Revolutionizing Obesity Treatment: Dr. Richard Kennedy on the Impact of Weight Loss Medications

Unlock the mysteries of weight loss drugs with us, as we  inform you about the groundbreaking GLP-1 medications transforming obesity treatment. Joined by Dr. Richard Kennedy, we explore how these diabetes drugs, like Ozempic, have taken center stage in the fight against obesity. From reducing cardiovascular risks to improving sugar metabolism, these injectables are more than just weight loss solutions—they're potential game-changers for health and wellness. Aussie Mike James adds a fitness perspective, while Kettle Hiding delves into the economic dimensions of this pharmaceutical trend.

We tackle the gritty details, discussing potential side effects and the critical need for medical supervision when using these medications. Discover why maintaining muscle mass is crucial and how weight training serves as a powerful ally in preserving it. We question the conventional reliance on BMI as the sole measure of obesity and advocate for a more nuanced assessment of body composition. Our conversation also touches on the controversial idea of micro-dosing these drugs, weighing the pros and cons with a cautious lens.

The broader implications of these medications stretch far beyond individual benefits, reaching into global health landscapes. We discuss the accessibility hurdles for low income people and less affluent nations and how the production of generics might offer solutions. With anecdotes and studies underlining the psychological and societal pressures of weight loss, we underscore the importance of lifestyle changes and a holistic approach to health. As we wrap up, we invite you, our listeners, to join this ongoing conversation, sharing your questions and insights as we navigate these complex issues together.

Through expert insights and personal anecdotes, we explore the interplay between medication, lifestyle changes, and societal attitudes towards obesity.
• Discussion on how GLP-1 medications work
• The dual benefit of managing blood sugar and promoting weight loss
• Importance of muscle preservation while using these drugs
• Cost barriers and insurance implications for accessing weight loss medications
• Societal views on the stigma of using weight loss drugs
• The necessity of medical supervision when using these prescriptions
• Long-term effects and sustainability of weight loss achieved through medication

Chapters

• 0:05 Weight Loss Drugs
• 5:42 Side Effects and Muscle Loss Prevention
• 13:46 Long-Term Commitment to Weight Loss Medication
• 31:18 Global Impact of Weight Loss Drugs
• 38:10 Maintaining Weight Loss and Muscle Building

Transcript

Dr. Richard Kennedy: 0:05

So these drugs? Initially they were made for the treatment of diabetes and they're in a class we call GLP-1, which is a chemical inside the body that when you stimulate this, when you stimulate this, it actually decreases the release of sugar from different parts of our body where it's stored and helps with the metabolism of sugar that's coming into the body. Incidentally, what they found when they initially started using these drugs, with Ozempic being the classic example is that not only did it improve people's blood sugars, but also they found that people who might work at greater risk for cardiovascular disease events ie heart attack, things like that, and strokes, non-fatal strokes the incidence of those occurrences in this patient population decreased. And as a side effect of this, they realized wow, many of these patients were losing weight.

Aussie Mike James: 1:24

Hello and welcome. In this episode of the Wellness Musketeers podcast, the Musketeers explore the complex world of weight loss drugs from three unique perspectives. Dr Richard Kennedy shares insights from his experience as a physician working with patients using these medications. Aussie Mike James discusses how these drugs intersect with fitness and long-term wellness strategies, while Kettle Hiding provides an economist's view of the financial drivers behind the obesity epidemic and financial implications for individuals and society of these new drugs. Through personal stories, professional insights and engaging conversation, the team tackles key questions what do weight loss drugs really offer? Are they accessible and affordable for all, and what do they mean for the future of health and wellness? Whether you're considering weight loss medications, curious about their societal impact, or just love a good discussion on health and economics, this episode offers something for everyone, and whether you're seeking practical tips or exploring big wellness topics, we're glad you're here.

Aussie Mike James: 2:39

We hope you enjoy today's episode. Please like, share and subscribe and let us know what you think. So let's get right into today's episode. Please like, share and subscribe and let us know what you think. So let's get right into today's episode. Perhaps we could just start with Dr Kennedy. The common question, I guess, dr K, is what are these weight loss drugs and how do they actually work?

Dr. Richard Kennedy: 2:58

So these drugs are drugs made initially. They were made for the treatment of diabetes and they're almost all of them are injectable drugs and they're in a class we call GLP-1, which is a chemical inside the body that when you stimulate this, when you stimulate this, it actually decreases the release of sugar from different parts of our body. Did it improve people's blood sugars? But also they found that people who might work at greater risk for cardiovascular disease events ie heart attack, things like that, and strokes, non-fatal strokes the incidence of those occurrences in this patient population decreased. And as a side effect of this they realized wow, many of these patients were losing weight and that is where this class of drugs has taken off to in the last two to three years for sure.

Dr. Richard Kennedy: 4:27

And now these drugs are specifically being prescribed to treat obesity, meaning a BMI greater than 30. And 30 to 35 BMI is what we call overweight, a greater than 35 is morbid obesity. And so what they found is by decreasing the weight of people again, you improve their health by getting rid of their diabetes, which is a major risk factor for cardiovascular disease, kidney disease, stroke, etc. So that's sort of how this started, and now it has become one of the classic drugs, because it has been proven in several studies that patients who take these drugs lose much more weight than doing lifestyle changes lifestyle modifications and they maintain that weight loss better than if the person did lifestyle modification, ie diet and exercise.

Aussie Mike James: 5:42

Quick question on that, dr K. Has there been any side effects nausea and so forth?

Dr. Richard Kennedy: 5:47

I've heard yes, the most common side effects are gastrointestinal, so nausea, upset stomach, vomiting in extreme cases some diarrhea, all of that. And that's why, when they initiate treatment with this in anybody, they start at the very lower doses. They continue it for a week to see if the purpose. Because, like any drug and it's important to understand there is no drug that has ever been developed, be it prescribed or an over-the-counter, that doesn't have side effects, an over-the-counter that doesn't have side effects, and so not everybody who's going to take it is going to have the side effect. But if they do many of the side effects, if the patient takes it consistently enough, the side effects will become less significant and even go away.

Dave Liss: 6:39

Are there issues with loss of muscle mass, strength or issues affecting bone?

Dr. Richard Kennedy: 6:45

density. Well, I don't know if it's not really clear on this, but I would say that muscle mass might be an issue. And I would say that's a two-pronged problem to me, because sometimes when you give a person a drug that you tell them it's going to help you lose weight, which means you're going to burn calories, you're going to burn fat. If you are not simultaneously doing some kind of workout regimen, yeah, your muscle mass will decrease. It's like anything else If you don't use it, you will lose it.

Ketil Hviding: 7:32

Yeah, so we don't know whether this is worse when you use the drug relatively.

Dr. Richard Kennedy: 7:34

to just weight loss in general. I don't think so. It's possible, but I don't.

Aussie Mike James: 7:39

Okay, that's an interesting perspective. I know in the fitness industry and I've looked at the position statements of groups like the American College of Sports Medicine, american Council of Exercise and the American Health Clubs Association, which represents the largest industrial group, if you like, of health clubs throughout the world. They all have pretty similar position statements, if you will saying that. One, that the use of them has to be under medical supervision and two, they really emphasize weight training because of the evidence of muscle loss and it's, I think, reading into that a little bit more.

Aussie Mike James: 8:14

I think for a long time the standard guideline was that you lost it by one or two pounds a week over a long term. Hence you'd have a lot of people drop out because they couldn't keep that sort of discipline up and they don't see immediate results. So I think the groups are realizing that these drugs are here to stay. So you've got to work with them because they're not going to be stopped, going down in usage or anything. Weight training is an essential part of the fitness regimen and I guess they're really promoting that to help the decrease in muscle loss. It's been evidence and that makes perfect sense. Yeah, yeah, perfect sense. I think that's one thing you notice visually from people who you've seen on it that there's sort of a look, if you will, that makes it look like they've lost muscle weight.

Dave Liss: 9:00

Are there different considerations for someone starting a weight loss medication like this if they're a younger person, a middle-aged person or an older person? Like what kind of what does sarcopenia? Is that a relevant drug? Is that you have an in-depth discussion?

Dr. Richard Kennedy: 9:27

with your provider who's going to prescribe it. One, the benefits of taking the drug. Two, the problems that you might have taking the drug. Three, how this drug may affect your overall wellness in life, because all drugs have an effect. So you know, drugs are like no different than exercise, diet, rest, sleep. It is part of the formula for a person becoming healthy.

Ketil Hviding: 9:58

So you know you mentioned overweight, so I am just overweight a little bit. Would that be okay to start with the drug, maybe microdosing it?

Dr. Richard Kennedy: 10:09

I would probably at least for me, I probably would then overweight, because to me I think that there's to me it's the conflict of what we use as the measure of obesity. The PMI is essentially measuring your body weight and your height. It does not take into account your fat, and what we always see is that you technically could take any. In the United States, any football player.

Ketil Hviding: 10:38

Yes.

Dr. Richard Kennedy: 10:39

Football player, many basketball players. Basically, by default, they are overweight and, in some, morbidly obese, except for the fact that when you look at their muscle mass compared to their body fat content, it's very different than ever. So we have to now. That's because it's hard to you know. It's not difficult to measure body fat. It takes some effort to do it. There's some simple tools that we can use to measure body fat, and so all I have to say I have a discussion with your doctor. I wouldn't with your doctor, knowing as active as you are, that it would be fool's gold to be putting you on a medicine to make you lose 10 pounds.

Ketil Hviding: 11:36

I want to look fitter. I want to have those six-packs.

Dr. Richard Kennedy: 11:40

Yeah, but being on those medicines is not going to give you a six-pack.

Ketil Hviding: 11:50

But I can also work out a little bit.

Aussie Mike James: 11:51

I have dave and kia they can kind of, uh, put me on a strict regimen.

Ketil Hviding: 11:53

Yeah six packs for sure, yeah, and then I get some fat off.

Dr. Richard Kennedy: 11:59

Then I go yeah, I'm joking, I mean for the term anything is okay, as they say, everything in moderation is okay. It's the extremes that get us into trouble.

Ketil Hviding: 12:11

The microdosing. What do you think about that? Is that something that's relevant or can be done?

Dr. Richard Kennedy: 12:17

I'm sure that people are considering it. I personally wouldn't do microdosing. I would tell my patient. I'd say look, you're pretty close to be an ideal weight, but you're no longer 25. And so the real issue is if you get back to your weight of when you were, in your mind, most physically fit, that might not be a good weight for you now, because your body has changed, your metabolism has changed. You hold on to things a little bit more now than you did before. I have more muscle, yeah so. So it's not necessary. And muscle and and muscle mass is heavier than fat, so technically you could actually be overweight but be fit. That's why I say that micro dosing would not be what I would recommend, Unless the person has told me look, you know, I've been doing this workout regimen for the last six months. I eat like a little rabbit and I still can't, I still can't, I still can't lower things down. So I have to be able to work on that and to get what I need, what I need best for me.

Dave Liss: 13:46

Do you think that people have a realistic expectation about what they should expect, or that this may be a lifetime commitment to the medication when they start, or that they think, well, I'll use it to get through this hump in my weight situation and then I'll get off it once I lose my weight?

Dr. Richard Kennedy: 14:05

I think people do it for different reasons. There are going to be those people who I'm going to be in a wedding in six months. I need to get into this gown, I need to get into this, I need to get into this. Yeah, I need to get into this, I need to fit into this tuxedo. So what I'm going to do is I'm going to go talk to my doctor and say, look, I need to lose weight fast, you know Oil.

Ketil Hviding: 14:30

I mean I think we all know by now people who've been on this drug and seeing some of the potential side effects. But I wonder whether there's even more than side effects because, as you said, it affects the metabolism. I mean, the body goes through a big change because of this medication. So it would kind of seem foolish to have the body going through all of these things and then just kind of drop off it and then go back and forth, that kind of, so you get this kind of yo-yo effect again. That would probably not be good for the body.

Dave Liss: 15:05

There's a weight loss program at GW Hospital. It's sort of like one of the last places on the bus before you go to gastric bypass surgery or something else, or had been before this. And I knew a man that you're on a calorie restricted diet less than a thousand calories a day. They have a behavior modification part of the program. Well, these people are really busy and they don't take advantage of this. And I knew a man.

Dave Liss: 15:28

His issue was wine. Basically he would. He and his wife would have two or three bottles of wine a night. His wife wouldn't drink anything. He and his wife would have two or three bottles of wine a night. His wife wouldn't drink anything. And he went on this program all these holidays and family events where he was having his smoothie and a bar and not eating, and his wife was angry with him because she didn't think he'd do it in the first place. And then he did it. He lost like 60 pounds and then he got off of it and he didn't do any kind of gradual reintroduction of food and then in a couple of months he drank it all back and he spent thousands of dollars to be in this program.

Aussie Mike James: 16:04

Yeah, but turning to personal stories and real life experiences, guys and I guess we've all got anecdotes, maybe we could share a few. But one quick question is it still? Is there still reticence in the community to sort of say, listen, I'm on these drugs. Are there still a lot of people who go on them without telling anyone? We've found that in the fitness world that there's quite a few people will go on these without really telling you. You know, is it are people happy to share it now or is it dependent on the individual?

Dr. Richard Kennedy: 16:37

I think there's a little of both. I think it's become more acceptable because they advertise it and I always say you have to look at it from the perspective they stop sort of using the providers as the ones to introduce drugs to patients. They went straight to the consumer. So there isn't, you know, there isn't a every time you watch a television show when the commercial comes on. There's a Wegovi, there's a Rebelsis, there's a Ozempic commercials, and so what they're doing is they're advertising it to the patient.

Dr. Richard Kennedy: 17:19

So, by default, once you do that, you make it acceptable to the community as a whole that it's an acceptable thing, that it's not a bad drug it's not that it is and they know how to highlight and accent this person lost 25% of their body weight, that this person lost 10% of their body weight. And you know, they show the before and the after photos sometimes. So with them now. That being said, yeah, there are people who don't. I have patients who clearly don't tell their family members that they're on it. Now it's pretty interesting.

Dr. Richard Kennedy: 18:02

It becomes obvious that you could have something that you have to inject all the time. So, okay, again, once people get used to sticking themselves, because it's not a deep stick, it's a very superficial injection and you only have to do it once a week. So there are ways you can do this and nobody be aware of it. Then, of course, what they want is the results Wow, you look good. Wow you look good, wow, you look great. You know, I have, I've had a couple of patients over the years who are in the public, in the public image. They're in front of the camera, they're public speakers, et cetera. For them, it's good business.

Ketil Hviding: 18:52

It takes us a little bit to the whole thing about image, a body image, as well as what it means to be thin, because always this thing about having the willpower to go through a regimen that's considered to be good, now we can do it without the willpower. Yes, so that changes all of that.

Dave Liss: 19:14

It's interesting. I knew this one woman who did this same program at GW. She lost about 100 pounds may need to lose 100 more, unfortunately and she noticed that she was getting depressed. And she talked to the people there and she said that it was very common for people to lose weight and have depression. And they said the reason was that people thought once they lose the weight, all the problems in their life will go away. Then they realized they've lost weight and they're just thinner.

Ketil Hviding: 19:43

There might be many explanations, but I think there could be other explanations as well. We are being constantly bombarded by temptations. Yeah, the food industry has incentives to sell us by tentations. You know, yeah, and as you know, I mean the industry. The food industry has incentives to sell us whatever we want, and one of the things we are primed to eat are sugars. It's very easy, it's fast, it's something that you know. When you are hunting and you see something that's sweet, you're going to go for it because it's going to give you a lot of energy. You can fight better, everything. So we are primed for that.

Ketil Hviding: 20:19

Refusing and rejecting it is strenuous for us, it's hard. It also intervenes in our social activities. Think about all the parties. It involves I mean, from childhood involves sugar in some way or another. Then it goes from sugar to alcohol yes, which is another form of sugar. Yes, not partaking in this as well is also hard. Yes, now this drug comes in there and I'm not sure we have really understood how it affects the whole thing, because in a way, maybe now what you probably will see is that, for instance, the food, food industry they're going to see losing sales of candies, for instance. They're going to have to figure out something yeah yeah.

Dr. Richard Kennedy: 21:04

I mean it's interesting like this.

Dave Liss: 21:07

I've known people they had gastric bypass and it didn't address the craving, and so there were people who managed to find a way to gain weight while having had gastric bypass. Physical capacity is limited but they can't eat a box of M&M's bag of M&M's in five minutes, but they can eat three in four hours. And then people I've known that have taken the drug. They just don't have that interest in eating. They're done when they're done, and that seems to me to be the primary distinction between the two kinds of treatments.

Aussie Mike James: 21:40

Turning to the real nuts and brass of these things, as a manager of fitness centers in two different countries, if there was one constant I used to see, it was that scenario we talked about before about people wanting to get fit for an event in six months, whether it's be fit into a wedding dress or something like that, and the amount of people. I could almost pick them. They would come in. You would see they'd start yawning. They hadn't eaten breakfast, they hadn't eaten hardly the day before, their blood sugar's low and they they faint. And you just almost. I could almost catch them before they fainted. I got to see it so often. So I would think taking something like Wegovy would be a hell of a lot healthier in the long term. I mean you wouldn't have these sort of episodes. Jumping conclusions is.

Dr. Richard Kennedy: 22:26

Dr K. No, that makes perfect sense. Yeah, and again, I would tell you, there aren't as many people on these drugs just for the short term and for short term to me is six months or less Whereas this is because these people have reached a point where they and the medical establishment has said to them yes, you're overweight, you're obese, you need to lose weight. I have an option for you here now that might be helpful, and if you can tolerate this, you'll be able to lose the weight. And so, for some people initially, particularly for those who haven't really tried, you know that there are lots of people who will go on diet. You know that diet. And that's the problem.

Dr. Richard Kennedy: 23:26

Diets are, as they say, self-limited by nature. Even if they work, you have to eventually go back to some form of a regular eating routine for you, and I always say that's mainly the dilemma. Most diets work because, technically, you are eating less. The bottom line is you're eating less by default. What happens is remember, the stomach is a big, is a tube that expands and contracts based on the amount of substances coming into it. If you decrease the amount of substances coming into it, the stomach will get smaller. I mean, it's essentially the principle of what bypass surgery is? They literally make the stomach smaller.

Dr. Richard Kennedy: 24:17

Principle of what bypass surgery is they literally make the stomach smaller. So therefore, and again, they cut out other things, but they make the stomach smaller and, by default, if you have less, if the stomach won't expand, but so much, you get full quicker. Well then you'll eat less. And it's why, when they have the people go through this bypass surgery, before you go through bypass surgery you have to go through mental health therapy, you have to go through exercise programs, you have to go through a diet regimen. They want to prove that you're motivated enough because they know, once the surgery happens, just doing the surgery itself, when you come out of the operation, you've lost quite a bit of weight, almost always.

Ketil Hviding: 25:10

So the question is how do you sustain that going forward? So now we found a solution. This is pretty much the wonder drug. No, Even with a solution. This is pretty much the wonder drug?

Dr. Richard Kennedy: 25:17

no, even with that solution it serves the purpose. And partly because we have in front of us, on the movie screen, in the theaters, we have the bodies and faces of people who we saw them when they were in this role and they were 220 pounds and now they're 107.

Ketil Hviding: 25:43

Yeah, I know they're starting. There is this influence that they said oh, thin is good, yes, and now, suddenly, you know this is less of a problem to talk that way. Yeah, you know this is less of a problem to talk that way, but I mean, is this, though, also the one drug? Only for the rich, that's the next point.

Aussie Mike James: 26:02

I thought we should bring up Kettle Cost and affordability. I mean how affordable is it for the average person and discuss like Medicare and all of this. I mean how much does it cost, say, for the average person to undertake a course of Wagovi?

Dr. Richard Kennedy: 26:19

It's expensive.

Ketil Hviding: 26:22

I mean it's in the $1,000 a month.

Dr. Richard Kennedy: 26:25

Without insurance. $1,200 to $1,400 per month. Wow, Per month. So what happened is is, when the drugs came out, they knew that they, so they said they made they, they, they partnered with the health insurers and said look, okay, we will make this drug, but you have to be able to give us something back. And what they do is they give to the patient.

Dr. Richard Kennedy: 27:02

If you have commercial insurance in the United States, different in Europe, but commercial insurance the Aetna's, Blue Crosses of the world if you have that, they're going to pay a percentage of it. So, based on what your plan is you're going to pay, it's going to cover 80% or whatever and what the Goldberg Company says. We're going to give the patient a card that says $25 per month. We're going to charge you and that's all. You're going to pay out of pocket for the medication for a year, and so that mitigates the cost. Now, that doesn't help if you don't have insurance. It doesn't help if you have insurance and right now, Medicare not being a commercial insurance, it wasn't being covered, being covered. So the only way you could get it covered is if, okay, this person needs to take it, not just for obesity, but because they happen to be diabetic, because they had a cardiac event that they survived, and so this is to promote their wellness and well-being going forward and well-being going forward.

Ketil Hviding: 28:33

So then we have a situation where still a certain percentage of the United States population is uninsured and it's towards the lower range of income that will not benefit from this, and these are actually the part of society where you find more obesity. They're living in food deserts where you probably only can get McDonald's or other kind of fast food providers and no fresh food, whereas the rich, the wealthy, can gobble up these things that are, by the way, also in short supply. So it's a risk, is risk of increasing differences in society.

Aussie Mike James: 29:13

Is there a possibility of that changing, at least in the US, so that it becomes more affordable? Are there any indications of that?

Dr. Richard Kennedy: 29:20

Well, with Medicare being the largest insurer in the United States with them. Now it appears that I know the Biden administration has put into place ways that they can. Medicare will be able to negotiate with the drug companies to be able to get a more affordable price, but we'll see. The jury's still out. It will be better.

Ketil Hviding: 29:53

I don't know how much better and when on the prices and because the industry has been pushing back on this and they've done this only for a few drugs so far. They might include this and we'll see whether the new administration would allow that to go forward. Yeah, I mean just looking at europe, where most countries have as it was at all, have some kind of national health insurance and they negotiate with the companies, and I also think there is some kind of pan-European possibility there. And there are the prices about 10 times less, yeah, which is still expensive here, still expensive there too. And that takes us to the other issue that, even with reductions, this is the cost that the insurance system, however it's organized, will more or less have to bear, and it's going to affect budgets. Now, on the other hand, of course, having much less obese people if that is going to be the result that get actually rolled out will save money for the society. Yes, so you know, it's going to be interesting to see how this pans out.

Dr. Richard Kennedy: 31:18

Well, and from the standpoint that the drug companies will, they're always looking at a way to use their drug as a way to treat a condition, and so if you just think about these drugs in particular, how they started out specifically to treat diabetes, then they found out, wow, people's cardiac events and stroke events decreased. So then they had another indication to promote it. Then they found out, oh, wow, obesity is a big disease in the United States. We now have a drug regimen that can actually help to reduce that and promote wellness at the same time. So they'll you know, because to me the issue is is what's the end point? Do you people on on the drug for the next five?

Ketil Hviding: 32:23

years. And then there's actually something I think is not discussed a lot the we are talking now about the United States, europe, and the obesity epidemic that you talked about is also spreading. It's not only the United States, yes, but you're also having a large part of the world being affected by it. I mean you can have less. I mean emerging markets, relatively poor countries where obesity is also a problem. Because what are we pushing them? Soft drinks, often, okay, soft drinks, for instance, in a lot of Middle East. Soft drinks, same in Mexico, for instance. Obesity is becoming a big problem as well, india, but they don't. I haven't actually. Do you know anything about the rollout of drugs in these parts of the world?

Dr. Richard Kennedy: 33:14

No, not off the top of my head, I would suspect, because, as expensive as they are, most of the health insurance plans that do exist and again a lot of the developing world countries don't even have them there's no way to ban it out Now. They'll eventually figure out a way when the poorer countries so that they can benefit from it, like we've done with many other drugs over the years.

Ketil Hviding: 33:48

We've come with many other drugs over the years and also I think, if I am not wrong, but I understand that for instance, in India they would be producing. India and Brazil in particular, been producing medication. That is actually not it's still on patent, but they're producing it, so I am not sure I haven't actually seen that they actually started with this.

Dave Liss: 34:08

I would expect they're not. Isn't India, where many drugs are formulated anyway already, like for global distribution?

Dr. Richard Kennedy: 34:15

Yes, they are. The problem is is the quality of the drugs that come out of there, whether it's real or not. So a lot of times there are drugs that come from different parts, from India and other places, but people are not so sure that they are as effective because they don't go through the same scrutiny that they would in Europe or they would in North America.

Ketil Hviding: 34:44

There is even in the United States. Now I understand some pharmacies are compounding the drugs.

Dr. Richard Kennedy: 34:50

Yes.

Dave Liss: 34:51

I know a woman who's going to a compounding facility to get her medication starting next week and because she's a pretty fluent person. But it's cheaper for her to get the formulation than it would be for her to get a prescription.

Aussie Mike James: 35:05

Look, cheaper is a dove. Do you know how much cheaper it is prescription? Does it like cheaper?

Dave Liss: 35:09

as a dove. Do you know how much cheaper it is? I don't know what the difference is, but it's substantial enough to make that arrangement.

Ketil Hviding: 35:15

Okay, but if I understand that it can only be done as long as there's supply constraints, because the companies have patent on this? Yeah, and I understand the patent lasts for about 10 years, is that right? Yeah, 10, us 10 years.

Dave Liss: 35:32

Well, it's interesting, Like I was in a prescription study a few years ago and, as it turns out, what it was trying to do was for an ADD medication, was that the medication lasted four hours and if they change the formulation so it lasted six or eight hours, they could extend the patent. So rather than have an expiry and go generic, by changing the formulation they could extend the life of the exclusivity of the patent. I don't know if there's similar kind of considerations.

Dr. Richard Kennedy: 36:00

Well, they always are. They did the same thing with Viagra. The Viagra patent lasted almost 20, 25 years.

Ketil Hviding: 36:11

Yeah, there's another one, that's right.

Dave Liss: 36:13

Yeah.

Ketil Hviding: 36:14

So we have Viagra and we have Ozempic. We are, you know, if you have the money, you can be a new person.

Aussie Mike James: 36:21

But what about the long-term? That's a whole other talk show there, ketel, sorry.

Ketil Hviding: 36:29

I'm taking on this though Hard to, believe.

Aussie Mike James: 36:32

Turning to the long-term effects, we looked at the economics sustainability but, dr K, many listeners wonder about the safety and effectiveness of these drugs over time. Has there been any long-term studies on, or is there gaps in research on, these studies about long-term effectiveness and, well, any side effects?

Dr. Richard Kennedy: 36:52

well, I mean they've done studies that have gone on for eight years, with the people being on the drug for eight years they've been pretty effective.

Dr. Richard Kennedy: 37:00

Four-year studies eight four-year had been pretty effective and the side effect profile that you get at the very beginning of taking the drug is pretty much the same across and the side effects seem to dissipate.

Dr. Richard Kennedy: 37:25

You start out with the, you know, 0.5 milligrams, which would, depending on the drug or it, or 1.3 milligrams I can't remember what it is let's say as an example, once a week for four weeks.

Dr. Richard Kennedy: 37:39

And if the person tolerates it then, but they're not getting the desired effect, meaning that they haven't really lost much weight or no weight at all, then they'll bump it up to the next level of the dose of the drug and try that for a month, come back and measure whatever parameters are they met and they'll always easy to measure sugar, easy to measure on a scale what the person's weight has become. So you can do that and you can see along. And the people who discontinue the drug because they can't tolerate it, you know, one of the things you tend to always see is that even though the drug was helping them to lose weight, they couldn't tolerate it because of the side effects. So they stopped it and it would go right back to their free weight, free treatment weights, so they would gain the weight back that they might have lost. You know, and this is no different than when you know you have people on these different diets back in the day.

Aussie Mike James: 38:47

Yeah. And they go back to whatever is normal and do the same thing, and if they lasted that long to go through the regimen, that's the difference. I think yeah.

Dr. Richard Kennedy: 38:57

And that's been the case. Yeah, you know, they used to have this television show Big Fat Loser.

Aussie Mike James: 39:04

Yes.

Dr. Richard Kennedy: 39:06

Where people would get, there was incentive. Yes, where people would get there was incentive, there were these intensive programs where they got them to cut back on what they ate, exercise, do all these other things and they of their body weight during the course of the show. They would regain the weight within a year.

Dave Liss: 39:38

yeah, yeah, I had someone say to me that the whole thing about weight loss is it's sort of like mountain climbing, that people think that the hardest thing is the losing of the weight, but really, like the most dangerous part of climbing a mountain often is coming down from the mountain and that once you've lost the weight, finding a way to keep it off is the most difficult thing.

Dr. Richard Kennedy: 39:58

It still falls back on lifestyle.

Aussie Mike James: 40:01

Yeah, yeah, I think it's not going to change exercise habits. I mean, in fact, I guess in the gym culture the people on Mugabe will be sort of clapping their hands because they'll be saying all the people who wanted to put on muscles that had steroids for years and they're walking around with these bulging, at least we've got our own back, you know. We've got our own drug now.

Dave Liss: 40:21

But I think that sounds trivial, but it's true.

Aussie Mike James: 40:25

People want to get out of the gym.

Dave Liss: 40:26

I mean you. You want to have the benefit, not have to do the work. You know, in a way, and yeah, but I think I kind of wonder about, is I?

Aussie Mike James: 40:34

do say, though, when I alluded before to the visuals of people have been on ozempic, I've lost a lot of muscle. I always refer to the sydney carver bridge effect you've got a big suit. People have had suits that they previously wore. Yes, they no longer feel like a suit and it's just like a big suit. People have had suits that they previously wore. They no longer feel as though it's a suit and it's just like a big hanger sitting off them.

Aussie Mike James: 40:52

Quite a few of the recent politicians who I won't name, who you can tell with that?

Ketil Hviding: 40:58

As you said before, these drugs don't. I mean, it's the weight loss, the fast-paced loss problem. How do you actually deal with that? These drugs don't enter a new thing in the equation there, so they should have a chance to build up muscles.

Dr. Richard Kennedy: 41:14

Yes, yeah, yeah, and that's important. They should be willing to work on it and realizing that they could, because in many, what you'll find is in the people who do the muscle toning and the muscle building, who happen to be on these drugs, what will happen is they'll plateau where it won't look like they're really losing any weight.

Dr. Richard Kennedy: 41:36

But these are the same people who will tell you that their one or two sizes smaller in clothing because they've reduced the fat, tone the muscle, so they've gotten fitter in that regard, but their weight on the scale may not have changed very much.

Ketil Hviding: 41:58

You guys. I have to run out to get to Tregno.

Aussie Mike James: 42:04

But run to the gym. Run to the weight training gym straight after.

Dr. Richard Kennedy: 42:08

That jiu-jitsu and fencing what are you talking about.

Aussie Mike James: 42:17

Well, you know, there's this. Okay, guys, should we I mean edit, should we sort of wrap it up now?

Ketil Hviding: 42:25

Yeah, I think we'll wrap it up and maybe we should think about having another episode and then take questions. Maybe I'll wrap it up with yeah, I think we'll wrap it up, and maybe we should think about having another episode and then take questions.

Aussie Mike James: 42:31

Maybe I'll wrap it up with saying that the three things that we should look at are doctor supervision, weight training yes, and general lifestyle modification yes, yeah, okay.

Dave Liss: 42:42

We'll just wrap it up. I'm cutting and then when you start, that's where we'll redo it. If you want to do something with questions like I could take, like family members, like you know, your spouses and they could ask questions.

Ketil Hviding: 42:54

I think it would be great to get some questions. We might even get questions from India, since you have your biggest podcast in India.

Dave Liss: 43:03

Yeah, we're 130th in the health and wellness space in India.

Aussie Mike James: 43:13

Well, I think we need to figure out how they actually are going to get it there's only 131 in there.

Dave Liss: 43:16

There's over a billion people in India and we're 130th. I think that's pretty good.

Ketil Hviding: 43:20

Yeah.

Dave Liss: 43:21

Okay, we're going to go up, I'm leaving Wait wait, kettle. Can you just wait till he wraps it up, then we'll close that way we don't lose you.

Aussie Mike James: 43:30

Wait, wait, wait. I'll close it up now and I'll just finish off with that close. Well, okay, I guess the real takeaways from this just to get verification from you, dr K is that one, if we take these drugs, or if you get them prescribed, they should be definitely under a doctor's supervision. Weight training should be included, or at least some sort of strength resistance work, and three, general lifestyle modification. It's not just the drug that's going to do the work. You have to actually work with the drug, so to speak.

Aussie Mike James: 44:05

So, on that note, and we're going to talk more on this and we'll get some questions from our listeners and maybe discuss this in a future episode. But thanks for tuning in folks. We'd love to hear your thoughts and if you have any comments or questions, connect with us on our social media with links in the program notes, or visit our website at wellnessmusketeersbuzzsproutcom. Don't forget to like and share this episode. Subscribe to Wellness Musketeers for more insights. Your support helps us reach more listeners, spreading wellness to everyone. Stay healthy, stay inspired, and we'll see you for the next episode of Wellness Musketeers coming soon.