Dr. Sarah Stombaugh:
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:
If you have been thinking about starting a GLP medication, or maybe you have started your GLP medication, and you’re having a lot of doubt and maybe fear come up because you are hearing so many negative things about this medication, this episode is for you because we are talking today about the 10 most common myths that I hear about GLP medications, and we are going to debunk those because there are some crazy things happening on social media, and it is so easy to go down a rabbit hole where all of a sudden you are convinced that GLP medications like Zepbound, like Wegovy, are incredibly dangerous, and either you should not take them at all, or let’s say you’re already taking them, that you should stop taking these medications. And you can come to that conclusion in a matter of minutes or certainly hours. I don’t know if you’ve had that experience like I’ve had, but being on social media and maybe you’ve searched something, or maybe you’ve just watched something that has been fed to you, and you watch a video about a side effect that someone had on GLPs, the algorithm is picking up on that. Like, wow, they watched that entire one minute long video. Let me start feeding them more content like that. So all of a sudden, your algorithm starts to shift and you are seeing just bad thing after bad thing, people who’ve had severe side effects, people talking about the risk of these medications, and you will walk away from that experience feeling really probably pretty nervous and wanting to discontinue or never take these medications. So I believe very strongly, as a patient, you should be informed about the choices that you’re making for your body. And so today we are going to talk about those myths and we are going to talk about some of the science behind it so you can make the decision that is right for you.

Let’s go ahead and dive in with myth number one that GLP medications are cheating. Now, this is something I feel very strongly about. And if you have been following me for any length of time, you may have seen me post about this topic before. I have entire podcast episodes dedicated to this. But let’s talk about why these medications are perceived as cheating and then why they are absolutely not. So, for one, we know that GLPs are treating a chronic disease. If we took out obesity and we replaced it with asthma or hypertension or depression or arthritis or cancer or any other number of conditions, and we thought about the treatment for those conditions, a lot of times we would feel very differently. Your doctor says something to you like, hey, you have asthma. I recommend you take two different medications. Here’s your daily inhaler that’s going to prevent your asthma flare-ups from happening. And then if an asthma flare-up does happen, here’s your rescue inhaler, your albuterol inhaler, and you should use that to treat your symptoms. And you would probably not feel like you had a, you know, any sort of moral failing that you hadn’t failed yourself in any sort of way. You would realize, like, hey, I drew sort of a rough card in life. Maybe there are a lot of allergies and asthma conditions in my family. And so I need to treat this condition. Similarly, we should be thinking about that honestly with any condition. There may be things that we can do in order to help reduce the risk. You know, someone who has asthma, if they are severely allergic to certain things like pets or certain outdoor allergens, they are going to do their best to avoid those. They may make sure that they shower every time that they’ve gone outside. They may take other allergy and asthma prevention medications, they might be seeing an allergist regularly and doing allergy shots, and all of these things can be helpful with treating their asthma. So they’re still thinking about okay, what is the role that I can have? And my body needs the support of these inhalers in order to treat my asthma.

The reality is obesity is no different. When we think about obesity, it’s a chronic disease that is driven by so many different factors. We have our genetic factors, which to be clear, make up about 70% of our propensity to put on weight or not. And so a significant amount of obesity is genetically driven. There’s also epigenetics, meaning how our genes interact with our environment. And then we layer on other pieces, like maybe other health conditions and the medications used to treat those conditions. Many different medications out there can drive weight gain. We think about things like our neurobehavioral relationship with food, how we’ve been trained, the environment that we live in, the access to food that we have on a day-to-day basis. And it’s easy to understand why so many people struggle with obesity in the way that our society does. And so the amazing thing about GLP medications is they help to treat some of the underlying insulin resistance so that our body can metabolically be functional in the way that it was designed to be. They are not designed, though, as a standalone tool. They are designed as one tool in the toolbox that allows everything else to take effect in a way that it would not without that medication. So we still want to be doing diet and exercise and sleeping well and thinking about the treatment of our other health conditions and really understanding our relationship with food, what’s our day-to-day routine, how can we help support ourselves to make choices in line with our goals? And most people are doing those things. They’ve been trying to do those things, yet they feel like they’re fighting against their underlying metabolism, their underlying genetics, and oftentimes that is exactly what’s going on. So GLPs become the tool in the toolbox. They are absolutely just the one tool that allows everything else to take effect in a way that we wanted to. GLP medications are not cheating.

Let’s move on to myth number two. I hear this one come up all the time on social media, which is you’re just not gonna have an appetite. That is not the goal. Now, GLPs, the goal is to normalize hunger. One thing we know is that obesity, so having adipose tissue in our body, drives a lot of disordered metabolic signaling. And two of the disordered signals that happen are insulin resistance and leptin resistance. With insulin resistance, our body is spending more time in energy storage mode. Our body may have cravings for sugary foods or more carbohydrate, processed carbohydrate type foods. And then leptin resistance drives not realizing that our body is full at the end of a meal. So when we have leptin, our body says, okay, I’m done eating. And then leptin resistance, your body is ignoring the signal. So you may both be eating more frequently, you may have more desire and craving for foods because of insulin resistance and a propensity to store weight rather than release it, as well as then with leptin resistance, your body may not feel full as quickly. So you’re hungry more often. When you do eat, you are eating larger quantities of food before your body gets the hunger signal. So the goal of these medications and the way that the effect of the medications work is that they help to reduce that underlying metabolic disrange. I just making up words here, but that metabolic dysfunction that is happening. And by treating that underlying metabolic dysfunction, the goal is to normalize hunger, that you experience normal hunger, that you experience normal satiety.

Now, is it possible that people experience really significant reduced appetite or no appetite on these medications? Absolutely. That effect may be significant for anybody who starts these medications when they are first being introduced to a medication or when they titrate up to a higher dose of the medication. But the long-term goal of these medications is not just to suppress appetite completely. The goal is to normalize hunger so that you are able to experience hunger in a way that feels comfortable in your body. So your body isn’t screaming for, you know, screaming out, go eat this thing, thinking about food all the time. It’s such that you can eat when you’re hungry, that you can stop when you’re full. If you are on higher of a dose of a medication than you need, you may find that your appetite is overly suppressed. And you should talk with your physician about that because that can drive other issues where your body is just feeling kind of miserable because you’re not able to adequately fuel your body. So while it can overly suppress the appetite, that is not the goal of how we utilize these medications.

Let’s talk about myth number three. The more medication you take, the more weight you’ll lose. Now, this actually ties pretty closely to myth number two, where appetite can be overly suppressed. One of the things that I sometimes see, especially for people who’ve been treated in outside clinics, is that they are driven sort of every month to the next dose of medication without a lot of checking in in between in terms of how their body’s feeling, how they’re able to fuel their body. And so people are driven up to the next dose and the next dose and the next dose. Also, if you go on social media, you’ll hear all sorts of things like, oh, I felt more responsiveness at this dose than compared to this dose. Certainly, if weight loss is slowing down a little bit, you might be like, hey, it’s time to move to the next dose. And that absolutely may be true. However, we want to make sure at your current dose of medication that you were able to adequately fuel your body. Taking a dose that is higher than what you need may actually just drive a place where you’re not able to eat much at all and may not actually be driving weight loss in the way that you want it to. So your body may feel tired, like it may feel fatigued, it may feel cold, it just may feel exhausted, like you have very little energy. And so the goal of these medications is not just to drive up the dose. The goal is to find the dose that adequately supports what your needs are at that time. And that may adjust over time, but going on a higher dose is not necessarily going to drive higher weight loss, especially if you’re not able to eat at all. And it may drive an increased risk of side effects. So do not feel pressured to move to the next dose of medication. If you are a patient and you’re taking these medications and your doctor automatically sends in the next prescription, but you’re like, hey, at this current dose, I’m still losing weight, I’m still feeling fine. My, you know, my appetite is well regulated. I’m able to eat, you know, what I would perceive as in a normal quantity of food throughout the day without experiencing a lot of food noise. My side effects are not significant right now. That’s the goal. And so we do not need to be driving people to the next dose of medication too quickly. And so make sure as a physician that you’re aware of these things, as a patient, that if you are taking this, that you’re helping to advocate for yourself. And as a physician, a lot of times too, I’m keeping my patients in check. You know, they’re excited, they want to move to the next dose of medication, but the current dose is working phenomenally for them. So there’s no reason to push that.

Let’s go ahead and talk about myth number four, which is that everyone loses weight quickly when they’re on a GLP medication. And this is also absolutely not true. When we think about the effect of these medications, while some people have effect from day one that they’re taking these medications, there are other people may notice it takes a little bit of time before they find the effectiveness of the medication. One of the biggest things that will drive this is the severity and amount of metabolic disease that someone has. When I say metabolic disease, I’m really referring to both weight, but more importantly, blood sugars. So does someone have elevated blood sugars? Do they have prediabetes? Do they have type 2 diabetes? It is common that if someone has more significant metabolic disease, like they’ve had type 2 diabetes, let’s say for a period of time, their body may be slower to respond to these medications. And that is okay. It may mean, you know, as long as side effects are well controlled, that we can move up to the next dose of medication, that we’re really reviewing what are the different components of the meals that you’re eating. Are you getting good fiber? Are you getting good protein with your meals? And if those things are met, your body is not releasing weight yet, it we’re still seeing elevated blood sugars. It will often make sense to move then after a month at a titration dose to move to the next dose of medication. So you want to be working really closely with your doctor to make the decision that’s right for you. But some people it takes a while. Some people feel it right away, and other people it may be a couple of months before their body is really starting to experience the weight loss effect of these medications. Now, the wild thing is that while weight loss is often the goal for people, it’s so obvious from the outside when we’ve lost weight. One of the things that’s amazing is we’re often seeing behind the scenes that changes are starting to happen. So even when the body hasn’t lost huge amounts of weight, we’ll see things like blood sugars are improving, the liver health is improving, cholesterol is improving, blood pressure is improving. So sometimes, even preceding the weight loss, we’re seeing other changes. So we’re paying attention to those as well because that can be a really powerful tool. So if your weight loss is low, that is not necessarily a problem, but make sure you’re connecting regularly with your doctor about that.

Now let’s talk about myth number five that GLP medications cause eating disorders. And I think this is probably one of my biggest pet peeves in that there is no evidence to state that GLP medications drive eating disorders. And I will actually argue that untreated obesity, someone who has not used medications like GLPs or had other interventions to help support their metabolic dysfunction and has tried for years, they’ve been on this diet, they’ve been on that diet. We know that diet culture can absolutely drive eating disorders. And someone who has untreated obesity, untreated metabolic disease, a lot of times we will find that actually that is driving eating disorders because we are restricting food. You know, if you’ve ever been in a diet that’s overly restrictive, it’s eliminating foods, it’s eliminating whole food groups, you’re like, I can never eat that thing for the rest of my life. There can be a really significant restriction that comes up. And having a significant restriction to a specific food or to a food group may drive increased craving and desire psychologically for that food and can create this binge restrict cycle that happens very commonly when people are trying to lose weight. And so treating the underlying metabolic disease allows us to re-establish that relationship with food. And I’ve seen this all the time where people who have binge eating disorder, people who’ve had significant food noise, whether it’s a formal eating disorder or whether they’ve had a lot of food noise related to former history of their relationship with food. A lot of people, even if we look at things like ADD or ADHD, we look at obsessive-compulsive disorder, OCD, there may be compulsions driven around eating. And that GLP medications helping to suppress some of the underlying food noise allows our brain to be more quiet in a way that we can make choices that are in line with our goals. So if anything, I actually see that these medications decrease eating disorders. Now, is it possible for someone to develop an eating disorder while they are on these medications, particularly when we think about the restrictive eating disorders? The answer to that question is absolutely. And it is why in my practice we are routinely at the beginning of our time together, as well as throughout our work with patients, screening patients for the presence of eating disorders, screening for the language that they are using around weight loss, screening for how they are perceiving their body, how they are perceiving their relationship with the scale. Is there, you know, do they want to be able to make food choices? Do they want to be able to fuel their body versus are they really, you know, that restriction and feeling like food noise is overly suppressed, hunger is overly suppressed such that they don’t eat at all? Could that be fuel on the fire of someone who has a developed eating disorder? Absolutely, which is why it’s important for people to be getting these medications alongside a collaborative relationship with their prescriber so that they can make the best choice for them. So there’s someone who has accountability, both in terms of the benefits from this medication, but also in terms of any downsides or risk of this medication. So eating disorders can come up, certainly come up in our society, and these medications do not drive them in and of themselves, but it’s something that we should be mindful of for people who are in the weight loss journey. So eating disorders are not a side effect of these medications.

Now, let’s talk about the myth number six that GLPs will ruin your metabolism and cause muscle mass loss. Now, again, this is something maybe the most common myth actually that I hear like you’re going to waste away, you’re going to lose all your muscle. What is absolutely true is that when you lose weight, you are likely to also lose muscle as a proportion of that weight. If you imagine living in a 300-pound body, and now you’ve lost 100 pounds and you live in a 200-pound body, there are significant differences in what is happening in those two bodies, including the fact that the person who weighs 300 pounds every single day is carrying around 300 pounds of body weight. Every time they go to the shower, they walk to the mailbox, they walk to the school bus stop, they walk down the, you know, to the bathroom at their office, every single thing that they do, they are carrying their body weight with them. And that is really good for the muscles. It is really good for the bones. It builds muscle strength, it builds bone strength if you are moving your body carrying that weight. And in losing 200 or losing 100 pounds, now you live in a 200-pound body, every single thing that you do all day long, your body is not carrying around that 100 pounds of excess weight. So we do see that the body does not require as much muscle, as much muscle rather, in order to function compared to when we lived in a larger body. So there may be a proportionate decrease of muscle mass that can happen. And that is not a problem. What is a problem is that when we are not adequately fueling our body with protein, we are not adequately moving our body, particularly with resistance training, and our bodies are breaking down muscle for energy, breaking down muscle for the breakdown products of those to be used in other metabolic functions in our body, and we lose muscle mass disproportionately. Now, what we know is that people who are adequately eating protein during their weight loss journey, people who are moving their bodies regularly, including resistance training, are not likely to have a disproportionate muscle mass loss compared to people who lose weight with any other method alone. So these medications are no different than if you lost weight through diet and exercise, they’re no different than if you lost weight through bariatric surgery. All of the same principles apply. We want to eat protein, we want to move our bodies regularly, but you can absolutely support your muscle mass. Now, as we’ve talked about a couple of times earlier in this episode, if you are under fueling your body, feeling like you’re not able to eat at all, feeling exhausted and tired all the time because you’re under fueling your body, that absolutely may put you at risk for losing muscle mass in a disproportionate fashion. So, all the more reason not to take too high of a dose of medication and make sure that you and your prescriber are working together to choose the choice of medication that is best for you and for your needs.

Let’s move on to myth number seven that these medications are dangerous. GLP medications are dangerous, they’re not well studied, and they are not designed for long-term use. And that is just simply all wrong. These medications have been FDA-approved for over 20 years. The very first GLP medication called Byetta was FDA approved in 2005 for the treatment of type 2 diabetes. When something is FDA-approved, it has already been in the process of being studied and evaluated in both human studies and then previously in rodent and animal studies prior to coming to market. So we really have 25 plus years of safety data for these medications, which is amazing. When we think about long-term use, they are absolutely studied in that way. People, whether you’re talking about for diabetes, whether you’re talking about for weight, we have data on people utilizing these medications for long term. We know that while side effects absolutely can and do come up with these medications, side effects are most common at the beginning of the journey and tend to decrease over time. The risk of more severe side effects is much more minimal. There are certain people who are going to be at increased risk of those side effects or who should not use these medications. So people, for example, who have a personal or family history of medullary thyroid cancer or MEN2 syndrome should not use these medications. Patients who have a history of severe gastrointestinal disease should not use these medications. And then other people, on a case-by-case basis, there may be people who are not a great fit for these medications. And you should talk about that with your doctor. But generally speaking, these medications are well tolerated in many people and can absolutely be a safe choice. Now, I think one of the things that we often compare is what is the risk of taking medication to not taking medication? But it’s not really the risk of medicine versus no medicine. It’s the risk, what is the risk of taking the medicine versus what is the risk of untreated obesity? And these are the two things that we are often not comparing to one another. Because we know that untreated obesity can drive many health conditions like cardiovascular disease. So things like heart attack, things like stroke, it can drive cancer risk. We know there’s many cancers that are Associated with obesity and having adipose tissue on our body. We know there are biomechanical factors. So people who have arthritis, for example, that we can slow the development of arthritis with treating weight early on. We can help reduce pain and improve function for people who already have arthritis. We see improvements in other health conditions like liver disease, in mental health conditions like depression and in dementia. And this is just a small subset of things. We know that untreated obesity can drive risk of many other health conditions. And so it’s not about what is the risk of medication versus no medication. It’s what is the risk of medication versus the risk of untreated obesity. And those two things are very different. And when we support someone with their underlying metabolic health, we allow them to help reduce those risk factors, which can improve. And we’ve seen this in clinical trials. There are clinical trials across many different health conditions where we see improvement not just in weight, but in those other health conditions as well. And so that’s the piece that we should be comparing. And so treating obesity all of a sudden becomes very different because we’re thinking about what is that risk long term of untreated obesity. And the risk of these medications, there are real and known risk of them, but they will pale in comparison compared to the risk of untreated obesity, especially when you’re talking about working closely with a prescriber to make sure these medications are right for you based on your known medical history. So definitely make sure you are talking with a prescriber, you know, not just getting these medications from an online shop or the med spot on the corner, but if you have concerns about what do these medications mean for you, that you have that regular and consistent relationship with your provider to make the right choice for what you need.

I think let’s talk about the myth number eight that comes next, which is that these medications are not designed for long-term use. And if they worked, we would stop them. And this is just simply not how it worked. Even coming back to the very, very first myth that we talked about today, talking about cheating with these medications. When we think about chronic disease and we think about obesity as a chronic disease, it deserves long-term treatment. And so if you stop the medication, you are stopping that underlying support that allowed all of those other things to take place. And so when we think about long-term treatment, that’s exactly what we’re talking about. How do we continue to use this tool alongside diet, alongside exercise, alongside sleep and other medical condition treatment and all of the other pieces? How do you as just one tool in the toolbox? So stopping the medication, especially abruptly, may lead to weight regain and typically does lead to significant weight regain. We do know that there are a small subset of people who may do well off of these medications, particularly if they’ve had less significant metabolic disease, so less excess weight on their body or less elevated blood sugars, no prediabetes, type 2 diabetes, things like that, particularly people who’ve responded well at low doses of medication. There may be a small subset of patients who come off of these medications, which is why you hear about it happening all of the time. And most people will need to use these medications long term. They are designed for that long-term use.

Let’s talk about myth number nine that people who use GLP medications should only be those who haven’t tried hard enough. Now, I will argue that most people, by the time they come to see me in my medical weight loss practice, is that most people have tried many different things. I talk to people who’ve tried three, five, 10, 20 different diets, people who’ve had bariatric surgery, people who’ve used other medications to support their weight, and they are like so ready to get the support from a medication like a GLP, and it can be life-changing for them. Now you think about that person and you think about the struggle that they’ve had. It makes me so sad to think about the many women in my practice, men too, but especially women who at an early age, they went to Weight Watchers when they were children. Their mothers, their society was like, hey, you are living in a body that’s too large, and they have been chronically dieting a lot of times since grade school or middle school. And for that person, they have absolutely tried hard enough. Now, if you ask that person, if you could have prevented that experience in your lifetime, if you could have had these medications early on alongside all of the other changes that you’ve been working on making, why wouldn’t we do that? And so most people have tried hard enough. They’ve tried all of the other things. And what if we could instead support people early on such that they could make the long-term changes rather than having to have a lifetime of struggle?

And then number 10, that GLP medications fix everything without lifestyle changes. Now, you have heard me allude to this many times in previous episodes, as well as already in today’s episode, that they are one tool in the toolbox. We have phenomenal data to show that people who do intensive lifestyle modification, so they make the diet program, they make the or make the diet changes, they make the exercise changes, they’re working on their sleep, we’re maybe shifting medications for other health conditions. Alongside all of those things, people who make those changes and then layer on the GLP medication, it is absolute magic. And it allows those other changes to take place, to take effect in a way that they hadn’t before. And I think one of the biggest challenges is that people have been struggling, they’ve been doing all of the things and it’s not been working. And so the GLPs become one tool in the toolbox. And those other lifestyle stuff, it absolutely makes a difference. And it is the reason why, if you look at the average weight loss in clinical trials ranging from 15 to 20%, there are people who lose 30%, 40%, or more of their body weight. And it is not just luck. They are not just super responders on these medications. Those are the people who are doing the GLP alongside the other pieces of the puzzle. And so that’s what we really want to be thinking about for them. So it’s one tool in the toolbox, it is absolutely not cheating, and these can be amazing for supporting the underlying metabolic health.

Now, I would love to see you if you are in one of the states I’m licensed in. I see patients in Illinois, Tennessee, and Virginia. My private practice is located in Charlottesville, Virginia. So in any of those other states or uh distance in Virginia, I would want to see you by telemedicine. I’m a board-certified obesity medicine physician. If you are looking for a physician that’s near you, I would look up an ABOM, an American Board of Obesity Medicine physician who can help to support you in your weight loss journey. We also have an amazing online program called The GLP Guide. This is your area for all the most frequently asked questions so you can understand how do I use my medications? How do I travel? How much protein do I really need? What should I be thinking about in terms of side effects so that I can be successful on the medication? We have all the support that you will need in order to find success on your GLP medication. You can learn more about that at www.sarastombaughmd.com/glp. Thank you so much for joining me today for this week’s episode. I’ll see you all next time.