.png)
Your Checkup: Patient Education Health Podcast
Ever leave the doctor’s office more confused than when you walked in? Your Checkup: Health Conversations for Motivated Patients is your health ally in a world full of fast appointments and even faster Google searches. Each week, a board certified family medicine physician and a pediatric nurse sit down to answer the questions your doctor didn’t have time to.
From understanding diabetes and depression to navigating obesity, high blood pressure, and everyday wellness—we make complex health topics simple, human, and actually useful. Whether you’re managing a condition, supporting a loved one, or just curious about your body, this podcast helps you get smart about your health without needing a medical degree.
Because better understanding leads to better care—and you deserve both.
Your Checkup: Patient Education Health Podcast
91: GLP1 Pill for Weight Loss? Understanding Oral Wegovy
Oral Wegovy is officially FDA approved — but what does that actually mean for patients? In this episode of Your Checkup, we break down the December 2025 approval of oral semaglutide 25 mg for chronic weight management, who qualifies, how it works, and how effective it really is. We review the clinical trial data behind the approval, including expected weight loss, common side effects, and long-term expectations, and explain how oral Wegovy compares to injectable GLP-1 medications. We also tackle common misconceptions, dosing and lifestyle considerations, and the very real challenges of cost and insurance coverage. If you’ve heard the headlines and want the facts — without hype — this episode is for you.
Check out our new graphics. Thank you, Vantage Design Works. Check out our website, you can send us an email, yourcheckuppod@gmail.com. Check out our website, you can find us on Instagram, share us with a friend or a neighbor. But most importantly, stay healthy, my friends.
Send us a message with this link, we would love to hear from you. Standard message rates may apply.
Production and Content: Edward Delesky, MD, DABOM & Nicole Aruffo, RN
Artwork Rebrand and Avatars:
Vantage Design Works (Vanessa Jones)
Website: https://www.vantagedesignworks.com/
Instagram: https://www.instagram.com/vantagedesignworks?igsh=aHRuOW93dmxuOG9m&utm_source=qr
Original Artwork Concept: Olivia Pawlowski
Hi, welcome 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 doctor in the Philadelphia area.
SPEAKER_00:And I'm Cola Ruffo.
SPEAKER_01:I'm a nurse. And we are so excited you were able to join us here again today. So we have a nice episode here lined up for you today, a marriage of both news update and a topic that we cover lots of, but we wouldn't like to move on to our, you know, learning section without first bantering for a little bit. Um, we have live parallel play happening here. Nikki, what are you up to at this exact moment?
SPEAKER_00:We love parallel play. Well, I'm doing a puzzle, a 1,000-piece puzzle of 101 pooping puppies, and I've taken over our dining room table, aka our podcast studio, and I think I've made good progress. You're I mean I started the day after Christmas, and it's now three days after Christmas. I didn't really work on it a lot yesterday though, but yeah. I think we're coming along.
SPEAKER_01:Yeah, you you're impressive, is all I've got to say about this. Um, I really did not know this about you, that you were so into puzzles. It stresses me out.
SPEAKER_00:Yeah, I like doing them. I don't know. And then I guess I haven't done one in a while. We like periodically would have them like out at my house growing up, and then my parents had one in the living in the on like the coffee table on Christmas that we were working on. Well, I was working on. You were you weren't you were stressed out about it.
SPEAKER_01:No, I didn't.
SPEAKER_00:This one's hard though.
SPEAKER_01:But well, tell us a little bit more about where we acquired and why 101 pooping puppies.
SPEAKER_00:We acquired this. Our friend Chris got this for you. I think it was part of your like graduation gift.
SPEAKER_01:Yes, I think it was.
SPEAKER_00:And he got it because he saw it and he thought of us or thought of Eddie, I guess, because in our downstairs bathroom we have four pictures, like black and white artsy pictures of Ollie pooping.
SPEAKER_01:Yeah, it's it's the best. I love it. And anytime people come back.
SPEAKER_00:Everyone gets a kick out of it.
SPEAKER_01:They do, they do get a kick out of it. Well, like early on in our time together, every time he would poop, because Ollie's my first doggy, that every time he would poop, I was like, Oh my god, this is so cool. So I would pretty much every time take a picture of it.
SPEAKER_00:Send a picture to me.
SPEAKER_01:Yep. Um, so that's what's going on here. I can't fathom like your strategy is I mean, you have some strategy, right?
SPEAKER_00:Um a little bit. Well, you do the outside first, which this top I need to spend some more time with because the sky, something with like the sky and the trees and the branches is off and it's not connecting. So I need to look at this more. Like I'm trying to finish this. The dog is like in a tree pooping on a branch. So I'm trying to fix that, but I need to figure out the top, the top part of the frame. And then yeah, then you just go from there.
SPEAKER_01:Wow. So that's what's happening there. Um, we also, I guess kind of transitioning a little bit. We know very soon, if not, by the time you're listening to this episode, you will see some new artwork that we have from this episode. A little so our rebrand is from Vantage Design Works. And I mean, we know her as our near and dear brother Vanessa, um, who it plays a very big role in our lives. But for the purposes of the pod, she expanded on the previous design that we had and now made us avatars and not just us, but also our intern. And yeah, he looks so cute. He looks so cute. We are so happy with how things look, and we couldn't be more honored that she would help us. I mean, she spent a lot of time working on this. Seems like she like really put her heart and effort into helping us out.
SPEAKER_00:Yeah, she gave us a lot. I mean, like we knew it was gonna be good. But she really did a lot.
SPEAKER_01:She did. She like, uh, you know, she went and forth and did resizing, she kept the branding consistent, like things that you and I definitely would not have thought of, like colors and no, I mean, like it was incredible. So we hope that you guys enjoy the new branding. And if you have any, you know, graphic design needs, Vantage Designworks. Um, she's on Instagram and believe she has a website too, um, with the aforementioned name, advantage designworks.com. But yeah, we we know that she makes great stuff. So thank you so much, Vanessa, for helping us expand our image, I guess, right, Nick?
SPEAKER_00:Yeah, that's awesome. Our image is expanded.
SPEAKER_01:I'm super excited to share that with people. Um, you know, while you're working on the thing over there, I have one very important question for you.
SPEAKER_00:Oh my gosh, I know what this is gonna be.
SPEAKER_01:What does tiki mean to you?
SPEAKER_00:Tiki means absolutely nothing to me, personally. On a deep personal level, it means nothing.
SPEAKER_01:I really, you know, what I was asking people, so the reason that this came up is because last night was Tiki Christmas. And now I think people probably surmise that I'm obsessed with Mike, which probably is pretty close to the truth. Um, and he had Tiki Christmas last night, an intimate Christmas soiree that had a flavor of Polynesian flair. And, you know, it invited the question: what does tiki mean to you? And I will explain some of the answers that I heard last night. Um, from one person I heard that tiki meant Moana.
SPEAKER_00:Which a little Polynesian flair.
SPEAKER_01:A little Polynesian flair. But I think this was unintentional because that person who, just for their sake, will remain nameless, said Moana means family.
SPEAKER_00:But I think Ohana.
SPEAKER_01:Ohana.
SPEAKER_00:Who said that?
SPEAKER_01:Well, um, it's someone who I just, you know, I'm not sure if they would be so comfortable with me name-dropping them. Um, and I want to respect their privacy. So, but you know, we love them dearly. And Moana may not in mean family, but it definitely means Polynesian flair to me, Disney princess wise. Yeah. So I think it fit with what does Tiki mean for you? Um then there was Ohana means no one gets left behind, which invited someone to think about, you know, early 2000s educational stitch and early 2000s.
SPEAKER_00:Family means no one nobody gets left behind.
SPEAKER_01:But it also means early 2000s educational um incentives or programs from the U.S. government from in the George Bush era.
SPEAKER_00:Bring Bush into this.
SPEAKER_01:I am. So that's what tiki meant to that person. Um, otherwise, tiki meant things like elevation or person, um, you know, with the tiki pole. And then a very astute Riley said that actually gave us the definition of tiki, which maybe we'll try to provide here for you today. Um, you know, it actually has like quite the cultural meaning. So the New Zealand definition is that a tiki is a large wooden or small green stone image of a human figure. Ollie's very excited. Um, the word tiki wasn't frequent frequently used um as frequently as it was.
SPEAKER_00:Oh my goodness, Ali.
SPEAKER_01:My goodness, Ali. So otherwise, in Polynese, Polynesian culture, the tiki represents the connection between man and nature, between heaven and earth, and symbolizes creation and life itself.
SPEAKER_00:Oh, really? Yep.
SPEAKER_01:So I definitely felt that last time. No, um, he he gave Well, he's also like a history teacher, right?
SPEAKER_00:Is that what he teaches?
SPEAKER_01:He he teaches a lot of AP classes. I I heard he teaches AP microeconomics and several other ones too.
SPEAKER_00:Not a history teacher.
SPEAKER_01:I know I think he also might be a history teacher. That's on me for not finding out enough. Um he did not know that off the dome. He looked that up. Um, but he also tried his hand at pronunciation of a lot of them. Um, and I credit him for that.
SPEAKER_00:Of a lot of the tikis?
SPEAKER_01:Well, there's a lot of like cultural language and like names of a story and like involve players in the story that he was, you know. Um, and then you know, I invited the question, which to some seemed like it was a bold question, of what is your favorite conspiracy theory? Oh my god. Now, like I didn't, I I wasn't implying that people had to believe the conspiracy theory, but like, what was your favorite conspiracy theory? And, you know, some people took it to heart. Like, some people said that the there was a flood that, you know, is across multiple religious like writings of the time, and that everyone had this common experience of a flood that ended humanity, if you will. Um, and that the Sahara was one of the main locations for Atlantis in somehow related lore to the flood. Um, other people said that, you know, the US government um and the CIA changed writing um post-World War II to be more reflective and less self-critical of U.S. capitalism and related concepts. Um, that was a very insightful one. Um, you know, another person said that Michael Jordan was forced to retire instead of choosing to retire because of his gambling problems. But, you know, our personal favorite conspiracy theory, which is more of a playful one, Nikki, can you tell us what our favorite conspiracy theory is?
SPEAKER_00:Our favorite one is that when we leave the house, Ollie stays home and he does experiments.
SPEAKER_01:Yes. And that leads to his Professor Oliver Jones PhD. Actually, no, pr Professor Oliver Cheese Jones Arufo PhD. Extraordinaire. We're still waiting to see the scientific, uh, the scientific journals of his experiments, but well, he can't let all his secrets out, you know. Yeah. And that's, you know, and then he goes right back to normal when we return. Oh, there was something that happened.
SPEAKER_00:Okay, so there's like a light fixture in our kitchen, and there are three light bulbs on it, and one of them was out. Yes. And we like left to go do something one night to like go to dinner or something, and we came back, or well, while we were out, you know, we leave and we're like, all right, Ollie, have fun. You're doing your experiments. And one of us was like, wouldn't it be so funny if like Ollie's just like at home changing the light bulb, and then we came home and all three light bulbs were on.
SPEAKER_01:Yeah.
SPEAKER_00:And then we just like looked at each other and looked at him.
SPEAKER_01:He's like looking at his chops.
SPEAKER_00:And he's like, Hey guys, I'm back. You're back. Nothing to see here.
SPEAKER_01:I loved those. Um that's my favorite that's that's my favorite conspiracy theory. We'll keep it there. Let's see what else I've got.
SPEAKER_00:Conspiracy theories are like a crazy thing though, because if you I feel like it just goes to show like if you really try to like explain something and convince someone of something, you can make them think that it's real.
SPEAKER_01:Yeah.
SPEAKER_00:You know, and like you can be as delusional as you want, and you can like make someone think whatever. Like if someone sat me down, like a flat earther sat me down and was like, these are all the reasons, you could probably convince me that the earth was flat. I know the earth is not flat, right? But you can make a good argument out of anything, you know.
SPEAKER_01:Exactly. 60 40.
SPEAKER_00:Maybe like 70-30. I could be very convinced that that whole thing was fake. Namely because of the whole like live streaming of it. Like Netflix couldn't do a Love is Blind reunion live stream. Good point live. But you're telling me they could do that in like the 60s. The 60s, when was that? Yeah. Like I can't get a good signal sometimes on my cell phone when we're sitting on the beach. But like you could have streamed this to everyone in the world.
SPEAKER_01:That's a good point.
SPEAKER_00:Like 60 years ago?
SPEAKER_01:Yeah.
SPEAKER_00:You know?
SPEAKER_01:I mean, is it possible they took a video and like they called it a live stream?
SPEAKER_00:Maybe.
SPEAKER_01:And like, let alone live streaming from Earth. Talking about live streaming from the moon.
SPEAKER_00:That's what I'm saying.
SPEAKER_01:I think we have to be a little careful here, because that we're gonna start sounding like anti-loon maning.
SPEAKER_00:I'm not anti, I'm just saying I could be convinced that it didn't happen. You know, like the more like you think about it or something, and then you're like, wait a second, these conspiracy theorists could make a point, could make a convincing point, but are they just like making a point to try to make a point, you know?
SPEAKER_01:Yeah. I think um maybe we have to put away the tinfoil hat for now and keep thinking about what we're gonna what we're up to. So wow, as luck would have it, we are 14 minutes in. Why don't we get started? Um, you are you ready to get started? Or I'm ready to get started. Great. So what are we gonna talk about today, Nick?
SPEAKER_00:Today, this is going to be very exciting because we're talking about oral wagovy.
SPEAKER_01:Yes. So this is like everywhere in the news. I think a lot of people who have any sort of tangential interest in the GLP1 medicines or weight loss have heard about this. And so my hope here today is to find a, as we normally do, a balanced middle-of-the-road perspective that's educational about what this actually means for people, how it works, and all other good stuff that you wouldn't gather from just a headline. So you might be thinking, like, wait, so now is Wagovi just a pill? Is it the same thing as an injection? Does this mean that the meds got easier? We're gonna slow down today and explain what actually got approved, who it's for, how effective it is, and what people should realistically expect. So we're gonna try to separate the excitement from more understanding so that we can keep our, you know, unsexy balanced perspective like we normally have. Seems fair?
SPEAKER_00:I think so.
SPEAKER_01:Cool. So it seems like December is a big time for GLP news because last December the Zetbound got um FDA approved for treatment of sleep apnea, which has been helping a lot of people. And so in this December, the FDA, Food and Drug Administration, approved oral somaglottide or oral wagovi. So oral somaglotide 25 milligrams, branded as Wagovie for chronic weight management. And by and large, this is the first oral GLP1 receptor agonist approved specifically for obesity. It is not the first one or only one that will be coming out, but right now it's the first one that's FDA approved and it's expected to hit the market soon. So, who it's approved for? These are adults who have a BMI of greater than 30, having class one obesity or higher, or a BMI of 27 with at least one weight-related complication. And I thought this is very interesting because these are very, very common. So, someone with a BMI of 27 or greater with high blood pressure. Wow, what a common thing we talk about, and how many people would benefit. Um, there's a whole lot of mechanistic reasons that would explain why some weight loss would help someone's blood pressure that maybe we'll save for a different episode. 27 or greater and type 2 diabetes, 27 greater BMI and cholesterol issues, 27 or greater and sleep apnea, and 27 or greater and cardiovascular disease. That these are the groups that this medicine is approved for. So there's an important distinction that I want to say is that ribelsis, ribelsis is also oral semaglatide, and this has been out for a while. And these doses, it's for diabetes, is what ribelsis is for. And so it's not designed to have any weight loss, um, meaning that the doses are not up to snuff in that case. So ribelsis is different in the way that it has 7 milligrams and 14 milligram doses. You probably remember earlier from just a couple seconds ago when I told you that oral Wagovi is approved for a 25 milligram tablet. What seems to have borne out in the trials that they looked at this is that higher doses, like 50 milligrams, work very well, but are not quite ready for prime time for FDA approval. And so 25 milligrams is the top dose currently FDA approved, while 50 milligrams of Wagovy, oral Wagovie, has been evaluated and is still under consideration, but not approval yet. Um, other FDA indications for oral Wagovy, it would include reduction in major adverse cardiovascular events, that means heart attack and stroke in people with obesity, and established heart disease. So if you've had a heart attack or a stroke, which is a lot of people, you're a person that this could benefit in truth. We've had lots of data. This is not something we've done a whole episode on, but we've talked about in passing, is that these medicines reduce the risk of heart attack and stroke in people with obesity. And also FDA indications for metabolic associated steatohepatitis, which is a form, a later stage form of metabolic associated dysfunctionis, the fatty liver, essentially. Um what would how that would be discovered is with fibrosis with F2 or F3, which is an indication that is a thing that comes from the imaging study, the ultrasound imaging study that can help describe the fatty liver. You were really cooking at that puzzle over there.
SPEAKER_00:Yeah, I am. Sorry. No, but you're just cooking on the I'm just cooking. The education, you know.
SPEAKER_01:I am. So it turns out that the one bottom line is that not all semagletide pills, the ribelsis versus oral bugovi, they're not interchangeable because the doses aren't the same. And currently only one specific dose is approved for the weight loss. That makes sense.
SPEAKER_00:I think so.
SPEAKER_01:Did that sound okay to you over there? Great. Cool. So the concepts, let's go back and venture into how oral semagletide works without trying to get too bogged down to too bugged. Down into my one of my first loves educationally, biochemistry. So the big idea is that it's the same biology as the injectable ones, but it's a different delivery system. Semaglottide mimics GLP1, a hormone that's involved in appetite regulation, satiety, which is a sensation of fullness, and glucose metabolism. There are central effects that people notice. Um, the central effects being ones that affect your brain and your body's communication with hunger. So the central effects are reduced hunger, feeling full faster, and something that's been very described as less food noise. The peripheral effects, these are effects that are happening outside of the brain on the body, are for at least a small period of time, slower stomach emptying, which we've talked about and why it's prudent to eat slower, eat half your portion size. Um, increased insulin when glucose is high, meaning that like that there is more insulin sensitivity, glucose can be used more effectively, and lower glucagon release. So, you know, these were made injectable for a while, and it was like, oh, like that's the expensive part. So the concept of a pill coming around makes this more accessible for sure. But for our purposes, what makes the pill possible? And it's combined with an absorption enhancer that allows a peptide drug to survive the GI tract. You know, when you deliver a medicine right under the skin into the subcutaneous tissue, which is the skin underneath the tissue underneath the skin, it's a little bit easier, honestly, to deliver medicine. Um, the GI system can be harsh. You have to go through an acidic stomach, you have to go through the rest of it, and then you have to go through the liver and be processed by the liver oftentimes. So, not you'll notice that like wagove, semaglotide, 25 milligrams, is way higher than the injectable dose, the top injectable dose, which is 2.4 milligrams. So, food for thought. That's also why when you take it matters. And so this is a very important part. These are some administration rules. And this is, I really want to like bold underline, emphasize that for when people start taking these, you have to take it on an empty stomach. You should take it with no more than half a glass of water, is their current direction. And at least 30 minutes before food, drinks, or other medications. And so this is very important. It's a little unique. It's not a medicine that you can take at any time of day. It's not one you can take as needed. So, you know, the trade-off for the once-weekly injectable medicine is that you have to be pretty particular about how and when you take this medicine. You know, it works very well, but only if it's absorbed properly. And so if you don't adhere to these, you will probably notice that it might not be working as well as it could be. So that's how or why it's a little different. Um, the third section I want to talk about is how effective it is. Um, I think people care a lot about this. So I will take us through these. A series of trials done under the name Oasis, O-A-S-I-S. Um, and Oasis 4 is the FDA approval trial at the 25 milligram dose. What they discovered is that there was an average weight loss of 13.6% over 64 weeks. And this is compared to the placebo group who got 2.2%. And something that gets tucked away in there is that everyone in these trials were doing diet and lifestyle changes. So the people in the placebo group were taking a water, like a sugar pill or something, and they were doing diet and exercise changes, just like the people in the oral Bogovi group, which is not like I don't think that's emphasized enough because I think people were probably just going through their average day, or the concept is people think people in these trials are going through their average day and they're just adding the medicine, but it's technically two interventions it's the diet and exercise and the medicine. So just keep that in mind. Another interesting result is that nearly one in three people lost 20% or more of their total body weight. And overall, that's a lot. It is a lot. Um, so what you know, they also look at what's called categorical weight loss, which is weight loss of populations of people, like what percentage of person lost this? So, like how many people lost 5% of their body weight? How many people lost 10% of their body weight, 15, 20, so on and so forth. And the reason that this is important is because we know at those thresholds, people start to have metabolic benefits at different thresholds. Maybe we'll talk about this is a whole episode in and of itself, I think, but at different thresholds, people, their diabetes improves, their insulin resistance improves, blood pressure improves, sleep apnea improves at different thresholds, 5, 10, 15, 20, so on and so forth. Oh, good. So I did find um for the oral somagalide, I found at 64 weeks that 79, this is the categorical weight loss from the study. So for the percentage of participants on oral somagite, 79.2% of them lost greater than 5% of their total body weight. That is pretty much eight out of 10 people. 63% lost 10% of their total body weight, which is a like very distinct clinical, meaningful outcome. Losing 10% of your total body weight will do a world of difference. Half of them lost 15% of their total body weight and 29% lost greater than 20% of their total body weight. So I thought that was a very interesting thing. This is um, it's already better than all of the other, it's already better than the now Trexone Buproprion combinations and fentramine topiramane combinations that have been used prior to this for oral medications. So it very, very effective. Any thoughts so far on the any of that?
SPEAKER_00:No, I think it sounds great.
SPEAKER_01:Um, so then what they also looked at the higher dose trials, and that this is not yet approved, but important for context. So Oasis one, you know, I just spent all that time talking about Oasis 4, but there were other ones to get there. Oasis one was evaluating the 50 milligram dose. And in that one, the mean weight loss was 15.1%. In this case, 85% lost at least 5%, and 34% lost 20% or more. I do think that they reported there were more side effects in that trial for maybe what's a marginal improvement in total body weight loss. And that's maybe why 50 milligrams is not the go-to dose right now. And then something that we should spend more time about, but we'll discuss here is the Oasis 2 trial, in which they exclusively looked at East Asian populations of people. Something that I'm here to tell you is that people of East Asian and Southeast Asian descent have increased risk of metabolic disease at lower body weights. I don't understand why at this point, and I'm not exclusively sure if many people do. Um, I'd be happy to learn more about it for you guys, but it's just a fact. And so in Oasis 2, they looked at this specific population of people. And also of note, like if you're listening to this and this is you, like you people of East Asian descent qualify for these medicines at lower BMI ranges because BMI cutoffs are not the same. Like for the average person here living in New Jersey, like the BMI, and maybe they're Caucasian or African American, what have you, their BMI cutoff for class one obesity is 30. For someone of East Asian descent, it could be 27.5. I have seen some guidelines suggest 25 as a cutoff. Wow. Yeah. So um it is very significantly different for these people. And when they looked at oral somagaltide for people of East Asian population descent, that they found the overall total body weight loss to be 14.3% sustained over the timeline, I believe 64 weeks. And people with diabetes lost 10.7%, which is also an anomaly that we see that people who have diabetes tend to lose less weight on these medicines overall. So the show's effectiveness across different populations is one takeaway. And that hopefully you learned today that these populations of people are a little more vulnerable to metabolic disease. So a key takeaway that I want you to remember is that maybe oral semaglide at a higher dose matches the injectable cemaglide. And it isn't just a weaker option just because it's oral. So the next section we want to talk about is side effects and safety to set some expectations, honestly. Um, the most common side effects, which seemed to be very similar to injections, um, well, I'll put it to you this way: the style of side effects was very similar. The proportion of side effects experienced was more. Um, types of side effects include nausea, vomiting, diarrhea, and constipation, and abdominal discomfort. And the question is, how common did these happen? Probably more than people would like to hear. It turns out that about three out of four people reported GI symptoms at some point. Um, the number of people that discontinued the medicines because of the GI symptoms was much less. However, you would expect to experience something I would be more surprised if you didn't seeing three out of four. Um all that to say, most of the side effects are mild to moderate, they're temporary, and they are worse during dose increases or initiation of the medicine. More serious but uncommon risks include gallbladder issues and more specifically, cole lithiasis. This is the medical term for uh gallstones. Um, that is not a feature of the medicine, it is a feature of the pretty rapid weight loss that happens when people are on them. So if you have too rapid of weight loss, um, because this is also seen in bariatric surgery, if you have too rapid weight loss, you can precipitate gallstones. Rarely you can see pancreatitis. Um, I think this more affects people who've had a previous history of pancreatitis. This came out when the medicines were first coming to market. It was in the trials, and then real-world data suggests that maybe there is less pancreatitis than we initially thought. And additionally, there is a very low risk of hypoglycemia unless it's combined with insulins or medicines called sulfonurea. Um, I'm thinking one coming to mind is glimepuride or glipazide. These are very commonly medicines used previously in diabetes care. What we also saw is that large reviews showed that there was no meaningful increase in major cardiovascular events. We actually have data that it decreased cardiovascular events. There was no increase in mortality, which is great. We saw it actually decreased mortality, and there was no meaningful increase in cancer. And so this is all very important because safety first, first, do no harm. These meds are powerful and they're not dangerous when they're used appropriately. That seem reasonable so far.
SPEAKER_00:I think so.
SPEAKER_01:Cool. So people who should think about not taking oral will go V, um, the absolute do not pass go, what's called a contraindication, a thing you have that you can't take it for, is a personal or family history of medullary thyroid cancer, a rare endocrine disorder called multiple endocrine neoplasia type 2. If one is pregnant or breastfeeding, and there's whole strategies that could be had around like being a woman who might get pregnant soon and being on these medicines beforehand. Um, and then second thoughts about people who have severe allergy to semaglotite, of course, and its purpose in type 1 diabetes remains inquisitive because sometimes people have multiple components going on, including insulin resistance and type 1 diabetes. These medicines should be used in caution, or you should be used with caution in people who have a prior history of pancreatitis, severe gastroparesis, already known gallbladder disease, and active suicidal ideation. What's also important to recognize is that these should not be combined with other GLP1s or medicines called DPP4 inhibitors, which are also very commonly prescribed for diabetes. So that's the list of people who should think twice if they're taking this. Sound reasonable so far? Cool. So then the, you know, we've been preaching this for a while, but then getting back to section six is the long-term reality is that this is a chronic treatment because treatment of obesity as a chronic disease involves chronic treatment with changes in lifestyle, medicines, and sometimes surgery. And so the weight loss is maintained while in therapy. And what they discovered is that when people stop, they can regain up to six or eleven percent of the lost weight within a year. I've also seen other data that suggests that people, after the course of time, can re back, can regain back to two-thirds of their total body weight that was previously lost, which makes sense to me. If you stop taking your blood pressure medicine, your blood pressure would go up. If you stop taking your cholesterol medicine, your cholesterol would go up. So, nitty-gritty, practical use, how patients actually take it. This stuff is exciting. So there's a dosing and titration protocol. Um, the idea is to start low and go slow. So the first usual starting dose is often three milligrams. The idea, similar to the injectables, is to increase it about every four weeks. And so the titration protocol may look like three to seven to fourteen to twenty five. And if one needs a slower titration protocol, may lead to fewer side effects. Um, just some quick tips that can really help. Eating smaller meals, avoiding very fatty foods early on, staying hydrated, treating constipation early, and short-term nausea meds if needed. Does that seem pretty clear? You were just burn churning and burning on burning and churning on that puzzle over there.
SPEAKER_00:I am. Did you see this whole part I got?
SPEAKER_01:Oh my gosh. No. I think this is so cute. I love how like genuinely interested you are in this. All right. So now time for cost, insurance, and access. And this is always the hard part with these medicines in this day and age. The annual list price of this medicine, which is usually not what people pay, but the annual list price is$14,000. Sometimes with people with coupons can pay$7,000 to$8,000 in the year. And it turns out that only about 25% of people get coverage for these medicines available. So why is lame? It is lame. So why this matters that uh high costs lead to high rates of discontinuation. And this disproportionately affects people who have lower incomes, which is unjust. So one important warning that I have, we have a whole episode about this, is to, you know, in the event of them being more expensive, what has come about is compounding pharmacies and compounding GLP1s. And the tough part about these is that they are unregulated. They are discouraged by the FDA because there is data that people can suffer more harms because of the unregulated nature of them, meaning that like there could be more medicine in the compounded version than you anticipated, or a quiet harm of less medicine and not getting the actual benefit, what you're paying for. And overall, they are not equivalent in safety or reliability to the standard preparations from the companies that make these. The other last piece on cost that I'll say is that practically speaking, I've seen a number of$150 for the starting dose tossed out in the news. And my two cents are that I do believe it will probably be more expensive than that. Um, you know, if the starting dose is three milligrams, you do the math in your head, three milligrams all the way up to 25 milligrams. It will probably be more expensive than 150 a month. And I also realize that it will probably fall somewhere under the current thresholds, which are around 250 to 300 to 350 for the ranges of the injectable Wagovi. So I don't know what the pricing will be. No one knows yet. And by the time someone listens to this month later, the information will be out. But when we're recording this, we don't know at this time. So I have done a lot of talking. Um, and I think what I want to do is kind of wrap things up. So oral wagovi is a real advance, and I think we're all really excited for this. I think it's going to improve access quite a bit in the course of time. It keeps pushing obesity medicine forward as a priority for so, so many people. Um, this really helps for people who don't want injections. It's effective, it's evidence-based, and it treats obesity the way we treat other chronic diseases, which may change the conversation or change what people or how people think about it. But overall, it still requires the right patient. It does require long-term use. It requires all of the beautiful lifestyle changes that happen in between your injection or in between the moment you take that pill, the moment-to-moment changes, the healthy choices you make every day in your life. And I mean, the honest conversations about these are expensive, they're tough to get right now. Hopefully one day that changes, but that's the reality right now. And if you're hearing this and you're wondering whether this might be right for you, it's actually a terrific conversation to have with your doctor. And now you have a little bit more information to be informed and be a part of that discussion. And that's what I got for you guys today. Any takeaway thoughts?
SPEAKER_00:Well, more people might be more inclined to take this versus doing an injection, you know.
SPEAKER_01:Yeah, I think because it's we've talked about that. It's like common to think about taking oral medicines. And I mean, even if you think about like now, this one medicine might be able to replace your blood pressure pills, your I mean, this is like this is me speaking from a couple experiences that I have seen, but like if you lose weight from these medicines in a way that you've tried before, and like 10, 15% of your total body weight, which is within the realm of possibility for these medicines, your blood pressure gets better, your cholesterol gets better, your blood sugar gets better, all from one medicine.
SPEAKER_00:Sounds like a nice deal to me.
SPEAKER_01:It does. It does sound like a nice deal. So I'm hopeful and will be keeping my ear to the ground for more information to share with you all. But mostly, thank you for coming back to another episode of Your Checkup. Hopefully, you were able to learn something for yourself, a loved one, or a neighbor. Check out our new graphics. We're so excited about them. Thank you, Vantage Design Works. And check out our website, your checkup podcast at um, well, actually, you can send us an email, your checkuppod at gmail.com. Check out our website, you can find us on Instagram, share us with a friend or a neighbor. But most importantly, stay healthy, my friends. Until next time, I'm Ed Delesky.
SPEAKER_00:I'm Nicola Rufo.
SPEAKER_01:Thank you and goodbye.
SPEAKER_00:Bye.
SPEAKER_01:This information may provide a brief overview of diagnosis, treatment, and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments, or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I'm not your doctor. I am not your nurse. And make sure you go get your own checkup with your own personal doctor.
