I'm Anne, Danny and this is WPSU Conversations Live, Ozempic weight loss and he We're talking with two experts and we'd love to hear your questions as well.

Our toll free number is one 800 5438242.

You can also email us at connect at WPSU dot org So, Dr. Wagner that these medications have made the news or getting a lot of atte And people are also seeing other people who have success stories with them?

Yes, for sure.

They're knowing people that are yo u know what's going on here?

Like, you know, I' What's you know, what tools do you have that maybe I don't I feel like that's definitely part of it, too.

But you also have the other end where someti a lot and you try to talk to them about it, but they're kind o they might have actually talked to somebody.

Maybe that drug wasn't for them.

And now they think that So sometimes, you know, can get rid of some mi about some of the drugs, too, can be challenging as well, especially around some of the stuff you see in the news.

But, yeah, I mean, I feel like coming to us some, a provider providers, a specialist in it, is kind of the way to go because we can kind of spell all those things before you kind of realize t A good place to start right?

Dr. Soleimani, do you get that?

You do you have people or ideas that maybe somebody else has experienced Absolutely.

So you'd be having much more effective medications.

One of the things that I want to mention about th that we showed up on the screen and discuss is that in we have a group of medications that we call them first generation weight loss medication, where we have been seeing about 5 to 10% weight loss.

But now with the second generation weight loss medications, like if they go up and they're are seeing somewhere between 15 to 20% and in So that's a pretty significant weight loss.

People are going to notice that when an individual is they are going to be asking them, what are you taking that is working so well and you're losing the weig And I think that's how it ends up that patients are ge from friends, family, social media.

And I think unfortunately, always there's another layer in what is the coverage looks like.

Is this an appropriate Do I have any contraindication to t which really highlights the import or going to an obesity medicine specialist or a physician to have a sit down and have a proper assessment and conversation of And we're looking at a graphic right now.

Maybe you can kind of walk us explaining the effectiveness of the Absolutely.

So as Q seminar, Country and Psych Center, they are first generation anti-obesity medication and then ZAP and they they are the second generation anti-obesity medication.

This graph will be here really shows one of the trials that were done with big old and really highlights the importance of why it is important to take this medication long term because as Dr. Beckner also mentioned, this is a chronic disease, obesity that does relapse.

So in this graph, what you'll see in the initial red line that is coming down, this group of participants who were given a lifestyle modification program told how to change their nutritional behavi how much physical activity to do, kind of how much calorie to be eating.

And they were also given wegovy as well.

And then after some time, that group was divided t that continued to receive the treatment through recovery.

And while the other group continued with a lifestyle by stop An d as you can see, the line that kind of comes right back up really shows that when you're not getting the treatment, the disease which again we really have to treat the physiology, which can really only be done through pharmacotherapy or bariatric surgery while you're supporting the patient from a lysell standp Okay.

One of the issues that has come up is insurance is that something bo th of you have seen where maybe a patient you think Dr. Wagner might benefit from one of these medications, And we hear about the cost of these medications.

Some of them can be $1,000 a month.

okay.

with some of these insurance companies with pressure off.

Can I get this person this medicine?

I think they're going Fortunately, sometimes some of these medicines like Ozem and Munjal, if you have diabetes, they're slam dunks to get yo but not the weight loss drugs, which baffles my mind.

Why would we wait for you to develop a chronic and othe without treating the first one first right?

So that's where we're at.

That's my biggest frustration now is wh en they come in for these weight loss meds, I screen them Maybe we can find something so I can maybe even get them on a simi But, you know, also in a sense kind of cure their diabetes as well, which is kind of what we're trying to do.

But yeah, it's t Access is a huge one right now because you can't afford th It's like 1000 1400 dollars retail out of pocket like that.

And there's no way anybody expected to pay for that.

That's a lot of money.

And I wo they're pre-diabetic or maybe they're not even pre-diabetic, but if they're able to take a medication and get their weight in a more wa y, that that might save problems and save money down the down the road.

Is that right?

Right.

You would think so.

Right.

You know, you're going to have lots of cost work and treating the diabetes condition rath it kind of deal.

Yeah, definitely give you frustrat I feel like that's the or waiting until you develop Bu t I think now we're trying to look at it Can we treat obesity as a strictly as a disease itse rather than just treating it as a precursor to other Ye s. Dr.

So to make a forecast, but do you think over time, as these drugs maybe become more accepted or commonplace, that there wil So while we've made so much progress in this field in understanding how we need to treat this disease better, we really are falling behind and not doing this.

Our patients good service by not covering the anti-obesity medication, being in the field of obesity medicine for the past 1314 years, we are seeing more employers are actually covering their medication, which is great.

But still there are many that remain who don't provide the coverage for the patient.

So, for example, Medicare patients don't h and that makes it very difficult when a patient comes in, they have to reduce their weight to obtain that knee operation.

And we know that we can do a really good job if we can add that pharmacotherapy, that anti-obesity medication, the weight loss medication to part of their lifestyle treatment.

But then we cannot afford it because it costs is so expensive.

Really, our hands are tied and I do think that it's quite unfair.

And I agree with Dr. Buckner's frustration.

We certainly see in our clinic the trajectory of the patient that does have access to pharmacotherapy and those who do not and how they will do in terms of their obesity treatment.

So we really I encourage all the listeners to be go out there a for better coverage for weight loss medications.

Well, I did speak with one person who is on a weight loss medication about her personal experience with it.

So we're going to listen to wha And here's that interview.

Tamara, for Tammy Body, thank you so much for coming in to talk with us.

You're welcome.

I'm happy to be here.

I should mention that you are a WPC employee, although that' You're here today to share your personal experience, your story.

We're taking weight loss drugs.

So thank you for coming in.

So you started taking Mozambique about two years ago.

Is.

Is that right?

Yeah, it'll be And what led you to that decision?

Why did you decide to try it?

Well, I've struggled with my weight my w I think my mom took me to see my first diet doctor when I was about ten years old.

So I've been on every diet I' ve tried everything you can think of.

Having kids, of course, added a litt And so, you know, I was getting on in years and it was getting harder and harder to do things.

And so I finally made the decision to actually talk to the weight loss team at my local clinic.

And they had some suggestions.

One of them, which was, you kn But then, you know, I had heard a lot about weight loss drugs becoming more accessible and that they were actually really working So I decided to to go for it.

And how is it going so far?

Do you feel like you've made the right I absolutely made the best decision for me.

I would never go back.

I hope I would never go back to where I was t It was a little scary in the beginning, but it honestly has been life changing for me.

What do you mean by that?

In what wa I used to think if someone invited me out for a meeting or dinner or something, I would always think about where are they?

Where are they inviting me for?

Because is it a long Because it was a struggle to walk to do those things I was afraid to travel, to fly, to go on planes because of the tight seats, having lost about #80.

Now I've lost that fear and I've rea I tried not to let it affect me professionally, but I think sometimes it did.

But it definitely affected me person in my in my experiences with my family, in traveling and doing things together.

Now I'm able to do what everyone else can do.

And it's just been it's been amazing.

And what was it like for you when you did go to the doctor?

Were they open to talking about it?

Was it easy for you to do that?

Because as you mentioned, there are a lot of tim Yeah, It you know, there are weight loss or weight management programs pretty much everywhere at this point.

I guess the one I go to through our insurance here at the university has its own weight management program.

So I spoke to a nutritionist, to a physician, to a physician assistant, and they were all really, really helpful with giving me the information abou I wasn't interested in the weight loss surgery.

I didn't want to go that route.

I was skeptical about whether fo r me or not because so many things had not worked for me.

And in the beginning I'm pretty needle phobic.

So in the beginning I took some pills, you know, medication in a pill form, and it worked a bit, but not as well as the the injections that I take now.

It's a weekly injection and they tried to convince me from the beginning that the weekly injections were my best option.

I was a little afraid.

So I went with t But after a few months I agreed to start taking the injections.

And while the first couple were a little scary, I actually had my husband do them for me.

Now it's just.

It's nothing.

I'm so used to it at this point So, I mean, they were they were very open about what my past, my options were.

And what does it feel like for you taking it?

You feel less hungry.

Do you think about food less I'm sure a lot of people who are maybe thinking about ta it are just curious about I want to know what it fee Yeah, I've had so many friends who have, you know, noticed my success with this, come to me and ask And I still enjoy food very much.

A lot of what I do here at the station is food related, the programs I work on, and so I still enjoy food and I don't know if I would do it if it if it totally took away your enjoyment of food, because you know, that's important to me.

But I get full faster, I don't have the cravings that I used to have.

I don't feel like I need to have a second helpin You know, I make my plate and I do I do little tricks with myself.

I use smaller plates or, you know, things like that to kind of trick my mind.

But I also just feel like, you know, it's food doesn't hold the place in my life that it used to.

Now I eat to live.

I don't live to eat.

Have there been any surpri They warned me about the side effects and I, while I have been very, very lucky and have not had some of the major side effects that some people can have, a lot of people talk about constant nausea.

I never had any of that.

I do have some mild side effects that I deal with, but there are some, you know, other other things you increased fiber and things like that that can help with those side effects.

But but in the long run, anything is worth what how I feel now.

Right?

You were talking about some of th And I want to get to that question again of societal perception.

You were just talking about having to plan for everything.

Do you think even though we're we're talking about in some of these other weight loss and weight management dr and they're getting a lot of attention and people are sharing their stories.

But do you feel like there still is a lot of stigma w Well, there's certainly a stigma of being an overweight person.

You know, I think we talked a little before this interview about, you know, my feelings when I would get on an airplane and I would come to the row I'm supposed to be and I would look over at the person sitting there and you can just see on their face that this person's going to take up my space in An d, you know, so I would try to make myself as small as possible and, you know, pull in on myself the whole flight.

You know, it it you learn to live that way.

And it's it's really, you know, it's demoralizing.

It makes you feel bad about yourself.

One of the one of the key things that happened when I saw this weight management team was having them do do my history, do some blood work, you know, look at everything and come into the room and say, this i And I was like, wow, I literally cried in the room because your whole life you're looked at as being, you know, you e or you don't do enough or you're you're lazy or all of the things.

So those negative things and you start to internali But when you have somebody say to you, this is a chemical imbalance in yo your body doesn't know how to use the fuel you're giving it, and if you take this medication, your body will start to use the fu You're giving it correctly and you will begin to lose weight as long as you do the things you need to do.

Obviously, I am on a diet in a sense.

You know, I watch what I eat, but when I would do that before, it didn't work.

Now it actually is working.

So yeah, the stigma associated Th e stigma associated with taking the drugs.

I'm not one of those people who is looking to shap I had medical issues and in my mind and everything about me, this is a medical issue.

I you know, I was pre-diabetic for many, many years.

I was right on the borderline.

My agency was terrible You know, my health was bad.

I use a CPAP, all the things tha with being overweight that are now lessening and lessening and lessening.

And I'm not there yet.

I've still got a One of the other questions that has come up is whether people will have to s that there's really something that's going to become a permanent part of your life.

And the recent studies seem to point in that direction that if people stop taking it, then they gain weight Do you have any thoughts or feelings about that?

Yeah, to be honest, I think when I initially st a couple of years ago, either I misunderstood or they weren't cl I'm really not 100% sure, but I think I. I thought this was something that I could do until I got to I wanted to be at, and then I could slowly go off the medication.

And now it's been made very clear that that's not the case.

I am probably going to have to be on this medication for life.

And, you know, as long as I have the resources to do that, insurance is very, very important.

In this instance.

Some people's in it doesn't cover the drugs, which is r I'm lucky, very happy that my insurance does cover it.

And as long as I have that and I'm able to, I will stay on it.

It's so worth it.

Do you have any other messages or what it's meant for you?

I guess from what I understand, I think who works the best for or people like me who And it's actually this chemical issue within us that is is holding us back from weight loss.

I would say talk to your doctor, talk to a weight management team, do what's right for you.

But I can easily say that this has be the best decision that I've ever made for myself medically in my life.

Tamara, for Tammy Body, thank you so muc Thank you.

Tamara raises a lot of really impo And I want to just start with just the idea that this has been life ch This has had a profound impact on her li I wonder with both of you if that's th Dr. Wagner for sure.

That's sometimes not a rewa is when you have these people that have th and they can share these stories, things that you won't even think abou now in a restaurant that I couldn't sit before.

I had to sit at a table instead.

And you're like, okay, th with throughout their lives because they have, again, this An d if you treat that, then that does see world in kind of a different light, which has been really, really, really rewarding for sure.

And Dr. from your patients that has had a life changing impact Absolutely.

And not only causes what we call cardio metabolic conflict issues of obesity like hypertension, cardiovascular disease, mechanical complications like osteoarthritis, obstructive sleep apnea.

There's also a psychosocial complications of this disease anxiety, an d things that actually impacts a patient's quality of life, which exactly what Tamara was talking about, that prior to getting on example, how her quality of life was impacted just from a simple act of going on an airplane and sitting in a seat and not because of the weight loss How much easier it is for her to actually navigate her world.

Right.

to write any of that stuff.

She's be She tells you, like my her mom took her from th If I saw her in the office, I would be like talking abou modifications with her because I'm sure she could probably tell me Bu t nutrition than most people would.

So I think in her case that's very good that she saw And when you talk go ahead talk about some medicines tha In addition, everything she's doing right now.

That's a great point.

I mean ev and there's a lot of discussion about it, there's a lot of news coverage of these weight loss medication But there still is that stigma.

And I think sometimes you still see you know, if you would just, you know, eat less or exercise more, Not easy to take these medicines, not easy to make a doctor's appointments, that easy to go talk to somebody about this.

Right.

So you're doing all that stuff already and it's not like you just t and do you live the way you live before Yo u still have to put the work in.

It's just another tool Ye ah, that's a great point.

And and if I could just add one So for decades now, there have been many Ma ny patients, including Tamara, have tried them.

But what we do now know is that just through lifestyle change alone, we can expect somewhere between 5 to 10% weight loss.

Of course, there's variability within that, but it's important to keep in mind if you get a pat of their CPAP machine, we need to lose more than 10% weight loss and sometimes 5 to 10% doesn't go far enough for a patient who has diabetes.

And when the individual does do is that 5 to 10% weight loss, the body's physiology as part of this disease will try to push back to get the way back up to right where the patient had started.

And I think these two is what really highlights the importance of why medication has to be a part of obesity trea If we are serious about treating this of this disease completely.

Great point.

Well, we h And Joe writes, I was prescribed ozempic but experienced severe acid reflux, stomach cramps and constipation.

After six weeks, I stopped.

If I kept taking it, would these symp And is it important to maintain a strict diet and exercise program while taking Ozempic?

Dr. Solomonov, do you want to start us off with that So sev And he just it sounds like he's decided to stop taking it.

And should he try it again now?

I think when it comes to the side effect, the first thin is to pick up the phone and call your health car and talk to them about the side effects that you're experiencing.

That's how they can get in.

Ask some question to Was the titration was done too fast?

What are the other symptoms that you were expe So I would say really talk to your provider before you cross out the medication as a p I do think that is very variable from patient to patient.

Some patients take a little bit longer to adjust, others don't.

And that's why it's important to really talk to your provider.

To the second question about the strict diet, really, I don't think anything stric I think the goal is to have a healthy, balanced diet, and particularly with these medications that are so effective in reducing hunger and increasing the sensation of fullness, it becomes critical for the patient's calories to not drop down to low.

They're not eliminating any specific food group, and they're really sitting on top of their protein inta really just trying to kind of follow that kind of common sens middle of the line, kind of that nutritional intake.

I think, you know, I think we try to coach people before they start the medicine.

I'm going to tell you the side effects are.

So when you have them, y Kind of deal, right?

So it sl So what you put into it doesn't come out as quickly, ri So if you eat a large meal and there's no room for it to go, you're going to feel nauseous.

It's going to co You're eating a lot less food now.

So if you don't have a you're probably going to have constipation issues.

You might be drinking less water thirsty, too, from it now, in addition to may So if those things if you try to keep somebody regular, sometimes I'll coac Hey, maybe you like Metamucil.

Start that when you st even try to help like an osmotic laxative to try to keep you the regular too.

Because the whole goal in medicine is not to make you sick at all.

It's just as a tool to help you with this process.

Also, we need to look at like what dose maybe he was on, right?

Did he go up like Dr. Sullivan only sa You know, maybe.

Maybe he's d Maybe it's not the medicine for him.

That's not.

It So everybody can be re Right?

and there could be another option that maybe might not be like a cheap one.

Okay.

because there could be thes Maybe there's other medications, maybe the dosage level, whatever, who But to go talk with the doctor before you just call it quits.

So we're going to remind people that if you have a question or comment, you can give us a call or send us a I'm Ann Dennehy and this is WPC Use Conversations Live Ozempic weight loss and health.

And we're talking with two experts and we'd love to h Our toll free number is one 800 5438242.

You can also email us at connect at double ups you.

Dot org.

And I want to go back to kind of talked about a little bi And that's something that Tamara mentioned too.

There's seems to be a push away from that, though.

Instead of going on a diet, because then you have to go of probably is to maybe look at more lifestyle changes.

Is that is that true?

Is that what you tri Same thing I tell myself.

Same thing I t You know, that's kind of nutrition, the backbone of things, right?

So, yeah, I feel like, you know, definitely that's always going to be the first part of it f Yeah.

An The idea that instead of thinking abo anyway has an end to it, trying to make shifts in lifestyle?

Absolutely.

Yeah.

Because And I think trying to go too restrictive, we always will be running the risk of the patient feeling that they cannot keep up with it long term is just not compatible with their life.

I think being on the medications, it will certainly help the patient re the volume of their food intake so it becomes easier for them to achiev which is a calorie deficit, which then becomes much more important to look at the whatever amount of calories that they are eating, when are eating it, how are they eating, and what is the composition of what they are eating?

Certainly in our clinic, we really advocate for a balanced compos We don't push five, a very low carbohydrate diet or very low fat diet, or eliminating a particular group of f because certainly pizzas and burgers and French fries are not going to get out of our lives.

They are part of our food Ou r focus is more just really working st andpoint to understand how to incorporate it in a reasonable way while trying to kind of maintain that lower calorie intake.

So we've talked about some of the short term side effects.

How much is known about the long term side effects?

Have there been research on this?

Is this something that's under Dr .

Suleimani, Do we know long run?

Is it okay if someone needs to be on this for for th Are there going to be any problems with that?

So certainly these medications have been studie So, for example, would they go be one of the trials that was done to actually look at how effective is in terms of delivering the weight loss and maintaining the level of we about two years out?

So I think we need to learn more sle I think certainly in our medical community, there's a lot of concern in terms of what is happening to a patient's muscle mass as they're going through the significant amount of weight loss.

Also, there are concerns about how much is it really slowing down what we call the peristalsis, the movement of the intestine, the GI tract, and how does that results into obstruction of the in I think those we need more time.

That's why, again, I highlight the importance of wo with a health care provider that is key so things can be done at the ri that works for you.

And there is that oversigh So if you are experiencing issues, you make sure you let your doctor know about it right away or try to get in for sure and talk to that You can figure it out.

We can say, okay, well, what did you eat last?

Did you have a big meal night before and you felt sic Maybe that's the reason that you eat too.

And maybe you're trying to put a lot of large me into a space volume that just wasn of Give us a l ri like you're eating, you have to eat less, right?

Or you have to change the way that you're eating b So the mindset is a little bit people because they're just used to eating a certain way all their lives.

And that's really hard to change.

And that's why som You can't just flip a switch and fl So, yeah, another that's come up is a shortage of medicatio So these drugs are becoming extremely popular right now.

Yes, they are expensive, but in some cases they are covered for d or other reasons and other times people think it's worth paying for.

So we're seeing shortages.

And I wond with your patients who maybe have a prescription but are having filling that prescription?

That's frustrating b we got somebody on the medicin no, we can't find it anymore.

It's working great for y You back to scratch, titrated up.

Yes.

That's very challengi So do you work with people on, thou I think it's going to ge You just tell them.

that might have it or something.

You have to alter But yeah, they can definitely be heartbreaking because people really don' and then see their weight gain back that they went all this hard work and an effort Sure.

Dr. Solo there'll be a curve on that and those sh So when you look at seven out of ten Americans are struggling with overweight and obesity and potentially qualifying for this medication and we have only two medications and one that was ZAP and was just very recently approved for obesity treatment.

It's just not possible for the supply to meet the demand.

And what I would and I completely agree with Dr. Wagner, when patients are on this medication and they can see the positive effect is certai breaking to see that the patient can no longer access it.

And they are experiencing, they think, and it's q Couple of points that I want to put out there.

Number one, it is important for patien that they're the empathize with kind of where they are in terms of being desperate to be on the medication so they can continue to lose weight or maintain the weight loss that they have accomplishe But I would really caution that they to obtain medications because those are not FDA regulated.

They have not been research and they could be dangerous.

So that's number one.

Number two, yes, the and Zyban are second generation we But keep in mind, in the lesson we looked at earlier, there are other weight loss medications that c You know that there's a minimized utility of some modification in helping the patient maintain the weight loss that they have accomplished.

So again, they are effective medication.

I do think the supply demand issue will subside with but I caution patients to not go to compound pharmacies and keep in mind adorably loss medications that are available Okay, is for people not familiar with a compound pharmacy, is it correct that there's somewhere where this might be a pharmacy that th And that might be a case of if somebody has a specific allergy.

So they want to make sure that they're tailoring it to that person.

So there's kind of tailoring the medications.

But in this case, you're saying, no, to have this kind of customized made medication.

Correct, because it's not the same active ingredient that exists and make all the ends up that.

So the molecule is are not the same.

And that really does bring out the question of its its effectiveness, short and long term.

And there are patients who have actually experienced pretty severe side effects with these.

And that's why these are not So yeah, I really do get on some my blood type, which is an active ingredient in the body and enters appetite, whic The only form that the patients should really get them is under those two names because that's where the studies have been done.

That's where we know the most in terms of this effectiveness, how to monitor the patient and in terms of the safety data.

Okay.

and try to find someplace that's going to going to make it for you.

Well, a lot of what we've been talking about far has really been focused on adults, I th But these medications are available for children, too.

Is that right?

what is that like?

I guess work come out.

Are there different questions and different concerns?

Right.

to looking at the as as a I think that's good that we can get to spell some of those stigmas early for them so that they're like they talk you know, Tonya did throughout her kind of life.

Yeah, I think those are very great because again, we want to try to prevent some of these other chronic diseases from developing in t And again, it's just a tool that they can use just like everybody else to help them through, you know, their disease management.

Yeah.

And Dr. Salomone, what been working with ch I mean, I would imagine you want to help the child.

You want them to be able to not have to strug but you don't, on the other hand, want them to or embarrassed about how they look, because that can be a struggle for for kids with that age 12.

Absolutely.

And I th to try to treat when it comes down to obesity.

And you're absolutely right, they do experience a great deal of weight, from their peers, from their teachers, even from their own family.

But I think also, again, more importantly, it's it's important to keep in mind that, you know, since they have and not allow the weight to continue to go up.

And part of that treatment is going to be farm pharmacotherapy medication and lifestyle modifica So we certainly do have prevalence of overweight and obesity in the pediatric population.

And both because we and you said meal has been approved for those individuals at our age of 12 until 17 years of age.

So they can be prescribed those medication again.

I would go back to talking to a provider who has experience in treating obesity in pediatric population because I think there are many things to be considered, such as many kids.

They don't make their own decision in terms of what is brought into t and what is prepared for them at So it's very much is a joint decision to be involved in that effort.

So I do think it's important to reall that does have an experience with pediatric obesity Okay.

That's a great point.

And I want to come back to that issu But first, we have a call, and this is from J.R. in Clearfield.

Hi, J.R.

Thank you for calling in.

Do you have Okay.

since this weight gain is are being obese or overweight is a disease, I'm asking why this disease has progressed to this point in this country.

Okay, that's a good question.

So why are more people no w in 2024 than 20 or 40 years ago?

If it's a disease?

I think if it's a disease, wouldn't it have bee And it is is now.

Dr. Wagner, do you have any.

Yes.

So there's lots of probably Yo u I think one of the things maybe that's simply what he's asked the question is, but how we look at disease and we look at it more of like a severity scale.

So we don't use the terms like m We use more like Class B, C, Class one, Cla So we can actually define like the severity of the disease itself.

You know, I think there are pr healthier than, say, maybe it's more expensive or if, hey, I'm Trina, let's talk with people and you can kind of get a sense, hey, I'm traveling a lot.

You know, I know very well or my I want to give my son a treat, but I don't have a lot So the most inexpensive way I can do that, it's like which might be might not be like the best food choice for them.

But, you know, you're doing something, you know, in a human experience for somebody So sometimes those are challenges And if that's why it's available and ther certainly there's a lot of there's DoorDash, there's a lot of high, you know, carbohydrate dense foods that are so delicious, You know, places are open a lot more.

Now.

I can get food delivered to me.

We're very good at man You know, I don't know if that plays into it well, but again, it's not nece you know, again, willpower, right?

It's again, your kind of genetics and ho so you can still live and do all these things and navigate away from all these things, but still have that kind of you have this Dr .

Soleimani, do you have any thoughts on that, too?

I imagine, regardless, once you hav is going to be challenging.

Absolutely.

So is a difference between obese and obesity.

So obesity is a disease.

Obese really says something about an indiv So which is why in our field, we've been really trying to shift away from using the word obese and really try to stick with obesity So to a dad and there certainly there are a lot of environmental factors that exist, such as our sedentary lifestyle.

We have a very obesogenic food environment that we are living in, which makes it much easier to gain weight.

But I do think it's important to keep in with overweight and obesity, they have some type of a genetic predisposition.

And yes, is that genetics then is going to be handed down to the offsprings?

Absolutely.

I'm perhaps may not have the healthiest eating habits or be necessarily very active, but they're not gaining weight versus somebody else that this is not wh en a patient will say, well, me and my sister pretty much are the same, but I don't know why I have gained so much weight and she has not.

And I think that tells us a lot about the genes that were handed down to that individuals, how they are expressing themselves, which really highlights what we alre that really determines when we begin to experience weight gain.

Does it start in pediatric or after we had menopause, how much weight gain you're actually experiencing is as a 30 weight, #30 weight gain over our lifetime?

Or are we talking about more of #130 of weight gain and we're actually are regaining that weight?

Are we more of an apple or a pear shaped?

So I do think it's important to keep in mind that gene but those environmental kind of factors that are in play as well do co So they really do work hand in hand together.

Okay.

and this is from Pat, and he writes, What do you think about these dieting apps like Noom that seem to focus more on psychology?

Are they worth looking into?

Okay, that's a great quest So we see a lot of those apps And, you know, the commercials are having a lot of success.

I don't know how well they work that something that you patients or recommend.

Dr. Weiner T Use all the tools you ca Like, hey, you're putting in the w Why not?

That's a great, I think, There's, you know, tracking calorie counting.

Now we got to make sure, hey, Yo u know, there's some contraindications, like if you had th we wouldn't want you to count calorie track th So this is again, why it's important wh en you're kind of maybe look Dr. Solomon, any thoughts on that?

Any of the apps that people as a way to either track or try to help themselves Yeah, absolutely.

I But I do think, again, going back to the point that we've been th roughout the program, it's important for the listeners to keep in th at treating obesity you have to do this all treatment.

I think news does a great job from a lifestyle modification standpoint, but again, we do have to treat this kind of maladaptive physiology of the disease itself through pharmacotherapy.

So if a patient's does not know, let's say they don't lose weight or they do lose weight, they hit the plateau too early or they're regaining weight in all of those scenario really does have to be concerned because I'm sorry.

Yeah.

who are on one of these weight loss medications that they plateau so they lose a certain amount of weight and then they plateau?

And is there anything that can be done?

Is there a way to kind of continue losi What is the outlook there?

So plateau is i that we have, whether it's lifestyle change, medication or bariatric surgery, our body will lose weight until a certain point, until it hits what it's called.

That's kind of set of weight that we have or the brain will actually become uncomf mass loss we're experiencing and is going to make some changes in the hormonal status and our metabolism trying to push the weight back up.

And I think this is perhaps where weight loss medi of how well we can do in helping a patient break through that plateau or if we are not able to help them keep that weight off long term.

Because keep in mind, when an individual hits a weight loss plateau, more than likely they're going into a phase that we call weight regain phase, which is the biggest cha is one of the top things that particularly women come to my clinic and ask and the Tommy Tommy had to I never regained it back.

And don't think we have that a But I do think we can do a better job of helping that patient, keeping that weight down long term with the utility of medication and keeping them engaged from a lifestyle standpoint.

And I want to go back to the issue of working with not just children, but families.

So if you're an adult or a child an d you're trying to also make the lifestyle and eating changes that go with that, do you have to have your family on board?

And is that something that can be a challenge?

It can definitely be a challenge.

I think it's hel I think I have heard stories of people that said they kind of fel at the dinner table because the family would be questio Why aren't you eating the same portion sizes that you're eating?

Is there something wrong with you kind of deal?

I think sometimes having a conversation with you know, I'm starting this medicine so that way ever kind of on same team.

It would be helpful.

modifications and just, you know, just having healthier food intake.

Dr. Solomonov, can that be a challenge sometimes to get the whole family on board, whether it's with a child or another adult?

Certainly is.

you'll have a family member participating in your weight loss effort, the outcome is really good for the individual and also their partner.

Lose weight along with you.

That being kept in mind if y you know, let's say toddlers, you cannot get them on board with your diet.

The reality is that chicken nuggets and French fries and mac and cheese is going to be part of your dietary pattern in the An d again, I think that's when it becomes really important to really have that one on one conversation with the obesity kind of medicine group where they do have a dietician, they have a behavior, certain obesity medicine specialist, they can sit down and really do an d help them figure out if they have a partner on board, how they can make it work with a partner as well.

If it's difficult to get all the family memb how do they really make it work for themselves as well as their family members?

But I actually would say this Well, that's a perfect segue way to our last question.

And Dr. lifestyle or losing weight, but can feel kind of overwhelmed by all and also just the daunting prospect that they're not because many of us have been down that road before.

Do you have any of you kind of key easier first steps for pe For sure.

on the Internet eating Qualcomm's fo r some nutritious eating, and that's a free website.

But also, you know, just seeing your primary care physician, it's goo just to go in there and make sure, hey, if you're having, you k if you have this, you know, obesity is a disease, let's make sure it's not the reversib Let's make sure there's no other metabolic arrangements as well, and we'll set you up for success.

This is a lifelong journey.

This is something that you can just learn all Thank you.

So I'm sure we'll change.

We'll get more So I think that's where it's kind wi th your primary care doctor, so I can help you with tha throughout the whole course of yo once and then just, you know, fixing it, which is the case.

And Dr. Solomonov, do you have any thoughts on that?

Just a few key steps that somebody might take if they're feeling overwhelmed but they do wa Absolutely.

I that they're not the only one that's overw I think almost all the patients that come through our clin What is right for me, How should I go about it?

Which I exactly?

I wo don't have to do this by yourself and alone.

We understand the this is better.

We do have better treatments an d get in and talk to your health care provider so you can at least discuss what are the r and be open and discuss what has been the struggles for managing your weight long term and what are you really look Well, Dr. Wagner, thank you both to talk with us and sharing your expertise I know I learned a lot.

Thank you.

Thank you.

Our guests to I'm Anne Danahy.

Thank you for wa And please join us again on February 22nd for a conversation on the state of the economy.

Rewatch this and previous episodes of Conversations Live and more of your favorite WPSU programs on the PBS app.