I've to wait now the. problem is solved but the problem isn't. solved because the disease hasn't gone. away that's right just because you lost. the weight that's right the disease is. still there so it's just like in. alcoholism I just had this now it's.

absolutely it's like in. alcoholism uh you cannot go back to. drinking because your brain we just just. just because you've gotten sober that's. right doesn't mean you can now have a. drink we can't go back otherwise you. gain the weight that's right that's. absolutely right and that is why when we. these. medicines I just had that aha it's a. beautiful aha it's it's and it's such an. important one because again these are. not the AA too did you get it Amina.

absolutely absolutely and this is why. this is actually critical when we think. about the words we use these are not. weight loss drugs they are medicines. that treat obesity they treat the. disease processes in the brain that's. another way to look at it cuz if you. look at it as a weight loss drug now. you've lost the weight so now I'm. finished but the disease doesn't go away. and that is why I think so many patients. ask us that for that exact reason.

they're like well I lost the weight. aren't I am I I'm cured I'm cured but. it's the same way with diabetes. hypertension just because your blood. pressure decreases or your blood sugars. decrease doesn't mean you no longer have. high blood pressure yes that's right. that's absolutely right oh my god oh. good I'm so glad we had an aha this is. so important well that's that's also the. reason why I meina asked that question. and everybody I've had that question. everybody has that question do I have to. stay on it cuz now I've lost the weight. the weight disease is not gone isn't the. issue that's right you think the weight. the weight is the symptom of the it is.

the symptom just like the blood the high. blood sugars are the symptom of diabetes. and the high blood pressure is high. blood pressure is it is hypertension so. the the the analogy is perfect with. diabetes especially especially thank you. for asking that and causing me to have. multiple ahas here today thank you Amina. thank you thank you so much yeah thanks. Amina let's talk about all the different. you know every every it seems like every. couple weeks or so there is another.

disclosure about what these obesity. medications have revealed in terms of. helping people drink less alcohol and uh. not not obviously lowering blood sugar. but what are all the other health. benefits that we are discovering yeah I. mean there are studies coming about out. about heart disease about heart failure. about improving knee pain obstructive. sleep apnea and all of these are obesity. related diseases I even heard.

Alzheimer's well and that is also being. looked at what are the effects in the. brain in terms of again improving that. and we'll have to see that those studies. haven't yet been um you know been. conducted out out as far as these other. ones so the heart disease the the what. is it about it that makes you not want. to drink as much alcohol I mean I used. to be the tequila Queen and now it's. like take it or leave it yeah so so that. those studies are being done we think. that again it's similar Pathways in the. brain that are being targeted so just as.

your craving or your hunger may come. down as you're taking these medications. in the same way you're craving for other. things other things that may be. pleasurable goes down now that doesn't. mean that makes you unhappy you can just. take it or leave it Emma is a dental. hygienist and a mother of two zooming in. from Winder is it Winder W Georgia hi. Emma hi OA thank you so much for. allowing me to be a part of the. conversation I have been on Zep Bound.

for the past 10 months and I'm down 66. pounds wow yeah physically I feel. absolutely amazing um but what this. medication has done for me mentally and. given me self-confidence giving me. self-worth and giving me the ability to. love myself. again um you know in the past I have. tried exercise I have tried diets uh I. constant recently had fatigue. inflammation and I just didn't feel good.

after having my first daughter uh those. things continued and I went to multiple. doctors seeking answers because I just. didn't feel good and each time I would. leave and I really didn't feel like I. had an answer um this past December I. went for my regular doctor's appointment. and sat down with a nurse practitioner. and told her all of these things and she. said you know Emma I think if we can get. some of this weight off of you you would. start to feel better and like you said.

it was an aha moment for me because I. feel like it was the answer to so many. prayers that I had had that I was not. crazy and that I really did have. something wrong and she listened and so. you know from the outside I had. everything going for me I had a. beautiful family two healthy children a. dream job that I loved but I was. drowning on the inside because I didn't. love myself and so within one week of.

taking this medicine I could see that. the inflammation was going away I. started feeling better I started having. more energy and I knew I needed to share. my story because I knew that there were. other people that had the same symptoms. and so I started showing up every single. day for the past 10 months on social. media just sharing my story and hopes. that I could help to encourage and. Inspire somebody else that may have been. having those same symptoms all right. y'all it's my I'm on a journey for a.

healthier happier me thanks to Zep bound. and I have hit an all time PL today on. the scale so that's something to. celebrate and so when you got I'm sure. you got push back or people saying. negative things on social media how have. you managed that for. yourself you know I that at first that. bothered me but along this journey. gaining that self-confidence gaining. that self-worth and realizing that it. doesn't matter what the other people. think because this is for me and I'm.

doing this for me and I feel better so. then I can have a longer life so my. children can love their mother and you. know I've dropped the opinions of what. other people think because this is for. me and for my help because we only have. one life to live absolutely what what. what do you want to ask Dr Anna here. today what I would love to ask is that. you know with you saying that this might. be a medicine that we have to be on long. term and if that's what I have to do. totally fine with that because if I had. diabetes I would take the medicine to.

survive do we know what the long-term. effects would be from taking these. medications so that's a great question. and another very common question that we. we get from our patients um and first. you know I'll start off by saying that. as you've identified there are risks to. having obesity in a of itself right um. and when we treat patients for any. disease we say okay what are the. benefits of treatment what are the risks. of treatment what are the the the. benefits of not treating or treating.

right we we really look at all that very. very carefully um and right now all the. data is pointing to the fact that these. are very beneficial but that doesn't. mean that we don't have to do our due. diligence be very careful and monitor. everything long term because millions of. people are taking these medicines and. millions more will take them having said. that glp1 receptor Agonist have been. used for the treatment of diabetes for. 20 years now. all of these medications also for we're.

just now hearing about it but some. people have been using them we have been. using them for 20 years yes the first. one was FDA approved in 2005 so it was. nearly 20 years ago that these. medications were were first um FDA I. know 20 years so the earlier ones were a. little bit different um than the newer. ones and they were shorter acting and. they had to be taken more more you know. daily rather than weekly so there are. differences there but the the point is. is that we do have data all the trials.

that's why that's why we do all the. trials that's why I do all the trials. right to make sure that the FDA has the. information that it needs not only to. know that these medicines are effective. but to know that they are safe and well. tolerated and if there's a signal that. they're not then the FDA says no we're. not moving forward um so what we have to. do is keep on doing the studies we need. to gather real world data what health. impacts are these these medicines having. on those diseases I know the question.

that Amina asked before about whether. you have to be on the medication forever. uh did you hear the answer when I had my. big aha moment there Emma yeah yeah yeah. yeah that it's it's. like I I've always thought that you. solve the problem once you lose the. weight but then when you regain the. weight again it's like the problem came. back but when you have the hormone that. allows for the Obesity to be prevalent. in your life then it's never going to go.

away it's never going to go away it's. like once you have diabetes you always. have diabetes it can be treated or. controlled diabetes same thing with. obesity once you have obesity you always. have obesity is it treated and. controlled that's the question and so. when we're when we've lost the weight or. in the process of losing the weight. that's when you're controlling it you're. controlling it but it doesn't mean the. problem is solved that's right that's. right and and the important thing which. is another way to look at it isn't that.

a aha moment yeah it's such an aha. moment and you know what if I have to. take these forever I'm okay with that. because you know what it's fighting the. disease of obesity and I'm getting my. life back and I get to live so getting. your life back and I'm I'm wondering. whether or not once you reach the set. point once Emma gets to the go gets to. her goal are you a goal weight yet not. quite yet I'd like to do about 30 more. pounds but it's kind of like what she. would saying I feel like I've kind of. hit that Plateau um I still have the.

effects of no food noise and but I feel. like my weight is not maybe going down. as much I do feel the inches may be. changing but I'm just sticking the. course sticking with the process because. I know it's working because I can I can. feel it yeah it's just I'm not losing it. as fast as I was and that's the way it. works for everybody right and it takes. time so the more highly effective a. medication is it we're we're seeing it. may take longer to see the effects. that's why the trials are getting longer. MH will you reach a point where when.

you've reached the goal weight that you. may be able to lower the dosage to. maintain and and that is the question. you know that we were starting to answer. and the last thing is for some patients. maybe but right now we don't know how to. determine that a you know ahead of time. a priority so basically that's why when. patients if they ask me to go off or. they some patients asked to go down on. the dose we try that but then bring them. in quickly because the hard part is if. you start gaining back weight that is so.

you know people think again it's my. fault and it's not their fault it's not. their fault if you de biology it's. biology if you decrease your um blood. pressure medicine what's going to happen. your. blood same thing with your blood sugars. for diabetes it's no different with. obesity isn't that just powerful to know. for. yourself totally and it is not my fault. not your fault yeah it it it it it helps. getting your life back feel like.

Redemption doesn't it completely and you. know I'm glad I'm I'm 37 I wish I would. have found it sooner oh girl please you. have got so much life left in you so. that's so wonderful that you you've. discovered it now at the right time for. you thank you so much Emma thank you. thank you so much I love the beautiful. photograph of you and your daughters. that's gorgeous babies babies thank you. Dr Ana so can you set the record. straight on side effects because I've. heard everything from vomiting to.

throwing up to. diarrhea yeah that's a great question. and and side effects do occur right with. any medicine for any disease is there. any medicine for any disease that. doesn't have side effects and and also. heard hair loss is is is hair loss from. these medications a real thing well it. depends how much weight someone loses. and how quickly because losing weight is. a stress it's a stress on our body right. so we've actually seen the hair loss. with things like bariatric surgery and.

now with people who lose a a large. amount of weight in a short period of. time we're also seeing those types of. effects that we saw with bariatric. surgery but let's focus in on the most. common side effects as you were asking. about so the most common side effects. are gastrointestinal so they are um. things like feeling nauseated um having. um diarrhea constipation and for some. people vomiting but there are ways that. we can really um combat those side. effects and again they don't happen in. everybody so number one what Physicians.

or providers can do is invite their. patients to share the side effects with. their provider and make sure that the. provider says look I'm not going to stop. the medicine let's work through these. together the main thing that a. healthcare provider can do when they're. prescribing these medications to help. avoid or mitigate those side effects is. start low and go slow always start with. the lowest dose and then you do not have. to go up once a month you do not have to.

go up once a month you go up as is right. for that patient so if a patient is. having nausea I do not go up on the dose. I let them stay on the dose let their. body get used to the medicine yeah if. somebody if you if you go to someone and. they immediately put you on a a high. dose you're going to the wrong healthc. care provider because that should not. happen absolutely absolutely then you. know look around see if there's another. healthare provider um that somebody who. really knows how to how to treat obesity. and understands that it's a disease that.

this is not about weight loss this is. about weight reduction and optimizing. health and knows to pair them with the. diet the correct nutrition the exercise. someone who really knows okay so uh for. most people this is this is a medication. to treat OB obesity and to understand. that once you lose the weight it doesn't. mean that the problem is solved that's. correct that is that's the big aha for. me today and that that's a very good aha.

to have and take away thank you Dr Ana. it's always a joy to talk to you thank. you so much for being here we value your. expertise on this topic it must feel. rewarding for you that this moment has. finally come and that these medications. are being made available to so many. people because you get to see it in your. own patients yeah absolutely I I mean I. always say people ask me well how did. you know that you wanted to do that. the first time that I helped a patient. lose uh a meaningful amount of weight.

for that person I was like I'm never. doing anything ever again this is it and. I'm so grateful that I get to do this. and I'm so grateful that patients trust. me they trust me to care for them and I. again I I couldn't imagine I couldn't. imagine doing well well I I can see how. rewarding it is because you have people. saying I got my life back yeah I got my. life back absolutely and and again it's. you know there's there's good and bad.

things about everything everything in. life these medicines are right now what. we're seeing they're helping people. transform their lives in so many ways in. terms of their health in terms of their. overall life they're just really. incredible in terms of helping people. well I want to thank you uh Amy thank. you Amina thank you Emma thank you for. all of our guests sharing your stories. go well everybody thank you for making. time to be with me today I really hope. that you join me for part two of this. conversation as we continue to see how.

these new medications result in dramatic. loss of weight almost the equivalent of. an entire person you've lost 165 lb wow. congratulations so what happens in the. aftermath of that the doctor said to me. um when are you going to stop blaming. yourself and let somebody help you when. you lose up to 100 lb or more do people. treat you differently everyone was so. much friendlier to me how does that. impact how you see yourself in the world.

and even within your own family to be. honest I feel like she kind of takes it. for granted a little bit like she. forgets where she's come from that's my. next conversation with Dr Ana and new. guests who have a lot to say about their. experiences so we'll talk to you then. and thank you so much for being here you. can subscribe to the over podcast on. YouTube and follow us on Spotify Apple. podcast or wherever you listen I'll see. you next next week thanks everybody.