From The Heart #9: Rethinking Weight Loss Drugs

What if your hunger isn’t lazy, it’s loud, and the volume knob is biological?

We pull back the curtain on GLP-1 medications like semaglutide, separating stigma from science and showing how these tools can help the right patients quiet food noise, stabilize hunger cues, and lower chronic disease risk. No moralizing, no shortcuts, just a clear-eyed look at when these drugs help, when they don’t, and how to safeguard your metabolism along the way.

Across a series of real patient conversations, we challenge the “cheating” narrative by comparing our comfort with blood pressure and cholesterol meds to the judgment that surrounds weight care. 

You’ll hear why willpower isn’t the missing ingredient for many people, how genetics and environment shape appetite, and what to expect during the first 12 to 18 months of treatment. We also dig into practical strategy: protein targets to protect lean mass, resistance training that defends your basal metabolic rate, and body composition tracking to ensure you lose fat, not muscle. Instead of aiming for a quick fix, we focus on building a plant-predominant, fiber-rich diet that supports the microbiome and reinforces satiety signals for the long haul.

We also address long-term planning: who might taper off, who may benefit from ongoing therapy, and how to weigh side effects against the well-documented risks of obesity. The goal isn’t a perfect body, it’s a durable plan that respects complex biology and delivers better health. If you’ve been curious, skeptical, or stuck, this conversation offers a grounded path forward.

If this helped you rethink weight loss medications, follow the show, share it with someone who needs it, and leave a review with your biggest takeaway. Your notes help others find evidence-based, stigma-free guidance.

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Peace, love, plants!
Dr. Jules 

Transcript

Section A

SPEAKER_01 0:00

Yo funday buddies. Welcome to a new segment of the show that I'm gonna call from the heart. These bonus episodes are different. No script, no plan, just me speaking openly and honestly like listening to stories that come from real conversations with real patients. It's raw, unpolished and honest, but packed with insights that matter. Most of the time I simply open my phone camera, record a video, and this is the audio of these conversations. So if you're ready for something a little bit more spontaneous, this is from the heart, unplanned, unscripted, but straight to the point. Today I'm going to talk about patients that I saw this morning and conversations surrounding azempic, wigovi, and weight loss drugs. Now, for some reason that I do understand, but some days I don't, is there's still a lot of taboo surrounding conversations about these medications. Some people use them in situations where they might not have been needed and might actually create negative outcomes. And some people don't want to use them because of fear of being judged by other people or other people finding out. And other people really have a downright problem with these medications, seeing their use as some sort of form of cheating, right? So when someone comes to my office and their blood pressure is high, and we discussed lifestyle interventions like reducing caffeine, sodium, alcohol, improving sleep and stress management, aiming for a healthy body weight, increasing the amount of phytochemicals and antioxidants in your diet and fiber. If your blood pressure remains high and you've done everything right, then we need to have a conversation. Maybe you suffer from essential hypertension. And if we do nothing, this condition will absolutely lead to poor outcomes and take years away from your life, but not only from your life, from your quality of life. Now, no one would see taking antihypertensive as cheating. Or if someone has high cholesterol and no matter what he does, lives his life perfectly, his cholesterol remains high. And statistically, these risks could make you at very likely to either suffer from stroke or heart attack with a considerable amount of these causing death as their first presentation. But when it comes to managing weight, people tend to see that differently, and I'm not sure why. First of all, people that have maintained a healthy body weight all their life will not be able to relate to someone who has struggled with weight all their life. So that's why people who have not struggled with their weight tend to make it about will power and grit and discipline and calories in, calories out. Don't you know you simply need to eat less and move more? Whereas people who have struggled with their body weight, they know all of this. It's not a lack of education and it's not a lack of motivation. Some people that have excess body weight, they carry excess body weight or body fat, they're extremely disciplined and high performing in other facets of their life. It is not a problem of consistency, grit, or willpower. Some people simply have their appetite termostat that's dysregulated or dysfunctional. Some people have food noise and food cravings turned up to a volume of 10, whereas most of us maybe live at a volume of one or two. Personally, I am well versed in the science of these things, but I have no personal experience with managing weight because I've always been a healthy body weight. Now I have cravings like everyone else, but these cravings are rare, and sometimes I have a little binge eating session, but I don't feel guilty after. I know that's just part of my reward systems. Sometimes I reward myself for emotional comfort. Sometimes rewarding yourselves with food is just part of our culture and tradition, but it never gets out of hand. Whereas some people could eat in one sitting three, four thousand calories, right? I may be exaggerating, but you get the point. Now, a lot of these people, when they start taking a Zempic or Wigove, they a lot of the feedback that I get is that these patients say, Oh my god, is this what it feels like to live with normal hunger cues? The food noise went away. I feel so much better. My relationship with food and cravings is so different. Now, that doesn't mean that it was a problem of willpower. It means that their biology simply wired in a different way. There are genetic factors, but environmental factors and even maybe adverse childhood events could all play a role in our relationships with food. Now, when someone has been struggling with their weight for 20 years, has been on multiple diets, have tried lifestyle interventions and coaching and spent hundreds of dollars on quick fixes, and even on long-term sustainable solutions that haven't worked. What's the problem with using weight loss medication? You can either say I'm not using weight loss medication, and these patients will simply succumb to the statistics that are not that great in terms of chronic disease risk, diabetes, hypertension, cholesterol, stroke, heart attack, cancer risk is increased because of obesity, autoimmune diseases are as well. So when someone says, I'd like to consider taking a Zempic or Wagovy, it's a conversation between me and my patient to decide if they're a good candidate for it or not. But I still hear a lot of people demonize these drugs, but I think what they're doing is demonizing the misuse of these drugs. And that I agree. If you're using a Zempic to fit in your wedding dress where you just have three pounds to lose, maybe that's misuse and abuse of that drug. But what's happening is people are demonizing these drugs so often that people who could actually benefit from it are hesitating before asking for it. This morning we decided to start Wigovi on a patient. Keep in mind that Azempic and Wigovi that they're both semaglutide, they're the same molecule. One is marketed for diabetes, the other one is marketed for weight loss. Now, this patient had a BMI of 39 and asked a whole bunch of great questions. Do I stay on this long term? Well, first of all, what we know is that these medications and similar medications have been on the market for years. We have drugs like Victosa, Saxenda, Trullicity, Azempic, Wigovi, Manjaro, all GLP1 or combined GLP1 GIP agonists, meaning that agonist means it binds to a specific receptor, and then that receptor triggers a cascade of biochemical reactions. Now, the reason azempic has become more popular is because the amount of weight loss that it causes is higher, and the frequency of injections is more spaced out. Because we had Saxenda and other medications that are GLP1 agonists, but patients needed to inject them every day. So they're not very popular, but they were there. Weight loss wasn't as impressive. Now we have drugs that cause weight loss ranging from 15 to even up to 22 to 25% with Manjaro in certain populations. The question now is well, what do we do long term, right? Most of the weight loss happens within 12 to 18 months. And then there needs to be a conversation on what do we do with these drugs after that? Well, number one, we always need to combine these drugs to lifestyle interventions because if your lifestyle was the problem and you don't change that, well, what's gonna happen is that when you come off of these drugs, your food cues and your hunger cues and the food noise will just come back if you're biologically predisposed to this. So we have a certain percentage of people that gain some of the weight back. Rarely do they gain all of the weight back, but it's not impossible. And just that weight loss, even if you gain a little bit, will still put you at a lower risk for chronic disease than where you were when you started, right? So we need to go slow if we're gonna wean off these drugs. And we need to make sure that lifestyle interventions are managed during this medication, right? Now, one of the other things that we need to consider is well, if you regardless if it's a zempic or a crash diet or fasting, anyone who's on a large calorie deficit, a deficit of energy that's more than four to five hundred calories per day, is highly likely to lose fat, but to lose muscle mass as well. Unless that calorie deficit is met with an increased intake of protein, aiming towards the 1.6 grams per kilogram per day, which protects muscle mass, or the main stimulus for gaining muscle mass and protecting it is weight training, resistance training, lifting weights, doing bodyweight exercises. So, in patients that are in large calorie deficits, which is the exact mechanism of these drugs, if they're not lifting weights and they're not taking more protein, they might lose muscle mass. If you lose muscle mass, muscle mass is the main metabolically active tissue that contributes to the amount of calories you burn. So if you lose a lot of weight with these drugs and you lose a lot of muscle mass because you weren't increasing protein and increasing exercise, your BMR, your basal metabolic rate, aka, the energy you burn every single day will go down as well. It takes less energy to exist as a smaller person. So if your calorie maintenance was 2,000 calories, meaning that it takes 2,000 calories to maintain your weight, but you lose 15 pounds of muscle, maybe your BMR now is 1800 or 1700 or lower. On top of the fat you lost, maybe your BMR is 1500. And that means to maintain your weight, you need to be eating 500 calories less than when you started your weight loss journey. And so for a lot of people, they go back to old habits, they overeat calories, and they regain the weight. Now, that's a failure of the system because a lot of these patients, they're starting as MPIC, they're starting with GOVI, and they're not getting their muscle mass measured. We do that here through an in-body scan for my patients that get on these drugs. And then we're able to monitor to make sure we know is this patient losing weight through fat mass, which is what you want to lose, or are you losing muscle mass and water, right? That's important to know. So, regardless of the calorie deficit you're on, whether it's from drugs or from fasting or from any crash diets, protect your muscle mass because otherwise your basal metabolic rate or BMR will go down, and it will be very hard to sustain once you go back to eating and living the way you used to, right? Now, these drugs are tools and when applied in the right circumstances in the right patient with the right follow-up and lifestyle interventions combined, that's when you get the best results. In studies, all of these factors are accounted for and they're taking into consideration. Whereas in the real life, people go see their doctor, they get a prescription of Wigovi or Azempic. No one measures their muscle mass, their fat mass, their visceral fat. No one takes a look at these parameters, and no one tracks them over time. And then a year or two later, when it's time to discuss coming off of these drugs, these patients may have lost 10, 15 pounds of muscle, and they may have lost a significant portion of their BMR. So it's going to be very difficult and more challenging to keep your diet in a calorie deficit because now your BMR is so low that you really almost need to restrict yourself more. And for a lot of people, that's simply unsustainable because these habits are the same habits that got you in the in trouble in the first place, right? So the best type of dietary pattern to support someone taking these drugs are the same type of characteristic of a normal healthy diet, a diet that is calorie controlled, that is high in protein, that's high in fiber, both in terms of quantity and of variety of fiber, and contains all of your micronutrients, so vitamins, minerals, and phytochemicals. And you get that through a plant-predominant diet. Now, if you get on this diet or you eat this way while you're taking these GLP1 drugs, I'm surprised your microbiome will get healthier and will help support satiety signals, will help to make your gut microbiome will produce compounds that'll help to kind of synchronize your biology and your physiology so that when you remove these drugs, you have good habits to fall on, but you also have good physiology and good biology, a good microbiome that's producing chemical signals after feeding off of fiber that helps slow down digestion, make you feel fuller for longer. All of the appetite-regulating hormones from ghrelin to leptin to cortisol to insulin to glucagon, they're operating in physiological ranges. And it makes it a lot easier to turn down the volume of that food noise that people were hearing before starting these drugs. Some people biologically will just be predisposed to having to stay on these medications long term. Some people will be able to stop them within a year or two. The most important thing is that you cannot generalize, right? It is a conversation between a patient and a doctor, and there are pros and cons of taking these drugs, but you need also to think about the pros and cons of not taking them. I have patients that have BMI that have BMIs, body mass index, over 40, which means they're morbidly obese. They're scared of taking these GLP1 agonist drugs because of side effects. When the side effects of not taking them and remaining obese are exponentially higher. And that's what we called the risk perception gap. I've talked about it in the past. We fear the wrong things. We fear dyes, red dyes in ultra-processed foods when people are getting 60 to 70% of their daily calories from ultra-processed foods, the foods most linked with increased risk of cancer, cardiovascular disease, and other chronic diseases. We fear GLP1 agonists when obesity increases your risk of cancer by over 30 to 50 percent. So I just want everyone here to reflect on if you have if you have a an already Already made up opinion about these medications. Why? Reflecting on that is very important. But the most important thing is that before you dismiss these drugs, have a conversation with your doctor about if they're right for you or not. Many of my patients that we have coached through lifestyle interventions, they've gotten their lives back because of these medications. Right? It's not black or white, it's not for everyone. But when a patient has done everything in their power and has not succeeded, maybe that person's biology is the issue, not their willpower. Right? Hope this helps understand these weight loss drugs because they're gonna be coming even more popular. Drugs these days are an injection every week, they're working on injections every month, and they're working on pill versions of these medications to increase compliance and reduce barrier to entry. Cool, right on. Hope this helps. Let me know in the comments what you think about these drugs and if they've helped you on your weight loss journey. Cool. Peace out.

SPEAKER_00 21:39

Hey everyone, go check out my website, plantbased drjewels.com to find free downloadable resources. And remember that you can find me on Facebook and Instagram at Dr.Jules Cormier, and on YouTube at Plantbase Dr. Jewel.