Weight Loss Medications: Exploring Ozempic, Wegovy, Zepbound, and More

 In this episode of Your Checkup, we dive into the world of weight loss medications, with a special focus on the popular GLP-1 drugs like Ozempic, Wegovy, and Zepbound. We’ll explain how these medications work, the potential challenges they present, and their role in the broader treatment of obesity. Whether you're curious about the science behind these treatments or wondering if they're right for you, we cover everything you need to know, including why they can be tricky to use. Tune in to get the full picture on how medications fit into a comprehensive weight loss strategy. 

Takeaways

The podcast aims to bring medicine closer to patients.
Weight loss medications are a hot topic in healthcare.
GLP medications are now first-line treatments for obesity.
These medications were initially developed for diabetes treatment.
Nausea is a common side effect of GLP medications.
Lifestyle changes are crucial for sustainable weight loss.
Patients should follow up regularly when on weight loss medications.
Not all patients will respond to weight loss medications.
The effectiveness of GLP medications can vary among individuals.

Keywords

patient education, weight loss, obesity medicine, GLP medications, health podcast, family medicine, lifestyle changes, medication side effects, diabetes treatment, health awareness

Transcript

Ed Delesky, MD (00:00)
Hey, welcome back to your checkup. We are the patient education podcast where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky, a family medicine resident in the Philadelphia area.

We are so excited that you were able to be here again with us today. So we're still doing the recovery thing with our intern.

Nicole Aruffo, RN (00:25)
Yeah, I wonder if the mics picked up his wine in the background.

Ed Delesky, MD (00:30)
know if

they did. These are pretty good mics. So he remains extremely energetic and he's doing really great, but we're really trying to limit his activity as the prescribed recovery, which is very long.

Nicole Aruffo, RN (00:42)
very long eight weeks.

Ed Delesky, MD (00:46)
Yeah. And he hears that we're recording and he's not necessarily a part of this right now.

Nicole Aruffo, RN (00:50)
He's on FMLA, so he's not allowed to work, and he keeps trying to come to work.

Ed Delesky, MD (00:55)
He's still got that dog in him. He really wants to.

Nicole Aruffo, RN (00:59)
I don't know why now he's talking. He was like in there most of the day and was fine.

Ed Delesky, MD (01:04)
And what we did move the, where his crate was to sit where we usually sit, but now we happen to be sitting over here where we usually do the.

Nicole Aruffo, RN (01:10)
He should love it though. Like the kid is living in the lap of luxury. He has a luxury apartment. He has this huge crate. A new memory foam mattress.

Ed Delesky, MD (01:19)
He gets a new toy to keep him occupied every other day.

Nicole Aruffo, RN (01:22)
Yeah, the delivery guy brings a new toy, a new, what do they call them? Like there's like a word that they call them. Now I sound dumb, like stimulating dog toys are like to make them like he has like his sniff pads and his lick mats and all that stuff to like make him burn energy while he's in his little apartment. And he has a nice cozy blanket over it. So it's like a little den. It's quite nice.

Ed Delesky, MD (01:51)
It is. I think he'll settle in. think just as we got started here, he really wanted to be a part of the episode and he is just from 15 feet away. Yeah. All right. And what do you what are you drinking over there?

Nicole Aruffo, RN (01:52)
He should be complaining.

I have a cream soda ollie pop.

Ed Delesky, MD (02:09)
Seems

like we've almost defected from Poppy, oops.

Nicole Aruffo, RN (02:12)
I know. Oh my gosh, I have to tell you something. I wasn't going to tell you, but I think you're going to notice because I put it on the company card and I went to Acme because, okay, well I went to Whole Foods to get our sweet treat for tonight because we really like these like brown butter cookie dough things that they sell and then we just make the cookies at home and they were out and then I was going to get poppies, but the poppies were, are the...

Ed Delesky, MD (02:21)
Yeah?

Nicole Aruffo, RN (02:39)
line, not the poppies. The line for Whole Foods was like around the whole store. So then I just went across the street to ACME, grabbed my two poppies and then I was paying and the total was like four something or whatever, five something. And then I went to pay and I tapped my thing. But apparently I hit a number on the like, would you like to make a donation? So I paid $10 for two Ollypops on the company card.

Ed Delesky, MD (03:05)
you

What do we make a donation?

Nicole Aruffo, RN (03:12)
I don't even know what we made a donation to.

Ed Delesky, MD (03:15)
Probably ending hunger. That's usually the one that comes up at ACME. It's a noble cause. Maybe we can do it as a tax write-off.

Nicole Aruffo, RN (03:18)
yeah.

Yeah, I was thinking that of how I was going to explain this when in like a week from now you were looking at our credit card statement. You're like, when did you randomly spend $10 on a

Ed Delesky, MD (03:33)
Okay,

no, do not make this seem like I am the arbiter of the credit card. that's great. See, he's calming down. I mean, in the last two minutes, he's moaned once and now he's occupied. So this is great. Well, I'm going enjoy the heck out of this $6 alley pop. You should.

Nicole Aruffo, RN (03:38)
He's drinking his crate water.

Maybe like five something. Yeah, it's a tax right? Well, it is because now like we're drinking them all. We're recording the podcast.

Ed Delesky, MD (03:54)
five and change. Yeah, we'll make it.

Well, we don't have like. Well, speaking of that, it's reminding me that we should shout out one of our loyal listeners who's very active on our fan mail. Your brother.

Nicole Aruffo, RN (04:03)
No money for it.

He is, I know he was hanging out with our cousin Chris on Friday, like he does every Friday night and every once in a while they like randomly call me late on a Friday. they called us on Friday night and then they got talking about the podcast and my cousin Chris might have the attention span of a goldfish. So he said that he doesn't like to listen to things like podcast and things like that. And then my brother was like, well I listen every week.

And then like I told him something about Ollie and he's like, yeah, well, the only reason I know that is because I listened to your podcast.

Ed Delesky, MD (04:50)
And you know, we're bringing up your brother because he always leaves such vivid detailed fan mail. He does. He's actually the most active person on fan mail with the only reason generally for the public who listens, please send us fan mail. We can't tell who it is, but we just happen to know the last four of his phone number and where he lives. And he's very proactive.

Nicole Aruffo, RN (05:12)
That he is. He has left us some requests.

Ed Delesky, MD (05:17)
I can see Hasliff does a couple of requests.

Nicole Aruffo, RN (05:19)
And when we were at Nona's making or for her birthday, they talked about a couple of requests.

Ed Delesky, MD (05:26)
that's so true. Yep.

Nicole Aruffo, RN (05:28)
which we've not fulfilled yet.

Ed Delesky, MD (05:30)
We haven't fulfilled yet because today we're going to be wrapping up our recent run here that we've had on this like obesity medicine type series. But before we get diving in there, what's that?

Nicole Aruffo, RN (05:42)
You know what else

I was thinking? So we were at, last night we were at Eddie's sister's future in law's house for the both sides of the families to meet. And so we were, all of us were meeting like each side for the first time. So we were like talking with all of Brett's family and getting to know everyone. Do you know, we didn't mention the podcast one time.

Ed Delesky, MD (05:53)
great way to describe it.

No, not one time.

Nicole Aruffo, RN (06:11)
Which I guess like maybe that's fine. We had other things to talk about. And then like you you start with the bare minimum like what do you do for work? You live.

Ed Delesky, MD (06:14)
We had plenty of

Right.

I think it's pretty cool thing that we're up to and like, don't want to be like, Hey, my name's Eddie. I do a podcast. But we should be proud of it.

Nicole Aruffo, RN (06:28)
We should have brought a flyer and put it in Amanda and Marty's mailbox.

Ed Delesky, MD (06:31)
That we should have brought our flyers. We should bring our flyers everywhere we go. I guess I wanted to address one piece of fan mail that we also got when one of our loyal listeners mentioned that what happens in our last episode, we talked about calorie breakdowns of meals and that you can eat more calories earlier in the day. And maybe it would have more of a benefit to weight loss, something like 700 calories for breakfast, 500 calories for lunch, and 200 for dinner.

And we got a piece of fan mail that says, well, what do you do if you eat 200 calories while you're making dinner? I don't have a great answer.

Nicole Aruffo, RN (07:10)
You do this a lot. Like easily consume 200 calories like while I'm making dinner or something.

Ed Delesky, MD (07:11)
Do what?

Yeah.

Well, like we said, long, like many times over and over again, is that any diet or eating plan has to be sustainable. And so if you're not going to commit to 200 calories at dinner, that's not the thing for you. Yeah. So that's what we'll say about that.

Well, this was a nice warm up. How do you feel about getting started?

Nicole Aruffo, RN (07:40)
Wait, did we talk about my boom arm?

Ed Delesky, MD (07:42)
my God, again!

Nicole Aruffo, RN (07:44)
We're recording the first episode with my new boom arm.

Ed Delesky, MD (07:47)
They're coming

to you nearly live with the first episode where Nicole has a boom arm. Her neck is better. She's sitting. What's that? Where Nikki has a boom arm and she's sitting, her back is on the chair. She's able to relax her blank.

Nicole Aruffo, RN (07:57)
You caught me Nicole.

Posture is erect.

Ed Delesky, MD (08:06)
Posture is perfect. And this is great. We finally got the boom arm. It's in tow. That's why we're so excited to do this today. Wow. How do you feel about it?

Nicole Aruffo, RN (08:19)
No, it's nice. It feels good. I see why people do this. I could sit here all day and talk. We can record four episodes tonight. There we go.

Ed Delesky, MD (08:26)
Go.

I love that energy. But while we're talking about recording an episode, why don't we give the people what they came here for? yes. Yeah. Which I'm not sure. Maybe they like our banter in the beginning. some people might think that they, sorry, you can't see us, but we got a little sigh because our intern really wants to contribute.

Nicole Aruffo, RN (08:46)
Didn't that sound just like.

Ed Delesky, MD (08:49)
He'll be okay.

really did sound just like him. All right. Let's start hacking away. So what are we talking about today? Nick?

Nicole Aruffo, RN (08:58)
Today we're talking about weight loss medications.

Ed Delesky, MD (09:03)
are.

And some other ways. Topic. Yeah, it's a very hot topic. You can think of them as treatments for obesity, if you will. We've done this long run of episodes, six or seven now, probably the most comprehensive coverage we've done of any topic so far. And we'll consider this the last episode for a little while on this topic, just so it doesn't get stale. weight loss medicines are in the zeitgeist. They're everywhere.

And I guess we should probably think about getting started.

Nicole Aruffo, RN (09:37)
Let's do it.

Ed Delesky, MD (09:39)
So all the while we've been talking about on our several other episodes are managing obesity and maintaining a healthy weight using a combination of diet, exercise, and other lifestyle changes. whenever we think about using medicines, they really should come with the mindset that you were also doing those things.

Nicole Aruffo, RN (10:00)
where she was.

Ed Delesky, MD (10:01)
So I guess a couple of high points before we really get into the nitty gritty about some of these medicines is that a lot of them can be expensive. They can be tricky to get. Long-term safety data are emerging. They've been out for a while, longer than people think, but we're still learning things about them. And oftentimes, supply is an issue. So I just wanted to put those couple things out as a almost caution to the wind tale. But as we dive in here.

Nick, why don't you tell us what the clinical scenario is for a person who may qualify for a medicine for obesity.

Nicole Aruffo, RN (10:42)
So these medicines are recommended for people who have not been able to lose weight with just traditional diet and exercise and have a BMI of 30 or higher. Or if you have other medical problems and your BMI is about 27 to 30. Yeah.

Ed Delesky, MD (11:03)
So it's something that you can consider talking to your own doctor about. So I guess one thing we've talked about is that BMI may not be the perfect way to capture someone's fat percentage in their body.

Nicole Aruffo, RN (11:14)
But that's what's used.

Ed Delesky, MD (11:16)
It's what

we got. So that's what we're going to use. I think it's I've actually seen it more recently where I've seen some people who have the 27 to 29 and have a complication related to obesity who qualify for this. So it does happen. It happens quite a bit. So something that I really want to get at today is that we are going to be talking about the GLP medicines the most today.

Nicole Aruffo, RN (11:32)
Good for them.

Ed Delesky, MD (11:42)
And I'll say that the reason that we're doing that is because they have become the first line recommendation for the treatment of obesity. And all that to say is a hot button issue because I think there's a lot of medical misinformation out there. And I also feel like it can be challenging for research to keep up with the speed of social media. And so here we are kind of like towing the line here between social media and

Nicole Aruffo, RN (12:12)
the social media doctors.

Ed Delesky, MD (12:14)
medical

information, which I don't think we are by any means.

Nicole Aruffo, RN (12:17)
No, I'm talking about like people who got their medical degree on Google.

Ed Delesky, MD (12:21)
Hmm. Yeah. So, as we're starting to think about the GLP medications, or it stands for glucagon like peptide one, this lives in a family of medicines like liraglutide, semaglutide, or semaglutide. There are a bunch of other brand names as well, like Wegovy or Ozempic. But why don't you tell us where did these medicines initially come from? And like, how did we get here?

Nicole Aruffo, RN (12:52)
They were initially used for to treat diabetes, which I think probably is like a, I feel like people know that like it's was used for diabetes and then was found to have weight loss effects and then is now like approved and marketed as a weight loss drug.

Ed Delesky, MD (13:08)
Yeah, and like certain types of them live in the diabetes bucket and some of them live in the weight loss bucket. Because I think in the beginning of this rush, it was like a gold rush. There was like not enough for the people who had diabetes because once that indication came out for the use of the medication for BMI above 30, a lot of people qualified for this medicine.

Nicole Aruffo, RN (13:32)
Is it just a BMI of 30?

Ed Delesky, MD (13:35)
Yeah.

Well, it's just a BMI of 30 to be considered, but it's the availability that's the issue. you can, many, many people easily qualify, but then whether the insurance actually pays for it.

Nicole Aruffo, RN (13:54)
Yeah, no, that's what I mean.

Ed Delesky, MD (13:57)
Well, I also think you have to make a pretty convincing argument, too. Yes, people with BMI over 30 should qualify for this medicine. But oftentimes, they just price it out. They'll say they cover it, quote unquote, but then it'll be $500 a month. And so later in the episode, we're going to touch on less expensive options that do exist. But these are one of the early pitfalls with these medicines. So like Nick said,

These medicines initially were used to treat diabetes and then in the trials were found to have side effects of weight loss. So then other trials were made to actually figure out like how much weight can people lose on these medicines and are they safe?

Nicole Aruffo, RN (14:38)
Do you want to give a like one-liner about how the GLPs work? Like high level? Yeah, yeah, yeah.

Ed Delesky, MD (14:44)
total. What

they do. So what they do is threefold. And it's evolving as we understand it. But from my understanding, it works in these three ways. It increases the amount of insulin that the body uses during meal times. It also slows down your GI tract. So it slows down how much food moves from your stomach.

to the other parts of your intestine, like the next part, the duodenum, and it makes you feel fuller longer. What it also does is it changes the ratio of hunger to metabolism or appetite to metabolism ratio that we talked about on our episode about the metabolic set point and changes how your body responds to hunger. So in the past we said,

every two pounds you lose, your metabolism slows down 25 calories. But this gets at the every two pounds you lose, your hunger goes up 95 calories. The GLP medicines may cut that in half even.

Nicole Aruffo, RN (16:00)
wow, that's a lot.

Ed Delesky, MD (16:02)
Yeah.

So in those three ways.

Nicole Aruffo, RN (16:06)
Gorgeous. All right, we know what they are, how they work, other than being a magic injection that just makes you lose weight. So that's what it's doing in our body. Now, should we talk about the side effects? Are the most common ones?

Ed Delesky, MD (16:25)
So there are multiple side effects. And the first side effect that I usually talk about is nausea. And the nausea happens when a certain amount of food goes into the stomach and it expands the stomach. And if the stomach is moving more slowly to have food transit from the stomach to the small intestine, that expansion can cause nausea. So the tip is to, when you start taking the medicine to cut your portion size of food in half,

so that you don't experience the nausea as much.

Nicole Aruffo, RN (16:59)
That's a good tip. Thanks.

You're welcome.

Ed Delesky, MD (17:04)
So the other side effects are either constipation or diarrhea. I think constipation is diarrhea. I think the constipation is way more common. And I've seen some strategies actually employ using a bowel regimen. So like using something that makes your poop softer and come out more easily and like spark up your bowel a little bit ahead of using these medicines. One of the other side effects is actually something called

pancreatitis, which is an inflammation of your pancreas. Sometimes people will actually think twice about prescribing these in patients who have had pancreatitis. I mean, don't come after us for like exploring the idea of maybe using these in people who have had pancreatitis in very specific situations, but it's certainly something that you talk with your own doctor about. And there had been some, some evidence in rat models of

some evidence and rat models of something called medullary thyroid cancer, which is a very rare type of thyroid cancer and is thrown caution into the evaluation of whether someone should actually take this medicine or not. And of course, over time, we're learning that there's more there are more side effects. One major side effect kind of gets at the fact that of how the medicine works, if you go too far on the end of the medicine working too much.

something called gastroparesis. That's where your stomach actually stops moving food forward. It's kind of gets at the fact of like how the medicine actually works. And if it works too much, your stomach can stop moving food forward, which is just a bad thing. Yeah, that's rough. That's why these like are so powerful, but need to be monitored all the time. Off the top of my head, I do not know the rates of how that, like how often that happens, but it's something that has been described.

Nicole Aruffo, RN (18:50)
Yeah.

Ed Delesky, MD (19:01)
Yeah. And so now we've talked about generally how these medicines work. We've talked about some general side effects, understanding that we're recording this on Sunday, September 8th, 2024, and we're learning things every day about medicine. But why don't you tell us generally how these medicines are delivered?

Nicole Aruffo, RN (19:22)
Generally, it's an injection done right under your skin. It's called a subcutaneous injection and it's done with a very, very small, thin needle. And you would put it, so if you kind of grab like the back of your arm, that skin, you would like pull that up and inject there or like your stomach or do the same thing on your thigh. So it's not going into your muscle. Like if you get like a vaccine or a flu shot.

and it really goes deep and it hurts really bad, the subcutaneous injections are typically a little less painful.

Ed Delesky, MD (19:58)
And do you see the needle?

Nicole Aruffo, RN (20:00)
No, so well, if you get a pen, no, you don't see the needle.

Ed Delesky, MD (20:06)
I think they usually come in pens, don't they?

Nicole Aruffo, RN (20:08)
Yeah, but sometimes you can just get it depends how you get it and like what pharmacy that you get it from. I've seen some people like get the vial and like the insulin needle type thing where you can see it. but I don't think that's very often. I think it is sometimes or not. Sometimes I think it is most often in a pen that you just dial up at all. It has a dial. It'll say whatever dose that's on it. And then you just dial it up and then.

you'll get a separate needle, so it's a one-time use. You screw it on, do the injection with the pen, and then when you're done, that needle comes off and you put it your sharps container.

Ed Delesky, MD (20:50)
Yeah, and there's usually like a lot of videos on a lot of different locations, like probably ones on YouTube or ones from the company themselves that instruct you how to use it. Or you can go to a local pharmacist who might be able to explain to you as well about how to use the medicine. That was great. Thank you so much. So Lira Glutide was one of the first medications that was used for this purpose, one of the GLP medicines. And that was actually a daily injection. And so

in the ever of all.

Nicole Aruffo, RN (21:20)
yeah, we didn't say that. Now they're typically just once weekly.

Ed Delesky, MD (21:23)
But now they're typically once weekly. this we're talking about the samaglottide based ones. So like we'll go V and ozempic and their later cousin tersepid, which is also known by brand names, Zep bound and Mounjaro moon Jaro. So we were talking about earlier, like moon Jaro lives in the diabetes bucket where Zep bound lives in the weight loss bucket essentially. these days from when I was doing some listening earlier for some lecture material,

they were suggesting that Liraglutide actually was going generic in June. So, 25. No, I this past June. So that's something that's worthwhile for us to look up. That would change the cost a lot. Speaking of cost, I was kind of thinking about this before we were gonna get started. That's a huge issue with these medicines, they're thousands of dollars.

Nicole Aruffo, RN (21:57)
Like this past June or? Like this past June.

Yeah, yeah they are.

Ed Delesky, MD (22:19)
But I also found myself thinking about the first Apple Watch. Also, very expensive. Or the first smartphone. Very expensive. But as things go on, the way the markets work, they should get less expensive over time. Yeah. You think?

Nicole Aruffo, RN (22:37)
I think it's also a little bit of a supply and demand thing. wants it, so they're just going to charge whatever because the big pharma can.

Ed Delesky, MD (22:45)
That's fair. So let's explore how effective the GLP medicines are.

Nicole Aruffo, RN (22:50)
If there are any unloyal listeners who don't listen every week, you won't know that Eddie's doing a board certification in obesity medicine. So a lot of the information from all of these obesity episodes are from those lectures.

Ed Delesky, MD (23:08)
It's been very helpful overall. Anyway, so it turns out that liraglutide, albeit less popular these days, probably gets in, I think these studies were done well over a year follow up. These people got like 10 % to 15 % weight loss. But the more popular of these medicines are in the semaglutide and tirzepatide components, being like in the Wegovy or Ozempic.

set-bound or moon jarrow. And in the semaglutide ones, there was a whopping 15 % weight loss at follow-up, which was well over a year. So just sit with that for a second.

Nicole Aruffo, RN (23:51)
.

Ed Delesky, MD (23:53)
Well, because even think about that, like whenever we're talking about like we set weight loss goals in a couple of episodes ago and we said the first goal was to stop gaining weight. What was the second goal?

Nicole Aruffo, RN (24:04)
The second goal was to lose about 5 % of your body weight.

Ed Delesky, MD (24:09)
And if you wanted to have an amazing effect on how obesity was affecting your health as a whole, you were looking at 15%. And that's what this medicine was doing.

Nicole Aruffo, RN (24:22)
And then the tirzepatide was or had a weight loss of more than that, about 21%.

Ed Delesky, MD (24:29)
Yeah,

so that was even the cousin. It is a very strong, very powerful medicine. I mean, when you're getting this much of an effect, you absolutely need to follow up with your doctor when they prescribe it to you because they're so powerful, especially the tirzepatide-based medicines. like anything, like if you're going to start treating blood pressure, you have follow-up appointments to make sure that everything is safe and healthy. And you need to do the same with these medicines. What I actually was...

just recently learning is that if you're going to start any weight loss medicine, you should follow up at around three months and see if you got 5 % weight loss. If you didn't get a 5 % weight loss, then you kind of jump ship. really? Yeah. And you move on to the next thing because it's just not working. Also, by the way, these medicines don't work for everyone, which might come as a shock.

Nicole Aruffo, RN (25:24)
Yeah, it does. Is there, I don't know if you know this, like a statistic of people it doesn't work for, like numbers wise? Or no? There may be one out there, but.

Ed Delesky, MD (25:37)
or maybe one out there.

Nicole Aruffo, RN (25:40)
It also could change two weeks from now, so it might be around.

Ed Delesky, MD (25:44)
Yeah, we say like tirzepatide example, like an average of 21%, but there were people who lost more and people who lost less. So that's definitely something to keep in mind as well. So before we kind of get into our like thoughts and feelings about these medicines, I'll say that the current state of the market and the medical recommendation is that these medicines are the first line for weight loss medication.

But there's also emerging evidence that they are protective of the heart and even maybe even earlier, like newer evidence coming out that they may be protective of the kidney as well, which is all just incredible stuff. Incredible stuff. Incredible stuff. And it really just adds to the fact that there's going to be more of a supply issue. But at some point,

Nicole Aruffo, RN (26:34)
they're using the same meds for diabetes and the diabetics are fine.

Ed Delesky, MD (26:40)
That's also true. Well, they were also talking about like.

Nicole Aruffo, RN (26:44)
But then I don't know if there's like, are there like considerations for like dosing and like, is the dose for weight loss different than the dose for diabetes and all that stuff?

Ed Delesky, MD (26:55)
There are, well, you get to the maintenance phase. mean, we've talked a lot about on our episodes our weight loss, but there is.

Nicole Aruffo, RN (27:03)
I guess we also didn't really talk about how you go up for X amount of weeks and then is there a standard of how much you should go up or like for how many weeks you should go up before you hit maintenance or is it based on like each person and

Ed Delesky, MD (27:17)
I think a lot of strategies go after the lowest effective dose to get to a clinical goal. So something that we've talked about here is that one clinical goal could be your BMI of 30. And we talked about all those life-changing risks going away or becoming reduced at 30. So if you're on a low dose and you're still losing weight, you probably can afford to stay there.

But if you stop losing weight and you're not at your goal, then you can go up.

Nicole Aruffo, RN (27:49)
Okay, so you kind of, it's not a standard. This week you go up, it's kind of like you're losing weight and then when you plateau a little bit, increase.

Ed Delesky, MD (27:58)
your

dose. Yeah, that's what I was learning like as soon as even today. And it's a part of a practice that I've seen some people because there are other different types of medicines where you go up to the highest tolerating dose. I don't think this is one of those. I think you try to do the lowest, the lowest dose that you can and get the most out of it.

Nicole Aruffo, RN (28:20)
Yeah, because then I guess maybe like in the future if you have to go higher, you have that wiggle room.

Ed Delesky, MD (28:28)
Yep, if you have the wiggle room. Something they were also employing on these lectures was that you can stack different types of medicines too. Like you may go after the GLP pathway for weight loss, but some other medicines, just to name drop them here, we're not gonna talk about these a lot today, but Phentermine Topiramate, Naltrexone, Bupropion, Orlistat, or just Phentermine by itself are older.

They have been used for weight loss in the past and are still reasonable in the certain situations. But you may stack one of those on top. And they were even talking about a strategy where someone was on a GLP, had a tremendous amount of weight loss, but then started having cravings. And they used one of those medicines to stack on top to keep getting to the desired effect.

Nicole Aruffo, RN (29:18)
Well, I wanted to quickly talk about.

what happens when you stop taking them. Really just to touch on it because I know people are going to ask and we've had this conversation with another loyal listener, my mom and her go-to every time we're talking about this. She's like, but when you stop taking it, you just gain the weight back.

Ed Delesky, MD (29:35)
Yes.

That's fair. So I'll follow up with a couple rhetorical questions that I hope you'll answer.

Nicole Aruffo, RN (29:50)
Do I

feel... Okay. Well, what are your questions? I have some things to say about it.

Ed Delesky, MD (29:57)
I would love to hear what you have to say, but for those people wondering what would happen, what would happen if you had high blood pressure and stop taking your blood pressure medicine?

Nicole Aruffo, RN (30:06)
Yeah. my God, this was where I was going to go to.

Well, OK, I was going to say that and kind of like, you know, all roads lead back to hypertension. We always refer to blood pressure because it's like the easiest thing to relate something to. Yeah, so if you had high blood pressure and you stop taking your medicine. Your blood pressure is going to go up if you're taking these weight loss medications. And you just stop taking it, you are going to lose weight.

Initially, probably because one, like physically what was happening in your body is not happening happening anymore. But then you also have to do the lifestyle changes. Yeah. And it's not just this is not a magic cure all. You have to do the lifestyle changes for this to be sustainable, because I don't think most people I guess it's too early to tell, but I don't think most people are on a maintenance dose forever.

probably too soon to tell.

but then also relating it to blood pressure, you're just going to be more successful if you're not just taking a pill and like, let me not exercise and let me have a really poor diet and just hope that this pill fixes everything. So there is that consideration, but if you are changing the way that you eat, you're changing how active you are in your daily life, how much you're exercising. When you stop taking the medication, yeah, you like might gain a little weight back, but.

we're probably gonna be fine.

Yeah.

think I have any more thoughts. Do you? I feel like this was a good round out on our obesity series. Yeah. Which we can always do more because we can do whatever we want. It's our podcast.

Yeah, so we actually might have few episodes sprinkled in here.

Cool. Well, I think it's time for me to make dinner and you can watch football with Ollie.

Something else. put, I added chicken broth to his lick pads.

Yeah, did it earlier today. Wow. I mean, too. So they should be good.

These perfected my perfect dirty martini.

No, wouldn't let me say my hot take at the beginning of this episode. We're going to get canceled.

yeah, this is gonna be a Nicki produce episode, so it's gonna be great.

neighbor.

Bye.

I am not your nurse.