Ozempic & Weight Loss Drugs: Game Changers or Health Hazards?

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0:47Welcome to The Wellness Scoop, your weekly dose of health and wellness inspiration. And as always, we're here as your hosts. I'm Ella Mills. And I'm Rhianna Lambert. And today we are diving into some juicy topics as chosen by you. Now, we have had so many questions, haven't we, Ella, about weight loss drugs, GLP-1s recently. And I think these drugs have obviously become, well, they've dominated a lot of the conversation and the headlines on health and wellness over the last year or so. We have just been inundated with questions from our community on the topic. So we thought now is the time to get our first expert guest in for our weekly Q &A so we can give you all the best answers to your questions.

1:30That is exactly right. So this is really exciting. So we're going to welcome Dr. Jack Molesley here today, who recently wrote a brilliant book called Food Noise. And it was just this rigorously researched, deeply insightful guide to the rise of GLP-1s, these weight loss medications. So Jack felt like the perfect person to come on and take your questions. But Jack, before we get into everybody's questions, I thought, you know what, could we start at the top with just what are GLP-1s? Yeah, thank you so much for having me and great to be here. So GLP-1s are gut hormones. And the reason they have become so interesting and so popular is because of their ability in reducing weight.

2:18I'll just go into how GLP-1s actually work and the kind of medical version of them, the synthetic version. So GLP-1s, firstly, they've been used for 20 years in type 2 diabetes, and they work by reducing blood sugar. But the other kind of main ways they work is they slow down the bowels and they slow down your digestive tract. And this is one of the reasons why you actually have quite a lot of side effects with GLP-1s as well, which I'll kind of get to later. but the reason they have really become so popular and so widely used is because of their ability to act more centrally on the brain and they reduce your physical hunger but they also seem to reduce your cravings what's kind of become known as your food noise and ultimately that's how you lose weight with the GLP-1s they reduce your cravings they reduce your appetite you eat less and you ultimately lose weight.

3:18Jack, thank you for giving that overview. I think what people perhaps are seeing GLP-1s as is like this kind of magic drug, you know, a magic jab that will instantly enable you to lose weight. Is there any way out there that this wouldn't work for somebody or is it pretty much 90 to 100 % you will lose weight if you take this jab? For the most part, they do seem to work on most people, I'd say, at least in the studies. And we're kind of seeing with semaglutide, so that's a Zempic, you lose around 15 % of your body weight in the trials over about a year period. And with Manjaro to Zepatide, typically people do lose around 20 % of their body weight.

4:01But I think the really important thing to note is actually in these trials, people were provided a lot of support, a lot of nutritional guidance, and they were encouraged to exercise and do all these other things alongside it. So in the real world, we're definitely seeing less weight loss, and we're actually seeing slightly higher rates of people stopping these medications. It's so interesting. I know quite a few people have taken them, and one of them did it with quite a lot of that support and a nutritionist and a complete overhaul of diet. And it was so effective and has seemed to create amazing habits.

4:38But anyway, it's been very interesting to watch. But moving on to our community questions. This is from Anonymous, but I think it's such a great place to start. Jack, do you think this is going to become the norm? I think they're going to become more and more widespread in their use. And especially as we see more medications becoming available. So we are seeing there's dozens of medications in the pipeline at the moment. So currently they're once weekly injections, but we will see injections at once monthly as well. And next year, we're likely to see these new oral medications come through, which are currently in these kind of phase three trials.

5:17So I think they are going to become more and more widespread. And they are very likely to be a passing fad. And as you know, as we all know, we do live in this kind of obesogenic environment and obesity has just risen and risen over the last few decades. I think though, the kind of message remains that they're not a magic fix they they are powerful drugs they you still do need to make those lifestyle changes alongside them the concerning side of it of course there's so many positive benefits and I reiterate where Alice said I've also seen people have wonderful results in the clinic and personally but Georgie's got a really good question and she said if you're not overweight is it bad for you for example if you just wanted to do it for four weeks or if you're considered a healthy body size and shape and you just wanted to drop a little bit of weight because that's what we're seeing a lot of in the media.

6:12And I think this is where we have to be so careful because these are not cosmetic drugs. They're not aesthetic drugs. These are medications designed for people living with obesity or overweight with obesity related diseases. They haven't really been studied in populations of people who are of a healthy BMI. I think this is where we do have to be so careful because they're not medications that you can really take for a few weeks or get Beachbody ready or ready for that wedding. I think we still do have to approach them very carefully. We don't know what the risk to reward becomes more difficult, especially when you have a healthy beer mind.

6:59It's really interesting to hear you talk about that, because that is what we have seen so many questions on. I think because there has been in the press quite a lot of positive things. Obviously, these drugs are being so heavily researched at the moment where there's things coming out saying, to your point, it changes the food noise, but people wanting to drink less and potentially being interesting for addictive behaviour, for some anti-inflammatory benefits, potentially some cancer protective benefits. And as a result, they're getting this. It feels like sometimes in the media, this halo effect of actually should everybody, no matter what their BMI should be on them.

7:36So someone else has said BMI is normal, but have a huge amount, huge, huge amount of food noise. That was not me. They said lots of huges and really battle to stay this weight. Can I get it? Should I get it? yeah i think once again with people of a healthy bmi there are potential risks and there's all these other risks of so you have these gastrointestinal risks you do have nausea vomiting diarrhea constipation you do have some more serious risks like pancreatitis gallstones bowel blockages and then you also have these more long-term consequences which i think are important to consider so muscle loss and i'm sure you guys have talked about this a lot is that kind of malnutrition side of things because you know we're already not necessarily eating enough fiber and all these important healthy fats and polyphenols and fruits and veg so so it could restrict that further and i think i think the final thing to say is if you have a kind of past history of any eating disorders especially restrictive eating disorders i do have concerns as it could exacerbate them.

8:46I'm so glad you brought that up because I think the psychological impact as well is absolutely massive. And if you don't have the right support network around you, this is obviously for people, because people can get this on the black market, Jack. We know this is happening. We can't deny that there doesn't seem to be a cutoff criteria if you pay privately to be able to get hold of one. So there's lots of different factors to really take into account. and I do question I don't think people are being screened that way before they take these medications and the question from Nat that I have next for you really leads on to the main concern that's a reason why a lot of people are not opting for it perhaps which is what do you know the long-term side effects of this drug?

9:31So we do have we've got 20 years of these medications being around and being used for type 2 diabetes what we don't necessarily know is the weight loss doses are often much higher than what has been used for diabetes and we've also got this new generation of weight loss medications a new generation of the glp ones that's like i say a zempic and majaro and there's more coming and these these lead to significantly higher body weight loss than the old generation. And like I say, when your appetite is being restricted that much more, we don't really know the full long-term consequences, how some of that kind of subclinical micronutrient deficiencies could play out and how things like the muscle loss could play out.

10:19And I think the other thing to think about with this is most people on these medications are not getting anywhere near the level of support we're seeing in the studies. So like you say, is kind of like the wild west of online pharmacies. So even if you are getting the right medication, most of these pharmacies are not providing nutritional advice at all, really. And I think the kind of aim with a lot of these online pharmacies is just to get out as much medication, as high doses possible without considering the kind of wraparound support. I was really struck actually speaking to someone I know who's on them at the moment.

10:54And when he started them, it was through a big online pharmacy and they say, do you think you need to go up a dose? And he was like, I don't know. You know, it's really interesting. These are obviously powerful drugs and they're kind of being put out to layman's, you know, to the point of like just general public people with no medical knowledge whatsoever to say like, do you think you should increase your dose? Do you need to increase your dose? Yeah. All online, just a kind of online questionnaire, which I was so surprised about. But we mentioned a minute ago about the pros that, you know, the positives of these drugs that have been, as I said, quite widely reported.

11:29And I think what's creating quite a lot of the confusion to my mind in terms of people with a healthier BMI or wanting to lose three or four kilos sort of thing, wondering if they should take them because as I said, there's sort of, you know, conferences and studies coming out saying, oh, actually it could be positive for cancer prevention, anti-inflammatory. Lenny's asked for that? What are the pros as well of these drugs, particularly regarding inflammation? Are we seeing some interesting new developments there that we weren't expecting outside of the weight loss? There definitely are some fascinating studies looking into this.

12:06Especially, I think, the inflammation side of things is particularly interesting. What we are seeing in the studies, like you say, we are seeing this reduction in all sorts of things from heart disease, type 2 diabetes stroke obstructive sleep apnea polycystic ovary syndrome all of these things and um and like you say cancer and even dementia too what we haven't quite kind of teased out is whether there is this independent glp1 effect on this or whether a huge amount of that is actually just improving your metabolic health and reducing obesity because we know a lot of the initial fat you actually lose when you lose weight can be visceral fat and that's the fat that's metabolically active that can cause a lot of this this smoldering inflammation in the first place so i suspect a lot of the effect is just due to weight loss and improved metabolic health there may be a small independent effect but i think it is possibly too early to stay for sure and and we still again a lot of this studied in people living with obesity and is not studied in people of a healthy BMI.

13:17I think that's the really key thing to reiterate, isn't it? Because it's the fact that these drugs are appealing to everybody. That is really it. And like Ella said, I think we get very excited. If this could help cure cancer, it's such a huge sweeping statement to make. We have seen media out, let's jump on that. We've seen these stories come out. And a story, not a story, a question I've got from Ali, it's almost like a little anecdote. Ali said, thanks for talking about GLP One. As a personal trainer, this is something my clients bring up all the time. I think it's great for those who have a lot of excess fat.

13:54And what I've noticed though, is that clients who are only slightly overweight and wanting to take it to lose six to 10 pounds, I think that the Serena Williams advert hasn't helped. Can you also discuss what happens when people try to come off GLP-1? So most people plan to, will this be the next yo-yo diet on and off meds for life? Which I thought, what a good question. Yeah, no, that's a great question. So just kind of tackling the bit about the yo-yo diet and that weight regain. So we do know with these medications, so they reduce your appetite and they reduce that food noise. And I kind of think of them as these noise cancelling headphones that you can go about your day, you can ignore that pesky food noise.

14:40But once you tape them off, that food noise does return with a vengeance. And we're seeing in the studies that two thirds of the weight you initially lost is regained within the first year. And actually by 20 months, all the weight is really regained. At least that's what we see in the studies. And that weight regain is actually quite significantly higher than if you go even on what you describe as maybe a more conventional diet. So there is this concern that, especially if you don't change your eating habits and you don't do all these extra lifestyle interventions whilst you're on the medications, and if you're not using them as maybe a way to embrace these healthy eating habits, then I think that's when the weight regain is a concern.

15:28we had so many questions on that i can't kind of list them all out because there was so many but all of these saying i think it's everybody wanting to get to the root of is this a miracle honestly because as i said there were so many people saying well can i take it and then will i regain the way because i do think they're being given this kind of halo to some extent which is why i was curious about your viewpoint at the beginning of like will this be the new normal because i think they're touted as this idea that kind of it's the next frontier, like actually in future, we'll all be taking them.

16:02And someone had asked in particular, like, what are the benefits of micro dosing? Because I think there is some suggestion, certainly I feel from things that I read, that these are so powerful, actually, should everybody to be taking them? Should everybody be micro dosing on them? Yeah, well, I think with the micro dosing avenue, I, like I said, We still don't know whether the inflammation is actually just because you're improving the root cause of many of these problems, which often is obesity and eating potentially too many processed junk foods as well. So we don't know whether there are these independent effects.

16:39And even back to the cancer thing with obesity, obesity increases the risk of 13 different cancers. So there's all these upstream effects of what obesity, of the problems obesity can cause. So it will be interesting to see if they do do studies into people of a healthy BMI. But I think I'm a bit sceptical for now, because, again, we kind of talked about some of these addiction issues. It does actually seem to reduce your, for instance, your alcohol consumption, but only if you are living with obesity. And I think if you are giving it to someone who is a healthy BMI, who might even be malnourished because they drink too much alcohol, then the risks rapidly increase or further malnourishment.

17:28It raises the question. I know what we find in the nutrition clinic is, you know, weight loss is never a linear line. It's very rarely a linear line. You know, I think that's what most people when they go on these drugs, they're like, wow, you know, it's just been a there's no plateau. I'm just losing and I'm losing. And yeah, weight loss requires psychology. and it requires nutritional intervention. Like you said, most people are going to be deficient in fiber, their gut microbiome is going to be impacted, their nutrient absorption. And I think a lot of people are now also releasing books on GLP-1s and things are popping up everywhere before we have the research, which is another thing to question, you know, completely with nutrition.

18:08But Lizzie's asked such a good question. She said, are there natural alternatives? Because are there foods that act like GLP-1s? So it's a really interesting question. And so there are certain foods may slightly increase your GLP-1 more than others. But the important thing to remember here is that there's so many other gut hormones involved in appetite. And GLP-1 is just one of dozens and dozens of gut hormones, including important hormones like ghrelin and leptin are particularly important in appetite. So what is happening when you take the GLP-1s, you're giving this incredibly much higher dose of GLP-1 in your bloodstream.

18:51And the other important thing is that it's not broken down rapidly. So when you get this natural occurring GLP-1, it's broken down within two minutes, really. So when there's a lot of stuff saying, oh, this will naturally increase your GLP-1s, again, I would be a bit sceptical of that. So I would be careful, especially when there's supplements and products that are promoting a natural GLP-1, I would be aware, especially on social media. It's funny that you said that because we had another question for Martina, literally saying that, are natural GLP-1 supplements that are available on the market a good substitute or are they a money grab?

19:29I would say a money grab, almost certainly. These medications have been carefully designed to not be degraded by the body and keep that really high level of GLP-1. So often actually the levels are more than 10 times higher than your body would be producing. So that's another thing to consider. It is so important to me that my home feels like a calm and cozy sanctuary from the chaos of the world. I found that beyond decorating, sensory things like warm smells and soft textures make the biggest impact for that. And especially as it cools down outside, I'm looking for the best ways to snuggle up on my couch.

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22:51You may have some degree of malnutrition. And then it'll also be more difficult to keep that weight off for the long term. So I think the book really is, and I've got 50 nutritious recipes written by my mum, who has written many successful health books, Claire Bailey Mosley. just to provide all the right nutrients you need and encourage you to retain that muscle. So I think it's just so important to provide that kind of wraparound information. So would you say food noise then is definitely just it's marketing everywhere, it's advertising, it's the lack of information, is it social media? There must be so many facets to it.

23:36hmm yeah so food noise itself is a term that was basically popularized because of the weight loss medications and yeah it's your cravings it's that it's that constant mental chatter around food and i think the interesting thing with food noise is the volume is likely turned up a lot higher for some people than others so for some people it may just be that urge to go out and grab that sugary salty snack but for others some people do wake up thinking about food they're often planning their next meal even when they're currently eating and i think all of this is so exacerbated by well firstly things like our stressful lives but but also you kind of you mentioned that that food environment we live in this food environment where these addictive foods are everywhere and And they are designed to be overeaten.

24:28And the kind of sight, sound and smell is designed to attract us. So often our best intentions can be derailed by that food noise and by the food environment we live in. Do you think there's enough conversation when we're looking at GLP-1s and all these drugs around the kind of irony here that we have created to a point this? I mean it's a deeply capitalist problem but that we've created this food environment that we now have to medicate our way out of because you know it's really interesting I went to the supermarket yesterday it's major birthday yesterday we're having a birthday party on Saturday I went to buy some stuff for the birthday party it was I just had breakfast it was nine o 'clock in the morning like all was good and suddenly I find myself in like the sweet aisle and you're like oh I could eat a bit of this I could eat a bit of that and you just you know I didn't even want it.

25:18But suddenly you're there and you are surrounded by, you know, bright packaging and all the rest of it. And you're like, and we have that all the time. And it's so difficult to consistently say, no, thank you. I don't know. I feel quite strongly that we're not talking about the kind of insanity of the situation where, you know, there is a conversation or, well, maybe everyone will be on these drugs. Maybe, you know, people of a healthy weight will be microdosing and everyone of a slightly overweight or obese will be on these drugs in the kind of fuller sense of the drug and we'll all be on it forever.

25:52And that will be how we cure food noise. And then you hear that some manufacturers are trying to manufacture products that get around the GLP ones and still make you want to eat more food. And you just sort of have to step back and think like, this is a dystopia, isn't it? I completely agree. I think big pharma is trying to solve of a problem created by big food ultimately and we do live in this situation where for many decades these big food companies have just been allowed to run rampant many people consider some of these big food confectionery companies are almost the they're the new big tobacco and they've used a similar playbook so we do live in this situation where these medications are effective at reducing that food noise at kind of providing what some people class as like a sticking plaster, but it's not solving many of the root cause issues.

26:51And I think the only real way to tackle some of that is realistically some degree of regulation. And I think people are making steps in that direction, which is great to see. Yeah, it is very dystopian. I think we live in such a strange place where if you really strip it back to basics, we've got more access to food than ever before. And it's just caused so much ill health, essentially. And of course, we've got to look at ultra processed foods here. We've got to look at the types of foods, like you said, hyper palatable options that are being produced and marketed everywhere. And Jack, can I just ask what your opinion is on the changing landscape?

27:30So I saw, for instance, the other day on quite a well-known podcast, two girls on a TV show openly discussing the fact that they went from you know a size 10 to a size 6 or a size 12 to a size 8 you know healthy sizes essentially for women and they said well it's because I've been using a Zenpik and they're very open about it but what kind of message I mean Ella the messaging around it is is big yeah I think Jack we've talked a lot this year and it started back in kind of January February time where it was award season and you had your you know the Oscars and all the rest of it and there was quite a lot of commentary on the kind of return of size zero, the celebrity landscape, and, you know, the return of the lollipop body where your head is, you know, the top of the lollipop and your body's because your body's so small.

28:21And I think something Rhi and I have just consistently noticed in the show and our community and the headlines that we've been picking up, there's this increasing pressure again, outside of these drugs for people from a health perspective, when we're talking about, you know, obese BMI and health conditions associated when we're looking at actually just particularly the female body, I think, unfortunately, in this case, and the insecurities it's creating, and people starting to use it just solely for aesthetics. I think we're both quite nervous about the pressure that that's putting on people. What are your take on that landscape?

28:58And do you think it's shifting? This is probably one of my biggest concerns with the GLP ones is that unfortunately there is a lot of stigma around weight which is often exacerbated by the media really and this is where things do become quite dangerous because when people who are taking them who are maybe of a healthy BMI or what's kind of described as a normal BMI between 18 and 25, then I think we have to be very, very careful because these sorts of weights may become the new norm. If someone of a normal BMI is taking these medications, and then someone who's not taking the medications, they see their friends taking them, then it could be that they are encouraged to take them themselves.