88: Weight loss and Ozempic. What you NEED to know. Worth it or too risky?

Lyndi Cohen: 0:02

Hello you good thing and welcome to this week's episode of the no Wellness Wankery podcast. I am your co-host, lindy Cohen, dietitian nutritionist, and excited for today's topic with my co-host, jenna DePiece.

Jenna D'Apice: 0:13

Hello, yes, my name is Jenna. Thank you for listening to the podcast. We always love recording these each week for you because there's always new things popping up that we need to chat about in the wellness world, and I've seen this article, and this is not the first time I've heard about Ozenpik. I feel like it is everywhere and I saw an article the other day about an Aussie mum who was trying to slim down for a wedding and has started taking Ozenpik and has sadly lost her life, and it just made me thinking more about what is this Ozenpik? And it was her daughter's wedding.

Lyndi Cohen: 0:49

I mean, the whole story is just so devastating to me. And we've had this drug, ozenpik, coming to the market. And if you don't know what Ozenpik is, basically it's a drug that you take via an injection once a week and it suppresses your appetite. Now, the way that it does that is it mimics a hormone. So you've got a few hormones in your body, right, that regulate your hunger and fullness, things like leptin and grelate we talk about those ones a lot, but there's another one called GLP1. And basically it's mimicking this hormone, so it makes you feel full, so it makes you feel like you're not really that hungry to, suppresses appetite. And the way that it kind of does this is it slows gastric emptying and that is a really like fancy way of just saying the food in your stomach goes out at a slower rate and, as a result, you feel full for longer, Right? So people who are taking Ozenpik are feeling like they just I don't know the way.

Lyndi Cohen: 1:44

Anytime I've seen someone talk about it, they say it's just like that excitement around food just isn't there anymore. It's like gets a bit. Food is just food. It's almost like food becomes fuel. So even if someone's had, you know, a huge dieting history. They get to the point of much more neutrality around food and we'll talk about the dangers of how that also goes the opposite way.

Lyndi Cohen: 2:05

But the other names you would have heard Ozenpik under is Semeglotide. Semeglotide I have a really hard time saying that Semeglotide and you would have heard the name work of E as well, which is kind of the brand name. Now Ozenpik is one type of drug that's been released. At the moment there are about four other kinds of drugs that kind of work in a similar mechanism for weight loss. Previous weight loss medication was a whole different ball game. Now we used to have old school weight loss kind of drugs had insane side effects and they just were never tolerated well by people. Now this new wave that will work, this new wave of weight loss drugs that are working on this GLP1 hormone kind of regulation, they are seeming to be a little bit more better tolerated than old school weight loss medications.

Jenna D'Apice: 2:54

So why are these? I've heard things about it's made for diabetes. Is that what the drugs actually really made for? And then people that are using it for weight loss.

Lyndi Cohen: 3:04

Well, it was kind of a bit of a fluke discovery the impact on weight loss. So first this drug was created to help people with blood glucose control of which it is pretty effective at doing that. But they also found that when they were trialing this with people, that weight loss was a side effect of it. And so then the pharmaceutical company was like all right, let's rebrand this and turn it into a weight loss medication. And so there are. It's certainly now being prescribed to people with diabetes, with pre diabetes. It's also being prescribed to people whose BMI is in the obese and above kind of categories, and there is different treatment protocol. So the amount of the drug that goes into differs whether or not you've got diabetes or you're just being treated for something like trying to lose weight. And the way that it works is I told you, it's got this this weekly injection that you administer yourself.

Jenna D'Apice: 3:58

Yeah, I was going to ask that you give yourself the needle.

Lyndi Cohen: 4:01

Yeah, and I've seen videos of people doing it. They really have to like psych themselves up. If you ever done like IVF or something, I feel like you know this is no big deal for you, but you got to pinch some fat, you got to stick it in and apparently it's pretty painless. It's not a huge deal, but it's more a bit of a daunting process. So you do that once a week and then you have that drug in your system for the rest of the week and, as you're on different protocols or like a weight loss protocol, it's a different amount of that drug goes into your body each week. So, because there are some side effects from doing it which we are going to talk about, you taper into it. So you have a small dose, small dose, and then you slowly, gradually build up your doses, allowing your body hopefully some time to adjust to what is happening to it and some of those things.

Lyndi Cohen: 4:47

What is happening to our body, some of those negative side effects is nausea, which is, like I, apparently the most common complaint from people. Diarrhea is also equally as common, and then for some people they get things like vomiting as well. So can we get really unpleasant gastrointestinal symptoms as a result of this and that's quite the norm. This isn't like we're seeing most people kind of tolerating it without those symptoms. No, in this case, most people are having those symptoms, from all the reports that I've seen about it, and it's just something that you kind of come to terms with Perhaps. There's like fluctuations where you have one week where it's crazy diarrhea, you've got to run to the toilet really quickly and the nausea can be pretty intense. Now, of course, there's already kind of that natural appetite suppressance that's happening from the chemical. But there's also like if you feel nauseous, you don't feel like eating. You know my first trimester pregnancy I was so nauseous I lost weight in that first trimester and I think that's another thing. That's what's kind of contributing to this quick weight loss.

Jenna D'Apice: 5:51

So you say an appetite suppressant, and I know, in everything we talk about intuitive eating like your appetite is set to how much food your body actually needs, so you're suppressing it past less calories than your body needs, or is it? How does that work?

Lyndi Cohen: 6:08

Totally. It's exactly what's happening. So you're basically dysregulating your ability to tune into your appetite. So you cannot really eat intuitively when you are on a drug like work of the ozepic, whatever you want to call it. As a result, one of the huge things that a lot of doctors are seeing and it's quite problematic is the amount of muscle wasting that is happening. So when people are on ozepic you don't feel like eating. So people say, oh, instead of having my breakfast, I only ate half my breakfast, and then I ate the other half for lunch and then I kind of had like a coke and then you know, maybe a few bites of something else and then I was done for the day. So really low intake of food and what we're seeing is a much higher rate of muscle wasting.

Lyndi Cohen: 6:55

So what we're going to know is like if someone's losing fat, they're losing a really large proportion of muscle as well. As you lose weight, you might actually be getting fatter. Your ratio of fat might be increasing even though your body mass is shrinking, and I think one of the big issues with this drug, the way that it's. There are many, but one of the issues is the way that FDA works, which, if you don't know? That's the governing board in America that controls drugs. They don't actually permit you to use something like a dexa scan to measure an effectiveness of a drug. Instead, they only use body weight.

Jenna D'Apice: 7:25

So dexa scans, that machine that shows your muscle and fat. Indeed.

Lyndi Cohen: 7:28

Spotting tells you the weight of your bones. It's basically breaking down your body and giving you a really clear composition of what your body is. Now, when I hop on the scale, if I drink some water or if I have a very low amount of muscle and I just you know, you know, have a lot of weight on me, it's not going to show me that. So two people can have the same body weight but have very different compositions. One person's got high muscle, lower amount of fat, and the other person cannot. And these people, if you just look at body weight, you're going to go there. The same health. You know that's what the BMI tells us. Same amount of healthy, even though we know they are absolutely not.

Lyndi Cohen: 8:05

And so this drug to kind of get clearance doesn't go all right. Well, we're relating to muscle wasting and well, it's leading to fat loss. That was not nearly as important as the fact that, like, we're just helping people drop weight and from an effectiveness perspective. So when we have, you know, we know dieting has a very low success rate of helping people lose weight and keeping it off. We know that bariatric surgeries and bypasses and all that stuff, there's a very high rate of helping people lose weight, certainly with a lot of people. We see people regain weight, a lot of the weight, and some people are able to keep that weight off. This drug is as effective as those operation, surgical routes, but with just taking an injection, and so that is. I guess, what is getting everyone so hyped up about is it's a much less of an intervention than what we've seen before.

Jenna D'Apice: 8:59

But I suppose my question would be like with those weight loss surgeries, like ones like with the stomach, like there's not, like half of their stomach or more than half of their stomach is gone, they can't get it back, whereas can they just stop taking the injections and then their appetite would come back and everything would go back to normal.

Lyndi Cohen: 9:17

Totally so. There's like the impermanence of this as a solution, as opposed to having to go through a surgery which is a big deal, incredibly expensive, requiring a lot of surgeons, nurses and care staff as well, versus something like this, which is something that you can administer by yourself and have your healthcare professionals supporting you from the outside.

Jenna D'Apice: 9:37

I suppose, with all of these diets, when you are doing things that so heavily impact your appetite, are we seeing people staying on drugs like OZMPG until they can't handle the side effects anymore and then going off and then having more problems with their appetite, like you do when you've been on dieting and you're so out of touch with your appetite? I?

Lyndi Cohen: 9:58

think this is the crux of what gets me about OZMPG is, firstly, we do not know long term what's going to happen to people's bodies. There is some early research that says that it can lead to kidney failure in some people and have some serious side effects, like this lady who's passed away, which, as I said, makes me feel so sad. And so we do not know what is going to happen long term. And the strategy is do you have to then take OZMPG for the rest of your life cycle? In and on OZMPG, is it worth it? For some people, the side effects, the nausea, the diarrhea, the vomiting it's a pretty extreme and hard way to live. Not only that, if you have a history of disorder and this is very important, and I would say that most people do have a history of disorder, we know that 80% of women do and most people who are in the position to be prescribed OZMPG probably, I would say, would fall into that bucket.

Lyndi Cohen: 11:00

Going through this journey can be really triggering for your eating disorder voice and it gets really latched onto this weight loss, the comments from people and in a way it's almost like you're willing to sacrifice so much of your life to lose weight. And I'm not here to judge anyone, because sometimes you do get to a point where you go. I've tried everything and I've got diabetes and I know what my family history looks like and I don't want to go down that way, and so I've never been one to say that there is only one way to be healthy. I just think that if you go, if you're listening to this podcast, there is a chance that you fall into that disorderly eating bucket and to go on a drug like OZMPG without seeking treatment for a disorderly eating first. And I'm talking about one-on-one support with a psychologist, with a dietitian, someone who's going to help you with your relationship with food.

Lyndi Cohen: 11:51

That is an essential thing to do. It might mean that you don't ever need OZMPG. It might mean that even if you're doing OZMPG, that you go. I'm going to do this in tandem, so by the time I get to the point that I have lost weight, I'm not going to still have all the problems that have led me to get to this point. And I hate how often, with bariatric surgery or something like OZMPG, it so often feels to me like we're slapping a band-aid on a headache, like it's just. It feels like we are not treating the actual problem, and it really gets to me. So we really need to get to the crux of how we got ourselves into this position and healing ourselves from all that. Dieting yes.

Jenna D'Apice: 12:28

Because I suppose it's the same. Like I know, when I, when I was about 17, I lost 20 kilograms just through dieting and I remember when I lost 20 kilograms I still felt overweight because I wasn't happy with my body and I had done none of that work. And then that is what kind of resulted me in eventually putting on weight again because I hadn't. I was still never forget it to the day I died that I felt no different at X weight and 20 kilograms lighter, because I had just been dieting and I had done nothing different. So I suppose it's the same thing If you take any weight loss drag or suck, any protocol, when you are still disordered in the way you look at your body and your food, nothing will change, even when you are at the goal weight you think you want, because by the time you get to that goal weight it's not going to be the goal weight you think will make you happy.

Lyndi Cohen: 13:20

I think so. Okay, Bex, the question of why are we chasing this as well? Why are we chasing this weight loss? Potentially, your doctor is saying to you listen, I'm looking at your bloods and it's looking like we need to make some changes here. And you know, I wonder have you tried all the options?

Lyndi Cohen: 13:35

I do think Osempic is that last resort and I think there's a lot of people who are going. I've tried lots of diets and they've all failed me. I still think there is a middle ground where you're going. I'm working on my relationship with food and that takes a long time, I know, and that's tricky before we're kind of getting to that point of going okay, fine, let's, let's give the Osempic a go. There's also a bunch of people who are really slim who are getting Osempic, and I think this is part of what the controversy is about is there were shortages in the initial stages, preventing people who had diabetes from getting the medication, preventing people who perhaps genuinely needed medication from getting it, and there was a bit of a privilege problem. I think that those shortages have been rectified, but I think that will still be an ongoing problem where we're seeing people with eating disorders seeking out Osempic for no reason no, like health reason that they need it, but purely because they'd like to be skinny.

Jenna D'Apice: 14:28

And would there be any people who are on Osempic and there's reasons why, like it wouldn't, they wouldn't be losing weight, like? Is it always like a it's going to just drop, or is it also to do with what the person's doing?

Lyndi Cohen: 14:42

I think there are some people who it's doesn't lead to as fast weight loss as it does for other people. I don't know the reason for that, no idea. And some people the weight comes off really quickly. Some people the symptoms are so extreme and for some people, regardless of whether or not they've got a lowered appetite, still continue to eat.

Jenna D'Apice: 15:03

Because I suppose that's also like in your like binge eating, and you have that frame of mind. You're not hungry, so it's, you're just eating because it's the motion. So sometimes didn't matter if your appetite was so stuffed you felt sick, you would still keep eating.

Lyndi Cohen: 15:17

Totally so. If that's still the your way of coping with hard things, then you still resort to that emotional eating. It's not going to have an impact on your weight. The way this drug works is it does require you to eat less as a result of you not being hungry, and that's the mechanism it's similar to if you had a gastric bypass or those kinds of surgeries.

Lyndi Cohen: 15:36

Back to this whole muscle wasting thing. I want to say muscle wasting. It means like losing muscle, one of the challenges as well. So let's say you've got this really lowered appetite. Food is very uninteresting to you, but you still have the exact same protein requirements that you did before to maintain your muscle mass. Now the last thing you feel like eating is some bloody chicken or like eggs or tofu. When you've got no appetite, that's a real struggle.

Lyndi Cohen: 16:03

But you need to be getting your protein in. That's absolutely important. It becomes your most important macronutrients so that we don't lose all that muscle. And I think that's one of the biggest challenges is how do you get someone who does not feel like eating to get a nutritionally balanced meal at all? You know all their important junctions that are giving them all the micronutrients, all the macronutrients. So getting enough carbs, healthy fats and protein for their body to thrive. And I hate this idea in the health world Like we're willing to sacrifice so much health to reach this kind of goal. Weight and it just it really kills me when we do stuff like that.

Lyndi Cohen: 16:40

You know, someone might come into the end of their ozempic journey and be like so deficient in so many nutrients and lacking in protein, having lost all this muscle, and so if you are going, I'm considering doing ozempic. I am on ozempic. What I really want you to do is prioritize protein as think of it as medicine. You know I rarely think of food as medicine, but in this case, think of it as like this is just what needs to get in and being a little bit prepared to just having those options. You know, it could be something like barbecue chicken and you just have that in the fridge and you just go. You know, if I'm going to eat, I'm going to eat that. If you're going to eat your meal, eat your protein first. You know, prioritize that over the other stuff. You need to speak to your doctor about what other kinds of multivitamins you might need to be taking, so that we're not ending up deficient the other thing you absolutely need to be doing is hydrating.

Lyndi Cohen: 17:27

So let's say you have chronic diarrhea, a very normal side effect of ozempic. The amount of liquid you are losing from your body is wild. People report that they feel really tired and fatigued. And yes, if you are barely eating, you're going to feel tired and fatigued, and if you're dehydrated you're going to feel tired and fatigued. Ozempic may also impact your sleep patterns, for some people finding it hard to fall asleep. There's been some reports of impacts to your mental well-being. So some people reporting anxiety, suicidal ideation in some cases.

Lyndi Cohen: 17:59

So this drug is not for everyone and there is a whole host of crazy side effects and I think everyone's running to praise this drug is like this big solution, this like incredible pancia that's going to fix everything. But I think the skeptic in me and I'm actually not a hugely skeptical kind of person, but I do feel a little bit hesitant about everyone rushing to get on this medication. What I will tell you is this is just the start of a whole new wave of weight loss drugs. This is, like you know, with chat, gpt, like the world's changing with AI, it's changing. It's changing here as well, so there will be multiple versions that come afterwards. In fact, there is a new kind of ozempic that's come out that's shown to be more effective than ozempic at weight loss. So I'm not saying wait for those drugs, but I am also saying don't rush, don't go, let's just jump on this bandwagon. There is time to work on your relationship with food. In fact, it's what I think everyone should be doing and focusing on.

Lyndi Cohen: 18:58

This is a big deal. Taking a drug like this. Don't take it lightly. I really want you to be really mindful of this decision. Speak to your doctor. And just one more note on that I think doctors are really nearly prescribing this drug. They're just handing it out like candy. And I just want you to be really trusting of your healthcare professional. Remember weight stigma, fat phobia exists everywhere. It's very deeply ingrained in our culture and our doctors are not immune to it. In fact, I'd say they're probably a bit more highly affected than most people. So really have to have a trust in relationship with your doctor and ask yourself why am I doing this? Do you think it's that eating disorder voice inside of you going it would be nice to lose weight, like the lady who we started the story with, who just wanted to lose some weight so she could be skinnier at her daughter's wedding. And now she's not going to be able to go to her daughter's wedding. So just really think about is this your eating disorder speaking?

Jenna D'Apice: 19:51

I think it's such a good conversation to start having, especially, you're right, I think this is just the beginning of these type of drugs and it is such a good time now than ever if they are coming to try to work on that relationship with food and your body. So you are more prepared if you do decide one day that that is something you would like to do.

Lyndi Cohen: 20:09

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