Anti-Obesity Medications: A Life Sentence?

Welcome back to another episode of the podcast. I'm so excited to be here with everyone. I am fresh off of having had Covid for the first time, if you can believe it, since the pandemic hit, so I think three years. Making it in is a, a pretty good track record. So today I was inspired to make this episode because several people on social media. Made comments like this, whenever I see something pop up in several different places, I always know that it's time to talk about it on the podcast.

Before I get to that, I just want to remind all of you, if you are loving this podcast, if you are listening to this right now and you have not left a written review, wherever you're listening. Please go ahead and do that cuz it really helps to spread the word about this podcast. I love doing this. I love helping and advocating in this area, it definitely helps if we can have other people that get this message as well. All right, so today I really wanna talk about this.

Thought process that people have to wrap their mind around when they consider going on these anti-obesity medications. And it's this struggle with, am I gonna need this medicine for life? So the specific question that I got asked, I had someone make a comment. What are your thoughts on being on Wegovy? That's a GLP one injection that's once a week. It's the same medication semaglutide that's in Ozempic. What are your thoughts on being on that for life?

Then they had several other comments that said I've changed a lot of my lifestyle, what I'm eating, how I'm exercising, all of those type of things. And then they even said this was something else that they messaged me then that they had even gotten down to the lowest dose and they really wanted to stop it. And of course, I cannot ever give you medical advice, so nothing on this podcast. You do not ever change medications or do anything without talking to your doctor.

But I want to address today the mental aspect of this constant conundrum that I see people going through, which is, am I gonna need this medicine for life or can I stop it? Things like that. So what I wanna go through first is this,

obesity is a chronic medical condition, and what that means is it. You have periods where you can lose weight and you're doing great. You have periods where you're managing it, where your weight's stable or you're losing weight, and then you have periods of struggle where you don't even realize that weight's coming on or weight's coming on and you feel so out of control with it. There's just such a variety, but the main.

Thing that persists is that everything that people have done for decades is not effective. And when I say that, whenever I see people in the clinic, and this is pretty standard for OB c medicine physicians, we take this history and we say, Hey, tell me all the things that you've tried before. So everything like trying to count calories, increasing exercise, doing programs like. Weight Watchers, Jenny Craig that just went out of business. What else? Keto, 75. Hard, right?

It's just, it's endless what people have tried. And while they might have had some success on that program, the weight usually comes back on and they end up usually not only at the same place, but actually a little bit higher. When we document these repeated fails again and again and again, what we know is that chronic dieting doesn't work long-term for a moment. Anything that works if you're sticking to it can be effective. But does it last long term?

Like if I look five, 10 years out, have you kept it off? Are you still doing okay? No. And so the change has been with some of these medications, these newer ones, that not only do you lose the weight, but you keep it off. What I always say is this, if you could have done it on your own, you would've. There's no one that ever comes to work with me that has not tried a million things before.

If you are needing a medication to help assist, either start losing weight or continue to lose weight, or to make some of these other changes, if the medicine allows you to. Be able to eat in a way that supports you better, and then you do have the energy to go and move and these things are really working for you. It does not make sense to get rid of that medicine. Then now it might look different in quote unquote maintenance. So once you got to whatever goal that it is, it might be.

That the dose stays the same because that's what you need to maintain it. It might be that the dose is lower. It might be that the dose is more spaced out. That maybe is all negotiable, but to a hundred percent remove it. The studies show us that the weight comes back and. I always say this online, there's always the the hero story where someone says, well, well, I did it. I lost the weight, and then I got off of it and I'm fine.

And I always like to remind this person, but you're three months out, six months out, you're not five to 10 years out, which is. We see by five years most people have regained the weight. If whatever intervention it was is taken away. I want you to start to think long-term here. I want you to start to really care about your long-term metabolic health and weight cycling, where it goes up and down and up and down. Really not great for us.

The other thing we know each time you reattempt weight loss, it is usually harder for people. Elise, this is what I see in clinic. It's not like, oh yeah, great, we just do this again. It becomes more and more effort that's needed to get the same results that you got before. My biggest goal with people, it's to help them. If weight loss is one of the objectives that we think will improve their metabolic health, it's to help get that weight off and keep it off to keep it stable.

So for me, it's not even about. Getting to a certain weight with someone. It's about whatever we do, can they maintain it, and I will not start something or do something if I don't think it's feasible long-term, or if I don't have a follow-up plan, or if I don't think that they're gonna be compliant with follow-up. If I don't think they're gonna do all those things, I will not start these things with someone.

Instead of focusing so much on, I'm gonna need this med for life, I want you to focus on how can I maintain this amazing thing that is happening for me right now where I'm able to work on these things and I'm able to do all these things. How can I maintain that? And if you taking a medicine as part of that, I want you just to question. Is there anything wrong with that?

I think everyone all day long is trying to figure out how they can get off the medicine and things like that, but is there anything wrong with needing that help? One of the questions that, I always like to say to people, they always think that there's somehow something better about being gone less. It's almost like it's this morality thing, like, oh, well I've titrated down to the lowest.

Dose and I'm just sitting there thinking, well, whatever works and gets the job done, that's where we need to be. It's this irrelevant question that's being asked all day long and I get it again, it's always this thought of like, less is gonna be better. Whatever it takes to help you on your health journey is what is needed.

So one of the things that I would encourage you to do, if you're someone that's struggling with this concept of either debating starting a medicine or you're on it and you're really wanting to get off of it, things like that. I want you to go back as much as you can and take data from the past. So have you tracked your weight in the past? Have you looked at things in the past? I want you to look at the long-term trajectory of your weight. Most people, it has sort of progressively gone up and up.

Some people it's a, it's a slow creep. Other people, there will be life events. Like for women, it's very common that pregnancy would bring on weight and they were just, no matter what they tried afterward, they couldn't get rid of it. Or it might have been that there are certain big life changes such as a divorce or other upsets like that that might have led to weight coming on again, or it could just be slowly over time, but I want you to look at that pattern, okay?

So draw that out pictorially for yourself, little x y axis if you know what I'm talking about. So draw it out and then I want you to write, All the different things that you tried along the road. So this is like your little historical encounter if you would. So I want you to write like high school Weight Watchers, and then I want you to write college, going to the gym two hours a day, and whatever it was you did, and I want you to write all these things out.

This might be a really hard exercise for you to actually see it written out. This might be a really hard emotional experience, so please have compassion for yourself as you do this. But I want you just to look at the data to get rid of all the other thoughts. Just look at the data, okay, this has been my weight over time, and these are all the things that I've done. Okay, now you can put your thoughts into it. You have the data there, and I want you to ask yourself this question.

Knowing what I know now, what are my thoughts about either starting a medicine, being on a medicine, or continuing on a medicine? It comes from a place of data that is usually the most empowered place, because what ends up happening is you're not coming from a place of emotion of, well, I am a failure. I can't keep this weight off again, again, and again and again. You're putting that bias and stigma on yourself. This is a chronic medical condition.

Like anything else, you have no thoughts if you need a thyroid hormone, you have no thoughts about taking that. You have no thoughts about if you had rheumatoid arthritis taking something for that or other rheumatologic conditions. But yet when it comes to weight, there's this strong desire to come off of something that is helping you manage a chronic condition.

So looking at that data, what are my thoughts now? And typically, Most of the time, and maybe this is just the, the group that I'm working with, but once they get to that point, they look at, I call it the graveyard. They look at all these ineffective things that they've been trying, the keto, the calorie counting, the trying to trick their body with the high volume, low calorie foods, all the stuff that never worked.

And they look at it and they say, gosh, when I got on the meds, this was the first time. That I might still think about food, but I don't have that urge, that desire to go eat it. That's through the roof, not there. I'm able to make the healthy choices and it's not hard, and they start to realize, oh, this is the playing field that everybody else is on when they're not struggling with their weight. The reality is a lot of these medications allow all those behaviors that are amazing.

Where you're making those great healthy food choices and you're going and doing the movement, and you're taking really good care of yourself. A lot of those things are allowed because of the medication. I say medication assisted behavior change. So then the fallacy is, okay, I'm gonna remove this medicine, but I've developed these habits. That's not necessarily true because you got physiologic help with hormone imbalances in your body when you went on a lot of these medications.

So this is one little angle. I just felt that a quick podcast episode on this would be really timely. So if you are someone that's struggling with you don't know if you wanna go on a medicine or, again, this question of going on it for life.

The other thing is this, I don't know that you have to make all of those decisions right now. That is something that I always tell people. I definitely don't think you should go on it if you're not thinking about possibly I would be on this for life, I think cuz we, we know that you can put it back on if you go off. But let's say that. You just don't know if you wanna be on this for life, but you really know that it's time to get this help.

You don't have to decide all those things because also things will declare themselves over time. Maybe it is that after five, 10 years on these medications, your weight set point is where it at, where it's at, and we can take the met away. I can't see that being a reality, but I reserve the right to be wrong. Right? There are plenty. There are plenty of new medications coming out. It's, it's really amazing what's happening in this area.

But the point is this, you don't need to make all these decisions today. I think the only thing that might make this journey lighter for you is to stop judging yourself if you are needing one tool in the treatment of chronic obesity. I, I was actually listening to another obesity medicine physician that I really love in Canada, and she said, stop calling these things, tools. They're treatments now. I like using the term tools, that these are tools, right? The right tool, the right time.

I like saying that. But these are ultimately treatments. They're not band-aids. They're not gimmicky, they're not things that work, you know, like meal replacement things, which by the way, can totally have a place at certain times, but it's not that, okay, we lose a hundred pounds and suddenly it all comes back the minute I stop the meal replacements. This is a very different land. I know this was a little bit more of an impromptu episode, but I wonder what your thoughts are.

One of the best ways to get me what your thoughts are, it's if you're on my email list, if you go to rentier clinic.com, you click on podcast right on the right hand side there. You can get on the email list that goes with this podcast and when episodes like this go out, I would love to get your feedback. You can just hit reply to those emails and let me know. What you thought.

We will have the link if you wanna get on that email list down below, and I hope that this was a great episode for you and let me know your thoughts. Talk soon.