GLP-1 Over 60: Obesity Doctor Explains Part 2

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GLP-1 Over 60: Why This Feels Different Now Part 2
***Note: Kim had some sound issues, so we appreciate your patience and grace with her audio this episode.


What does it mean to start GLP-1 treatment later in life… after years of trying to make weight loss work?

In this episode, Kim and Kat talk with Dr. Lindsey Ogle, an obesity specialist, and Deb Cooperman, an obesity care advocate and content creator, about starting GLP-1 treatment in your 60s and why the experience can feel different this time around.

As more adults over 60 explore GLP-1 medications, Deb shares her story openly, from decades of diet culture and early messaging about weight to grief, food noise, and navigating obesity treatment later in life. And we also discuss the upcoming coverage of GLP-1s for obesity on Medicare (and maybe Medicaid) in July 2026. Dr. Ogle helps connect those experiences to the science, including expectations, side effects, protein, muscle preservation, and what support can look like as we age.

What we cover:

- GLP-1 weight loss over 60
- Food noise and obesity beyond willpower
- Diet culture and lifelong messaging around weight
- Grief, stress, and emotional eating
- Protein, muscle preservation, and aging on GLP-1s
- Side effects and realistic expectations

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Transcript

SPEAKER_01 0:00

Can you tell us a little bit about who you are and how you help people?

SPEAKER_02 0:04

Yeah, so I'm Dr. Lindsay Olgel, and I'm board certified in both family medicine and obesity medicine. And I feel so fortunate that I was introduced to obesity medicine during my family medicine training. I went into family medicine because I was passionate about preventative health. And my whole goal was to help my future patients achieve and maintain their health so they could live longer and better lives. And during my residency program, we had some available elective rotations. And I worked with an obesity medicine physician, and she was based in Denver. And so she introduced me to the field. And what I saw that was happening in her clinic was so different than what was happening in my primary care residency clinic. These patients were actually improving their chronic conditions and they were feeling better and their lives were improving in so many different ways. Whereas in a lot of primary care, we're just kind of managing all of these chronic conditions and managing them independently as different conditions, where so many are results or related to uh obesity. And so by going into this field and working in obesity medicine now, I can really kind of focus on more of the underlying concern and treat almost just one thing that then touches every other aspect of that person's life. And I think Deb did such a great job at explaining her story and just sharing how with, you know, finally treating her disease that has now expanded her life. And that's my favorite thing when I hear about my patients. I love hearing when they are starting to do more activities and um just engage in their life more. Um, that's my favorite thing to hear. And again, that's originally why I went into family medicine. And I just feel so lucky to now be an obesity medicine physician.

SPEAKER_01 2:11

I love it. Yeah, I mean, we're so thankful to have you. Obviously, we have we don't have enough specialists. Um, we don't even have enough doctors, honestly, treating them on people to have this disease. Uh so the more I think like presence and education and you taking the time to make the content that you make, it's so important and it hits so many people that you may have never touched, you know. So, like, thanks for doing that and for coming on the show and letting us fly will off of that as well, you know, because that's what we want. Um, I'd love to talk today about several things that have come up since the Facebook post and all the comments and stuff. And specifically, I wanted to do this because um it's interesting the timing, because you know we've had this scheduled. Um, it's the same demographic. Deb is in, my mom is in, so you know, 60s and 70s, right? That I hearing these things from. And so I figured this would be a good way because they've probably found us and they're probably here and listening. Hey, we're so glad you found us. Listening or watching. And um, I think that it would be good to understand people that are possibly, because who knows when they'll hear this, like if they're getting approved through Medicare, God hope, let's hope, right? Um, or even Medicaid, let's hope even more, right? And they're just new to understanding GLP one. I think it may be good to kind of baseline set, you know, things that are important specifically for I think anyone on this journey, but also specifically when you're at a certain age. So, like, for example, the strength training piece. So this is something that they've, I feel like they've only really just been talking about people that are in menopause and perimenopause recently, right? How important this is. And I think it will be good for our listeners who are on this journey to understand that um a little bit. Can you explain? Because I know what they've heard, because I haven't seen it in the comments, which is, you know, GLP1 eats your muscle. So um, I think, oh yeah, not kidding. Not kidding. They're still doing that. Yeah. Yeah, it's everywhere. Yeah, unrelated, you should take that. Um, there's a video that Dr. Silas Wayland made. Like, well, how about Ozempic liver and Osempic heart and Ozempic back? Yeah, find that thing on post it to them. But anyway, anyway.

SPEAKER_02 4:29

Oh my gosh. So this is exactly why I do what I do and create content to address this, uh, all of this misinformation that is out there. Um, so to speak on that specifically, because I think that deserves it, um, GLP1 medications do not eat your muscle. Um, and there is no direct relation between GLP1 medication and muscle mass loss. Any type of weight loss can lead to muscle mass. And there are things that you can do to help maintain your muscle. Um, and we all should be doing these things whether or not we're on a GLP1 medication. And that is we want to make sure we're getting enough protein on a regular and consistent basis, and we want to be exercising. And I also try to use terms like physical activity, movement. Um, and that is for most people, it's good to do some cardio and some strength training. And strength training can be really intimidating, especially for older populations and many women who did not grow up doing that. They were mostly focusing on, you know, walking, running, biking. Um, but strength training can be yoga, it can be Pilates, it can be bodyweight exercises. Um, I know I do the Peloton app and I'll do like the like three-pound weights um arm exercises, and they are really difficult. Um, so you can do light weights and build your um strength over time. And it does also have to be a long period of time. You can do five, 10, 15, 20 minutes um periodically throughout the week, and that adds up. Um if you are on a GLP1 medication, as Kat explained earlier, you want to go slow and steady with the titration, because if you're going quickly on your titration and you're overly suppressed and you're so full you can't get in enough nutrients, and that's protein and calories in general, then your body is going to be looking for those nutrients in other ways. And sometimes that would be in your muscle stores. Um, so doing all the things that we're always told to do on getting the protein in, the strength training, and then going slow if you are on a GLP1 medication. Um, another thing that's really important in older populations is to work closely with your doctor and make sure that if you have other health conditions, those are being monitored. Um really thinking about like high blood pressure, if you have diabetes, if you have osteoarthritis or any other musculoskeletal condition, um you need to be monitored while you're on a weight loss journey because if you are now losing weight and exercising more, changing your nutrient intake, that could impact um both, I mean, just your blood pressure and how your medications are interacting and how much medication you need. So you need to be monitored really closely with that. Um, and then if you are starting to um introduce physical activity, uh, I highly recommend um working with a physical therapist um and or a personal trainer to make sure you're doing it in a safe um and steady way.

SPEAKER_01 7:54

Yeah, I think that's those are all such good points. Gosh, I just clipped that right there. To get out there because that's amazing. And I think really important, um, I do think we need to think about when it comes to this, just because of I feel like poison, the diet culture has uh stretched across generations, right? There are different ways, right, that we think that it equals healthy. Like I'm telling you, I literally thought that I need to eat a thousand calories a day and exercise six days a week. Seriously. Oh, the the point I really helped some point, you know, because we're it's things are evolving now. Sometimes you you may be surprised that your insurance may cover a dietitian. Um, and technically, I think sometimes your insurance can also sometimes like cover, I don't know if it's training or any sort of like movement, maybe not like a strictly like straightforward trainer, but I think a a lot of insurances uh can help cover movement. You're in the next team, if we get the Treat and Roosevelt Act, you know, obviously we want to get all this codified, right? So that you know, anybody just can't come and change it or they have to work real hard to try. Um, and uh we want to get that changed too. And that will, you know, we want there to be specialists that are available if you have Medicare, you know. Um, the other thing is not just specialists, but like like she, like you mentioned, like dietitians and stuff, not not a lot's covered, you know. So those are all things that are, I think, really important for you to have access to because this is a roller coaster. Like if you are if you are just starting on this medicine, no matter what age you are, this is a mental and physical roller coaster. Okay, right? Yes. And I think what else I see in the comments too, I feel like I see this for all of us, but specifically within Facebook, specifically this demographic 50s and 60s, 70s, um, I'm hearing I'm not losing weight fast enough. And um, or I'm a slow loser. And then I'll be like, well, how much are you losing? They're like, only a pound a week. I've only lost five pounds, and it's only it's been two whole weeks. And it's because of what what they're seeing, right? And you know, and also probably what they've experienced with better me and all these other different things we've taken. So I think it's important that they understand what's like this slow unsteady, or if you do lose past, like why that is, like, so that they can just understand what's going on there in the beginning because it can be so fucking terrifying. Sorry, dad, but it can. And I can only imagine what that must feel like, you know, if you're not in our community. Like, you know what I'm saying? Like we have our community and it's scary, we talk to our community, but if you don't, and we already know that even the medical care, like many PCPs, they don't understand this yet. And the amount of time between the access to these medicines and that scaling up is gonna be like, you know what I mean, really fast. And so the more I think we can let them know about kind of what to expect and when these stalls happen, I think that would be really helpful.

SPEAKER_02 11:00

Yeah, I get that all the time from my patients who um are either newly on the medication or really it can happen at any point, but comparison is so dangerous and it can really affect your mental health and your success on these medications. And most of the time when people think that they're not doing well or not responding, they either are just not at their right dose yet that's right for them. And because any dose can be a treatment dose or a maintenance dose or an effective dose, I see people who do very well sometimes at the first dose, and then sometimes they don't respond until we get to one of the higher doses. Um it's all individualized and everybody responds differently. Um, but a lot of times, from my standpoint as an obesity medicine physician, they are doing perfectly. Um, like you said, somebody people very often um will come and they only quote unquote only lost four pounds in the first month. And that's amazing. And they may even have control of their appetite and food noise, and they feel satiated at the end of a meal, but they are discouraged about their progress because they're comparing themselves to somebody else. And the truth is, you know, as someone who does this every day, and I see people responding to the medication, everyone responds differently. There are those people who right away, and it has to be water weight where they they lose a lot of weight that first month. Um, and like I said, then there's people that that don't have that. And it can be discouraging, and I understand, but that does not mean that it's not going to work for you. It's it doesn't mean that it's not working for you. It just means that we need to, you know, keep going and moving forward. And as I feel like the theme of this talk today is kind of dismantling diet culture. Um because what I'm spent almost all my time doing is redirecting the focus and framework towards treating a chronic condition um and not um, you know, no longer working within diet culture.

SPEAKER_01 13:20

Yeah. I think that's a really good point too, and like probably better said than what I was saying, because I get all in my feels, but like we would not look at any other disease and blame the person for it and be like, should have done that. You know what I mean? Like we wouldn't, but we do look at this that way. And even to ourselves, you know? Yeah. Yeah.

SPEAKER_02 13:41

The only other thing is I another condition I treat and focus on is opioid use disorder. And it's so interesting because I see very I just see parallels all day, every day, because with opioid use disorder, there's so much stigma and addiction. And we now have a really great, or we have a few different medications that can treat that very well and can help control cravings and withdrawal symptoms from opioids. And the same thing with um, you know, obesity. We now have GLP1 medications and a few others that, you know, kind of do the same thing and help control that condition. And as when you guys were talking earlier about, you know, the older demographic and having a lot of negative comments about people utilizing these treatments, I see that in um addiction medicine as well. People tell me their experience in NA or AA and the older population gives them a really hard time for utilizing these medications and say that they're not in recovery if they're on these medications. So it's very similar to people who are saying you're cheating if you're using a GLP1 medication. Um, that's just stigma and bias. And I think they're honestly kind of jealous that they didn't have those options when they were younger. Um, because from a medical standpoint, in my eyes, it just is an obvious choice to, you know, utilize the treatment that's available.

SPEAKER_01 15:06

Yeah. I had I had one comment in particular, and um I replied back to it because I'm I was like, you know what, I'm gonna use this as an opportunity to see if I can just have people just think a little different. I'm not gonna come at them, which of course I want to, but I'm not. And the girl said, You had me until you said that it'll be C is disease, and now you don't, because of blah, blah, blah, blah. And I'm fat and I'm this man, and I did that because and all this different stuff. And I replied that, and then she's like, I lost all the weight by myself and I kept it off and blah, blah, blah. Instead of being like, Do you know the statistics that you're gonna keep that off? Very, you know, instead of doing all that, I said, I have a question for you. I was like, Why are you so upset? Right? Do you feel like just consider it that maybe you had to white knuckle, right? And you had to suffer. And so therefore, other people should have to too, you know, but no more comments after that. You know, and I think that because that is I think true, like a lot, and I think we have that mentality as humans, right? Like we look at the the younger generation and the way they're coming up and what we had to do to get our place in corporate America or whatever it is, right? Like it's a little idea of money, that's the way I speak, Kim. Like, you know, I'm like, listen, they don't know, they can get the coffee, you know what I mean? Like, I think it's human nature. Like, if I had to work hard into this, then so do you. You don't get a free pass, right? And I think they're doing it with this too, right? You know? And that's one of the many reasons.

SPEAKER_00 16:44

But I also think we look, we uh and I've said it before, and I think you've all we've all said it in different ways, that we are are learning too. We're all learning now. Yeah, but we didn't know you know, uh I didn't know a year ago. You guys have been, Kim and Kat, you guys have been on a while longer. So you didn't know two or three years ago. Yeah. Um Dr. Ogle, you have been practicing for I don't know how long, but maybe we're all coming up. And so I think the challenge is these uh of course they don't know. They uh aren't uh it's it's an it's a new wave, right? It's a new wave of learning. And so it's I think it's hard once uh uh you've ta I can't remember in in um in the matrix, you take the red or the blue pill, I can't remember. Once you've taken the pill that opens your mind and you see the matrix, the diet culture matrix, you want to just shout and scream at these people who are in the matrix. Don't you see what's happened to you? But they haven't they haven't uh they're still, you know, they're not there yet. Yeah. And so Yeah, it's gonna take what it's gonna take. And I think what you you guys are doing with your podcast, what you're doing with yours, uh, Dr. Lindsay, I think what we're all doing in our various ways on social media. Trying to get that word out that it's different now. Uh it's changed and it's different. And hopefully people will see, you know. I keep using the word, and here's the who who metaphor. We are the who's and who will. You are the who's an ooville, right? And we just have to keep on shouting because a lot of people don't get it yet. We just have to keep shouting.

SPEAKER_01 18:43

Yeah. I think it I think it'll be like that for a while. And I I I but it's like I said, I mean, I kind of got into a point because we've been doing this for years, me kinda, you know. And I was like, maybe they don't have us to do it anymore. Do we cover it? Oh no, we haven't covered it on, and then I posted on Facebook and I'm like, oh dear God. Oh they're underserved and many people there with misinformation, and many people being misled. And there were people that would like not listen to my video and like say things like, um, you shouldn't listen to an influencer on TikTok. And I was like, hey, um, I say all that in that video. Like, if you listen to that video, you will hear that I say all that. And I I recommend you language for your doctor, like for you to use with your doctor, you know? But it's, it's, it's, it's, it's, I blew my mind. It blew my mind, Eb. Like, and I think like less like you said, that that matrix piece, I think that's so important because not everybody does get that right away either. Right. Like sometimes, you know, they may be on 7.5, sometimes they may be on 15, sometimes like they may get it right away. I just think that you have to kind of let that unfold. And like I feel sometimes like in the community, just because we've been here for a while, like I while four years, but like, you know, I look at it and I feel kind of like an old person because like when they when they make videos like that, saying those things about themselves, I know that they have to process through that. I know that they have to journal, right? Like I know they've got to get through that. And that me coming in is not going to help them. They have to come through their own time, you know? And and that's like a a big thing. And I I do worry, like as we have more and more access, it's weird, it's because we've been fighting for that, right? More access, more affordable access, blah, blah, blah. We went from $1,400 a month to $500 a month, right? And all this, and now we're gonna have all this access. We don't have an infrastructure to support the amount of people that are sick. I mean, like the mental community.

SPEAKER_00 20:40

But you kind of do. It's just gonna be it, you kind of do. You guys, there, you're you're one of many podcasts who are and and and lives and things like that, people who are putting out the information. You know, you've got Dr. Oval, you've got Mateo Rentia, you've got you guys, you've got Dave, you've got uh, you know, you've got so many different people. You've got people on TikTok who are providing services. And I we're uh all going to be like creating this quilt that will hold them. And yes, it's gonna put extra strain probably on those of us who are who are out there. But I think one of the things that we might all say, I think we would all say, is we're here for it because we know how much it's changed us and how much it's helped us. So of course we're gonna show up for those people. Of course we're gonna do it. And they're gonna we're gonna bring some of the people who are starting to come up and who are starting to bring what yeah, of course. Like I'm I've only I haven't even been at it a year. And look, I'm like all in, right? Like I'm fighting the fight. So we're coming up. There are other people coming up. Like we're we're at the early part of the wave. It doesn't feel like we're at the early part of the wave, but I think we are.

SPEAKER_01 22:00

It's a wild, wild west in terms of data, right? We're not. Right. But in uh in terms of like them knowing that this works, right? And then knowing this is primarily safe. And them knowing those different things, like I think we know that. And there's a a good bit there. But in terms of what it's what it's like in operationally, like I think we don't. And like for sure, I guess when I was saying infrastructures, I meant like, you know, in the medical system. So I think there's infrastructure to support it, are a bunch of people with a VCD on the internet. You're right. But I do think you're right. And in in the gap of not having it, like we do exist, you know. And I think there are many of us that take this very serious and want to make sure that the it's very like are the reputable and we have the right voices with the right education, right? Ty telling these things so that we can spread that, spread the gospel.

SPEAKER_00 22:54

Just right. So I'm an evangelist, baby. Do you feel like you're ready? Do you feel like you're the medical community is ready to support this community?

SPEAKER_02 23:06

That is a great question. Um in some ways, yes, but in other ways there are definitely concerns. Um, I mean, every year there's more people sitting for the you know, board certification for OBC medicine. So we are getting more and more doctors every year who are interested in you know this field, which I think is wonderful. So that will hopefully expand access to um specialists. But um just our American healthcare system has so many issues in it. And when I did practice primary care, um it's just it's overwhelming how much you have to manage and address with your large patient panel and you have short appointment times, and there's all the it's just a it's a lot. So to focus on something as complex as um obesity, if you're gonna do it right and and correctly, um that takes time. And that's part of why I you know stepped away from primary care and opened up my practice. And I do 100% telehealth, um, which I love because I can reach patients who typically don't have access. I can reach them where they're at. Um and I set up my practice to where new patients, I book for a whole hour, and then follow-up appointments are 30 minutes. And so we have time to I really get to know my patients and what their whole health history and their weight history and all their other concerns, um, what their life looks like, what their job is, um, their nutrition and physical activity and sleep. And we can go over all of that. And I can touch base on most of that at each follow up appointment. So we can build on those pillars of obesity medicine, nutrition, physical activity, um, behavioral health, and medicine. And so to do it properly, you need you need the time. And again, in in traditional clinics, you don't typically get that. Um, so hopefully with more specialists coming out, I think many people are kind of going into private practice and doing their own thing so they can create that because they do want to do right by their patients. But then there's also a lot of organizations out there that know that there are, you know, a large portion of our population who is looking for this treatment and they're looking to maximize that from a financial standpoint, and they are going to do as short of appointments as possible. And some of them, you know, not even really seeing their patients.

SPEAKER_01 25:42

Um, so that's that's not and it's very real even now, and I I I fear will continue. And it's like the thing is it's so hard because I know what people deserve, right? Um, but I also know that they're not that the care that they deserve is not available en masse and um or affordable. And so then it's like I get to this point where I'm like, I just want you to get safe medicine. And then I'm like, in between, here's your community. Because, like, what else are we gonna do? Right? Like, um, because it it had they have the that that's the that's sort of the and you and I talked about this before on the show, right? Trust kept kicking the can down the road, right? People were becoming you know, obesity, pre-diabetic, kicking the can at somebody else's problem in two, three years because they're gonna switch insurance, right? But now we're everybody's fucking problem, right? But we are like that's the thing because they made it that way, right? There was no treatment to try to control any of this, even though it was available and has been available. I mean, even with, you know, we even with the original GLP ones, like, you know, but they weren't. They picked somebody else's problem, right? And so now it's like this mass issue, you know. So I worry that, but I do want people to have the quality of care that they deserve, but you know, I also understand that that is and it is a privilege to get that. And so in reality, I'm just hoping that in between those gaps that they can get guidance here, you know, I'm on the show.

SPEAKER_00 27:16

That's my my suspicion is that you're going to see people going in to their primary care doctors because it will be available through Medicare. They'll go to their primary primary care doctor and say, I meet the criteria, I want the medication, and they will do what they do to so many, unfortunately, which is give them the prescription and say, here you go, go get your prescription and good luck to you. And those, and that's when people will do what so many of us have done, which is we will start to search for support and we'll find hopefully. Hopefully that yes, hopefully we'll find Kat Carter and her fabulous exercises, etc. And the whole baby and the whole and the whole podcast. But I do, I hope that they will find community. You know, community and see. But you know, like you said, um, Dr. Ogle, that you know, you you can't you can't know. We can only hope. But that's why you have to do, as Kim often says, is get loud and change things, right?

SPEAKER_01 28:20

You know, I want to ask you, Dr. Ogle, because I remember you posted something on TikTok a couple, uh, it might have been a few months ago, where uh like a fellow like practitioner kind of poo-pooed on, I think it was obesity as a as as a disease and the GLPs.

SPEAKER_02 28:36

Is not all doctors are on board with prescribing GLP1s or um believe it, um believe in it, which sounds so crazy to say because we are trained as scientists and we should be following, you know, the studies and the facts. And those are very, very clear that GLP1 medications are safe and effective, um, and they can help many different metabolic conditions, and we're finding more and more all the time. Um, but yes, so that video you're referring to that was an interaction with somebody in a like in a non-professional setting, um, a physician that I know um that we were, you know, not at work um talking about, and he's in a different field. He's in a surgical specialty. So um, you know, he's not used to prescribing these medications, um, but has definitely has a bias against them. And the his comment was they don't work because when you stop them, then the people regain their weight. Which it's not an antibiotic, uh, you know, it's within a chronic condition. Um, so and my thought process with that as a primary care and obesity medicine physician is that's proof that they do work, is because when you're taking them, then it's controlling the disease. And then when you stop taking them, then the disease is uncontrolled. So I thought that really that unsatisfied here.

SPEAKER_01 30:02

We split flat around. I think that's true. Like, like I say all the time, I'm like, guys, I would love if there's a world where we can come off these. I I I am hopeful that there will be more science where there's a maintenance dose or a getting off dose or whatever it is. I am hopeful and I will have hope in that area, but this is not a cure. Right. And it is a disease. So if it was a cure, then that would mean we could take it and get off of it and then be cancer free or whatever it is, right? Disease-free. But it's not. It is a chronic disease, it is a progressive disease. And so ultimately we would want to continue to treat it. And the only reason that people even consider that is because they don't think it's a disease. Because any other medicine that we talked about, about a display, nobody would question that. If you talk about diabetics, for the most part, if you think about it, years ago, everybody was like, nah, like that's it's diabetes is because you're and you're lazy and you just need to exercise and lose weight, all this other stuff. But now, if you tell somebody that you're in a geological diabetic, they don't blink. They don't even blink. Like I'm because it's accepted as a disease now, but it wasn't always, you know, and I think that that level of where we need to be in society, you know, needs to evolve so that we can get there. Like if we have people that are new and again, like deconstructing the diet culture thing. I think understanding set weight and how that works, especially if we do have friends from a new different demographic that are joining, like hitting these different set weights, right? And what these means. And then kind of I think to probably understanding how this isn't just about like weight less, what happens in the brain. Like what's because you know, I talk about what June has telling me, you know, that it's weights, the regulation centers in the brain, right? So I think if people could understand that, maybe they could understand that it's a disease and it just doesn't make you just eat less. There's a lot to it.

SPEAKER_02 31:57

There is a lot to it.

unknown 31:58

Yeah.

SPEAKER_02 31:58

There is a lot to it. And that's why the GLP1 medications are so effective, especially compared to some of our other medicines that we had in the past, because they address multiple components of the disease of obesity. It helps with appetite control at the brain level. Um, and it also helps with insulin resistance, um, which can contribute to waking and difficulty losing weight. Uh, and then it slows the emptying of the stomach, um, which helps with satiation. Um, so it helps with different aspects because obesity is a multifactorial disease. Um we mentioned the brain side of things. And I was thinking about this earlier when Deb was sharing her story, and we're talking about um using food as a way to comfort, and that's normal, everybody does that. Um, but for certain people and for various reasons, that could develop a pathway in the brain that your brain gets used to, and it's looking for that, you know, reward and that dopamine signal signaling. Um and if it continues over time, then you will look for that, you know, in the future when you're going through a stressful, difficult time. Um so that's just one example of how this can happen in that food reward pathway in the brain. Um and then there is, we mentioned kind of hormones. So there's the um insulin resistance, there's also cortisol, so stress hormone can have an impact on weight. Um there's the you know, sex hormones, um, and that's it's a whole topic in and of itself with perimenopause and menopause and how that can then impact weight. Um there's environmental factors that can contribute to obesity. Um, there's our genetics and um epigenetics, so what we were exposed to when we were in our mom's womb, um that has an impact on our you know, eventual weight set point, um, our nutrition, how we were fed when we were younger. And um so there's just so many different things, um, pollutants, microplastics. Um, and then there's things that we don't even, you know, aren't even aware of yet. Um, oh, the gut microbiome, that plays a role. So there are so many factors that are at play here that we don't have control over. Um and that can then lead to um the set point over time. So our body wants to stay in homeostasis. It wants to stay um in a certain range for body temperature, a certain range for blood sugar, certain range for you know, sodium level, potassium level, and and weight is another one of those um set points that our body likes um with homeostasis. And um, they're all of those factors that I mentioned will then contribute to what your personal set point is. And for most of us, that kind of that will increase a little bit over time as we become our age adults. Um, and and that that can be normal, but it can become dysregulated with those different factors and it can can eventually raise. And anyone who has ever gone on a diet, um, most of us have gone on many different diets, you know that um once you start to restrict your calories, then your hunger is gonna go up. Um, and that is your body trying to get back to its set point. So it's trying to get you to eat more food so then you can, you know, maintain at that weight that it thinks that is safe and comfortable for you. And that is an evolutionary um mechanism that's developed to protect us um when food was not um readily available like it is.

SPEAKER_01 36:01

I was watching, you know, I love Oprah. Um, I was watching this this that Oprah had recently on where Serena Williams was done. And um, she was with another OBC doctor that I just we just read her book, actually. And um, and she was saying it didn't matter like how much I would diet and exercise, right? My body wouldn't budge. And the doctor was like, yeah, because your body decided to to like, and I don't even remember she, she said burn energy differently, or somehow things and that she like it didn't matter because it was like, no, no, no, we gotta hold on to some of that. And I think that piece is really important. And the reason I do is one, not we don't talk about it much. The reason I too is because what I see in the comments, you know, is that when people stop losing, right? Or whether it's for a short amount of time or or a long amount of time, they'll get they think that they need to restrict further and further and further. Right. Right. And said she was eating 900 calories a day and exercising more because it was her fault that she was on this stall. Clearly, she needed to restrict more, but there is something biological that has happening there, and I think it's really important that people understand it so they don't do this too. That's why I make this content. So they don't do that for themselves because I I see things other people don't see because of what we do. And and they they do this because that's what they that's what they think. And they here's the thing, Dr. Ugal, uh, you're wonderful. But ultimately, the relationship between a patient, especially obese patient, and doctor is very broken. The trust is very broken. And even me, and you, I have my friends are doctors, you know, even me, I won't come to you first. I will go to them. And I it's it's it is that way. And I think for sure, you know, I think I'm gonna say my mom's generation, because I don't even know, you know, for it feels that way too, because it that's all they've ever been told is that it's their fault. So if we could, I think, understand the science behind that a little bit and why that's not good. That would I think that would be really helpful.

SPEAKER_02 38:13

Yeah, yeah. I mean, that's just a great example of diet culture and diet mentality, and you know, probably disordered eating as well. Um, and you're just it it takes a long time and like kind of like Deb was mentioning earlier, and I think we need to have a lot of compassion with ourselves and hopefully when people are, you know, are addressing somebody who's in this mentality, it takes time to change that mindset. Um, and medication can help. Um, but definitely working with a therapist, I think, is very, very helpful to help, you know, with that mindset. Um, and honestly, a lot of people, especially when they've been on the medication and truly have been successful, like you mentioned, some people lose 20% of their total body weight and they still think that they have not done a good job and have you know a lot more to go, have body dysmorphia as well. And so they need to um work with a professional um in regards to that. Um, because what we really need to refocus on, and that I I try to help with my patients, is getting away from just the constantly thinking about restriction. The restriction is the answer. Um, the 100% diet culture. What we what we need to think of is what does my body need right now? Um, and what it typ it's going to need is you know nourishing food and enough calories to function. And there's no adult that that's gonna be 900 calories. It needs to be more than that. Um, so it's it's it's a hard thing to you know give an answer to, but I I really think building a team around you while you're on this journey is so important.

SPEAKER_01 40:04

Yeah. I think like just like you said, there when anybody asks me, you know, how I'm not it happens all the time. How many calories should I eat in a day? Well, I don't know. Like, you know, what one calculator.net. But even that is many things aren't taken into account. Like the doctor is going to know your health and know what's best. But again, this goes back to that is a privilege, right? And so I think like we're I want people to just have like a general understanding, right? And what I'm what I'm what I'm saying with Dr. Oval, right, is that your body, like she was talking a while ago, like in and tell me if I'm wrong, is is always adapting to survive in case you don't have calories, in case you don't have all these things, like this looking for a famine, right? It is a famine, but there's no famine, right? And you can do these things with restriction, but it's your body is going to decide and regulate how those things are burnt. And you do have some control over that, right? With your nutrition, right? And your movement and your mental health, all these different things, managing stress, right? But a lot of it you you don't. And so I think that it's important to understand that the answer is not always I need to eat less. Sometimes, actually, a lot of times, I would love your opinion on this, you need to eat more. Like, I mean, I and I and I don't think that we have that conversation enough. But uh, you know, whether it's more protein or any of those different things. Um, but a lot of times that happens, you know, and it's like, and and people especially with especially with dolls, it's and especially when this dolls go on for months or months and months. The cat had a two-year doll, you know, and like I mean then and then she lost like 30 more pounds, like at a kind of normal, you know, like so it's like I think people don't understand this sort of as like a marathon, not a sprint for most people, friends in our community that were like 200 pounds. And so if they lose 20% of their body weight, that's great, or if they lose 40%, that's wonderful, and they would be closer to what many of us deem the like elusive low weight, right? And I think that a lot of times people who have had like myself, I've had obesity for as long as I can remember, right? I've always struggled, middle school, everything, you know, and I've had a really long time and I bounced around a lot. And so my body often loses and gains and just drops 10, then gains 20. And then, you know, even on the mids, I still have had regain. Not 110 pounds, right? But some regain. And I think it's because there's just like a lot of things that affect weight, right? It's like you were mentioning earlier, a lot of things that affect obesity and how complicated it is. So I I think it would be good for people just to like uh understand that that that your body is making that adaptation, right? And I think also uh if we and make sure I'm right, if I say it wrong, you'd you would tell me. But I think that piece. And then the other thing is when they do stop losing, right? And maybe it's not a stall, and maybe they didn't hit goal and whatever goal weight equals, right? Are there other things that they can do to possibly get further to goal weight? I hate it, but you know, it's their fucking diet culture. Sorry, dad. Yeah, are there other things that you can do, like other ways to treat obesity, or is it GL human or bust?

SPEAKER_02 43:34

Um, so to start with, um back to that person who is eating 900 calories a day, um, talking about how those things that you can't control, um yeah, your body will adapt to that. And so it'll slow your metabolism over time, and then you it'll make it even harder to you know maintain that or be able to eat um more calories um and maintain the weight that you were. At that point. So that's another way the body adapts over time is slowing the metabolism also while increasing hunger. So it's a it's a tough combination. And then you mentioned goal weight. I don't set them to have a goal weight. Because truly, I don't know what that should be for them. There are so many factors. And what that'll even out to be will be for most people five to ten. Some people it's a little bit less, some people it's a little bit more range where you'll fluctuate between for various reasons. Um and it may be in the quote unquote normal BMI, or maybe it's higher than that. And that's okay. Not everybody needs to be in a normal BMI. Um as most people know, there's all those issues with BMI. Um but um what we uh schools issues, we just say pay BMI is bullshit. Perfect. I agree. Um and yeah, many people think that they they need to to be healthy, but that's not the case at all. Um and so what we're looking for is that weight range um that is has got you to a point where you feel healthy, you feel energized, you can do the things that you want to do in your life. Um, if you have chronic conditions, they're um either controlled or in remission. Um, you've lowered your risk factors for heart disease or stroke or diabetes if you don't have those conditions. Um, and you are able to maintain this weight range long term. So that person who's doing 900 calories a day, I doubt they're able to maintain that long term. So maybe they do it for a period of time and get to their quote unquote goal weight, but it's not sustainable and they're miserable. So that's not what we want out of life. We want to be healthy and enjoy our life. Um, so that best weight range is really what I'm going for. And even as an obesity physician, I can't predict what that's gonna be for people. Um, and everyone responds differently to the medications like I started off with. Um, there's people who only quote unquote lose 5% on Zetbound. Um, and then there's people who will lose, you know, over carry for there's so many different factors. And so we don't we don't know. We we will see. And if we've found that somebody has um maxed out either the max doses that bound, so 15 milligrams, or their max tolerated dose, and they are not yet at that best weight range. They have um uncontrolled conditions or they still have further goals. Um, that's okay. There are other medication options. Um, we can combine treatments. So um for that patient, I would probably keep them on Zbound if they're doing well, they've had benefit from it, um, and then maybe add medications. Or when we have our new medications available, um, potentially switch to one of those. Um and then also for some people, consider um metabolic and bariatric surgery as well. Um, and they would probably have better outcomes now that they have um their condition um a little bit better under control prior to surgery and decrease their surgical risk.

SPEAKER_01 47:48

Yeah. Yeah. Yeah. All I mean, I think that all makes a lot of sense. And you obviously what we've heard from from doctors for years on here, um, it always blows my mind to be honest. Like, it's just the stuff that we thought and now the stuff that we know is crazy. Like, you know, but I think um I think that many people, like I said, like kind of get to this this place where they don't realize that there are these other, you know, anti older anti-obesity medications they can do with their GLP one, right? Just like you said, they don't know that. I I can't even tell you how many people don't know that. I didn't know that and didn't let so far out these questions. It it's it's vast, you know? And so I think like understanding that there's that, there's the future. Um, it might be good just I know one was just approved, right? Um, which was uh for co-promp or something just can you maybe tell us just about a little bit of them? Like maybe whether like if it could help people, whether it's get further in their journey, or maybe they haven't had success with the ones they've tried, and maybe like might be one that would work better, or anything that you know about the data around them.

SPEAKER_02 48:56

Yeah, so thank you for bringing up our older medications that many people forget about or almost like poo-poo because they're fo only focused on GLP1s. And I have patients who have have and continue to do very well on those medications. So um most commonly pentramine, keucemia, contrave, um sometimes mixing, you know, metformin in there. Um, and so people do well on those uh individually, and then also in combination with GLP1s because they um you know hit different aspects of uh the disease of obesity. So just like any other chronic condition like high blood pressure, some people need multiple medications to manage. That's such a good example. Yes. That's my favorite example. That was one of my first TikTok posts that um blew up for me um was comparing um obesity treatment to hypertension, high blood pressure, um, and got a lot a lot of traction. But I like that analogy. I think it it's it's really cool. Um so those are our we have our older medications. The newer ones coming out are all GLP1 in that family. Um earlier this year, um, we got oral WIGOV, um, so that's an option available. Um, and then now there's high-dose Wigovy. Um, so it's gonna be up to 7.2 milligrams. So people who have been doing well on WIGOV, um, but again have not reached their best weight or their health goals, um, they will be able to go up to 7.2 milligrams. Um, it should be available very soon. Um, so that's the perfect patient for that medication. Um the orflorgapron, um, which is a hard one to say. Oh, um, so this one's another oral on GLP1, but um importantly, this is a non-peptide small molecule GLP1. And why that's important is with oral weak OB, you have to take it on an empty stomach with a small amount of water. You can't eat or drink or take other medications um within a half an hour after taking it for it to absorb and be effective. So it has those restrictions. Um, or forgopron does not have those restrictions. You can take it with food, other medications, as much water as you need, um, and it will absorb very well. Um, this one does not seem to be as effective as oral weak will be. Um I was looking at one of the studies earlier, so um looks like they studied, they studied up to 36 milligrams, and average weight loss for that was about 11% total body weight loss. Um, but I saw that they only approved up to 17 milligrams. Um so maybe we'll say around 10% total body weight loss to expect on average. That being said, there were people who who, again, did more um and who did less. So there definitely will be people who will respond to that. And potentially um that could be an option for maintenance for some people is one thought. Um, cargisema um will probably come out uh next. This is a combination of semaglutide and an amylen analog. Um, so what we're seeing with a lot of these new medications um is a more combination treatment. Um, as we mentioned many times, obesity is a complex multifactorial disease. And so anything that we can use to treat those different aspects, um, we expect to, you know, be uh hopefully more effective over time. Um so that's gonna be available um later this year and then Red the True Tide. Um I don't think that's gonna be available until 2027. Everyone's super excited about that one because um it looks like that'll be the the most effective option once it's available.

SPEAKER_01 53:10

I want to try caragersema. I had re I lost most of my weight on Ozempik. And I I'm telling you, like, I I if well, I mean I tried Red at first, but but if I could I I'm I'm like the classic person, like I'll take it all. Like karma era. Okay. If there's a medicine to make it better, I'm gonna take it. I'm 46, I don't care. Okay, like I want to feel better and live my life. So it's like, you know, but I think I I want to try that one because I've heard, you know, a lot of my peptide friends love the canolinitite or whatever it is. Um, and so like I'm super curious because that's a double agonist, right? So, like, because that's the thing with Ozempica, it was just a single agonist and the Madraro is not double. So I'm really curious about those. I'm wondering, like, do you think that they'll how they're gonna come get approved for obesity and type 2 diabetes? Or are they just gonna go for obesity? Like, I I'm curious about that. They were doing studies for both.

SPEAKER_02 54:04

So I saw on I saw studies for both for all of those. Um I don't know about Radotrutite. I'm assuming that they were, but uh for high-dose vegobi or fluorgopron and cargisema, yeah, they did. Um studies as well.

SPEAKER_01 54:21

Well, you know, insurance, geez, Louise. Well, a lot of this as we're learning is a lot about conversation. Like, and that's the thing is us getting together, sharing perspectives, like that's the way forward, right? Because I only know my stuff, you know, and and so I think like when we can kind of see ourselves and each other, then it kind of gets us in a better place. And and that's true for what we're trying to do here, because it's not just healing one person, like, you know, we're all anybody that's got this disorder, it's pretty fucked up. Sorry, dad, you know, and it's like fun that we know as much as we can, and that it is presented to us in a way that we can understand, um, because that's another problem. So we're so thankful for you, Dr. Irville. I would love for you to tell us where people can find you. Then then I don't know what states you're in next.

SPEAKER_02 55:10

Yeah. So my practice is called Missouri Metabolic Health. Um, so it's based in Missouri. Right now, that's only where I see people, but I'm licensed in a few other states, and so I'm thinking about expanding. Um, I'm licensed in Mississippi, um, New Jersey, Virginia, and DC. So maybe seeing the patient more quotes. But my website is Missouri Metabolic Health.com. Um, so you can you know find me there. I have links to all of my social media. I'm on TikTok and Instagram, Dr. Lindsay Ogle, and then I have um a YouTube channel and a podcast. The podcast is Modern Metabolic Health Podcast. Um, and my YouTube is um metabolic health with Dr. Lindsay Ogle.

SPEAKER_01 55:57

Nice. I love it. I love that. And what about our dev, our sweet dev? Where can people find you?

SPEAKER_00 56:03

Uh you can find me on the Tiki Talk, uh Deb Cooperman. I know so many people uh like put a different name on. I did not think to put a different, I just get my name, Deb Cooperman. Um and um I'm also on Instagram a little bit, um, the Deb Cooperman, because there was an actual Deb Cooperman in in the beginning. She got rid of her account, so now that's my backup. But yeah, so I I love it. So, so there you go. So that's where I am. And you know, on TikTok, I do a I do a um a community um event on Sunday nights, Sunday stories where I interview members of the community.

SPEAKER_01 56:42

Deb does a lot of content around journaling, right? And understanding yourself. And I think, like, in absence of uh, you know, I think, I mean, even if we had therapists that we could all afford and get a hold of, this is wonderful. It is a really good way to deconstruct what's going to happen to your brain if this works like it does for most people. So make sure you follow that because it's very helpful. And I will put everybody's link in the dial notes. Thanks everybody for the time. We'll release this in part one and two so you don't explode. Deconstructing zyaculture plus technical difficulties. Okay, it took some time, but you know what? I think you got there. All right. Awesome. Okay, everybody, thank you so much. See you again, Dr. Ogo.