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I'm Chelsea Daniels and this is the Front Page, a daily podcast presented by The New Zealand Herald. From Celery juice cleanses to infomercial ad busting gadgets, society has always been on a diet. It's a global, multi billion dollar powerhouse industry. The latest trend that you would have heard about are golp ones or weight loss injections. Far MAC is seeking advice on whether they should be funded for
certain people. Australia is committed to it for certain patients, taking the cost to about twenty nine dollars per script. A drug like Wagovi, for instance here costs about four hundred and sixty dollars per script. But are they really beneficial or is it just the next get skinny quickplow. Today on the Front Page, obesity specialist doctor Gerrard mcquinlan is with us to explore whether these drugs should be funded or is diet and exercise really the only answer?
First off, Gerard, can you give me a brief history of weight loss drugs, because it seems like you know they've been around for ages. Weren't the first iterations essentially just speed?
Yeah, certainly back in the sixties and seventies. You know, the weight loss drugs were emphetamine based and they had that addictive component to the medication, so you know, the long term use back then sort of led to concerns about heart disease being a stimulant and sort of lost a lot of popularity when the heart issues came out.
Then they reformulated that sort of appetite for presant drugs to take out the addictive part, and I guess for probably three or four decades there wasn't really much in the way of medications to treat obesity. They tried zenecaw, which was a drug that limited absorption of fat through the gut, but it wasn't very well tolerated. It work for some people, but most people didn't tolerate it. And then about two thousand and five, these new GLP medications
came into existence to treat obesity. So that was they came about because of studies into gut hormones and the influence that that had on insulin and diabetes. And then the treatments for diabetes sort of came out in the twenty tens twenty fifteens, and what they noticed treating diabetic patients with these drugs is a lot of lost weight, which wasn't really seen with the diabetes treatments. So then that's how they became a weight loss strikes was because
they saw the effect in diabetic patients losing weight. So now we've got this burgeoning attention in medicine about GLP medications and GAT hormones. So now we've got much more effective treatments for weight loss.
So what do GLP ones actually do?
Yeah, so these hormones control the sensation of satisfaction light, feeling satisfied with what you've eaten. So with a ba IF, I sort of reframe a BC as a disease because it hasn't been framed that way, but the Lancet Commission sort of looked at ABC. The World Health Organization also classified ABC as a disease back in twenty thirteen. So trying to cut through the stigma of a BC, lot of people thought it was to do a person's personality
and there's a well powered failure, but it's not. It is a disease, and it used to be just tastified according to the BMI, the body mass index, but that's quite crude. So now we look at you know, we asked a couple of questions. You know, does a person have excess body tissue in their body? So that's the first question, and then the second question is is that excess back causing disease? So that's how we look at obesity now because we know that patients with obesity it's
a difficult life. It affects everything day to day, movement, sleep, and it contributes to other diseases. You know, it's a direct modifiable risk factive for thirteen different canses. But it's also related to diabetes, it's related to heart disease about turns and thirteen different diseases are impacted by obesity. So that's the message that I've get through today is that obesi is a disease that needs long term care.
Well, it's important to ask those other questions, hey, because the bear My scale has had its issues. I mean, you look at any of the all blacks, for instance, and they're probably all technically obese.
Right, yes, based on that crude measure, But you have to ask the second question, you know, is the amount of fat in a person's body is it causing disease? So we have sort of two groups of patients. Now we have those with pre clinical obesity, so they do have excess fatty tissue, but they don't have any disease. And then you have the patients who do have excess fatty tissue and have a disease like osterearthritis, like pre
diabetes or diabetes high pertension. So if they have those two things together, we should start treating that early because just take arthritis for instance. You know the arthritis, you know it's related to age, and it's related to weight. Now, if you can treat the weight part early on with orits often it goes away, so people don't need surgeries or excess painkillers or so I see that a lot
people come in with knee pains, joint pains. We treat the obesity and then the pains go away and they're much more mobile.
In terms of these drugs and the suppressing of appetite portion of it, What is the difference between suppressing your appetite and eating disorders, because in both you're limiting what you eat, right, but one is unhealthy and the other is, you know, being prescribed.
So eating disorders is important, and that's why people with obesity need to have a consultation because some of it will be psychological. So we're talking about restrictive eating patterns and eurexia not so much, but binge eating disorder in disorder eating, So yeah, we want to sort out that because the treatments for those are different. We would say consider binge eating disorder, would use medications that can alter
a person's psychology. But we have found that actually treating obesity and patients say with binge eating disorder, these treatments for OBSI are very effective because it cuts the noise. People don't think about food when they're on these medications. And I'll just come back to the point about appetite suppression. We don't use appetite suppression so that it's like those amphetamine stimulants. The glps are more about satiety, that feeling
that you've had enough to eat. And that's the problem with ABC is that people don't feel full, so they overeat and that's what keeps the weight up.
A friend of mine who is a very smart guy, very very rich, very powerful man actually, but he's very fat, and he took the fact I caught the fat drug. I won't give you which one. It was a z empic I won't tell you that.
After I told him that the drug does not work on him, because I saw him recently he's actually fatter than ever. I said, the drug is not working on you. You're going to have to go to something else. But it does work on a lot of people. And he said, thanks, you make me feel good. I said, well, I got to be truthful. You always tell the truth.
Obesity in New Zealand is obviously nothing new. We hear about how we're always one of the most overweight nations in the world. Tell me more about the common misconceptions about obesity. So number one is treating it obviously like a disease, But what are some other things?
Probably the biggest misconception is that it's a failure of willpower. It's a failure of personal attribues. Highly is not a failure willpower. In fact, you know people who diet can make the obaesitly worse. So we know that diet and lifestyle just by themselves, they've worked for a short period of time, but only about one in twenty patients will actually succeed and keep the weight off. That means, you know, nineteen out of twenty patients that doesn't work. And they'll
actually put on it even more weight. So a common story we get is people who've been on like three or five diets in their lifetime and over that time they just got bigger. And that's not a chance thing. That's due to the brain's hormone control of weight. So weights controlled by hormones in the brain that interact with the gate.
Isn't that kind of like the fad diets though, you know, like the juice cleansers and the drinking citric acid or something and hot tea every morning, those kind of things. When you stop those we I think we all know that you do pile the weight back on. But in terms of making long, long term lifestyle changes, would that work, Yeah, I.
Think if it's if it's if it's monitored by a doctor, or if the program even a dietician. So lifestyle and diet changes, we want those, but we know that just by themselves, they don't. People don't stick to them, and it's very hard to keep up with the diet. Keto diet has been quite popular. That cance diet. I've heard of diet Yeah, yeah, So diets tend to fail because the hormone control for dieting and it's overcome because people just eventually get hungry if they restrict their diet in
the end. So you know, most people want a keto diet for instance, can maybe hack it for about six months before they revert back to their normal diet.
In terms of I mean, there's a lot of talk about taxpayers funding drugs like over like these weight loss injections, these GLP ones. Would it be worth perhaps subsidizing gym memberships first before subsidizing something like a weight loss drug.
Now I'd strongly disagree with that. I mean, if you take just say one disease related to a busy just say ostearthritis. About five hundred thousand people in New Zealand lived with some degree of osterearthropis. Probably about one hundred thousand people need a joint replacement because of osterearthritis, and we only do about fifteen thousand operations per year. Now, if you treated the obesity that's present in that population,
half of the arthritis goes away. Now you also put those same group of people into gym memberships, that's really not going to help with their weight. It's not really going to help with the rights. Well to a degree, but not quite losing weight. So I see people getting much how they're much better quickly once they start on
these glps, but it is a lifetime treatment. I think if the government, like Australian government, who's invested in subsidizing these medications, I think they see the benefits, the economic benefits because it reduces the harm from other co morbid diseases that a lot of people are the best that you have. So I think, you know, they've taken the bolt step to fund it. I think our government will probably follow so hopefully because they'll see that the benefits
outweigh the costs. But you know, these medications are expensive, and I don't know. I think there could be more competition. I think Monjarro is coming to New Zealand and we expect that to be.
Cheaper in terms of I mean, I'm just going to play Devil's advocate here. You are an obesity specialist, right, and you will get more business if these presumably do our taxpayer funded. If you strip all of that away, would you still do you reckon? Would you still go with this route as opposed to say, getting outside and going for walks and stuff?
Oh? Yes, one hundred percent. Even if it was all funded. I mean probably the limiting step for patients to get access to the medications, not only the costs, but also doctors who are prepared to treat obesity as a long term disease. So my clinic, yeah, I'm prepared to trigger
these patients for life. So well, just like you would with any chronic disease, whether it's high blood pressure, you need doctors who are skilled in using these medications, that are prepared to put on the effort to follow these patients long term. So I follow them long term. We do cholesterol tests, we do blood pressure tests, and I see a lot of reversal of even pre diabetes can
reverse with weight loss. So yeah, I'm measuring, you know, and managing other does the other conditions that patients have. So that'll be a right limiting step is actually are there enough doctors to actually treat the population. There's about one point five million people in the Zelan have a BE study, and I would say probably half of those patients probably have significant other diseases that go with a BESTY.
I read that you were initially skeptical of the GLP one. Absolutely yes, because it's like this guinea shot and like it's a shortcut, and so for years I didn't well, not for years, but for a long time I didn't do it, and I didn't want to do it. Yeah, and I thought like, I'm not going to take the shortcut, you know, I'm going to work harder. But then eventually I was like, I've tried everything. I've tried every diet,
I've tried every workout. I've tried walking for hour. I would go to Europe in Paris and I would just walk for hours, the twenty thousand steps a day, like every single thing, you know, and nothing was working well. I would so this was killing me. Backstage, I would lose the weight, but my body liked to be at a certain way. So eye opening for me.
Do you reckon there are still doctors out there though, Like, for example, if I use the example of going to the doctor and the doctor saying not prescribing anti antibiotics because of you know, your immune system and we need to build that up, et cetera. You know, you've got those doctors out there who are very hesitant to prescribe medications.
Do you think there are still a lot of doctors out there who would be hesitant to just prescribe these medications and instead maybe sign you up to go see a nature path or something.
Oh, most definitely, And we doctors need to have education to see ABC as a disease because the stigma about BC is that it's your faults, the patient's fault and if only they could diet and exercise and do those things, that that will get better. But if it's a hormone condition, if you accept that it's a disease of hormones that control weight, you know you're fighting a losing battle. You die and their size will work for some people, maybe for some of the time, but it won't work for
the long term for most patients. So yeah, I do get patients who've come from doctors said no way, you know, And I think that's just really an education thing and having statements from the Lance that Commission on Obesity, they will falter through. I think students in med school will start learning about OBC and treating as a disease, and same for GPS.
So there are going to be some people listening to this and they're going to be angry that their taxes might be going towards funding these in the future. How does it though, compare to funding obesity. In the long term, I think.
If it's tracked well, I think the government could probably see savings less liver transplants, less patients with diabetes who then have other significant operations, less ostere arthritis, less disability, And don't forget that people with obesity, you know, their quality of life, like getting a job, performing a job, they are all quite reduced. And I'll tell you that when I treat patients with obesity, you know, I don't imagine their productivity goes up because they tell me I
can walk up the steps, I can move better. When I wake up, I feel like I've had a good sweap. So it's quite life changing. Losing weight, I think the cost benefit of just treating the BC itself is key because it reduces the occurrence of other diseases like osteoarthritis, like diabetes, even high blood pressure gets better as people lose weight.
Are these weight loss medications kind of like the silver bullet through obesity? Or am I just looking up too many social media profiles?
Yeah, definitely not a silver bullet. It's helpful, so you know, there's a limit to what medications can do, and it sits alongside say weight loss surgery, so you know, some people surgery will be a better option than weight loss medications. And then there's other patients. We have lifestyle and diet if managed, and people need to coach for this stuff. So if they can do that and lose weight, the
goal should be to reduce our weights of obesity. You know, in the last six years, you know, we've gone from thirty one percent of the population having obesity to about thirty five percent, so just in a short space of six eggs, So there's an avalanche of pre diabetes diabetes coming. That's what the epidemic's all about, is all the ill health from that stems from obesity. So we need to do something right now, sort of like on the front
lines as well as public health policy. So it's really the tool for us to treat obasily right now.
And in terms of I mean, I've seen these articles about you know, if you go on the weight loss drugs, you're on them for life. If you ever stop them, you're just going to pile everything back on. Is there enough research anyway to suggest that I do have.
Patients who've been on these GLP medications and then stop for whatever reason, Maybe it's financial, maybe it's other Yeah, and the weight does come back on, so we understand that. We know that even with surgery. We see patients who've had bariatric surgery, so they've had most of their stomach bypassed or removed. Even those patients put on weight, So
it's not just a mechanical physical part. It's really again to do with those hormones that control how much people eat, how much they think about food, whether they're satisfied with how much they've eaten. But there's always a pressure on people to put on weight. And one of the biggest triggers for gaining weight, believe it or not, is actually losing weight, and it's mediated through hormones that work in the brain, hunger hormones, the appetite hormones, and obviously these
society hormones. So when I talk to patiency, I spell that out at the beginning, that these medications are for life. We need to manage your obesity for life.
It might not.
Be an injection. There's new tablets coming into the market. We gave these in a tablet form now, so I think with new developments, new research will be able to manage long term obsy, just like we would manage blood pressure or hypertension diabees, we manage that with medication. So I see a future where we would manage obesity with medication. Because whatever we're doing, it's the current date. It's not working right because the rates are going out.
Thanks for joining us, Jared, my pleasure. That's it for this episode of the Front Page. You can read more about today's stories and extensive news coverage at enzidherld dot co dot enz The Front Page is hosted and produced by me Chelsea daniels Kine. Dickie is our studio operator, Richard Martin, our producer and editor, and our executive producer is Jane Ye. Follow the Front Page on the iHeart app or wherever you get your podcasts, and join us next time for another look beyond the headlines.