Dr. Sarah Stombaugh:
Before we get into the episode, I am thrilled to announce we are launching an online course, The GLP Guide. The GLP guide is a must have resource for patients who have been prescribed any of the GLP medications such as Wegovy, Ozempic, semaglutide, Zepbound, Mounjaro, tirzepatide, Saxenda, liraglutide. There are a lot of them and this course is available for anyone to purchase. We often hear from people who haven't been given much information about their GLP medications. No one has told them how to handle side effects, what nutrition recommendations they should follow, or what to expect in the longterm. And it can be really intimidating and simply frustrating to feel like you're alone in your weight loss journey. With the GLP guide, you'll get access to all of the answers to the most common questions for patients using GLP medications, not sure how to use your pen, struggling with nausea, wondering how to travel with your medications. We've got you covered for only $97 for one year access. This is an opportunity you do not want to miss. The course is launching on October 1st. For more information and sign up, please visit www.sarahstombaughmd.com/glp. You don't have to be on this journey alone. We are here to guide you.
And now for today's episode, this is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight podcast.
Announcer:
Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh.
Dr. Sarah Stombaugh:
Hello everyone and welcome to today's episode. We are talking about what has become a controversial topic are the GLP medications. So medications like Ozempic, Wegovy, Zepbound, Mounjaro. Are these just the newest, latest weight loss gimmick in a series of trendy diet fads and all of that? And my short answer to that question is no, these medications are not trendy when they are used properly. These are actually a huge game changer. And so we are going to get into why I think that's the case and what it looks like to utilize these medications properly. And if you are interested in these medications, what you should look for in a program or in a prescriber as you're thinking about how you can best be supported during your health and weight loss journey. Before we do that, I would love to invite you to be a patient in my practice.
I have a practice in Charlottesville, Virginia where I do see patients in person. I also see patients virtually throughout the states of Virginia, Illinois, and Tennessee. So if you are in any of those states and you have been looking for support with your health and weight journey, I would love to support you in that journey. In our program, we make sure that patients get the answers they need to questions, they get nutrition guidance, they get health coaching. We can recommend exercise programs. We're talking about things to make sure that you have all of the support that you need to understand side effects, understand how these medications work. We will spend 1, 2, 3 hours if we need to on the phone with your insurance company getting a prior authorization for good or for bad. We have become experts in that space. And so if you have been looking for a doctor who really knows what she's doing, knows how to support you and is willing to go the extra mile, I would love to help you with that.
So if you are interested in working with us, you can learn more at www.sarahstombaughmd.com. In there we have a great frequently asked questions section. You can go through those schedule free meet and greet with me, and I would love to connect with you and learn if we can support you in your weight loss journey. And let's turn and talk about these GLP medications and how they work, why they work and why I think no, these are not just the trendy new thing. So when I look at the GLP medications and we talk about them sometimes all under one category, but some of these medications are actually dual receptor agonist. So they target the GLP receptor, but medications that are tirzepatide based. So the Zepbound and Mounjaro products are actually targeting both GLP as well as GIP. And that second receptor has, I will say almost a synergistic effect with the GLP component such that these medications are having receptors in more sites make the medication more efficacious.
And we have found that head-to-head while ozempic and wegovy are phenomenal medications, those are the same medication. Those are both semaglutide products. The head-to-head trials of Wegovy versus Zepbound. So Zepbound and Mounjaro are both tirzepatide products. We find that Zepbound is more effective for weight loss compared to Wegovy. Now both of them, like I said, are great medications and may make sense for one person or another depending on a lot of factors. But in today's episode we're not going to get too much into that. But rather focusing on these medications as a whole, how they work in our body and why, honestly, this is a paradigm shift in our understanding of the treatment of obesity. So I like to compare this to other major shifts that have happened in the healthcare space. And I think for those of us who are young, I'm in my late thirties and I grew up in a world with antibiotics.
I grew up in a world with SSRIs, a selective serotonin reuptake inhibitors for the treatment of depression and anxiety. But the reality is there are so many different types of treatments and different types of health conditions that have just shifted completely the way that we understand and treat certain disease processes. So right now at the time of this recording, it is 2025. Did you know that antibiotics like penicillin and all of the newer ones, literally 100 years ago we did not know that antibiotics existed. It was in 1928 that penicillin was first isolated and it wasn't even commercially available for 15 years later. It was in 1943 that medication was first available for the treatment of bacterial infections. Since then, we have seen the discovery and production of other antibiotics, but before the 1940s, there were not antibiotics. If someone had a bacterial infection, whether that was a urinary tract infection, an ear infection, a pneumonia, or much worse, the treatment for that was just supportive care.
We did things like rest and fluids and bloodletting. That was not that long ago that we were doing some of these things. And the discovery and purification of medications like antibiotics, like penicillin and now newer ones have shifted how we treat and understand that disease process. Similarly, type one diabetes for example, which is a condition where we do not have insulin. Our body stops making insulin. That was a deadly disease. That was something that was a death sentence because we need insulin in order to help store our energy away for later. It has a big role in, it's a growth factor. It has a big role in our energy and metabolism. And without insulin, we die. And so when patients were diagnosed with type one diabetes, often they would live days, but sometimes weeks or months if they had gone onto a ketogenic diet for example.
But the reality is we cannot live without insulin. So it was only the discovery of insulin, again, less than 100 years ago or about a hundred years ago now that we actually saw this paradigm shift and this became a chronic condition rather than something that people would automatically die from. Similarly, the SSRI, this was elective serotonin reuptake inhibitors. These are medications like Zoloft, Lexapro, Prozac, you've probably heard of these different ones. Others in that group as well. Those were first Prozac. The very first one was invented and FDA approved in the mid to late eighties. So 1987 it was FDA approved and 1988, that medication was first used for the treatment of anxiety and depression. And before that, we had some older medications that me effective but really not particularly effective. A lot of psychotherapy was around and different things like cognitive behavioral therapy. But we look at the treatment of psychological conditions.
This group of medications has fully shifted how we understand and support patients. And what is a really safe way in understanding there are underlying biochemical pathways that drive some of these disease processes. Now, when we look at obesity, I think one of the first things to recognize is that obesity in and of itself is actually a disease. And that is something that those of us who practice in this space understand that and have believed that for a while. But it's really only been in the last couple of years that we've started to see shifts where it is being defined as a disease and therefore treated as a disease process rather than some sort of character flaw, some sort of laziness or other, which has really been traditionally how our society has looked at obesity. And the interesting thing is that in 2025, as we look forward over the next couple of decades, there is so much yet that we have to discover about the causes of obesity.
We know that food in terms of our overall food supply, the processing, our food, potentially additives that are in our foods, things like microplastics or other endocrine disruptors, things like Teflon pans for example, that shed into food microplastics that are consumed other things. All of these contribute to our health. Looking at our gut microbiome, we know that the gut microbiome plays a huge role in obesity. At this point though, we don't necessarily have a specific treatment to say, okay, you should do a fecal transplant or take this specific probiotic with a prescribed diet. But those things are coming. There's a lot. When we look at what is causing obesity in our society, it is all of these factors added together. And the challenging thing is that when we look at fat mass, a lot of times we think of fat as this blob of tissue on our body.
But the reality is fat itself, adipose tissue is actually very metabolically active. And that's part of what makes treating obesity so challenging is it's not simply a eat less and move more thermodynamic equation. It is all of these other factors that signal what is our hunger? What is our satiety? What are our insulin levels? What are our leptin levels? What are the things that tell us to eat? What are the things that tell us to stop eating? What are the things that they're telling us to store energy? These levels get deranged when we have chronic excess fat mass because that adipose tissue contributes to things like insulin resistance, where our body is not able to properly store energy where it requires more insulin in order to do that, that is a precursor for conditions like pre-diabetes or diabetes. We know that fat mass contributes to leptin resistance.
Leptin is our satiety hormone or one of our satiety hormones. And what happens with leptin is it can signal to say, Hey, I'm full. I should stop eating. But with leptin resistance, our body needs to send sort of higher and higher levels of that amount of hormone before we start to recognize it. So we know that people with chronic obesity do not feel satiety at the expected point, but rather feel inappropriately hungry. And so it is not just eat less and move more because when we eat less or when we move more without increasing the fuel that we are giving our potty, we feel ravenously hungry. Our body has protective mechanisms in place to ramp up those hormones to say you should eat so that you don't waste away and die. So when we look at medications like the glp, these medications are working directly on some of those pathways to reduce insulin resistance, reduce leptin resistance, such that for so many people who have been working on dietary changes, they've been working on other lifestyle changes like movement for example.
They've been trying to prioritize certain macronutrients, like getting lots of vegetables, like getting lots of protein, but they find that they're having really significant cravings for food, that they're thinking about food all of the time that is because of these underlying hormonal changes. So that's where these GLP medications have been such a huge game changer for people is that they actually work in those pathways to stimulate the glucagon-like receptor in order to help support people in their weight loss journey. So what we know is that these medications allow people to really work through the dysregulated hormonal cycles that are there such that they're able to eat amounts that feel good in their body. We do need to make certain changes, for example, like making sure that we're eating enough protein when we are eating less in general, that is going to lead to weight loss.
And while weight loss is wonderful or the goal for a lot of patients who are taking these medications, we do want to make sure that as we're losing weight, that we are preferentially losing fat mass. And whenever I say that to someone, they always agree like, oh yes, of course we want to lose fat mass. But the reality is, when you are losing weight, there are certain things we need to do in order to best protect our muscle mass. So we need to be moving our body, particularly with resistance training. We need to be eating adequate amount of protein throughout the day, distributed well throughout the day, and those are things that are going to best protect our muscle mass. Now, there may be some decrease of muscle mass that happens during the weight loss journey, and that is normal and common. We just want to make sure that this is not a disproportional decrease in our muscle mass, that this would be no different or maybe even better than compared to other weight loss regimens.
So that's something that has been studied and continues to be studied to make sure that we are not seeing that patients while they're seeing a lower number in the scale, are maybe actually not improving their health outcomes. As we see all of this, we see this decrease in body weight, specifically this decrease in fat percentage. What we start to see is all of these improvements in other health conditions. So we see improvements in hypertension, which is high blood pressure, hyperlipidemia, high cholesterol, insulin resistance, pre-diabetes, diabetes, polycystic ovarian syndrome in joint pain, and osteoarthritis in depression, in cardiovascular disease, in sleep apnea in many cancers, we see that as we lose weight, there is this direct effect on all of these other areas of our life. So these GLP medications have this indirect effect on so many other things in our overall health. And what we've started to see over the last couple of years is that these medications are being studied also for specific disease conditions.
So we saw in the spring of 2023 that these medications were approved for the treatment of cardiovascular risk reduction in patients with a history of cardiovascular disease such as heart attack or stroke, which was game changing. And we started seeing these medications being approved for that indication. So not just for obesity in and of itself, but for people who had this cardiovascular risk and independent of the weight loss effects of these medications. The GLP receptor decreased that cardiovascular risk, which is amazing, right? It's showing that these medications have such a profound impact across a lot of different areas of our health. Similarly, just last month in December of 2024, these medications were FDA approved for sleep apnea for moderate to severe sleep apnea in adults with obesity. And we're seeing that again, Medicare will be covering those and we'll wait to see what happens with commercial insurers in terms of covering those for the treatment of moderate to severe sleep apnea in patients with obesity because we find that these medications are really supporting other disease conditions, other disease states, and we're seeing them studied, of course, they've been studied already in type two diabetes, but also in things like chronic kidney disease and other addictive disorders.
And the effect of these medications across so many different health conditions, both dependent, but then also independent of the weight loss component, shows us that having excess fat masses, adipose tissue that is hormonally active, that is inflammatory in our bodies, is having a detrimental effect. And for the first time ever, we have a medication that works directly to reduce that. We've had other medications in the past that can be very effective for supporting patients in their weight loss goals, but these are the first medications that actually work directly in the pathways that are dysregulated in obesity. And that is really, really cool. And so what I am hopeful for as we look forward over the next five years is that we start seeing these medications being covered beyond just for diabetes, beyond just for diabetes or for obesity rather, and that we actually, the patients who have simply just obesity, they don't have that cardiovascular disease yet they don't have sleep apnea perhaps.
And that we actually see that commercial insurers and employers are covering this for the treatment of obesity. And we see that the downstream effects of the improved health conditions is really, really phenomenal. And so it's an exciting time to be in this space prescribing these medications. As I mentioned, as with anything, this is just part of the picture, right? It is just part of how do we support the underlying physiological changes while making sure that someone is also working through the lifestyle intervention piece. And we know that's true across many different disease processes. We know that in depression, for example, we talked about the invention of these SSRI medications, but once the SSRI medications were invented, brought to market, that didn't decrease the need for psychotherapy. And so things like CBT or other types of therapy continue to be a mainstay of treatment for the treatment of anxiety, depression and other mental health conditions.
And similarly, like in hypertension, high blood pressure, for example, while people go to the doctor and get a medication for the treatment of their blood pressure, they are often prescribed things like certain dietary interventions to reduce sodium, for example, to make sure that they're getting plenty of exercise because we know that those lifestyle factors have a role in the treatment of their hypertension. So as we look at the treatment of obesity, the GLP one receptor agonist, all of them, ozempic, wegovy, ze bound monaro, these medications are such an amazing tool to have in your tool belt. And when we combine that with lifestyle intervention, with nutrition, with movement, with sleep, with stress management, with understanding how and why we eat and working to evolve our behaviors so that the choices that we're making are really in line with our goals. When we combine that with the medications, people do really, really phenomenally.
And when we think about what this looks like for the long-term, for most people, these GLP medications are designed to be long-term medications. When they were brought to market, that was always the intention that people would be continued to be supported in this physiological way, such that all of the lifestyle interventions that they were doing were able to take some effect. Now, I think one of the things that brings up this question about trendiness is that there's been a very common narrative recently about the short-term use of these medications, about using these medications for a period of three months or maybe even six months, but kind of jumpstart your weight loss goals, lose the weight, and then you can stop the medication. And what we know from studies of patients who take these medications is that most people should be taking these medications in a long-term fashion.
Now, I have seen that there are some patients who stop these medications because they feel like, Hey, I've lost the weight. I don't know if I need the support of this medication. And one thing that I feel very strongly about is that any of my patients or really anybody, you're the boss of your own body. You get to decide what you are taking, what you're not taking. If you feel like, Hey, I'm not sure if this medication is serving the role that I need it to, I would fully support any of my patients in stopping any of their medications as long as we had a plan for how to do them. And so I have had patients who have stopped these medications. What I will say is that, or stop them rather, because they've sort of hit their goals and decided to wean off of them.
And what I will say is that there's a very, very small set of people for whom that may be appropriate, people for whom they're sort of just above the body mass threshold. People who have maybe a BMI in the overweight category, a body mass index of 27, 28, maybe 29, people who gained that weight over a short period of time. So maybe they had a medical illness or during the course of pregnancy or postpartum or IVF, for example, that if they had not struggled with weight chronically throughout their lifetime, but had this happen over one or two years, those are patients for whom it is possible potentially to stop the medications. But I would never want someone to start their journey expecting that they would come off of them for all patients. We start at the lowest dose of medication and over time we titrate that dose upwards.
There are people who are, I would say sort of super responders or hyper responds to these medications who at a very low dose of medication have weight loss goals, sometimes profound weight loss in the order of two pounds per week for people who had body mass index in the low thirties, for example, and continue that trajectory for months on end. The Zepbound medication was FDA approved in November of 2023, came to market in December of 2023, and it's so a little over a year now that it's been on the market and available to patients. And I actually have a handful now, literally just a handful of patients who have been on the lowest dose of medication and have done phenomenally find that it's supporting them in their goals. And so there are patients for whom if that is the case, great, do we need to continue to titrate them up to higher and higher doses?
Not necessarily. And some of those patients have expressed a desire that eventually they may stop this medication. But the reality is the way that this medication is supporting our underlying physiology, a lot of people find that they simply feel better, they feel less inflamed, they have less cravings for their food, they feel more energized, and people are having less cravings even for things like alcohol, for example. And so they find that on these medications, it really continues to support their goals. And so I think that piece of using it for a short-term intervention, again, while I believe anybody is the boss of their body, recognizing that that's really not how these medications are designed to be used. And most people upon stopping the medication will find that they have weight regain either partial or even potentially all of their weight. And so I think in starting these medications, it's important that we have responsible prescribing to understand, are we really giving these patients to patients, helping them to understand how to use them.
So this doesn't become just another failed diet in a long list of diets that they've done in the past, and especially at this time where the GLP medications feel like they're available on every corner. I was walking in an outdoor mall, and so I'm advertised on a triangle stand outside of a shop, for example, like come in and get your tirzepatide shot or your semaglutide shot. And I would just really caution you, if you are going to pursue these medications, they can be absolutely life-changing. There are so many people for whom I have prescribed these medications, and they have achieved health and weight goals that are so far beyond their wildest dreams, really have changed people's life. People who've lost 20, 30, 40% of their total body weight and have found this new view on their life. And I am so, so excited for them.
And I would really encourage you if you are interested in utilizing these medications to find someone who is board certified in obesity medicine. You can look at the ABOM, the American Board of Obesity Medicine. They have a provider finder search tool where you can look for people who are certified in this area and make sure that you're finding someone who is not just looking to sort of make a quick buck to sell these medications because that's been happening a lot recently. But rather, is there someone who could work with you, potentially get brand name medications, ideally that you're getting brand name Zepbound, Wegovy, Ozempic, Mounjaro, depending on what health conditions you have. Are they working with you to look into your insurance, looking at all of the different coverage options because there are a decent number of patients who really do have coverage for these medications.
Are they helping you with nutrition plan, with movement, with sleep, with stress management, with your other health conditions such that as you're taking the medication, for example, and achieving some of your weight loss goals, it's common that patients find maybe they don't need one of their other diabetes medications or maybe they don't need one of their high blood pressure medications. And we can either decrease those doses of medications or even stop them completely sometimes. And it's really important to work with someone who understands and can support you comprehensively so you don't feel like you're on online forums or TikTok or my podcast, just trying to get that information. If you have those questions, you deserve a provider who can support you. And finding someone who is board certified in obesity medicine is 100% the way to go. So with that, we are going to end today's episode.
I am so excited that you're here taking a listen. And if you have been wondering, can I get help, are there options out there? There are so many people who could support you in this journey. And the first question is just, who is in my area? What can I do? Is this help that I'm interested in seeking? Again, if you are in Illinois, Virginia, Tennessee, I would love to support you in your health journey. You can reach out on my website www.sarahstombaughmd.com. Thank you so much for joining me today. We'll see you all next week. Bye-bye.