Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health.
The FDA recently announced an obesity drug that could have major implications in the weight loss battle. The drug is going to be called Wegovy.
Performance Medicine has actually been using the same drug now for almost two years in the form of Ozempic, which is a medicine for Diabetes. But we have also used it for weight loss as well.
As you may know, half of what doctors use is off label. Most people with obesity have metabolic syndrome, or at least prediabetes.
Ozempic is really a diabetes drug, but now has been approved by the FDA for weight loss, using a different dose and under a different name (Wegovy).
They’re saying it’s going to be a game changer, because it actually targets the gut rather than the brain for weight loss.
This is a new way of thinking! I will try to unpack the process in this note.
The Complexity of Weight Loss
Obesity is a chronic disease that you have to treat like a chronic disease, because for most people that’s exactly what it is.
It’s a lifelong disease.
There are hormones, metabolism, and eating patterns to consider. There’s also a lot of psychology around what and why people eat.
You also need to take into account our genetic differences.
Some people just have more tendency to retain fat than other people.
It’s a complex medical issue.
It’s not calories in, calories out. And it’s not simply a matter of eating less and exercising more.
Obesity is much more complex than that. As a matter of fact, weight loss is one of the more complex things we have to deal with in medicine.
Because of all the factors, it is very difficult for patients to achieve lifelong weight loss.
We have some tools that really help with this, but you have to treat it like a lifelong illness of insulin resistance.
How does Wegovy (Ozempic) work?
Wegovy is based on what is called a GLP-1 agonist.
GLP-1 stands for Glucagon Like Peptide, which is a hormone that is secreted naturally in the body by the gut. It helps regulate your metabolism which has a lot to do with insulin, etc.
The thing about these peptides and what makes them different, is that they regulate the output of these hormones in your body:
Both of these hormones are secreted by the pancreas.
This drug works in a number of different ways. Here’s a breakdown:
- It slows down the gastric emptying. This means you’re going to feel full longer.
- It helps insulin secretion by the pancreas. Remember that insulin takes the sugar in your blood and puts it into the cells. That’s where you want it for energy.
- It also decreases the output of glucagon. The pancreas secretes glucagon where you’re fasting, when you’re hungry, and when your blood sugars are low. Glucagon stimulates the liver to put out glucose. Therefore, it decreases glucagon and indirectly decreases the liver output of glucose so you you won’t have as much blood sugar. Note: that’s why these medications work for diabetes.
- There’s also evidence that it decreases the appetite center in the brain as well.
So there’s actually four ways this drug works, and we’ve had tremendous success with it.
Contraindications: You can’t take it if you’ve had Pancreatitis (rare), Medullary Cancer of the Thyroid (extremely rare), MEN Syndrome 2 (extremely rare).
Side Effects: Nausea. This is a minor problem. The way you counter this is by working the dose up slowly.
Wegovy and Insurance Coverage
This is not going to be a total game changer unless insurance companies start approving it for weight loss. Insurance companies are very hesitant to approve drugs for weight loss. It’s not because they don’t realize that weight loss is good for your health, as well as cuts down on your future medical expenses. They don’t care, because it’s about the money to them. They know it will reduce overall costs of that person’s health lifelong, but they reasoned that by the time those effects take place, the patient will be with another insurance company.
I know this because I’ve actually called the insurance companies and asked them.
My point in saying that is to remind you that you need to take care of yourself! An insurance company is not in it for you.
Note: we’ve been able to get quite a few patients covered for Ozempic. We will continue to find ways to use this new drug and use it effectively for weight loss.
Everything gets better with Weight Loss
With weight loss, all of this stuff fits together: hormones, nutrition, metabolism, sleep, stress, as well as some genetic factors.
You can’t just take this once a week shot and your problems are solved. You still have to change your eating patterns for the most part (which usually means lower carb and incorporating some sort of intermittent fasting into your regimen).
But this is still exciting news!
We’ve been using this drug for two years and had great success with it. It’ll just help us get another way to use a different dose under a different name and maybe some better coverage. Who knows what the insurance company’s going to do.
I’m hoping they will sample a lot of it so we can help get people started.
Obesity is such a major problem in our country for the healthcare system. I think that obesity and drugs are the two biggest problems that we face in the medical community.
Almost 50% of Americans are obese, and it’s getting worse!
Ninety percent of the Covid-19 deaths worldwide were from countries that have an epidemic of obesity. If you noticed with Covid mortality early on, it was mostly obese people that were dying or getting very sick along with the elderly and diabetics.
With Wegovy, we have another tool to help us fight obesity.
The average weight loss on this new drug is about 15%, and sometimes as high as 20%. Think about a 15% weight loss in a person who weighs 200 pounds. That’s 30 pounds!
That’s life changing!
If you can lose that much weight and keep it off, it’ll change your whole life. Every parameter will get better.
- Blood sugar levels
- Blood Pressure
- Liquid Profile
- Inflammatory Markers
- The way your knees and back feels
- How well your brain works
With weight loss EVERYTHING can get better.