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This is the eat well, think well, live well podcast.
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I'm Lisa Salisbury, and this is episode 136 weight loss medications with Dr.
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Lindsay Ogle.
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This is the episode I have been wanting to do with the perfect person and Dr.
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Ogle.
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is the one.
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She is a double board certified physician in family medicine and obesity medicine.
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We are going to dive deep into the pillars of obesity medicine, what the options are in weight loss medications these days, what you need to do while on them.
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And at the very end, we will talk about the possibility of weaning off and how that looks.
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We also get into who is a good candidate for these medications and just a lot of deep dive.
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On the options.
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I just wanted to offer you this episode so that you have a lot of good information to decide if alongside coaching, talking to your physician about some of these options would be right for you.
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Welcome to eat well.
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Well, the podcast for busy women who want to lose weight without constantly counting, tracking, or stressing over every bite.
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I'm Lisa Salsbury, a certified health weight loss and life coach, and most importantly, a recovered chronic dieter here.
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You'll learn to listen to your body and uncover the reasons you're reaching for food.
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When you're not truly hungry, freeing you to focus on a healthier, more fulfilling approach to eating.
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Welcome back to the eat well, think well, live well podcast.
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I am so excited to be interviewing Dr.
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Lindsay Ogle today.
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She is a double board certified in family medicine and obesity medicine.
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And, um, just, she reached out to me and I was like, yes, yes, yes.
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You may have been noticing as a listener that I have been leaning more towards evidence based guests lately and really trying to get away from people that are termed, um, functional or holistic or things like that, that really aren't science or evidence based.
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And so I could not be more thrilled to have a double board certified doctor here on the podcast.
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So welcome Dr.
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Ogle.
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Please give us a little introduction to you and what you do.
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Yeah, thank you so much for having me on here, Lisa.
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I'm very excited for this conversation.
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So, um, as you said, I'm Dr.
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Lindsay Ogle.
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Um, I went into medicine really to help people achieve and maintain their health.
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And I chose family medicine originally to practice primary care and build those lasting relationships with my patients.
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And quickly I realized that many of our chronic conditions that I was seeing and my patients were related to lifestyle.
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And I actually did some elective rotations during residents.
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and worked with an obesity medicine physician, and she really introduced me to this field, and I fell in love with it very quickly because of its emphasis on lifestyle, nutrition, exercise, mental health, and then utilizing safe and effective medications, um, when appropriate or referring to surgery when appropriate.
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And I just saw the benefits that these patients were having with improving.
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their health and well being long term.
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And so I, after I finished residency, I did some additional training, um, and then sat for those obesity medicine boards, um, as well.
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Um, I did a couple of years in primary care and now I'm really focusing on weight management and metabolic health, um, through my telehealth clinic.
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Perfect.
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You are the perfect person to be asking all of these questions.
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So if you notice from the title, we are going to be diving into a little bit on the GLP 1 medications.
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But before we talk about medicine, let's talk about the four pillars of obesity medicine.
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I think it's really important that we hear from you on this because I have been seeing several, um, I, I'm on Instagram, love it or hate it, you know, I, I'm on there to, to let people know what I do.
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And so I, of course I'm scrolling and so many times I see things like, Oh, these doctors, they just only want to put you on medicine.
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They just only want to prescribe things.
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And it goes not just for obesity, but for everything.
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I think doctors get a really bad rap in that way.
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Um, I don't believe that, but I want to talk about the four pillars because medicine is only.
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One of them.
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So if you could introduce those, what those four pillars of obesity medicine are under your training.
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Yeah, thank you so much for bringing this up.
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I think this gets overlooked, especially in popular media and the general public, but anyone who is trained in obesity medicine is taught these four pillars and it is nutrition, and physical activity, behavioral modifications, and then medication management, including um, medications or the surgical interventions.
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And so medication and surgery is just one of those pillars.
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We spend the rest of our training and our focus on those lifestyle interventions.
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And so if you are working with an obesity medicine physician, then you are able to, um, have that all encompassing, um, you know, full picture evaluation and treatment.
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Um, if you don't have the access to a obesity medicine physician, because there are not.
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Um, a, a lot of us out there, um, we're a minority of the physicians and you, if you happen to be prescribed, um, a GLP one, then that is when it is so beneficial to work with, um, either a dietician, a trainer, or a coach, or one of each to really.
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Touch on all those pillars because they are so important for us to really focus on your health and well being long term.
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I love that.
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I, um, I of course specialize more in the behavior modification section of those.
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Uh, on those pillars and helping people to figure out why they're eating when they're not hungry and it's such a still important piece, even if you're on medication or if you've had surgery, you still have this, you know, you still have a brain and that brain is still in, you know, going to be stuck in some habit loops and that, you know, you're not maybe aware of and so that's where, you know, coaching can really come in.
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So let's dive into really attacking some of those.
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Yeah.
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Yeah.
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Yeah.
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information as well as some misinformation on the GLP 1 medications.
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Can you start with some background, some context, um, you know, things like how long they've been around.
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I think because of the increased popularity recently, it feels like they're brand new drugs.
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And spoiler alert, I'm, I know they're not.
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She, she, we're both laughing here.
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Um, but if we could just Kind of get into that.
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That would be great.
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So
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Yeah, absolutely.
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And that was perfect timing.
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I actually just did a post on social media.
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on on Tiktok actually, and I'll post it on Instagram soon about how I need to stop myself.
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I need to stop saying our new weight loss medications are new injectable medications because I still catch myself doing that.
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And this class of medications, the GLP one agonist have been around since 2005.
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And so we have been using GLP one agonist.
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Um, initially for type two diabetes only, but we have been using this class of medications now for 20 years, and they were studied for years and years prior to that.
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So we have a lot of data and real world data, real life data, um, proving that they are safe and effective when used appropriately and for the right, right patient.
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And so, like I said, they've been around for a long time, um, I heard this great analogy, which I am going to continue to use moving forward.
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It's like, uh, our iPhone.
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So we had the iPhone version one that came out and then every so often they have a new version and it's an upgrade and it's better, more efficient, it has more features, um, in it, and it's very similar to this class of medication.
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So we started with, um, it was Byetta was the name of the brand name of the first one.
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And then we've had new inner iterations.
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Um, there's been several iterations over time, and now we have our weekly injections on.
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And we have a couple of brand names that are now FDA approved for weight management rather than just type 2 diabetes.
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that's why they feel new then is because of the recent approval to use this class of medication strictly for weight management and not just for type two diabetes.
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absolutely, yes, yes.
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I just think that's really, like, good to know as to why they feel new.
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right, right.
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It wasn't that, you know, doctors or the healthcare field was hiding the medications or keeping them, um, for certain uses.
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they just were not FDA approved for that reason.
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They were very effective for treating type two diabetes, and we were seeing such great results.
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Our patients were feeling better, having more energy, um, they were losing weight, um, just seeing great outcomes, and then While we were watching how great patients with type two diabetes were responding to these medicines, then they were studied for patients without type two diabetes and we saw very similar outcomes for those patients and then that's when they were approved, for weight management.
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Okay, perfect.
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So, all medication comes with risk, as we know.
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Everyone has seen, you know, the jokes about the, I mean, Saturday Night Live has parodied drug ads forever about all of the different risks.
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So, of course there's risks.
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Um, but again, I think social media and popular culture has, confused people as to what the risks are.
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So from somebody who is, again, board certified in this, totally qualified to prescribe these medications, what are the risks?
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And, and then of course we'll talk about the benefits and why that is of course outweighing some of those risks.
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Yeah, absolutely.
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And every physician, like you said, with any medication we're prescribing, we are always thinking about risks and benefits because with anything we do, um, there are risks and benefits.
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And so we are wanting to make sure that, that those benefits are outweighing the risk.
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For for patients and for anybody who qualifies for the medication for the most part for the majority of people, those benefits do outweigh the risks and I don't blame anybody for maybe being nervous about trying to medications because there are very scary.
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about what can happen if you take these medications, but in reality, if you are being prescribed appropriately by your physician or your provider, um, the, the side effects are fairly mild if they happen at all.
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So on average, about a third, of people have GI side effects.
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So GI side effects are by far the most common.
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and that is Um, and really a result of how the medication works.
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So one of the ways that the medicine affects our body is that it slows the GI system down the GI tract down.
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And so food sits in the stomach longer.
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And while that's happening, that can trigger nausea or acid reflux, and the slowing can also then lead to constipation or changes in bowel habits.
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and those can really be.
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managed by making sure that we're eating small, frequent meals, staying really well hydrated, avoiding greasy or sugary foods.
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and then making sure we're getting enough fiber to offset that constipation.
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And then we always start at our lowest
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I'm going to, sorry, I'm going to interrupt you right here for a second, Dr.
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Ogle, and just point out this is, this is where that one of those pillars of obesity medicine comes in into play.
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We have to have behavioral modification along with the medicine.
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You don't just get to take the medicine and have it like, quote unquote, do its job.
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Like that was a lot of behavioral modification that you just listed.
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And so,
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Yes.
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I just, anyway, I just think it's interesting.
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Carry on.
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No, that's it.
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That is a great point.
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Um, uh, yeah, a great point.
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Absolutely.
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Um, so I, I do think that that's very important to highlight because there's a disconnect between, you know, taking a medication.
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I think that people think that it medicine just like Burns the fat off the body or increases metabolism and automatically leads to weight loss that way and and that is just not the case.
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There are, the medications are improving biologic changes that happen when somebody has obesity and and so that is what the medicines are correcting.
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They do not by themselves.
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It's a tool to augment those behavior changes that you are working on, um, to, help you to be successful.
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Um, but yeah, but we start at the lowest dose and then slowly work our way up, over time.
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And if at any point you're having, you know, side effects on a regular basis, uh, we always hold off on increasing the dose and maybe back down on the dose, uh, and address that until Uh, Um, and then we can go back to adjusting the dose if needed.
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the more serious side effects that we hear about are really rare.
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and a lot of them are related to weight loss in general.
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So I'm referring to, um, the gallbladder disease, gallstone development, pancreatitis.
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We see this happen with any amount of significant weight loss, especially if it happens in a short period of time.
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So it's less from the medication itself.
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It's more from the fact that we are more people are losing weight on the medicine.
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And then the one not really any that we are very strict about is any personal or family history of medullary thyroid cancer.
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in animal studies, there has been an association of an increased risk of that specific type of cancer, medullary thyroid cancer.
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So we're very cautious if anybody has that in their family history or personal history, then they should not be taking these medications at all.
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Not a candidate.
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Yeah.
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Okay.
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So another risk I think that we see a lot, which isn't so much listed on, you know, on the label is the risk of losing more muscle than fat and this, you know, people are very worried about this.
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And I think it's, again, common to be shouted in the grocery stores from wellness influencers, like, don't do that because you're going to lose all this muscle.
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And it seems to me like it's just along those lines with the gallbladder that we see this with any rapid weight loss.
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if I was able to just snap my fingers and change your lifestyle overnight and you started losing weight, you would see this if you weren't actively combating what causes that.
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And I believe that that's the case with these medications that people are not doing the two things, eating enough protein and strength training.
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Would you agree?
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I totally agree.
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Yes.
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Yes.
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Those are so important for anybody who is losing weight If you're losing weight from any means, then that is a concern.
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We want to make sure that we are maintaining your muscle mass as much as possible.
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but There is no way around to lose some amount of muscle mass.
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So when we are carrying more weights, we need bigger muscles to carry that weight.
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Um, and so sometimes even just the ratio, um, maybe that main maintains the same, you know, as we're losing weight, but you're going to lose some muscle, um, with that.
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But yeah,
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Yeah.
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If you have a hundred pounds to lose, you can't possibly make that all fat.
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That's just not, it's just not a thing.
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You can't do that, but that doesn't happen.
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Cause yeah, like you said, you're going to have smaller muscles when your body is smaller because that is what you need to function.
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yes, absolutely.
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The only way to do 100 percent fat loss is liposuction.
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Okay.
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Okay.
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So, um, let's talk about why someone would choose, um, a 1 medication.
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I have had clients, I've had both.
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I've had clients that are like, You know, I would never, I would never do, and for some reason they just think that that's, I think there's some, uh, stigma with it being quote unquote cheating, which I think is ridiculous.
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If my clients are open to it, I always say, ask your doctor.
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Um, and I have coached clients that have been on medication.
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And so when someone asks me well, should I work with you or should I get medication?
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I'm like, yes, but what would be some of the indicators that would be like, yeah, this person's really a, a good candidate for asking their doctor about, getting on a medication.
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Yeah, and I really appreciate your approach there.
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And I try to have a similar approach of really individualizing recommendations for for that person and working with you know what somebody's goals are and what they're comfortable doing.
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And I definitely agree with yes and let's do both let's let's use.
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Let's focus on the health and medicine side and then let's focus on the mental health and behavior side as well.
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Um, And so I really think that, um, medication should be considered maybe more strongly if somebody has really the majority of their life struggled with their weight and, as for decades, really not been able to either.
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Lose a significant amount of weight to be able to get them into not even a a normal BMI because we know there's a lot of Problems with BMI and that's not our goal our goal is to help somebody improve their health and to function in a lot in their life function and participate in their lives in a way that they want to and sometimes our weight can hold us back from that and And so we want to, um, help you find, you know, that best weight for you.
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And if you have not been able to, to do that over, like I said, years or decades, then maybe it's time to talk to your doctor and think about correcting those, um, biological changes that are underlying.
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Also kind of maybe taking a look in your family and if a lot of people in your family struggle with weight, then there's a high chance that there's a genetic component going on.
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And these medications can, can really help with that.
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Um, if you've done a lot of yo yo dieting back and forth, these medications can also really help just stabilize, those ups and downs, and really again, focus on, on health and nutrition and it can, I know there's a lot of talk about the food noise.
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and I know I'm, yeah, and I know you do a
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about that for
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yeah, and I know you do a lot of work with that with, with coaching and, and our thoughts around food, which could be so powerful.
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but there, there, for some people, I would say even for most people, when you lose a significant amount of weight, Your hunger hormones and those signal hunger signals to your brain increase because your body wants to maintain the weight that it was at because it's trying to protect you.
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It thinks that you're starving.
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We, you know, food used to be scarce.
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And so it's trying to conserve energy.
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So hunger signals and those hormones go up and it can be very, very difficult over a sustained period of time to fight those hunger signals.
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And that is where medication can really be powerful because it can help lock those.
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Those hunger signals and then it can allow you then to follow the healthy nutrition plan that you have set on and this ties back, you said something in the very beginning about when we were talking about mental health and I forget, forget exactly what you said.
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But I was talking with somebody about using food to help, um, cope with certain emotions and we all do it.
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And that's a normal human, you know, coping strategy, but sometimes it gets out of hand and difficult to control and can lead to a negative health consequences, whether physical or mental.
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And if you're on a GLP one.
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Your hunger signals are going to be suppressed.
00:21:00.748 --> 00:21:09.508
Your cravings are going to drop down significantly, and you're going to lose that coping mechanism of food that you were turning to before.
00:21:09.807 --> 00:21:15.758
And so it is so important to have the support and strategies in place.
00:21:15.817 --> 00:21:26.897
So then you can Learn how you can cope with that stress and those negative emotions that are going to come up when you don't have food to turn to like, like we used to.
00:21:28.142 --> 00:21:39.241
so on this topic of who it's appropriate for, that's a lot of good, you know, I think people can see themselves in, in that, but what about strictly in terms of weight to be lost?
00:21:39.682 --> 00:21:40.511
Is there.
00:21:40.811 --> 00:21:50.412
an appropriate amount of, like, if you have this much weight to lose, you're a candidate, but if you only have X amount of pounds, you're not a candidate.
00:21:50.442 --> 00:21:52.701
Is there a cutoff guideline
00:21:53.372 --> 00:21:58.781
Yeah, so, um, medically, uh, we are still using BMI mostly.
00:21:59.271 --> 00:22:25.557
Um, so, A BMI of 30 or above qualifies medically for for medications or BMI of 27 or above with a weight related condition like high blood pressure, diabetes, cholesterol, sleep apnea, and you can calculate your BMI really easily by searching BMI calculator and then putting in your height and weight and it'll tell you.
00:22:25.936 --> 00:22:28.146
so those are the, medical cutoffs.
00:22:29.353 --> 00:22:35.083
That does not mean that your insurance will cover the medication, though, which is very frustrating component.
00:22:35.573 --> 00:22:41.232
Right now, insurance companies are not required to cover medications for obesity.
00:22:41.794 --> 00:22:43.173
There are a lot of people.
00:22:43.663 --> 00:22:53.253
I know, I know it will be actually only been recognized as a chronic medical condition since 2013.
00:22:53.673 --> 00:23:02.933
And so it has not been that long that we have the medical community as a whole has seen it as something that needs to be treated directly.
00:23:03.759 --> 00:23:17.118
And so there it does take time to make those changes, but there fortunately are a lot of people who are, you know, supporting supporting the cause and hopefully insurance will will start covering it more consistently moving forward.
00:23:18.076 --> 00:23:20.355
Yeah, hopefully that's, that can be the case.
00:23:20.365 --> 00:23:25.556
So it's not necessarily a, I have 20 or 40 or 90 pounds to lose.
00:23:25.586 --> 00:23:31.195
It really, at this point, still, you need to go off of your BMI, which.
00:23:31.945 --> 00:23:37.455
I know like every time you've said it, you've kind of like put it in air quotes and so which people aren't seeing.
00:23:37.455 --> 00:23:39.695
So it is, it is still a challenge.
00:23:39.786 --> 00:23:44.949
So it sounds like still something you need to just have that conversation with your provider.
00:23:45.679 --> 00:24:00.933
So let's talk about, GLP 1s are very obviously popular, there are certain types that are approved just for weight loss and you don't have to have a, a secondary diagnosis like type 2 diabetes, but there are other medications.
00:24:01.374 --> 00:24:05.193
So, can you speak to some of those options?
00:24:05.412 --> 00:24:06.491
Yeah, absolutely.
00:24:07.011 --> 00:24:16.221
So, outside of the class of GLP 1s, there are really, I would say, three main medications that are used.
00:24:16.602 --> 00:24:26.761
The first is Phentermine, and Phentermine was FDA approved in 1959, and so it's been around for 66 years.
00:24:27.287 --> 00:24:41.366
Um, so another one that we have a lot of data on its safety for, um, it gets a bad rep because at one point it was combined with another medication that had significant side effects, but by itself it has been proven to be safe.
00:24:42.067 --> 00:24:42.346
Again,
00:24:42.523 --> 00:24:50.358
Yeah, so, I'm just going to say for those, I, I was, um, kind of, I think in my early twenties when this happened, so you might be familiar with the combo.
00:24:50.378 --> 00:24:55.388
They called it Fent Fen because the other one also started with the, with the prefix Fen.
00:24:55.409 --> 00:24:55.699
So
00:24:55.906 --> 00:24:56.457
Yes.
00:24:56.576 --> 00:24:57.057
Yes.
00:24:57.067 --> 00:24:57.356
Fen.
00:24:57.366 --> 00:24:57.747
Fen.
00:24:57.757 --> 00:24:59.646
And so that is no longer available.
00:24:59.946 --> 00:25:03.747
but fentamine by itself is still an effective appetite suppressant.
00:25:03.747 --> 00:25:06.096
And so that's really where it helps a lot.
00:25:06.106 --> 00:25:22.356
So, if somebody is having that increased hunger, you know, when they're cutting calories that this can be helpful, um, this should really be done with, uh, or prescribed by an in person provider because we want to monitor your vitals closely, um, because it is a stimulant and it is technically a controlled substance.
00:25:22.813 --> 00:25:26.782
Although I always say, you know, people are not selling phentermine on the streets.
00:25:26.782 --> 00:25:43.403
People don't really become addicted to it Um, but it is a stimulant so it is controlled then really great thing about it is it's very inexpensive Even if your insurance does not cover weight management medications With a good or x coupon you can get it for around 20 a month.
00:25:43.403 --> 00:25:45.432
So very very affordable.
00:25:45.482 --> 00:25:51.857
Yeah compared to the GLP 1 agonist, which without insurance can be closer to a thousand dollars a month.
00:25:51.867 --> 00:25:53.678
So huge difference there.
00:25:54.577 --> 00:26:00.087
Qsymia is a brand name that combines Phentermine and Topiramate.
![Weight Loss Medications with Dr. Lindsay Ogle [Ep. 136]](https://getpodpage.com/image_transform_gate_v3/yoEvRVQg-u6mOMrFXEIAVExG959-PmZ0Vm-RFydFPpY=/?image_url=https%3A%2F%2Fstorage.buzzsprout.com%2F8f0rbrw9726hfyisnebdshsokfnp%3F.jpg&w=1200&h=630&fill=blur "Weight Loss Medications with Dr. Lindsay Ogle [Ep. 136]")
