Weight Loss and GLP-1 Meds with Dr. Ania Jastreboff

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Speaker 2 Whether you are listening on the Oprah podcast or watching on YouTube, I appreciate you being with us. Last year, millions tuned in to my special on ABC, Shame, Blame, and the Weight Loss Revolution.

Speaker 2 It's now streaming on Hulu if you want to check it out. We're continuing the conversation around weight loss medications like Ozimpic and Munjaro.
People still don't understand it.

Speaker 2 Is it the easy way out?

Speaker 3 It's absolutely the opposite.

Speaker 2 I'm joined on this podcast by Dr. Anya Yastrovoff, an endocrinologist and associate professor at the Yale School of Medicine.
She has been studying GLP-1 medications for more than 20 years.

Speaker 3 Obesity is not a choice. It is about biology.

Speaker 2 We are diving into the latest research on these medications that roughly 15 million Americans are now using. Can you set the record straight on side effects? Dr.

Speaker 2 Anya is here to answer a lot of your common questions.

Speaker 3 Is this something I could taper off of?

Speaker 2 You may remember Amy, who I met on the ABC special. She had lost 160 pounds after starting a prescription of Monjaro.
She's zooming in with an update. Hello, hello.
Good to see you again.

Speaker 3 So good to see you.

Speaker 2 A quick note, my guests on this podcast asked us to show their before and after weight loss pictures because they believe the photos are a vital part of their life's journey.

Speaker 2 It's wonderful to talk to you again. You know, that new study says that nearly 75%

Speaker 2 of American adults are overweight or obese. So what determines obesity versus overweight, just being overweight? Okay.

Speaker 3 So in terms of that first question, right now there aren't really great definitions. Yeah.
So we used to use definitions of BMI. Yeah.
But BMI is really a screening tool.

Speaker 3 It's not something that was actually ever designed to be a diagnostic tool. So technically, overweight was defined as a BMI of greater than 25 and obesity as a BMI of greater than 30.

Speaker 2 And that's BASMA body index.

Speaker 3 Yes, body mass index. Yes, BMI is body mass index.
Now we're really starting to rethink what that means. What does it mean to have obesity?

Speaker 3 And the indications for the medications were based on these initially.

Speaker 3 And now that's also evolving and changing as well because we're really trying to understand what is obesity, how does it affect our health, because ultimately, when we're treating obesity, the point is not just weight reduction, it's improving and optimizing overall health.

Speaker 2 That's the goal. Yeah, the focus has been on weight reduction.
Yes.

Speaker 2 But the real truth is, and we're going to hear from some people today who tell you that what has happened to them in terms of their physical health, their emotional health, the way they see themselves, the way the rest of the world sees them, including their family members, is the big

Speaker 2 bonus for this. It is

Speaker 2 why. It's Life-changing.
It's absolutely life-changing. And I know the term life-changing gets thrown around a lot, but this really is.
Okay, so let's talk about why is, this is the thing.

Speaker 2 I recognize this probably now. It's almost going on two years that I realized that obesity was a disease, having a discussion like this.

Speaker 2 Can you share with our audience, with every person who's listening, who has doubts, who's heard, I saw on TikTok, and yeah, why is obesity a disease? Yeah.

Speaker 3 And that is such an important and critical question. So, as you said, so many people have obesity now.

Speaker 3 And two-thirds of Americans and half of the world population did not wake up one morning and decide to have obesity. Obesity is not a choice.
It is about biology.

Speaker 3 So, what is obesity and why do so many people have it? And why is it so difficult not just to lose weight, but to maintain that weight loss?

Speaker 3 And so, our body is amazing.

Speaker 3 It has this amazing, beautiful biology and basically what it was designed to do is to make sure that we stored enough energy or enough fat because we store energy as we by storing fat i'm tracking that yeah and so it said okay how are we going to do this well there are these hormones they're stimulated when we eat food they're called nutrient stimulated nutrient stimulated hormones and they communicate with our brain how hungry are we how full are we how much energy do we have yep and so this beautiful biology, so hormones inform the brain.

Speaker 2 And this is in every person's body.

Speaker 3 Every person's body, every person's body. And so basically it says, okay, this is how much energy you're storing.
This is how much fat you're storing.

Speaker 3 And so you would think, ah, we have this beautiful biology. Wonderful.
Then why do so many people have obesity if this is so carefully regulated?

Speaker 3 Well, it turns out that our obesogenic environment, an environment that is filled with ultra-processed food, lack of sleep, lack of physical activity, all this stress on a population level, that obesogenic environment that developed so much more quickly than the biology, it basically pushes up how much energy or how much fat our body wants to store.

Speaker 3 So our body ends up defending a higher amount of fat, the defended fat mass or the set point. These are terms that you may have heard, but that's exactly what our body's doing.

Speaker 3 So our body's doing what it needs to be doing, what it should be doing, but a little bit too much in this environment.

Speaker 2 So why does it do it for some people and not for others?

Speaker 3 Yeah, and that's a really great question and one that we're trying to sort out and figure out.

Speaker 3 What we do know is that for most people, maybe, you know, over centuries and millennia, we evolved in this way where basically you wanted to make sure that you didn't starve, right?

Speaker 3 So you wanted to store enough energy so that if there was a famine, you would not starve. But if you think about this, this is actually very, very tightly regulated.
So we all eat incredibly,

Speaker 3 we all eat a lot more than what we actually need. So, our body actually figured out how to burn extra.
But after a while, with this obesogenic environment, it actually says, No, store it.

Speaker 3 Maybe I need it for later, right? So, when we try and lose it, our body fights back and it says, No, no, no, no, no.

Speaker 2 Okay, but that's that's in somebody's and not in others. That's true.
Okay, and so is that because in my body, because I obviously have an issue with obesity.

Speaker 2 In my body, in people who are prone to be overweight, as I have been,

Speaker 2 is that because my hormones are different than the other person's brain?

Speaker 3 They may be, or your brain, because obesity is a neurometabolic disease, or neuroendocrine. Hormones inform the brain.

Speaker 3 So maybe in your body, your body's like, I'm really good at holding on to that energy. I'm really good at holding on to some extra fat, just in case I need it later.

Speaker 3 And somebody else's body says, no i don't need that but for most people to you know where we started the conversation for most people

Speaker 3 we want to store more we want to store extra and that is where our body is happy and that is what our body defends and it's because of the environment we live in and that tells us two things one is we have to change the obesogenic environment We have to, because if we don't, we're not going to be able to do that.

Speaker 2 And what do you mean by obesogenic environment?

Speaker 3 An obesogenic environment. So one that is filled with ultra-processed food, lots of stress, lack of sleep, lack of physical activity.
All these things are built into our environment right now.

Speaker 2 But when I'm,

Speaker 2 listen, I've done every diet, as we're going to talk to people today who have also done every diet. And even when I'm not, when I'm not, quote, dieting, I considered myself eating healthy meals.

Speaker 2 And,

Speaker 2 you know, I'm not a person who, you know, goes to fast food restaurants or, you know, I do eat a lot of potato chips. But I'm not sure.

Speaker 3 And that's what your brain brain craves your brain

Speaker 2 craves those potato chips it craves a chip or something that's crunchy or salty that's right and it's my go-to if there is any discomfort in my life whatsoever a bad phone call yes i have to do all of my

Speaker 2 help with your stress yeah absolutely I don't know why a pretzel calms me down, but it does. But it does.

Speaker 3 And here's the thing. So those pathways.

Speaker 2 And is that my hormones?

Speaker 3 It's your hormones and your brain. And my brain.
And your brain. So, for example, for you, it's maybe it's potato chips.
When you consume those foods, when you eat those foods,

Speaker 3 that signals to your brain something positive. So these hormones, they communicate with all sorts of areas of our brain, including reward motivation areas of the brain.

Speaker 3 So we find these foods highly rewarding. Our brain does.
And the thing is, again, we were designed to function this way. Because let's say that we some people find them rewarding.

Speaker 2 Some other people find them. Some people don't.
Potato chips don't turn them on. Exactly.

Speaker 3 It's something. And that is actually why I started doing the research that I do.

Speaker 3 Because I thought to myself, well, why is it that some people crave potato chips and other people want the cheesecake or the

Speaker 3 crispy creams?

Speaker 3 So why is that?

Speaker 3 And the answer is right now, we don't know.

Speaker 3 But initially, I was doing these brain studies to really try and understand what that was about and what reward regions of the brain were actually responding.

Speaker 3 Let's say you saw a picture of a potato chip. How would your brain respond differently than somebody else's? And again, that has to do with...

Speaker 2 I see a bag of ruffles or I see a ruffles commercial.

Speaker 2 Listen, I've gotten up and left my house to go get a bag of ruffles.

Speaker 3 And that's, and this is the thing. And

Speaker 3 maybe we'll talk about food noise, but that's what it is. If there is a bowl of brownies on the table, I would not be able to focus on you.
I'd be like, oh, I want the ice cream and the brownies.

Speaker 3 And the thing is, is it's.

Speaker 2 But that wouldn't affect me. A brownie wouldn't affect you.
Wouldn't affect you. Right.
But the potato chips, then that's what.

Speaker 3 i would not if there were potato chips here it would it would be a battle it would be a battle not to not have one yeah and i know that if i had one yes because i have an addict's brain i would not be able to you would eat all the potato chips yeah when lays did that you nobody can eat just one i think they knew what they were doing they knew what they were doing they had called you but to your point about the fact that you're eating very healthfully and you have for a majority of your life um again the amount that we eat and again our body craves a larger amount of food the amount that we eat is a lot more than what we actually need.

Speaker 3 So our body actually burns a lot. It's just that different people may hold on to less of that food than others.

Speaker 2 So, you know, one of the big breakthrough for me a couple of years ago when I was doing, having this discussion, the state of weight on O'Dale, the big breakthrough for me was understanding, oh, the aha for me was like, oh, this is like the years in the early 80s,

Speaker 2 mid to late 80s. This was like the years of the mid to late 80s.
We started the Oprah Show in 1986.

Speaker 2 And I remember doing a show on alcoholism in 1987, on a whole family of alcoholics and generations passing it on. And people were outraged that you would call alcoholism a disease in 1987.

Speaker 2 Like, how dare you? They just need to put the bottle down and they're really just drunks and so forth. And over time,

Speaker 2 through education, through information, through people looking at other people in their family, through corporations understanding what it was, people came to understand that it actually is an addiction born of disease.

Speaker 2 Yes.

Speaker 2 And I think that's where we are now with obesity. People still don't understand it.
They want to blame other people for it. They want to say, just put your fork down and quit

Speaker 2 eating those brownies or those potato chips. And what's wrong with you? And one of the reasons why I was reluctant to use them in the beginning

Speaker 2 when I was trying to lose weight after my knee surgery, because I also felt it's cheating, it's the easy way out. I've got to prove this one last time.
I could do it by myself.

Speaker 2 And I don't want people saying I took the easy way out. And I think that that's one of the major issues that people who are now open to using the drugs are experiencing from

Speaker 2 their their their friends or colleagues their families and also within themselves is it the easy way out yeah i mean i couldn't agree with you more and your story is one first of all

Speaker 3 i'm so sorry that you went through all this and in such a public way oh my goodness when i think about it i just you're so strong

Speaker 2 and to have that so publicly and you just you thank you for that yeah because now that i look back on it i I've said this on other occasions, that I was publicly humiliated for 25 years, every week, exploited by the tabloids.

Speaker 2 Every time any comedian wanted to make fun or make a joke about it, they could make a joke about it. And I accepted it because I thought I deserved it.

Speaker 2 I accepted it.

Speaker 2 I was shamed by it. And I received it because I thought, well, they're right.
Right. And they were wrong.
And they were were wrong. Now I know they were so hard.
They were wrong.

Speaker 2 But now I know why they were wrong.

Speaker 3 When you're living it, it is so hard.

Speaker 3 Blame yourself. It's so hard.
It's so.

Speaker 2 And any person who's watching or listening to us right now who has suffered from obesity or being overweight, you know exactly what I'm talking about.

Speaker 2 You do not have to be on television every day to experience the same level of shame and embarrassment. And why can't I do this? And I'm so good at so many other things.

Speaker 2 And I can take charge of my life. I can do all of this.
And why can't I?

Speaker 2 So the outside world telling you that you are less than, that you should be shamed. That's right.

Speaker 2 Feels like the punishment you deserve.

Speaker 3 And

Speaker 3 it's absolutely the opposite. It's absolutely the opposite.
And none of this is in our control. Somehow in society, we think that how much we weigh is in our control.
And it's not. It's not.

Speaker 3 It's in our brain is in control.

Speaker 3 It's like the alcoholic finally finally realizing that it's not my willpower that caused me to not to be able to pick up the next yeah and just like with alcohol those reward motivation pathways those regions in the brain really respond in a certain way when someone who has alcohol use disorder is drinking alcohol In terms of obesity, those are the same brain pathways.

Speaker 3 Now, obesity is not an addiction.

Speaker 3 The thoughts of food and the wanting of food, that is something different. And again, that's

Speaker 2 the food noise.

Speaker 3 It's a manifestation of the biology. It's a biological body.

Speaker 2 And all the people who don't have obesity as a disease don't even know what we're talking about.

Speaker 2 Yeah. You don't know even what we're talking about.

Speaker 2 Because one of the things that I realized the very first time I took a GLP-1

Speaker 2 was that all these years I thought that thin people,

Speaker 2 those people,

Speaker 2 were just had more willpower, they ate better foods, they were able to stick to it longer, they never never had a potato chip.

Speaker 2 And then I realized the very first time I took the GLP-1 that, oh, they're not even thinking about it.

Speaker 3 That's right.

Speaker 2 They're only eating when they're hungry, and they're stopping when they're full. That's right.

Speaker 2 There was a guy named Bob Schwartz who had a diet called Diets Don't Work. And the whole principle was to eat when you're hungry, stop when you're full.

Speaker 2 Did multiple seminars three times with him on that. And the principle is great,

Speaker 2 except if you have obesity, it doesn't work. That's right.

Speaker 3 That's absolutely right. And to get to your question of, well, is this the easy way out? Is taking medications the easy way out? It's not.
Think about it.

Speaker 3 Think about when we treat someone who has, let's say, high blood pressure. Yes.
And they come to see us and we have to.

Speaker 2 Lots of Americans have to be able to do that.

Speaker 3 Lots of Americans have high blood pressure.

Speaker 2 And we have people who have high blood pressure.

Speaker 3 Exactly.

Speaker 2 So we say, okay.

Speaker 3 Low salt diet is very helpful. And here are some medications that can treat the disease biology.
Yes. And we need to do the same for obesity.

Speaker 3 We need to say, yes, healthy diet and exercise are critical and they're very important for optimizing health.

Speaker 3 And to treat the biology, the biology of obesity, here's a medicine or medicines or surgery or what have you that will help actually treat that biology.

Speaker 2 We do the same thing for diabetes. My mother was a diabetic.
She was an insulin shooting diabetic for most of her life.

Speaker 2 And

Speaker 2 she would be told to stay off of sweets and every now and then because people in the South, just a lot of people in the South, not generalizing, but a lot of people that come from my family in the South think that having a little bit of coconut cake is okay.

Speaker 2 Because they used to call it sugar diabetes. Yes, sugar.

Speaker 3 I have a touch of sugar.

Speaker 2 I have a touch of sugar.

Speaker 2 And they call it a touch of sugar and never realized how

Speaker 2 really definitively

Speaker 2 bad it is for you to have a little bit of sugar when you have diabetes until you end up going blind or end up having to have your leg amputated and all the things that happen.

Speaker 3 Exactly. And so diabetes is another perfect example.
We say we recommend a low-glycemic index diet.

Speaker 2 So less sugar. Less sugar.

Speaker 3 And here are the medicines. Yes.
And for your mom, if it was insulin,

Speaker 3 and here are the medicines.

Speaker 3 So we pair them together to help that person's health, whether it's to help prevent all those downstream complications that can develop or whether it's to treat that disease in and of itself.

Speaker 2 So if you have high blood pressure, which a lot of people do, you are recommended not to have salt. And here's a blood pressure medication.

Speaker 3 Here's a dash diet and here's a medicine.

Speaker 2 Yeah, everybody's out there taking their blood pressure medications and not once do they think, boy, this is the easy way out. That's right.

Speaker 3 That's exactly right. And with obesity, for whatever reason, we have this different perspective and we need to change things.
Because we don't understand. We don't understand.

Speaker 2 It's my hope that this conversation with Dr.

Speaker 2 Anya will help you become more informed about the research and medications that are literally flipping the script on everything we thought we knew about being overweight. Stay with us.

Speaker 2 We'll be back in a moment.

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Speaker 2 Hey again to you. I'm with Dr.
Anya talking about the GLP-1 medications that are revolutionizing weight loss. Why do you believe it's so important to tell your patients that obesity is a disease?

Speaker 3 It's critical. It's It's absolutely critical.
And when I approach this, so when I see a patient, the first thing I do is one, I set the stage and I say, this is a no judgment zone. Yeah.

Speaker 3 And the first thing I ask them after that is, tell me about your weight journey.

Speaker 2 Tell me about your struggles.

Speaker 3 Tell me, just tell me, tell me. And then I listen.
And as I listen to them, I bet you get a lot of tears for that. A lot of, I mean, they cry, I cry.

Speaker 3 It's, and the thing is, is there's something that happens in that moment where people begin that journey of understanding that it's not their fault and it's not something that they chose.

Speaker 3 And we're here to help them to treat that biology.

Speaker 2 Because why, why would you choose it? And why wouldn't you change it if you could?

Speaker 3 That's right. That's absolutely right.

Speaker 2 Why wouldn't you change it if you could?

Speaker 3 You can have the,

Speaker 3 you know, the healthy foods, and still, our body is so smart.

Speaker 2 It's so smart that it's like, no, And some people, your body is going to hold

Speaker 2 on to the fat. Yeah.
It's watching. And you're just built that way.
You're just built that way.

Speaker 3 And

Speaker 3 if you

Speaker 3 begin the discussion of this is really about biology and that your body's smart and that the hormones are communicating with your brain and all these organs and your body and your body's doing exactly what it was meant to do, exactly what it was meant to do.

Speaker 3 And then again, patients start to

Speaker 3 start to let go. And there's something magical that happens in that moment because they become curious, curious about the disease of obesity and open to treatment.

Speaker 2 That's right, because you're no longer blaming yourself. That's right.

Speaker 3 You're no longer blaming yourself.

Speaker 2 Okay, can you explain why these GLP medications

Speaker 2 have been a game changer for so many people?

Speaker 3 So as we talked about, hormones, nutrient-stimulated hormones, they communicate with our brain to let our brain know how much energy to store, how much fat to store.

Speaker 3 The medicines, they target the same receptors as these nutrient-stimulated hormones. In your brain.
In your brain. And those receptors are all over the brain, including reward-motivation regions.

Speaker 2 People are thinking it's targeting your stomach because I know some people take their shots in the stomach.

Speaker 2 It's not targeting your stomach.

Speaker 3 No, obesity is a neurometabolic or a neuroendocrine disease. It's literally a disease.

Speaker 3 Yes. And so what happens in obesity is that there's something that is dysregulated or broken in terms of the set point, in terms of how much energy we want to store.

Speaker 3 And the medicines, what we think that they do is that they re-regulate that set point. They decrease that set point.

Speaker 3 So as you start taking a medicine during that first phase when you're losing weight, what happens is your body is trying to chase a lower defended fat mass, a lower set point.

Speaker 3 And so that's why people eat less in that first phase. Then once they plateau, once their their weight plateaus out,

Speaker 3 then some of the hunger and cravings and things can return, but the weight does not. And we have to reassure our patients that that's exactly what's supposed to happen.

Speaker 3 Because once you get to a new weight plateau, you're not chasing a new defended fat mass. So the medicines lower or reset the defended fat mass or the set point.

Speaker 3 And then basically they re-regulate it to a new place. So as you increase the dose.

Speaker 2 So let's say you start out, you're 200 pounds, and then you start taking the medications

Speaker 2 and you start to lose weight. And when you say it's chasing another set point, it means what specifically? What give me an example of what that number might be?

Speaker 3 So let, and it's different for every person. This is a really, because there's more than one type of obesity.
There's many different types of obesities. We just haven't defined them yet.

Speaker 3 But let's say, so somebody starts at 200 pounds and let's say they start one of these medicines.

Speaker 3 Maybe with the first or the second dose, that set point goes down to, let's see, let's say 180 pounds, right? And then they keep on taking the medicine.

Speaker 3 And after some time, their doctor increases the dose. And then their set point decreases, let's say, to 170 pounds.

Speaker 3 So with every dose escalation, you're chasing a new lower reset defended fat mass or set point.

Speaker 2 Okay.

Speaker 2 So many of you might remember Amy from the ABC special I did back in the spring. Feels like years ago now.
Shame, blame, and the weight loss revolution.

Speaker 2 What happened after you went on Manjaro?

Speaker 3 Immediately, almost within days, that voice that I've had in my head since I always say my earliest memory is five years old, I remember thinking about food, when I'm going to eat food, how much I'm going to eat food, where I'm going to what I just ate, how many calories was it?

Speaker 3 And all of a sudden I took this medication and it felt like I was freed. Like I literally felt like I'd been trapped.
And it felt like I don't have to think about this all the time anymore.

Speaker 2 And Amy is zooming in from Naperville, Illinois. Amy, hello, hello, good to see you again.

Speaker 3 It's so good to see you.

Speaker 2 I remember you telling us your highest weight was around 300 pounds, and you found out that you had diabetes and your A1C number

Speaker 2 were dangerously off the charts. And then you went on Manjaro in March of 2023, as I recall, right? And you lost 160 pounds in one year.
What has happened since we last spoke?

Speaker 3 So much has happened. The one thing that's remained the same is that I've now maintained the weight loss for about a year now.

Speaker 2 And in that period of time, that is, in itself, is huge. It's wonderful.
That's wonderful.

Speaker 3 Yeah, I mean, I always say that it wasn't about losing weight for me. I knew how to lose weight.
It was how to maintain the weight loss. So for me now, having maintained for a year is pretty great.

Speaker 3 And I'm pretty proud of myself for that.

Speaker 3 And during that time, I have sort of established this sort of community of people on social media who are kind of feeling the same as you and I, where it's all about,

Speaker 3 you know, I am so tired of feeling bad about my weight. And I'm so tired of being shamed for my weight.
And it's not my fault. And I'm not alone in this.
Yes. And

Speaker 3 I'm tired of people shaming me for being on a Zempic or being on another GLP-1 medication.

Speaker 3 It's been kind of a whirlwind since we last chatted.

Speaker 2 And I hear you're getting messages, hundreds of messages every week from people online. What is the number one question that people are asking you or comments that are coming to you?

Speaker 3 People want this time to be different. Like I said before, I know how to lose weight.
I didn't know how to sustain it because often when I was losing weight, I would feel that I was starving myself.

Speaker 3 I wasn't giving myself the right nutrients. I wasn't allowing myself to have a piece of my daughter's birthday cake at her party because if I ate carbohydrates, I was going to gain weight.

Speaker 3 And and so this time around people want to know how to do it differently so they might be on a GLP-1 medication or maybe they're not yet or they're thinking about it but they want to know how can I heal my relationship with food how can I heal my relationship with my body it goes so beyond the exercise regimen and the diet changes but how can I really heal that part that Well, I just want to applaud you because you took what was one of your greatest pains and shames and have now turned it into a powerful movement for yourself and to help other people what are the biggest misconceptions that people are sharing with you about the glp1 weight loss drugs what are they saying oh my gosh it's all day long unfortunately um on social media platforms people uh continue to say you're lazy if you're on a glp1 medication you're lacking motivation you should just be able to go to the gym It's only for diabetes.

Speaker 3 You shouldn't take it if it's for weight loss.

Speaker 2 People don't even know that there's a drug that's been created specifically for weight loss. And so

Speaker 2 I think all the time. A couple of years ago, people were saying, oh, you're taking drugs away from the diabetics.
That is no longer true.

Speaker 2 because there is a specific drug for diabetics and the specific drugs for people who are trying to lose weight. And

Speaker 2 what else are they saying to you?

Speaker 3 You know, I think people just assume that glp1 medications often they'll just phrase it as well all it does is make you starve yourself that's all it does there's not more to it and when you get off the medication you're going to gain all the weight right back and uh

Speaker 3 i mean so much shaming around these meds to the point of uh your face looks a certain way if you're on these medications or your body looks a certain way ozempic face and ozempic button yeah yes exactly i'm told i have ozempic face and ozempic butt and in reality it's just blue skin from significant weight loss.

Speaker 3 It has nothing to do with the medication. But, you know, medications like Ozempic and Manjaro are, in my opinion, a perfect sort of scapegoat for the continuation of shaming people in larger bodies.

Speaker 3 Yeah.

Speaker 3 I mean, I can't agree more. It's, it's, you literally can't win.
You, you cannot win. You're shamed if you have obesity.

Speaker 3 You're shamed if you don't have, if you, if you don't try and lose weight, you're shamed if you lose weight. You're shamed if you use the medicines.

Speaker 3 If you don't use the medicines, there's literally no winning. So, you know, I wholeheartedly agree.
You are sharing your story so vulnerably and bravely online. And you're fighting for what's right.

Speaker 3 And what's right is to stop shaming and blaming people. Just let people do what they do.
You're taking care of your health.

Speaker 2 Yeah. And people ask me all the time how I, how I kind of deal with a lot of the negativity that comes my way.

Speaker 2 And to me, I mean, so many people, when I talk about food noise or when I talk about obesity being a disease, they're like, I thought I was the only person that had these thoughts up here.

Speaker 2 And that, that out, outweighs the, no pun intended, that outweighs the, the, the other stuff, the negativity that, you know, comes my way. Well, you know what else I realize too, Amy and Dr.

Speaker 2 Anya, is that the people who are shaming

Speaker 2 oftentimes have never experienced the food noise themselves. They don't even know what you're talking about when you're saying food noise.

Speaker 2 And so that brings us to the point of, I interviewed Mel Robbins recently, who has a great book out called Let Them.

Speaker 2 You just have to let them say what they say, do what they do, and let yourself understand the power of what you're doing by creating community and building connection with people who've experienced some of the same things and are looking to improve their health.

Speaker 2 I'm so happy to know.

Speaker 2 First of all, you were telling me that back in March when we talked that you were still trying to adjust to buying the right size for yourself because you were still thinking that you needed to get larger sizes.

Speaker 2 Has that eased itself?

Speaker 3 It's definitely gotten better. You know, even though I've now been on this medication for about two years, now I've been on this weight loss journey, so to speak, for about two years.

Speaker 3 I have to remind myself that this was decades. I mean, since I was a little girl of thinking one way about my body and about food.

Speaker 3 And so lots of progress has been made, but there's still times where I look at, I'm folding laundry and I look at a pair of pants and I'm like, whose pants are these?

Speaker 3 There's no way these are, these, these still fit your, these fit your body.

Speaker 3 But I'm coming to terms with it. I challenge myself.
I take pictures of myself now. I had no pictures of myself with my children from when they were little.
I take pictures.

Speaker 2 That kind of thing.

Speaker 3 challenges some of that thinking, but I think it's going to still take more time.

Speaker 2 Yeah. Yeah.
In another conversation, Dr. Anya and I were talking to a woman who said she's kept herself out of every picture

Speaker 2 in her entire life with her family.

Speaker 3 Wearing dark colors.

Speaker 2 Wearing dark colors or standing behind other people or standing to the side or trying to avoid the picture. We're glad you're putting yourself in the picture now.
Thank you so much. Thank you.

Speaker 2 Thanks, Amy. Good to see you again.
You too. Keep up the great work you're doing.
Where do we find you online? What is your

Speaker 3 on TikTok and Instagram? It's Amy in half.

Speaker 2 Okay, great. Great.
Keep it up.

Speaker 2 Thank you. Stay with us.
I'll be back with more of my conversation with Dr. Anya.
We're talking with more people who have experienced a dramatic weight loss from these medications.

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Speaker 2 Hi, and welcome back. I'm with Yale University's Dr.
Anya, and we're talking with people who have lost a dramatic amount of weight with the assistance of the new anti-obesity medications.

Speaker 2 Next, Amina is a mom of two young children zooming in from Lee Summit, Missouri. Hi, Amina.
How are you? Hi, Opera.

Speaker 3 How are you? Thanks so much for having me today.

Speaker 2 Well, thank you. I heard that the ABC special that we did,

Speaker 2 the same one that Amy was on, inspired you to make a change in your life. So tell us what happened.
You were watching the special and you saw Amy, you heard her story.

Speaker 3 Yes, I was watching the special and, you know, I had actually quietly started the medication in January of that year, earlier that year, but I, you know, I just didn't want to share it with anyone.

Speaker 3 But hearing the personal stories that were shared about how, you know, GLP1s were really helping people take control of their health and really just, you know, changing their relationship with food, it really motivated me to really give it a really true shot and hopefully, you know, it would work out for me too.

Speaker 2 I had great hope. Wow.
And so do you have a question for us today or do you want to share something?

Speaker 3 Yeah. Yes.
So, you know, as someone who has struggled with weight for most of my life and emotional eating as well, you know, food was always an escape for me

Speaker 3 just from deep emotional pain, from anxiety, you know, and the journey for to my health didn't really start until after the birth of my two children. And in between that, two miscarriages as well.

Speaker 3 And so, you know, experiencing that level of physical and emotional trauma was something I was unprepared for. And I knew that I needed to take control of my health and make a change.

Speaker 3 And, you know, I started the traditional way as well, Oprah, in terms of diet and exercise and all of those things.

Speaker 3 But I found after the birth of my son, the weight just wouldn't drop and my health markers were not improving.

Speaker 3 And so GLP once gave me, you know, a second chance to really take control of my health and start again.

Speaker 3 And so I started in January of this year year and have lost 50 pounds, which has been incredible, you know, just my energy, everything that I have.

Speaker 2 And the food noise stopped, right? The food noise.

Speaker 3 And the food noise stopped, the constant cravings for sugar and carbs and always thinking about the next meal.

Speaker 2 All of that went away.

Speaker 3 And it's something I've, I've never experienced before. It's been incredible.

Speaker 2 What's your question? What's your question today?

Speaker 3 So

Speaker 3 I'm wondering if it's, if I will still need to stay on this medication for the rest of my life, or is this something I could taper off of?

Speaker 2 Yeah.

Speaker 3 I mean, I think that's a great question. It's probably one of the top questions, if not the most commonly asked questions that my patients come to me with.

Speaker 3 Right now, you know, what we do know is that obesity is a chronic disease. It's a chronic disease.
So let's say that you had high blood pressure and you started taking a blood pressure medicine.

Speaker 3 What would happen if you were to stop taking that blood pressure medicine? Your blood pressure would would go back up. Same thing with diabetes.

Speaker 3 If you were taking insulin, if you stopped taking the insulin, your blood sugars would go back up. And what we're seeing in

Speaker 3 not just in clinic, but also in trials, we just conducted a trial. It was three years with one of the medications is that the weight was completely maintained while people were taking the medicine.

Speaker 3 And then when the medicine was stopped, people started gaining back the weight. Now, what I can say is we see the same thing in clinic.

Speaker 3 So that is the case with most of my patients. What I usually do when patients say, well, I really like to see what happens when I stop, is I decrease the dose.

Speaker 3 I go down on the dose by just a little bit, by one step. And then I say, come back and see me in two, three months.
And they come back and see me and we see how they're doing.

Speaker 3 If they're maintaining their weight and the food noise isn't back and they're not struggling, then great, we stay on that dose.

Speaker 3 But if their weight is starting to trend up or if that food noise is coming back and they're having a really hard time, then we go back up on the dose.

Speaker 3 And I do think that just as there's differences in how much weight people lose, we will see differences in terms of how much people gain back. So we'll see variability in that weight regain.

Speaker 3 But right now, for most patients, on average, what we see, and in the studies, we've seen this as well, most people, yes, you have to continue taking the medicine because it's targeting your biology.

Speaker 3 It's targeting your obesity biology.

Speaker 2 I think it's such a crucial thing. And I actually,

Speaker 2 I've heard you say this before, but this is, I just had an aha moment.

Speaker 2 And my aha is, we think because you've lost the weight, you've solved the problem.

Speaker 2 Because in the past, every time you went on a diet, once you lost the weight, you thought, now this is it. I've done it.
I've succeeded. And we think,

Speaker 2 and I'm sure you're feeling this. I'm saying we,

Speaker 2 assuming that you feel the same

Speaker 2 that I lost the weight now, the problem is solved, but the problem isn't solved because the disease hasn't gone away

Speaker 2 just because you lost the weight. That's right.
The disease is still there. So it's just like in alcoholism.
I just had this aha down.

Speaker 3 It's absolutely nothing.

Speaker 2 It's like in alcoholism,

Speaker 2 you cannot go back to drinking because your brain,

Speaker 2 just because you've gotten sober

Speaker 2 doesn't mean you can now have a drink. We can't go back, otherwise, you gain the weight.

Speaker 3 That's right. That's absolutely right.
And that is why when we, these medicines, ah, I just had that aha.

Speaker 2 It's a beautiful aha.

Speaker 3 And it's such an important one because, again, these are not.

Speaker 2 You can't get the aha too. Did you get it, Amina? Absolutely.
Absolutely.

Speaker 3 And this is why, this is actually critical when we think about the words we use. These are not weight loss drugs.
They are medicines that treat obesity. They treat the disease processes in the brain.

Speaker 2 That's another way to look at it. Because if you look at it as a weight loss drug, now you've lost the weight.
So now I'm finished. That's right.

Speaker 2 But the disease doesn't go away.

Speaker 3 And that is why I think so many patients ask us that for that exact reason. They're like, well, I lost the weight.

Speaker 3 I'm cured. I'm cured.

Speaker 3 But it's the same way with diabetes, hypertension. Just because your blood pressure decreases or your blood sugars decrease doesn't mean that.

Speaker 2 Meaning you no longer have high blood pressure. Yes, right.
That's absolutely right. Oh, my God.

Speaker 3 Oh, good. I'm so glad we had an aha.
This is so important.

Speaker 2 Well, that's also the reason why I mean I asked that question. And everybody, I've had that question.
Everybody has a question. Do I have to stay on it? Because now I've lost the weight.
Yes.

Speaker 3 The disease is not going to be.

Speaker 2 The weight isn't the issue. That's right.
You think the weight is the symptom of the disease.

Speaker 3 It is the symptom. Just like the high blood sugars are the symptom of diabetes.
And the high blood pressure is high blood pressure. It is hypertension.
So

Speaker 2 the analogy is perfect with diabetes especially especially thank you for asking that and causing me to have multiple ahas here today thank you amina thank you thank you so much yeah thanks amina let's talk about all the different you know every every it seems like every couple weeks or so there is another disclosure about what these

Speaker 2 obesity medications have revealed in terms of helping people drink less alcohol and not obviously lowering blood sugar, but what are all the other health benefits that we are discovering?

Speaker 3 Yeah, I mean there are studies coming out about heart disease, about heart failure, about improving knee pain, obstructive sleep apnea, and all of these are obesity-related diseases.

Speaker 2 I even heard Alzheimer's.

Speaker 3 Well, and that is also being looked at. What are the effects in the brain in terms of, again, improving that? And we'll have to see that.
Those studies haven't yet been

Speaker 3 conducted

Speaker 3 as far as these other ones. So the heart disease, the...

Speaker 2 What is it about it that makes you not want to drink as much alcohol? I mean, I used to be the tequila queen, and now it's like...

Speaker 2 Take it or leave it.

Speaker 3 Yeah.

Speaker 3 So those studies are being done. We think that, again, it's similar pathways in the brain that are being targeted.

Speaker 3 So just as your craving or your hunger may come down as you're taking these medications in the same way, your craving for other things, other things that may be pleasurable goes down.

Speaker 2 Now, that doesn't mean that makes you unhappy right you can just take it or leave it emma is a dental hygienist and a mother of two zooming in from winder is it winder

Speaker 5 winder georgia hi emma hi opra thank you so much for allowing me to be a part of the conversation i have been on zap bound for the past 10 months and i'm down 66 pounds wow

Speaker 5 Yeah, physically, I feel absolutely amazing.

Speaker 5 But what this medication has done for me mentally and given me self-confidence, given me self-worth, and given me the ability to love myself again.

Speaker 5 You know, in the past, I have tried exercise. I have tried diets.
I constantly had fatigue, inflammation, and I just didn't feel good.

Speaker 5 After having my first daughter, those things continued and I went to multiple doctors seeking answers because I just didn't feel good.

Speaker 5 And each time I would leave and I really didn't feel like I had an answer.

Speaker 5 This past December, I went for my regular doctor's appointment and sat down with a nurse practitioner and told her all of these things.

Speaker 5 And she said, you know, Emma, I think if we can get some of this weight off of you, you would start to feel better.

Speaker 5 And like you said, it was an aha moment for me because I feel like it was the answer to so many prayers that I had had

Speaker 5 that I was not crazy and that I really did have something wrong. And she listened.
And so, you know, from the outside, I had everything going for me.

Speaker 5 I had a beautiful family, two healthy children, a dream job that I loved, but I was drowning on the inside because I didn't love myself.

Speaker 5 And so within one week of taking this medicine, I could see that the inflammation was going away. I started feeling better.
I started having more energy.

Speaker 5 And I knew I needed to share my story because I knew that there were other people that had the same symptoms.

Speaker 5 And so I started showing up every single day for the past 10 months on social media, just sharing my story in hopes that I could help to encourage and inspire somebody else that may have been having those same symptoms.

Speaker 5 All right, y'all. It's in my, I'm on a journey for a healthier, happier meet, thanks to Zepbound.
And I have hit an all-time plug today on the scale. So that's something to celebrate.

Speaker 2 And so when you got, I'm sure you got pushback or people saying negative things on social media, how have you managed that for yourself?

Speaker 5 You know,

Speaker 5 at first that bothered me, but along this journey, gaining that self-confidence, gaining that self-worth and realizing that it doesn't matter what the other people think, because this is for me.

Speaker 5 And I'm doing this for me. And I feel better.
So then I can have a longer life. So my children can love their mother.
And, you know,

Speaker 5 I've dropped the opinions of what other people think because this is for me and for my health because we only have one life to live.

Speaker 2 Absolutely.

Speaker 2 What do you want to ask Dr. Anya here today?

Speaker 5 What I would love to ask is that, you know, with you saying that this might be a medicine that we have to be on long-term, and if that's what I have to do, totally fine with that, because if I had diabetes, I would take the medicine to survive.

Speaker 5 Do we know what the long-term effects would be from taking these medications?

Speaker 3 So that's a great question. And another very common question that we get from our patients.

Speaker 3 And first, you know, I'll start off by saying that as you've identified, there are risks to having obesity in and of itself, right?

Speaker 3 And when we treat patients for any disease, we say, okay, what are the benefits of treatment? What are the risks of treatment? What are the benefits of not treating or treating?

Speaker 3 We really look at all that very, very carefully.

Speaker 3 And right now, all the data is pointing to the fact that these are very beneficial, but that doesn't mean that we don't have to do our due diligence, be very careful, and monitor everything long term because millions of people are taking these medicines and millions more will take them.

Speaker 3 Having said that, GLP-1 receptor agonists have been used for the treatment of diabetes for 20 years.

Speaker 3 Now, all of these medications also for

Speaker 2 it.

Speaker 2 Some people have been using them. We have been using them for 20 years.

Speaker 3 Yes, the first one was FDA approved in 2005. So it was nearly 20 years ago that these medications were first FDA approved.
20 years. I know, 20 years.

Speaker 3 So the earlier ones were a little bit different than the newer ones, and they were shorter acting, and they had to be taken more, you know, daily rather than weekly. So there are differences there.

Speaker 3 But the point is, is that we do have data, all the trials,

Speaker 3 that's why we do all the trials. That's why I do all the trials, right?

Speaker 3 To make sure that the FDA has the information that it needs, not only to know that these medicines are effective, but to know that they are safe and well tolerated.

Speaker 3 And if there's a signal that they're not, then the FDA says, no, we're not moving forward.

Speaker 3 So, what we have to do is keep on doing the studies. We need to gather real-world data.
What health impacts are these medicines having on those diseases?

Speaker 2 I know the question that Amina asked before about whether you have to be on the medication forever.

Speaker 2 Did you hear the answer when I had my big aha moment there, Emma? Yeah,

Speaker 2 sure. Yeah.
That it's, it's like

Speaker 2 I've always thought that you solve the problem once you lose the weight, but then when you regain the weight again, it's like the problem came back.

Speaker 2 But when you have the hormone that allows for the obesity to be prevalent in your life, then

Speaker 2 it's never going to go away.

Speaker 2 It's never going to go away.

Speaker 3 It's like once you have diabetes, you always have diabetes. It can be treated or controlled diabetes.
Same Same thing with obesity. Once you have obesity, you always have obesity.

Speaker 3 Is it treated and controlled? That's the question.

Speaker 2 And so

Speaker 2 when we've lost the weight or in the process of losing the weight, that's when you're controlling it. Yes.
You're controlling it.

Speaker 2 But it doesn't mean the problem is solved. That's right.

Speaker 3 That's right. And the important thing is that.

Speaker 2 Which is another way to look at it. Yes.
Isn't that an aha moment? Yeah.

Speaker 5 It's such an aha moment. And you know what? If I have to take these forever, I'm okay with that because you know what?

Speaker 5 It's fighting the disease of obesity and I'm getting the life back and i get to live so getting your life back and i'm wondering whether or not once you reach the set point once emma gets to the goal gets to her goal are you a goal weight yet not quite yet i'd like to do about 30 more pounds but it's kind of like what she was saying i feel like i've kind of hit that plateau um i still have the effects of no food noise and but i feel like my weight is not maybe going down as much i do feel the inches may be changing but i'm just sticking the course sticking with the process because I know it's working because I can feel it.

Speaker 5 It's just I'm not losing it as fast as LEDs and that's the way it works for everybody, right?

Speaker 3 And it takes time. So the more highly effective a medication is,

Speaker 3 we're seeing it may take longer to see the effects. That's why the trials are getting longer.

Speaker 2 Will you reach a point where when you've reached the goal weight that you may be able to lower the dosage to maintain and and that is the question you know that we were starting to answer.

Speaker 3 And the last thing is for some patients, maybe, but right now we don't know how to determine that a priority, you know, ahead of time, a priority.

Speaker 3 So basically, that's why when patients, if they ask me to go off or they some patients ask to go down on the dose, we try that, but then bring them in quickly.

Speaker 3 Because the hard part is if you start gaining back weight, that is so, you know, people think, again, it's my fault and it's not their fault.

Speaker 2 It's not their fault. If you decrease, it's biology.

Speaker 3 It's biology. If you decrease your blood pressure medicine, what's going to happen?

Speaker 2 Your blood sugar is going to go back up.

Speaker 3 Same thing with your blood sugars for diabetes. It's no different with obesity.

Speaker 2 Isn't that just powerful to know for yourself?

Speaker 5 Totally. And that is not my fault.
It's not your fault.

Speaker 2 Yeah.

Speaker 2 It helps getting your life back feel like redemption, doesn't it?

Speaker 5 Completely. And, you know, I'm glad I'm 37.
I wish I would have found it sooner.

Speaker 2 Oh, girl, please. You have got so much life left in you.
So that's so wonderful that you, you've discovered it now at the right time for you. Thank you so much, Emma.
Thank you. Thank you so much.

Speaker 2 I love the beautiful photograph of you and your daughters. That's gorgeous.
Babies. Yep, thank you.
Thank you. Thank you.
I thank you for listening.

Speaker 2 We'll be back with weight loss expert and research scientist, Dr. Anya, after this.
I thank you so much for listening and being with us here. We're back with Dr.
Anya. Dr.

Speaker 2 Anya, so can you set the record straight on side effects? Because I've I've heard everything from vomiting to throwing up to diarrhea.

Speaker 3 Yeah, that's a great question. And side effects do occur, right, with any medicine for any disease.
Is there any medicine for any disease that doesn't have side effects?

Speaker 2 And I also have heard hair loss.

Speaker 2 Is hair loss from these medications a real thing?

Speaker 3 Well, it depends how much weight someone loses and how quickly, because losing weight is a stress. It's a stress on our body, right?

Speaker 3 So we've actually seen the hair loss with things like bariatric bariatric surgery.

Speaker 3 And now with people who lose a large amount of weight in a short period of time, we're also seeing those types of effects that we saw with bariatric surgery.

Speaker 3 But let's focus in on the most common side effects, as you were asking about. So the most common side effects are gastrointestinal.
So they are things like feeling nauseated,

Speaker 3 having diarrhea, constipation, and for some people, vomiting. But there are ways that we can really combat those side effects.
And again, they don't happen in everybody.

Speaker 3 So, number one, what physicians or providers can do is invite their patients to share the side effects with their provider and make sure that the provider says, look, I'm not going to stop the medicine.

Speaker 3 Let's work through these together.

Speaker 3 The main thing that a healthcare provider can do when they're prescribing these medications to help avoid or mitigate those side effects is start low and go slow. Always start with the lowest dose.

Speaker 3 And then you do not have to go up once a month. You do not have to go up once a month.
You go up as is right for that patient. So if a patient is having nausea, I do not go up on the dose.

Speaker 3 I let them stay on the dose, let their body get used to the medicine.

Speaker 2 Yeah, if somebody, if you, if you go to someone and they immediately put you on a high dose, you're going to the wrong hair healthcare provider because that should not happen. Absolutely.

Speaker 3 Absolutely. Then, you know, look around, see if there's another healthcare provider

Speaker 3 that somebody who really knows how to treat obesity and understands that it's a disease, that this is not about weight loss, this is about weight reduction and optimizing health.

Speaker 3 Suppose to pair them with the diet, the correct nutrition, the exercise, someone who really knows. Okay, so

Speaker 2 for most people,

Speaker 2 this is a medication to treat obesity and to understand that once you lose the weight, it doesn't mean that the problem is solved. That's correct.
That is

Speaker 2 the big aha for for me today.

Speaker 3 And that's a very good aha to have and take away.

Speaker 2 Thank you. Dr.
Anya, it's always a joy to talk to you. Thank you so much for being here.
We value your expertise on this topic.

Speaker 2 It must feel rewarding for you that this moment has finally come and that these medications are being made available to so many people because you get to see it in your own patients.

Speaker 3 Yeah, absolutely. I mean, I always say, people ask me, well, how did you know that you wanted to do this?

Speaker 3 The first time that I helped a patient lose a meaningful amount of weight for that person, I was like, I'm never doing anything ever again. This is it.
And I'm so grateful that I get to do this.

Speaker 3 And I'm so grateful that patients trust me. They trust me to care for them.
And

Speaker 3 again, I couldn't imagine, I couldn't imagine doing anything. Well,

Speaker 2 I can see how rewarding it is because you have people saying, I got my life back.

Speaker 3 Yeah.

Speaker 2 I got my life back. Absolutely.

Speaker 3 And again, it's, you know, there's good and bad things about everything, everything in life. These medicines are right now what we're seeing.

Speaker 3 They're helping people transform their lives in so many ways in terms of their health, in terms of their overall life. They're just really incredible in terms of helping people.

Speaker 2 Well, I want to thank you, Amy. Thank you, Amina.
Thank you, Emma. Thank you for all of our guests sharing your stories.
Go well, everybody.

Speaker 2 Thank you for making time to be with me today.

Speaker 2 I really hope that you join me for part two of this conversation as we continue to see how these new medications result in dramatic loss of weight, almost the equivalent of an entire person.

Speaker 2 You've lost 165 pounds? Wow. Congratulations.
So what happens in the aftermath of that?

Speaker 3 The doctor said to me, when are you going to stop blaming yourself and let somebody help you?

Speaker 2 When you lose up to 100 pounds or more, do people treat you differently? Everyone was so much friendlier to me. How does that impact how you see yourself in the world and even within your own family?

Speaker 3 To be honest, I feel like she kind of takes it for granted a little bit.

Speaker 2 Like she forgets where she's come from. That's my next conversation with Dr.
Anya and new guests who have a lot to say about their experiences.

Speaker 2 So we'll talk to you then and thank you so much for being here. You can subscribe to the Oprah podcast on YouTube and follow us on Spotify, Apple Podcasts, or wherever you listen.

Speaker 2 I'll see you next week. Thanks, everybody.