Weight Loss Medications

Confused about weight loss medications and what might be right for you? Advanced Practice Provider Andrew McDevitt from Sarah Bush Lincoln talks about how these drugs evolved from diabetes medications to weight loss wonder. He’ll explain how they work, side effects and more.

Transcript

Hello and welcome back to Health Styles. I'm your host, Lori Banks. According to the Pew Research Center, in 2021, almost 2 million people in the U.S. were taking semaglutide,

which is the generic name for Ozempic and offshoots like Wegovy. That's more than three times as many in 2019.And those numbers will continue to grow. Social media feeds are full of ads and influencers touting results. It can be information overload to sift through what's a brand name, what's generic and how to compound. Drugs differ from something you get from your medical provider. Advanced practice provider Andrew McDevitt from Sarah Busch Lincoln is here to explain it all to us.Andrew specializes in medical weight management and has seen firsthand in his practice how these medications have helped his patients achieve their weight loss goals. We have so much to cover in today's podcast, so don't go away.

 This is where remarkable things happen, where technology and discovery beautifully intertwine with compassionate care. Where people trust the health care professionals of Sarah Bush Lincoln for the most successful of treatments. This is where you'll find some of the brightest minds in medicine, changing people's lives for the better. This is Sarah Bush Lincoln trusted, compassionate care right here, close to home.

 Andrew, it has been two years. I can't believe it that since we've had you on the podcast and the world of medications for weight loss has just exploded, as you know. Yeah, it seems there's more ways to get these medications, including online options. I know my social media feeds are full of it.But before we delve into that, let's get on the same page with some names and terminology. So we know we're talking about the same thing. So let's talk with GLP one for sure. 

 So like this is one of the bigger things that I talk about just in clinic because there's a lot of confusion out there based on the names based on what things are indicated for, based on why one thing would be covered, why the other, you know, the other thing wouldn't. So I'm going to I'm going to break it down. Pretty simple here. Okay. So Victoza a or generic name liraglutide. Liraglutide okay. However you want to say it, it's from I don't know, close enough one way or another. First came out in January 2010 that was introduced as a type two diabetes medication. Now, what I'm going to do first here is I'm going through is I'm going to tell you all of these that were introduced specifically as type two diabetes medications.

And, you know, they're indicated for type two diabetes and nothing else. And then I'll expand on that here in just a second. So everybody's clear. So Victoza first came out in January 2010 for type two diabetes. Then Trulicity. Which is do I the tide. Another medication for type two diabetes, came out in November of 2014. Then Ozempic or semaglutide came out in December of 2017. And then there was an increase in the dosage to two milligrams in March of 22. Again, all indicated for type two diabetes. Then Manjuro came out in May of 2022, indicated for type two diabetes. Now there there are some others that are in this class, but these are our most, prominent ones, especially based on our discussion that we're having today.

 So all of those medications that I just named, I gave you the, the, but the generic name and the brand name, and mind you, anytime any of these medications come out, there's a generic name for them. And, that's what the, the, you know, what the generic trade name, if you will, of the medication is. And then there's the brand name that's put on there from the company that's making the medication. Whenever those medications are being used for type two diabetes, they also were realized that they help significantly with weight loss. And, we all knew that. And we we can see that happening. And, many of those medications were being used off label which off label sounds like a bad term, but off label usage of medications happens all the time. It's not an uncommon thing. It's a it's a very, very common thing. Whenever we find that certain medications help with other, disease processes or whatever, that they're not necessarily, you know, quote unquote indicated for, but they were being used off label to help with weight loss. So we all knew that that was that was the case.

 But, they started testing them for, or testing them in non diabetics to help with weight loss, which is where some of these other names came from. So in two, 2014  Saxenda, which is a different brand name for Victor's liraglutide. Liraglutide was released for weight loss. That was the first one of these GLP one medications that was released for weight loss was six under that. And that's the brand name for it. Then, let's see then in 2021. So summer of 21, which I think I talked about or I know I talked about this one last time that we had, done the podcast, with Wegovywas released, which is the same medication as Ozempic. Dosing is a little bit different, but, it's semaglutide.

 And it had a, it just has a different brand name on it of Wegovy, which is indicated for weight loss. And there's other indications to it that we'll get in later. Then Zepbound was released in December of 2023, which is Mannjaro. Same medication, TRS appetite. It's a generic name for that. Zepp mount is just the brand name that's indicated for weight loss, and that was what was released in December 2023. So there's a lot of times that I'll have people that will come in and they'll, you know, I'll, I'll ask during an appointment. I'll say, you know, what do you know about some of these different medications? Because stuff's out there everywhere. Like you said, it's on social media. It's on, you know, it's on the news. It's on, you know, TV, it's on.

 Like, you just see it everywhere. And so I'll ask people and almost, I don't know, 75% of the time, like I hear all the time, people will be like, oh, I know about Ozempic. And I'm like, okay. Yeah. He could probably sing the theme song. Oh yeah, oh yeah, for sure. That catchy marketing. Yeah. I just don't want to, you know, or people's ears with my singing here.

 But, yeah, you know, I guess people will be like, oh, I, you know, I know of Ozempic. I know Banjara whatever. And not not realizing like, okay, well, those do have different brand names that are the indication for weight loss as opposed to type two diabetes. So why that's important is it comes down to insurance coverage a lot of times on what is going to be potentially covered by insurance based on the indication.

 So there are times when, you know, Ozempic, Victoza Trulicity, Manjaro those medications wouldn't be covered by somebody's insurance because they're not a type two diabetic, and that's the indication for it. Whereas a six under I would go V as that bound, even though they're the exact same medications as those counterparts that I just talked about. They possibly would be covered by somebody's insurance because they have a weight loss indication. It's semantics. I know it is like it. We all we all know it is what it is. But that's insurance. That's the way we're you know, we know it's the same medication. But sometimes it's just kind of figuring that out and knowing what can be covered by another, but that I hope that that kind of clears some of that up, because those are questions I get all the time.

 Well, you know, we'll go. We won't get covered. But, how about you order Ozempic? That's like, okay, well, are you type two diabetic? Like you're not okay. That's probably not going to get, you know, covered either. So like those are things that we hear constantly. You talk about how mainstream it is. My goodness. South Park had an episode about it. So like, yeah, it's it's it's gotten mainstream so. Well and talk about, you know, they're finding, you know, a medication comes out for this and then it works for that. 

 I just was watching the news this morning. And they're saying some of these medications may actually help with addictions. Addictions too. Yeah I think some of that's coming some of the you know, obviously this that's all preliminary stuff, but for sure there's some of that coming.

 There's going to be a lot of things coming with some of these medications, like, which is common. I mean, that happens with all sorts of medication. Absolutely, absolutely. If you want to look at so so this is something that I'll probably dive into a little bit more later. But Wego V, for example, has gotten a secondary indication for cardiovascular risk reduction.

 And and that's, you know, and those that have established cardiovascular risk. So, you know, somebody that's had a previous heart attack, previous stroke, peripheral artery disease, you know, coronary artery disease, something like that. Well, we you know, that that's something that's kind of been out there and it's like, okay, well, we're pretty sure it helps with cardiovascular risk reduction.

 Well, that officially got that indication in Wegovy specifically earlier this year. You know, and so it's like okay. Well yeah, this you know, this medication technically, with Govi has been out for, you know, three years now. But, you know, you look at Ozempic, it's it's been out for seven years now, you know, I mean, it's just takes time to get all that stuff figured out.

 Another one that's coming. Is that bound to appetite? Adoro. Whatever. You know, you want to whatever word you want to use. I use that bound because that's the one that I think is going to get the official indication by the by the brand, obstructive sleep apnea. There's going to be an indication coming that's going to be reducing, pretty significantly reducing obstructive sleep apnea events.

 Which I said, I'll probably get into some of that a little bit later as we're going, but, yeah, I mean, there's all sorts of stuff that's come in and I listen, I give you some anecdotal stuff too, of that I see in clinic and something that is super interesting, you want to talk about, you know, addiction and whatnot.

 I've had people that have come in that are not necessarily addicted to alcohol per se, but, you know, drink fairly regularly that have came in and been like, yeah, I don't really have that urge anymore. You know, instead of drinking every weekend or, you know, most evenings or whatever. Yeah, I don't really want to, you know, whenever I do, it's just kind of like, man, whatever.

 You don't necessarily have that desire to do it. And it's not just 1 or 2 people. I'm talking that I've had several, several, several people come and tell me that. So it would not surprise me at all that some of that stuff is going to be coming down the, down the pipeline. So how do these drugs work to help people lose weight as compared to some of these older medications?

 Like, you know, back in the 90s, we had the ones that worked in your brain with serotonin. This works in your gut. Okay. Yeah. So so GLP one is a hormone that's created in the gut. And then when you're looking at is that bound manejar alters appetite. GI P is a second hormone that's also created in the gut that that particular medication works on.

 They do a, they do a few different things. But specifically when it comes to weight loss, I'm going to highlight two things that they do. One of which is it delays gastric emptying. So they help to hold food in the stomach longer. Which naturally allows people to get fuller, faster, stay far longer. So we see portion sizes reduced.

 We see satiety satisfaction increase, you know, so that people are, like I said earlier, staying fuller longer. So it's not, you know. Oh, I ate something two hours ago. Now I'm hungry again. We're just seeing that satiety lasting longer. So that's one aspect that it does, but then it also helps both of those hormones, help work in the brain to help reduce, appetite somewhat, but cravings more so.

 And the, the terminology that's used, and I just, I don't change it because I think it hits the nail on the head is it helps to reduce the food noise. So, you know, food noise in the brain of like, oh, dang, that sounds good. Or, so-and-so brought in donuts today. Oh, man, I'd really like one of those.

 Or I'm watching TV and, you know, a commercial comes on for this food. Oh, man. You know what? I think I'm going to go get me a blizzard or whatever, you know, like, it really helps to turn that down to where those desires in the brain are reduced. So the point of all that is, it's making it easier on us to make the lifestyle modifications.

It's making it easier on us to make the dietary changes that that are necessary, obviously, to, you know, help with weight loss. Okay. So what are some of the side effects that start with minor and then work into the major ones that maybe aren't as common? Yeah. So the the minor ones, you know, you might see some nausea, upset stomach bloating.

 Sometimes diarrhea, constipation. But, you know, on one line it says can cause constipation. On the next line, it says can cause diarrhea. So good luck figuring that out sometimes. But but, you know, some of that can be self-induced. And I'm not saying every case is, but, you know, you think about the mechanism of action of the medication.

 It's holding food in the stomach longer. It's delaying gastric emptying. What happens if we eat too much or it's sitting in there longer? What do you feel like when you eat too much? You feel that bloated, that fullness that, you know, sometimes even upset stomach, nausea, don't feel good, all that stuff. So, you know, if somebody over eats, they're going to feel that and it's going to be enhanced a little bit because of the way that that, you know, the medications working, holding food in the stomach longer.

 If somebody eats foods that they don't tolerate real well, and specifically with these meds, your greasy, fried higher fat content foods are more significant. It's going to be sitting in the stomach longer. Those those, you know, those things are going to be magnified. You're not going to feel great. You're going to feel nauseous, you know, upset, stomach bloating, those kind of things.

The other thing that I note and I said, eat too quickly. You got to give time for the signals of satiety, of satisfaction to catch up to the brain. So if somebody eats in five minutes and they throw all the food down real quick, guess what? Those signals of that fullness or satisfaction have not caught up to the brain.

So, you know, then we'll see ten minutes afterwards, after they get done eating, it's like, oh my God, you know, it's that whole after Thanksgiving dinner, you're unbuttoning the pants and leaning back, oh good lord, you know what's the same deal if those if those signals haven't caught up up there and we eat too fast afterwards, probably going to feel, you know, probably going to feel, bloated and not feel good.

Those kind of things. So one of the things that I tell everybody is, is, you know, I tell them the mechanism of action, like we talked about here that delayed gastric emptying. And I tell them, say, slow down while you're eating. Take your time. You want to try and find that feeling, being satisfied, not full. Those are two different feelings we're going for, like the 75 to 80%, fullness, if you will, versus the oh, God, I don't feel real great because I just stuffed myself, you know, that that kind of a, feeling there.

Usually if people, if people understand how the medications work and do, do those things the right way, and I say usually because it's not 100% of the time, don't speak in absolutes here. But, you know, usually people do pretty good. They get it, they kind of get it figured out and pretty short order. And I think that one of the benefits that, you know, I have anyway, as far as seeing people or people that see me rather, is I try and really, really explain that and really go into it, make sure that they are aware, like, hey, this is what you need to do.

Try and avoid some of those, you know, quote unquote, minor side effects when you talk about the major stuff. There's there's kind of two big things that we look for. As far as it's not necessarily side effects as much as it is contraindications. So the first thing is, is a history of pancreatitis, whether that be acute or chronic.

Now, it's not an absolute contraindication for those that have a history of acute pancreatic itis, because somebody could have had a gallbladder issue that induced pancreatitis or something, you know, something happened. And then they got that fixed. And then now it's okay. Chronic pancreatitis. Right now it's recommended that that, you know, these medications are contraindicated in those that have, that have, chronic pancreatitis, the other thing is medullary thyroid cancer in the, in the immediate family or personal history. 

And what it, what it was is that these medications, when they first came out, there was findings in rats of, you know, essentially medullary precursors to medullary thyroid cancer. And, it's not necessary it's not been found in humans to be the case, but it was enough in the in the testing in the rats that they were like, okay, well, this is you know, this is significant enough that they made it a black box warning.

There's actually some discussion out there that that might get dropped as a black box warning at some point in time, because there's so much human data now. But but right now, anyway, that's an absolute contraindication. But, you know, that's very few and far between. Majorly. Thyroid cancer is not a common thing at all. So those are kind of your big, big things you're looking for.  As far as, you know, potential major issues, minor side effects. Okay.

we've heard words like she has a Wegovy face or Wegovy butt, is that the medication doing that or just you're just losing weight and if you're a certain age, your skin is going to sag when you lose weight, so does the medication making you lose muscle, faster than fat.

So I'm going to answer that in two parts. Okay. So when it comes to when it comes to the skin aspect and you know, guess what. Usually if you're over like 40 40, 45 and I hate to be the bearer of bad news, if you lose a significant amount of weight, I don't care how you do it, you're going to have some skin sagging, 

It's just the way it is. Like, you know, now, under under the age of 40, you have a much better chance. I'm not saying it won't happen. You have a much better chance of having some rebound. And all of it depends on how much weight there is to lose as well. If somebody has an extremely significant amount of weight to lose, they're going to have excess skin afterwards.

You know, somebody losing 40 or 50 pounds, that's not nearly as significant. And, and, you know, may not necessarily have that. So like I said, I hate to be the bearer of bad news, but it is what it is. People are going to have, you know, some, some sagging skin with a significant amount of weight loss, especially as we get older. 

Now, when it comes to muscle loss versus fat loss there, there's some trials that are still being done on that, but a lot of that is going to be dependent on what people are doing while they're losing the weight, how rapidly they're losing the weight. And, you know, making sure that they're taking care of the muscle mass. 

And this is one of the things, if you're any of my patients that are listening to this, you have heard me harp on this over and over and over again. And it doesn't matter if it's bariatric surgery, if it's, you know, a different a different weight loss medication, if it's a you're doing, you know, Weight Watchers to lose weight or whatever.

If you do not address your muscle mass, you will lose muscle mass with weight loss. And especially and I mentioned this just a second ago, like how fast it's happening. So we know that we can only lose about 1 to 2 pounds of fat mass on average per week in our most efficient, you know, and our most efficient fat loss, state, if you will. 

So if somebody is losing, on average, four, five, six, 7 pounds a week, they're losing muscle mass like that, there is no doubt about that. So I usually tell people unless there's some kind of crazy, you know, we need to lose a very significant amount of weight very quickly, which there's cases of that. And, you know, I've had to tell people that before, I usually only want people losing a maximum of like to maximum 2 to 2 and a half, 3 pounds per week. 

Ideally I want them falling within that 1 to 2 pound range, because I want them to retain as much muscle as possible. Muscle equals metabolism. That is something I tell people all the time in my, you know, in, in clinic or during appointments, whatever, tell like, listen, muscle equals metabolism. The more muscle mass we have, the better our metabolism is going to be. 

Long term, the better our, you know, the better our our continued weight loss weight maintenance is going to be because our BMR, our basal metabolic rate, is increased with more muscle mass that we hold. Now, we got to make sure that we're keeping that around. And there's two ways to do that. There is, you know, keeping the or keeping the fuel there, keeping our protein intake up, which is very important during, during weight loss, I usually will try and recommend doing close to about a, a gram of protein per kilogram of body weight per day.

That's kind of the rough estimate. And when I say per, kilogram of body weight, I'm looking more towards a goal weight, not necessarily what somebody is right at that moment. Okay. But keeping that protein intake up because that's the fuel for our muscle mass. But then also, strengthening, you have to, have to have to give the muscles a reason to stay around.

The comparison that I give in clinic all the time is doing the same, same repetitive motions over and over again. Our muscles adapt to it, you know, it's not going to be stimulated enough to stay around. So here's the comparison. Think about a marathon runner. Think about the way that a marathon runner looks, right? And not that there's anything wrong with this.

There's there's a purpose for it. But I want you to think about a marathon. Runners. One of the 26.2 6.20 6.2 miles. Okay, you can tell I've never ran a marathon. Well, I haven't either. Okay. Oh, no, I assumed you did. You know, quickly. But anyway, you know, you think about the way they look, and like I said, I'm not saying there's anything wrong with this, but I'm just using it for a point here. 

Very, you know, usually very skinny. And and when I say skinny, I'm talking about, you know, legs are very, very small, in diameter. Hypothetically, somebody would think, oh, my God, they're running 26 miles. They're using their legs all the time. They should have a lot of leg muscle mass. Well, that's not the case, is it? It's because they're using that same repetitive motion over and over again, and their body adapts to it and loses some of that muscle mass that they, you know, that they, that they need, or that they not necessarily that they need, but that they're not having stimulated because they're doing the same thing over and over again. 

Whereas if you see somebody that's an explosive athlete, that's strength training consistently, you're going to see that they carry more muscle mass, have larger, you know, have much larger muscle mass, larger legs, whatever. Even though the marathon runners using that all the time. But I tell people, Mike, listen, doing steady state cardio all the time and not doing explosive strengthening movements is not going to stimulate the muscle mass enough to stick around.

So that's the second component to it is making sure that we're doing strengthening movements to keep the muscle mass around. So going back to the original question, do these medications cause somebody to lose, you know, muscle mass? Not necessarily if you do it the right way, if you are doing these things while you're losing weight, you're averaging the 1 to 2 pounds.

You know, per week your strength training, you're keeping your protein intake up, you're going to keep a lot of your muscle mass around. I'm not saying you won't lose some, but you're going to keep a lot of it around and you're going to set yourself up for success, success in the future. And there's studies that are going to be coming out that are showing this.

They're they're in the works right now. Well, we have to remember, as we get older, we're losing muscle mass just by getting older. So if you're not doing the things you just talked about and taking the weight meds and you're of a certain age, you're going to lose muscle mass. Yeah, absolutely. It just by aging. Well, that's that's a good point too.

And I you know, I tell people obviously aging plays a role for sure. But I also tell people and you know, it is what it is. It's just physiology. Like females lose more muscle mass than males do. That's just the way it is. So it's doubly important to that. You know, my, my female patients are including the strengthening aspect not only for the, for the muscle mass aspect, but for their overall health, you know, osteoporosis. 

What's one of our best things we can do? Weight bearing exercise. Right. So I mean, like there are so many I was listening to, not too long ago, you had Seth, bland on from from, from the center for Healthy Living. Awesome. Dude. I was listening to his, podcast that he did a while ago, and he was talking about that, about how that strengthening aspect helps every aspect of your health.

And he has 100% on there. It's not just as simple as like, oh, well, you know, I look better because I have some more muscles or whatever. Now it is, it is very, very much so proven that that helps the longevity of your health. So yeah. So what's the current protocol for taking these drugs? How long? How often say I come to you and I'm like, I want to lose 75 pounds.

Yeah. So yeah. You have to remember, first off, the way that these, these medications were initially or initially created. So they were initially created as type two diabetes medications, which of course is a long term, you know, anticipated to be a long term lifetime type deal. So I'm not saying that somebody will be on these medications for their lifetime, but they have the indication to be there forever.

So it's not a prob lem to be on them long term. So that's that's the first thing sometimes I get asked about that as well. You know. Is it is that a problem that I'm going to be on them for, you know, a year or two years, whatever. And the answer is no, that they were created for that purpose for type two diabetes.

So that should, you know, that's not going to be a, an issue as far as duration of therapy. It is extremely individualized. My goal, what I try and do is I try and get somebody to whatever the goal weight is that we're looking for. And then we try and maintain that and oftentimes are using the medications.

We try and maintain that for, you know, a 1 to 2 year time frame after they've hit that goal weight, to allow the body to get used to being at that, that certain weight, to kind of reset the set point, if you will, and then try and slowly taper off of the, you know, off the medications. 

And there's, there's, there's there's definitely some data that's still coming in, like we discussed earlier, a lot of this is new, so there's still data that's going to be coming out, but there's some newer studies that are showing that tapering off and weaning off of the medications over time, while of course continuing the lifestyle modifications, which, you know, is the foundation of a lot of this, you know, can keep a lot of the weight off. 

And I've had patients that have done that, like, there's no doubt I've had several patients that have done that. I've also had some patients that, you know, I've tried to taper off and struggled. And so we've had to go back on. I've had some patients that have taper down to using a very small amount of the medications, you know, using and, you know, it is what it is. 

Technically this is off label, but whatever, you know, doing, doing one of the injections every two weeks, every three weeks, once a month or something like that and are maintaining at that as opposed to doing that every week. Very individualized. It's it's an extremely fluid situation. And, it just kind of depends on the person and where they're at.

And, you know, but I've had success in kind of all, all aspects of it, if that makes sense. All right. So this next topic is going to be interesting. I've learned a lot about this. So we're seeing more ads and sites where you can purchase these weight loss drugs online. Are they the same as what I would get from a medical provider because they're compounded?

So I think you might need to educate us on what compounded, pharmacies are. Yeah. So there are compounding pharmacies that are, out there. And these are, these are 100% legit, pharmacies, that are FDA, excuse me, FDA regulated. And they're, they're compounding the medications right now. Specifically the two that you're seeing are semaglutide and TRS appetite. 

And I'll tell you why they're why they've been able to do that here in just a second. But they're compounding the medications. And the way that it's listed is that it's the same active ingredient as Ozempic or Wego V or zap bound. And I mean, they are semaglutide terms appetite. What what we're seeing is there are these, I mean, essentially it's 5 or 3 b compounding pharmacies.

And I will tell you, I am not 100% the expert in pharmacy terminology. And everything. So, forgive me if I get something slightly off here, but, but these compounding pharmacies that are able to then outsource these medications, what has happened is in the last couple of years, semaglutide ozempic with govi, trs appetite Majuro is about have both went on the national drug shortage list.

And because of that, the compounding pharmacies now have the ability to produce these medications with the same active ingredient without, the risk of being sued by the companies that have the patent on the on the on the drug. So this has become more prominent, like you said, you see it all over the place. You see it online, you see it on Facebook, Instagram, whatever.

Like it's a it's a, it's kind of a constant in your face and probably after, listening to this on the algorithm, all of these ads will start showing up in people, but, but anyway, it's definitely out there. Yeah. I will tell you, I've not written any compounds. I'm not written to any compounding pharmacies.

I've only written the branded medications. And it's not because I'm a shell for the branded, you know, medications or whatever. I just don't personally, I don't feel like I know enough yet about the compounding process, and what that is going to look like in the future. And at this point in time, you know, and I've told patients I just it's not something I've felt comfortable with yet.

 I'm not saying they're not totally legit because these are pharmacies that have regulations on them. They're all of their ingredients that they're purchasing to compound these medications, have legitimate, you know, they come from legitimate, FDA regulated places. So I'm not saying that they're that it's, you know, Joe Schmo making it in his garage. I'm just saying that like, it's something that I don't know enough about right now to write.

That is where you're seeing all this stuff online, though. You're seeing all these different online providers, wellness clinics, whatever. Being able to do this because of these shortages, these national shortages, and then having this ability to, to, to produce these medications with that same active ingredient without the risk of being sued. Now, just, Three weeks ago, two weeks ago, trs appetite actually was taking off of the national shortage.

So that's minerals that abound. So there were I know Eli Lilly, the company that makes that bound Maduro sent out, you know, a bunch of cease and desist orders to, these large and large outsourcing, compounding pharmacies that have been making TRS appetite because now they're no longer on the shortage list. There's there's going to be a legal aspect battle that's going to go on with that. 

And I am not at all qualified to speak on that. But there's a reason you're not seeing nearly as many ads for that for TRS appetite as you are semaglutide, because semaglutide is still on the shortage list. So that's what you're seeing. That's why these medications are out there for all these different online things.

One of the things that I hear a lot of it. And I have a lot of patients that have gotten compounded. You know, medications from, an online provider, from a a service, from a wellness clinic, whatever. And I'm not I'm not sitting here trying to disparage anybody. I'm going to build myself up rather than knock everybody else down.

One of the things that I feel like that I provide better than a lot of other places is a full knowledge of not only the medication mechanism of action, of how they work and how to work with them, but also the other least lifestyle components that go with weight loss. In my experience with other patients that have went to some of these places, They don't nearly have the comprehensive plan that we do in, in, you know, in our clinic.

And like I said, I'm not knocking anybody down. I'm just. I'm toot my own horn. You know, here, that's one of the things that I think that our clinic does very well is we, we try and provide a comprehensive plan, to to show people how to work with the medicines, how to make sure the lifestyle components are all in place.

And it's a lot of the stuff that we've talked about already here. You know, to make sure that somebody is being a successful as possible. There's like, we could write one of these medications for somebody and just say, hey, go take this and it's going to help you lose weight. But more likely they're going to have some side effects and they probably will lose some weight, but they're not going to be nearly as effective as they could be without the other components.

So that, you know, if we're just looking at what separates us, you know, even if the medications are the exact same, I think the the more comprehensive approach separates us more there and, you know, separates our clinic as opposed to, you know, some of the online aspects or whatever. Okay. Well said. So it's just like anything you've got to think about.

You know, this is your health. You're putting something into your body. You know, it's your choice to decide where you want to get that medication. And I think there's always value in, you know, working with someone who's had a lot of people take this and then you've got that advice. Will this it have this happened to this patient?

You do have that knowledge to share on on how it's affected, you know, other people. Oh yeah. And and so I mean, that's the thing like, you know, I know and I said it earlier like I know it's anecdotal. It's it's stuff of like, oh, you know, hey, I had a patient earlier today that told me that this helped them, you know, but like when you've seen thousands of people that have done it or whatever, you know, I mean, it gives you a lot of different information, you know, it gives you a lot of different ideas to approach and, and incorporating.

You know, one of the things I tell people, a lot of times, and this one, it's just funny more than anything. I've had different people that have said that where they inject it makes a difference. And like, you know, I have some people that'll be like, yeah, if I do the injection in my in my stomach numb, they're all subcutaneous injections. 

It's not like it's changing anything. But I'll say if I do it in my stomach, it, you know, I have side effects, but if I do it in the side of my leg, I don't have those issues. And then I'll have the next person that comes in and they're like, if I do it in the side of my leg, I have side effects, but if I do my stomach, I have no issues and I'm like, I have no clue why that is, but it's it's it's legit enough because I've heard so many people that have said it that I'm like, okay, whatever, you know, whatever works for you.

But like, you're not going to get that from somebody that doesn't deal with this all the time, you know? And I it's just it's it's a funny little thing more than anything. There's no real data to back it up, but I'm just like, yeah, that's legit. I've heard it several, several times. So anyway, so Andrew, as we wrap up, what is your last bit of advice for people considering you have listened to this?

They've heard all the ups and downs. What would you say to people thinking about talking to their provider or seeking out a provider's specialist in weight loss? Well, you know, here's here's here's the way that I would look at it. Now, you know, you've heard me say this before on different podcast, but you gotta you got to look at obesity through a different lens.

Obesity and weight, is a chronic disease, not just I, you know, I have some extra weight to lose. And I think that that's getting more and more mainstream, which, we're seeing or. Hey, listen, I talked about South Park earlier. They opened up and I've watched it, I definitely I watch yeah. They open up that show with for those that have seen South Park and whatever, you know, some people like it, some people don't.

Whatever. Cartman is in the doctor's office and they're talking about. And Cartman, the characters always struggle with his weight, and they've always stigmatized that in a bad, bad way. In this show, they they open it up in the doctor's office, and they're talking about all the weight related comorbidities and high blood pressure and pre-diabetes and sleep apnea and these different things.

And like, to me, that was extremely significant. And it's like, oh, like, this is the first time I've seen, you know, this show not stigmatize weight in a bad way, but looking at it and being like, whoa, this is a legit health concern. In all honesty, that episode, like, was really good for what they did. Like. And I took it ethics of South Park course in college. 

So, you know I can I can speak to how that, how that goes. But anyway, no, it was, it was to me, it was kind of eye opening that it's like, okay, the mainstream, you know, we're seeing this a little bit more being realized is a health concern as opposed to just, oh, somebody needs to go lose extra weight or whatever.

So my advice is, is look at it that way. You know, I talked earlier about tours appetite being hopefully indicated soon for sleep apnea. Hopefully by the beginning of next year. Well, you know, obviously weight reduction helps with sleep apnea. We know that. But that's not people haven't been able to do that. We've not been able to see people have significant weight reduction, weight reduction without like bariatric surgery or something like that, you know, and now we're seeing a medication that can help reduce that significantly in some, some people, complete resolution of the disease a sleep apnea won't like.

Obviously, weight is a significant route to that. You know, we're looking at the root cause of something and helping to fix that. And I think that, like you know, if you kind of change your line of thinking on things as opposed to just being, yeah, I got some extra weight lose and realizing, like, now this is a disease process that's a root cause for a lot of other things.

It's going to make a big difference. Listen, you wouldn't just stay at home and be like, well, I just got to go fix my blood pressure. If your blood pressure is running 200 over 100, you know, or or diabetes, your blood sugar's constantly running 300. You wouldn't just be like, well, man, I just got to. I got to do a better job about fixing it.

No, you're going to go seek some help. It's the same deal with obesity. We just got to kind of reform that thinking and realize this is a disease process. This isn't just a I gotta go lose some weight kind of do. Okay, Andrew, this has been really informative. I've learned more in this last 30, 38 minutes by listening to you than listening to all that and reading all the things online 

Yeah, there's there's a lot that's out there. Yeah. Tell everybody to listen on this, one one and a half speed so they can get through it quicker as opposed to, taking. They didn't realize it had been 38 minutes. Sorry to talk to you. That's okay. We had a lot to cover. And, just great information. So thank you so much.

We won't wait two years until we have you on again. Okay. Sounds good, sounds good. Thanks. Andrew. I thank you. 

If you want more information on Andrew McDevitt or the Medical Weight Management program at Sarah Busch Lincoln, visit our website at Sarah bush.org. Remember that Sarah with an H. And remember, the information we present in our podcast should not be considered a substitute for medical advice. Talk to your own health care provider about what medical options are best for you. We hope you'll join us again for health styles. This is your host, Lori Banks.