Welcome to Health Matters. Your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Faith Salie.
You probably have heard the buzz about obesity medications like Ozempic and WeGovy, but how do they work? Are they truly game changers? This week, joining us are Jamie Leskowitz, a registered dietician, and Dr. Judith Korner, an Endocrinologist at NewYork-Presbyterian and Columbia.
Jamie and Dr. Korner explain how these medications help people lose weight, the health benefits they bring, and the side effects to be aware of.
Faith: Jamie Leskowitz and Dr. Judith Korner, hello. Thank you so much for joining me.
Jamie Leskowitz: Thank you for having us.
Dr. Korner: Yes, thank you, our pleasure.
Faith: Dr. Korner, what are some medications used to help with weight loss? I’m sure through your decades as a doctor, you’ve seen different medications come and go. And we’re at this time where everybody’s talking about the same ones.
Dr. Korner: There have been medications to help with weight loss since the 1950s. But the problem in the past is: some of these medications weren’t really that effective or caused side effects. The big new kid on the block are what is called a GLP 1 receptor agonist like the Ozempic and the WeGovy and the Saxenda that everyone is talking about. It really takes advantage of GLP 1 which is a hormone that we all make. GLP 1 is made in our intestine so that when food gets down into our gut we make GLP 1, which then goes to the brain and tells the brain there’s food in your gut, now you should feel full and stop eating. Because if you think about it, there has to be a signal to stop eating. Otherwise, you would eat and eat and eat until the food just came out of your mouth. When you take this medication, you already have GLP 1 on board so that as you start eating, instead of having to wait for the signal from your own gut, you’re already getting this signal to start feeling full.
Faith: So these medications are synthetic versions of GLP 1, which is the hormone that tells us, You’re full. Stop eating.
Dr. Korner: Exactly. And that’s one of the reasons why most of the formulations need to be injected. Because if you take it by mouth the stomach acids and other enzymes will sort of degrade and destroy it. Although there are some formulations now that are being made so that you can take it as a pill form without the GLP 1 getting destroyed.
Faith: Jamie, this seems like something everybody is talking about. So, as a registered dietitian, are you having more and more people come to you asking “what do you think of these medications?”
Jamie Leskowitz: Many people are trying to lose weight, so when we hear there’s, you know, a medication that can help us do that, it’s pretty tempting. But I think there’s still a lot of education that people need and we need to understand more who is an appropriate candidate for these medications. It’s still about diet and lifestyle which are needed for anybody on a medication or not. And these medications are incredibly helpful tools to help us listen to our bodies and our hunger and fullness cues more easily.
Faith: So, Dr. Korner, what you’ve described is the way that these medicines work to signal to our brain that we’re satiated.
Dr. Korner: Mmhmm.
Faith: Jamie, can you talk about what that means for what folks like to call “food chatter?”
Jamie Leskowitz: It’s so interesting working with people and hearing what hunger feels like or fullness feels like and hearing about how some people are just thinking about food all day long. And I tell everyone, we all have different genetics, gut hormones, metabolisms. Some people feel like they’re living to eat. And some people feel like they’re eating to live. I go over things like a hunger and a fullness scale with patients so we can really think more about “what does it feel like to be hungry, you know, on a scale from one to 10?” I talk a lot about becoming more aware of what we really are feeling, right? Is it physical hunger that we’re feeling? Is there something else that’s going on? Whether it’s a habit that we formed or something is cueing us to want to eat. Or some sort of emotion is making us want to turn to food. Some of us have more food noise than others, but really trying to explore some of those feelings a bit and understanding more about ourselves and our eating behaviors and our thoughts can be a helpful first step.
Faith: It sounds like these medications, then, sort of help people leapfrog over training themselves to be mindful of their hunger or fullness and they do it for you. “Hey, you’re full.”
Jamie Leskowitz: For sure. I know I’ve had patients say to me, “Wow, being on this medication is so validating. I finally feel like I can eat like a normal person.”
Faith: What health benefits do people get from taking these weight loss medications?
Dr. Korner: Well, excess weight produces a myriad of health conditions. It adversely affects how our organs function. So if you have excess weight, the fat has to go someplace. It goes into organs where it doesn’t belong—it goes into the liver, it goes around the pancreas, it goes into the muscles, it goes around the heart and that causes these organs, vital for our health, to malfunction. It causes inflammation and fat’s not just a depot, but it actively makes inflammation markers. So those are the things that will make us prone to coronary artery disease. So with these medications and losing weight, you know, we’re losing the fat that is causing our body to malfunction. And one of the real exciting things lately are studies that show it’s not just weight that’s lost, but there seems to be a protection against cardiovascular disease.
Dr. Korner: So there’s probably improvement in fatty liver. And there’s improvement in diabetes. In addition to that, it’s also a lifestyle component. People have trouble getting around. They have trouble navigating stairs, running after their grandkids, which causes joint pain. And that can cause a cycle of weight gain. If you’re in pain, you can’t do the type of exercise that you were used to doing. There are just so many benefits. I could go on forever.
Faith: Jamie, do you find that patients who go on these medications are more inclined to start or continue to have a healthy exercise regimen and eat more healthfully?
Jamie Leskowitz: I do. I wouldn’t say it’s that happens to everybody, but I think when anybody sees a little bit of weight loss on the scale or they feel like their clothes are fitting a little bit more loosely, you know, it feels easier to listen to your body. Once you start eating a little bit more healthfully, it feels good and maybe they’re getting better nutrients.
Faith: So why aren’t we all taking this? Who benefits most from this? And who does not need to take this? Because I hear this and I’m like, sign everybody up!
Dr. Korner: Right. There are certain guidelines and that’s based on body mass index, which is basically a person’s weight that’s adjusted for their height. And if you have a body mass index 30 or above and you have tried non medical ways to lose weight and haven’t really gotten to where you would like to be, then we consider adding on the medication. As you increase your body mass index, you’re at risk for all of these weight related health problems. Now we’re always hearing about Hollywood and Ozempic and who’s on it and who’s not on it.
Faith: We sure are.
Dr. Korner: And yeah, you know, “Oh, she fit into that dress, like she must be taking Ozempic.” Well, those are a small number of people and it’s our experience, if anything, people don’t want to take medications in general.The people we see who are wanting these medications are those individuals who have been trying to lose weight most of their life and they need help just like they need help to control cholesterol or high blood pressure. We really do discourage using medication for, “okay, my, my son’s getting married. I need to lose five pounds to get into the dress.” And we do have people requesting that, but we try not to because I mean, after all this is a medication.
Faith: Do prescriptions for these medications differ from person to person, or is it generally the same treatment for each patient who qualifies?
Dr. Korner: So Ozempic, for example, that’s really a diabetes medication. It originally came out to treat diabetes because one of the other things that GLP 1 does is it talks to the pancreas and it tells the pancreas to make insulin when glucose levels are high, so it controls diabetes. But because GLP1 also goes to the brain and controls appetite, people lose weight. So the original prescription for Ozempic, was reformulated, the generic of it is “semaglutide.” To look at what it does just for weight for people who don’t have diabetes and it causes weight loss and then it was given the name WeGovy. So we now have basically two identical medications, but they come in different pens and different doses. And then the newest kid on the block, Mounjaro or Terzapatide. That’s a dual medication. It has GLP 1 and then another hormone in it, GIP. So currently, that is just approved for diabetes. But it also produces weight loss. It is currently being looked at by the FDA just for weight loss. And then it will probably be given some other new name. So, the diabetes and the weight loss indications kind of overlap and it really depends which we prescribe based on a person’s conditions, what their insurance will cover but the insurance doesn’t always cover it, even if a person meets the criteria.
Faith: So, what are the potential side effects of these drugs?
Dr. Korner: When you get this medication, you’ll see this big black box warning. And when you hear this advertised, if you have a history of medullary thyroid carcinoma, or multiple endocrine neoplasia, this medication isn’t for you. Those are very rare conditions. The main issues with them are gastrointestinal side effects. Which can be either nothing, or they can be horrible. Usually it’s somewhere in between because they work in the gastrointestinal tract to sort of slow things down, but they also work in nausea centers in the brain, so people can experience nausea occasionally to the point of vomiting. Some people may get diarrhea. Some people may get constipation. And those are the major side effects. You asked earlier about, does everyone get the same treatment? Well, sometimes we really have to play around with the dosing of the medication. So, with these medications, we start at very low doses and over a certain period of time, we kind of increase the dose as the body gets used to it. But for people who are very sensitive to the side effects, we may titrate up slower or we just may not even go to the maximum dose. So sometimes there’s a bit of hand holding between us and the patients as we navigate through what the benefits are and how much discomfort they may be willing to go through.
Jamie Leskowitz: Yeah, everyone is different. I’ve seen patients that don’t experience any side effects and I’ve seen patients of Dr. Korner’s who need to go off the medication or, you know, lower the dose because the side effects are too much for them to handle. And then I obviously work closely with them to help find a diet that works best for them, and we obviously make sure they stay hydrated. Which foods are they able to tolerate? Maybe somebody is having smaller, more frequent meals, especially in the beginning, if they just can’t tolerate that volume that they previously tolerated.
Faith: Jamie, are there any food or beverages that should be avoided when someone’s on this medication?
Jamie Leskowitz: I don’t think there’s one food that I would say to avoid just because you’re on one of the medications. We should still focus on good nutrition, meaning following an overall healthy eating lifestyle where we are allowed to indulge and we could see, Hey, how do I feel after I eat a piece of chocolate cake? And if I just didn’t feel great after it, maybe that just doesn’t sit well with me, or maybe I need a smaller portion. So I think there’s a lot of trial and error and working to find that eating lifestyle that just feels best for you and feels most sustainable is key.
Dr. Korner: One of the interesting things that’s been found and sort of a bit unexpected is some people report a decrease in cravings. I thought about that, Jamie, when you mentioned chocolate cake. It seems to also work on parts of the brain that’s evolved in sort of reward addiction type centers. So people just say, well, yeah, I don’t crave sweets as much. Even I’ve had a few patients report alcohol. It’s not that they necessarily had like an alcohol abuse disorder, but they just find, “I don’t really feel like drinking as much as I used to,” which for us is a good thing because alcohol is calories.
Faith: Jamie, what role does exercise play when taking these medications?
Jamie Leskowitz: So exercise becomes a more important piece of the equation when we’ve lost weight and we’re trying to now maintain the weight loss. Whether you’re on a medication or not, I always talk about physical activity with patients because it’s important for overall health and disease prevention.
Faith: Yeah, it sounds like while this is a game changer, it also shouldn’t be seen as a magic pill where you take it or rather inject it, right? And then don’t think about what you’re putting in your body or how you’re moving your body. That’s not the message.
Jamie Leskowitz: For sure. We do want to remind patients of the importance of consuming a healthful, balanced diet and continuing with activity to maintain the weight loss and just optimize overall health.
Faith: Jamie and Dr. Korner, thank you so much for the clarity on this topic that everybody is talking about and everyone is curious about.
Dr. Korner: Thank you for having us.
Jamie Leskowitz: Thank you so much. This has been a lot of fun.
Faith: Our many thanks to Jamie Leskowitz and Dr. Judith Korner.
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