Wellness Curated

Weight Loss Drugs: What No One Tells You About Ozempic, Wegovy, Mounjaro, and More

• Anshu Bahanda

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Are weight loss drugs like Ozempic, Wegovy, and Mounjaro the miracle breakthrough for obesity and metabolic health—or a dangerous quick fix with hidden risks? In this powerful episode of The Wellness Algorithm with Anshu Bahanda (Wellness Curated), we cut through the hype, celebrity buzz, and TikTok trends to uncover the real science and long-term effects of GLP-1 medications.

Joined by leading experts—

  • Dr. Renu Joshi, endocrinologist on the frontlines of obesity and metabolic medicine
  • Rebecca Maas, holistic health practitioner and naturopath (author of the upcoming Whole-Body GLP-1 Protocol)
  • Dr. Raj Ragoowansi, renowned plastic surgeon specializing in post-weight-loss transformations

Whether you’re considering GLP-1s, already taking them, or simply curious about the wellness conversation reshaping 2025, this episode gives you the science, safety insights, and balanced perspectives you need.

✨ Listen now to learn whether weight loss drugs are the future of wellness—or a medical gamble.

For a transcript of this show, go to https://wellnesscurated.life/weight-loss-drugs-what-no-one-tells-you-about-ozempic-wegovy-mounjaro-and-more-2/

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Anshu Bahanda: Weight loss drugs. Ozempic, Mounjaro, Wegovy. Everyone's talking about them. Celebs swear by them. TikTok glamorizes them. Doctors warn about them and you may be wondering, are they a miracle or a medical gamble?

Today we're going to cut through the noise, the myths and the judgment to uncover the truth about weight loss drugs and what they really mean for your body. This is Anshu Bahanda from Wellness Curated. Welcome to the Wellness Algorithm where science meets self care.

Today we're unpacking one of the biggest wellness stories of our time. Weight loss drugs. We've seen them all over TikTok and in celebrity headlines. Ozempic, Wegovy, Mounjaro. They promise up to 20% body weight reduction and they're shifting how we think about health, beauty and even aging.

But behind the hashtags are the real questions. How do they work? Are they safe? And what do they mean for our relationship with food, with body image and wellness long term? To explore the science, safety, cultural shifts and emotional aftermath.

I'm joined by Dr. Renu Joshi, endocrinologist On the frontline of metabolic medicine, Rebecca Mass, holistic health practitioner, naturopath, who's currently writing a book about her whole body, GLP1 protocol. And Dr. Raj Ragoowansi, plastic surgeon, who's seen the physical and emotional aftermath of rapid weight loss. Let's begin with welcome to the chat and thank you for being here with us today. 

Dr. Renu, I'm going to start with you. For listeners scrolling TikTok or Instagram these medicines can seem like magic. Renu, what are you seeing with your clients and patients who are on GLP1? Do they really work like magic?

Dr. Renu Joshi: I would say just two things about obesity before I talk a little bit about their magic. So one thing we have to realize that obesity is a combination of lifestyle, exercise, genetics and many more.

So for the most time, for the longest time, we have said, oh, you don't eat well and you don't exercise and you become obese. Yes, there's a lot to that. But obesity is considered now a disease and not just a condition. So we have to think about it that like, we have diabetes, we have high blood pressure, we have obesity as a disease and that is why it has an ICD code and that's why we worry about it.

The second most important part about obesity or weight loss, that it's a marathon, it is not a sprint. So it's a lifelong journey where you actually have to worry about your lifestyle throughout your life. Not just for a few months. Now that brings us to the magic of GLP1.

And I would say that in the last 10 years, when I had chaired the obesity department at UPMC, that these drugs have really brought to us a very new way of treating disease of obesity. And in the clinical trials have shown that they can actually reduce the weight by 20, up to 30%, which is a very rapid weight loss over six months to one year to even two years.

So in real market, post market data, when I see my patients, I do see these drugs work much better than any other obesity drugs we have used in the past. And I've been doing this for 25 years, so I've used a lot of obesity drugs.

But the amount of weight loss we see with these drugs are much more and phenomenal. Important part to know is that when you lose the weight, not only you lose fat mass, but you also lose muscle mass. And 25 to 30% of the muscle mass is also lost because the weight loss is very rapid.

Yes. It's not like clinical trial, so you see somewhere between 10% to 15% but, but it's still very, very significant and I cannot forget to say the importance that lifestyle change, diet and exercise has to be on the crux and is very important when you use these drugs.

AB: Thank you for that. Thank you, Renu. So Rebecca, in just two years, Ozempic, Mounjaro, Wegovy and many, many other drugs have gone from being niche diabetes treatments to viral obsessions. What combination of celebrity use, influencer testimonials, social media buzz do you think has created this tipping point and this obsession, this global obsession?

Rebecca Maas: You know, of course celebrities and influencers helped make these drugs viral. But I think the real tipping point has been the perfect storm of timing and unmet needs. Millions of people are struggling with metabolic illness, weight obesity, and they just haven't been able to receive traditional approaches to give them substantive answers.

As Renu said, this is a marathon, this is a lifelong battle. So the buzz has been amplified, I think by the demand, again, these unmet needs without any real framework for long term success, no nutritional support, detox strategies, guidance for behavioral change, mindset change, we have not had any substantive approaches.

So looking at this from a, holistic lens, we don't want to use this just as a quick fix, but as a chance for lasting transformation. 

AB: Very interesting because I've got questions to do with that later. But for the moment, Dr. Raj, I want to ask you, from your perspective, what are the biggest misconceptions that people, when they first hear about these drugs that they have, especially around, their bodies, what do they think or don't think is going to be the effect of taking these drugs?

Dr. Raj Ragoowansi: I've been, a plastic surgeon, two very important multidisciplinary teams for the last 20 years. One team is, is a team that is involved with weight loss surgery, I.e. gastric banding, gastric bypass, to lose weight.

And the other team of recent, in the last six, seven years, has been endocrinologists who I work with closely, who have been administering these weight loss injections. When the patients have reached a steady state in terms of weight, then they are sent to me for plastic surgery.

And when I interview these patients, I go through their life history first, right from when the obesity started, how they managed it, pre treatment and then treatment with each and every patient. What I find a common thread is that they do not appreciate what their body will look like after weight loss.

Now, with the gastric procedures, especially stapling, I saw gradual weight loss with sleeve gastrectomies. The weight loss was a bit more dramatic. But I have to say with Mounjaro, which I've been seeing for the last four or five years, the weight loss is up to 20, 25% of body weight within six months, one year.

And therefore, that deflation of weight and its consequences of skin and soft tissues, patients do not appreciate because they are primarily focused on reducing the fat mass in their body. What is not appreciated, as Renu pointed out, is a loss of muscle bulk and loss of skin elasticity.

So to answer your question, the misconception is that they do not appreciate what their bodies will look like following such rapid weight loss. What they have in mind is just weight loss means I will look slimmer, I will look sexier, I will look thinner, I will look leaner.

And that is not the case because these weight loss drugs do make you lose weight very quickly and the body can't catch up, if you like. And the consequences are loss of muscle mass, loss of skin elasticity, and stretch marks.

AB: Interesting, very interesting. Studies show, you know, you can lose up to 21% body weight. There can be dementia, benefits. People can reverse biological age. How sustainable are these results especially? I mean, can you come off these drugs, or is this something that's lifelong use? Other wonders I know of these drugs, as great as people say they are. 

RJ: One of the wonder, we have realized that how quickly the weight loss happens. And the drugs are very, very, prompt in improving diabetes and other things. The Dementia data? Yes. There's at least three or four papers who have now come out to talk about that. Actually, there's a science behind it. They change the DNA in the brain, they change the telomerase activity, and they actually do reverse the aging cycle. But because the DNA destruction is slowed down with these medications, however, the data is only for six months to 12 months.

Unfortunately, recent study showed four papers have come out now that as soon as you stop the drug, the weight gain is very rapid, so you gain the weight even more rapidly than you actually lost it. So the problem is most of this weight gain is fat mass, which is not good for you from cardiovascular standpoint and metabolic standpoint.

So there is no data that shows that there is preserved effect of these drugs. So it's like hypertension and diabetes and some other chronic illness. You have to take these medications for the longest time possible to see the impact. And that is my most challenging thing, that hopefully one day we can find something when there is a preserve effect.

But, yes, clearly the data is out there on improving dementia, improving aging, and many other effects, which we'll get into more.

AB: Thank you for that, Rebecca. So beyond the obvious, what are the lesser known risks or safety concerns like nutrient deficiencies, hormonal imbalances that people often overlook when starting these drugs?

RM: I have an answer for that, But I would also like to dovetail on both what Raj and Renu has just said. They have brought up some real concerns that they are seeing as clinicians, you know, the loosening of the skin and the inability to maintain the weight.

So I am not a prescriber. I'm a holistic health practitioner. I have patients come to me that are already on these drugs or in their time working with me, they become prescribed. So I'm at a little bit of disadvantage because I can't prescribe them. But I get to really see in real time in the trenches.

And. And I might just say here, if I may, that I feel that the two issues that were just mentioned by the physicians here might be addressed with lower dosing. And I think that if the prescription insurance model is giving us these very high doses, which don't work, they're not a physiologic dose.

They're not a dose that our body makes endogenously, you know, GLPs. Our body makes GLPs. So I think the idea is to try to match the physiologic dose for each person. So I see a lot more benefit when I see compounded. And then we don't, you know, rush onto the on ramp and then just dump them off the side of the street.

I like to see a really, you know, low and slow is the tempo. So I'm sorry, I want to answer your question. So beyond the side effects that everyone knows about, the nausea, the constipation, these are real concerns. But there's lesser known ones, as you mentioned. You know, whenever we suppress appetite, when we take our eating window, we eat this much in one day and then we shrink it.

We're losing a lot of nutrients. We're losing essential amino acids, which are the building blocks of protein. And we know that skeletal muscle now is the organ system of longevity. These muscle cells act like Pac man, that gobble up excess free floating glucose in the bloodstream.

So that's a very big deal. We can actually damage our metabolism, that is our metabolic health, by going on these drugs and not having a proper protocol. Because, for instance, going back to the side effects, rapid fat loss also releases stored toxins into circulation.

Our body's a genius. We store lots of toxins and viruses and heavy metals in our fat cells to keep them away from the heart and brain. So when we start burning fat, we can, you know, I think of a snow globe.

Do you? Are we all old enough to remember? I'm in my 50s. The snow where you shake the snow globe and all this kind of glittery snow comes up, that's sort of what happens. People don't talk about. Fat is actually a detox pathway because we're burning it up. And the liver is the organ of fat loss.

No patients ever come to me and says, Rebecca, I want to lose weight. What's the organ I need to support to lose weight? It's the liver. So if the liver comes, is, is congested, we have rapid fat loss. We're releasing all this smart, sparkly snow of toxins into the bloodstream and they can get reabsorbed.

So something like constipation might sound, you know, commonplace, but if we are not evacuating and we're releasing more toxins then our tox. So people can actually become more sick. We more fatigue, more brain fog, missed work days.

When we are missing a protocol that really supports the whole body, then we are actually doubling down on the side effects rather than using a protocol that might require, you know, more, protein, amino acids, essential fatty acids.

When a patient is nauseated, the last thing they want to eat is, you know, salmon and broccoli with olive oil, etc. They're going to crave the saltine crackers and then right there, they've lost a beautiful opportunity to change their relationship with nutritious food.

AB: Renu, I'd love you to tell me what you think about what Rebecca's just said. 

RJ: I can tell you I also send people to compounding pharmacy because most of the people cannot afford. So the only thing I would say for my listeners is compounding is good, but you have to have a good pharmacy. If you have to do it, you have to go to a renowned pharmacy who does it right.

There are a lot of people who are actually making drugs and filling up with sand. 

AB: Sorry to interrupt. Renu, will you explain to us what compounding pharmacy is? For the layman.

RJ: Compounding pharmacy is where they actually mix the drugs together and then sell it. It is as opposed to FDA, and FDA does not have any regulation on compounding pharmacies as to what they're mixing.

So if you have a good pharmacy and you have a renowned pharmacy who is doing it right for many years, it's okay. But every compounding pharmacy is not the same and people have now made it a business. There's a lot of pharmacies out there who are not actually providing the good amount of drug, and we also don't know what else they're mixing in it, which could be harmful to your body.

So that's on compounding Pharmacy. The second part about nutrient deficiency. Yes, I absolutely agree with Rebecca, but you do rapidly lose weight. You are going to lose nutrients, you're going to lose your vitamins and minerals because of the rapid fat loss. The only thing which I would say is that there is very clear data for NAFLD, which is the liver, fatty liver.

And as you know, obesity causes fatty liver. And then fatty liver now has been associated with increase in heart disease and increase in risk of cirrhosis and liver failure, actually. And if 50% of your population has fatty liver, you know, again, what are going to be the consequences of it?

So there's at least five papers now out there which talk about these drugs lowering fatty liver and improving fatty liver. So there's some data to support the liver function actually improves overall with these drugs. So I don't know what to make of it long term because we just don't have long term data.

AB: Right. Thank you. Now, Dr. Raj, I want to ask you about the surgical side because that's how this whole conversation started. You know, I remember you and I talking about it, that you've had so many complications because of these drugs and the way they've affected people's bodies. Can you talk to me a little bit about it? When people have rapid weight loss, what are some of the issues that you have seen? 

RR: As I mentioned earlier, I've been doing plastic and aesthetic surgery on these patients for the last 20 years, be it after surgery for weight loss, and then, of course, of recent injections.

I ask my patients to stop these injections between two to four weeks before the surgery because they do slow down gastric emptying. And my anesthetists feel that that is a danger when they're putting patients, to sleep for a general anesthetic.

I also encourage them to be nutritionally efficient, and that is why I treat these patients in association with endocrinologists and weight loss surgeons, because I'm a surgeon, of, course I understand the physiology of how things heal and so on.

But ultimately is my colleagues, such as Renu, who understand the exact mechanisms of these drugs and the nutritional deficiencies. So I make it a point to get a green light from physicians such as Renu and, bariatric surgeons that, yes, Raj, go ahead.

This patient's weight is now steady. I don't operate on patients where the weight is not steady. If the weight is fluctuating, I leave for another six months. I ask them to go back to their referral, and then I wait for them to give me the green light or the amber light to then see the patient when the weight loss is steady.

And also, with the same token, I insist that nutritionally, that they are up to date in terms of their albumin, in terms of their minerals, in terms of their carbohydrate, fat, ratio, and so on. Also, hydration is a big thing as well.

And a lot of these patients, become dehydrated on these. On these injections. So that's the sort of the prehab, as I call it, pre-habilitation. But even the surgical technique, you know, with these patients, I try and keep the blood supply of the skin that I preserve very, very intact.

And also, I use microscopic glasses to ensure that the tissue that's left behind has got a good blood supply. Because as skin stretches and hangs, the blood supply is chinuous. So it's very important as surgeon to ensure that what you leave behind has got a good blood supply.

I close with some very fine sutures, and I use a lot of suspension sutures from within to keep the results longer lasting and to maintain longevity of the results. Because the other thing that I see post op is that these patients, their skin has lost elasticity.

It's almost like thin paper with stretch marks. And therefore if you do a tight, let's say breast uplift or a tummy tuck, the skin is thin. Within four to six months it'll start sagging again. So I use a lot of internal sutures to not just rely on skin to hold their results up, but to allow the internal tissues, the internal fascia to hold the breast tissue or the abdominal tissue up.

Skin closure is meticulous with fine stitches because I also find post op healing of these patients in poor. I now have more than 250 patients I've operated on who've had extreme weight loss. The scar is pink for a good 18 months to two years.

And if they've got lots of stretch marks, then I do remove obviously as many as I can. But I do tell the patients that I cannot remove all the stretch marks. You may have some stretch marks which are still there. So in addition to surgery, it's important to maintain that skin health by giving them supplemental skin tightening procedures as well.

And as a surgeon it's very important that we understand the mechanisms of weight loss and try and prevent stretch marks, pink scars, and also in terms of swelling and bruising, they do bruise quite a bit. And I wonder whether again I can ask Renu whether there is an adverse effect on the intrinsic extrinsic pathways of clotting which happens with these patients.

RJ: You have made a very interesting point. And we used to see that more with gastric bypass patients because we never had so much weight loss with any medical drugs. So some of the bariatric patients actually went into depression because they had so much skin tags everywhere that they hated it and because the lost weight loss was 60, 70, 80, 100 pounds.

And now we are seeing this same weight loss even more rapidly with the weight loss drugs. So I agree with almost all points which Raj is making. And we honestly do not even know what these drugs change in our body. Every day there is a new paper. So just to tell you, I mean there's at least 300, 500 papers out on these drugs in the last five years which just is telling us what these drugs are doing.

And while we are looking at a lot of positive effect, I don't want to undermine the positive effect though. The cardiovascular data is phenomenal. So people who have diabetes, people who have high blood pressure, people who have high cholesterol and they're not able to lose weight, not only these drug will improve all three parameters but, but they will also improve the heart disease.

There is actually approval for zepbound for obstructive sleep apnea, which happens with almost 70% of obese people. So if you have sleep apnea, that means again, you're suffering, your lung is suffering because you get anoxic, you don't get oxygen while you're sleeping.

There's an improvement in sleep apnea, so you don't have to put that big machine to sleep. So there's really a lot of very good tangential benefit which we're looking at. And some of these side effects are now erupting and emerging. Although I can say that there's more data that needs to be clarified.

So, yes. Could there be an effect of clotting factors, the healing like we talked about? Muscle mass? If you're losing 30% of your muscle mass, you're losing protein and collagen. And that is the most important part in healing. So I do agree that this may happen.

And how do you fix that? Very difficult. And that is why it is so important. To Rebecca's point, I'm, not saying you have to do compounded, but you also can stay on the lowest possible dose of for the longest time possible. And to make that lifestyle change.

Once again. I have seen people who take these medications and they don't exercise. So because they're eating less, they still eat junk. That's not appropriate. The change is lifestyle. You eat healthy, you eat less, and you continue to build up your muscle strengthening, which is very, very important.

You do exercise on a daily basis and that's when you, you use these drugs as a starting building block for a lifestyle change. In my opinion, take them for six months or eight months at, the most if you have to. Let's say if you lost 10, 20 pounds, stay, stop the drug, maintain that lifestyle change and see how long can you go without gaining that weight back.

And I bet you all of us believe in lifestyle a lot more than other things. 80% of that is lifestyle. 80%. If you will make a rapid change and you will sustain that lifestyle change for life, I believe that the weight gain will not be as much, in my opinion.

AB: No. That was very interesting and I think it's given people a lot to think about. Rebecca, I want to ask you something. You said when people come to you, they've already been prescribed the medication. So how do you see these drugs affecting gut health or mental well being, energy levels?

And what do you tell people as ways of counteracting that?

RM: First, let me just say I see these can be used sort of for the positive or for the negative, I observe that the problems that we have with them needn't exist.

If the dosing is handled well, if clinically, their side effects are managed. If these patients can work in tandem, with somebody, whether it's a physician, clinician, nutritionist, to dial in their lifestyle habits.

So, like I said, these are peptides. Our body makes these endogenously. And I believe our body has innate wisdom. So what do these peptides do in the body? They help modulate appetite, cravings, even addiction pathways.

I'm not a physician myself, but I work with teams of integrative and functional medicine doctors who treat complex chronic illness. Lot of autoimmune, chronic. We're seeing autoimmune remediation. So on one hand, we have the gut health. So one of your questions was about, you know, gut health as an integrative practitioner.

So one of the dangers with gut health is something that's called endotoxemia, which is what I referred to earlier. When we have circulating toxins, then we are reabsorbing toxins from our gut. And we know now that this gut brain axis, we have a two directional bidirectional freeway from our brain to our gut and our gut to our brain.

So when our gut is toxic due to one of the side effects, slow gastric emptying, that is a pitfall. When we have this slow gastric emptying, as Raj had mentioned, this is one of a, very concerning side effect, then we can actually be. Our guts can become more toxic, slow down endotoxemia, recirculating toxins, and then gallbladder sludge.

No one likes to talk about the gallbladder. It's not a very interesting organ. But in the work that I do, it's very important. We have gallbladder congestion. And so these people become nauseated, and they're at risk for gallstones and gallbladder attacks. Conversely, we also have, like I said, this autoimmune healing we're seeing.

I have a patient with ulcerative colitis who went on an appropriate dose for these for her prediabetes. And the ulcerative colitis has healed as a function of this. So I think we have. There are some untapped sort of pathways here that we don't know a lot about.

We're also seeing addiction. Addictions. Calming down smoking. Yes, because. So we have receptors for GLPs all through our body. Our brain, our gut, our kidneys, our pancreas, our liver. So these perform a function.

That's why I'm such a proponent of, of figuring out what's the right physiologic dosage for each person because they do have these potentials. So I see these as a sort of temporary catalyst, a catalyst for change. And I'd like to, you know, introduce a concept we're all familiar with.

But I'd like to apply it to the use of GLPs, which is neuroplasticity. We all know now that the brain is plastic. It's shaped, you know, very much like grooves in a record. If we all have been around, remember vinyl records, these grooves in our brain are very similar and they are carved out by what, what we do every day creates these grooves.

So I love these as an opportunity. These drugs create a window of neuroplasticity. So it's a prime time to retrain taste and food preferences, address food addiction, unconscious eating, compulsive eating.

Also our ultra processed foods hijack our reward centers and people patients who are so accustomed to eating processed food, they don't even know the joy of real good tasting nutritious food. Like a steak with butter and broccoli.

I mean chickpeas. And all these nutrients, the spices, there's so many wonderful spices out there that are healing. The Indian food has beautiful healing spices. So healing for the gut. And so when our brains have been hijacked by these ultra processed foods, this can create this window to break these self sabotaging eating patterns and to hardwire in new habits that support a primed metabolism.

So I do think these drugs have a real potential to heal our metabolic engines because insulin resistance is tied to already mentioned stroke, NAFLD, you know, non alcoholic fatty liver disease, heart attack, depression and you know, we call Now Alzheimer's, type 3 diabetes.

Because these broken metabolisms is body inability to make and use energy. And that's really what happens when we lose insulin signaling. The body doesn't know what to do with energy and it becomes, you know, very, very toxic. So I see these do have application for addressing all cause mortality when used with a targeted approach.

An intelligent targeted whole body approach. 

RR: Rebecca, for a cosmetic surgeon, that is so above my head. But I understood something. Thank you. I was going to say, I mean, vital records, I don't know any of that. I was born much after that, so.

RM: Okay, well how about a scheme when fears going down? But I have to say Raj,

RR: I fully understand, I fully understand the vital record.

RM: I was trained in systems thinking and when I hear about your patients that aren't healing well, what's called poor wound healing, Inflammation, scars, skin laxity.

What I think of right away, because I go to root cause thinking, I think this answer is rather simple and it goes back to the thesis of our conversation. I think micro and macronutrient deficiency. I think inflammation. I think these patients, maybe they're not healthy, the skin.

So our skin, from a functional medicine perspective, our skin is tied to the health of our gut. The gut lining and the skin sort of have this mirrored similarity in terms.

AB: Absolutely, absolutely, yes.

RM: I think, well, if the gut isn't so healthy, the skin, as soon as someone comes to presents to me with all kinds of skin issues, I'm like, time to clean up the gut. And what nutrients are we, you know, we see elderly people, their skin tears like tissue and they bruise easily.

These are also signs of inflammation. Macro micronutrient deficiency. So I sort of think this, I want you to give me your patients and let me help heal them from the inside out and work themselves,

AB: Sort them out. 

RR: Yeah, I love that. I love that. 

RJ: I think I did want to say something because we also don't want to paint a picture that these drugs are horrible and nobody should take them.

I really don't want people to walk away from the seminar that these drugs are bad for you. That is not the message we want to give people because some of these people, like Raj mentioned how have tried everything else under their lifetime and are miserable and they have diabetes, high blood pressure, cholesterol, and they're gonna die from stroke and heart disease.

So these drugs actually will save lives. There's no doubt about it. And as Rebecca mentioned, they actually are. There's many, paper for addiction now and that's being studied. So they are changing. And actually what I found I was looking at and I'm not a nutritionist, so please don't quote me, but I found and I wrote them down that they're at least they actually improve good gut microbiomes, like akkermansia and SCFA producers.

So there is actually an improvement in some gut microbial which are anti inflammatory and they actually reduces inflammation for the heart, reduce inflammation to get a stroke. So I think we have to be very balanced in our approach as to what we tell people. I mean I do at least two GLP1s or three GLP1s a week because I see patients with diabetes, I see patients with obesity.

And so I'm not going to say that we should not use them. And they are these, one of these bad drugs. I think what you should not use them is to just look sexier and improve your body image. That's where I have a problem, that you have a BMI of 26 and 27 and you want to have a BMI of 20 and you want to look like that thin ballet dancer.

That's where I have a problem, that every Tom, Dick and Harry in the world is using it, but the people who need to use it are not getting it. 

RR: I have seen in the 200 plus patients, 250 patients I've done, a lot of patients have hair loss and also dry skin.

Now, can one or both of you clever doctors tell me about why? First of all, I'm seeing hair loss. I know that the telogen effluvium phase is prolonged with these GLP peptides, but I just don't know why is it that they're getting them and I see them more with Mounjaro than I see them with Ozempic.

RJ: One of the reason why we think that the hair loss will occur and the dry skin is again goes back to the nutrients. If you look at the bariatric surgery data, with a 50 to 100 pounds of weight loss, what you saw was three major things. A very severe anemia, iron deficiency.

You saw vitamin B12 deficiency to the point that they would have brain fog. And you saw vitamin D deficiency and they will break their bones because they're actually affecting bone metabolism. And this is also being studied with, the GLP1s. Now so all three things are important for hair growth because they're nutrients for hair.

They need vitamins. You need a good hair growth. The dry skin is the same because you're dehydrated, you're not drinking enough water. So those can be consequences which we saw with bariatric surgery. We will see with these GLP1 and I think those are consequences of nutritional deficiency we see.

So I'm always checking their B12. We even check B12 with metformin because it causes vitamin B12 deficiency. So I am a regular checker of vitamin D, vitamin B12 and iron with these drugs all the time. And I supplement them early on, early on if they need it.

RR: Quite a few of these patients, because I work in a multidisciplinary team, these patients who come to me have already, are already on supplements, they've already been taken care of, the nutritionist, they've seen nutritionists and so on. But I'm still seeing these side effects. So I'm just asking why is it that despite being nutritionally optimized I'm still seeing these, side effects, but I see your point.

I think primarily it is the nutritional side of it. And of course, as they are then rehabbed back into their normal diets and so on, as the doses are reduced, they then start eating better and so on. And I guess it takes time for that telogen phase, for example, to restore itself to normal hair growth.

AB: Right. Thank you, Rebecca. I'd love to hear your view on the hair loss, the dry skin. Have you been able to help patients with that, with the whole holistic approach that you take? 

RM: I love it when a patient comes to me just before they're going to start the GLP journey, because then, we can really hedge against some of these side effects.

We, with their compliance. I have a wonderful patient population, high compliance. They're really willing to do the work. And I always tell my patients, the only reason to ever open your mouth and put food in it is for nutrition.

We are biologically evolutionary match to be eating certain types of foods. And if those foods don't, our body doesn't recognize them as nutrition of our ancestors, irrespective of where we come from on the globe. And if your ancestors wouldn't recognize it as food, or you couldn't duplicate it and make it in your own kitchen, then don't eat it to go with what?

Who's the famous author that says if it doesn't go bad, it was never good? So, So, yeah, going back to the skin hair loss again. I know I sound like I'm beating the same drum, but I'm going to, you know, dovetail on exactly what was already said, their micro and macronutrient depletion.

So the macronutrients are fat, protein and carbohydrate. So we need to balance those. But that's too superficial because, you know, for fat, we could be eating processed seed oils. For protein, we could be having some processed protein powder.

I'm not against protein powder, but processed cheap protein powder is not a good idea. And, you know, for, fiber, we could just be eating white potatoes. So we have to go deeper into the Mac and from the macros into the micronutrients. So something that I really see. We talked about essential fatty acid depletion.

We talked about amino, acid, which is protein depletion. But I see a lot of mineral depletion. And we need these minerals to remake our hair growth, like iron, zinc, selenium, copper, magnesium. We see a lot of. And this can be driven by, as we mentioned earlier, Dehydration.

Dehydration is no small matter. I know people that drink a lot of water and are actually dehydrated because the water is insufficient in our minerals. And then if we're eating, if we're not eating enough and we're not eating of the right things, then we also have mineral depletion that can also cause depression, etc.

And I love that Renu says she supplements with B12. The B vitamins are really important for mitochondrial health. So our mitochondrial is. Everybody on this platform knows, I don't know if the audience knows, are basically the batteries in our cells that make energy.

You sort of have to ask. Okay, so the mitochondria make energy. What do the mitochondria need as the building blocks to make the energy? Well, B vitamins are very important. Coq 10, especially for anybody on a statin. So you have to get really foundational.

Like, what's the cement under the house? What's your foundational nutrition? When you take biochemistry and you see the Krebs cycle, you see, see these are all nutrients that get used by cells. So we have to make sure we're filling the holes and getting really deep nutrition.

And that will include supplementation. Sadly, we can't get everything from our food because of soil depletion, etc. And, so we do need really targeted supplementation, which, you know, I do with all my patients. And that's based on lab work, based on symptom presentation.

But don't guess test. I like to look at labs. What's your body doing? What's your body saying? Body's always speaking to us. Our body's always communicating. We're very, very ancient, ancient beings. And we were designed to have this incredible feedback loop system.

I think if we really listen to our body, our body will tell us what it needs. Then going a little bit back to gut health, I also supplement with pre and probiotics. So we know now that there are probiotics that support endogenous GLP production.

We have Akkermansia as one of them. There's a host of them that can help the body make its own. So while we have this window of change, we're making these lifestyle changes, we're dialing in nutrition, we're addressing addictive eating patterns. We can also be supplementing with targeted probiotics.

So when we have the taper, we titrate off of the drugs. Our gut is in an ideal situation to make its own. Our gut uses very specific types of fibers and converts those fibers into probiotics or good bacteria, and then into small chain fatty acids, which are postbiotics.

I know this gets really granular, but this is just the miracle of food. Basically what your body does is it takes food and it converts it into medicine, like real medicine that heals our brain and body and our gut. So we can use this window not just for the neuroplasticity, but also for laying down these foundations of health so that when we drop the person off at the curb and they're off the drugs, they're not at a loss.

They really have a full top to toe approach to have a new body, not just a smaller body, but a new metabolically sound body.

AB: Very interesting. So, Renu, I want to ask you something.

Say you have a patient who's needed it, who's needed dramatic weight loss. Once they've had that drastic weight loss, how do you deal with the emotional and the psychological side effects of it? How do you help them in that kind of a situation? 

RJ: So in my experience, actually I see the emotional and psychological side effects are actually all positive.

As Raj is mentioning, that they feel so much better with the weight loss that they don't want to go off these medications. 90% of the time the problem is it's not covered. So what do we do? How do I get it? That is my most challenging question. I get on an everyday basis because this year the insurance company has just stopped covering completely.

They're not going to cover these drugs unless you have a really life threatening problem or you have been to a nutritionist. To Rebecca's point, you have shown that six months to one year of nutrition therapy has not changed you. And the nutritionist is advising that they need medications. So I think, that's a good thing in my opinion, that you have to do lifestyle changes.

So I deal with more positive emotional changes and psychological changes. And it's the same thing with the hair loss, which Raj said. If you see pregnancy causes rapid hair loss in at least 10 to 15% of the population. If you don't know that, they see very rapid hair loss.

And that's because of, the rapid changes in weight and metabolism with pregnancy. So I feel some of the hair loss is exactly due to the same. You're having a rapid weight loss. So hair is very, very sensitive organ out of all as we don't pay attention to it much. But hair is probably one of the most sensitive organ in the body and it shows it.

And many of these patients, when that rapid weight loss goes away and they are in the maintenance phase, then, as opposed to some people where it doesn't. But most of the people I have seen, the hair loss starts to come back, but this may take two to three years. 

AB: Okay, and Raj, what is the most common surgery?

Is it breast surgery for weight loss patients?

RR: Yes. I think breast would be the most common. Breast uplift with or without, fat augmentation, as opposed to implants. I'm using more and more fat, which is their own tissue. And the second would be, a tummy tuck with reshaping of their hips and waist.

Would be the second most commonest, supplemented with skin tightening, of course, for both. These are the two main ones, really, that I see. I do see, now more and more of arm lifts where there's saggy skin on the inside arm, and patients don't like that. So again, either with skin tightening procedures or with plastic surgery to remove the excess skin, tuck the scar underneath the arm so you don't see it.

That's also quite common. Those patients who started off with BMIs of group greater than 40, 45, and have lost weight on these injections, quite a lot of them require thigh lift. So again, I would say, again, anecdotal here. Sorry, guys, I don't have the scientific literature yet. But for patients who have started off with a BMI of 45, let's say, plus, and I've lost lots of weight.

And are now steady, this inside thigh skin tends to sag and chafe. So they get. They're uncomfortable in their mobility, and of course, clothing and so on. So those patients then do also benefit from a thigh lift, which again, is a procedure where the scars hidden, on the inside of the leg, thigh skin, is lifted, so is the skin around the knee, with lots of liposuction around the thigh to reshape them.

So I would say in that order. I'd say breast first, then abdomen, then arms, then thighs. And then as these patients are young, they do want some sort of facial enhancement. So to redefine the. The jowl and the neck and perhaps the mid face, with or without volume transfer.

If they've lost volume, that is Ozempic face. So again, some of them then also, want to have a face and neck lift at the very end as a sort of icing on the cake. 

AB: Wow, that's a lot of surgeries. But like you said, it can be life changing. For some people, there is really not one size fits all.

It depends on the person very clearly. Dr. Renu, tell me from a purely medical standpoint, who is an ideal candidate for these drugs and who would you say don't touch them with a Bajpur?

RJ: That is a question which we did touch on before that.

People who I see in my practice clearly have a BMI. BMI of 27 and above with one of the disease problem like diabetes, high blood pressure, cholesterol, high triglycerides, heart disease, sleep apnea, depression, arthritis or any of these complications which they're already paying a price for.

BMI of 27 and above can be used for these drugs. These are the FDA approved guidelines. So I'm just going to go by what is Approved by FDA and people who have a BMI above 29 or moderate obesity or severe obesity, of course they can use these drugs without having any of these complications and it is approved by FDA at least in USA.

So that's the one thing people who I would clearly not use these drugs. So the clear contraindications, if you have a family history of pancreatic cancer. Now the data on the pancreatitis has now been panned out for 10 years and we do not see increased risk of pancreatitis with these drugs except very rarely.

But if you have somebody who has a family history of pancreatic cancer, I would caution them against going on these drugs. If you have history of medullary thyroid cancer, which is a very specific type of thyroid cancer. And I think it is important for our people, people to realize that cancer is very uncommon.

So if you have, and it's actually genetic. So if you have a family history of medullary thyroid cancer, I would not use these drugs at all. Zero. But there is slight increased risk in thyroid cancer. That data has come out in the last year that any thyroid cancer can increase, but the risk is very small.

And I think what we are finding is because more and more people are doing thyroid ultrasounds before we start the drug, I cannot tell you, I get at least two consults a week that this person has thyroid nodules and should they be on a GLP1. So then I end up looking at the nodules, doing a biopsy and then giving them a clean bill of health that hey, you're fine, you can go on GLP1.

So there is that data. I think we believe based on the literature out there that it is because we are doing more ultrasounds and we are finding more thyroid cancer because thyroid cancer does not cause any deaths and people can live their normal life with thyroid cancer. And you know, it's a very common disease nowadays because of over testing and over checking.

So we find more of that. So that is something which I talk to the patient very cautiously and tell them, hey, if you have family history of thyroid cancer, it's up to you. You want to take the drug or not? But I will make sure that I'll biopsy that patient if they have thyroid nodule to make sure they do not have an existing thyroid cancer.

There's also to remember that there's a slight increased risk of gallbladder stones, which Raj mentioned before. And there's also a slightly increased risk of kidney stones, again because of altered protein, fat, carb metabolism as to what is going into your kidney. So dehydration plays a big role.

So these are the two major contraindications which I will not. You should be very cautious in people with type 1 diabetes who are on insulin because it can sometime worsen the risk of decay like SGL2, although the risk is very small. And they're really still not approved for.

For patient with a type 1 diabetes. For type 2, clearly. But with type 1, it is not FDA approved for their use. So we still use them in some obese type 1 diabetics, but with caution. One thing which I do want to again emphasize, and I think all three of us are emphasizing the same thing, that it should be used only in people who need it.

It should not be used in people who are looking to just improve their body image. And going from a BMI of 26 to 21, I really don't think they should be using these drugs, in my opinion. 

AB: Thank you for that, Renu. I 100% agree with you. But Rebecca, I want to ask you now, looking beyond BMI, what lifestyle or mindset factors, we've touched on this on and off, but I would like you to list them all here that you think people should look into to improve their chances of long term success. I'd like to answer that.

RM: May I make a comment about BMI? Because in my practice I don't use something else. BMI is really helpful when we're dealing with the egregiously categoric obese. But it doesn't answer the. It doesn't assess a patient's metabolic health.

So let me just explain BMI for the listeners. BMI only measures weight relative to height. It cannot tell the difference between lean muscle and visceral fat. And visceral fat is the highly inflammatory fat that's sometimes invisible.

So a very muscular person can be labeled overweight by this metric. Yet somebody who has low muscle mass, but high visceral fat might appear normal by this chart. So you could be quite unwell with a healthy BMI and then conversely true.

So I like to use what's called a DEXA scan. And, anyone that's on a GLP that works with me has to get DEXA scan scans periodically. And so that tells us the percent of body fat and the percent of visceral fat, which are two different types of fat. Again, the visceral fat is the fat around the organs which is very, very inflammatory.

That's where the cytokine storm. That's where these people were really vulnerable to Covid. And then this, DEXA scan also gives us ta-da. The thing we've been talking about our muscle mass, we want to know we're preserving muscle mass, so we will lose some muscle, but we want to make sure that we're losing very little and that we're actively putting it, back on.

And we don't know that with BMI. We only know that from a DEXA scan. So I just wanted to mention that, if I may.

AB: Renu, I want you to tell me, what do you think is the future of weight loss drugs? 

RJ: So I believe that the future of weight loss drug is very good. There are at least three drugs in the pipeline which are coming.

One of them is oral, where you don't have to take an injection. The effect on weight loss will not be 15, 20, 25% weight loss, but the effect will be 10 to 12% weight loss, which in my opinion, again, goes back to slow and steady, wins the race.

It is a marathon, not a sprint. So if you do a slow weight loss, and I usually tell, even with GLP1, I don't increase the dose for 3 months, 4 months, 6 months. If they're losing weight, my gosh, stay on 2.5. I start with the lowest possible dose. And many times for a year and a half, I keep them on the same dose because they're losing it.

Why worry? And I want them to lose no more than one pound a week. Just a standard weight loss, one pound a week. So in 52 weeks, they will be losing 52. But it doesn't happen. It doesn't happen. That's not our goal. And I tell them I'm happy even if half pound a week is good.

The other drug, which is actually in the pipeline and does it is, there's a GIP and a GLP. So GLP is produced by the intestines. And GIP is another compound produced by the intestines. It almost does the same thing as GLP1 with improving insulin resistance, increasing insulin secretion after meals when you need it the most, but it does not have an impact on glucagon.

And again, we can talk an hour about that. So there's a GIP GLP1 combination which is now in the progress. They're phased, three strides going on and it'll be approved. And actually the oral GLP1 is going to be submitted for approval in the next four months.

So very quick that they're turning things crazy because of a lot more drugs. One of the biggest problem with the future of the drugs that nobody is going to make them generic to make it cheap so people can afford it. So one of the biggest problems is going to be cost in my opinion. In the US currently, if they're not covered, they're generally costing $400 to $600 a month.

How many people shelve that kind of money for a long time? So people are getting from Mexico, they're getting from China, they're getting from India and then I still worry about the quality as to how and what they're getting. Are we mixing some of the bad things in there which are going to be harmful to you because there's no FDA regulation.

So I think I worry about all that, but I don't think these drugs are going to go anywhere. I hope that we can find one day that they're allowed for limited use so you can use it for one year and two year and then let the lifestyle and your lifestyle change take you through the next journey.

And that's really my hope with the GLP1 drugs.

AB: Thank you, Raj. Last question for you before we wrap up. Are these drugs reshaping beauty standards or are they just reinforcing old ones?

RR: I actually think that they are reshaping the standards.

Very slow but steady. I gave you one example earlier of the Ozempic breast and how patients are no longer asking for enhancements volume. They just want to be subtle in their clothes. It may just be cultural because in the UK generally, especially in London, patients are more sophisticated and they don't want huge announcements.

They just want to look subtle in their clothes and just feel confident. But I do think that these drugs are slowly turning the tide as to how patients think about their own bodies. As long as they are happy mentally, like Renu said earlier with these weight loss drugs and having lost the weight when they are satisfied that they are the weight they want to be.

Then, rather than going back to youth and trying to turn back the clock, they are now looking for subtle enhancements. And again, I'm talking about those patients who are not extremely obese, who lost lots of weight and have loss of excess skin. Skin that's, almost a separate group and a separate cohort of patients.

I'm talking about those where the BMI was between, let's say 35 to 45, maybe 30 to 40. They've lost weight, they're now steady nutritionally, they are, optimized, and then now just want to feel confident to remove the excess skin.

So, for example, I'll give you. I'll give you another example. Last two years, I've increased the mini tummy tucks I've done previously in these patients. A standard tummy tuck was done where the scar is along the groin crease, another scar in the belly button, all the skin is removed, and 360 lipo.

In the last one and a half, two years on shoe, I'm now doing mini tummy tucks where all they want is when they sit down, they don't want to feel that roll above their pubis. That's all. They don't want to have the full tummy done. They just want to feel comfortable. And for those, I do a mini tummy tuck where the scar is just longer than a cesarean scar hidden in the underwear, through which I excise the excess skin, do skin tightening, do some lipo, around the hips and waist, and that's it.

So to answer your question, yes, I'm seeing a slow but steady change in a patient's perception of body image after these injections. 

AB: Okay, so I would like each of you to leave the listeners with one scientific fact about weight loss, drugs and health.

RJ: One scientific fact about these drugs, that these are scientifically proven to work on the aspects of obesity by changing hormone levels, improving insulin resistance, decreasing appetite. So these are good drugs for weight loss, but they have to be used genuinely and appropriately.

AB: Rebecca, 

RM: These drugs can fine tune your metabolic engine or they can drive metabolic fragility. The difference is in the protocol. 

AB: Thank you, Raj. 

RR: With your clinician, choose the dose that suits you best so that you lose weight slowly and therefore you avoid the secondary effects of rapid weight loss, such as excess skin and stretch marks.

AB: Thank you so much. Thank you for your time. Today's conversation reminded me, when it comes to weight health and the choices we make, there is no one size fits all. These drugs may be life changing for some unnecessary for others and extremely complicated for many.

What matters is that you approach any path with curiosity, compassion, and correct information. If this episode has sparked new questions for you about your health, your habits, or even how society shapes our choices, then we've done our job.

And trust me, we're only scratching the surface. So stay curious, stay compassionate, and as always, remember that your wellness algorithm is yours to design, no one else's. I'm Anshu Bahanda from Wellness Curated, and I can't wait to see you next time.

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