In this episode of my Hungry for More series, I talk about how we should see obesity as more than just a cosmetic problem, but also as an alarming disease as well. Sine weight loss medication is one of the easy modern solutions to battle obesity, I discuss how do they help you in your weight loss journey, what are the drugs found in it, and what are their side effects. Always know that you are not alone in this!
Highlights:
If you haven’t listened to previous episodes in my Hungry for More series, go back and check them out to deepen your understanding of hunger:
Episode 1: The Anatomy of Hunger: How Your Body Signals Hunger
Episode 2: The Science Behind Emotional Eating
Episode 3: Why Mindset Matters
Episode 4: Self-Compassion: The Importance of Cultivating Kindness and Care Toward Yourself
Episode 5: The Five Pillars of Nourishment and Nutrition (Part One)
Episode 6: The Five Pillars of Nourishment and Nutrition (Part Two)
Episode 7: 10 Practical Tips for Weight Loss
Episode 8: Can Exercise and Weight Loss Get a Divorce: Why Movement is a Spiritual Experience
Episode 9: Journaling: A Gateway to Awareness, Self-healing, and Transformative Change
Connect with Dr. Adrienne Youdim
3 Ways to Get More From Adrienne
1. Subscribe to our Newsletter. Subscribe Now and get the 5 Bites to Fasttrack your Health and Wellbeing https://dradrienneyoudim.com/newsletter/
2. Buy the Book. The current weightloss strategies have failed you. Its time to address your true hunger. Purchase 'Hungry for More' https://www.amazon.com/Hungry-More-Stories-Science-Inspire/dp/0578875632
3. Leave us a Rating and Review via Apple Podcast. https://podcasts.apple.com/us/podcast/health-bite/id1504295718
In this episode of my Hungry for More series, I talk about how we should see obesity as more than just a cosmetic problem, but also as an alarming disease as well. Sine weight loss medication is one of the easy modern solutions to battle obesity, I discuss how do they help you in your weight loss journey, what are the drugs found in it, and what are their side effects. Always know that you are not alone in this!
Highlights:
If you haven’t listened to previous episodes in my Hungry for More series, go back and check them out to deepen your understanding of hunger:
Episode 1: The Anatomy of Hunger: How Your Body Signals Hunger
Episode 2: The Science Behind Emotional Eating
Episode 3: Why Mindset Matters
Episode 4: Self-Compassion: The Importance of Cultivating Kindness and Care Toward Yourself
Episode 5: The Five Pillars of Nourishment and Nutrition (Part One)
Episode 6: The Five Pillars of Nourishment and Nutrition (Part Two)
Episode 7: 10 Practical Tips for Weight Loss
Episode 8: Can Exercise and Weight Loss Get a Divorce: Why Movement is a Spiritual Experience
Episode 9: Journaling: A Gateway to Awareness, Self-healing, and Transformative Change
Connect with Dr. Adrienne Youdim
3 Ways to Get More From Adrienne
1. Subscribe to our Newsletter. Subscribe Now and get the 5 Bites to Fasttrack your Health and Wellbeing https://dradrienneyoudim.com/newsletter/
2. Buy the Book. The current weightloss strategies have failed you. Its time to address your true hunger. Purchase 'Hungry for More' https://www.amazon.com/Hungry-More-Stories-Science-Inspire/dp/0578875632
3. Leave us a Rating and Review via Apple Podcast. https://podcasts.apple.com/us/podcast/health-bite/id1504295718
Transcript
Hi there, and welcome back to Health Bite, our podcast dedicated to small actionable bites towards better physical, mental and emotional health and well-being. I am your host, Dr. Adrienne, and I'm so happy to be back with you here today. Thank you for sharing your time with me. I know that time is our most sacred, precious, and valuable resource. And I really am grateful for you spending these few moments with me every week.
So today I would like to speak about my particular area of interest in expertise, which is in obesity medicine. And as many of you may have heard, in the last few weeks, the CDC released some recent data on obesity statistics in the United States, which showed that obesity, of course, is on the rise. Not surprisingly, many of us have experienced weight gain over the pandemic. And there are many reasons for that which I have discussed in prior podcasts. But even before the pandemic, obesity was on the rise in the United States, and CDC has been collecting this data since the early 80s.
Is My Weight Normal?: What is BMI and how does it work
Back in the 80s, we had a prevalence rate of about 10% of obesity. And, obesity, I know is a term that we don't like to hear, it has kind of a negative connotation in the general public, but this is a clinical term, and it just refers to a degree of excess weight as measured by something called the BMI or body mass index. So the BMI is a number that is calculated using an individual's weight and height, and it gives us a number that tells us the degree of excess weight that a person has.
Now the BMI is an imperfect tool because we use one standard number for all races, all genders, all age groups. And we know now that there are differences in different ethnicities, for example. So Caucasian populations can tolerate a higher BMI before they start to experience the negative consequences of excess weight. Whereas Asian populations will start to have consequences or cardiometabolic outcomes like diabetes or high blood pressure at much lower BMI. So to use one BMI to qualify all people is probably flawed, or is flawed, but it is a generally good tool. So you can calculate your BMI, going into a BMI calculator. You can find that online. Plug in your weight and height and they'll give you a number. And essentially a BMI of 18.5 to 24.9 is considered "normal", it's a range. A BMI of 25 to 29.9 is considered overweight. And a BMI of 30 or greater is considered obese. And that, again, refers to the degree of excess weight that makes us susceptible to obesity-related comorbidities or conditions.
Pandemic Stress: How the pandemic has shifted our pre-pandemic routines and resulted in weight gain
So again, back to the CDC data. They started tracking obesity rates in the United States. And back in the early 80s, obesity rates were about 10% on average, in any given state. Pre pandemic, the average was about 30%. So the prevalence of individuals who had a BMI of 30 or greater was about 30% in most states. Following the pandemic, the most recent data has shown that 16 states in the United States have prevalence rates of 35% or greater, and a handful of states are approaching 40% or greater.
In addition, there was a survey done in March by the American Psychological Association, the APA, that showed that 42% of Americans reported weight gain at an average of 29 pounds per person. And then finally, our children have also been affected by this pandemic, right? Not surprisingly, they have been at home. They have been on Zoom. Their extracurricular activities were cut out of their lives. They haven't been exposed to the same stresses and uncertainty that we have as adults. And that definitely has had a negative impact in terms of their weight, as the average incidence of obesity has gone up in all age groups, including our younger kids, ages five to seven.
So that is to say that excess weight and weight gain have affected and impacted every age group, every state, and also, of course, every ethnicity and population in our country.
Always remember: You are not alone in this weight loss journey
And my first comment is, while we judge and blame and shame ourselves, can we just take a moment and have compassion for ourselves? Because this is something that we have all dealt with. And can we also understand the universality of it? So part of my- sharing all this data is to say, "You are not alone." We have all universally been affected. And the reasons for that are multifactorial. Yes, we've been at home. Yes, we've been closer to our pantries. Yes, there have been emotional eating. There have been more alcohol consumption. There have been more sedentary behavior. All of this contributes to excess weight. But I also want to point out the connection between stress and eating our emotions and soothing with food, because there is physiology that happens there.
Let’s Talk Science: What are hormones and what roles do they play in our hunger
First of all, again, as I have mentioned in prior podcasts, our hunger is dictated by hormones. So tiny chemicals that are released by our fat cells, our gut, our pancreas, that signals hunger to the brain. And those signals are typically regulated by our food intake, right? So you eat food, and there should be a signal telling your brain that you've received food, and therefore you should no longer be hungry. But what we know is that when individuals are stressed, stress literally hijacks our hunger hormones such that it triggers hormones that tell us or tell our brains that we're hungry when we actually have received nutrients and we're not.
If you want to hear more details, again, you can go back to a prior podcast, The Anatomy of Hunger, for example, that describes the science behind this in more detail. But on top of that, we seek to soothe difficult or negative emotions, and we do so with things that give us pleasure. And when we eat highly palatable foods, A.K.A. yummy foods, foods that are high in sugar, fat, even sodium, it triggers a part of our brain, the pleasure centers of our brain, by releasing a neurochemical called dopamine. And that dopamine gives us a momentary feeling of pleasure. The fact that it is momentary or temporary is important because it goes away. And so the natural response is to want to seek out that food again in order to reproduce that feeling of pleasure, which then, again, is temporary and goes away.
And so you can see why these palatable foods will create this habitual response in us. We are stressed or feel negative emotions. We seek to be soothed. We know from our past experiences that palatable foods are soothing, and therefore we seek them out again and again and again.
The Easy Answer: Are there still weight loss medication that I can use after the Fen-Phen debacle back then?
I've also talked about some of the behavioral strategies that help us with weight loss and weight maintenance. They include dietary strategies, physical activity, of course, mindset is super important, sleep, which I talked about in a recent podcast. I think it was just last week. But today I want to talk about again an area that I specialize in which is weight loss medications. Weight loss meds, of course, have gotten a bad rap. Those of you who are old enough to recall the Fen-Phen debacle back in the 80s know that there was a medication called Fen-Phen that resulted in cardiac outcomes. It actually resulted in leaky valves, heart valves, and heart failure and so it was removed from the market. And that has kind of left a bad taste in our mouth in terms of our, you know, desire for weight loss drugs.
Debunking the Fen-Phen: What are the drugs present in this medication
But I wanted to go over some of the drugs that are still here and FDA approved for weight loss because I think they are an important tool for the right candidate. So again, let's go back to Fen-Phen. Fen-Phen was a combination of two drugs, Phentermine and Fenfluramine. It was the other Fen, Fenfluramine, that was problematic and has been taken off the market. Phentermine, however, is a drug that has been around since the 50s, is still around.
This is a medication that can be used for short-term use. And it works by preventing certain neurotransmitters in the brain from being taken up and creating a feeling of satiety or fullness in the brain. So again, Phentermine is approved for short-term use. It helps trick your brain into feeling full or feeling satiated, and so you can get by with eating less. Phentermine, like all medications, has side effects because it is affecting stimulating neurotransmitters. It can help, or it can cause people to feel a little bit jazzed.
Some people may feel anxious on this medication and so I caution those of us who have anxiety from taking this drug. It can also cause other stimulating side effects like insomnia. Most people will get a dry mouth, and it can also cause constipation. It is of course contraindicated in anyone who is breastfeeding or actively pregnant. We shouldn't be focusing on weight loss in those circumstances anyway. But Phentermine can be a good agent for people who are young, healthy, don't have any, you know, cardiac issues, aren't anxious, and are just looking for something to help control their appetite while they get all of their habits, all their ducks, in a row, as I say so that they can maintain those behaviors once on Phentermine.
Let’s Talk About Weightloss Drugs: Qysmia
There's another drug out there, the trade name is Qsymia that has Phentermine in it, and another drug called Topiramate. This combination drug also works.
So Topiramate is another medication that helps control appetite at the level of the brain. It helps inform the brain of satiety. And so basically in this one medication, you get two drugs that help control your appetite. Once again, the side effects can include constipation, dry mouth, insomnia, irritability, and even increased heart rate. I want to point out that this medication like Phentermine does not cause heart attacks. It is not a medication that- it is FDA approved. It is in Speed. I mean, there's a lot of different ways that people think about these medications, but it has to be prescribed in the right person- for the right person in the right way. But it can be very effective short or long term in terms of this second medication, Qsymia to help control appetite and to help people lose weight.
Let’s Talk About Weightloss Drugs: Contrave
The third class of drug or third drug I want to talk about it has the trade name of Contrave. This is a medication that is also a combination drug. It is a combination of an antidepressant called Bupropion and another drug called Naltrexone. Now we're not using this medication for depression. It just so happens that this anti-depression- anti-depressant rather, also helps control appetite because of the neurotransmitters, or the chemicals in the brain that it affects. And so once again, it is tricking your brain to feel fuller faster, or with less food.
Let’s Talk About Weightloss Drugs: Naltrexone
The other drug, Naltrexone is an opioid antagonist. So you may know about opioids, it is that part of the brain that is involved in pain, but also pleasure. And so what this medication does is it blocks, kind of, that pleasure center, so that people, in theory, don't get the same feeling of reward from food. And so this drug is also a combination medication that helps people with weight loss. It is also FDA approved for long-term use so people can be on it forever I guess. But I, in my practice, will really just use it as the patient sees fit. And oftentimes that means we use medication for a certain duration, get people initiated again on their healthy routines, get motivated from experiencing some initial weight loss, and then we start tapering or weaning off the medication.
This combo drug, Contrave, again, can have side effects. And the primary side effects are a short-term increase in blood pressure, usually, that's minimized or resolved within the first three months. It can also cause nausea. And it can also cause what my patients kind of describe, I put it in the category of "head funk" because sometimes it's a headache. Sometimes it's fullness. Sometimes it's just a non-descriptive sensation. And so those are the primary side effects of that drug.
Let’s Talk About Weightloss Drugs: GLP-1
I wanted to end with a class of medications that's hit the news a lot in the last few months, which is the GLP-1 or Glucagon-like peptide-1 analogs. So GLP is a hormone that we normally release from our intestines or our gut. GLP-1 is released from our guts when we eat food, and it does two things. Number one, it signals the brain that food has been received and therefore it suppresses appetite. Number two, it signals to the pancreas that food has been received, and therefore it stimulates the production of insulin so that the body can manage our blood sugar.
For these reasons, GLP-1 analogs have been approved both for the treatment of Type 2 diabetes, as well as, for the treatment of obesity or excess weight. GLP-1 analogs come in several forms. They can be taken orally, but the more effective ones for weight loss have been the injectables. They are injectable in pen form. So, if any of you have seen an EpiPen or an Epinephrine pen. For allergic reactions, you may know what these pens look like. And the injectable form can be administered either daily or weekly, depending on the type of drug or the brand. So GLP-1 analog signal to the brain, an analog just means like a mimic. So it's a mimic of a natural gut hormone that signals to the brain that you're full and signals to the pancreas that you need insulin. And so it is approved for diabetes and for weight loss.
GLP-1 analogs typically can result in GI side effects, nausea, maybe diarrhea, or constipation, depending on the person. They are contraindicated in certain classes of thyroid tumors, so people who have a family history of a certain type of thyroid cancer called MEN or M.E.N. are contraindicated from this drug. And probably the most concerning side effect is possibly pancreatitis, which is an inflammation of the pancreas which can be a serious medical condition and occurs in less than 1% of people using this medication.
So this list is not meant to be completely inclusive of all the potential side effects and contraindications. Of course, this is a conversation for informational purposes only to make you feel comfortable about talking about weight loss medications, either with your own physician, or looking up an obesity medicine specialist who specializes in weight-loss drugs, and who might feel more comfortable with the use of these medications because we use them so frequently. We are very comfortable with who we can and cannot prescribe to, explaining side effects, potential side effects, and prescribing practices. And this is, of course, not meant to take the place of medical advice. And to-you know, we must acknowledge that every individual is unique, and so that conversation needs to be had on an individual basis with your prescribing doctor.
Truth or Not: Debunking the misinformation and bias around weight loss medications
But I do want to bring up this topic and talk about weight loss medications because I think there is a lot of misinformation out there. I think there's a lot of historical bias against weight loss medications, again, because of some of our past histories with these drugs, Fen-Phen being the main one. And because I think that these are important tools that should be a part of the discussion for someone who has failed diet and exercise or diet and exercise has failed them and might need some additional help in order to initiate the weight loss process.
We talk about obesity and excess weight often in cosmetic terms. We often only look at the cosmetic consequences, but obesity is in fact considered a disease. It is defined that way by the American Medical Association because there is a physiology behind it. We know that excess weight is not a cosmetic problem because obesity affects every single organ system from head to toe. It can affect the brain in terms of increased risk of stroke, the cardiovascular system, increasing the rate of heart attacks, hypertension, hyperlipidemia, or high cholesterol. It can involve the gastrointestinal system by increasing the incidence of reflux, a fatty liver disease that can go on to result in cirrhosis, or fibrosis of the liver. Excess weight is associated with an increased risk of our most common cancers-- breast cancer, prostate cancer, colon cancer. It can, of course, result in joint issues, and joint disease, skin conditions. And of course can affect the overall quality of life, including increasing the risk of depression. So this is an important disease with important medical consequences.
You Are Not Alone In This: Some things to remember
So I want to empower you with a few take-home messages. Number one, you are not alone. Excess weight is so common in the United States and across the world, for that matter. It was common before the pandemic and many people have been affected by the pandemic in terms of increasing their weight, regardless of age group, gender or ethnicity, or background. So know that you're not alone. Number two, know that there are physicians out there that specialize in this area of medicine, and that can help you with dietary changes, exercise prescriptions, sleep prescriptions, mindset, and mindfulness, as well as, other tools including weight loss surgery, and medications for weight loss. And so if you are curious, find a physician that is well versed or specializes in this area so they can give you some real one-on-one guidance. And lastly, again, consult with your provider because the information that is contained within this podcast is really for informational purposes only and not to serve, obviously, as medical advice.
I hope that this has been a helpful primer on weight loss drugs and weight loss medications. And if you find this information useful, I encourage you to subscribe to our podcast, Health Bite. If you think this is information that would be of service to others, I encourage you to share this episode with your friends and family, maybe take some notes and take it back to your doctor or your physician. Finally, if you are interested in more information on health and well being, mind and body, physical, emotional, and spiritual, please visit me on my website dradrienneyoudim.com where you can sign up for my newsletter, read our blogs, and also find other offerings like my new book, Hungry for More, exploring the emotional and spiritual hunger, as well as, the compendium journaling course to help you explore and identify your own hunger. And finally, you can find me on Instagram (@dradrienneyoudim) where I offer daily inspo and musings for my patients and audience. Have a great week and I'll see you again next time. Bye-bye!