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:
Taking your very first GLP shot, whether you’re taking Zepbound, Wegovy, or something else, can be a really exciting and honestly nerve-wracking time. But if you have made the decision to get started, you’re feeling ready, you’re ready to start seeing movement on a scale, you want to feel the effect of the medication immediately, and that is not always everyone’s experience. One of the most common questions that we get asked is, “When will I feel this medication kicking in?” And the reality is the answer to that question is really different for a lot of different people, but I want to help you today understand, are you going to be someone who responds sooner? Is it going to take a little bit of time? And how do we stay patient with this journey so that over the long term, you can get the results that you’re looking for to get the weight loss goals, the health goals that you have been working towards?

I think we see a lot of times on social media the stories of people who’ve been super responders. That’s been a phrase we hear a lot. People who’ve taken maybe a low dose of the medication and seen a lot of weight loss, even people who’ve taken a higher dose, they’ve seen a hundred pounds or 200 pounds. We see these really significant amount of weight loss happening for some people, which is really, really awesome for them. And that is not the universal experience for everyone. There are people who will take their first dose of medication and within a couple of hours or certainly the next day, they will be feeling the effects of that medication for good or sometimes for bad. And there are other people for whom it takes time. We’re starting everybody at the introductory doses of these medications and then every month we’re titrating up slowly until we reach a dose that is helping to support them in their goals.

So you will very commonly see people say things like, “I didn’t really notice a difference until I hit Zepbound 7.5 or Zepbound 10, or I didn’t really feel anything until I got to the Wegovy 2.4 dose.” It is very common that that can be the experience as well. And what I want to share here is that that is normal. Any and all of the above is normal. One of the biggest challenges is that when we look at others’ individual stories, we so want our stories to mimic theirs. Even honestly, when we look at the clinical trials, we look at hundreds of hundreds of patients that are enrolled in these clinical trials and we’ll say things like, “Oh, the average weight loss for this medication was 15% or the average weight loss for this medication was 20%.” And so as we’re thinking about what our anticipated goals for our own journeys, we can look at some of those numbers.

But the reality is there are people who are non-responders to these medications or slow or low responders. There are people who lose 5% of their total body weight. On the other hand, there are people who are incredibly responsive to these medications, losing 30% or 40% of their total body weight, and both of those extremes can exist, but most of us are going to fall somewhere in that spectrum. But the reality is you are an individual, so you are not the average, you are not another individual. You are going to be walking on your own journey. And what I want to normalize is that it is not a universal timeline. So certainly everybody should start out at the lowest dose. And then when I’m assessing my patients, we’re looking at a couple of different things. How is the medication feeling in your body? So from an effectiveness standpoint, are you noticing changes in appetite, feeling like you’re getting hungry less often?

When you are eating, are you noticing that you’re getting full more quickly? Are you having any issues from a side effect standpoint? So are you having nausea? Are you having changes in your bowel habits? Are you having more significant side effects? What are we seeing in terms of number on the scale? Are we seeing that there is movement on the scale? And we’re looking at all three of those components to decide, okay, are you doing well on this dose of medication and/or do we need to titrate you up to the next dose of medication? So for the person who is a slow responder, and I honestly don’t even like that terminology, so if you’re seeing the video version of this, you’ll see the air quotes. But for someone who is a slower responder, they take the first dose of the medication and they’re like, I mean, I guess there’s some medication in there.

We’ll see. It can take a few weeks as the medication builds up in your system, depending on which medication we’re talking about for the injections at least, it takes about three to four weeks before you’re feeling the full effect of that medication. And so it can take a little bit of time. And then after that first month, we’re evaluating those three questions. What are you seeing the movement on the scale? What is the effectiveness of the medication and what are the side effects of the medication? If things have been a little bit slower than anticipated, you’re not seeing much movement in the scale, not feeling it significantly, which usually goes hand in hand also with not having significant side effects, then absolutely we are going to move you up to your next dose of medication. So we’ll continue that titration up. Now, if you’re someone who takes that first dose of medication, let’s say you take it in the evening and the next morning you wake up and you’re like, oh my gosh, I don’t know if I ever need to eat again.

I feel so full. Maybe I’m feeling a little nauseated, get that swimming feeling, throwing up feels like not that far away, having side effects like loose stool or over the next couple of days realizing that constipation is developing. Those are the people for whom it’s like, oh, you’re responding pretty significantly to this medication that is someone who we would traditionally label as a super responder. So these are the people that you see on social media that are losing five pounds in a week. So over the course of a month, they’ve lost 10 pounds, 15 pounds, 20 pounds, and you’re like, oh my gosh, how did they lose 20 pounds when I lost three pounds my first month? How is it possible that both of those things exist? So we’re asking those same questions. What are you seeing in terms of movement on the scale? What is the effectiveness?

What are the side effects? Now this person who’s responding really significantly to the medication, they are someone for whom we’re probably going to keep them at that titration dose. They need more time at that dose of medication before we would ever consider increasing their dose. This is a mistake I see happen a lot in other practices where people are automatically titrated to the next dose of medication even when they’re having significant responsiveness as well as significant effectiveness and side effects from that medication. It can be a little bit challenging because of the insurance coverage of these medications to do a slow titration if that’s appropriate. But we’ve always been able to get it covered for our patients sometimes with a second prior authorization to the insurance saying, “Hey, this patient’s really been responding pretty significantly. We’re worried if we titrate them too quickly that they’ll have side effects.

We’d like an approval for another month at this titration dose of medication.” So commonly we are able to get the medication approved to re-initiate or redo those titration months. But this happens where people then are brought to the next dose of medication, sometimes it feels like pretty quickly, and these are often the people that are having those more significant side effects. They are people who are pretty responsive to the medications, again, the air quote super responders and then they’re titrated up and up and up, maybe perhaps too early and maybe they didn’t even need to at all. I have very few patients for whom we’ve not needed to titrate, but I do have a couple of patients for whom they’ve responded incredibly well at the lowest dose of these medications and we’ve never had to titrate them up. So that is the case for some people.

Again, this is the minority of people. And I also want to say that you do not get any sort of award for taking a lower dose of medication. Obviously it’s a little bit more cost-effective for someone who is paying cash for these medications, but the best dose of medication is the dose of medication that helps support you in what you need. And that is going to be different from everyone based on your height, based on your starting weight, based on your gender, based on your metabolic status. So do you have prediabetes or diabetes? Based on your age, based on other aspects of your movement and your metabolism and your muscle mass, based on so many different factors, we’ll determine how quickly or not you respond to medication and there is nothing good or bad or right or wrong. We just have to look at how is the medication feeling for you?

Are we getting the response that we expected? And if not, it makes sense for us to continue titrating up. Now, there are some people who are non-responders to the GLP medications and for those patients, it may not be the best medication. What’s really exciting is over the next couple of years, we are going to see other things coming down the pike and so stay tuned. It’s really an exciting time to be in the world of obesity medicine. One thing I love more than anything is being able to partner with my patients and help them to understand and normalize what is going on with their body. You did not gain weight overnight. You gained weight over the course of many years, usually even decades, and your weight loss journey, it is okay if we take that in a slow and measured way. Now, certainly you want to make sure you’re getting the medical support that you need, but that can look like taking it slow, listening to your body, managing your side effects, making sure you’re nourishing your body and moving your body.

And I love to be able to partner with patients to help them do that. I see patients in person in Charlottesville, Virginia and by telemedicine throughout the states of Illinois, Tennessee, and Virginia. If you are looking for an obesity medicine physician who just really gets these medications, I prescribe them every single day and we provide the comprehensive lifestyle support. We’ll talk about nutrition, we’ll talk about behavioral intervention. If there are other medical conditions going on, I got you. We will address those and take care of those as well. My goal is to support you as comprehensively as I can in your weight loss journey. You can learn more at www.sarahstombaughmd.com. Thanks for joining me for this week’s episode. See you all next time.