Semaglutide & Tirzepatide: Revolutionizing Obesity Treatment Beyond the Scale

I recently tuned into a podcast with Jillian Michaels—the trainer from The Biggest Loser (possibly one of the most problematic shows to ever grace TV). I listened as she doubled down on the same old narrative: weight loss is all about motivation, eating less, and moving more. It was frustrating, especially because two respected physicians in the obesity medicine community were trying to bring a more evidence-based approach to the conversation, but it was falling on deaf ears.

As research continues to reveal, chronic obesity is a complex condition that differs significantly from simple weight management. It’s clear that it’s time to move beyond these outdated beliefs and focus on the science shaping our understanding of obesity today. In this episode, we'll explore the latest scientific research on obesity, including how metabolic and hormonal responses to weight loss differ for those with chronic obesity, as well as the benefits of GLP-1s and GIPs that go far beyond weight loss alone.


References

Hinte, L.C., Castellano-Castillo, D., Ghosh, A. et al. Adipose tissue retains an epigenetic memory of obesity after weight loss. Nature (2024).


Audio Stamps

02:38 - Dr. Rentea critiques Jillian Michaels’ outdated stance on obesity as a chronic condition, and emphasizes the importance of evolving with current science in understanding obesity and its treatments.

07:56 - Dr. Rentea discusses the growing body of evidence showing that GLP-1 medications offer numerous health benefits beyond weight loss, including improvements in various metabolic and cardiovascular conditions.

10:49 - We learn how GLP-1 medications help protect the cardiac system by improving endothelial function, reducing blood pressure, and lowering inflammation and cholesterol.

13:20 - It’s becoming increasingly difficult to ignore the wide-ranging health improvements these medications offer beyond just weight loss.


Quotes

“I believe radically different right now than what I did five, six years ago. Every single year I'm learning new things.”

“The biggest question I always get asked from people is, ‘When I lose the weight, am I good? Can I then just go on with my life?’ and I always say, ‘It's a chronic medical condition, meaning it's there for life. We can manage it, we don't have a cure.’”

“It's been an explosion recently of updates from long term trials and new trials that are showing ever increasing benefits of GLP-1s and GIPs.”

“It

All of the information on this podcast is for general informational purposes only. Please talk to your physician and medical team about what is right for you. No medical advice is being on this podcast.

If you live in Indiana or Illinois and want to work with doctor Matthea Rentea, you can find out more on www.RenteaClinic.com

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Transcript

0:28

Welcome back to another episode of the podcast. Today I am in a totally different location than normal. I found a coworking space that's not too far from my house and they actually have a room that you can rent where it's a podcast recording studio. Now are we going to get all fancy with a big mic and all this kind of stuff? No. In fact, right now I'm just in the exploration phase to figure out if this space is going to work for me. I love the fact that they have, maybe, I don't know if we can put, maybe we can put some photos in this, blog post for this episode. So I want you to look out for that. I'm going to take a few photos today and we'll, we'll upload them there, but, so click on in the show notes, there'll be the link for rentiaclinic. com forward slash blog. And the most recent one, I'll put some photos of where I'm sitting. So they have on the walls, we're called like, I think they're like dampeners, where they It makes the sound quality really good, right? So you're not having this echoey noise. So that's all incredible and everything. Now, things I didn't think through when you come to a communal rented space, you have to bring everything with you. That is a big pain in the tush. I mean, I came today with such a big bag. You have no idea all the things you need. You need your laptop. They do have a microphone here, but I have a microphone that I normally like, there's just so much that I had to bring. So I was. Total pack mule situation. And honestly, it made me question, it made me question if this is actually going to work in the future. So stay tuned. We might even, as of next week, say abort. One of the main reasons that I got to this space is because I thought, hey, if the sound quality could be better, if we could also do video, if we could also, you know, get YouTube, things like that. And then if I'm really being honest with you, I hate this. Recording video at the same time when I do the podcast. I have now been podcasting for, I don't know if it's five, six years. It's been a long time because I had a previous podcast for several years. And there's something about when you bring video into it where it changes it. I don't know if it's that you're looking at yourself on there or what it is. And ironically, you all know me. I love making short videos online to educate, but I just don't enjoy combining the two. So this is an ever evolving process. I always say I reserve the right to change my mind. Absolutely tomorrow. So, but anyway, I'm sitting in this space really liking the acoustics in here. So hopefully what's coming across as good. Now, what I really want to spend some time today talking about is how these GLP 1 medications are about far more than just weight loss. And I want to bring up a few really amazing studies, some different medical conditions that they're helping with. And then also just a little bit of the nitty gritty science, because I feel we don't dig into that much. And something that made me realize, my Lord, we need to talk about this a lot more is that. If any of you are not familiar with Jillian Michaels, Jillian Michaels is a trainer, right? She doesn't have more training than that, really. And she got big in the world in the past, kind of social media wise, because she was one of the trainers on The Biggest Loser, which we know was one of the most abysmal, Things long term with majority of them having gained all the weight back. Although she'll try to tote, and I know this'cause I listened to a podcast of hers recently. She'll try to say that 30 something percent of her personal clients didn't gain the weight back. So, okay. I guess that is better than, than the, than the national average. But the point is that. She sort of gained in popularity with that, wrote several books. To me, she was very influential when I was younger. I did her workouts, of course, that injured me. I read her books. And so, you know, I knew who she was. And, and what's increasingly come out that I've seen in the past few years is she's really, raging against the idea that obesity or overweight is even a medical condition. She won't even acknowledge that. She'll say, well, you know, this organization didn't think it should be, made into a chronic medical condition. Cause you know how things change over time, right? We reclassify things, we change, we learn more, we evolve in medicine, right? In my mind, I'm realizing more and more, she's really one of these people that's a flat earther. Like she's not. Coming up to date with the most recent science and things like that and really evolving and progressing and of course these things change with time. I believe radically different right now than what I did five, six years ago. Every single year I'm learning new things, changing what's happening in the science, what's happening with patients. I say this every single episode. We need to stay on top of at this moment what's occurring and we don't look back to years and years ago and say that that was the only truth. And so what I'm, what I see with her and this is obviously part of her marketing strategy that. She's just vehemently against any GLP 1 and just ever really believing this is a chronic medical condition. So the reason that I bring this all up is that there is so much science behind how it is so different for someone that struggles with chronic obesity compared to people that don't. And one of the, one of the studies I wanted to bring up here that is just fascinating, this literally is hat off the press. This came out, when did this come out? This actually got published November 18th of 2024. Yesterday from when I'm recording this. The title here, and this was published in Nature, this is an incredibly reputable scientific publication, and the title here is Adipose Tissue Retains an Epigenetic Memory of Obesity After Weight Loss. So, you know, the biggest question I always get asked from people is, Hey, when I lose the weight, am I good? Can I then just go on with my life? And I always say, It's a chronic medical condition, meaning it's there for life. We can manage it, we don't have a cure. So we treat, but there's not a cure. So the difference being that we have to keep up these things. So most people, if you've struggled for a long time, and you know that you, having tried exercise and trying nutritional changes and decreasing stress and doing all those things, it wasn't enough to move your weight set point to make meaningful changes with, for example, reversing pre diabetes, helping with fatty liver disease, things like that. We bring in a GLP 1 medication that has multiple functions and more and more and more we learn about it. And then you're finally able to treat that, but it doesn't mean that it's entirely gone. So we've reversed some of the things, we're helping with some of the things, but it's not gone. And so this paper really showed that they used, it was a rat model that they were looking at. They showed that even after they had lost weight, there were still transcription changes. This is the, think the code that your body uses to make protein within the body. So there's a whole way that we bring it from the DNA in our cells. We make RNA, that's the messenger. And then your body is able to make a protein based on that. And these changes persist after weight loss. And then what they saw consequently is And so this is something where when I have patients that will either come off medication or maybe they never use medication to begin with, they use lifestyle, and you'll notice that they will have more rapid weight gain compared to, let's say, counterparts that never struggled with their weight. Where this comes up is that, People really think, well, at some point, I've maintained this weight, I'm good, I have these lifestyle factors in place, I'm good, I can come off the medication, and they're not realizing that literally within their epigenetics, with it, with how things are expressed in their body, there are changes from before. And so this is something that, Wow is this validating because I know this working with patients, but then for the science to really back it up It's really incredibly powerful. So when someone like Jillian Michaels is saying we'll just do XYZ These changes do not occur in other lower weight counterparts that have never struggled with this. Literally, this does not occur Okay, so that's just one thing that kind of made me think along these lines But I was sitting there and it's been Honestly, an explosion recently of updates from long term trials and new trials that are just showing ever increasing benefits of GLP 1s and GIPs, so meaning semaglutide and terzapatide. So, again, semaglutide is Wigovy Ozempic, terzapatide is Mangiaro Zep Bound. And so I just want to talk about a few of these areas. So the one thing here that I really want to stress is that this is more than weight loss. If it was just about weight loss, there's a million things you can do, but listen to all these benefits. This is why it's like, it's not just the weight goes down. So number one, we're seeing, I just did a review online of, The, a study that showed significant improvements in sleep apnea for moderate to severe patients. That was the, the group that they had in this study. And so that is absolutely incredible. We know that obstructive sleep apnea is something that leads to so many health consequences. A lot of them being cardiac. And so for that to improve is an absolute win. There is a, Other studies that show improvement with liver function and what I mean by that is reversing fatty liver. So non alcoholic fatty liver disease, this is something that is increasingly common as our population has had an increased weight set point. And so, oftentimes they'll say, well, lose weight, right? Okay, great, but that's not always possible for everybody. And so with use of these medications to see that that has improved. The other thing that we're seeing are dementia risk going down, which that is something, progression of that. That is something that is incredible. And I'm sure there's lots of confounders there, right? Because we know now, for example, another, continuation study showed that the chance, if you were on terzepatide, of developing type 2 diabetes was decreased by 94%. Okay. That is phenomenal. So obviously, if you're not developing things like diabetes, then stroke risk and cardiac risk, things like that are going down. And I'm not shocked that dementia gets better. Okay, the other thing that we're kind of keeping along those routes, we knew before that cardiac risk goes down, we know that's a risk of future things like heart attacks going down. We now also have a study that shows with terzepatide, that heart failure, that that goes down as well. Lots of improvement in that, which is just Super significant and everyone's saying, hey, it's now putting trizepatide on the map. This is incredible for heart failure patients to have some options to help with that. Okay, the other one that I thought was just super incredible is showing that, with semaglutide, patients that are on that versus being on placebo, that they had significant improvements, not only in weight loss, like obviously we know that, but also Also significant improvements in their pain score. So for example, their knee pain and also better improvements in activities of daily living. So actual quality of life improving. Okay. The other thing, let's see where there are more that I had on here. Cause I just wrote a brief list. I didn't really even go through everything. So I wanted to dig in here. You know, when we say, well, cardiac risk improves this and that I am going to have on the podcast soon, Dr. Simmon Lee, and she is a, a really great cardiometabolic, cardiologist. And She talks a lot about how these medications actually affect the cardiac system. So she talks about three areas that it protects, within the cardiac system. So she talks about number one, the endothelial function improving. So endothelial function, it's the lining of the blood vessels, so it's more relaxed. And so that helps you, for example, your blood pressure can go down. Okay, number two, that these medications can release ANP. Atrial natriuretic peptide, it's like urinating out salt, so again, that can help to bring down blood pressure. And then number three, they decrease inflammation and cholesterol levels, so you have less plaque buildup. So when we, when we talk about this, I think everyone's always sitting there sort of, Again, I always come back to, it's the same argument I hear every single day, which is, oh, weight should be something where you just have more motivation and you just eat less and you move more and, and da, da, da. Well, guess what? People have done all that and it doesn't work. So there are so many different drivers and physiologic things that are not working anymore. metabolic things that are off. And when you hear the function of what things are actually getting improved and helped, no wonder people finally have a fighting chance at this. And we're seeing so many different cardiometabolic parameters improve. So I think that this is really encouraging because the larger the body of evidence, the harder it is to ignore. So once you start to have just So many studies that are showing cardiac risk goes down, heart failure going down, sleep apnea going down, not developing type 2 diabetes, dementia, like when you have all these different things that you're talking about, it starts to get really hard to ignore that this is just about weight loss. So I'm really hoping that the more we can shift this conversation to look how these metabolic diseases improve, or don't. occur to begin with, right? Remember, we don't always want to be chasing our tail. Once you've already developed, for example, type 2 diabetes, it is much harder to treat than if you could have done that before. For example, with semaglutide, if you look at how much someone with type 2 diabetes is able to lose compared to someone that does not have that The person that does not have type 2 diabetes can lose a higher percent. So for example, like 15 percent total body weight loss and someone with type 2 diabetes, it might only go up to 10 percent that they can lose. We want to get to things before they're ever a problem. But again, I'm just sitting here reflecting on, and this was my fault, I listened to one of Jillian Michaels podcasts, because someone in the obesity medicine community, two very reputable physicians had podcast and were kind of debating her and, and trying to bring this information to light for her. And it was really a firing squad of her just holding on vehemently to her beliefs and, and literally ears plugged. She was totally not listening. But when I was listening to that I was thinking, you know, Right now, she can do whatever she wants to do, but there comes this moment and we're really getting there where there's just so much evidence that you just look foolish at some point if you're not listening to any of this, if you're not taking in any of this, if you're not researching any of this Alright, so I hope you all, appreciate us kind of talking about some of these different aspects and maybe it really, gives you some peace of mind to know, wow, this is actually much more powerful than just bringing down my weight set point. That's ultimately why I have the Rentier Metabolic Clinic and not a weight loss clinic, because I really love seeing when cholesterol levels improves and blood sugar comes from the type 2 diabetic range or pre diabetic range and goes to normal and incontinence improves and All these things improve. It is just absolutely incredible for people to get their health back. I was talking to a patient the other day and this person said, I just feel much more energetic. I just feel like I can do all these things easier. And that's what it's about. It's actual health improving. It's never been about shapeshifting. It's never been about what size you are or things like that. It's really always about health. And this is a hard shift because most people are just obsessed with what the scale number is. And you know that I'm really about body composition, you making sure to have to keep all that muscle mass as you're losing weight or to make sure that, that you're not saying, well, I need the scale to go out even more when you actually have maybe 15 pounds more muscle compared to a counterpart of yours. And it really doesn't make sense. So anyway, I'm going to leave this here today. Today was a little bit more of a sciencey episode, but I hope that you appreciate it and that it's hitting home for you. I want to ask you a massive, massive favor. If you are listening to this podcast and you have not left a review, please do that for us. It really helps us to get the word out and to spread this out more.