Podcasts about liraglutide

Fat Loss & Metabolism with Dr. Ben Bikman Challenging the dogma surrounding heart disease. (1:32) Is there a connection between dementia and heart disease? (12:05) Strength training and Alzheimer's. (17:49) Learning something new helps put off dementia. (22:45) The connection between insulin resistance and your body's inability to fight off infection. (25:17) We put TOO much attention on total cholesterol. (27:55) Fat cells dynamics explained. (30:13) Why your metabolism is EXTREMELY complex. (44:14) Mitochondrial uncoupling. (48:51) Ketones and athletic performance. (55:39) The problem with DNP. (58:11) Why he is a HUGE advocate of creatine. (1:01:03) The brain loves ketones. (1:04:33) Keep your running shoes in the closet, GO STRENGTH TRAIN! (1:05:32) The metabolic origins of chronic disease. (1:08:10) How GLP-1s are being overused and the proper way to use them. (1:14:48) The resurgence of religion. (1:37:57) As a scientist, did he ever doubt his faith? (1:41:28) The most profound moment of his life. (1:45:51) Related Links/Products Mentioned Why We Get Sick: The Hidden Epidemic at the Root of Most Chronic Disease - and How to Fight It – Book by Dr. Benjamin Bikman How Not to Get Sick: A Cookbook and Guide to Prevent and Reverse Insulin Resistance, Lose Weight, and Fight Chronic Disease – Book by Dr. Benjamin Bikman Unlock sharper focus and support long-term brain health with Ketone-IQ—clean brain fuel for deep work, mental clarity, and sustained energy with no crash. Get 30% off your subscription, plus a free gift with your second shipment at https://ketone.com/MINDPUMP June Special: Shredded Summer Bundle or Bikini Bundle 50% off! ** Code JUNE50 at checkout ** Most heart attack patients' cholesterol levels did not indicate cardiac risk Study: Doubling Saturated Fat in the Diet Does Not Increase Saturated Fat in Blood Insulin signal transduction pathway Mind Pump #1922: Fatphobia & Other Lies That Are Keeping You Fat, Unhealthy & Sick Diabulimia: Why This Eating Disorder Is So Dangerous for People with Diabetes Harris-Benedict equation - Wikipedia Mitochondrial Uncoupling: A Key Controller of Biological Processes in Physiology and Diseases DNP (Dinitrophenol): Overview, Mechanism, and Risks Mind Pump #2497: The Amazing & Weird Side Effects of Creatine Muscle strength and fitness linked to reduction in cancer deaths Fighting Cancer By Putting Tumor Cells On A Diet - NPR Healthy Weight Loss Maintenance with Exercise, Liraglutide, or Both Combined Attenuated GLP-1 secretion in obesity: cause or consequence? Mind Pump #2597: Before You Take Ozempic, Wegovy, or Mounjaro Listen to This! Liraglutide modulates lipid metabolism via ZBTB20-LPL pathway Mind Pump #872: Dr. Warren Farrell- The Boy Crisis Mind Pump Podcast – YouTube Mind Pump Free Resources Featured Guest/People Mentioned Benjamin Bikman (@benbikmanphd) Instagram Website Zach Bitter (@zachbitter) Instagram  Thomas N. Seyfried (@thomasseyfriedbc) Instagram Warren Farrell, PhD (@drwarrenfarrell) X/Twitter  

Listen in as Joseph Kim, MD, MPH, MBA; Manish Shah, MD; Martha Grugel, MA, discuss how they manage the prior authorization process for antiobesity agents to improve the quality of their care delivery, including:The information to collect during patient visitsThe available resources to help you submit prior authorizationsThe supporting documents that are often necessary to accompany prior authorizationsHow to address denials and appealsWhen to access manufacturer-based or foundation-based financial assistancePresentersJoseph Kim, MD, MPH, MBAPresidentQ Synthesis, LLCNewtown, PennsylvaniaManish Shah, MDClinical Associate Faculty MS1 PreceptorUniversity of Florida College of MedicineGainesville, FloridaMartha Grugel, MAMedical AssistantWesley Chapel, FloridaLink to full program: https://bit.ly/45P0v8z

“Obesity Rx

This week on Fat Science, Dr. Emily Cooper, Andrea Taylor, and Mark Wright answer listener questions from around the world about metabolic health. This mailbag episode explores widely-debated topics like “starvation mode,” weight loss plateaus, the relationship between metabolism and cognitive health, cannabis and metabolism, metabolic effects of liposuction, and the latest on GLP-1 medications.Key Takeaways:Dr. Cooper dispels myths around “starvation mode,” citing research on the long-term metabolic impact of dieting and caloric restriction.Weight loss plateaus are often misunderstood—Dr. Cooper explains the natural adaptations behind them and how to assess true progress.Metabolic health plays a major role in brain function, cognitive decline, depression, and dementia prevention.Cannabis affects metabolic pathways in complex ways, with regular use potentially causing negative metabolic effects.Liposuction can trigger metabolic rebound and rapid fat regain for some patients, especially when leptin levels are low.Updates on GLP-1 meds: Liraglutide is available in generic form, but costs fluctuate. New oral and combination therapies are on the horizon.Personal Stories & Practical Advice:Andrea and Mark reflect on their own journeys with dieting, weight plateaus, and medication.Dr. Cooper shares clinical experiences with metabolic rebound after liposuction and ways to navigate pharmacologic treatments.Correction: Lilly has a lower cash pay for Medicare and Medicaid, but Novo Nordisk is not yet.References related to diet-induced metabolic adaptation, also called biological adaptation and defense of body weight. 1. Keys, A., Brozek, J., Henschel, A., Mickelsen, O., & Taylor, H. L. (1950). The Biology of Human Starvation. University of Minnesota Press.2. Dulloo, A. G. (2021). Physiology of weight regain: Lessons from the classic Minnesota Starvation Experiment on human body composition regulation. Obesity Reviews, 22, e13189.3. Müller, M. J., & Bosy-Westphal, A. (2013). Adaptive thermogenesis with weight loss in humans. Obesity, 21(2), 218-228.4. Rosenbaum, M., & Leibel, R. L. (2010). Adaptive thermogenesis in humans. International Journal of Obesity, 34(S1), S47-S55.5. Fothergill, E., Guo, J., Howard, L., Kerns, J. C., Knuth, N. D., Brychta, R., ... & Hall, K. D. (2016). Persistent metabolic adaptation 6 years after "The Biggest Loser" competition. Obesity, 24(8), 1612-1619.6. Johanssen, D. L., Knuth, N. D., Huizenga, R., Rood, J., Ravussin, E., & Hall, K. D. (2012). Metabolic slowing with massive weight loss despite preservation of fat-free mass. Journal of Clinical Endocrinology & Metabolism, 97(7), 2489-2496.7. Sumithran, P., Prendergast, L. A., Delbridge, E., Purcell, K., Shulkes, A., Kriketos, A., & Proietto, J. (2011). Long-term persistence of hormonal adaptations to weight loss. New England Journal of Medicine, 365(17), 1597-1604.8. MacLean, P. S., Bergouignan, A., Cornier, M. A., & Jackman, M. R. (2011). Biology's response to dieting: the impetus for weight regain. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 301(3), R581-R600Resources:Connect with Dr. Emily Cooper on LinkedIn.Connect with Mark Wright on LinkedIn.Connect with Andrea Taylor on Instagram.Fat Science is a podcast on a mission to explain where our fat really comes from and why it won't go and stay away. We are committed to creating a world where people are empowered with accurate information about metabolism and recognize that fat isn't a failure. This podcast is for informational purposes only and is not intended to replace professional medical advice.If you have a question for Dr. Cooper, email us at info@diabesityinstitute.org or dr.c@fatsciencepodcast.com.Fat Science is supported by the non-profit Diabesity Institute which is on a mission to increase access to effective, science-based medical care for those suffering from or at risk for diabesity. https://diabesityresearchfoundation.org/

SKIN & WELLNESS APPBLOGMy Epic Semaglutide Taper Journey! Astonishing Ozempic Weight Loss Transformation!Ozempic weight loss before and after. I used semaglutide for six months in 2023 to lose 25 lbs. This is my generic Ozempic dosage, how I tapered off, and how much weight I lost over six months.In this video, Ozempic weight loss before and after I share my Ozempic semaglutide dosage and taper calendar, plus a ton of photos and what I'm doing after using Ozempic. This is my semaglutide taper experience. If you can relate to any of this please tell me and we connect over this experience.Mommy Makeover Playlist: https://urlgeni.us/youtube/playlist/MMOplaylistCarnivore 1 Year Blood Work Results https://urlgeni.us/youtube/Carnivore1yearSemaglutide is the peptide in the name-brand Ozempic weight loss pen.Other GLP-1 are Liraglutide and Tirzepatide.SKIN & WELLNESS APP: ⁠https://urlgeni.us/AppInstall⁠NEWSLETTER ⁠https://urlgeni.us/NATURALKAOSNEWSLETTER⁠ASK IT any question you would ask me: ⁠https://mindos.com/share/265992794323804160⁠AMAZON LOCATIONSUS FACE SKINCARE ⁠https://www.amazon.com/shop/naturalkaos⁠CANADA FACE SKINCARE ⁠https://www.amazon.ca/shop/naturalkaos⁠UK FACE SKINCARE ⁠https://www.amazon.co.uk/shop/naturalkaos⁠SKINCARE SHOPSSHOP MY SHELF Products & Devices ⁠https://urlgeni.us/ShopMyShelf⁠ACID PEELS: ⁠https://www.makeupartistschoice.com⁠ KAOS20DR PEN USA CODE: KAOS15  ⁠https://drpen-usa.com⁠WHAT I USE TO CREATEMUSIC: Epidemic Sound ⁠https://www.epidemicsound.com/referral/qt9tsb/⁠FILMING EQUIPMENT: ⁠https://bit.ly/MyFilmingEquip⁠SOCIAL     MEDIAWEBSITE ⁠https://urlgeni.us/NKsiteAndblog⁠TIKTOK ⁠https://urlgeni.us/tiktok/NKskin⁠INSTAGRAM ⁠https://urlgeni.us/instagram/NKskin⁠FB PAGE ⁠https://urlgeni.us/facebook/NKFBpage⁠#weightlossjourney #ozempic #semaglutide #naturalkaos

As we work our way through the alphabet from A to Z in my drug pronunciation series, we're on the letter “L.” Disclaimer: we don't cover pharmacology in this series. Just drug names.   In this episode, I'll divide liraglutide, Victoza, and Saxenda into syllables, tell you which syllables to emphasize, and share my sources. Written pronunciations are helpful, so you'll find all three below and in the show notes for episode 324 on thepharmacistsvoice.com. Once you've listened to this episode, practice saying liraglutide, Victoza, and Saxenda. Repetition is the key to mastery.   Thank you for listening to episode 324 of The Pharmacist's Voice ® Podcast. The FULL show notes (including all links) are on https://www.thepharmacistsvoice.com/podcast.  Select episode 324.   Liraglutide = LIR a GLOO tide  LIR, like a Learjet Uh, which is a short “A” sound or a schwa “A” sound.  GLOO, like the sticky substance we use to stick two things together And tide, like the ocean tide Sources: Novo Nordisk Customer Service, MedlinePlus, and drugs.com    Victoza = VIC-tow-za  VIC, like Victor Tow, like a tow truck And za, like pizza Emphasize VIC Sources: Novo Nordisk Customer Service, drugs.com, and the FDA's website    Saxenda = sax en duh Sax, like a saxophone En, like the letter “N” in the alphabet Duh, which is an interjection we use in the US to mean, “Isn't it obvious?!” For example, if someone told you, “Water is wet,” you might say, “Duh! Water IS wet.”

Da diverso tempo l'uso di una specifica categoria di farmaci per indurre il dimagrimento è diventato motivo di dibattito. Sulla rivista  The Lancet in particolare, si sottolinea l'importanza della massa muscolare scheletrica nel contesto della perdita di peso indotta farmacologicamente, in particolare con l'uso diffuso di agonisti del recettore GLP-1. Questi farmaci, celebrati per la loro efficacia nel trattamento dell'obesità, hanno sollevato preoccupazioni riguardo una sostanziale perdita muscolare come parte del processo del calo di peso. 

On this podcast episode of the top 200 drugs, I'm covering liraglutide, folic acid, clotrimazole, empagliflozin, and semaglutide. Liraglutide is a GLP-1 agonist that can be used for weight loss as well as diabetes. The most common adverse effect of this medication is nausea. Folic acid is a commonly used supplement in pregnancy as well as in those patients taking methotrexate. Deficiency of folic acid can lead to anemia. Clotrimazole is an antifungal agent. It is mostly used for topical purposes such as athlete's foot and vaginal yeast infections. Empagliflozin was originally developed as a diabetes medication but can be helpful in patients with heart failure and CKD. I discuss this in greater detail in the podcast. Semaglutide is another GLP-1 agonist that is used for diabetes care as well as weight loss. The formulation used for diabetes is Ozempic while the weight loss product is Wegovy.

Dave brings you up to speed on the latest for all GLP-1 compounded medications. https://www.onthepen.com/post/zepound-and-mounjaro-shortage-judge-makes-shocking-move https://forum.policiesforpeople.com/t/compound-tirzepatide-and-semaglutide-transparency-in-fda-drug-shortage-process-503b-protection/7821 Decoding GLP-1: A Guide for Friends and Family of Those On The Pen By Dave Knapp

In this episode of Fat Science, Dr. Emily Cooper, Andrea Taylor and Mark Wright take a comprehensive look at the current FDA-approved medications designed to treat metabolic dysfunction and what may be approved next.  Dr. Cooper discusses the range of factors that determine whether these essential drugs are available for those who need them. Government approval, drug company strategies and insurance company policies all play a role.  Key Takeaways: Pharmaceutical Approval Process: Pharmaceutical companies typically seek FDA approval for one drug indication at a time due to the high costs and extensive trial requirements. Approval for obesity drugs is more stringent than for diabetes, involving costly and rigorous trials. Rebranding Drugs for Accessibility: Drugs like Liraglutide (originally Victoza for diabetes) are rebranded as Saxenda for obesity to bypass insurance coverage issues. However, rebranding can create coverage gaps for weight-loss purposes, leaving some patients without access. Insurance Coverage Challenges: Insurance companies often limit coverage for these medications unless a patient has a diagnosed condition like type 2 diabetes. Preventative benefits of metabolic medications are frequently overlooked by insurers, limiting broader access. Risks with Compounded Medications: Compounding pharmacies are creating untested versions of GLP-1 drugs to address affordability and shortages, raising safety concerns. Future Developments in Metabolic Meds: New potential drugs, such as a dual hormone agonist and high-dose semaglutide as a daily pill, show promise in improving metabolic health and accessibility. Resources: Connect with Dr. Emily Cooper on LinkedIn. Connect with Mark Wright on LinkedIn. Connect with Andrea Taylor on Instagram. Fat Science is a podcast on a mission to explain where our fat really comes from and why it won't go and stay away. We are committed to creating a world where people are empowered with accurate information about metabolism and recognize that fat isn't a failure. This podcast is for informational purposes only and is not intended to replace professional medical advice. If you have a question for Dr. Cooper, a show idea, feedback, or just want to connect, email us at info@diabesityinstitute.org. Fat Science is supported by the non-profit Diabesity Institute which is on a mission to increase access to effective, science-based medical care for those suffering from or at risk for diabesity. https://diabesityresearchfoundation.org/

Explore the big names in GLP-1s - Semaglutide, Liraglutide, and Tirzepatide - and learn how each one is shaping the weight loss landscape.   Jesse Frank https://www.lvrgfit.com jesse.dfrank@gmail.com   Charlie Seltzer https://drseltzerlifestylemedicine.com info@drseltzerweightloss.com

We're seeing a LOT more medications like Ozempic in the emergency department nowadays. In fact, 12% of U.S. adults have used a GLP-1 drug! So, what do we need to know about these drugs? Dr. Megan Boysen Osborn, Professor of Emergency Medicine at the University of California Irvine, discusses these GLP-1 agonists with host Maiya Smith.

TODAY ON THE ROBERT SCOTT BELL SHOW: Healthcare Consumerism vs. Patient Trust, Iron Overload and Liraglutide, Nutrition's Role in Medical Training, Psychological Bioterrorism Exposed, U.S. PR Campaign Against Pesticide Critics, Endocrine Disruptor Crisis, Hidden Dangers of Seed Oils, and MORE! https://robertscottbell.com/healthcare-consumerism-vs-patient-trust-iron-overload-and-liraglutide-nutritions-role-in-medical-training-psychological-bioterrorism-exposed-u-s-pr-campaign-against-pesticide-critics-e/

In this episode, we're diving deep into GLP-1 agonists, a topic that has sparked considerable debate within the fitness and health communities. Our special guest, Anthony Castor, brings a wealth of knowledge as the first non-physician to earn a fellowship with the Seed Scientific Research and Performance Institute. Together, we'll address controversies, debunk myths, and uncover the multi-faceted benefits of GLP-1 agonists far beyond their well-known role in weight loss and diabetes management. We'll explore their neuroprotective effects, benefits in managing neurodegenerative diseases like Alzheimer's and Parkinson's, and their surprising impact on cognitive decline, addiction, and ADHD. Moreover, we'll break down complex mechanisms, historical context, and real-world applications in an easily digestible format. Stay tuned as we demystify GLP-1 agonists and reveal how they can enhance not only physical but also mental resilience. Anthony Castor, a health advocate and educator, delves into the intricate world of peptides and their multifaceted benefits.   With a passion for making complex biochemical processes understandable, Anthony focuses on the potent impacts of GLP-1 (glucagon-like peptide-1), GIP (gastric inhibitory polypeptide), and myelin, among others. By demystifying how these peptides interact and function together, Anthony aims to shift public perception and drive forward significant improvements in health. Known for his use of analogies to clarify scientific concepts, Anthony is committed to educating people on the transformative potential of these sophisticated biochemical tools. Anthony's Website: https://www.castoremethod.com Instagram: https://www.instagram.com/anthonycastore/   Join Duffin Community & Education: https://www.skool.com/endless-evolution-8560/about www.chrisduffin.com

Suicidal ideation and GLP-1 agonists, a repeat of PARADIGM HF in Chagas CM, CASTLE HTx critical appraisal, and primary prevention of SCD in HF are the topics John Mandrola, MD, covers this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Suicidal ideation with GLP-1 Signal of Suicidality With GLP-1 RA Semaglutide, but Experts Urge Caution https://www.medscape.com/viewarticle/signal-suicidality-glp-1-ra-semaglutide-experts-urge-caution-2024a1000fa7 Disproportionality Analysis from World Health Organization Data on Semaglutide, Liraglutide, and Suicidality   Variability in Disproportionality paper https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2021.668765/full II. PARACHUTE HF: Repeating the Mistakes in PARADIGM HF PARACHUTE HF https://www.jacc.org/doi/10.1016/j.jchf.2024.05.021 SOLVD https://www.nejm.org/doi/full/10.1056/NEJM199108013250501 CONSENSUS trial https://www.nejm.org/doi/full/10.1056/NEJM198706043162301 Meta-analysis of Low vs High Dose ACE/ARB https://doi.org/10.1161/CIRCHEARTFAILURE.117.003956 Meta-analysis of Sac/Val vs ARB/ACE Inhibitors https://link.springer.com/article/10.1007/s00228-024-03686-6 PARADISE MI https://www.nejm.org/doi/full/10.1056/NEJMoa2104508 III. CASTLE HTx Critical Appraisal Critical Appraisal of CASTLE HTx https://doi.org/10.1016/j.jacc.2024.06.020 CASTLE HTx https://www.nejm.org/doi/10.1056/NEJMoa2306037 CASTLE AF https://www.nejm.org/doi/full/10.1056/NEJMoa1707855 IV. More Data Suggesting Modest Benefits of the Primary Prevention ICD First and Recurrent ICD Shocks: JICE Paper from Denmark https://link.springer.com/article/10.1007/s10840-024-01873-0 HF trialists https://www.nejm.org/doi/full/10.1056/NEJMoa1609758 PROFID Trial https://profid-project.eu/ DANISH  https://www.nejm.org/doi/full/10.1056/NEJMoa1608029 SCD-HeFT https://www.nejm.org/doi/full/10.1056/NEJMoa043399 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Audio Commentary by Dr. Valentin Fuster, Emeritus Editor in Chief

Dr Dave teaches Dr Jo about Heart Foundation resources, Atrial fibrillation and anticoagulation, Liquid morphine formulations, Liraglutide and dulaglutide, Oestrogen patches, Potassium in dietary supplements, Medicine-induced hyponatraemia, pseudoephedrine, Prescribing to competitive athletes subject to drug testing, Montelukast, Vitamin D supplementation in pregnancy and infants, and Abortion reversal.

It's In the News! A look at the top diabetes stories and headlines happening now. Top stories this week: The Eversense CGM could soon be approved for one year of continuous use, the first generic GLP-1 medication is launched, a new company tauts and all-in-one sensor and pump infusion set, a new diabetes accessory in the Roblox game, and more! Find out more about Moms' Night Out  Please visit our Sponsors & Partners - they help make the show possible! Learn more about Gvoke Glucagon Gvoke HypoPen® (glucagon injection): Glucagon Injection For Very Low Blood Sugar (gvokeglucagon.com) Omnipod - Simplify Life Learn about Dexcom  Edgepark Medical Supplies Check out VIVI Cap to protect your insulin from extreme temperatures Learn more about AG1 from Athletic Greens  Drive research that matters through the T1D Exchange The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com Episode transcription with links: Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and every other Friday I bring you a short episode with the top diabetes stories and headlines happening now. XX In the news is brought to you by Edgepark simplify your diabetes journey with Edgepark XX The first ever generic GLP-1 medication will soon be available in the US. It's a generic of Victoza, originally approved by the FDA in 2010 for diabetes, is part of the same class of drugs that includes Ozempic and Mounjaro. Liraglutide is Glucagon-like peptide-1 receptor agonists (otherwise known as GLP-1s or GLP-1 RAs) are a class of incretin drugs that mimic the body's natural hormones to help treat diabetes and obesity. However, the popularity of the drugs has spiraled out of control at times, leading to shortages and supply chain issues in the US and abroad.  The arrival of a GLP-1 generic drug provides reasons to be hopeful for doctors and patients alike, but there are also caveats. Couple of caveats - liraglutide is injected once daily (vs. weekly) and many doctors say it doesn't work as well for as many people as semaglutide and terzepatide. No confirmation on the price Two other generic options are being developed and could launch in December 2024. Patents for newer GLP-1 medications like Ozempic and Wegovy won't expire until several years down the road https://www.healthline.com/health-news/victoza-generic-glp1-drug-available XX Senseonics plans to launch a 365-day sensor in the U.S. in the fourth quarter of this year. A one-year Eversense CGM could be a game changer for the company.   In 2024, Senseonics expects to more than double U.S. new patient starts and increase the global installed base by around 50%. The growth is built on the current 180-day version of Senseonics' implantable Eversense CGM. Eversense's 180-day sensor can need calibrating twice a day, something Senseonics CEO Tim Goodnow said “has been a competitive disadvantage.” Users calibrate the 365-day sensor once a week. Senseonics is in talks with insulin pump manufacturers about integrating its Eversense CGM with their devices but has yet to commit to a timeline for finalizing an agreement. https://www.medtechdive.com/news/senseonics-365-day-cgm-2025-sales/719717/ XX People who take Ozempic or Wegovy may have a higher risk of developing a rare form of blindness, a new study suggests. Still, doctors say it shouldn't deter patients from using the medicines to treat diabetes or obesity.   Last summer, doctors at Mass Eye and Ear noticed an unusually high number of patients with non-arteritic anterior ischemic optic neuropathy, or NAION, a type of eye stroke that causes sudden, painless vision loss in one eye.   The condition is relatively rare — up to 10 out of 100,000 people in the general population may experience it — but the doctors noted three cases in one week, and each of those patients was taking semaglutide medications. The risk was found to be greatest within the first year of receiving a prescription for semaglutide.   The study, published Wednesday in the medical journal JAMA Ophthalmology, cannot prove that semaglutide medications cause NAION. And the small number of patients — an average of about 100 cases were identified each year — from one specialized medical center may not apply to a broader population. The ways that semaglutides interact with the eyes are not entirely understood. And the exact cause of NAION is not known either. The condition causes damage to the optic nerve, but there is often no warning before vision loss.   For now, patients who are taking semaglutide or considering treatment should discuss the risks and benefits with their doctors, especially those who have other known optic nerve problems such as glaucoma or preexisting visual loss, experts say https://www.reuters.com/business/healthcare-pharmaceuticals/wegovy-ozempic-linked-with-sight-threatening-eye-disorder-study-2024-07-03/ XX We got some updates at ADA about the over the counter CGMS Dexcom Stelo and Abbot's Libre. Dexom plans a late august launch of stelo, which you'll order from their website – it won't be physically in stores. Abbott also plans to sell its wellness-oriented Lingo device this summer through an e-commerce website. That's a sensor that's been available in other coutnires for a while, but was recently okayed in the US. It's not meant for people with diabetes. The Libre Rio is designed or adulst with type 2 who don't use insulin. No timing yet on that product's launch. Neither Abbott nor Dexcom have disclosed pricing for the upcoming products. https://www.medtechdive.com/news/abbott-dexcom-over-the-counter-cgm-launch/719928/ XX Insulet is looking to expand the label for its Omnipod 5 insulin pump for people with Type 2 diabetes. The company said Friday it recently filed with the Food and Drug Administration. Insulet presented study results at the American Diabetes Association's 84th Scientific Sessions that evaluated Omnipod 5 in people with Type 2 diabetes who were taking basal insulin or multiple daily injections. The results showed “substantial improvements in blood glucose outcomes and overall quality of life,” said study chair Francisco Pasquel, an associate professor of endocrinology at Emory School of Medicine. Omnipod 5 is currently cleared in the U.S. for people with Type 1 diabetes. Insulet hopes to expand the pump to people with Type 2 diabetes, with an expected launch in early 2025. The FDA has not yet cleared any automated insulin delivery systems for people with Type 2 diabetes, Insulet said. The company has a basal-only insulin pump, called Omnipod Go, that was cleared for people with Type 2 diabetes last year, but it does not connect to other devices. Even though Omnipod 5 is not currently indicated for Type 2 diabetes, doctors prescribe it for their patients with full reimbursement since the pharmacy channel doesn't distinguish between Type 1 or Type 2 patients, J.P. Morgan analyst Robbie Marcus wrote in a research note on Sunday. https://www.medtechdive.com/news/insulet-omnipod-5-type-2-diabetes-study/719644/ XX In the keynote address at the American Diabetes Association annual conference, FDA Commissioner Dr. Robert Califf expressed concerns about the rising rates of diabetes in the U.S. Though revolutionary medications and technologies for diabetes and weight loss continue to emerge, these treatments are vastly underused. The silver lining lies with type 1 diabetes therapies, which are showing great promise in clinical trials. “For the larger epidemic of type 2 diabetes, we're failing right now,” Califf said. “I don't say that lightly.” A huge problem, Califf said, is access. While most health insurance plans cover medical devices and medications for diabetes, without insurance, costs add up quickly. Ozempic, for example, costs nearly $1,000 per month without insurance. Studies have found that regardless of insurance status, roughly 26% of Americans skipped or delayed treatment due to cost. https://diatribe.org/diabetes-management/fda-commissioner-says-were-failing-people-type-2-diabetes XX Embecta presented two abstracts at the American Diabetes Association Scientific Sessions last weekend making the case for its insulin patch pump for Type 2 diabetes. The company submitted the device for Food and Drug Administration clearance in late 2023. The diabetes device company developed a patch pump with a larger insulin reservoir that can hold up to 300 units. Embecta, which is better known for making equipment such as pen needles and insulin syringes, has been developing its first patch pump. The company found that a device with a larger insulin reservoir could provide longer wear times and fewer disposable patches. https://www.medtechdive.com/news/embecta-insulin-patch-pump-volume-american-diabetes-association/719779/ XX   Pump/CGM sensor in one The niaa signature patch pump, shown with a watch displaying current blood sugar level The niaa signature patch pump has a manual bolus button and is part of an in-development AID system. Swiss technology maker Pharmasens demonstrated a new semi-reusable tubeless patch pump and glucose sensor in the same compact device, called the niia signature, which the company says can be worn for five days.   The top of the device, which includes Bluetooth connectivity and the electronic and mechanical parts to control the pump, separates from the disposable 300-unit reservoir along with the adhesive used to attach the device to the body via a steel cannula. A small button on the device allows manual bolusing. The company says an AID system will manage the device, controlled by smartphone.   PharmaSens' simpler basal-bolus patch pump, the niia essential, was submitted for FDA approval in late December. Availability of the niia signature AID system has yet to be announced. https://diatribe.org/diabetes-technology/diabetes-technology-display-ada-2024 XX Edgepark Commercial XX New international consensus statement offers guidance on the care and monitoring of people who are at high risk for type 1 diabetes (T1D). This is all about screening and testing for islet autoantibodies. These individuals are classified as: At risk or Stage 0 (single autoantibody or transient single autoantibody), Stage 1 (two or more autoantibodies with normoglycemia), and Stage 2 (two or more autoantibodies with dysglycemia but without symptoms and not yet meeting diagnostic criteria for Stage 3 clinical T1D). The document was presented on June 24, 2024 in a 90-minute symposium at the American Diabetes Association's annual Scientific Sessions and published simultaneously in both Diabetes Care and Diabetologia. "This is not guidance around who to screen or when to screen. This is guidance for the hundreds of thousands of people around the world who have participated in screening, mostly through research programs, and have been identified with positive autoantibodies and need care in the clinical setting," panel co-chair Anastasia Albanese-O'Neill, PhD, APRN, CDCES, of Breakthrough T1D, told Medscape Medical News.   The recommendations also include when to start insulin, and how to provide education and psychosocial support to individuals and family members of those given the early-stage T1D diagnosis. https://www.medscape.com/viewarticle/experts-advise-early-risk-monitoring-type-1-diabetes-2024a1000bpo XX Roblox has added a diabetic option, complete with insuli pen and Dexcom You can find it in the marketplace JDRF – now breakthrough t1d – started a world in roblox a couple of years ago as well Roblox is a super popular online game that a lot of kids play. https://www.roblox.com/games/5823990610/Breakthrough-T1D-World XX FFL next week! Join us again soon!

In this episode of the MS Boost, we sit down with Associate Professor Priya Sumithran, an endocrinologist and clinical researcher to discuss weight loss medications, with the most popular and commonly known, being semaglutide or known as the brand name Ozempic. Priya discusses the surprisingly long history of this medication, how it works and what considerations there are before starting this medication, especially for people with other chronic conditions or MS. Priya touches on the barriers to treating obesity, as well as the stigma around weight loss medications but also being obese, and the importance of a comprehensive approach to weight management. With thanks to Associate Professor Priya Sumithran.Associate Professor Priya Sumithran, MBBS (Hons), PhD, FRACP, is an endocrinologist and clinician researcher. She is Head of the Obesity and Metabolic Medicine Group in the Department of Surgery, School of Translational Medicine, Monash University, and Clinical Lead for Obesity Medicine at Alfred Health (Department of Endocrinology and Diabetes).A/Prof Sumithran completed a PhD at the University of Melbourne (Dept of Medicine, Austin) in 2012 and was a senior endocrinologist for 15 years in the obesity management service at Austin Health, including as Head of Obesity Medicine from 2021-2023.A/Prof Sumithran has co-authored >80 peer-reviewed papers, including publications in the New England Journal of Medicine, Lancet, British Medical Journal, Annals of Internal Medicine, Obesity and the Medical Journal of Australia. She served on the council of the Australian and New Zealand Obesity Society from 2017 to 2022.You can read the episode transcript here Reach out for support:MS Plus Connect 1800 042 138 or email connect@msplus.org.auFor support to manage your diet and nutrition, get in touch with an MS dietician to tailor a plan to your nutritional needs.  Get in touch to share your comments and suggestions about this episode, or for future guests and episode topics by emailing education@ms.org.au Views expressed on the MS Podcast, including any discussions or reference to medications or treatments by podcast guests, do not necessarily represent the views of MS Plus and should not be seen as either an endorsement or rejection of a treatment. MS Plus does not recommend any specific treatment for people living with MS. Decisions about any treatments, taking into consideration the potential benefits and side effects for each individual's circumstances, should be made in careful consultation with the person's neurologist or health care professional.

How many patients maintain weight loss 1 year after discontinuing semaglutide or liraglutide? Find out about this and more in today's PeerDirect Medical News Podcast.

A class of medications known as GLP-1 receptor agonists has revolutionized the treatment of type 2 diabetes and obesity. These drugs mimic the action of glucagon-like peptide-1 (GLP-1), a hormone that stimulates insulin secretion and inhibits glucagon release, helping to regulate blood sugar levels and promote weight loss. In this podcast, we'll talk about the differences among some of the most well-known GLP-1 receptor agonists for type 2 diabetes. Ozempic (Semaglutide) Form: Injectable Dosing Frequency: Once weekly Uses: Primarily for type 2 diabetes (lower blood sugar and A1c); also approved for reducing the risk of major cardiovascular events like heart attack and stroke in adults with type 2 diabetes and known heart disease. Keep in mind, Wegovy (semaglutide) is a higher-dose version that's approved for weight loss. When you start taking Wegovy or Ozempic, you'll begin with a low dosage. Your prescriber will increase your dosage every four weeks until you reach the target amount. However, the specific dosage you inject will differ depending on the medication. The maximum dose for Ozempic is 2mg weekly, while the target dose for Wegovy is 2.4mg weekly. Rybelsus (Semaglutide) Form: Oral tablet Dosing Frequency: Once daily Uses: Lower blood sugar and A1c in people with type 2 diabetes. Rybelsus shares the same active ingredient as the injectable medications Ozempic and Wegovy. Ozempic is also approved for Type 2 diabetes, while Wegovy is approved specifically for weight loss. Rybelsus is available in three different strengths: 3 mg, 7 mg, and 14 mg. Similar to Ozempic, the dose is slowly increased every 4 weeks.  Good to know: It's important to take Rybelsus first thing in the morning with 4 oz of water. After taking it, you should wait at least 30 minutes before eating, drinking, or taking other medications. Failing to do so may reduce its effectiveness. Currently, Rybelsus is undergoing clinical trials to evaluate its effectiveness for weight loss. The trials involve higher doses than those approved for diabetes treatment. Results indicate that a 50 mg dose of oral semaglutide (Rybelsus) achieves weight loss comparable to Wegovy.  Trulicity (Dulaglutide) Form: Injectable Dosing Frequency: Once weekly Uses: Type 2 diabetes; and like Ozempic, it's also approved for reducing the risk of major cardiovascular events in adults with type 2 diabetes and established cardiovascular disease. Like Ozempic and Rybelsus, you will start at a low dose to help reduce side effects. Your healthcare provider will then gradually increase the dose, balancing the management of side effects with the benefits of blood sugar control. The maximum dose for Trulicity is 4.5mg weekly. Victoza (Liraglutide) Form: Injectable Dosing Frequency: Once daily Uses: Type 2 diabetes; also approved to reduce the risk of major cardiovascular events in adults with type 2 diabetes and established cardiovascular disease. Victoza is one of three GLP-1 agonists approved for treating Type 2 diabetes in children aged 10 and older. The other options are Trulicity (dulaglutide) and Bydureon BCise (exenatide). More on this later. Ozempic, however, is only approved for use in adults. Saxenda and Victoza are both injectable medications containing liraglutide, but they are approved for different uses. Saxenda is FDA-approved for chronic weight management in people 12 and older, while Victoza is approved for treating Type 2 diabetes in people 10 and older. Victoza also helps lower the risk of major adverse cardiovascular events in adults with diabetes and heart disease. Both medications are injected once a day, starting with a low dose that is gradually increased over time. The target dose for Saxenda is 3 mg once daily, whereas the maximum dose for Victoza is 1.8 mg once daily. Byetta (Exenatide) Form: Injectable Dosing Frequency: Twice daily Uses: Type 2 diabetes. Additional Benefits: It has a shorter duration of action than other GLP-1 agonists, which may be preferable for some patients. Byetta, approved in 2005, was the first GLP-1 medication of its kind for diabetes. Its active ingredient, exenatide, is a synthetic version of a substance found in Gila monster saliva.  The recommended starting dose for Byetta is 5 mcg twice daily, administered within 60 minutes before your morning and evening meals. After one month, your healthcare provider may increase the dose to 10 mcg twice daily. Starting at a lower dose helps reduce stomach-related side effects. Bydureon BCise (Exenatide Extended-Release) Form: Injectable Dosing Frequency: Once weekly Uses: Type 2 diabetes. Additional Benefits: Extended-release formulation provides a more convenient dosing schedule compared to Byetta. Unlike Byetta, Bydureon BCise has a fixed dose of 2 mg administered once weekly, on the same day each week. It can be taken at any time of day, with or without food. Mounjaro (Tirzepatide) Form: Injectable Dosing Frequency: Once weekly Uses: Type 2 diabetes. Additional Benefits: Dual action as it targets both GLP-1 and GIP (glucose-dependent insulinotropic polypeptide) receptors, potentially offering enhanced efficacy in blood sugar control. Mounjaro is not approved for weight loss; however, its active ingredient, tirzepatide, is approved for weight loss under the brand name Zepbound. Typically, Mounjaro's starting dose is 2.5 mg once weekly for four weeks. By week 5, the dosage is often increased to 5 mg once weekly for another four weeks. Following week 9, if necessary for better blood sugar management, the dosage can be escalated to 7.5 mg weekly. It's important not to increase Mounjaro doses by more than 2.5 mg every four weeks. The maximum recommended dosage is 15 mg once weekly. Unlike Ozempic, Trulicity, or Victoza, Mounjaro is currently not approved for any heart-related uses. However, an ongoing clinical trial is assessing its effectiveness in reducing major adverse cardiovascular events in people with Type 2 diabetes. The study is anticipated to conclude in October 2024. Key Differences and Considerations The right GLP-1 agonist for you will likely come down to a few key factors like age, treatment goals, and underlying health conditions. Personal preferences like dosage frequency will also come into play. Dosing Frequency: Once weekly: Ozempic, Trulicity, Bydureon BCise, Mounjaro. Once daily: Rybelsus (oral), Victoza, Saxenda. Twice daily: Byetta. Administration Form: Injectable: All except Rybelsus (oral). Oral: Rybelsus. Indications: Type 2 Diabetes: All medications. Cardiovascular Benefits: Proven cardiovascular benefits: Ozempic, Trulicity, Victoza. Pediatric Use: Approved for children: Victoza (for children 10 years and older). Thanks again for listening to The Peptide Podcast. We love having you as part of our community. If you love this podcast, please share it with your friends and family on social media, and have a happy, healthy week! We're huge advocates of elevating your health game with nutrition, supplements, and vitamins. Whether it's a daily boost or targeted support, we trust and use Momentous products to supercharge our wellness journey.  Momentous only uses the highest-quality ingredients, and every single product is rigorously tested by independent third parties to ensure their products deliver on their promise to bring you the best supplements on the market. 

Is there potential for recovery in patients who are withdrawn from life support? Find out about this and more in today's PeerDirect Medical News Podcast.

Join me with Dr. Damon McCune as we dive into the hot topic of Ozempic and its impact on the world of weight management. We explore not just Ozempic, but other groundbreaking weight loss drugs, discussing their potential, efficacy, and what bariatric patients specifically need to consider. Tune in to uncover the latest advancements in medical treatments for obesity and learn how these innovations can be part of a comprehensive approach to health and weight loss. Need Support ? www.theritelife.com support@theritelife.com

Two articles in the March-April 2024 issue of the Journal of Clinical Psychopharmacology present research on glucagon-like peptide-1 receptor agonists (GLP-1 RAs),  a class of medications that has drawn considerable media attention in recent months for their ability to promote significant weight loss. The articles in JCP consider their use in specific populations of patients: individuals with bipolar disorder or eating disorders (in this case, atypical anorexia nervosa). This podcast features a discussion of the articles by authors Susan L. McElroy, MD; Anna Ward, ARPN; and Dr. Anna Guerdjikova, PhD, LISW, from the Lindner Center of HOPE in Mason, OH, and the University of Cincinnati. The first article, Liraglutide in Obese or Overweight Individuals With Stable Bipolar Disorder, reports on a placebo-controlled double-blind trial, which showed that compared with placebo, liraglutide was associated with greater reductions in percent change in body weight, and reductions in weight, body mass index, binge eating and hunger. Obesity is common among individuals with bipolar disorder, possibly contributing to their well-documented higher risk of cardiovascular-related mortality. The second article is titled Semaglutide Misuse in Atypical Anorexia Nervosa – A Case Report. The report presents the case of a patient with a history of an eating disorder who intentionally misused the GLP-1 semaglutide and lost more than 40  pounds in 9 months. The case report is designed to alert clinicians of the importance of reviewing patients' medical and psychiatric histories, being attuned to patient histories of weight fluctuations, and screening for eating dysregulation when prescribing weight-loss approved medications.

In this episode of The Atlas Podcast, we dive into the world of weight management and body optimization with Kelley Wright, MD, and IFBB Bikini Pro. With her 25 years of medical experience, Dr. Wright illuminates the science and myths about Semaglutide, Liraglutide, Ozempic, and Wegovy. We share personal stories, discuss the effects of hormones like leptin and ghrelin, highlight the true benefits, and clear up myths, such as muscle loss and 'Ozempic face.' Furthermore, Dr. Wright offers insights into the specific challenges bodybuilders face, from reading bloodwork and managing liver enzymes to balancing hormones. The conversation also covers PEDs, female fertility, TRT, gut health, and optimizing sleep. This episode is perfect for anyone eager to bridge the gap between medical science and competing as an athlete. The Atlas Podcast is available on: YouTube: bit.ly/AtlasPodcastYoutubeSpotify: bit.ly/AtlasPodcastSpotifyApple Podcast: bit.ly/AtlasPodcastAppleGoogle Podcast: bit.ly/AtlasPodcastGoogle Stay Connected: @navydoc_ifbbpro @413medicalaesthetics Discount links: https://linktr.ee/Jamesayotte Team Atlas Website: www.teamatlasfitness.com James Ayotte's Website: www.jamesayotte.com Team Atlas on Instagram: @teamatlasmtl & @teamatlaslifestyle James on Facebook: https://www.facebook.com/james.ayotte.79 James on Instagram: @jamesxatlas Atlas Podcast on Instagram: @atlaspodcastx

In this episode, Jennifer Green, MD, and Carol Hatch Wysham, MD, break down the latest headlines on incretin-based therapies and how to address these topics with patients. Their discussion includes:Beneficial effects beyond glycemic control Adverse events and how to manage themNon- or partial responders and the importance of setting expectations with patients Weight rebound when discontinuing therapyMedication access issues related to cost and drug availability Presenters:Jennifer Green, MDProfessor of MedicineDivision of Endocrinology and Duke Clinical Research InstituteDuke University School of MedicineDurham, North CarolinaCarol Hatch Wysham, MDClinical Professor of MedicineClinical EndocrinologistMultiCare/Rockwood ClinicSpokane, WashingtonLink to online program: https://bit.ly/48b6XnW

Beginning with a discussion on the evolution of these medications, Dr. Bikman emphasizes their significance in combating obesity-related health issues. He proceeds to analyze the mechanisms of popular weight loss drugs, such as Orlistat, Phentermine, and the combination of Phentermine with Topiramate, elucidating how each functions to aid weight loss.While highlighting the benefits, Dr. Bikman doesn't shy away from detailing the potential side effects, ensuring a comprehensive understanding for the audience. Moreover, he shares an intriguing scientific fact regarding lactate's role in fat metabolism, adding depth to the discussion. Throughout, Dr. Bikman maintains a balance between scientific evidence and personal insight, fostering an engaging and informative session.In discussing liraglutide's mechanism of action, Dr. Bikman reveals its role as a GLP-1 receptor agonist, mimicking the actions of the incretin GLP-1. He then previews next week's class dedicated to incretins and their use in weight loss drugs, including medications like wegovy and ozempic.Liraglutide primarily promotes weight loss by reducing gastric emptying, leading to prolonged feelings of fullness and decreased appetite. Additionally, it inhibits glucagon, lowering blood glucose levels and subsequently increasing metabolic rate and fat burning. Dr. Bikman notes common side effects such as gastrointestinal discomfort and hints at potential risks of thyroid tumors associated with GLP-1 agonists.Ben transitions to discussing semaglutide, another GLP-1 receptor agonist, and its similar effects on weight loss and side effects, including the possibility of ileus. He also touches on metformin's off-label use for weight loss, its mechanisms involving AMPK activation and ATP inhibition, and its potential interference with exercise-induced mitochondrial benefits.Learn more at: Insulin IQ Hosted on Acast. See acast.com/privacy for more information.

Dr. Ellen Csepe // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, MMOA faculty member Ellen Csepe discusses this new class of medicines and how they impact your patients and their overall journeys to maximize their fitness and manage their weight. Take a listen or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. ELLEN CSEPEHey, good morning everybody. And welcome to the PT on ICE daily show brought to you by the coolest continuing education company in all of healthcare. My name is Ellen Csepe. I'm coming to you live from Littleton, Colorado. I normally teach with the older adult division, but today we're going to be talking about GLP one agonist medications and their impact on your patients. Um, You guys have probably heard about GLP-1 medications. They're all over social media right now. They're used to manage obesity and weight issues um and diabetes, so These medications are the medicines like ozempic that you've heard all about or the medication brand of that same Ozempic, but used for obesity, which is called Wegovy. So you've probably heard a lot about these medicines already. And if you didn't see them on your board questions, you might be feeling a little bit out of the loop as to how they could impact your patients. If you're like me, these medications have come out after I've already gotten my licensure as a PT, and these medicines are impacting our patients in ways that I'm not really familiar with. So, this podcast episode today is for you to know a little bit more about how these medicines could be impacting your patients as a rehab professional. This podcast is going to be a lot about introductory level information to talk about these medicines in context of our Patients with obesity this podcast is not going to be a conversation to talk about How these medicines are used by celebrities they're not going to be we're not going to talk about how these compound medications or Illegal versions of these medicines are flooding our healthcare scene and causing a lot of illnesses today, we're gonna be really talking about what they are and how they work, who they're for, what they do other than help people lose weight, and some considerations and practical tips for your patients. GLP-1 MEDICATION So let's talk a little bit more about how these medicines work. So in context of treating obesity, these GLP-1 medications are super helpful to kind of overcome the biology behind our body's resistance to losing weight. Let me break that down a little bit. I know it's really easy to look at somebody with weight issues and think, gosh, wouldn't they just feel better if they lost weight? And it's an interesting paradox because our bodies actually fight to regain lost weight. Our bodies might feel better. We might have less pain, less inflammation, less joint problems, but Unfortunately, when we lose a substantial amount of weight, our body's biology fights to regain that. Why? Because usually in the context of our human existence, losing weight has always been a bad thing and it usually means being in starvation. Unfortunately, our biology doesn't know that obesity can be just as much of a threat to our health as starvation. So, when our weight changes, unfortunately our ghrelin or the hormone circulating in our blood blood that's Tells us we're hungry unfortunately that increases when we've lost weight and unfortunately leptin or that satiety hormone is decreases when we lose weight. What does that mean for our patients? It means that losing weight is very difficult to maintain because our body is constantly fighting to get that weight back. So let's talk about these GLP-1 medications. I'd like to first start out by saying GLP-1 medications are the newest medications that are used to treat obesity, but they're not the only ones. They just have a lot fewer side effects than some of the other medications that we've used in the past. For example, oralistat is a medication that works at our gut to decrease the absorption of fat. It comes with a ton of really gnarly side effects. Google what steatorrhea is, and you'll see what I mean. Unfortunately, there are tons of GI side effects for people that use this medication that cause significant fat in their stools and a lot of loose stools with it. Another medication is fentramine or topiramate. Those medications used in combination Basically act as a sympathomimetic to increase our metabolism But those medications are really only effective for a short period of time and they can have a lot of cardiac side effects There are some medications that are used in combination to treat obesity specifically naltrexone was a medication to use to treat opioid addiction and bupropion is which is another antidepressant, in combination that kind of changes our satisfaction behind eating. Those are medications used to treat obesity too. And usually what we can guess is that those medications aren't going to be quite as effective as GLP-1 medicines. Just to kind of review if you're tuning in now, those GLP-1 medications are medications like Wegovy, Sexenda, Ozempic, although of note, Ozempic is only used to treat obesity as an off-label benefit. Ozempic is actually only, excuse me, only approved to treat diabetes by the FDA right now. MECHANISMS OF GLP-1 MEDICATION So let's talk a little bit more about what this GLP medication is. GLP-1 is a hormone that we naturally secrete in our bodies. and the GLP-1 medicines are receptor agonists that look pretty similar to that hormone in our bodies and that when used mimic that hormones actions throughout our tissues. For example at the pancreas that GLP-1 receptor increases our body's secretion of insulin and helps to make that insulin last better. So that's why it's also used for people with diabetes. Interestingly enough, we also have GLP-1 receptors in our stomach. So another way this medicine works is to slow gastric emptying and basically make our food last longer throughout our stomachs so that we feel fuller for longer. What I think is the most interesting is that we have these GLP-1 receptors in our brain, in our hypothalamus, and the way these GLP-1 medicines work is to suppress both hunger and cravings. A lot of people with obesity experience something called food noise. And basically because of the obesity, they have these constant and intrusive thoughts about food. They could be eating something and have no hunger, but already be thinking about their next meal. So this GLP-1 agonists, Turn down that food noise to make it less likely for them to experience these constant intrusive thoughts about hunger So we talked a little bit about how they work. Let's talk a little bit more about who they're for so GLP-1 agonists are used for people with obesity. So that means generally their BMI is 30 or more or they could have overweight and a BMI of 27 with comorbidities. Comorbidities specific to their weight significantly causing risks to their health. So these medications aren't just for people who are looking to shed a few pounds. Obesity is a disease and these medicines really help us treat that disease process, which is a long-term, lifelong problem that relapses and recurs, unfortunately, in a lot of patients. It's contraindicated in a few patients. Good news, patients' physicians have to figure that out, not us. But just for context, people that are pregnant, people that have gastroparesis, irritable bowel disease, those patients might not be appropriate for these medicines, as well as those with certain thyroid cancers or familial risks of those cancers. So these medicines are also used to treat diabetes and in patients with obesity and diabetes, this is a great new medication to manage both conditions at once. Interestingly, or Wigovy, which is the ozempic for obesity, is also used to treat those who are 12 and older. So it's not just adults that are using these medicines, it's also those with obesity who are children who are 12 or older and weigh 132 pounds or more and have obesity. So let's talk a little bit about what they do. So pragmatically, they really reduce cravings. We talked about that. They can result in about an 8 to 15 percent weight loss in the first year of use. That's a lot compared to some of the older classes of medication. Liraglutide decreases the risk of diabetes compared to a placebo. So in those with obesity, liraglutide decreases the risk of obesity development and that rate of onset much sooner. So these aren't just to lose a few pounds before summer and celebrities. This medication can be very helpful for people who are struggling with their weight long term. Notably, Long term is how long these medications have to be used. So unfortunately, in most users, if they discontinue this medication, weight is almost always regained, and about 66% of the weight that they've lost over the past year is regained when people stop using this medication. but again, this isn't just a cosmetic thing to lose weight and a lot of us as Providers think about weight in the context of how we look societally and how we feel but this medication in those with obesity and diabetes Decreases the risk of cardiovascular events decreases the risk of stroke atherosclerosis Heart attack. So these medications aren't just here to help you get shed a few pounds These can be really life-saving medications for those with obesity CLINICAL CONSIDERATIONS Let's kind of talk through some of the considerations for you as a clinician. So keep in mind these medications are injected by the patient at home one time a week. And the dose is gradually increased to a therapeutic dose over several months. Here's why that matters. Because there are quite a few side effects with these medications. It's not a medicine that comes without side effects. This is not the easy way out to lose medicine. It does not feel good to be on these medicines. And a lot of the most common side effects are going to be nausea, vomiting, GI issues, cramping, bloating, dizziness, headaches and fatigue, hypoglycemia, which is important for us to consider for our patients if we're going to be having them exercising, acute pancreatitis, and gallbladder disease. So how does that impact our patients? Friends, team, we are in the business of helping our patients maintain their muscle mass. That's our job. Our job is to be fitness forward, to advocate for our patients, and to be here for them through every season of life. And on the days that they're taking these medicines and throughout the week, there's a lot of stigma attached to these medicines that we have to be aware of as providers. Where I'm going with that is that they need a hype squad. Patients need somebody to cheer them on and say hey, I know you feel like crap. I know that this medication is hard What I want you to know is that I'm here in your corner You are making a big decision for your health and even if you only lose five to ten percent of your weight Overall, that is a huge huge way to reduce your risk of overall cardiovascular disease. HYPE UP YOUR PATIENTS So friends We need to hype up our patients who are on these medicines when it's appropriate and it usually is if it's prescribed by a doctor. This needs to be our goal to hype up our patients and encourage them to maintain their consistency with this medicine. A lot of patients stop because they plateau losing weight after about a year. And they still have the side effects. So they feel like crap. They don't want to take this medicine. They're not seeing the pounds shed off anymore. And they need a health care provider to say, hey, this isn't just a quick fix to lose a few pounds. This is a lifelong endeavor to manage obesity, which has serious risks to your health. So another consideration, our business is to make sure that our patients are sticking through these medicines and Also maintaining their exercise participation and their muscle mass So patients who are taking these medicines feel like crap. They need somebody to still say hey I know you don't feel great. We still need to have a plan to have you doing strength training. We still need to have a plan for you to get enough protein in your, in your, in your mouth throughout the day, because unfortunately these medicines work by saying, Hey, you're not so hungry anymore, which is how those medicines are effective. But unfortunately, if you're not intentional, you will lose not only fat mass, but muscle mass with this endeavor with using these medicines. So, Encouraging your patient. Hey, I know you're losing weight. This is awesome Let's really keep this ball rolling and be super Intentional to make sure that you're still able to get to the gym that you're still able to get enough protein in your diet I'm on your team. I am in your corner to help you and These patients are prime time for behavioral change to say i'm making a change on myself already with this medicine. How can I really? Maximize this and get as much as I can and we are on their team team I recommend patients to talk with their doctor about these medicines. I talk with my patients about their weight all the time in a way that's constructive and empathetic. I listen to my patients and recognize that losing weight is a struggle. These medicines can be super helpful for our patients who have struggled for a long time to manage their weight. And that's not because they're unmotivated or lazy, it's because their biology is fighting to get that weight back. This is not cheating and these medications can be super helpful. I often talk with patients and recommend them to go back to their doctors and ask if it could be helpful in their journey to manage their weight. A quick caveat on that, not all insurances in all states cover these medicines the same, which is very unfair. These medications can be really life-saving for our patients with obesity, and unfortunately, insurance is making it hard for people that need it most to get access to it, specifically those in poverty. Obesity disproportionately affects those from a lower socioeconomic status, and it's really important to recognize that in the treatment of obesity, those people are unfortunately going to be the last to get access to this stuff, and that stinks. So knowing that as a provider is another important thing that I've learned. You can't just shoot from the hip and say, oh, you've got to go talk to your doctor about this. It might not be covered by their insurance, and that's super demoralizing. So make sure that you kind of know that before you make this recommendation that, oh, you can be on this new drug, it'll be super helpful for you, and it's not covered. So friends, to wrap up this summary, so these GLP-1 medications are new but not the only way that obesity can be treated medically. They're very helpful and effective in helping those individuals lose weight but they often come with side effects. Our job as providers is to know what those side effects look like and feel like and how to still emphasize exercise participation to our patients no matter how they feel and come up with a plan to say, hey, we still need to do strength training. We still have protein goals to make sure that you maintain your muscle mass. Thank you guys so much for taking time out of your morning to join me to talk about these medicines. And I hope that it was helpful in the long run for you to know how they can be helpful for your patients. Have a great day. OUTRO Hey, thanks for tuning in to the PT on ICE daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Today On Medical Grounds, we will be speaking with Dr. Heather Whitley. Dr. Whitley is a clinical professor in the Department of Pharmacy Practice at the Auburn University Harrison College of Pharmacy. She is a board certified pharmacotherapy specialist and a certified diabetes educator. Earlier this year, Dr. Whitley spoke with us about screening for diabetes in high-risk individuals. Today, she is back to talk about some new things going on in the diabetes and pharmacy world. This is part 1 of a two part series. In Part 1, Dr. Whitley will be discussing shortages in GLP-1 agonist drugs for diabetes and what pharmacists can do to address those shortages.Dr. Whitley recently published a paper in Clinical Diabetes about this topic:Special Report: Potential Strategies for Addressing GLP-1 and Dual GLP-1/GIP Receptor Agonist Shortages(00:09) Introduction to Dr. Whitley(01:08) Publication on strategies for GLP-1 and GLP-1/GIP shortages(02:36) GLP-1 and GLP-1/GIP agonists, names, and dosing(04:15) Why are there shortages?(08:52) Alternatives(10:11) What happens if a patient misses a dose?(12:19) Re-initiation of medications(14:51) GLP-1 agonist equivalency(15:31) Substituting SGLT2s(17:16) Self-sourcing or online sourcing problems(21:51) Managing patient expectations and concernsVisit us at OnMedicalGrounds.com for more podcasts! You can subscribe through your podcast platform, our website, or follow us on social media for podcast updates and medical news. Some of our podcasts offer FREE CME/CE credits.LinkTreeTwitterLinkedInInstagram

GLP1 agonist weight loss medications Wegovy and Ozempic have become popular medications for overweight and obesity and are also increasingly being used in psychiatry to target symptoms of depression and anxiety. But are Wegovy and Ozempic safe to use in psychiatry? University of Toronto psychiatrist and researcher Dr. Rodrigo Mansur discusses the research supporting the use of GLP1 agonist weight loss drugs and explores his clinical considerations when discussing these medications with patients. Could they be a new treatment for psychiatric disorders? That remains to be seen as we consider the potential adverse effects. But it seems clear these drugs are becoming more popular, so the more we know about them, the better! Expert featured in this episode: Rodrigo Mansur MD PhD https://psychiatry.utoronto.ca/faculty/rodrigo-mansur Dr. Mansur's publication mentioned in this video: Liraglutide promotes improvements in objective measures of cognitive dysfunction in individuals with mood disorders: A pilot, open-label study https://pubmed.ncbi.nlm.nih.gov/27721184/ About us: Metabolic Mind™ is a nonprofit initiative incubated by Baszucki Group. Our mission is to provide education and resources in the emerging field of metabolic psychiatry, including ketogenic interventions for mental disorders. Our channel is for informational purposes only. We are not providing individual or group medical or healthcare advice nor establishing a provider-patient relationship. Many of the interventions we discuss can have dramatic or potentially dangerous effects if done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications. #MetabolicMind #KetoForMentalHealth #MetabolicPsychiatry #BipolarTreatment #KetogenicMetabolicTherapy #NutritionalKetosis#MentalIllness#Bipolar#GLP1#Ozempic#Wegovy#Weightloss

What does the body of evidence say on Ozempic and its impact on diabetes and obesity? Plus: can you trade in your antidepressant for a jog, and Chris returns to the hot seat to diagnose a teenage boy who fell during a baseball game! Block 1: (2:22) Ozempic/Wegovy: GLP-1 receptor agonists; the difference between them; Mounjaro; Trulicity; diabetes biology; glucagon-like peptides 1 and 2; the problem with GLP-1; DPP4 inhibitors Block 2: (12:33) Ozempic/Wegovy: The venom of the Gila monster; how semaglutide became a blockbuster drug; weight loss; the numerous clinical trials; the impact on the stock prices of dialysis companies; downsides; the Internet craze Block 3: (27:03) Is running as beneficial for depression as medication? Block 4: (36:42) The case of the baseball player's heart   * Jingle by Joseph Hackl * Theme music: “Fall of the Ocean Queen“ by Joseph Hackl * Assistant researcher: Aigul Zaripova   To contribute to The Body of Evidence, go to our Patreon page at: http://www.patreon.com/thebodyofevidence/. To make a one-time donation to our show, you can now use PayPal! https://www.paypal.com/donate?hosted_button_id=9QZET78JZWCZE Patrons get a bonus show on Patreon called “Digressions”! Check it out!   References: 1) History of GLP-1 receptor agonists: https://www.statnews.com/2023/09/30/weight-loss-ozempic-nobel-prize-science/ 2) Liraglutide vs. exenatide: https://doi.org/10.1016/S0140-6736(12)61267-7 3) Meta-analysis of GLP-1 receptor agonists: https://doi.org/10.1111/dom.12849 4) A brief summary of the SUSTAIN studies, all 11 of them, which demonstrated the efficacy of semaglutide and its cardiovascular benefit: https://diabetes.medicinematters.com/semaglutide/type-2-diabetes/a-quick-guide-to-the-sustain-trials/12206922 5) A brief summary of the STEP trials, all 10 of them, which tested semaglutide as a weight loss medications even in non-diabetics: https://diabetes.medicinematters.com/semaglutide/obesity/quick-guide-step-trials/18854832 6) Announcement that the FLOW trial is being stopped prematurely: https://www.novonordisk.com/news-and-media/news-and-ir-materials/news-details.html?id=166327 & https://www.investors.com/news/technology/novo-nordisk-stock-pops-after-hinting-weight-loss-drug-treats-kidney-disease/ 7) GI side effects of GLP-1 receptor agonists: https://doi.org/10.1001/jama.2023.19574 8) Gid M-K's Slate article: https://slate.com/technology/2023/10/exercise-depression-anxiety-treatment-effectiveness-ssris-research.html 9) Study on running to treat depression: https://www.sciencedirect.com/science/article/pii/S0165032723002239?via%3Dihub#s0065:~:text=https%3A//doi.org/10.1016/j.jad.2023.02.064 10) Details on the DEA-Quebec app to find an AED near you: https://www.jacquesdechamplain.com/en/major-update-to-the-dea-quebec-application/ 11) Government of Canada's definition of a pesticide: https://www.canada.ca/en/health-canada/services/environmental-workplace-health/reports-publications/environmental-contaminants/human-biomonitoring-resources/glyphosate-in-people.html   It's Not Twitter, But It'll Do: 1) Jonathan's article on how natural health products and dietary supplements are regulated: https://www.mcgill.ca/oss/article/critical-thinking-health-and-nutrition/false-reassurance-dietary-supplement-regulation 2) Jonathan's article on fentanyl: https://www.mcgill.ca/oss/article/medical-critical-thinking/you-wont-die-touching-fentanyl 3) Chris' article in Medscape about the COSMOS study: https://www.medscape.com/viewarticle/996926 4) Chris' Gazette article on coated vs. uncoated aspirin: https://montrealgazette.com/opinion/columnists/christopher-labos-the-bare-facts-about-coated-aspirin

The market is flooded with claims of miracle weight loss pills and injections.  But which of these medications hold up under scrutiny?  In this episode, Mike discusses the science behind 7 prominent weight loss drugs, providing clarity on their effectiveness, potential side effects, and more. Timestamps: 0:00 - Please leave a review of the show wherever you listen to podcasts and make sure to subscribe! 0:40 - What Are Weight Loss Drugs, How Do They Work, and Why Are They Popular? 6:57 - What Is Orlistat and How Is It Used? 9:54 - How Effective Is Orlistat in Aiding Weight Loss? 12:32 - What Should You Know About Semaglutide? 14:41 - Are There Any Risks or Concerns with Using Semaglutide? 17:35 - Our Biggest Sale of the Year! Save 50% during our Black Friday Sale! https://buylegion.com/ 19:47 - How Does Phentermine Work for Weight Loss? 24:05 - What Is Plenity and What Benefits Does It Offer? 27:56 - What Are the Potential Side Effects of Plenity? 28:21 - How Does Liraglutide Function in Weight Loss? 30:34 - What Are the Side Effects and Risks of Liraglutide? 30:53 - What Is Naltrexone Bupropion and How Is It Used? 32:07 - Are There Side Effects or Risks with Naltrexone/Bupropion? 33:56 - How Does Tirzepatide Aid in Weight Loss? 35:27 - If I Stop Taking Weight Loss Medications, Will I Regain the Lost Weight? Mentioned on the Show: Our Biggest Sale of the Year Is Here! Save 50% during our Black Friday Sale. Go to https://buylegion.com/ and use coupon code MUSCLE to get double reward points!

Ozempic is being hailed as “the end of the Obesity Epidemic.” This week, Mike and Aubrey dig through the sensational claims. But will they make it past the caveats?Links: How a Canadian scientist and a venomous lizard helped pave the way for Ozempic The Discovery and Development of Liraglutide and Semaglutide Ozempic and Wegovy maker courts prominent Black leaders to get Medicare's favor Insurers clamping down on doctors who prescribe Ozempic for weight lossOzempic prescriptions can be easy to get online. Its popularity for weight loss is hurting those who need it most    Glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes: real-world evidence from a Mediterranean areaSemaglutide in Patients with Heart Failure with Preserved Ejection Fraction and ObesityReal-world weight change, adherence, and discontinuation among patients with type 2 diabetes initiating glucagon-like peptide-1 receptor agonists in the UKSafety of SemaglutideSemaglutide for the treatment of overweight and obesity: A reviewOnce-Weekly Semaglutide in Adolescents with ObesitySemaglutide 2.4 mg for the Treatment of Obesity: Key Elements of the STEP Trials 1 to 5Association of Glucagon-Like Peptide-1 Receptor Agonist Use With Risk of Gallbladder and Biliary DiseasesReal-World Adherence and Discontinuation of Glucagon-Like Peptide-1 Receptor Agonists Therapy in Type 2 Diabetes Mellitus Patients in the United StatesMedications and conditions associated with weight loss in patients prescribed semaglutide based on real-world dataThanks to Doctor Dreamchip for our lovely theme song!Support the show

A study compared fertility and sexual markers in obese men with low testosterone and erectile dysfunction who took liraglutide, uFSH + HCG, or testosterone. These men were separated into three groups based on their plans for parenthood; results showed impressive improvements on the GLP-1 agonist liraglutide. ResourcesGiagulli VA, Carbone MD, Ramunni MI, et al. Adding liraglutide to lifestyle changes, metformin and testosterone therapy boosts erectile function in diabetic obese men with overt hypogonadism. Andrology. 2015;3(6):1094-1103. doi:10.1111/andr.12099Jensterle M, Podbregar A, Goricar K, Gregoric N, Janez A. Effects of liraglutide on obesity-associated functional hypogonadism in men. Endocr Connect. 2019;8(3):195-202. doi:10.1530/EC-18-0514Latif W, Lambrinos KJ, Rodriguez R. Compare and Contrast the Glucagon-Like Peptide-1 Receptor Agonists (GLP1RAs). In: StatPearls. Treasure Island (FL): StatPearls Publishing; March 27, 2023.La Vignera S, Condorelli RA, Calogero AE, Cannarella R, Aversa A. Sexual and Reproductive Outcomes in Obese Fertile Men with Functional Hypogonadism after Treatment with Liraglutide: Preliminary Results. J Clin Med. 2023;12(2):672. Published 2023 Jan 14. doi:10.3390/jcm12020672Papadakis G. Sex Steroids Balance for Metabolic and Reproductive Health in Klinefelter Syndrome (KLIN-HEALTH). ClinicalTrials.gov identifier: NCT05586802. Updated April 4, 2023. Accessed September 27, 2023. https://www.clinicaltrials.gov/ct2/show/NCT05586802

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Barely a day goes by without more headlines around new weight-loss drugs, from the issue of global shortages, to investigations into suicide risk, and debate over just how long people will need to be on them. But in this episode of Inside Health we're going to look at something slightly different - and perhaps unexpected. James Gallagher meets lifelong dieter Cheri who has lost just over three stone on semaglutide but she's also noticed other effects from her weekly injection; a calmer mind and a complete lack of desire for her much-loved vapes. She wants to know what's going on – so we seek out some scientists to help us get to the bottom of it. From the evidence gathered so far, are there hints that these drugs could offer potential to treat serious addiction? And have you ever heard of “bed rotting”? It doesn't sound particularly enticing - but James gives it a go in the name of science and we explain all in the programme with the help of two experts. What health questions do you want us to answer? Email the team at insidehealth@bbc.co.uk Declared interests: Professor Giles Yeo: "I have a PhD student part-funded by Novo Nordisk. I consult for Novo Nordisk and Eli Lilly." Dr Tony Goldstone: "I have previously been a member of Data Safety Monitoring Board for clinical trials of Liraglutide for obesity by Novo Nordisk, and have received an honorarium as a conference speaker from Novo Nordisk." Presenter: James Gallagher Producer: Gerry Holt Editor: Erika Wright Production Coordinator: Jonathan Harris Studio Producer: Duncan Hannant (Photo: Cheri Ferguson with her Ozempic pen. Credit Cheri Ferguson)

Diabetes and obesity are on the rise, and there are new tools to help the prevention and management of this twin epidemic of "diabesity" in primary care. Drs Robert Kushner and Tim Garvey discuss. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/982635). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Obesity Treatment & Management https://emedicine.medscape.com/article/123702-treatment Type 2 Diabetes Mellitus https://emedicine.medscape.com/article/117853-overview Diabesity https://diabetesjournals.org/clinical/article/40/4/392/147743/Diabesity National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States https://www.cdc.gov/diabetes/data/statistics-report/index.html Prevalence of Diabetes by Race and Ethnicity in the United States, 2011-2016 https://pubmed.ncbi.nlm.nih.gov/31860047/ Trends in Prevalence of Type 1 and Type 2 Diabetes in Children and Adolescents in the US, 2001-2017 https://pubmed.ncbi.nlm.nih.gov/34427600/ CDC Diabetes and Obesity Maps https://www.cdc.gov/diabetes/data/center/slides.html Diabetes Technology: Standards of Care in Diabetes – 2023 https://pubmed.ncbi.nlm.nih.gov/36507635/ American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan – 2022 Update https://pubmed.ncbi.nlm.nih.gov/35963508/ Mediterranean Diet and Obesity-Related Disorders: What Is the Evidence? https://pubmed.ncbi.nlm.nih.gov/36178601/ The Look AHEAD Study: A Description of the Lifestyle Intervention and the Evidence Supporting It https://pubmed.ncbi.nlm.nih.gov/16855180/ Durability of a Primary Care–Led Weight-Management Intervention for Remission of Type 2 Diabetes: 2-Year Results of the DiRECT Open-Label, Cluster-Randomised Trial https://pubmed.ncbi.nlm.nih.gov/30852132/ Semaglutide https://reference.medscape.com/drug/ozempic-rybelsus-wegovy-semaglutide-1000174 Liraglutide https://reference.medscape.com/drug/victoza-saxenda-liraglutide-999449 Tirzepatide Once Weekly for the Treatment of Obesity https://pubmed.ncbi.nlm.nih.gov/35658024/ Glucagon-Like Peptide 1 Receptor Agonists https://www.ncbi.nlm.nih.gov/books/NBK551568/ Dulaglutide Injection https://medlineplus.gov/druginfo/meds/a614047.html Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitors https://www.ncbi.nlm.nih.gov/books/NBK576405/ Incretin Hormones: Their Role in Health and Disease https://pubmed.ncbi.nlm.nih.gov/29364588/ Glucose-Dependent Insulinotropic Polypeptide (GIP) Receptor Antagonists as Anti-Diabetic Agents https://pubmed.ncbi.nlm.nih.gov/29412817/

Episode 59 - Creating Your own Product, TYL's Previous Million Dollar Company, Semaglutide Side Effects, Liraglutide, Shoot Bigger Loads, TRT Telemedicine Ban Show Sponsors www.thetriggeredbrand.com - 15% Off Code - tmt15 www.ultimategymtowel.com - 25% Off Code - tmt25 Test Your Levels Links https://taplink.cc/testyourlevels Youtube Channel - https://www.youtube.com/channel/UCZwSsvti-iVhah5fyfbKwbg Instagram - https://www.instagram.com/testyourlevels/ TikTok - https://www.tiktok.com/@testyourlevels? Sam Stolts Links http://bit.ly/sam-stolt-links Youtube Channel - https://www.youtube.com/channel/UCAOWpCd7-DhAGs8BR3y8_HQ Instagram - https://www.instagram.com/sam.stolt/ TikTok - https://www.tiktok.com/@sam.a.stolt? #MensHealthPodcast #TestosteronePodcast #BodybuildingPodcast

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In part 1 we talked about a request that has been submitted for the World Health Organization (WHO) to add diet drugs (specifically GLP1 agonists like Novo Nordisk's Saxenda and Wegovy) to their list of “essential medicines.” We discussed who was making this request and the justification that they were using. In part 2 we took a deeper dive into the research that they used to try to support this request, and in this final installment, we will look at the research around efficacy, harm, and cost-effectiveness.First I'll offer a summary for each issue and then I'll give a breakdowns of the research that they cite.  Just a quick reminder that this request is asking the World Health Organization (WHO) to add these drugs to their list of “essential medications” globally.Before we get into the sections, I want to mention two overarching issues that are found throughout the entirety of this request and the studies that are used to support it.First, in general, a belief has been fomented (predominantly by those in the weight loss industry) that being higher-weight is so terrible then it's worth “throwing anything at the problem.” This leads to acceptance of poor, short-term, and/or incomplete data as “good enough” to foist recommendations onto higher-weight people, which means that part of weight stigma in healthcare is that higher-weight people are afforded less right to ethical, evidence-based medicine than thinner people.Second, is clinging to correlation (without any mechanism of causation) when it comes to weight, health, and health outcomes, including the abject failure to consider confounding variables. So throughout these studies “being higher-weight is associated with [health issue(s)]” stated uncritically in support of weight loss interventions. There is an utter failure to explore the idea that the reason for the outcome differences is not weight itself but, instead, exposure to weight stigma, weight cycling (which these medications actually perpetuate by their own admission,) and healthcare inequalities.  Issues with research supporting effectiveness, harms, and benefitsStudy Duration:This is the main issue. While there was one study that went up to 106 weeks, the vast majority of the studies are between 14 and 56 weeks. We know that these drugs can have significant, even life-threatening side effects (earning them the FDA's strongest warning.) 14-56 weeks is not not nearly enough time to capture the danger of long-term effects, or to capture long-term trends around weight loss/weight regain.Study PopulationMany of the studies included have small samples. Many have study populations are overwhelmingly white, which is a huge issue when making a global recommendations.Small effect and overlapMany of the studies show only a bit of weight loss (often 15lbs or less) and often there was overlap in weight lost between the treatment group and the placebo group. Even using the “ob*sity” construct that this request is based on, for many people, this amount of weight loss wouldn't even change their “class” of “ob*sity.”Failure to capture adverse eventsMuch of the research they use to support their claims of safety didn't actually capture individual adverse events or serious adverse events. Often they only captured subjects who reported leaving treatment due to side effects.Issues with research supporting cost effectivenessThe cost-effectiveness analyses they cite are based on Quality Adjusted Life Years (QALYs). This is a measurement of the effectiveness of a medical intervention to lengthen and/or improve patients' lives.The calculation for this is [Years of Life * Utility Value = #QALY]So if a treatment gives someone 3 extra years of life with a Health-Related Quality of Life (HRQL) score of 0.7, then the treatment is said to generate 2.1 [3 x 0.7] QALYs.This is a complicated and problematic concept that deserves its own post sometime in the future, but looking just at this request I think it's important to note that they are working on two main unproven assumptions:1. That being higher weight causes lower health-related quality of life and/or shorter life span (rather than any lower HRQL being related to experiences that higher-weight people have including weight stigma, weight cycling, healthcare inequalities et al.) 2. That this treatment induces weight loss and/or health benefits that increase the life span and/or health-related quality of life of those who take it.I don't believe either of these assumptions are proven by the material cited in the request to the WHO. Specifically, it's very possible that it's not living in a higher-weight body, but rather the experiences that higher-weight people are more likely to have (weight stigma, weight cycling, healthcare inequalities) that impact their HRQL.Further, the short-term efficacy data available (and Novo Nordisk's own admission about high rates of regain) fall far short of proving any assumptions about these drugs ability to actually improve or extend life. Further, the failure of the literature to adequately capture negative side effects of the drugs, both short and long-term, means that this calculation cannot be properly made.Incremental Cost-Effectiveness Ratio (ICER)ICER is how QALYs are turned into a monetary value. It is calculated by dividing the difference in total costs by the difference in the chosen measure of health outcome or effect.[(Cost of intervention A -Cost of Intervention B) / (Effectiveness of Intervention A – Effectiveness of Intervention B)]The result is a ratio of extra cost per extra unit of health effect of a more vs less expensive treatment which can then be measured in QALYs.Again, this is worthy of its own post because there are all kinds of ethical issues around things like how we value life, how we define “healthy” and the ethics of determining whether or not prolonging someone's life is “cost effective.” I'm not going to do a deep dive into that today, but I do want to note that it is a serious issue in these kinds of calculations.In this specific case, even if one was to get past the ethical issues, an accurate calculation is impossible to make on both of the measures of the equation.Cost of these drugs varies wildly between countries and sometimes within countries because, for example, Novo Nordisk is a for-profit corporation whose goal is to create as much profit as possible.  Per the WHO request letter, the monthly cost of liraglutide is $126 in Norway and $709 in the US. Semaglutide is $95 per 30 days in Turkey, but $804 per 30 days in US.When it comes to effectiveness of the treatment, again, there is virtually no long-term data. We do know that in Novo Nordisk's own studies, weight is regained rapidly and cardiometabolic benefits are lost when the drugs are discontinued and even when people stay on the drugs, weight loss levels off after about a year, at 68 weeks weight cycling begins, and at 104 weeks (when follow-up ended) weight was trending up. It's possible that these drugs are utterly ineffective over the long-term and/or that the prevalence of long-term side effects renders any treatment effects moot. We simply do not know.I do not think that this is a remotely appropriate basis from which to request that these drugs be declared globally essential by the WHO.Here are the citation breakdowns. These are not deep dives since there are enough issues with the research on a simple surface analysis.Breakdowns of evidence of comparative effectivenessEffects of liraglutide in the treatment of ob*sity: a randomised, double-blind, placebo-controlled study, Astrup et al.)This is a 20-week study funded by Novo Nordisk. It included 564 people on various doses of liraglutide and a placebo group who didn't get the drug and a group on orlistat. There were no more than 90-98 people in each group.The study explains “Participants on liraglutide lost significantly more weight than did those on placebo” by which they meant that those on the highest dose of liraglutide lose about 9.7lbs more than those on the placebo over the 20 weeks.III LEAD studiesThese are four studies that look at liraglutide in combination with other drugs for the treatment of Type 2 Diabetes that also included some information on weight changes. One was 52 weeks, the others were  26, the maximum amount of weight lost was only about 5lbs.   The first [Liraglutide, a once-daily human GLP-1 analogue, added to a sulphonylurea over 26 weeks produces greater improvements in glycaemic and weight control compared with adding rosiglitazone or placebo in subjects with Type 2 diabetes (LEAD-1 SU), Marre et al] was a study that looked at the efficacy of adding liraglutide or rosiglitazone 4 to glimiperide in subjects with Type 2 Diabetes to test effects on blood sugar and body size.The study followed 1041 adults for 26 weeks. The study found that those on .6mg of liraglutide gained 0.7kg, those on 1.2mg gained 0.3kg, and those on 1.8mg of liraglutide lost 0.2kg, while those on placebo lost 0.1kg.The second [Efficacy and safety comparison of liraglutide, glimepiride, and placebo, all in combination with metformin, in type 2 diabetes: the LEAD (liraglutide effect and action in diabetes)-2 study. Diabetes Care, 2009. 32(1): p. 84-90. Nauck, M., et al.,]looked at the efficacy of adding liraglutide to metformin therapy for those with Type 2 Diabetes. They found that over the 26-week study those on liraglutide lost 1.8 ± 0.2, 2.6 ± 0.2, and 2.8 ± 0.2 kg for 0.6, 1.2, and 1.8 mg doses. Those on placebo lost 1.5 ± 0.3kg.The third [Liraglutide versus glimepiride monotherapy for type 2 diabetes (LEAD-3 Mono): a randomised, 52-week, phase III, double-blind, parallel-treatment trial. Lancet, 2009. 373(9662): p. 473-81. Garber, A., et al.,] This was a study of the comparative effectiveness of Liraglutide versus glimepiride for type 2 diabetes, with small weight loss as an ancillary finding. Those in the liraglutide group lost an average of 2kg.The final study [Efficacy and safety of the human glucagon-like peptide-1 analog liraglutide in combination with metformin and thiazolidinedione in patients with type 2 diabetes (LEAD-4 Met+TZD), Zinman et al.]  was a 26-week study with 533 total subjects. The goal was to study the efficacy of liraglutide when added to metformin and rosiglitazone for people with type 2 diabetes. They found that those on liraglutide lost between 0.7 and 2.3kg (1.5lbs to 5.1lbs) in 26 weeks.Meta-Analyses and Systematic Review FindingsEfficacy of Liraglutide in Non-Diabetic Ob*se Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Barboza, J.J., et al., None of the included studies were more than 56 weeks and one was only 14 weeks. One had as many as 3731 subjects, but one had only 40. Some had body weight loss as a primary outcome, but some did not. Maximum doses ranged from 1.8 to 3.0mg. The mean body weight reduction was  3.35 kg (7.4lbs) but in one study there was no difference in weight loss. The maximum difference was 6.3kg (13.9lbs)They also refer to Iqbal et al which we discussed in part 2.Effects of glucagon-like peptide-1 receptor agonists on weight loss: systematic review and meta-analyses of randomised controlled trials. Vilsbøll, T., et al.The included studies are between 20 and 53 weeks long, and include some of the studies they already cited individually above. Of the 25 included studies only 3 had “ob*sity” as the main inclusion criteria, the rest were Type 2 Diabetes.The mean weight loss for those on the highest dose of the drug was between 0.2kg and 7.2kg. For those in the control group it was 2.9 kg, so there was actually overlap between the treatment and placebo groups.Summary of evidence of safety and harmsThey begin with the claim “The safety profile of GLP-1 receptor agonists is also well studied”To support this they cite: Efficacy and Safety of Liraglutide 3.0 mg in Patients with Overweight and Ob*se with or without Diabetes: A Systematic Review and Meta-Analysis, Konwar, M., et al.,This included 14 total studies, many of which the authors of the WHO request had cited individually and were included in other systematic reviews and meta-analyses above. The smallest study included 19 people, the largest included 2,487. The total number of subjects was 4,142.Their conclusion was “Liraglutide in 3.0 mg subcutaneous dose demonstrated significant weight reduction with a reasonable safety profile for patients with overweight or ob*sity regardless of diabetic status compared to placebo.”Their methodology says that they omitted studies from analysis due to “short duration.” They included studies that had a minimum of 12 weeks and a maximum of 56 weeks of follow-up.While they included 14 studies, only 11 of them actually included information about adverse events.In terms of adverse effects (AEs,) they found that the pooled estimate of nine studies in nondiabetic patients and two studies in diabetic patients revealed a significant proportion of patients experiencing the adverse events in liraglutide 3.0 mg group when compared with placebo., and the pooled estimate of the eleven studies showed that liraglutide 3.0 mg had higher risk of AEs compared to placebo.When it came to “serious adverse events” they found that there was a similar risk level between the drug and placebo groups, but remember that's for only 12 to 56 weeks, and Novo Nordisk is recommending that people take these drugs for the rest of their lives. A few months to a little over a year is not enough time to capture long-term serious adverse events.The efficacy and safety of liraglutide in the ob*se, non-diabetic individuals: a systematic review and meta-analysis. Zhang, P., et al.,This included five RCTs (which were included in various of the above systemic reviews and meta-analyses) ranging in follow-up from 14 to 56 weeks.The only adverse event information captured was the number of people who withdrew from treatment due to adverse events (which they found was similar between drug and placebo) and nausea (which was experienced more by people on the drug.)So, in addition to being short in duration, this was far from a comprehensive list of side effects. They made no attempt to capture serious adverse side effects and their short-term nature would have made this difficult anyway.Association of Pharmacological Treatments for Ob*sity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. Khera, R., et al.This looked at weight loss and adverse events with a number of different weight loss drugs. Interestingly liraglutide did not show the highest amount of weight loss but was associated with the highest odds of adverse event–related treatment discontinuation. It should also be noted that high drop-out rates of 30-45% plagued all of the trials which the study authors admit means that “studies were considered to be at high risk of bias.“Given that those who drafted the WHO request are asking that these drugs be considered essential globally, it is disappointing that they included this study and didn't bother to mention this issue in their written request.This included 28 RCTs (most of which were included in other citations above) and only 3 that included liraglutide. They didn't capture individual adverse events, but only “Discontinuation of Therapy Due to Adverse Events.” They only evaluated a year of data so, again, while it is likely that these studies would have captured common adverse events had they bothered to try, there isn't long enough follow-up to have any information about serious (possibly life-threatening) long-term adverse events.Association of Glucagon-like Peptide 1 Analogs and Agonists Administered for Ob*sity with Weight Loss and Adverse Events: A Systematic Review and Network Meta-analysis. Vosoughi, K., et al.,This study included 64 RCTs with durations from 12 to 160 weeks, with a median of 26 weeks. As is common in these studies, the majority of the sample (74.9%) was white.Like those above, they only looked at treatment discontinuation from adverse events, they did not capture specific adverse events (common or serious.) Of the seven GLP-1 drugs they tested, liraglutide was tied with taspoglutide for the highest discontinuation of treatment due to adverse events.The study authors also note that “Risk of bias was high or unclear for random sequence generation (29.7%), allocation concealment (26.6%), and incomplete outcome data (26.6%).”Breakdowns for Comparative Cost-effectiveness StudiesFirst, the WHO request authors themselves admit that when it comes to cost-effectiveness, “the analyses have generally been performed only for high-income countries.” This is significant since they are asking the WHO to consider these drugs essential for the entire world.It's also important to understand that none of the data looks at a comparison of cost effectiveness for weight-neutral health interventions to these drugs. Without that information there is no way to calculate actual “cost effectiveness” since it's possible that weight-neutral health interventions would have greater benefits with less risk and dramatically lower cost.  NICE's guidance:  Liraglutide for managing overweight and ob*sity Technology appraisal guidance [TA664]Published: 09 December 2020.Do recall that NICE is involved in the current scandal with Novo Nordisk for influence peddling.These guidelines are created based on a submission of evidence by Novo Nordisk. The committee's understanding of “clinical need” was based on the testimony of a single “patient expert” who “explained that living with ob*sity is challenging and restrictive. There is stigma associated with being ob*se.”Once again we see a rush to blame body size for any “challenges” and “restrictions” of living in a higher-weight body, accompanied by the immediate decision that those bodies should be subjected to healthcare interventions that risk their lives and quality of life in order to be made (temporarily, by Novo and NICE's own admission) thinner.  There did not seem to be a patient expert to discuss the weight-neutral options.It was not immediately apparent if the patient expert was provided/paid by Novo Nordisk, but they certainly forwarded their narrative that simply living in a higher-weight body is a disease requiring treatment.It should be noted that while the trial Novo Nordisk submitted covered a wider range of people, they specifically submitted for this recommendation only the subgroup of that population who were diagnosed with “ob*sity,”  pre-diabetes, and a “high risk of cardiovascular disease based on risk factors such as hypertension and dyslipidaemia.”So, even if we accept this guidance as true, the WHO Essential Medicines request applies to a population much wider than this and so this fails to justify the cost-effectiveness for that population.This guidance is also based on the costs associated with obtaining the drugs through a “specialist weight management service” since an agreement is in place for Novo Nordisk to give a discount to these services.In calculating the ICER per QALY gained, the recommendations note that “Because of the uncertainties in the modelling assumptions, particularly what happens after stopping liraglutide and the calculation of long-term benefits, the committee agreed that an acceptable ICER would not be higher than £20,000 per QALY gained”Again, this recommendation is based on a trial submitted by Novo Nordisk that included 3,721 people and lasted for three years, but only 800 met the criteria for this cost-effectiveness recommendation. The trial failed to show a significant reduction in cardiovascular events. Novo's calculation of risk reduction was based on surrogate outcomes, which NICE points out “introduces uncertainty because causal inference requires direct evidence that liraglutide reduces cardiovascular events. This was not provided in the company submission because of lack of long-term evidence.”The NICE committee admits “relying on surrogates is uncertain but accepted that surrogate outcomes were the only available evidence to estimate cardiovascular benefits.”I just want to point out that another option would be to refuse to experiment on higher-weight people without appropriate evidence.These cost-effectiveness calculations are based on someone using the drug for two years, with no actual data on reduction in cardiovascular events, and with the admitted assumption that “any weight loss returned to the base weight 3 years after treatment discontinuation.” Said another way, this committee decided that it was cost effective to spend up to £20,000 per QALY for people to take a weight loss drug with significant side effects for two years, with no direct evidence of reduced cardiovascular events, and with the acknowledgment that people will be gaining all of their weight back when they stop taking it.Those who wrote the request for WHO to consider these drugs “essential” chose to characterize this as “At the chosen threshold of £20,000 per quality-adjusted life year (QALY) gained, the report concluded that liraglutide is cost-effective for the management of ob*sity.” I do not think that is an accurate characterization of the findings.The request cites “A report by the Canadian Agency for Drugs and Technologies in Health (CADTH) found that compared to standard care, the ICER for liraglutide was $196,876 per QALY gained”For the US, they cite a study that found that to achieve ICERs between $100,000 and $150,000 perQALY or evLY gained, the health-benefit price benchmark range for semaglutide was estimated as $7500 - $9800 per year, which would require a discount of 28-45% from the current US net price.They also cite “Cost-effectiveness analysis of semaglutide 2.4 mg for the treatment of adult patients with overweight and ob*sity in the United States, Kim et al.Let's take a look at their conflict of interest disclosure (emphasis mine)“Financial support for this research was provided by Novo Nordisk Inc. The study sponsor [that means Novo Nordisk] was involved in several aspects of the research, including the study design, the interpretation of data, the writing of the manuscript, and the decision to submit the manuscript for publication.Dr Kim and Ms Ramasamy are employees of Novo Nordisk Inc. Ms Kumar and Dr Burudpakdee were employees of Novo Nordisk Inc at the time this study was conducted. Dr Sullivan received research support from Novo Nordisk Inc for this study. Drs Wang, Song, Wu, Ms Xie, and Ms Sun are employees of Analysis Group, Inc, who received consultancy fees from Novo Nordisk Inc in connection with this study.”Given that, you probably won't be shocked to learn that this concluded that Novo Nordisk's drug, semaglutide, was cost-effective. The reason I bolded the text above is that this study is based on modeling – they are taking what is, by their own admission, a “new drug” and making predictions for 30 years. Everything was simulated based on trial data (you know, those trials that we've been discussing that often have horrendous methodology…) and “other relevant literature.” The construction of the modeling and the interpretation of the results was directed by the company who stands to benefit financially from the findings, and carried out by that company's employees and consultants.  Also, and I'll just quote again here since I don't think I can improve on their text “Cost-effectiveness was examined with a willingness-to-pay (WTP) threshold of $150,000 per QALY gained” I do not think that this WTP is based on a global assessment.In their (and by their I mean Novo Nordisk's) modeling they find that semaglutide was estimated to improve QALYs by 0.138 to 0.925 and incur higher costs by $3,254 to $25,086 over the 30-year time horizon vs comparators.And, again, this is without any kind of actual long-term data. I think that the best way to characterize this information is “back of the envelope calculations” at best.To sum up, I do not think that the research they cite comes anywhere close to proving that these drugs have levels of efficacy, safety, or cost-effectiveness that warrant their addition to the WHO list of essential medicines. I believe that if the WHO grants this request I think it will be an affront to medical science, it will cheapen the concept of “essential medicines,” and it will harm untold numbers of higher-weight people all over the world.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings' Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison's Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In this episode, Dr. Christopher Tookey and Dr. Rose Wolbrink go through some common misconceptions patients may hear about with regards to some of the new weight loss medications everyone is talking about. This episode is focused on the injectable medications called GLP-1 agonists. Examples inculde Saxenda, Ozempic, Wegovy, Trulicity Mounjaro and Byetta  A disclaimer, we're providing general guidance but everyone is different and you should always discuss with your health care professional management of any disease and therapy before trying anything you discover from a source on the internet (including this podcast) 

The FDA is expected to approve Tirzepatide for weight loss sometime this year and we think it could become the best selling drug of ALL TIME. Today on Dumb Money, we'll weigh the data, size-up the opportunity, and give you the skinny on our diet drug investment thesis. Here are the GLP-1 RA drug makers and their drugs: Eli Lilly (ticker LLY) Tirzepatide sold as Mounjaro for diabetes. Weight loss version expected in 2023. Dulaglutide sold as Trulicity. Novo Nordisk (ticker NVO) Semaglutide sold as Ozempic and Rybelsus for diabetes and Wegovy for weight loss. Liraglutide sold as Victoza for diabetes and Saxenda for weight loss. --- Support this podcast: https://anchor.fm/dumbmoney/support

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!The American Academy of Pediatrics has put out a new Clinical Guideline for the care of higher-weight children. This document is 100 pages long including references and there are so many things that are concerning and dangerous in it that I had trouble deciding how to divide it up to write about it. I began on Thursday with a piece about the undisclosed conflicts of interest. Ultimately for today, I decided to focus on what I think will do the most harm in the guidelines, which is the recommendations for body size manipulation of toddlers, children, and adolescents through intensive behavioral interventions, drugs, and surgeries.A few things before we dive in. First, this piece is long. Really long. I thought about breaking it up to make it easier to parse, but I also know that people are (rightly) very concerned about these guidelines and I didn't want to trickle information/commentary out over days and weeks in case it might be helpful to someone now. Also, know that this may be emotionally difficult to read, in particular for those who have been harmed by weight loss interventions foisted on them as children. That will likely be exacerbated by the gaslighting these guidelines do to erase the lived experience of harm and trauma from the “interventions” they are recommending, and from their co-option of anti-weight-stigma language to promote weight loss. So please take care of yourself, you can always take a break and come back. Per my usual policy I will not link to studies that are based in weight bias and the weight loss paradigm, but will provide enough information for you to Google if you want to read them. I'll also use an asterisk in “ob*sity” for the reasons I explain in the post footer. Ok, big breath and let's get into this.In later newsletters, I'll address other issues in depth, but for now here are some quick thoughts and links about overarching issues before I dig into the actual recommendation:The claim that “ob*sity is a chronic disease—similar to asthma and diabetes”No, it's really not. And it's this faulty premise (that having a body of a certain size is the same thing as having a health condition with actual identifiable symptomology) that underlies everything in these guidelines. The diagnosis of asthma requires documentation of signs or symptoms of airflow obstruction, reversibility of obstruction (improvement in these signs or symptoms with asthma therapy) and no clinical suspicion of an alternative diagnosis. The diagnosis of diabetes requires a glycated hemoglobin (A1C) level of 6.5% or higher. But to diagnose “ob*sity” you just need a scale and a measuring tape. A group of people with this “diagnosis” don't have to share any symptoms at all, they simply have to exist in their bodies. That is not the same as asthma or diabetes, though the weight loss industry (in particular pharmaceutical companies and weight loss surgery interests) have absolutely poured money into campaigns to try to convince us that it is. (Note that the argument that ob*sity is correlated with other health conditions and thus is a disease actually proves the fallacy since some kids/people who are “diagnosed” with “ob*sity” don't have any of those health conditions and some kids/people who are thin do have them. It's especially disingenuous as it ignores the confounding variables of weight stigma and, in particular, weight cycling both of which these guidelines, if adopted, are very likely to increase.)The myth of “non-stigmatizing ob*sity care” Like so much of these guidelines, this idea and much of the verbiage around it mirrors that of the weight loss industry. In this case, it's attempt to co-opt the language of anti-weight-stigma in order to promote (and profit from) weight loss (there's a guide to telling the difference between true anti-stigma work and diet industry propaganda here!) In truth, there is no such thing as non-stigmatizing care for ob*sity, because the concept of ob*sity is rooted in size and the treatment is changing size (the word was made up to pathologize larger bodies, based on a latin root that literally means to eat until fat so…less science than stereotype there.) There is no shame in having a disease, it's just that existing while fat isn't one. The concept of “ob*sity” as a “disease” pathologizes someone's body size. The concept of ob*sity says that your body itself is wrong, and requires intensive therapy and/or risky drugs and surgeries so that it can be/look right. There is no way to say that without engaging in weight stigma.If someone claims that the treatment is actually about health and not size, then it's not “ob*sity” treatment since both the criteria for the “disease” and the measure of successful “treatment” of ob*sity are based on body size. If the treatment is about health and not size, then the treatment and measures of success should be about actual metabolic health, not body size (which would be ethical, evidence-based, weight-neutral care.)The idea that “It is important to recognize that treatment of ob*sity is integral to the treatment of its comorbidities and overw*ight or ob*sity and comorbidities should be treated concurrently”Again, I think this is demonstrably untrue. Any health issues that are considered “comorbidities” of being higher-weight are also health issues that thin people get, which means that they have independent treatments. We could skip body size manipulation attempts entirely and still treat any health issues that a higher-weight child/adolescent has.The dubious claim that “ob*sity treatment” is compatible with eating disorders preventionI wrote a specific piece about this here. Weight loss as a “solution” to weight stigmaThis is unconscionable. Regardless of what someone believes about weight and health, the message that children (as young as 2!) should solve stigma by undertaking intensive and dangerous interventions that risk quality of life moves beyond inappropriate to disgusting, especially when one is perpetuating weight stigma, as these guidelines (and the weight loss industry talking points that are repeated herein) do.There is so much more to unpack here, but I want to move into a discussion of the recommendations themselves.For this, I will start where I left off on the conflict of interest piece. Which is to say, almost all of the authors of these guidelines are firmly entrenched in the body-size-as-disease paradigm. They have pinned their careers to it. None of the authors are coming from a weight-neutral paradigm.  In fact, in the research evaluation methodology section, they explain that they excluded studies that looked at impacting health, rather than weight. In their own words:The primary aim of the intervention studies had to be examination of an ob*sity prevention (intended for children of any weight status) or treatment (intended for children with overw*ight or ob*sity) intervention. The primary intended outcome had to be ob*sity, broadly defined, and not an ob*sity comorbidity.Note that by “ob*sity comorbidity” they mean a health condition that happens to children of all sizes.I don't know if it was intentional, or just a myopic focus on body size manipulation as a supposed healthcare intervention, but the option to focus on health rather than size was specifically excluded by a group of authors whose careers on based on focusing on size.There are three main areas of their recommendation that I'll talk about today - Intensive Health Behavior and Lifestyle Treatment, Weight Loss Drugs, and Weight Loss Surgeries.RECOMMENDATION:  Intensive Health Behavior and Lifestyle Treatment (IHBLT)This is recommended starting as young as age two. That's right, they are recommending intensive interventions to kids in diapers (and they think that they should look into how to “diagnose” kids who are even younger, yikes!) What these guidelines subtly admit is that these interventions don't actually work. They include this (long-time weight loss industry) talking point “a life course approach to identification and treatment should begin as early as possible and continue longitudinally through childhood, adolescence, and young adulthood, with transition into adult care.”The translation to this is that they have absolutely no idea how to make higher-weight people of any age thin long-term. They are aware (and if not they are negligent) that a century of data shows that the vast majority of people will lose weight short-term and gain it back long-term. What they seem to be trying to do here is rebrand yo-yo dieting (aka weight-cycling) as a successful intervention. If there is a prize for moving the goalpost and declaring victory, they are in the running.Don't just take my word for it, they created a graphic as part of Figure 1 to show it:Pro tip: When they say “relapsing remitting” they mean “yo-yo dieting". I know why the weight loss industry loves this idea - it's how they've built a business that creates exponential growth with a product that doesn't work. What I don't understand is how this group of authors can possibly justify this ethically. The health risks of weight cycling are documented (and very consistent with the health risks that get blamed on higher-weight bodies) so setting people up for weight cycling starting as toddlers does not, to me, have the ring of sound science or ethical, evidence-based medicine.Let's dig into the evidence they are using to support this:The guidelines claim that “IHBLT is the foundational approach to achieve body mass reduction or the attenuation of excessive weight gain in children. It involves visits of sufficient frequency and intensity to facilitate sustained healthier eating and physical activity habits.” The study they cite to back this up (Grossman et al; 2017, Screening for ob*sity in children and adolescents: US Preventive Services Task Force recommendation statement) says “Comprehensive, intensive behavioral interventions (≥26 contact hours) in children and adolescents 6 years and older who have ob*sity can result in improvements in weight status for up to 12 months.”They also include a chart of seven randomized controlled trials (RCTs) from 2005-2017. The combined study population of all seven studies was just 1,153 kids. The largest study (with 549 participants) and the only study to include children from ages 2 to 5 had a duration of 12 months and showed a BMI change of 0.42 that year, and was only “effective” (if you consider a .42 change in a year “effective”) in kids ages 4-8 years old. There was only one study that followed up for more than 12 months, and from 12 months to 24 months, the BMI change decreased (from 3.3 to 2.8,) consistent with the weight regain pattern that we would expect.This will be a running theme in these guidelines - short-term studies will be used to justify life-long recommendations, and weight regain is ignored. In general, sometimes this is based on the idea that if a weight loss intervention works short-term, then it will continue to work forever, other times it's based on the idea that weight cycling is an ethical, evidence-based healthcare intervention. Again, the data on both the long-term failure of weight loss and the danger of weight cycling does not support this.They make a point to mention that IHBLT “involves interaction with pediatricians and other PHCPs who are trained in lifestyle-related fields and requires significantly more time and resources than are typically allocated to routine well-child care.” At this point I'll note that many of the authors of the guidelines run clinics or have practices that provide exactly this type of care.Their criteria for the studies was, I'll just call it lax: “Over a 3-12 month period: The criteria for the evidence review required a weight-specific outcome at least 3 months after the intervention started.” Obviously, this is a very short-term requirement and, again, excludes studies that looked at actual health instead of just body size.Here again they tell on themselvesTreatments with duration longer than 12 months are likely to have additional and sustained treatment benefit. There is limited evidence, however, to evaluate the durability of effectiveness and the ability of long-term treatments to retain family engagement.Note that the idea that longer duration treatment is “likely” to have additional and sustained treatment benefit is not remotely an evidence-based statement, and I would argue that it is biased and should not be included here. Also, they seem to be setting the stage for blaming families for the entirely predictable and almost always inevitable weight regain.Under “referral strategies” they get real about how little weight loss we're actually talking about:Pediatricians and other Primary Healthcare Providers (PHCP's) are encouraged to help to set reasonable expectations for these [BMI-based] outcomes among families, as there is a significant heterogeneity to treatment response and there is currently no evidence to predict how individual children will respond. Many children will not experience BMI improvement, particularly if their participation falls below the treatment threshold.”As described in the Health Behavior and Lifestyle Treatment section, those who do experience BMI improvement will likely note a modest improvement of 1% to 3% BMI percentile decline.So they are recommending an “intensive,” time-consuming, expensive intervention to kids starting as young as age 2 with no prognostics as to which kids might be “successful,” the stated result of which is that “many” (their word) of them won't experience any change in the primary outcome, those who do will see a very small change.They do mention the supposed actual health benefits of these interventions, but fail to mention that the health benefits may have nothing to do with the very small change in size. That's because often when health changes and weight changes (at least temporarily) follow behavior change, those who are invested in the weight loss paradigm (financially, clinically, or both) are quick to credit the weight change, rather than the behavior change, for the health change. Here again, the evidence does not support this. It's very possible that these same health improvements could be achieved with absolutely no focus or attention paid to weight, which would provide more benefits and less risks (including the risks associated with both weight stigma and weight cycling.) It could also allow the children (some, remember, still in diapers) to create healthy relationships with food and movement, rather than seeing choices around food and movement as punishment for their size or a way to manipulate it.As they move into specific recommendations, they start with:Despite the lack of evidence for specific strategies on weight outcomes many of these strategies have clear health benefits and were components in RCTs of intensive behavioral intervention. Many strategies are endorsed by major professional or public health organizations. Therefore, pediatricians and other PHCPs can appropriately encourage families to adopt these strategies. To me this sounds a lot like throwing the concept of “evidence-based” right out the window. None of this means “these strategies are likely to lead to long-term weight loss,” but I'll bet that won't be what is conveyed to the patients and families upon whom these “strategies” are foisted. Before we move on to their recommendations around diet drugs, here is some research to contextualize these recommendations:Neumark-Sztainer et. al, 2012, Dieting and unhealthy weight control behaviors during adolescence: Associations with 10-year changes in body mass indexNone of the behaviors being used by adolescents for weight-control purposes predicted weight lossOf greater concern were the negative outcomes associated with dieting and the use of unhealthful weight-control behaviors…including eating disorders and weight gain [Note: This is not to say that there is anything wrong with higher-weight, but that there is something wrong with a supposed healthcare intervention that has significant risks, almost never works, and has the opposite of the intended effect up to 66% of the time.] Raffoul and Williams, 2021, Integrating Health at Every Size principles into adolescent careCurrent weight-focused interventions have not demonstrated any lasting impact on overall adolescent healthBEAT UK, 2020 Eating Disorders Association, Changes Needed to Government Anti-ob*sity StrategiesGovernment-sanctioned anti-ob*sity campaigns* increase the vulnerability of those at risk of developing an eating disorder* exacerbate eating disorder symptoms in those already diagnosed with an eating disorder* show little success at reducing ob*sityStrategies including changes to menus and food labels, information around ‘healthy/unhealthy' foods, and school-based weight management programs all pose a risk.Pinhas et. al. 2013, Trading health for a healthy weight: the uncharted side of healthy weights initiativesOb*sity-prevention programs that push “healthy eating” are triggering disordered eating in some children, creating sudden neuroses around food in children who never before worried about their weightThey were all affected by the idea of trying to adopt a more healthy lifestyle, in the absence of significant pre-existing notions, beliefs or concerns regarding their own weight, shape or eating habits prior to the interventionFiona Willer, Phd, AdvAPD, FHEA, MAICD, Non-Executive Board Director at Dietitians AustraliaQuoted from: health.usnews.com/health-news/blogs/eat-run/articles/for-healthy-kids-skip-the-kurbo-app“Dieting to a weight goal was found to be related to poorer dietary quality, poorer mental health and poorer quality of life when compared with people who were health conscious but not weight conscious”Ok. Moving on.RECOMMENDATION: Use of Pharmacotherapy (aka Weight Loss Drugs)Their consensus recommendation is that pediatricians and other PCHPs “may offer children ages 8 through 11 years of age with ob*sity weight loss pharmacotherapy, according to medication indications, risks, and benefits as an adjunct to health behavior and lifestyle treatment.”They admit that “For children younger than 12 years, there is insufficient evidence to provide a Key Action Statement (KAS) for use of pharmacotherapy for the sole indication of ob*sity,” but then go on to suggest that if kids 8-11 also have other health conditions, somehow weight loss drugs (which are not indicated for the treatment of the actual health conditions they have) “may be indicated.”Their KAS is that “pediatricians and other PHCPs should offer adolescents 12 y and older with ob*sity weight loss pharmacotherapy, according to medication indications, risks and benefits as and adjunct  to health behavior and lifestyle treatment.”The studies that were actually included in the evidence review predominantly studied metformin (alone and in combination with other drugs,) which is not approved for weight loss, orlistat, exenatide, and one study that looked at phentermine, mixed carotenoids, topiramate, ephedrine, and recombinant human growth hormone.Even though the studies for other drugs did not exist at the time of the evidence review, they made the choice to include them anyway. (This includes Wegovy, the drug that Novo Nordisk, a donor to the AAP, has promised their shareholders will be a blockbuster and that announced its approval in children as young as 12 just days prior to the publication of the guidelines.) Let's look at the efficacy of the drugs they are recommending:MetforminAdverse effects include bloating, nausea, flatulence, and diarrhea and lactic acidosis which they characterize as “serious but very rare.” The guidelines describe the evidence of metformin for weight loss in pediatric populations as “conflicting” They evaluated 16 studies, about two-thirds of which showed a “modest BMI reduction” and one-third showed “no benefit.” Also, this drug is not approved for weight loss. They recommend that due to the “modest and inconsistent effectiveness, metformin may be considered as an adjunct to intensive health behavior and lifestyle treatment (IHBLT) and when other indications for use of metformin are present.”Orlistat:This drug is currently approved for ages 12 and up. Orlistat is sold under the name alli by GlaxoSmithKline and as Xenical by Genentech (both GlaxoSmithKline and Genentech are donors to the AAP.) The guidelines point out that the side effects (including fecal urgency, flatulence and oily stool) “greatly limit tolerability” but do say that “Orlistat is FDA approved for long-term treatment of ob*sity in children 12 years and older.” They cite two studies from 2005. One (Behzat et al., Addition of orlistat to conventional treatment in adolescents with severe ob*sity) started with 22 adolescents, 7 of whom dropped out within the first month due to drug side effects. The remaining 15 subjects were followed for 5-15 months with an average of 11.7 months of follow up. Those 15 patients lost 6.27 +/- 5.4 kg within the study time.The other (Chanoine JP et al, 2005, Effect of orlistat on weight and body composition in ob*se adolescents) was a one-year study with 357 adolescents (age 12-15) in the Orlistat group. They lost weight initially but the weight loss stopped at week 12 and by the end of the study the weight of those in the Orlistat group had increased by .53kg.Glucagon-like peptide-1 receptor agonistsThese are drugs that are type 2 diabetes medications that were found to have a side effect of weight loss. In some cases they have been rebranded specifically for weight loss and, in others, are prescribed off-label.ExenatideThis drug is currently approved in kids ages 10 to 17 years of age. The guidelines point out that a small weight loss was shown in two small studies but with “significant adverse effects.”LiraglutideThe study they cite for liraglutide (Kelly et al, Trial Investigators. A randomized, controlled trial of liraglutide for adolescents with ob*sity.) was a 56 week study with a 26-week follow-up period. Participants lost weight initially, but after 42 weeks began to regain weight (though they were still on the drug) at 56 weeks weight gain became more rapid and at the end of the 26-week follow up they were nearing baseline. The guidelines characterize this as “A recent randomized controlled trial found liraglutide (daily injection) more effective than placebo in weight loss at 1 year among patients 12 years and older with ob*sity who did not respond to lifestyle treatment.” They do not make it clear that participants experienced near total weight regain (see graphic below.) In addition to the near total lack of weight loss (and remember that it's pretty likely that subjects continued to regain weight after the tracking stopped at 82 weeks,) side effects included nausea and vomiting, and among patients with a family history of multiple endocrine neoplasia, a slightly increased risk of medullary thyroid cancer. Liraglutide is sold as Victoza and Saxenda by Novo Nordisk. This study was a clinical trial funded by Novo Nordisk, multiple study authors work for, are employees of, take payments from and/or own stock in Novo Nordisk (see disclosures below) and Novo Nordisk provides funding directly to the American Academy of Pediatrics, and has paid thousands of dollars to authors of these guidelines.Just for funsies I checked the disclosures: Dr. Kelly reports receiving donated drugs from AstraZeneca and travel support from Novo Nordisk and serving as an unpaid consultant for Novo Nordisk, Orexigen Therapeutics, VIVUS, and WW (formerly Weight Watchers); Dr. Auerbach, being employed by and owning stock in Novo Nordisk; Dr. Barrientos-Perez, receiving advisory-board fees from Novo Nordisk; Dr. Gies, receiving advisory-board fees from Novo Nordisk; Dr. Hale, being employed by and owning stock in Novo Nordisk; Dr. Marcus, receiving consulting fees from Itrim and owning stock in Health Support Sweden; Dr. Mastrandrea, receiving grant support from AstraZeneca and Sanofi US and grant support and fees for serving on a writing group from Novo Nordisk; Ms. Prabhu, being employed by and owning stock in Novo Nordisk; and Dr. Arslanian, receiving fees for serving on a data monitoring committee from AstraZeneca, fees for serving on a data and safety monitoring board from Boehringer Ingelheim, grant support, paid to University of Pittsburgh, and advisory-board fees from Eli Lilly and Novo Nordisk, and consulting fees from Rhythm Pharmaceuticals. Melanocortin 4 receptor (MC4R) agonistsThese are specialty drugs that are only FDA approved for patients 6 years and older with proopiomelanocortin deficiency, proprotein subtilisin or kexin type 1 deficiency and leptin receptor deficiency confirmed by genetic testing. They site a small, uncontrolled study in which patients experience weight loss of 12-25% over 1 year. PhenterminePhentermine is a controlled substance chemically similar to amphetamine which carries a risk of dependence as well as side effects including elevated blood pressure, dizziness, and tremor. These are FDA approved for a 3-month course of therapy for adolescents 16 or older. I'm not clear what good could come out of giving a teenager a drug with these kinds of risk for 3 months?TopiramateThis is a drug that is used to treat seizures and migraines that happens to have a side effect of making people not want to eat through what the guidelines admit are “largely unknown mechanisms.” These drugs cause cognitive slowing and can cause embryo malformation. It's approved for children 2 years and older with epilepsy and 6 and older for headaches and I cannot for the life of me imagine how it could possibly be ethical to cause cognitive slowing in a child (who is going to school!) in order to disrupt their bodies hunger signals.Phentermine/TopiramateYou read that right, those last two drugs with the dangerous, quality-of-life impacting side effects? The guidelines discuss the option of prescribing them together. To children. This is based on a 56-week study (Kelly et al, 2022, Phentermine/topiramate for the treatment of adolescent ob*sity.) In the study, 54 subjects were given a mild dose, 15 of them dropped out. 113 were given the “top dose” 44 of them dropped out. As we've seen in other studies, weight loss had leveled off and begun to rise slightly by week 56 and there is no reason to believe it wouldn't go back up, but we'll never know because they didn't do any more follow-up. By the way, like most of the other studies, these subjects were also undergoing a “lifestyle modification program.” Also, like the other drugs, I think it's important to note that this was FDA-approved for “chronic treatment” based on the results of a study that only lasted 56 weeks. That is a common situation with weight loss drugs.Finally, the guidelines don't mention that side effects of this drug include increased heart rate, suicidal behavior and ideation, slowing of linear growth, acute myopia, secondary angle closure glaucoma, visual problems; mood and sleep disorders; cognitive impairment; metabolic acidosis; and decrease in renal function.  As I was looking this up, I noticed that the lead author of this study is the same lead author of the liraglutide study. Phentermine/Topiramate is sold under the brand name Qysmia by Vivus. I had to do some digging to get to the disclosures on this one and what do you know, Dr. Kelly has received grant consideration and consults for Vivus. In fact, with the exception of Megan Oberle, every author of this study either receives funding from/consults for Vivus, or is an employee of Vivus. Megan Oberle lists no conflicts of interest in this 2022 study but, interestingly, in a 2019 study (It is Time to Consider Glucagon-Like Peptide-1 Receptor Agonists for the Treatment of Type 2 Diabetes in Youth) the disclosure states “MO serves as site PI [principal investigator] for study through Vivus Pharmaceuticals” so we know they're not strangers. LisdexamfetamineThis is a stimulant that is approved for kids 6 and older who have ADHD, in those 18 and up for Binge Eating Disorder, and while it is sometimes prescribed off-label for higher-weight kids, the guidelines note that “no evidence available at the time of this review to demonstrate safety or efficacy for the indication of ob*sity in children.”Summing up, there are significant risks of side effects (some life threatending) and not a drug among them has shown anything approaching long-term efficacy. Let's look at the last of the recommendations.RECOMMENDATION: Weight Loss SurgeryThis is the last bit I'll write about today. This section beginsIt is widely accepted that the most severe forms of pediatric ob*sity (ie, class 2 ob*sity; BMI ≥ 35 kg/m2, or 120% of the 95th percentile for age and sex, whichever is lower) represent an “epidemic within an epidemic.”Remember, for a moment, that this phrasing is from authors who swear up and down that they are working to end weight stigma. One wonders what they would have written if they were trying to stigmatize higher-weight children. (Just fyi, if anyone is confused, you can't usefear-mongering language, describing a group of people simply existing in the world at a higher-weight as an “epidemic” without stigmatizing them.)The KAS here (for me the most horrifying of those offered,) isPediatricians and other PHCPs should offer referral for adolescents 13y and older with severe ob*sity (BMI ≥ 120% of the 95th percentile for age and sex) for evaluation for metabolic and bariatric surgery to local or regional comprehensive multidisciplinary pediatric metabolic and bariatric surgery centers. [I'll note here that at least one of the authors of these guidelines runs just such a facility.]Before we get too far into this, let's be clear about what these surgeries do. They take a child's perfectly functioning digestive system, and put it into a (typically irreversible) disease state forcing, restriction and/or malabsorption (for an explanation of the various surgeries, check out this post.) If this state happens to a child because of disease or accident, it is considered a tragedy. If the child is higher-weight, it is considered, at least by the authors of these guidelines, healthcare.They make the claim “Large contemporary and well-designed prospective observational studies have compared adolescent cohorts undergoing bariatric surgical treatment versus intensive ob*sity treatment or nonsurgical controls. These studies suggest that weight loss surgery is safe and effective for pediatric patients in comprehensive metabolic and bariatric surgery settings that have experience working with youth and their families”To support this, they cite a single study. The study (Laparoscopic Roux-en-Y gastric bypass in adolescents with severe ob*sity (AMOS): a prospective, 5-year, Swedish nationwide study) included 81 subjects who underwent Roux-en-Y gastric bypass.The average weight loss was 36·8 kg over five years, but 11% of those who had the surgery lost less than 10% of their body weight.A full 25%  had to have additional abdominal surgery for complications from the original surgery or rapid weight loss and 72% showed some type of nutritional deficiency. And that's just in five years. Remember that the damage done to the digestive system is permanent. They are recommending this as young as 13, so a five year follow-up only gets these kids to 18. Then what?By the look of their own graph, what comes next may well be more weight gain, since the surgery survivors' weight loss leveled off after year one and started to steadily climb after year two. There's also the impact of those nutrient deficiencies. They also claim that these surgeries lead to a “durable reduction of BMI.” Let's take a look at the studies they cite to prove that.Inge et al., 2018 Comparison of Surgical and Medical Therapy for Type 2 Diabetes in Severely Ob*se AdolescentsThis study lasted two years. It looked at data from 30 adolescents who had weight loss surgery. They averaged 29% weight loss over 2 years and 23% of the subjects had to have a second surgery during those two years.Göthberg et al., 2014, Laparoscopic Roux-en-Y gastric bypass in adolescents with morbid ob*sity--surgical aspects and clinical outcomeThis study just rehashes information from the Olbers study above.O'Brien et al. Laparoscopic adjustable gastric banding in severely ob*se adolescents: a randomized trialThis study is about gastric banding and I'm not sure why they included it because in the paragraph above it they point out that these surgeries are “approved by the FDA only for patients 18 years and older, have declined in use in both adults and youth because of worse long-term effects as well as higher-than expected complication rates” (they cite 18 studies to back up this particular claim.)Olbers et al., 2012 Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe ob*sity: results from a Swedish Nationwide Study (AMOS)These are just the two-year outcomes from the five-year Olbers study aboveOlbers et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe ob*sity (AMOS): a prospective, 5-year, Swedish nationwide study.This is the exact same 5-year Olbers study from above, just given a different citation number.Ryder et al., 2018 Factors associated with long-term weight-loss maintenance following bariatric surgery in adolescents with severe ob*sityThis study included 50 subjects who had Roux-en-Y gastric bypass and had a follow-up at year one and another follow-up sometime between years 5 and 12. They were then divided into “regainers” and “maintainers” though by their criteria, “maintainer” subjects could regain, they just couldn't regain more than 20% of the weight they lost prior to their follow-up. Though the study is called “Factors associated with long-term weight-loss maintenance” they were not able to identify any factors that were predictors of “regaining” or “maintaining.” You'll note in the graph below that weight was still trending upward when they stopped following up.So let's recap: They cite 7 studies to back up their recommendation of referrals for these surgeries for kids ages 13 and up. Four of the seven are the same study. One is a study for a surgery that they themselves have said is declining in use, so I'm excluding it. Combined, the rest of the studies followed a grand total of 161 people. The longest follow-up is “5+ years” and the studies consistently showed weight regain that was trending up when follow-up ended, as well as high rates of additional surgery and nutrient deficiencies. This, to me, doesn't come close to justifying a blanket recommendation that every kid 13 and older whose BMI ≥ 120% of the 95th percentile for age and sex be referred for evaluation for weight loss surgery.And when it comes to their criteria for these surgeries, they predicate risk on size. Those with “class 2 ob*sity” are required to have “clinically significant disease” which doesn't make the surgery ethical but, in comparison; children with “class 3 ob*sity” simply have to exist in the world to meet the criteria to have their digestive system put into a permanent disease state. One thing they do point out is that recent data showing multiple micronutrient deficiencies following metabolic and bariatric surgery serve to highlight the need for routine and long-term monitoring. Here we see a serious issue with giving this surgery to adolescents. First of all, they are rarely in control of their access to food. If their parents don't buy them what they need, if a parent loses their job and can no longer afford the supplements they require, if they experience hunger and/or homelessness… there are so many things that could impact a 13-year-old's ability to eat in the very specific ways they need to after the surgery for the rest of their life. Also, these surgeries are going to change the ways that these kids eat - at every school lunch, birthday party, family holiday. Anytime food is served, it is going to become clear that they are different, and if they aren't in charge of preparing the food, there is no guarantee that they will be able to get what they need. And that's if they want to do that. Let's not forget, these are humans who are/will be exploring their independence, including through rebellion, they are humans whose prefrontal cortex is not fully developed, meaning that they can literally lack the ability to fully recognize the consequences of their choices. (Of course, given that we only have five years of follow-up data, I would argue that their doctors and surgical teams also lack the ability to fully recognize the consequences of their choices.)The authors end the section with a fairly shameless plug for insurance coverage of these surgeries. This is another long-time goal of the weight loss industry that has made its way into these guidelines.I think this is a good time for a reminder that thin kids get the same health issues for which higher-weight kids are referred to these surgeries and thin kids are NOT asked to take the risks of these surgeries or to have their digestive systems permanently altered. They just get the ethical, evidence-based treatment for the health issue they actually have. Also, remember that the authors' research methodology specifically excluded research about weight-neutral intervention to see if any health benefits that the surgeries might create could be achieved without the significant (and, from a long-term perspective, largely unknown) risks of these surgeries, and perhaps be more lasting?But there is more to this in terms of informed consent. There are many of the same issues that we see with adults (which I wrote about here). With kids, there is another layer. In the state of California, for example, it is illegal to give a tattoo to someone under the age of 18, even with parental permission. But an eighth grader can make the decision to have their digestive system permanently altered, impacting their life and quality of life in myriad ways, many of which are unknown, and with no prognostics? Given all of this, is informed consent even possible for these kids? I would argue that it is not.Even worse, how many kids' parents, in some combination of weight stigma, concern for their child, and acquiescence to a doctor who may be pressuring them, will make this decision for their child?While I'm sure that there are adolescents who had the surgery and are happy with their outcome, I'm equally sure that there are adolescents who had terrible outcomes and would give anything to not have had the surgery (I know because I hear from them). And I know that the research can't tell us why anyone has the outcome they have. When you combine that with the total lack of long-term follow-up (I'm completely unwilling to consider 5 years “long term” for a lifelong intervention,) I think what we have here are, at best, experimental procedures, not procedures that should receive the kind of blanket recommendations that these guidelines provide for kids as young as 13.Ok, there's a lot more to discuss in these guidelines but I will save that for another newsletter. I hope that the outcry against these guidelines is loud, sustained, and successful in getting them rescinded. Kids deserve far better than this.Finally, I just want to give a quick shout-out to my paid subscribers (I know not everyone can/wants to have a paid subscription and that's totally fine - absolutely no shame at all if you are reading this for free as a subscriber or randomly!) those who are able to pay are allowed me to spend HOURS this week going through these guidelines and creating Thursday's post and this post, I'm just super grateful for the support.I'll be posting additional deep-dives into the research they cite and I'll keep a list here:“New insights about how to make an intervention in children and adolescents with metabolic syndrome” Pérez et al.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This week we are continuing our mini-series on semaglutide. Today we'll cover how semaglutide compares to other weight-loss peptides that are on the market and promising weight-loss peptides in the pipeline.  What weight loss peptides are available? Besides semaglutide (Wegovy), another injectable glucagon-like peptide-1 (GLP-1) agonist available is liraglutide (Saxenda). Saxenda was the first medication in its class to be approved for weight loss. Unlike semaglutide, it's short-acting and needs to be given daily. A couple of weeks ago, we mentioned that one reason there's a lot of buzz around semaglutide is the amount of weight people lost during clinical trials. A 68-week study with almost 2,000 adult participants reported an average weight loss of nearly 15% on semaglutide compared to 2.5% on placebo. Liraglutide, on the other hand, has been shown to provide an average weight loss of 8% from baseline body weight.  Unlike semaglutide, Saxenda is approved for use in children at least 12 years old. Semaglutide is only approved for use in people at least 18 years old.  It's important to know that Victoza, an FDA-approved medication used to treat Type 2 diabetes, has the same active ingredient as Saxenda. However, Saxenda is approved at a higher dose (3 mg) than Victoza (0.6, 1.2, and 1.8 mg). The 3 mg dose has been shown to be more effective at helping people lose weight. This is why Victoza is not approved for weight loss.  What peptide weight loss medications are in the pipeline? Tirzepatide (Mounjaro), also a GLP-1 agonist, is a newer medication recently approved for Type 2 diabetes. Like semaglutide, Mounjaro was studied in people without Type 2 diabetes to treat obesity. Based on their weight loss findings, the highest dose of the medication reduced body weight by about 21% of the total body weight compared to the placebo group, who lost an average of 3%. These results are an important step forward for potentially expanding more therapeutic peptide weight loss options. In fact, on October 6 the FDA granted tirzepatide a “fast track” review to be designated as a treatment for obesity. To receive this label, Eli Lilly, the manufacturer of Mounjaro, will be using data from the SURMOUNT-1 clinical trial and the ongoing SURMOUNT-2 trial, which is investigating the medications use in people with type 2 diabetes who have excess weight or obesity. Although the SURMOUNT-2 trial won't' be completed until April 2023, the FDA's fast-track designation allows for the rolling submission of trial data. This means the FDA can review data as it comes in, instead of waiting for the entire trial to wrap up. This helps speed up the review process, resulting in a faster approval date. As always, speak with your healthcare provider or pharmacist to see what medication is right for you. You'll also want to keep in mind that most of these peptides are quite popular and difficult to get your hands on right now through retail pharmacies. If the medication you need is not in stock, you may be able to get your medication from a compounding pharmacy.  Always check that the compounding pharmacy you are using is credible. The pharmacy should follow USP 797 guidelines to help protect you from getting contaminated products.  Thanks again for listening to The Peptide Podcast. You can find more information at pepties.com. We love having you as part of our community. If you love this podcast, please share it with your friends and family on social media. Have a happy, healthy week! Pro Tips We're huge advocates of using daily collagen peptide supplements in your routine to help with skin, nail, bone, and joint health. But what do you know about peptides for health and wellness? Giving yourself a peptide injection can be scary or confusing. But we've got you covered. Check out 6 tips to make peptide injections easier. And, make sure you have the supplies you'll need. This may include syringes, needles, alcohol pads, and a sharps container.

Dr. Ebell and Dr. Wilkes discuss the POEM titled ' Liraglutide probably the best second drug to prevent cardiovascular events in patients with T2DM who take metformin '

Which glucose-lowering medications work best with metformin? Find out this and more in today's PV Roundup podcast.

Links and study details can be found at www.yourfertilitypharmacist.com

Episode 106: Weight Loss Meds. Anti-obesity medications are FDA-approved drugs to support your patient's efforts to lose weight. It is important for primary care providers to learn about these medications to continue fighting against obesity in our communities.Introduction: Obesity is a chronic disease.By Hector Arreaza, MD. Obesity has all the characteristics of a chronic disease. Let's use our imagination and think about a patient with hypertension, for example. Let's imagine you are the doctor or Mr. Lee. He is 45 years old and his blood pressure has been persistently high, around 150/100, even after lifestyle modifications. You decide to start chlorthalidone 25 mg and Mr. Lee takes chlorthalidone every day. Four weeks later you see Mr. Lee again and you review his labs with him. He has normal renal function and normal electrolytes. His blood pressure is now 119/75. He is feeling great and reports no side effects to chlorthalidone. Would you stop the medication at this time? Think about it. The most obvious answer is NO, you will not stop chlorthalidone. Today you will listen to a discussion about anti-obesity medications, common indications, contraindications, cautions, and more. We will learn that obesity requires chronic treatment with medications just like any other chronic disease. I hope you enjoy it.This is the Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.___________________________Weight Loss Meds. By Sapna Patel, MS4; and Danish Khalid, MS$. Ross University School of Medicine. Moderated by Hector Arreaza, MD. S: Hello and welcome back to our nutrition series! If you haven't already listened to our previous episodes, pause this and make sure to give them a listen. We have talked about physical activity, meal plans, and intermittent fasting. Today we are going to talk about the clinical management of obesity, specifically the pharmacotherapy that is used. We will divide these drugs into drugs that reduce food intake primarily acting on the CNS, drugs that reduce fat absorption and medications that are associated with weight gain. D: Can anyone who is considered obese take medications to help them lose weight? Pharmacotherapy should be considered if the patient will be taking the medication in conjunction with the overall weight management program, including changes in eating habits, increased physical activity, and realistic expectations of the medication therapy. Adjuvant pharmacologic treatments should be considered for patients with a BMI >30 kg/m2 or with BMI >27 kg/m2 who have concomitant obesity related diseases. A: You are going to find doctors who are pretty much against anti-obesity drugs, but that's not my case.  S: Drugs that reduce food intake primarily acting on the CNS: Let's start with Phentermine and other sympathomimetic drugs A: Phentermine has been in the market over 60 years and it is well tolerated by most patients. It is effective, expect 5-8 lbs weight loss a month when taken with dietary changes and increased physical activity. The weight loss happens mostly the first 3-6 months when you take anti-obesity medications. S: One of the longest clinical trials of the drugs in this group lasted 36 weeks and compared placebo treatment to treatment with continuous phentermine and intermittent phentermine. Both the continuous and intermittent phentermine therapy produced more weight loss than placebo. D: Other options are Phentermine and topiramate ER which is known as  “Qsymia”. These drugs combine a catecholamine releaser and anticonvulsant respectively.  Topiramate is currently approved by the USFDA as an anticonvulsant for treatment of epilepsy and for prophylaxis of migraine headaches. Weight loss was seen as an unintentional side effect during clinical trials for epilepsy.The mechanism responsible for this is thought to be mediated through the modulation of GABA receptors, inhibition of carbonic anhydrase and antagonism of glutamate to reduce food intake The common adverse effects include cognitive impairment, paresthesia, and increased risk for kidney stones. Topiramate is also a teratogenic drug, so patients need to be in a good birth control to take it. It causes cleft palate in the fetus.The 2 phase-III trials called EQUIP and CONQUER, both 1 year randomized  placebo-controlled double-blinded clinical trials, 3 different strengths of a once-a day formulation were tested: full strength dose (15 mg of phentermine and 92 mg of topiramate ER), mid-dose (7.5mg of phentermine and 92 mg topiramate ER) and low dose (3.75mg of phentermine and 23 mg of topiramate ER). Subjects  randomized to the full strength dose in EQUIP and CONQUER trials lost an average of 10.9% and 9.8% body weight in 1 year compared to 1.6% and 1.2% loss for placebo subjects respectively. Significant improvement in fasting glucose, insulin, Hemoglobin A1C and lipid profile were seen.Due to the dose dependent side effects of the medications an initial dose of 3.75/23 mg is prescribed daily for the first 14 days then increased to 7.5/23mg daily. These patients should be re-evaluated after 3 months. If 3% weight loss is not achieved by that time, either discontinue or escalate the dose to 15/92mg for 12 weeks. S: Drugs that reduce fat absorption:Orlistat. What is orlistat? Well it's a selective inhibitor of pancreatic lipase that reduces the intestinal digestion of fat. The mean weight loss when compared to a placebo was 2.51kg at 6 months and 2.75kg at 12 months. A: It is one of the few anti-obesity medications approved to be used in children 12 years and older. D: GLP-1 Receptor Agonist (-glutide): Semaglutide and Liraglutide - Only two that have been approved for treatment of obesity. A 20-week randomized trial, comparing Liraglutide, placebo, and orlistat, showed that patients assigned to liraglutide lost significantly more weight than those assigned to both. When compared to placebo, those on liraglutide lost a mean weight loss of 2.8 kg. Whereas compared to orlistat lost an average of 5.8kg, however this was on the higher doses of liraglutide. A 56-weeks trial, comparing liraglutide with placebo, showed a mean weight loss was significantly greater in the liraglutide group (8.0 kg vs 2.6 kg). Furthermore, those who initially lost weight with diet and exercise, a greater proportion of those taking liraglutide maintained the weight loss.  Similarly, clinical trials favored semaglutide, with a weight loss greater in the semaglutide group versus placebo. For both, weight loss occurred in patients with and without diabetes. Note: Semaglutide: once a week. Helps induce weight loss. Liraglutide: daily.  A: We dedicated a whole episode on Semaglutide and another whole episode on Tirzepatide. Tirzepatide (dual agonist: GLP-1 and GIP) seems promising for weight loss and it is likely to be approved soon for obesity treatment. So, when do we discontinue anti-obesity medications? We can ask the same question for other chronic diseases: When do we stop medication for hypertension or diabetes? When we have a patient is unable to keep their weight off, we can't see him/her as someone who has lost their motivation to keep their weight off. Really what's happened is that their hormones have changed in a way that is promoting weight gain and it's very hard to lose weight. We should be at the patient's side to fight it off. Conclusion: Now we conclude our episode number 106 “Weight Loss Meds.” Phentermine is the most widely used anti-obesity medication. It is a stimulant, and it is a safe and effective medication for most patients who are fighting obesity. Make sure you learn the contraindication, side effects, and precautions when you prescribe it. Also, learn about other meds that are very effective, including GLP-1 receptor agonists, and your patients will thank you. This week we thank Hector Arreaza, Danish Khalid, and Sapna Patel. Audio by Sheila Toro.Thanks for listening to Rio Bravo qWeek Podcast. If you have any feedback, contact us by email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References: Perreault, L., Apovian, C. (2021). Obesity in adults: Overview of management. Pi-Sunyer,  F.X., Seres, D., & Kunins, L. (Eds.) Uptodate. Available from: https://www-uptodate-com.rossuniversity.idm.oclc.org/contents/obesity-in-adults-overview-of-management?search=weight%20loss%20medications&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2 Perreault, L. (2022). Obesity in adults: Drug therapy. Pi-Sunyer,  F.X., & Kunins, L. (Eds.) Uptodate. Available from: https://www-uptodate-com.rossuniversity.idm.oclc.org/contents/obesity-in-adults-drug-therapy?search=weight%20loss%20medications&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Dungan, K., DeSantis, A. (2022) Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus. Nathan, D.M., & Mulder, J.E. (Eds.) Uptodate. Available from: https://www-uptodate-com.rossuniversity.idm.oclc.org/contents/glucagon-like-peptide-1-based-therapies-for-the-treatment-of-type-2-diabetes-mellitus?search=glp%201%20receptor%20agonists&source=search_result&selectedTitle=2~97&usage_type=default&display_rank=1 Perreault, L., Bessesen, D. (2022). Obesity in adults: Etiologies and risk factors. Pi-Sunyer,  F.X., & Kunins, L. (Eds.) Uptodate. Available from: https://www-uptodate-com.rossuniversity.idm.oclc.org/contents/obesity-in-adults-etiologies-and-risk-factors?search=medication%20associated%20with%20weight%20gain§ionRank=1&usage_type=default&anchor=H1612312650&source=machineLearning&selectedTitle=1~150&display_rank=1#H1612312650. Royalty-free music used for this episode: Salsa Trap by Caslo, downloaded on July, 20, 2022 from https://freemusicarchive.org/music/caslo/caslo-vol-1/salsa-trap/. Space Orbit by Scott Holmes, downloaded on July, 20, 2022 from https://freemusicarchive.org/music/Scott_Holmes/.  

Not medical licensed advice . Always consult with your doctor:New Treatments For ObesityBMI: 25-30 : overweight  >30 ObeseWHO 2016 40% are over weight and 13% obese slightly higher in females . This is triple that in 1975UK 2019 House of Commons Library  40% are overweight and 30% obese higher in middle aged and elderly menNHS 2021: Children Obesity has gone up in 12 years from 19% to 25% The Surprising Link Between Chronic Inflammation & Obesity—Plus What You Can Do About ItMay 5th 2021Leptins are hormones produced by adipocytes that communicate with the hypothalamus to reduce eating. If you have too much leptin you become leptin resistant and do not stop eating. High leptin levels are also associated with  chronic inflammation.Conversely losing weight reduces systemic inflammation. REVIEW articleFront. Physiol., 29 January 2020Sec. Clinical and Translational PhysiologyChronic Adipose Tissue Inflammation Linking Obesity to Insulin Resistance and Type 2 DiabetesFrederika ZatteralThe key mediator of inflammation in obesity is the innate immune system cell the macrophage that can account for up to 40% of adipose tissue and it differentiates into a pro-inflammatory M1 macrophage setting up chronic inflammation.Obesity and Inflammation: A Vicious CycleDoes obesity cause inflammation or does inflammation lead to obesity?Jun 25, 2020Jennifer LutzObesity causes chronic inflammation via a chronic immune reaction initiated in the adipose tissue but inflammatory cells can go round the body. In addition gut inflammation may be a result also of the poor diet that led to the obesity.We know that obesity has tripled in the last 50 years such that 40% of the western world are obese. In fact 75% are prediabetic.Cardiovascular disease leading to cardiac disease and strokes, diabetes, cancer, depression, osteoarthritis all feed back and make it more likely you will continue to be obese.Higher adiposity and mental health: causal inference using Mendelian randomization Francesco Casanova,Jessica O'Loughlin,Susan Martin,Robin N Beaumont,Andrew R Wood,Edward R Watkins,Rachel M Freathy,Saskia P Hagenaars,Timothy M Frayling,Hanieh Yaghootkar... Show moreAuthor NotesHuman Molecular Genetics, Volume 30, Issue 24, 15 December 2021, Pages 2371–2382, There is a bidirectional relationship between depression and obesity.Genetic sorting showed that it is obesity per se and not the metabolic unhealthiness due to the obesity such as diabetes that leads to depression.That said diabetes from obesity causes depression although obesity itself causes systemic inflammation which is an independent risk factor for depression and cancer.There are also huge psychosocial effects of obesity on mood.Once-Weekly Semaglutide in Adults with Overweight or ObesityNew England Journal Of Medicine March 2021John P.H. Wilding,Once a week subcutaneous Semaglutide reduced weight by up to 20%Semaglutide is a GLP-1 agonist so suppresses Glucagon and increases insulin hence controlling blood sugar. It also slows gastric emptying  increasing satiety and acts on Receptors in the Arcuate Nucleus in the brain to increase satiety.It is already licensed to treat Type 2 diabetes.It also reduces the risk of cardiovascular complication in Type 2 diabetes and at a cellular level reverses atherogenesis. There is a question on worsening the risk of retinopathy.Other GLP-1 agonists : Liraglutide Setmelanotide.CpdFDA Approved Medication for treating ObesityPhentermine, diethylpropion,benzphetamine, phendimetrazine , Orlistat, Phentermine/topiramate Qsymia, Bupropion/naltrexone, Semaglitide, Liraglutide, setmelanotideCpd Phentermine-topiramate: First combination drug for obesityInt J Applied Med Res 2015Singh et alPhentermine is a centrally acting sympathomimetic that reduces appetite and topiramate enhances GABA ergic transmission reducing Dopamine Response to food.This combination causes up to 10% weight loss maintained in 50% for 2 years.The relationship between early weight loss and weight loss maintenance with naltrexone bupropion therapy.THe Lancet Discovery Science 2022Le Roux et alNaltrexone blocks opiate receptors and bupropion (wellbutrin/zyban) blocks reuptake of dopamine  -reward pathways- .and noradrenaline . Weight loss is maintained at 1 yearBoth medications enhance each other on feeding and satiety