Weight Loss Medications, GLP-1s: What You Need to Know

Weight loss medications have changed the conversation around obesity treatment, but what should patients really know before considering them?

In this episode of MedLink Health Connections, we sit down with Dr. Michael Roundtree, a family medicine physician with nearly 30 years of experience, for a candid conversation about prescription weight loss medications and the growing role of medical weight management.

We discuss traditional options like phentermine and phentermine/topiramate, as well as GLP-1 medications such as Wegovy and Ozempic. Dr. Roundtree explains what patients can realistically expect from treatment, how nutrition and physical activity fit into the process, who may be a good candidate, and how BMI factors into the decision.

We also talk about why medical weight loss is about much more than appearance. For many patients, addressing obesity earlier can be an important part of reducing the risk of conditions such as type 2 diabetes, high blood pressure, and other health complications.

And because treatment decisions aren't just about effectiveness, we cover the real-world considerations too, including common GLP-1 side effects like nausea, constipation, and diarrhea, practical ways to improve tolerability, and the cost of treatment. We also discuss potential savings and pharmacy support options for eligible patients.

If you've been considering weight loss medication or simply want to better understand how these treatments work, this episode is for you.

Listen, share it with someone who could benefit, and subscribe to MedLink Health Connections for more conversations about your health.

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Transcript

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Welcome And Meet Dr. Roundtree

SPEAKER_02 0:07

Today, we are going to be talking about prescription weight loss medications, from newer GLP1 medications like Bugovi to more established options like spentamin and contrast. There are many choices and more choices than ever before. We'll discuss how these medications work and who they're for, what patients can realistically expect. And joining us is Dr. Michael Roundtree from our MedLink Cobra office.

SPEAKER_01 0:33

So my name is Dr. Michael Roundtree. I'm a family medicine doctor and I'm also board certified in addiction medicine. I've been practicing medicine close to 30 years now, a long time. And um I have recently restarted Medlink. Um I actually was here uh in the year 2000, so a very long time ago. Have always carried in my heart wherever I went in the world after this. And so when I came back to this area, I contacted the organization and um asked if I could work here again, and they were kind enough to say yes. So here I am.

Why Weight Loss Drugs Are Surging

SPEAKER_02 1:18

So let's kind of start off with just kind of like an overall general question of why are weight loss medications getting so much attention right now?

SPEAKER_01 1:29

Really, what it is is they've become so much more effective than what we had in the past. Um in the past, and and we we still prescribe the older medications. We do, and they are still effective. Um but the older ones probably the maximum effect is about 8% weight loss, which is great, by the way. I love it. Um, but with the new GLP ones, it's getting up to 15-20% weight loss. And so um being on them really dramatically affects um health and how people feel. And so, and it's of course really caught on in the media, partially because of that, partially because the celebrities sort of have figured this out. Many of them are taking them now. Um and so it's I think it's that combination. Um plus they've become at least somewhat more affordable. They're not inexpensive compared to they're just not. Uh they're they're expensive. Um and we can talk about that later. Um, but when I think about these medications, uh, I think they're very good investments in health and and really frankly worth it for most people.

SPEAKER_02 2:43

So

Who Qualifies And Why BMI Matters

SPEAKER_02 2:44

who are some of these people? So like who is a good candidate for prescription weight loss medication?

SPEAKER_01 2:49

Yeah. So you you you really need a BMI, body mass index, um above about 27, give or take. Um and so um, and that can be measured, you can actually figure it out yourself because it's just height and weight uh oriented. Um but you can obviously come to the clinic and we we do that automatically with everybody anyway. And it kind of helps compare apples to apples and oranges to oranges. Um because you don't expect a big giant person to weigh the same amount as a tiny person. It's just not realistic. And so the BMI kind of standardizes that. Um, so you need a BMI of at least about 27. Optimally, and and and it kind of depends. If if we want to have optimally, if you have a health problem that's associated with your weight, that's the best candidate. Things like um blood pressure, um, diabetes, um, stuff like that is those are the ultimate candidates. But frankly, I have no problem with taking them for people who just want to lose weight. Um, and I think actually that's again a good investment in health. Because if we can be thinner and healthier now, we don't get diabetes, we don't get hypertension. Um, and so um so I'm a little bit more liberal. Unfortunately, insurance companies usually don't cover it for that, but they will eventually, and that's coming fast now.

SPEAKER_02 4:23

So

Options Beyond GLP-1 Medications

SPEAKER_02 4:24

beyond GLP1 medications, what are other prescription weight loss medications that are available?

SPEAKER_01 4:32

So there are actually a fairly large number of them that are available, but the the sort of the classic one that we think of is the fentramine. Um it is a sort of a it is a controlled substance, it's an amphetamine-like medication, um, and it's associated with about 8% weight loss. Its enormous advantage is that it's very inexpensive. Um at medlink, it's it's approximately um the lowest um cost is about ten dollars a month, um, which is just shockingly low, frankly. Um and so that's sort of the traditional one. We can we sometimes combine it with other medicines called topiramate, um which is also fairly affordable. When you take the two, it's about $50 total, which again is that's a very good investment in health. Um, and that's associated with about a 10% weight loss when we take that. But then there are the other, there's other types of the GLP ones that are kind of more difficult to use. They're um they're an injection every day, um, and they have much less weight loss. Some people will want to be on them because they help with blood sugar. Um those are sort of the biggies. Um, and then there's the old Zenical, which some of us will remember. Um, it's a pill that you take every day that blocks the absorption of uh fatty foods and um and can help with weight loss. We prescribe that to some people who don't really qualify for the other ones. Um but it's it's not the most fun medication because it can cause that sort of oily diarrhea that nobody has ever thanked me for. Um but they work, so there is something to it. Um and and uh unfortunately there the Xenical is not quite as effective. It's about five percent um body weight loss, uh, but it's out there and it's an option.

SPEAKER_02 6:37

What kind

Realistic Results And What Helps Most

SPEAKER_02 6:38

of results can patients realistically expect with these medications?

SPEAKER_01 6:42

It depends on how hard you work. All right. So if you just take the medicine and do nothing else, you will still lose a significant amount of weight, probably in the range of 10 to 15 percent. And that's with m almost no effort on your part. Um, and that's because they block feeling hungry, um and and everybody sort of knows that they shouldn't be eating ice cream every day and things like that. I know that. Um, I still want ice cream every day of my life. Um, and so they they make it to where you're you're like, you don't really care very much anymore. You you sort of you look at food, you think, eh, I can have a Snickers bar, I can have a carrot. Eh, might as well eat a carrot because I don't care. Um and so it makes it a whole lot easier to sort of eat those healthy foods that frankly most of us aren't sort of drawn to. Um 10 to 15 percent, again, with the um with the uh no effort. Uh 20% if you really try. And and that's what we really want. Um the program we'd like to have here is people on medications, people seeing the nutritionists periodically, going over their foods, um, and um hopefully exercising to some degree also. If you combine those three, the weight loss can be just amazing. Um, and we've all seen it online. We've all seen the TikTok videos and the pictures and the before and afters, and um, those are the people who worked in addition to taking the medication.

SPEAKER_00 8:20

Hi,

Can You Afford It? Pharmacy Programs

SPEAKER_00 8:21

I'm Gunnar Sickler, one of the pharmacists with Medlink, Georgia. One question we get every day is can I actually afford these weight loss medications? Well, that answer depends on your insurance and your eligibility, but there are options for everybody. For eligible Medicare patients, Medlink Pharmacy offers the Medicare GLP1 Bridge Program, which allows qualifying Medicare patients to receive WIGOVI, Foundado, or Zebbound for as little as $50 per month. And if you're not on Medicare, no worries. We've got options for you as well. Whether it's commercial insurance or manufactured copay assistance, our pharmacists work closely with your providers to get you the best deal possible. If you'd like to learn more, talk with your medlink provider or contact your local medlink pharmacy. We're here to help you understand your options and find the best solution for your needs.

SPEAKER_02 9:09

So

Cost As A Long-Term Health Investment

SPEAKER_02 9:10

cost is one of the biggest concerns, and I know we've kind of talked about the cost for some of those other ones. So how do these medications compare when it comes to affordability on the GLP1 side of things?

SPEAKER_01 9:22

Almost everybody wants to be on these. The others are about 15% weight loss. I I for most people, bang for the buck, the simoglutide or the the Wagovie uh OSIPIC are kind of within range. When I talk to people about cost, I always remind them of a few things. Um, number one, the cost of your foods are going to go way down. Um, because A, you're just naturally eating healthier foods because you just, again, you just but you're fine. You can eat the salad or you can eat the steak, but um but you don't care very much. Um so that the price of your foods, so you save a huge amount of money there. If you lose weight and you're on other medications, a lot of people who take these are taking blood pressure pills, they're taking diabetes pills, they're frequently able to get off those medicines, so those costs go down. And then finally, I I sort of remind people um that when you take these medicines, you become so much healthier that future spending on health care goes way down. So I use the um the example of a loved one who was had trouble with his weight, um, ignored his health, ended up having a heart attack, um, ended up in the ICU for a week. And we all know what healthcare costs in America. Um, he probably spent close to $100,000 staying alive. If you continue to struggle with health, those things are coming down the line. We know that. We know that they're probably gonna come. You can spend it now or you can spend it later. You're gonna spend it. You might as well spend it now being healthy, looking good, feeling wonderful. It's something to really think about. Um I I think these are good investments. So are they expensive? Yes, they are expensive. There's no question that that's a that's a lot of money for all of us. Um, but are they are they good investments that save you money in the long run? Yeah, they probably are actually.

Side Effects And How To Manage Them

SPEAKER_02 12:51

And kind of going back to a little bit more on the medication side of things, what are some of these most common side effects that patients may experience or that they should know about?

SPEAKER_01 13:03

Yeah. The the biggie is the GI upset. So um the the gastrointestinal and and gastrointestinal. Um so the one of the ways that the medications work is by slowing the food going through your system. So you eat something, and instead of it passing quickly through your stomach, it just sits there for like hours and hours. In English, that means you can easily get nauseous. Um, some people even have vomiting. Um, a lot of people will have constipation. With the constipation, though, the body's still working. So if you're constipated and then the body starts to work, you then get diarrhea because you have a lot of food in you. Um and so you get a lot of this sort of fluctuating nausea, um, this uh constipation with a little diarrhea. Now, I I I would say that the body gets used to these fairly quickly. Usually these side effects are for a few days to a week whenever you start or whenever you go up on a dose. They're manager manageable for the vast majority of people. Um and um and and then, like I say, they go away. There is a some people who simply cannot take these medications, it's too much for their system. Um and and so they're not perfect, but they work very, very well. Usually, by the way, if people are having trouble with that, there's a fairly easy solution. It means you're eating too much. There's too much sitting there on your stomach. Okay. So guess what? Eat less. Um, we kind of used to, we have this image of our head, what dinner looks like, what lunch looks like. Cut that in half, whatever the image in your head is, and usually the nausea goes away and you end up feeling full in spite of the fact that you're eating half, and that helps a huge number of people.

SPEAKER_02 15:02

So since it kind of slows that um stomach process, does it have any effect on medications?

SPEAKER_01 15:13

Not that I'm aware of.

SPEAKER_02 15:14

Okay.

SPEAKER_01 15:15

Not that I'm aware of. There are there are some medicines that you know are very, very sensitive to um to that kind of things. I I think of you know the old warfarin and things like that, which are not used very commonly anymore. The vast majority of medications, probably I don't know, I I can't give you a percentage, the vast majority will be unaffected.

First Steps And A New Mindset

SPEAKER_02 15:37

So if someone is interested in medication for weight loss, what is their first step?

SPEAKER_01 15:42

So most people who are interested in in realistically, they they know they're weighing too much. I mean, we we we all feel it in our in ourselves when we feel that. Okay, I'm I'm getting too much now. Um so number one is just coming to the realization and acceptance and saying, I'm gonna do something about it. So that's the the top thing, doing something. Of course, please come in to see us. Please. Um we can help you kind of figure this out, figure out if it's right for you, figure out which medication is right for you. Maybe medicine's not the right thing for you, um, which is fine. We can get you to see the nutritionist and we can do the more sort of the more natural ways. Um, and so um I would say if you contact us, make an appointment, I'm happy to go through these things with you. I would emphasize to everybody here that weight loss is health care. And I think that's changed how we think about it. Weight loss is health care. I'm I've been doing I started by talking about the fact that I've done this for a long time now. I've been in practice for 30 years, and and I always saw weight loss as you know, particularly the medications, as vanity. They didn't interest me very much. Um I have now changed my mind. I was wrong. It is no longer about vanity, it is about your health. And so I think opening these up to people are really really going to change lives, really going to change the the projection of of what your life is going to look like. Um so I encourage really anybody who's interested, please come in, see us, and let's talk it through one-to-one.

SPEAKER_02 17:41

Thank

Wrap-Up And Staying Connected

SPEAKER_02 17:42

you for tuning in to the Mentley Health Connections podcast. We hope you found today's episode informative and helpful. If you enjoyed this episode, please subscribe and be on the lookout for our next episode. Remember, the information shared on this podcast is for educational purposes only and does not require professional medical advice. Always consult with your healthcare provider for any medical concerns. Stay connected with us on social media at medliftda or visit our website at medlienceca.org for more resources and updates. Until next time, stay healthy and take care.