This week, we're talking about some really big news that came out about the blockbuster anti-obesity med, Wegovy. This information is not just critical to the health of the public, but will also, I hope, dramatically change the way in which we prescribe this drug, as well as the way that this drug is received, hopefully opening up this label to so many more people who will benefit.
Welcome back to Health Bite. I'm your host, Dr. Adrienne Youdim. I'm a triple board certified internist, obesity medicine and physician nutrition specialist. And I help people like you redefine nutrition to include not only the food that we eat, but all the ways we can nourish ourselves physically, mentally and emotionally.
And last week we had a great conversation with weight loss coach and guru Corinne Crabtree, where she shared with us so many pearls and tips on how to change your mindset around weight loss. I am huge on mindset tips and tricks, positive psychology, as well as lifestyle change. I talk about redefining nutrition and incorporating all the nutrients that we have at our disposal, like sleep, movement, connection, community. And at the same time, I'm a big believer in weight loss drugs, or rather anti-obesity medications. I also make the mistake of calling these weight loss drugs. They are not. They are referred to as anti-obesity medications because they are treating the disease of obesity in a way that is really profound and significant. So let me tell you what happened this week. As you all know, the drug Wegovy has been approved for several years. Wegovy is the same drug as the famously named Ozempic. This is a class or one of the class of anti-obesity medications that act in a hormonal way to help suppress hunger, to help slow down the gut motility, helping people feel fuller longer, and as a consequence of that, help people lose weight in a way that we have not seen with any weight loss or anti-obesity medication prior to this. Wegovyor semaglutide can give us weight loss outcomes of, on average, 11 to 15%.
Some people will do slightly better, around 17 to 18% of weight loss. And then, of course, there is its near cousin, ZepBound, also known as Monjaro when labeled for type 2 diabetes. that can give weight losses as high as 28%. These are really big numbers in helping make a dent in the obesity epidemic. So let's talk about what happened with Wegovy.
So Wegovy, as you know, acts as a GLP-1 agonist. If you're interested in the science behind this, I have several podcasts that you can scroll through. and get the scoop. But in short, this is a drug that mimics a normal hormone that we all release when we consume food. When we eat, food travels down into the gut, into the intestines, and the intestines will send out a hormone called GLP-1 that signals to the brain that food has been received, and therefore the hunger trigger can be suppressed or shut down. However, with this drug, we get that signal in the absence of food and therefore people are able to be satiated with much less portions or much smaller portions. The other benefit of this drug, probably the more important benefit, is that it actually turns down food noise. Patients who are taking these drugs will say cravings, desire to snack, munch, to eat for reasons other than true physiologic hunger are really dialed down. Of course, making it so much easier to make the right choices to eat less and to eat less of the snacky foods that are non-nutritive and that contribute to weight gain. So what we have learned in the several years since this drug has been FDA approved for obesity is that it's not only helpful in treating obesity as the disease, but also has resulted in significant reduction in cardiovascular events. In fact, studies have shown that individuals who are on Wegovy are less likely to go on to suffer acute myocardial infarction, also known as heart attacks, as well as to suffer deaths from cardiac events, as well as reduced likelihood to go on and have a stroke. So again, this is not a matter of cosmetics. This is a matter of significant reduction in cardiovascular risk and therefore prevention against the number one cause of death in men and women in the United States, as we discussed in a recent podcast. Given this information, the FDA gave Wegovy a nod and allowed for the first time an anti-obesity medication to have on its label the indication that it reduces the risk of heart disease, cardiovascular death, heart attack, and stroke. This is really a major advance for public health because it broadens the indication of this drug, again, beyond weight loss to prevention of cardiovascular disease. What's more important is that this information will help twist the arm of third party payers and insurance companies. If any of you have been in this boat, I know a lot of my patients have, even if they are indicated to receive this drug, meaning that they have the diagnostic criteria to be a candidate and a physician or prescriber prescribes this drug for the right indication, we get stumped by the insurance companies. We get blocked by third party payers who refuse to pay for the drug. A big contributor to this is Medicare. Medicare as a whole does not allow or approve any drug in the anti-obesity space. So there is this full stop, a clause against any drug that is used to treat obesity, which if you think about it is quite outrageous. It really is outrageous because as of now, 42% of the population is considered to have a diagnosis of obesity with over 60% to be overweight. We know that people who have obesity are at risk for many other disease factors, including cardiovascular disease. And so the fact that this medication is showing not only a reduction in weight, but also a reduction in cardiovascular risk makes it a setup for now being covered and paid for by these third-party payers. So what is the data? Indication to change the label came from a large-scale study called the Select Cardiovascular Outcomes Trial, in which they tested Wegovy for over five years in nearly 18,000 patients who were overweight and obese. They found that those who were in the Wegovy arm, so individuals who were getting the medication, as compared to placebo, cut the risk of major adverse cardiovascular event by 20%. This has been shown in other studies to translate into a potential reduction of 1.5 million events in the United States, really quite dramatic reductions. Of course, the benefits were seen in those who were doing all the things, right? Changing their diet, moving their bodies, making the lifestyle changes, but so were the individuals in the placebo arm, demonstrating once again that lifestyle alone often is not sufficient. What they also showed was that it was reduced or associated with a 15% reduction in cardiovascular death and a 19% reduction in risk of death from any cause. Now, this falls in line with many other studies that have shown that individuals who are able to lose and maintain their weight loss successfully have a reduced risk of not only cardiovascular disease, but many other diseases, diabetes, which is closely related, as well as things like breast cancer, colon cancer, which are common cancers in the United States that are associated with increased risk. So really this is big news. And I think from a personal perspective, as someone who has managed patients with overweight and obesity for nearly 20 years, I think this information is going to go a long way towards hopefully countering the stigma and bias against obesity. I want you all to remember that when these drugs first started rolling out, there was a lot of backlash against people who were either prescribing or looking to use this drug for weight loss, as compared to those who were using the very same drug for diabetes. Now remember that excess weight or having a diagnosis of obesity is one of the main ways that people go on to develop diabetes, type two diabetes to be exact. But no one shames diabetics, nor should they. However, there was a tremendous amount of fat shaming happening on the side of individuals who had excess weight, who hadn't yet developed diabetes, who hadn't yet developed cardiovascular disease. And the question is, why? Why should we not focus on prevention? Why should we wait until people develop the consequences of excess weight before we take notice and decide to treat them when now we have drugs that have shown and proven to be effective in preventing the start of those diseases to begin with? I really want you all to sit with this. Whether you're an individual who suffers from obesity yourself or has a friend or a family member or a loved one that suffers from obesity, I want you to check your own bias because there is so much stigma related to this issue. Now, let's be clear. I do not recommend this medication for people who are trying to lose five or 10 pounds, and I have never prescribed it in that demographic. I'm also not prescribing it for people who have to lose some weight before they get to a wedding or to their summer vacation. That is not the target population. The target population is the individual who has struggled with obesity for so long and now has hope at reversing not only the disease of obesity, but all of the consequences that come with it. We tend to think in terms of this or that, yes or no, black or white. On this podcast and in my medical practice, I really try to promote the concept of AND. We can be mindful about our food, we can be intentional about our hunger, we can make use of the tools that are at our disposal. Using medication does not come at the exclusion of changing your lifestyle or your habits, and it doesn't come at the exclusion of doing the really intensive mindset work that is required to be persistent and to prevail in this long-term, lifelong pursuit. But I want you to question why we can't approach this problem and so many others that we face with the notion of and. We can be mindful and we can use tools. We can engage in lifestyle and behavioral changes, and we can utilize medications at our disposal that will help us achieve those very things that we intend to do. This is how we live in balance. This is how we can think in a more balanced way that takes us out of the reactivity of judgment, bias, and stigma. For those of you who have been on the sidelines looking at this a space of anti-obesity medications and injectables, and have felt that despite the fact that you are candidates, you have not been allowed to take part and to utilize these drugs, I genuinely think that change is coming. And I think when rolled out in the proper way, on a more population-based level, it is going to result in some dramatic changes in disease, in morbidity, in mortality, and in quality of life. While we're talking about this, I want to bring up one other topical news item that came out in the last several weeks. which is that many gyms around the country are starting to employ physicians to prescribe these medications in the gym. Now, at first glance and at first thought, it sounds kind of strange, even to me, that gyms should be prescribing drugs. But again, it appears that they will be doing it in the right way, meaning that physicians will be the prescribers and will hopefully use guidelines and consensus statements and good judgment in determining who and when to prescribe. But here's the other point. We know that because these drugs are so effective in helping people achieve weight loss, The downside is that they lose not only a lot of pounds and a lot of fat pounds, but they're at risk for losing a lot of muscle as well. Now, I wanna reiterate that this is not a function of the medication. So it's not that a side effect of the drug is losing muscle mass. It is a side effect of weight loss itself. Anytime you have an intervention that results in significant and successful weight loss, people are at risk for losing muscle. This happens most notably in the bariatric or metabolic surgery population. After having bariatric surgery and achieving successful weight loss, in large amounts, they tend to lose a lot of muscle. Again, not a function of the surgery, but a function of the weight loss. So going back to the gym, one of the main ways to help prevent the loss of muscle when you're losing weight is by engaging in some physical activity in engaging in both cardiovascular exercise, as well as strength training. We know that when people lose weight, they will lose some amount of muscle regardless of what they do. However, they can mitigate that loss of muscle, not only with the food that they eat, so consuming high protein diets will help give the body the nutrients it needs in order to preserve lean muscle, but also by using that muscle, by working that muscle, you enable the body to better preserve lean body mass and to be less likely to lose weight as muscle mass. So as strange as it may seem, bringing anti-obesity medications into gyms might actually have a big upside for users of the drug, reminding them that there's something that they can do that will substantially change the trajectory of their body composition as they're losing weight, as well as promoting healthy lifestyle by incorporating and engaging in physical activity, which has benefits that go way beyond the scale. This is really exciting news. For someone who's a obesity medicine and physician nutrition specialist, I love this. So take it all in. And if you have questions, head over to Instagram and send me a DM. Remember, I am a physician. I am not your physician. And so I can't give you direct advice. And the purposes of this podcast is really for information only, but I hope to empower you with knowledge so that you can take that information back to your own physician and have a conversation about what modalities are right for you. I invite you to engage with this community. We have hundreds of podcasts on all aspects of health, weight loss, wellbeing, mental health and emotional health that touches on the whole 360 range of issues that come up when we try to level up and do better for ourselves. body, mind, and soul. And finally, if you love this podcast, please head over to the app where you downloaded it and leave us a review. It really helps us get the message and the word out. Wishing you a very happy, healthy, and joyful week, and I'll see you here again next week on Health Bite.