#103 Why Ozempic Alone Won’t Fix Your Weight Problem with Dr Mitra Dutt

Weight loss injections like Ozempic, Wegovy, and Mounjaro are everywhere right now.

They’re being called a breakthrough.

A miracle.

A solution for people who have struggled for years.

But are they actually solving the problem…
 or just masking it?

In this episode, I’m joined by GP and lifestyle medicine doctor Dr. Mitra Dutt for a very honest, balanced conversation about GLP-1 medications.

We break down:

•  how these drugs actually work (and why they’re not “magic”) 
•  the real benefits beyond weight loss 
•  the side effects and risks that often get overlooked 
•  why so many people regain the weight after stopping 

But more importantly, we go deeper.

Because for most women, weight gain isn’t just about hunger or calories.

It’s emotional eating.
 It’s stress.
 It’s habits built over decades.
 It’s identity.
 It’s the constant search for a quick fix that never addresses the root cause.

This episode isn’t about saying these injections are “good” or “bad.”

It’s about helping you understand the full picture so you can make a decision that actually works long term.

Dr Mitra Dutt: https://www.linkedin.com/in/dr-mitra-dutt-506b7115/

Watch my The Cravings & Fat-Burning Masterclass:  https://www.neverdietagainmethod.uk/register-podcast

Follow me on Instagram: https://www.instagram.com/max.lowery/

Book a Food Freedom Breakthrough Call: https://www.neverdietagainmethod.uk/call-ig

Transcript

Are Weight Loss Injections Worth It

Max Lowery 0:00

Have you been wondering whether weight loss injections like Ozempic, Wigovi, or Monjaro are actually the answer? Are they a breakthrough tool that can genuinely change lives? Or are they just another quick fix that help people lose weight fast only to gain it all back later? In today's episode, I'm joined by Dr. Mitra Dutt, a GP and lifestyle medicine doctor, and we're having a very honest conversation about GLP1 medications. How they really work, who can they help, the risks, the side effects, and why so many people regain the weight when they stop taking them. We also get into the deeper issue that most people miss, because weight gain is not just about hunger. It's not just about calories and it's not just about willpower. For so many women, the real struggle is emotional eating, food noise, stress, habits, and identity, and the constant search for a quick fix that never deals with the root cause. So if you're curious about weight loss injections, if you've considered taking them or you're already taking them, this episode is going to give you a much more balanced, honest, and useful perspective than most of what you see online. So let's get into it. How do you create a life that allows you to lose weight, eat the foods that you love, and sustain the results? Over the last 10 years, I've helped thousands of people do exactly that. I'm Max Lowry, I'm an author, personal trainer, and weight loss coach. In this podcast, I'm going to share my top tips and tricks from within my one-on-one coaching program. It's my goal to give you the tools and the understanding so that you never die again. Mitra, it'd be great to hear a bit more about who you are, how you got into what you do and what you currently do.

SPEAKER_01 1:52

Hi, Max. Thanks for having me. It's great to be here. So, yes, I am a GP by background with over 15 years experience. Um, and then I moved into the world of lifestyle medicine. Um, and what took me there? Well, it was just getting frustrated with the system in the NHS where I felt like I really couldn't get to the root cause of many of my patients' problems. Um, so that led me down the path of lifestyle medicine, and from there I've also become a transformational coach, um, and I'm also working in medical technology with an interest in clinical innovation. Um, so my main job there is building medical consultations, ensuring that they're safe and clinically robust. Um, and one of our biggest services is medicated weight loss injections, so things like Wigovi and Manjaro. And what I'm trying to also do is bring in my passion for lifestyle medicine into these consultations as well.

Max Lowery 2:50

Really interesting. That's exactly what we're going to be talking about today, but I'm just going to give a bit of context about why we're having this conversation. But basically, uh, I was in India uh on holiday over Christmas with um my wife Lila's family. Uh, Lila's half Indian, and it's my first time in India, and we were in the middle of absolute nowhere in um Kerala on a coffee plantation. And yeah, Mitriz, your friend was friends with one of Lila's cousins, I think. Something completely random like that, wasn't it?

SPEAKER_01 3:22

Yes, it there was quite a long kind of uh way to this kind of like how we met. Like there's lots of people in between. But what was really interesting, I was at one end of the table, you're at the other. Um, everyone knew that what I did on that side, I was a doctor working with weight loss injections, and you're on the other side as a health coach uh helping women with weight loss. Um, and it was almost like, oh, you should talk to Max. It'd be really interesting to see um how you two get on. So yeah.

How GLP-1 Drugs Reduce Appetite

Max Lowery 3:50

Well, I think what actually happened was Lilo basically chucked a grenade at me because she was like, Hey Max, what do you think about GLP one? And I was like, I didn't know. I was like, why are we why are they talking about that? What should I say? Do I need to be uh careful with what I say here? So then I kind of like uh was rather political, I think, with how I responded, um, because I had no idea why they were talking about that. Uh but then yeah, we obviously got chatting and realized there was a lot in common. So that's why we're here, ultimately, because um, yeah, it's great, always good to get different expertise on the podcast, and it'd be great to hear your professional opinion um on GLP1 um and um everything to do with that. So let's start off with could we get a really kind of basic kind of understanding of how GLP1 medication works in the body and how um it creates weight loss.

SPEAKER_01 4:42

Yeah, so it's a really good starting point. So, what are these GLP1 drugs that we keep hearing about? So the main ones that are available in the UK are Wigovi and Manjaro. And um what is GLP? It's basically a drug that mimics a hormone that we naturally produce in our body, and that's called glucagon-like peptide one. And it's normally produced in our guts, and it's after we eat, it's released into our system. And what does it do? It actually regulates our appetite. Okay, so what's happening is when we're introducing drugs that mimic these um hormones, um, it's staying in the body longer and having a more powerful effect on our bodies. So um, we're regulating appetite, that means that it's reducing hunger in patients, it's slowing down how quickly our stomachs are emptying, so we're feeling fuller for longer, and as a consequence, that um reduces cravings and it kind of cuts out that food noise that we hear about that people really struggle with. And also, on top of that, it also regulates blood sugar levels. And what's really interesting about these drugs, um, we know they're associated, you know, everyone hears about these wonder weight loss drugs, but they actually first came out to help treat type 2 diabetes because they were known to help regulate blood sugar levels, and almost as a side effect in these like cohort of patients that were being uh treated, they saw weight loss was like a side effect. And that's when the research began um and studies were done uh to see how they could be used safely in weight loss. So um what I want to say, and you know, my main message is that these aren't wonder drugs, they're basically aiding the biology and our natural biology in terms of regulating our appetite, and what they do help with is uh maintaining a calorie deficit for people struggling with weight loss.

Max Lowery 6:34

Yes, and this is what I find the most interesting because obviously lots of people who struggle with weight say they are in a deficit, and a deficit doesn't work. But in essence, you know, you know, calories doesn't work, it's too hard, it's my genes, it's my you know, it's my biology, etc. But in essence, the GOP ones are decreasing appetite, which means you eat less food and weight comes off. So it's not some kind of like magical mechanism, it's literally just making you eat less.

SPEAKER_01 7:09

Absolutely right. Yeah. So what like I said, it's working on the biology of regulating um our appetite, um, but it's not addressing other factors that are really important in weight loss as well. So it's it's it's one piece of a much bigger and complicated puzzle.

Max Lowery 7:25

Yeah, which is we're gonna get into that. But I think what I what the point I'm trying to make here is uh people who have tried to lose weight over many years often come to this conclusion that eating less doesn't work um and that a calorie deficit is not as it's it's complicated and it's not as simple as that, which is true. But in essence, the same fat loss principles apply of eating less food, you lose weight. So I think anyone, in some ways, it should be um optimistic for people to hear that because you know if you can address the root causes and and uh end up eating less, then you can lose weight rather than being someone who tells themselves that a calorie death doesn't work and and you know it's it's genes and metabolism, etc.

SPEAKER_01 8:11

Yeah, I completely agree with you there. I would go along with that.

Max Lowery 8:15

So what would you say are the main benefits of GLP1 medication, Mitra? And obviously, you know, weight loss is one of them, but are there what I'm interested is are there are there extra benefits that happen without weight loss?

SPEAKER_01 8:29

Yeah. So um another big area. So, yes, like you've mentioned, we know uh that weight loss is a massive benefit. So if we just go back to how effective these drugs are, and then you can it kind of leads on to the benefits. So um with drugs like Wigovi, we know that patients can lose up to 15 to 20 percent of their weight, and with Munjaro it's slightly more effective with 20 to 25% weight loss. So this has transformed the treatment of obesity. Um, and we're seeing um patients achieve meaningful weight loss, but not just that, improving their health outcomes, and that leads on to what other benefits GLP1s have. So we've already mentioned blood sugar control, so that's great for people with type 2 diabetes or who are pre-diabetic. Um, we've talked about fat reduction or weight loss, um, and the type of fat that's being lost, we know that it helps with losing visceral fat. So that's the fat around the organs, and that's particularly dangerous, and that's the kind of fat that we don't want. So it helps with that. Um, Wigovi in the last few years has been licensed for heart protection, so it can reduce the risk of cardiovascular events, so things like heart attacks and strokes, and patients who are at risk of that.

Max Lowery 9:41

And that is in absence of weight loss, just to know. That is, yes, if you don't lose weight.

SPEAKER_01 9:45

Yeah, that's really important. It's been shown that it's independent of the weight loss. Because I first thought, oh yes, if you lose weight naturally, it's going to improve your cardiovascular cardiovascular risk, but actually they've shown that it's independent of weight loss. Interesting. Um, and there's lots of other studies currently going on. Um, so we know um, and during these studies, they've already had profound results, so we know it's good for kidney health. So patients with chronic kidney disease, it can help protect against that and slow that down, if not reverse it, and that reduces the risk of kidney um failure. It can help um improve fatty liver disease, which is a huge driver of metabolic um disease, which we can talk about later as well. So, what is fatty liver disease? That's when we're depositing fat within the liver and around the liver. That causes a lot of inflammation and cellular dysfunction, and that can lead on to very serious conditions like cirrhosis, which is scarring of the liver, liver failure, um, and liver cancer. So it's going to help to show to reduce that whole pathway. It can help with sleep apnea, it can protect brain health, so uh reducing things like dementia and Parkinson's. So, this is a very exciting area that they're researching with GLP1s. It's been shown to have benefits for people with Parkinson's disease. Um and then broadly, it's also helping um patients with addictions and cravings, particularly with things like alcohol, nicotine, and opioids, which are um very addictive or painkillers. So um I've discussed a lot of areas of the body, but essentially what it's showing is like this anti-inflammatory effect and working with different receptors, um, which can actually benefit a lot of chronic conditions that we're seeing in the Western world.

Max Lowery 12:26

It's very interesting. I mean, because if it is just acting on hunger, why why are there all these other benefits happening at the same time? And particularly the addiction and cravings. Like, do they do they do we understand the mechanism of what's going on there yet?

SPEAKER_01 12:42

So these these haven't been published yet, these results. We're getting just um like the initial kind of results, uh like what they're seeing in patients, but I suspect a lot of it's going to be to do with the receptors that they're working on. So GLP receptors aren't just uh in the gut, they can be all over the place. So um I know for the heart benefits, there are specific ones in the heart that they're acting on. So I don't know the exact mechanisms, but I think that is to come our way. So these health, these multiple health benefits are coming our way, but also just to make you aware, there are plenty of other GLP1 medications coming out in the next few years. So it won't just be injections, they're going to be oral forms available and ones that actually act on more than just one receptor, not just the GLP1 receptor, there'll be other acting on multiple receptors.

Side Effects And Safety Screening

Max Lowery 13:30

Yeah, so really interesting to see the other benefits. And in some ways, you know, you could argue that it is a wonder drug because of all these other benefits. Um, but we'll go we'll go more into that later. Um, so obviously a very long list of benefits. What would you say the risk and side effects are, Mitra? What's the research say?

SPEAKER_01 13:52

Yeah, so um, well, what I see in clinical practice very commonly, first of all, are the mild side effects. Um, so when someone starts on these medications, we always start them on the lowest dose possible. It's not just that everyone goes on this high dose straight away. Um, obviously, this is after doing a proper consultation and making sure they're clinically eligible to have the medication. Um but we the reason we start patients on the lowest dose is because they can get the um side effects that affect the gastrointestinal system. So things like nausea, reflux, diarrhea, constipation, so almost like an upset stomach. Um but these normally settle within a few weeks of being on a low dose. And then only then, once they've settled, we would titrate patients up onto a higher dose. So that's what we'll see commonly. Um for patients that have been on it for a bit longer, we know fatigue can be a huge kind of like common side effect and hair loss as well, and that can be all related uh to almost under eating because your appetite's being suppressed. We know, and we're increasingly seeing studies that are showing this as well, um, that patients are at risk of nutritional deficiency. So that could be leading to these symptoms. We also know that hair loss is common when patients lose weight rapidly as well. Okay, so these are more of the milder or common side effects that we see that we can manage. Um, but we also warn patients about serious side effects. So the one that's always making the headlines, things like um acute pancreatitis. So this is like a sudden, severe inflammation of the pancreas, um, and it's a medical emergency, and in rare cases it can be fatal. So it's really important to know the symptoms. So we're always warning our patients like if they have anything like severe abdominal pain radiating to the back, associated with a fever or vomiting, anything like that, um, they should stop the drugs immediately and contact a healthcare professional. Um, there is risk of kidney damage if patients are becoming dehydrated with some of the side effects. So it's really important to keep up fluid intake. And if you're vomiting or not tolerating fluids, you again you need to get in touch with your doctor. Um gallbladder problems, so you can be at risk of increased uh gallstones or inflammation of the gallbladder, and this is a risk not directly from the medication, but it's a risk of rapid weight loss, and that can cause these kind of side effects. And lastly, anaphylaxis, and that goes with any medication. If you're allergic to it, you could have a severe allergic reaction to it.

Max Lowery 16:25

And is there is it just kind of pot like whether or not you're going to get these side effects or not?

SPEAKER_01 16:32

Um so what we would do when we're doing a consultation, we take a thorough medical history. So, for example, with pancreatitis, if I have a patient who's told me they've had pancreatitis in the past or have risk factors for pancreatitis, or currently have mild pancreatitis or chronic pancreatitis, we wouldn't even be prescribing the drugs. So we're minimizing the risk base anyway. Also, gallbladder disease, we ask about that as well. Um, things like alcohol intake. So there's lots of various factors that we take into consideration before even prescribing to help minimize the risk of side effects.

Muscle Loss And Metabolic Health

Max Lowery 17:10

And there's obviously another big problem which is getting more uh kind of publicity, but it's not really um, you don't read this on the on the label in the in the risks, is the uh issue with muscle loss. Can we talk a bit more about that?

SPEAKER_01 17:27

Yeah, so a really important point. So we know um, or studies are also showing as well that patients can lose um muscle whilst losing weight. So what when you start this journey, your aim isn't just to lose weight, you want to lose fat and preserve muscle. And studies are indicating that up to 40% of the weight loss during treatment with these GLP ones can be muscle. Okay, so this isn't for everyone. 40% up to 40% of the total weight that they've lost, which is a huge amount. Um and when we talk about weight regain, which I think we'll talk about later as well, like when you stop the drugs, we're not sure if patients are regaining fat and muscle or just fat, and that's a bit worrying as well.

Max Lowery 18:12

Well, I mean, realistically, unless they are doing strength training, resistance training, exactly, and eating a decent amount of protein, why would they have a muscle?

SPEAKER_01 18:22

Yeah. So exactly that, and it the reverse works as well. So if you're rapidly losing weight without eating enough protein or doing any kind of resistance training, you're pretty much guaranteed to lose the muscle. And the other point is as we get older, we naturally lose muscle mass as well. Okay, so there's a few factors against it. So that's why it's really important at the start of any journey that patients are well aware of what kind of nutritional um advice they need to be um uh following and what kind of exercise they need to be doing as well. It's not just a case of taking the drugs by themselves. Um, and just to go a bit more into about in terms of why is muscle so important, um, it's almost like I call it metabolic insurance policy and why is metabolic health important. So, muscle protects your metabolism. And you know, what is metabolism? We throw this word around a lot, but I'm not sure how much people actually understand by what it means. So, metabolism is actually how efficiently we use food or fuel and convert that into energy in our body, and that's reflected by how energetic you feel, how you feel generally your well-being, but we can also monitor it with certain biomarkers as well. So things like your blood sugar, um, your cholesterol, triglycerides, which is a bad kind of fat, you don't want too much of your blood pressure. Um, if any of these are raised or out of range, these are indicating metabolic dysfunction. And another good one is your waist circumference as well, so that abdominal fat. Um, we want to reduce that as much as possible. So muscle protects your metabolism. And how does it do that? It acts like almost like a sponge in the body. The more muscle you have, um, the more effective you are at absorbing the glucose that's circular circulating around your body, which obviously gets released once you've eaten something like a meal or something. So if you're improving the absorption of glucose and it's going to the right place and being used as energy, then you're reducing your risk of developing metabolic like disease, things like um type 2 diabetes, and that reduces your risk of cardiovascular disease. So there's like a kind of a ripple effect down the line. And lastly, with muscle, we know it's so important in longevity. So we it's almost like your body's armor, it's helping to support your joints, it's preventing injury, and um, muscle mass is one of the strongest predictors of how well you'll age. So um, so in short, when you're losing weight, yes, you want to lose the fat, but you want to keep as much muscle as possible, if not increase your muscle mass, not only will you look and feel better, but your body is just going to work that much more efficiently and you're gonna have better health outcomes.

Do Benefits Outweigh Risks Long Term

Max Lowery 21:07

And this muscle loss thing happens with any quick fixed diet that you do. If you if you go and um lose a lot of weight using GLP1 or just kind of doing being very restrictive, it's the same thing. The muscle loss happens. And you know, as we were talking about earlier, this is particularly detrimental for everyone, particularly people as they get older, but for women, even more so because of the changes of the perimenopause and the menopause, uh, even more muscle loss happens, bone density issues. Um, so yeah, we want to retain as much muscle as we can, which is why gradual weight loss incorporating lots of protein and um uh resistance training is so important. So just before we get into like the kind of the weight regain stuff, I guess, Mitch, it'll be good to hear from you, in your opinion. Do the benefits of OZEMPIC outweigh the risks?

SPEAKER_01 22:03

So that's not a straightforward question. It's um I mean I was gonna come to this almost like a conclusion at the end, but I don't think um, oh, just to clarify as well, Azempic is only licensed for type 2 diabetes, we're using with OVM and Jara for weight loss. So when we're talking about these drugs, they're literally just one part of the equation. Um and for me, it's using them together with lifestyle changes and behavioural support together, which is what's going to lead to sustainable weight loss. So if you want to lose weight really quickly, yes, these injections are great just in the short term. But if we're looking at the long term about how you're going to maintain that weight loss, especially if you know you've got side effects. To the medications, or you can no longer afford it. Because remember, most people in the UK are getting these um injections privately, so they're paying out of their own pocket and they're not cheap, and the price of these injections fluctuates a lot. So if you're look, yeah, so if you're investing in this weight loss journey, you've really got to think: is this just a quick fix just temporarily, or do I want a long-term sustainable plan that, you know, I want to make habits that last a lifetime? Um, and if that's what you want, then no, I don't think Wigovi and Manjaro are the answer alone. And they can certainly help a certain cohort of people who have certain uh medical conditions or have a certain BMI, but they're not going to work in the long term without these other changes.

Weight Regain After Stopping Injections

Max Lowery 23:41

Which we'll go into. Um, yeah, so Mitch, it'd be great to talk about some of the studies that have come out recently which point to uh essentially the weight regain that happens when you stop taking the medication. Um, could we yeah, could we go into detail about that, please?

SPEAKER_01 23:58

Yeah, so you're right, all these studies have come out recently, um, just showing um how much weight regain patients um can expect to put on um a year after stopping the medication. So we've already seen this in practice as well. Nearly half of patients stop the medication within a year of starting it. And again, I mentioned earlier on there could be all sorts of reasons, whether it's they're not tolerating it because of side effects or costs, it's just simply not viable to keep on going.

Max Lowery 24:26

What is the current cost meter?

SPEAKER_01 24:28

Oh uh well, it it varies depending on where you're getting it from, but you could be spending up to two to three hundred pounds a month um depending on which um tab uh which injection you're taking. And it's dose-dependent as well, the higher the dose is the more expensive it gets. So um, but that that changes over time in terms of the price. So, yeah, it's not a cheap drug, it's a real financial investment as well. Um so we mentioned half of patients stop it within a year, and actually three quarters have stopped after two years. So this is a big chunk of people who are starting this weight loss journey that have then stopped. And what we've seen on average are people who have stopped these medications without any other lifestyle changes, on average, are putting on up to 60% of the weight that they originally lost. Okay, which is a huge amount. And it seems to plateau after a year to around 75% of the weight loss is regained.

Max Lowery 25:29

But they have And as we said earlier, sorry, and as we said earlier, that weight could be just fat and not muscle. So you've lost this weight, which would have included fat and muscle, but then you put the weight back on, and maybe you end up back at the same weight that you were before, but you've got less muscle. And that is incredibly detrimental for all the reasons that we described earlier.

SPEAKER_01 25:49

Exactly. And that is, yeah, that is a reality, especially if you're not making um changes that we discussed before. So when patients come to me, when they're coming to the end of their journey or they're reducing their doses, because we don't like to just stop them just like that. Say someone's on a high dose of Manjaro, we wouldn't just suddenly stop it, we would like to taper them down. So they're getting used to that food noise coming back, giving them time to implement these lifestyle changes as well. Um, so what I often describe it is like GLP is at like a break on our appetite, if you think of a car break. So um we're feeling fuller sooner, we're eating less, we're losing weight. But as soon as you stop these drugs, um you're essentially taking your foot off the brake, and that's what could lead to this rapid weight regain if you haven't got any like good lifestyle habits to fall back on. Um, so what I wouldn't say is that the drugs fail. Just because you've stopped them and you've regained the weight, it means that it's failed. What's happened is we've removed this support, which is suppressing your appetite, without changing the lifestyle habits of our patients. And that's what's failed, that system's failed rather than the drug itself.

Max Lowery 27:00

Yeah, and in essence, I don't know what you think about this, but if GLP1 is the only thing that you're doing, then it's basically the same as every other diet you've ever done. So it only works when you're doing it. As soon as you stop doing it, the weight comes back on. Um, so it is, you know, if you don't change anything else, then it is just another quick fix and the weight will come back on.

SPEAKER_01 27:24

Yeah. And the studies have shown that, but we're seeing that in real life as well. Um, and that's how we counsel our patients.

The Real Roots Of Overeating

Max Lowery 27:32

Well, so am I now as well, to be honest. Um, I'm having more and more conversations with women who have lost a decent amount of weight taking GRP1 medication, and then uh they've stopped taking it for a variety of reasons. Either it wasn't having the same effect, they couldn't afford it anymore, or there were side effects, and the weight's coming back on. Uh, and obviously, you know, you're you're dealing with more patients than I am, Mitra. But um, you know, just in my you know, small sphere of influence, um, I'm getting, you know, I would say this year in particular, um, it's really like every single week I'm getting at least five women who are inquiring uh with this with this issue. Um so there's no question that these drugs help you lose weight. That's not what we're discussing here. Like they clearly do. I think the question is what happens when you stop taking it if you don't change anything else uh with your mindset, your emotion, you know, the root causes, which we'll go into. Um so yeah, it'll be, you know, you said right at the start of this conversation, Mitra, you said you were frustrated with uh the NHS and not being able to address the root causes of people's weight gain and not being able to kind of help your patients uh the way that you would like to. Could we talk more about that, please?

SPEAKER_01 28:52

Yeah. So um, yeah, so I think we've already highlighted that these drugs are helping with the biology side of things in terms of uh why patients are putting on weight. Um, but one of the biggest misconceptions is that weight gain is purely about just feeling hungry uh physiologically, and it really is, and it's much more complex than that. Um so first of all, I think uh what we see with patients is actually what's actually driving this overeating, and often it can be emotional dysregulation, so it could be driven by things like stress, boredom, feeling lonely, anxiety, depression. Um, and food is almost used like a coping mechanism. It's quick, it's accessible, and it works in the short term to give you that kind of dopamine effect to kind of blunt out these other emotions. And then on top of that, when you're in an environment where these like highly desirable um ultra-processed foods are so easily available, you can order it online, you can get it from your corner shop, any supermarket. Um you're battling that side of things as well. You're in an environment where all this is readily available. Um, and what's ironic is that these kind of foods are also available in place safer spaces that I think should be safe spaces, like schools and hospitals. As a junior doctor, we had the worst diet because you'd have those dispensing machines with like crisps, busy drinks, sandwiches, whatever. So you know that that really frustrates me, and it's something that we really haven't tackled well. Um, so you've got this these emotional drivers, you've got the environment that's making it more difficult to eat healthily. Um, then moving on to things like habits. Um, so patients have these ingrained habits that they've not just developed over years, but usually decades. Um and what happens with habits, they become automatic over time. So you're not making a conscious decision when you're eating. So maybe you've had a really stressful week at work, and your reward at the end of the day is your glass of wine or two and making it a large one. You know, it's very easy to increase that. Or having um a nice, you know, luxurious meal at the end of the day with a dessert, you know, it could be anything, but these build up over time and it becomes a habit rather than a conscious decision. Um, another thing that's overlooked a lot of the time is how um our nervous system is responding and how we use food to help regulate that. So if someone's chronically stressed, um, you know, they've got busy family life, they're in a high-flying career, and they're trying to manage aging parents, you know, they've got pressures from all sides. You're just running on empty, and then you've got this stress driving it at high cortisol levels. Um, it can affect your sleep. We know when you have poor sleep, you tend to reach out for like high carb foods the next day, things that will give you instant energy. So you can easily lose.

Max Lowery 31:57

Oh, yeah, go through it. Yeah, um, so you know, this is really uh important to hear, right? Because diets, GLP1, do not address any of these things. Uh, and for some people, the emotional eating might decrease when they're on GP GLP one. But I've I've spoken, I don't know about you, Mitra, but I've spoken to many women who are on GLP1 and they are still emotional eating. It might not be uh as much food as it was before, but they are still craving the food. And this is because, as you said, it's oft like what I see with my clients is the me the meal times aren't necessarily the problem. They know what they need to eat, they know they need to more protein, they've they follow every Instagram influencer, they've read every book, they know they need to eat more fiber, and a lot of them like eating healthy, you know, balanced meals, but it's what happens in between the meals, um, when stress happens, when life happens, when they're feeling completely dysregulated within the nervous system, then because there's been a habit loop that has been created over time of associating negative feeling with uh using food to feel better, when you have those, you still have those feelings when you're taking GLP1 medication, so you can potentially still crave the food. And of course, if that's happening whilst you are taking GLP1 medication, of course, it's going to come back with a vengeance when you stop taking it. So this is completely missed out. And in my experience, is really one of the main reasons why women struggle to lose weight. And worse than that, they end up in the situation where they've done all these different diets which have never addressed this, and they come to the conclusion, I can't do this. It's my willpower, it's my motivation, there's something wrong with me. When in reality, they've never actually addressed this root cause.

SPEAKER_01 33:42

Yeah, absolutely. Um, and that's why the work that you do is so important because you're almost addressing the other side. So we've got the GLP ones, which yes, we can prescribe safely, but they are not going to change these underlying um behaviours or beliefs. Uh, there's a lot of belief systems as well, like the identity that um patients have with um their eating habits. So someone who genuinely believes that I'm, you know, they identify as I'm someone who struggles with food, I can't control myself when I open a packet of biscuits, I have to have two packets of crisps, not just one.

Max Lowery 34:18

Self-fulfilling, isn't it?

SPEAKER_01 34:19

Yeah. And what we find is psychopsologically, that's so powerful. If you start believing that, your behaviors will follow that pattern as well. So you may be on your GLP one for a good year and come off, but if you don't address those psychological traits, then that's going to come back as well. Well, it's probably there as well, still whilst you're on the medication, but it'll come back even stronger once you stop the medication because your appetite isn't suppressed anymore. So yeah.

Using GLP-1 As A Window

Max Lowery 34:47

I also, you know, I guess I'm probably slightly biased towards not taking GLP1 medication um purely because of I guess my ethos and how I've helped people over the years. I'm completely aware that obviously for some people it's a life life-saving. You know, I've got a one of my closest friends, um, his father had a very, very bad stroke, and he's like been bedridden for four years or something or more. And he has put on weight through this period, which means his rehab is even harder because he's lost all this muscle. Um, uh, he's put on weight, and because he's heavier, he it's even harder to improve. And I can I can see he's definitely a candidate for GLP one because it would uh help him lose the weight and then get back into the rehab. But I guess for the for the average person, um I feel like it's a bit of a quick fix. And really, these these issues that we're talking about, the identity, the mindset, the limiting beliefs, these impact other areas of your of your life as well. And if you just go and take GLP1 medication and you lose weight, you're still gonna have loads of problems in your life which are being impacted by these root causes. So I feel uh like addressing these root causes uh is not just important for weight loss, but actually important for you being the best version of yourself and a healthy, you know, happy uh individual.

SPEAKER_01 36:11

Yeah, absolutely. So um another way that I try and frame it to patients is um so, like you said, we know these are really effective drugs. You're going to lose the weight as soon as you, you know, you start taking them and tolerating them. But what I try and get patients to see is that actually it's a window of opportunity. Whilst you, if you do need these medications, say you've got certain health conditions or your BMI is above a certain range, use that time whilst you're on the medications to start looking at what else you can change, the habits you can change. So it's a window of opportunity where you're not battling with the food noise, and you can then focus on all the lifestyle changes we've just talked about and the behavioural change and psychologically addressing what needs to be addressed there. So um I keep repeating myself, but actually, I think for the right person, the combination of GLP1 with all these other changes is going to give you the greatest result in terms of sustainable long-term weight loss. Um, on the other side of the coin, there are going to be patients who aren't suitable for GLP ones, and actually they do need to just address these lifestyle issues and behavioural change in the long term, and that's the path they're going to go down. So it's not like a one size fits all. We're all humans, we're all individuals, and we're all going to need bespoke kind of um treatment. And actually, the future of that of GLP1s, I can also see is that actually you could actually have patients on much lower doses of GLP1s just to take the edge off the food noise rather than these high doses that we've got at the moment. Um, and yeah, so I think um there's a lot more to come this way, but it's never going to be that everyone needs to be on a GLP one who's overweight. I'm not saying that at all to certain people.

Max Lowery 37:56

And I again I probably have a bit of a negative prejudice here. Um but I guess in your experience, how many people who are applying uh and speaking to you, inquiring about taking GLP1, are actually genuinely interested in changing any of the other stuff?

SPEAKER_01 38:16

Yeah, um, a really good point. Unfortunately, I wouldn't say it's the majority. Um so we can give as much information as possible in terms of um what you need for sustainable long-term weight loss. Um, but unfortunately, once the patients have got this information, it's up to them to make an informed decision about um how they want this weight loss journey to work. And I think part of the problem is also um certainly in the UK, we don't have this ideal model of care set up that's easily accessible to everyone where you know they go to one person where they're going to get their medication. Um we can give the counselling, but also actually having the people, the nutritionists available, having um the PT available, or whoever it might be, or um having a health coach available, you know, all in like a whole package of care, where actually you're discussing what this whole journey is going to look like. We can do it whilst you're on the medications, what that journey might look like. But what's um being missed out, I feel, or there's a real gap at the moment, is actually as patients are coming off these medications as they're approaching their ideal weight. Um what does life look like after that? And that's where I think we can do a lot better. And we need, you know, there's room for improvement for sure.

Max Lowery 39:38

So it sounds to me like what's ironic is most people who are going to take, well, I don't know, this is me again interpreting, and I have my my prejudice, my bias, but most people who are looking to GL to take GLP ones are in essence looking for a quick fix, because it is a quick fix, right? Um but actually and in order to do both, to do the GLP1 and have do all the focus on the root causes, there needs to be a bit of a mindset shift and to be open to that. But if there was a mindset shift, then maybe they wouldn't need to take the GLP one medication because they'd be focusing on things that are sustainable and long term.

SPEAKER_01 40:19

Um I think again that would work for a group of patients. I don't think that would work for everyone because you think about patients, say they're morbidly obese, they've got a BMI of over 35 or 40. With that, there's certain health consequences as well. It's going to affect your mood, everything. So I I think in those kind of patients, I would see GLP1s just giving them that window of opportunity where actually the food noise is quiet and down, and it's got all the anti-inflammatory effects and all those other benefits on their health at the same time. It's not just weight loss because we talked about all the other benefits it can have. Um and use that window of opportunity to do all the things that we've just discussed. Um you're right, in an ideal world, if everyone had this one-to-one care where we could just address everything lifestyle, psychological, environmental, social factors, um, yes, you could do that. But how many patients do you think you can realistically achieve that with our current system?

Max Lowery 41:23

Yeah, yeah. And I think I should have added more context. Like when I said what I said, I didn't mean people who are in, you know, ob morbidly obese about to die. I think it was more the clients that I'm generally dealing with, um, you know, women uh over the age of 40 who have been dieting for most of their life, they've maybe got kind of, you know, 10, 20, 30, 40 pounds to lose. Um, because really look, part the the uh and I I guess the reason I'm pessimistic about this is because the hardest thing that I have, and this is why the podcast has been so useful, is getting people to realize that they need to address these root causes instead of instead of just looking for the next nutrition plan and the next workout plan. And I would say that's so even once they're bought into the program they've signed up, in in the initial few weeks, there is still a lot of fear of like I I need to be doing more. What do I need to be doing with my nutrition? Like, how many calories am I supposed to be eating? And it takes a long time for for for them to to for the penny to drop for them to realize that, oh, actually, it's it's me shifting how I process my emotions, it's being kind to myself, regulating my nervous system, shifting my limiting beliefs, getting out of all and nothing, um, consistency over intensity, uh, and learning to be consistently imperfect. And these things don't sell on on Instagram, right? They the the nuanced long-term approach um is difficult to sell and difficult to package. Um, so yeah, I guess I'm just kind of uh pessimistic on the uh the idea on on and helping people realize that you know they need to address these root causes because it it's hard in a very different way. You know, it's it's not hard in terms of restriction, deprivation, cutting out your favorite foods, like weight loss hard. But to face limiting beliefs, to shift your identity, to shift your relationship with food, those things can be very hard in a completely different way.

SPEAKER_01 43:23

Yeah, absolutely. And it's hard work, like you're just saying, it's investing in yourself and it's recognising that these need addressing as well. And I think you're right, it doesn't make headline news. It's not like sexy, you know, headliners, is it? But I think having conversations like you and me are having today is fantastic, and actually getting people from different um kind of uh disciplines in weight loss altogether and having this bigger conversation is really important. Um, and as these studies come out more and more, like the longer these weight loss injections are around, I think that message is only going to get stronger and stronger when they realize as soon as patients are coming off these medications without making any other changes or addressing um uh other issues, then the weight is going to come back. And then these, and it's very clear that these injections are not an answer alone. They need to work alongside other changes.

Why The System Pushes Quick Fixes

Max Lowery 44:18

And um I'm interested and curious. So when you're a GP, what what frustrated you the most about um because you you described earlier you couldn't help the patients in the way that you wanted? Like, what specifically was did you find frustrating about that kind of um that dynamic?

SPEAKER_01 44:33

Yeah, so um going back many years ago when I was NHS GP, I think my biggest frustrating factor was actually having 10 minutes with a patient. How much can you resolve in 10 minutes when you've got patients coming with chronic conditions, um, not just physical conditions, but mental health as Well. I wasn't getting to the root cause of patients' problems. I was almost practicing what we call defensive medicine. So we're trained in such a way, yes, we can recognize disease, diagnose it. And then when it comes to treatments, there's all sorts of drugs that we have at a hand. So it's always always like dishing out lots of pills to try and help these patients. But I just felt I was masking a lot of um underlying issues. Um and I think also personally as well, I got quite stressed out in the job I was doing. Um I think I was burnt out, very young children at the time, and just questioning why I was doing this, and my own health declined. And that's when I kind of grew an interest in lifestyle medicine, and it was all about finding the root causes. So you may have heard of um Rungan Chatterjee, he was a big uh influence. Um at the time he had that programme Doctor in the House. So he was a practicing GP like me in the NHS, and I've seen this guy going into people's houses with common conditions that I was seeing every day, like migraines, backache, depression. And then he was just seeing how they were living their life from the moment they woke up to the moment they went to sleep, which is what we don't get insight as a GP, yeah, in a in a 10-minute consultation, and actually really identifying which lifestyle pillars they need to address. We've talked about it before: nutrition, movement, stress, sleep, harmful substances, really looking at you know where the imbalance is and how a patient can actually almost um take full autonomy of their health and actually make those changes themselves, which would actually reduce the need to go and see your GP for 10 minutes to have some prescription for something that's really not going to address the root cause. So that was really inspiring at the time. I made some lifestyle changes of my own that I found were really effective and powerful. Um, so that's kind of yeah, that was my kind of route out of there and led me to where I am today. Um but I think I've seen how powerful it has been in my life, in my um family's life. Um, so my husband was um diagnosed as diabetic a few years ago, and with lifestyle changes, we managed to reverse that. You don't need to just go on to metformin because you've been diagnosed with diabetes. You can there's lots of other things you can do. So, and that's where I think I get my true satisfaction. I didn't become a doctor just to mask chronic disease. I I want to empower my patients to make changes that are long-lasting and powerful and meaningful.

Max Lowery 47:30

Yeah, and I think that's kind of um, you know, you hit the nail bang on the head there. And I think this is kind of my issue with uh GOP1, I guess. It's not necessarily the issue of GOP1, it's it's that it's a it's kind of a symptom of a broken system and a broken food environment, uh particularly in the West, of there's no awareness or knowledge for the average person on lifestyle changes and what they they need to do. Um, you know, you have to have a certain amount of privilege, I guess, to in order to, you know, be even have the headspace to to go and look those things up or to be able to invest in a coach, you know, like myself, or you know, to work with someone like yourself as a lifestyle uh medicine doctor, functional was it, lifestyle doctor. Medicine doctor, sorry. Um, and so you know, obviously big pharma uh come in and like, well, we don't need to change any of these things. We can just, you know, mask it with drugs. Uh and you know, this this obesity epidemic is is uh is on on the increase, and we can get everyone uh on drugs for the rest of their life, basically, which you know means big profits for them. And I think all the meanwhile, nothing really is changing within the system, within the knowledge, the you know, for in schools, um, uh GPs being able to have more time will be able to help uh their patients in in ways that actually address the root cause of the problem. So, yeah, it's it's um I can completely see with in an ideal world using both, you know, using lifestyle changes and GLP1 medication, but I'm I'm concerned that for a variety of reasons, that's not going to happen. Um, you know, for a small percentage of people it will, but on the whole, it's just gonna be, well, I don't need to change anything, I can just take this medication and you know, big pharma profit off it, and you know, individuals have to pay for it.

SPEAKER_01 49:22

There is that, but I think if we look at the studies that we were just discussing earlier on about the weight regain, I think patients are going to walk away realizing I can't just take these drugs because if I'm gonna put on back 60% of the weight that I've lost, I've just wasted a whole load of money and time and put up with side effects unnecessarily. So I do feel things are going to change. And remember, these drugs have only been around for weight loss for the last two years. We're coming into our third year. So we're very we're right at the beginning, even though these drugs have been around um for nearly a decade for things like type 2 diabetes, for actual weight loss, it's only come in in the last two to three years. So it's only now that these conversations are starting. So we medically we knew that at the beginning, if you're going to stop these drugs, more than likely these weight you're gonna gain weight unless you make certain changes. But I think as more and more patients start coming off the drugs, and we know a high percentage do, like I said, three-quarters are off it after two years, something's got to click that actually that wasn't the answer. Something else needs to change as well. So I think we're very early on in this GLP1 weight loss journey ourselves, um, as medics, as coaches, just seeing how that's going to influence patient behavior. And they're gonna realize it's not a quick fix, it's not like an Amazon service that I'm getting that drug, you know, so easily and that weight's gonna stay off. Um, the studies are showing it doesn't simply if you don't do anything else.

Max Lowery 50:51

So yeah, I think you're banging on because as I said earlier, that's exactly what I'm seeing, to be honest. Uh, as I said, this year it's like between three and five uh women contacting me saying that they have come off GLP1 medication and the weight's come back on. So um, yeah, I guess um people will find out for themselves that unless unless they have no side effects whatsoever and they can afford to pay for it for the rest of their lives, they will realize that if they don't change anything, the weight is gonna is likely to come back on.

SPEAKER_01 51:24

But the studies have already shown that's the minority.

Key Takeaways And Where To Follow

Max Lowery 51:26

There's not gonna be many patients doing that. No. So yeah, Mitra, what would how would you want to summarize this conversation? What is one thing that you would want the listeners to take away?

SPEAKER_01 51:36

Um, so I think the my key message would be that um, yes, GLP1 medications are a really powerful tool. And for some people, they can actually genuinely be life-changing if taken in the right way, uh, with the life right changes. But uh they are not a cure for obesity alone. Um so uh I think like we've discussed, obesity isn't just a biological issue, it's influenced by behavior, psychology, environment, and habits that develop over time. So we can't just focus on the biology of it all. We need to address everything else. Um so yeah, so essentially on their own, GLP medications are not enough to solve the obesity crisis in the long term.

Max Lowery 52:24

Thanks for sharing. I think, yeah, you again highlighted a very good point, uh, which I kind of see with in conversations I have with women every single day, is that they're always looking for the one thing they need to fix. Like they're like, oh, there it must be this one thing. And in reality, it's always a combination of things. It's holistic and that's kind of what's going on here, isn't it? It's like, okay, well, let's uh uh address the biology and and hope that fixes everything. And I think in reality, you know, as we've discussed, it doesn't. Um so yeah, thank you so much for joining us today, Mitra. Um, hopefully you will come back again soon. And um, I guess would you want to share how people can get uh stay up to date with what you're doing and get in touch with you if they wanted to?

SPEAKER_01 53:06

Um you can follow my Instagram profile, uh Dr. Mitra Dutt. You can contact me there, DM me there, and I'm on LinkedIn as well. So you can share my details.

Max Lowery 53:16

Yeah. Yeah, I'll link those beneath the show notes. Uh but yeah, thanks again, Mitra.

SPEAKER_01 53:20

Thanks, Max.