Episode 21: Celebrities Getting Thin & Fertility Weight Loss

Dr. Klimczak and Dr. Reed talk about how celebrities are using medication to get thin. But, can we use this medication to help our patients with fertility weight loss? Learn all about semaglutide and how it may help you on your fertility journey.

Transcript

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Hi, I am Dr. Beverly Reed. And I'm Dr. Amber Klinczak. And we are Two Peaks in a Pod. Well, hi everybody. Welcome back. It is the end of the year. And how did your holidays go? I can't believe it. Um, they were quick. Okay, yes, yes. Thank you for working, by the way. That was so nice of you to work. No problem. No, I just always feel like I need some time to like process after there's so much lead up. Yes. And then it's just over and I get with the vibe. Yes, yes. Well, I was so excited because since you covered, I had four days off in a row. I went manic. Because you know I can't just chill. I can't just relax. So I got, I deep cleaned my whole house. We, um, reorganized things. And then I came up to the office, I hung up all my stuff. I'm, I'm just ready for the new year. So I'm so excited. Oh my gosh. So I love, I love to clean and organize. It's weird. Actually. It's how I relax. That's so weird. I like it, but I prefer someone to do it for me. Well, sometimes you need some helping hands. There's nothing wrong with that, right? But it is, it is hard when you've got people working against you sometimes, you know? Like my husband, every time I clean out a drawer, my husband's like working in another drawer like Throwing stuff in there unorganized, and I'm like, what are you doing? I'm not going to be your husband. Unless I have to. Unless I have to. Um, okay, well this week I think you have a topic for me, right? Yes. Okay. Um, so I think something that's popping up a lot, maybe it started in celebrity culture like most things do, and then now I feel like it's filtering down. To everyday people, um, really hearing about this more and more commonly, and that is the use of medications like Ozambic, um, and just becoming way, way more common. And so I guess we saw this funny, like, reel or whatever of Amy Schumer. talking about how celebrities now are not really admitting to it, but it's fairly obvious that certain people have been engaging in these medications like Ozempic to help them. Definitely. It definitely seems like it because you know, I, I, sometimes you'll see celebrities, they've been a certain size for many years and then all of a sudden they're like a toothpick and you're like, you know, I mean, I guess there's could be other explanations too, but you can't help but wonder what changed. I haven't heard of Ozempic face. Yes. I have. I've heard that people are very stressed about ozempic face. Yes. So I think that that is what she's saying too, that you can tell that people are using, because a lot of the celebrities now have ozempic face. So what is ozempic face? Yes. So apparently what happens is when you lose a lot of weight, then you can start looking older and so your wrinkles are popping up and you've got saggy skin. skin everywhere. And so you've got people who've lost all this weight, but now they're worried about their face. So I hear plastic surgeons are doing very well this year. I can't even imagine what you can do about it. Well, I think you do like a facelift and I probably some stuff like that. Um, and, um, but I think initially people were worried, well, is ozempic causing this? Well, it's not that ozempic. It causes those things. It's just weight loss of any type can give you saggy skin. So it's kind of like you just have to choose, I guess. Do you want to be skinny or do you want to look young? I don't know. It's a hard decision, I guess. It is hard. The struggle is real. Um, so okay, so let's talk about what is Ozembic. This is medication that both Dr. Reid and I are really familiar with. We have definitely been using it appropriately for many of our patients now for a while. And so, you know, let's talk about, so what is the real name for Ozembic? Yes, so the real name is semaglutide. And interestingly, it started off as a diabetes medication, and it's very effective diabetes medication. But what they noticed in the initial studies is not only was it treating these patients diabetes, but they were losing weight when these patients had previously really struggled to lose weight. And so it works by binding to GLP one receptors in our body. And ultimately It makes you less hungry. You're just not hungry anymore. And when you take away that hunger factor, we find that actually it helps so many people be able to stick so much better to their diet. They're able to lose weight in a controlled fashion over time. And so, I just feel like it's been so amazing because as doctors a lot of what we prescribe or, or treat our patients with is, there are things that have been around for years and years. And so to have something happen in our lifetime that will change lives, I think is so fun really and amazing to be a part of it. Don't you think? Certainly really new. I think a lot of us are anxiously awaiting some more longterm data, but I mean, everything that we've seen so far is certainly shows that it works, especially for short term. And that's a lot of what we're using it for, for our patients to kind of get weight down prior to fertility treatment. So a very effective medication for that. Um, do you know which, which drug company does that produces Ozempic? I don't know the actual drug company, but I guess it's worth mentioning too, that there are a couple of different brand names. So for example, um, there's Ozempic, which has the indication to treat diabetes, but then there is basically the same medication with the brand name Ogobi, where that one has received the indication. for weight loss alone. And then there are some other mixtures of it, like manjaro, um, that have another ingredient um, added as well. So you'll see kind of different brand names and different recipes, but it's all kind of down to the same concept of how, how the mechanism of action works as well. Very interesting. You know, I was asking, cause I did listen to this podcast about the company that actually ended up taking Ozimbic to market. I think it's based off Denmark. I'm going to say it's one of those countries, Norway, Denmark, something like that. And, um, and, The amount of money that the company has made off of the medication is like more than like the worth of the country. Like, it's just insane how much money, because it's such a popular medication now, because it's so weak. Well need. Absolutely. And her demand has been so high. times where they're runni out of supply. And I do t too, especially this is w There were diabetics who needed their medication and then they tune in on the TV and they see, for example, Khloe Kardashian is taking something. They say, well, Khloe has myozepic. I need it for my diabetes, you know? And so I can understand when there's so many people that are all wanting the same medication that there might even be some ethical, um, things to consider, um, with that. Well, as well, who gets it and, and all of that, but it seems like they, the companies have been working really hard on. you know, keeping up with the demand. And I think this year, I feel like the demand has, or the, um, stock rather has been easier to get. What do you think? I haven't had, yeah, I've had problems getting it approved for patients through their insurance, but not that it's just not available. Right, right. Which I do think that's one of the frustrating parts. So it's been so variable on who has insurance coverage for them. We just don't know. So, you know, for example, when I'm prescribing it for a patient, Sometimes I'll just order it at the pharmacy. The patient will go to the pharmacy and pick it up for a 20 copay. And then I have other people who will get flat out denied. And then for most people, I usually get a fax with saying, okay, you need a prior auth. You need to tell us why this patient wants this medication. And I would say most of the time it gets denied if my patient doesn't have diabetes. Um, and that's frustrating because the cash price on this medication is roughly 1, 000 a month, and that is just not reasonable for anybody, so very frustrating when that happens. It's amazing to have such a great medication, but really, I do think, especially hearing that they're making record profits, they need to come down on the pricing. We need to make this available to everybody because it just has so many benefits for fertility and long term health. Honestly, in our healthcare system, I think that it's a good investment. If you can people help people lose weight, ultimately, they're probably going to spend less on insurance, um, for that patient. They're going to have less heart attacks and less diabetes and less strokes and all of that. And so, um, I think in recent, or hopefully in the next couple of years, we'll, we'll see a turnaround on that. But yeah. Yeah. So I, Dr. Reid and I have been using this a lot for our patients, more so in the fertility world, because we often have patients that come to see us who have been trying for years to lose weight. I would say a really common patient population we see this in is PCOS, polycystic ovarian syndrome. Um, especially, you know, PCOS patients can be lean or they can have problems with their weight, be higher BMI. And what I have heard over and over again from my PCOS patients is I do everything I'm told and I just can't lose weight and they always are telling us it's my hormones and they really understand what they should be doing and I really believe my patients that they're working really hard because I always say there's nothing as motivating as wanting to have a child. So I guess this is a really motivating time in my patient's life and it's So frustrating when they are really growing their lifestyle and they're not able to achieve weight loss. Yeah. So what we've been really introducing to our patients is, you know, short term stents on medications like ozomic to help them to get their weight down to a healthier level so that we can help them with fertility treatments and assist them in getting pregnant. Yeah, and I think it's interesting too because a lot of women are either told by other people or feeling themselves. It's my hormones It's my hormones and you know what it is your hormone, but it's your hunger It's not what everybody else is thinking is that estrogen is a progesterone or something No, it's your hunger hormone and we know that because it's so easily reversed With this medication, but you know, I always tell my PCOS patients I say look if you take two people They both do the same diet, the same exercise. One has PCOS, one does not. The person with PCOS will not lose as much weight. And it's not fair. It's part of the condition for many people. And whenever I say that, so many times, the female partner will look at her partner and say, See, I told you! You know, and it makes me sad because I feel like sometimes even the partner has been just on their partner saying, why aren't you losing weight or something? And it's not anything that they can help. It's not their fault, you know? Um, and so I think that's just such an important message to get out there is don't feel guilt. Don't feel shame. You cannot help this. And, but now there is something that, that can help you. Um, and so, you know, I think it's just been so. fun to see the feedback that I get from my patients whenever I start them. So these are things my patients have been telling me. So they tell me, um, Dr. Reed, is this what it's like to feel normal? Dr. Reed, is this what it's like to feel full? Like, I honestly don't think I ever felt full before is what they tell me. Or I have some patients who are like, Dr. Reed, I need a hobby now. Like all that food chatter that was going on in my mind and taking up so much of my thoughts and my energy is gone and now I need something to do. And so I just love hearing this feedback. It makes me. So happy to hear that. And it's just a huge burden, um, off of a lot of our patients. And so I think that has been great to see as well. Yeah. And, you know, we should mention also the other thing that really comes along with PCOS and things like. And disorders kind of related to PCOS is also insulin resistance and pre diabetes and even full blown diabetes. So, Ozempic is kind of the perfect medication for this particular type of patient that's really struggling with weight, but also struggling with insulin resistance and high glucose levels, because that is what it's targeting. And we really do see improvements in, you know, one of the lab levels, we look at hemoglobin A1c, that's a marker of what your blood sugar has been doing. three months and we really see that they improve after being on ozempic. So it's a medication that really targets everything for patients often that are in that realm. Yeah, absolutely. So I think you guys all hear that we're prescribing it, but here's the really hard part about it is you cannot or should not prescribe ozempic or these types of medications. While you're trying to get pregnant. And the reason for that is there were animal studies done, and the animal studies showed a higher risk of birth defects in the animals who got pregnant while taking semaglutide. And although this has not been shown in humans. Of course, we don't ever want to take that risk or get anywhere close to that. And so the manufacturer actually has special labeling and it says you must avoid conception for two months until that medication has completely washed out of your system. And so when I'm seeing a patient, and oftentimes it's for infertility, they don't even know they're seeing me for weight loss sometimes when they see me. We kind of talk about, okay, what are our goals? What are the timelines here? And sometimes in patients, we may not have time to work on weight loss. We may need to go straight to fertility treatment. But other times if my patient says, you know what? I didn't know this option was available. I'm really interested in losing some weight before I get pregnant to try to have the healthiest pregnancy possible. Or if we need to lose weight for, um, to make them eligible for certain, you know, anesthesia restrictions or things like that, then I'm offering it to somebody. But I'm like, look, if you know you're going to have to wait two months, then if you're going to try this medication, you really want to give it a good amount of time to work. So usually I suggest maybe taking about a six month break from trying to get pregnant to take the medication and really, um, work on weight loss. And then the hard part is though, people always worry. Okay, when I stop the medication, I'm waiting the two months. What if the weight comes back? And indeed, studies show it can. So then what we're doing is we're stepping down to another medication called Phentermine. These are pills. I would say I don't like it as much. It's not as effective, um, as Semaglutide, but also it's something to kind of stave off some of the weight regain, and it does wash out of your system a lot faster. And so that's kind of a step down regimen we've been using for our fertility patients, and I think it's been working well. Definitely. I think the tricky thing about Osembic also when we're trying to do this short term use is that you have to titrate the dose for patients. So something really important to know in case you're interested in Osembic, you feel like you would be a good candidate is that you need to be started at a really low dose and then gradually increased up to an effective dose for you. So you have to be patient and you have to make sure that you tolerate it well. Probably the most common side effects that we've seen. GI upset. So nausea, really feeling crummy from that. And we always kind of laugh because it's like once you do the injection, you can't really take it back. So we have had some patients that maybe dose themselves a little bit high and then they feel really bad for the next couple of days and there's nothing we can do about it. So. Slow and steady. Well, I'll interrupt you and I think the reason you would laugh is the rep that told us that who does this, the patients that do this, are usually doctors. Yes. Okay? So that's why we kind of laugh about it because here's the thing. Um, you know, most of our patients, they follow the advice on what to do, but doctors for some reason, sometimes we get an ego, and we think we're different or something, and so when I talked to the drug rep, she said that the ones that she'd seen who ended up super sick are the doctors who said, I don't need to start on low dose, I'll just give myself this high dose, and before you know it, they're vomiting, they're sick, and all the rest of it, and so learn from those doctors who did that. Shhh. And just be patient and start at a very low dose. And then we titrate up over time to get you to the right dose. Yeah. So it may take, you know, several weeks, even months to get you up to that effective dose. So it is a little bit of a challenge when we're dealing with an interval of time that's limited, but it does work. Yes. Yes. And I love how our electronic medical record can show a graph of the way I always pull up my patient's weight charts and you can just see this line dropping, dropping, dropping, which I think is. great. So the ultimate goal is that you lose about one to two pounds per week. That's about the healthiest way to do it. Now, I will say here is the hard part. We do still recommend you follow a healthy diet and you do exercise. So we usually recommend the Mediterranean diet where you're incorporating healthy seafood and lean protein and vegetables. You're really trying to stay away from sugar and simple carbohydrates. Stay away from processed foods and high fat foods. Um, so you still have to follow that. Um, for exercise, even just walking, um, is great. Um, but here's the thing, when you're on the medication, it's just so much easier to stick to it. You just don't have those cravings. You don't have that desire, and so it just becomes a lot easier as you, um, go along that journey too. Some of my patients have told me that actually certain foods like that that are high calorie, sugary foods, they make them feel worse when, it makes them feel worse being on a Zimbic than eating other foods, so they've felt like it's easier to make better lifestyle decisions as well. Absolutely, yes, yes. Um, so probably good to just talk about, um, some ways to avoid any, um, complications. from taking the medication that I really try to harp is making sure they stay the thing. If you're less drink less too. But if yo you're going to cause you types of problems that ca as well. So I recommend t bring your Stanley cup, e drink lots of water all t that even if you're not e used to, you're still sta Yes. I definitely agree with that. I think the other thing that I have seen with patients is depending on what their lifestyle is, they, like the first time you take your dose, you may want to do it over the weekend or something like that because I have had a couple of patients when they were first initiating it and they were like, Oh my gosh, I was so sick at work all day. And until we really figure out how your body's going to react, it's probably best to try it. Because it's a once weekly injection. I don't think we mentioned that. Yeah. It's not something you have to take every day. And so you can kind of time when you might increase your dose each week. Yeah. And I think all doctors do it a little bit differently. I've seen how some clinics have the patient come in for the injection or with us, we just have the patients do the injections themselves at home. And then my kind of workflow is I just have them send me a portal message every week, letting me know. Did they lose anyway? And did they have any side effects? And then I just messaged them back of, do we stay at the same dose or do we need to change the dose based on those? But you'll see kind of different workflows for how people do it as well. Yeah. So, you know, I mentioned what's the, what's a very common patient population that we do this in PCOS patients. Well, what happens a lot of times for PCOS patients is they aren't normally ovulating on their own. They're not getting a period regularly. They've, you know, sort of for most of their life felt like they didn't really have a risk of. ovulating and getting pregnant. Well, it's a very well known phenomenon that when you start to lose weight with PCOS, you can actually trigger your body to resume ovulation. And so we have had a couple of patients, I myself have had a couple of patients that have unfortunately conceived accidentally while taking Ozimbic, even though we talked about how we want to take a hiatus, and we're not going to actually, you know, try and get pregnant, but their body ovulates. They're not expecting it and they get pregnant. Have you seen this happen? Definitely. So I've had a handful of patients like this and it's such a mixed blessing because some of my patients have been trying, you know, for 10 years and everything. And I, of course, during the counseling have been so strict and I, I do not get pregnant. I know you think you're infertile. You need to use contraception and everything. And they nod their head and they say, okay, Dr. Reed. And then they call me, I'm pregnant. And I'm like, Oh, because Then the patient feels stressed because they're worried, um, about the risk of birth defects based on the animal studies. And then I feel stressed for the same reason, um, but then also we're happy because they're pregnant when they had been trying for so long. Um, and so I would say the encouraging thing is a colleague shared a study with me last week, actually, um, that showed, okay, what happens When somebody gets pregnant on this medication and it did show about 600 women that that had happened to and there was not an increased risk of birth defects in that group of women. Now, I don't think that's enough women to, um, give the final say on it. I don't, I still recommend strongly that patients not conceive on it, but at least when I saw that, it gave me a little bit of relief for my patients that had this happen over the last year that. According to what we know so far, there does not appear to be, um, an increased risk in humans when compared to the animal studies, too. That's certainly very reassuring. Yes. And a start to the data that we really need to see. Right. And, you know, I'm just always curious, too, like, how far along into the pregnancy were they before they realized and stopped taking the azindic? Yes. I think a really good thing for our patients is Our patients know the minute. Oh yeah. So we're able to stop very quickly. Mm-Hmm. terminate all ozempic. Mm-Hmm. But, you know, maybe patients who aren't in the fertility world, maybe they're not paying such close attention. Mm-Hmm. Mm-Hmm. Um, I did wanna talk about some of the risks. Um, to taking Ozempic as well. That's especially you'll see on the package labeling and everything. So, um, some of the more common things that they, um, mention are that people can get gallstones. You can be at risk for pancreatitis. Um, and that sounded kind of scary to me, but really when I looked into those things, anybody who's losing weight is gonna be at risk of those things. Even if you're just using diet to lose weight, you are at higher risk for getting gallstones at that time. It's just because your body was used to a different kind of diet and amount of food than when compared to before. Um, so with those things, yes, they can happen, um, but I feel that the benefits of losing weight really outweigh some of those risks that, um, that we see on the package lately. Um, the other one that had concerned me at first was risk for thyroid cancer. But I have actually seen more recent data on that since the package labeling came out that showed that that does not appear to be true. That is based on human studies, which did not show an increased risk of thyroid cancer. So I thought that was very reassuring too. Um, in terms of kind of real life complications that I've seen, I've only had one patient that I felt like had just a very adverse effect. And, I had given her the medication, she took the low dose, and she, whew, she was vomiting, she felt really sick and everything, but she thought she had a stomach bug. And she has a baby, and she's like, look, I get these stomach bugs, it was a stomach bug. And so I said, okay, you know, so she kind of rested and recovered, and then she tried it again, and the same thing happened, and then she told me, Dr. Reed, I think I have another stomach bug. And I'm like, I don't know if you, Like, I don't think, and so I said, look, there is this rare complication called stomach paralysis. Okay. With this medication, we know it can slow down your digestion. That's part of how it works. But in some people it could be that their body is just more sensitive to the medication than others. And instead of slowing it down, It just may stop digestion completely. And if your stomach is not working, it just comes right back up. And so after she had tried it a couple of times, we did feel that she probably had that very rare complication stomach paralysis. And unfortunately, it just means that she wasn't going to be a good candidate for the medication. So we ended up stopping it and having her, we'll end up having her see a weight loss specialist to see what other options are available for her as well. I had a patient, this was not a patient that I was helping to lose weight. She actually came to see me. see me much further down the line with her partner, but she had been on it for quite a long time. So this was the longest I think, cause I'm trying to, when she told me how long she'd been on it, I was like, has the symptom been around that long? Yeah. She had been on it for four years. Yeah. Continuous, every week been on ozembic, and she was having some pretty severe complications from being on it, and again, most of our experience is very short term, so I haven't really seen anything like this, um, in my patients, but Similar to what you're saying, she had delayed stomach emptying and she, interestingly, this patient actually has problems with herself because she really can't vomit really, really sick, right? Your stomach's not emptying one way. It can't feel like you can't really vomit the other way. And We do ultrasounds, we do ultrasounds for all of our patients and, and she was telling me, yeah, like my, my GI system is just really messed up and I'll put the ultrasound crib in and I have never seen bowels like this patient's. Mm hmm. They were the most active. Mm. I mean Seriously, the whole screen was vowels, and it just looked like, like, almost like if you had a pipe with running water going through it. Wow. It was really, really interesting. So she was, like, trying to take pictures, and she would show her GI diagram. I'm like, listen, I'm not a GI doctor. I will look at people's vowels, but I can't help but see your vowels on this ultrasound. I mean, it was really, really impressive. And she did say, I'm suffering from terrible diarrhea, I've, you know, Oh my goodness! It's like, you know, long, long time now, and I'm, you know, not certain that it could be the isthmic but I have suspicions because of delayed stomach emptying and things like this. Mm hmm. Really, really. Yeah! It's cross sex. Yeah, well, I know sometimes I think people don't realize because if you look in a textbook or any kind of image that may be out there on the internet, whenever you're looking at the uterus or ovaries, it only shows the uterus and the ovaries, but in real life, all wrapped around the uterus and the ovaries are your intestines. And so people don't realize that every single day we're actually looking at your intestines, too. Um, and I will say, too, like if you're constipated, sometimes that makes it harder for us to see, because it'll wrap around, you know, the ovaries, and you're trying to find the ovaries, or we have kind of our little tricks up our sleeves. to, to find them to get somebody to cough. Sometimes it'll shake the intestines off of the ovaries and all that. So, but that's interesting that you were able to maybe give some useful information for her to take back to her GI doctor. Yeah. So we look at them all day. You know, I don't really pay much attention usually. Yeah. Once in a while I comment, but yeah, that was, um, that was certain. a lot for that patient. Yeah. Yeah. Um, a lot of people, um, will ask me, okay, what do I do if I have tried these medications and they're not working, but I still want to lose weight. And I do think that's where it kind of gets out of our expertise. You know, we're certainly comfortable prescribing some of the basic weight loss medications, but if it becomes more complicated like that, I'm often referring to, um, one of my colleagues who are weight loss specialists. And I will say some people opt for bariatric surgery, and I think it's a very reasonable option. But one of the key things to know about opting for bariatric surgery is it also delays you being able to conceive. So most people say you should wait about 12 to sometimes even 18 months. And the reason is that over time after bariatric surgery, your body is losing weight, but you don't necessarily have control over that. And imagine a circumstance. where you get pregnant, but you're still losing weight. And the concern is what if you are to a point where you're not getting enough calories to support your body and the pregnancy. So they really want to see that your weight has plateaued before you get pregnant. And I do think this is a really important thing to consider when you're talking to a patient about this, because they may not have 12 to 18 months to wait either. So it's kind of one of those things. It's a joint. Decision. I think you have to make based on what's important for fertility versus safe pregnancy and all of that as well. Absolutely. A really good point. And I, I have had a few patients that previously I've had bariatric surgery and come to see me and, um, but they've already waited. So that's nice. Yeah. Um, but I do think that weight loss not only helps you have a healthier pregnancy, but I do think it increases your, um, chances of your fertility treatment working for you. Oftentimes we find that we need less medication. After a patient has lost weight, um, and I even saw a recent study that looked at women who did a frozen embryo transfer of a known normal embryo. And patients that weighed the most had the lowest chances for success. Um, now I do think sometimes it's important. So it's important that you're ruling out sort of other factors that may be contributing. So for example, somebody who is on the heavier side, I have found is more prone to getting polyps and inflammation in the lining. So sometimes when I've seen those studies, I would say, well, but are we making sure that we've done, for example, a hysteroscopy or some type of cavity assessment to make sure that that is not the reason that they're having issues or problems, but assuming they had all of that, there may be other factors coming into play. Like you mentioned the insulin resistance or things like that. Um, that can affect chances for success. So I just love that we have some other options to, um, help patients on their journey as well. Okay. Should we wrap it up for the week? Thank you guys.