Dr. Sarah Molasky
Appearances
Health Chatter
Weight Loss Meds
But another first line thing that I tell patients is, have you ever spoken to a registered dietitian? And that's really important because first of all, nutritionists and dietitians are two different things. You can be a registered dietitian and still be a nutritionist. But if I like literally anyone can call themselves a nutritionist. and get away with it.
Health Chatter
Weight Loss Meds
Like I could call myself a nutritionist online, right? I have no credentials, but you don't need them to call yourself a nutritionist. To be a registered dietitian in America, you need a certain set of schooling. So I tell my patients, talk to your doctor, right?
Health Chatter
Weight Loss Meds
Your clinic or whatever, and ask them if you can have an appointment with a registered dietitian to find out, okay, I'm eating less or I'm eating more carefully, but am I eating effectively? Because when it comes to dietary changes, that looks very different for each person. And I tell my patients, look, I can give you the quick and dirty, right? Cut out pop, cut out sugary drinks, cut out juice.
Health Chatter
Weight Loss Meds
Just getting rid of really easy sources of quick sugar is a very... simple way to cut down on excess calories that also flood your body with sugar that gets stored as fat because your your blood sugar spikes and then your body is like, OK, let's pump out insulin and store that as fat. So those are the main things I tell people is talk to a registered dietitian first. Talk to your
Health Chatter
Weight Loss Meds
you know, clinical team and find out what they recommend for you specifically. When people come up to me asking about diet pills that they can buy over the counter, I say, absolutely not. That's going to raise your blood pressure. Some of them can have been found to cause liver damage. Like it's not something that's worthwhile.
Health Chatter
Weight Loss Meds
And if people say, you know, my, my doctor said they're going to prescribe me Ozempic because I have diabetes and I'm really worried. Like I've like, I don't know, I don't necessarily want to lose a lot of weight, valid because some patients don't want to lose too much weight, right?
Health Chatter
Weight Loss Meds
Or they're worried that they may lose muscle mass, which is a concern with some of these meds if someone isn't getting both enough calories and enough weight resistant exercise. So it really is about what is the patient who comes up to me like concerned about and addressing that directly. But the main thing is get more information that's customized to you. Right.
Health Chatter
Weight Loss Meds
I, as your pharmacist only have your medication, assuming you're even my, my patient, right. I only have your medication list. I don't have your lab results. I don't have your health history, but your clinic does. And your healthcare, your larger healthcare team does have access to that. So work with a dietician for that.
Health Chatter
Weight Loss Meds
And I personally have worked with a dietician myself because I was trying to, um, I had the opposite problem where I stress starve, where I forget to eat when I'm stressed out. And so I went to a dietician to say, Hey, I feel like I'm eating enough, but I don't know if I'm eating effectively.
Health Chatter
Weight Loss Meds
And she was able to educate me on what sorts of foods to look for, for my personal health and my eating habits. So registered dieticians are horribly underutilized, especially when it comes to, you know, weight in blood sugar, just general health. So that would be my number one thing is.
Health Chatter
Weight Loss Meds
registered dietitian, and also talk to your healthcare team about whether any of these are even remotely appropriate for your overall health.
Health Chatter
Weight Loss Meds
I mean, if someone's weight is going up and down, that's again, something that should be, you know, discussed with their healthcare team. And that can happen for a lot of reasons. If we're talking a weight loss or gain of like five to 10 pounds at a time, a lot of people with uteruses naturally go through that throughout the month.
Health Chatter
Weight Loss Meds
So it's a matter of is this weight gain and loss like necessarily metabolic or is it just hormonal or fluid retention or is it in a cycle? But when it comes to people who are doing these crash diets or things like keto is really popular and I can't roll my eyes enough at that because I have to counsel patients on that all the time on why it's not the best idea overall for most people.
Health Chatter
Weight Loss Meds
I really do think that talking to their healthcare team, getting a meal plan from registered dietitian, and then also potentially, you know, seeing occupational therapy or physical therapy about how should I be exercising correctly so I don't injure myself. All of those are things that people should be doing first before they turn to medication.
Health Chatter
Weight Loss Meds
But if we're talking somebody who, yeah, my weight fluctuates by 10, 20 pounds, but I'm morbidly obese, well, I don't care about the 10, 20 pound fluctuation. I care about how, if this morbid obesity is negatively impacting your life and your health, how are we going to address that? And for some of those patients- then these medications may be clinically appropriate.
Health Chatter
Weight Loss Meds
But again, I, as their pharmacist, can't give them that advice. They would need to talk to their whole team and try to set up a plan. And healthy, maintainable weight loss is not fast. That's one thing I wanted to say is outside of bariatric surgery, if we're talking the behavior I'm doing is going to change my weight,
Health Chatter
Weight Loss Meds
when you're losing weight in a way that's maintainable long-term, it's not going to be like that. It's going to be a slog. And that's what's really hard for people. And I think that's maybe what isn't communicated super accurately a lot of the time in a lot of social media about weight loss, where we get to see the before and after. And it's like, yeah, a year went by. No big deal.
Health Chatter
Weight Loss Meds
That was a year. That was a year of discouraging stuff in the middle that isn't being shown.
Health Chatter
Weight Loss Meds
Yeah. So I fortunately or unfortunately went viral while I was on clinical rotations because I went on a gigantic rant about some of those like weight loss supplements and It wasn't tummy tea, although that's basically just a laxative. So you're, you're basically trying to poop really, really quickly so that you can eat stuff, but you're not absorbing it very well.
Health Chatter
Weight Loss Meds
And that definitely does damage to your GI tract and should not be done. And many of those weight loss teas and supplements, again, also contain stimulants. But there are the biggest, Story I have about those sorts of weight loss shakes and supplements and teas and how they can impact your health is the woman I saw in the hospital was on rotation.
Health Chatter
Weight Loss Meds
She was in there for like heart failure and other things. And one of the biggest issues they could not resolve was that her legs were super swollen with fluid. Right. So she had major water retention and they were pumping her with diuretics and just nothing was working.
Health Chatter
Weight Loss Meds
And I went in and, you know, did my medication rec, which is, you know, as a pharmacist or a nurse, you go through their med list. And I asked about supplements, health shakes. And her daughter was like, oh, mom, you're using that shake.
Health Chatter
Weight Loss Meds
I looked up that shake, which was very difficult because they make it hard to find the ingredients list and cross referenced every ingredient and found out that one of the ingredients, which was ginseng, can cause diuretic resistance.
Health Chatter
Weight Loss Meds
So when I said that, they switched to a different diuretic that was harder hitting, got the water retention under control, and I don't know what happened with the patient after that because I moved rotations at that point.
Health Chatter
Weight Loss Meds
But, you know, for someone with heart issues, taking a stimulant containing weight loss supplement, which is what almost all these over-the-counter weight loss supplements contain, is a laxative probably, right? a stimulant almost definitely. And then a bunch of other things that might cause many problems.
Health Chatter
Weight Loss Meds
And another one is a lot of focus supplements, like certain types of like coffee for focus or whatever. A lot of those contain additional things that can raise blood pressure and suppress appetites through the stimulant activity, but can cause, you know, really big issues for the heart. In some cases for the liver, it's, I do not ever recommend them is the short answer.
Health Chatter
Weight Loss Meds
Right. So I would, I don't feel as well versed at the age difference because most of my patients are on the younger end who are taking this. I have seen a lot of insurances not be willing to cover these for patients over a certain age because potentially there is higher risk. I would also argue that most of these meds weren't studied on that patient population. That's a big key issue.
Health Chatter
Weight Loss Meds
We talk about studies, but studies and data don't, they're not made equal, right? There's the clinical trials where you have a very specific subset of patients, like only patients from this age range, no pregnant patients, no patients on this list of medications, no patients with this list of problems, but only patients with this list of problems.
Health Chatter
Weight Loss Meds
Like it's very narrow and the drug companies are motivated to make sure it's the patient population that's most likely to show really great results, right? They're not trying to get some Joe Schmoe off the street who like may or may not care about their weight. Like they're really going for people where we're hopefully going to see really good weight loss off these people.
Health Chatter
Weight Loss Meds
So then you have post-marketing data and that's once a drug hits the market and you have the general population taking it and you have prescribers prescribing it to not just the very specific study group subset, what are we seeing? And that's where we're seeing a lot more side effects. There's like gastroparesis is a really big one where your GI tract basically gets paralyzed, which is horrible.
Health Chatter
Weight Loss Meds
There's potentially issues with the pancreas, potentially issues with the thyroid. That data is still very weak because, again, these injectables are quite new. So we don't have long-term data on, you know, Ozempic and Moonjara right now because they're they're pretty new to the market. So I would say the older you are, the more likely you are to have certain types of GI issues.
Health Chatter
Weight Loss Meds
And also I would be worried if somebody is already on a lot more medications, which the older you are statistically, the more medications you'll be on. So there's confounding factors. There's various reasons why someone who's older may be at a higher risk of side effects with these medications. So just logicking my way through it, that's what I would say.
Health Chatter
Weight Loss Meds
Yeah, so that's a really big question. point of discussion when it comes to these meds. And I have a maybe slightly different view than some would. I think the concept that these are forever drugs is oversimplified. I think for a small number of people, these might have to be forever meds. And when I'm saying these, I'm talking strictly the weight loss ones.
Health Chatter
Weight Loss Meds
Because there are diabetics who I have absolutely no qualms about certain diabetic patients being on Ozempic or Victoza or whatever for the long haul to control their blood sugar. I'm speaking strictly for people who do not have blood sugar issues but want weight loss.
Health Chatter
Weight Loss Meds
I think these drugs for people where they're clinically appropriate to use and clinically safe to use can be an excellent stepping stone. towards long-term maintained weight loss without lifelong use. And my example would be one of my patients who was in a wheelchair for a really, really long time and was using, they had like diabetes as well.
Health Chatter
Weight Loss Meds
So, you know, but they ended up losing a lot of weight. They were able to stop relying on the scooter basically when they were getting around and they were able to walk. more often. And this led to, you know, increased exercise, and they were able to continue losing weight.
Health Chatter
Weight Loss Meds
And, you know, even though they're still on this medication, I feel like that's a really good example of if your mobility is so negatively impacted by your weight, and this weight loss medication helps you get down to a low enough weight that you can increase your exercise, then potentially between diet and exercise, you can maintain that weight loss
Health Chatter
Weight Loss Meds
and not need to stay on the medication, you could safely taper off of it. And that's the other thing is tapering off. Unfortunately, many of our patients on these meds, either for diabetes or weight loss have not gotten to taper off of them, they just suddenly stop because they're not available anywhere. So I mean, we've gotten to see what people are experiencing when they don't get to taper.
Health Chatter
Weight Loss Meds
Yeah, so I have been in pharmacy since I believe 2011, 2012 as a technician and eventually became a pharmacist. I tried out different types of pharmacy, but my passion was community pharmacy. which is not generally what pharmacy schools want you to go into. They want you to go into hospital or research or more clinical care, which is more prestigious.
Health Chatter
Weight Loss Meds
And it's extreme hunger, right? Like that hunger comes back with a With a passion. So if someone were to say, I'm going to try using this medication to get down to a certain level of weight loss so I can be more mobile.
Health Chatter
Weight Loss Meds
And while I'm doing that, and I have the suppressed appetite, I'm going to work with a dietician to make sure I'm getting enough food to maintain my muscle mass because I don't want to starve myself. but also not overeating so that I'm not going to, you know, meaninglessly take this medication, then I think it can be a really useful tool for a small subset of people.
Health Chatter
Weight Loss Meds
I don't think it's clinically appropriate to have people stay on this medication for the rest of their life if it's strictly for weight loss, unless we get more data indicating that it would make sense and for who it makes sense to, right? Because we don't, We just don't have enough information right now.
Health Chatter
Weight Loss Meds
But as things stand for now, I think for a small number of people, it could be very useful to get them to a point where healthy eating habits, which means something different for everybody, and healthy exercise habits, which look different for everybody, can be maintained, can become a habit for that person, and then slowly taper off that med while they still maintain those healthy habits.
Health Chatter
Weight Loss Meds
Yeah, so the most common ones would be nausea, vomiting, stomach ache, just GI discomfort in general. Most of my patients... complain about these side effects when they start the medication. And I've had some patients go off of these medications because of the side effects, right? Where they're just like, I constantly felt nauseated.
Health Chatter
Weight Loss Meds
I don't want to lose weight if it means I feel like I'm going to throw up all the time. So, and for some patients, you know, these side effects may peter off after a couple of weeks on a certain dose, but for others, they persisted and it was very uncomfortable. I believe one of the studies that
Health Chatter
Weight Loss Meds
on Ozempic, like a third of the participants dropped out within a certain period of time because they just couldn't handle the side effects. So that's something worth talking about. That's a lot. That's a lot. And when it comes to nausea is one thing, but vomiting that causes damage to your esophagus over time.
Health Chatter
Weight Loss Meds
I mean, if you look at the health issues that many bulimic patients have, one of them is, you know, erosion of their esophagus, erosion of the valves that, you know, keep the acid in their stomach and not in their esophagus.
Health Chatter
Weight Loss Meds
So all of that is really important to consider and a good reason why, you know, we really need to think about should this patient even be on this if they're having this level of side effect. And another thing that is much more serious that I mentioned before is gastroparesis. I'm not going to go through the whole list because we don't have time.
Health Chatter
Weight Loss Meds
But gastroparesis is the biggest one that I wanted to talk about. And that's when the GI tract is paralyzed. So suddenly you just can't move things through your system anymore because the smooth muscle that's supposed to move things along is just like, no. I'm good. We're full. We don't have to move things right now.
Health Chatter
Weight Loss Meds
So it can go a little too far because slowed gastric emptying is one of the potential benefits of this medication that you feel full for longer because your stomach isn't just taking in food and then dumping it into your intestines. It's taking in food and then like slowly moving it into your intestines. But if that gets way too slow, it is horrible.
Health Chatter
Weight Loss Meds
And like I said, there are some things with like potential pancreatic cancer risk, potential thyroid cancer risk, but that hasn't really been supported with data yet because we don't have long-term data.
Health Chatter
Weight Loss Meds
But I really love working with people directly and building relationships with people. And I've been a pharmacist on Northside for almost five years. In July, it'll be five years that I'll have been a pharmacist in Northside. So really happy serving the community I serve and I wouldn't do anything else.
Health Chatter
Weight Loss Meds
Right. Via shot, by yourself, hopefully. Yeah, right. So the two main ones I wanted to discuss when it comes to the injectables is Victoza and Ozempic, because those are the only two brands that also have specific weight loss injections. So Victoza's weight loss version is Saxenda.
Health Chatter
Weight Loss Meds
Same thing. And then for semaglutide, there's Ozempic and Ligovi. However, there is also an oral version of semaglutide called ribelsis, which is strictly for diabetes. And that comes in three different doses. And the complaints I've gotten from my patients on side effects have been the same as the complaints I got from them about the injections.
Health Chatter
Weight Loss Meds
Um, so despite it being a daily pill, which, you know, my, my thought process was, well, if it's daily, maybe the side effects are less noticeable because it's more steady over time and you're not like doing an injection and then whatever. Uh, no, I haven't noticed a difference. I'm still noticing patients complaining about, you know, nausea, upset stomach, et cetera. Yeah.
Health Chatter
Weight Loss Meds
But Ozempic or Wegovy are once a week dosing, whereas Victoza and Saxenda are daily. So there's definitely a, not only does Ozempic show a higher weight loss than Victoza did, but also it's once a week. So for people who really don't like poking themselves, it's much more convenient.
Health Chatter
Weight Loss Meds
Yeah, they are hideously expensive, and actually pharmacies have been suffering because we take a bath on these medications. I think a lot of people don't realize that it's possible for a pharmacy to take a loss, but because... many insurances aren't a fan of these medications, they don't reimburse at a great rate.
Health Chatter
Weight Loss Meds
And if you work in a location where it's high Medicare and high Medicaid patient population, you're more likely to be taking a loss on these medications. So we are sometimes taking like hundreds of dollars of a loss for every prescription we fill for these, depending on the patient's insurance.
Health Chatter
Weight Loss Meds
So even if the patient's copay is only, you know, zero to four dollars and 60 cents or something, I might be losing six hundred dollars just filling that medication for them. Just on cost of medication, not even talking about the overhead, my pay, my technicians pay the power. Right. Just on the cost of the drug, we're taking like a six hundred dollar bath.
Health Chatter
Weight Loss Meds
So that is pretty rough on top of all the phone calls we get all the time about them. Like it's these medications are not doing pharmacies any favors right now.
Health Chatter
Weight Loss Meds
And it's very tricky because these... The pill forms being generic would potentially be helpful, right? But when you have a new generic, we're talking, okay, the brand name costs us $500 to order. The generic may cost anywhere from like $50 to $450 to order. It really depends on the pricing that they decide on. And anytime there's a drug shortage, we see drug prices go up.
Health Chatter
Weight Loss Meds
Because why not charge more for our product right now? You all want it. So so I don't know that a generic is going to help that much when it comes to cost. Also, you know, I don't have a whole lot of private pay patients. Right. And I don't have a whole lot of patients on fancy work insurance. I mostly have patients on government insurance at my location.
Health Chatter
Weight Loss Meds
So my colleagues at other stores have said that there are people who are
Health Chatter
Weight Loss Meds
legitimately paying 500 a month for their co-payment for these medications and i just don't know that that's going to change unless the generics are significantly cheaper and in my experience they haven't been that much cheaper when the generics initially come out it seems to take at least five to ten years before enough other manufacturers are making that generic for it to bring the cost down and this is in america specifically other countries it's much cheaper
Health Chatter
Weight Loss Meds
You know, like what is it, what I want to know is my patient's motivation, right? Like what is it that you're wanting to get out of this medication, weight loss, okay, how much weight are you looking to lose? Why that number? Are there certain activities you're not able to do right now that you miss being able to do or that you want to be able to do?
Health Chatter
Weight Loss Meds
And based on their answers, you know, I'm just going to give honest opinions, you know, from me about whether I even think that medication is
Health Chatter
Weight Loss Meds
worth asking their clinician about, or if it makes more sense, like, hey, you haven't really, okay, you've, you've cut down on, like, this thing, but you're still, I'm looking at your cart, and you have these things in it that, you know, you have, like, three boxes of pop in your cart, like, just cut out the pop. cut out the pop for a month and see how you do.
Health Chatter
Weight Loss Meds
I would rather give like non-medical options to people first before they jump to a medical option. And people may be surprised for a pharmacist to say that, but just because I'm an expert on drugs doesn't mean I want everyone to be on them. I want people to be solely on the things they need to be on in order to maintain a happy, healthy life, whatever that looks like for them.
Health Chatter
Weight Loss Meds
And, you know, I really try to push the lifestyle changes first. But if someone says, look, This is how I've been eating all this time. I'm working with a registered dietitian. I'm exercising, you know, in this many times day doing this type of exercise, and I'm still just not losing the weight. Depending on their body type, I might also ask if they've ever been put on metformin.
Health Chatter
Weight Loss Meds
And metformin was one of the drugs I wanted to talk about that's a diabetes med, but it's also used for various issues like polycystic ovarian syndrome. pre-diabetes and insulin resistance.
Health Chatter
Weight Loss Meds
And for some people who hold a lot of fat, like on their torso, rather than like all throughout their body or towards their lower body, insulin resistance might be part of what's going on because insulin resistance doesn't cause you to be obese.
Health Chatter
Weight Loss Meds
But if you are already holding a lot of fat in that midsection area, that can lead to insulin resistance, which can then lead to weight being harder to lose, or like, it's a vicious cycle. So metformin is extremely cheap. It's a very old medication, very well studied. And while it has side effects, we're talking like diarrhea,
Health Chatter
Weight Loss Meds
There are many other side effects to it, but the common one is diarrhea, and it's pretty manageable for most patients. So I would ask, have you talked to your doctor about trying that since you've done all these other things? Ask your doctor if this is appropriate for you, right? Because it's very cheap.
Health Chatter
Weight Loss Meds
Even if they don't have really good insurance, I think through like the discount program that my work uses, it's like 30 something bucks for a three month supply. Like it's really not bad. So it's worth trying.
Health Chatter
Weight Loss Meds
And for many people, by taking metformin to address insulin resistance, that can actually, that combined with not eating a ton of extra sugar and exercising can be really helpful because metformin also tells the muscles in the body, hey, there's extra sugar. sugar floating around the blood, could you like snatch it up and use it for fuel, which helps your muscles grow too.
Health Chatter
Weight Loss Meds
So then if somebody is actually working out because they want to have more muscle in their body than fat, metformin has been shown to cause a small amount of weight reduction. It's known for that. That's one of its known side effects. But also if you have insulin resistance, it can really be impactful.
Health Chatter
Weight Loss Meds
Yeah, so I would explain that the vaccines and the injectable diabetes or weight loss meds have very different purposes and go through the body in very different ways. Generally, the diabetic injections are done in the fat, whereas vaccines, most of them are done in the muscle.
Health Chatter
Weight Loss Meds
So like all the ones I give, that's not true, I do MMR, but most of the vaccines I give are in the muscle and they go into your body, your immune system responds to it done like that's that's it the vaccine doesn't hang around in your body forever, right?
Health Chatter
Weight Loss Meds
And with these injectables, they're being injected every week or every day or whatever, because they need to tell your body, give your body the messages, right? These are just messenger molecules that are saying, hey, do this. And your body's like, fine, I will. And then you have to keep telling your body to do this over and over. So they just work very differently.
Health Chatter
Weight Loss Meds
The vaccines are a one-time message that basically tells your body how to drop a wanted poster for a specific pathogen for a specific bad guy that's trying to invade your body so that your body can recognize it faster. These injectables are just telling your body the message.
Health Chatter
Weight Loss Meds
It's reminding your body, Hey, I need you to, you know, do these things so that we can keep the blood sugar under control and as a side effect, potentially lose the weight.
Health Chatter
Weight Loss Meds
Thank you. I've loved being here. This is the kind of thing I like talking about. And I don't There's one thing I wanted to say, just because I feel like there's a lot of takeaways from these drugs that are usually not helpful on social media. And I feel like this is a good place to do it. But I just like to remind everybody that every single body is different.
Health Chatter
Weight Loss Meds
What works for your friend doesn't mean it's going to work for you. Even if it works for your mom or your sister, your brother, it doesn't mean it'll work for you. So it really is important to get customized health care that is aimed at you. from your healthcare team, which can include your pharmacist, but it should be a whole host of people.
Health Chatter
Weight Loss Meds
And also when it comes to exercise, I think there's a lot of stuff on social media that's misleading, burn belly fat in this much time or whatever. I just want to tell people exercise, there's no right or wrong exercise for everybody. You need to focus on what you'll actually do, even though weight training is supposed to be really good for you. I find it so terribly boring.
Health Chatter
Weight Loss Meds
And my weight training is through rock climbing because that's weight training. It's just not boring to me. So find what you're able to do safely because not everybody has access to a gym. Not everybody has access to safe outdoor areas to exercise and just do what you can actually do on a regular basis to build your health.
Health Chatter
Weight Loss Meds
And if you have access to a physical therapist or to an occupational therapist, they can actually be amazing resources to to help you figure out how to exercise in a way that's good for your specific body and your needs, also in the environment that you have to exercise in.
Health Chatter
Weight Loss Meds
And over-the-counter stuff, because I tell everybody, any time before you're about to buy any supplement over-the-counter, ask me first. I will happily...
Health Chatter
Weight Loss Meds
look at the ingredients list and figure out you know whether i feel comfortable with you taking it as my patient whose medication list i know and i always tell people especially a lot of herbal supplements or a lot of weight loss supplements have ingredients that can interfere with your existing medications and other supplements so it's really important to not put your health in jeopardy because uh the vitamin and supplement industry is a multi-billion dollar industry as well they're also out to get your money so let's keep your hard-earned cash
Health Chatter
Weight Loss Meds
for something that's actually going to be appropriate for your body.
Health Chatter
Weight Loss Meds
Yeah, so historically speaking, weight loss drugs have been around for decades, right? And possibly longer if we go back into really old school pharmacy where you had tinctures and all of that. But in terms of government recognized weight loss medications, they started out as stimulants. And so stimulants can include things like caffeine.
Health Chatter
Weight Loss Meds
Because caffeine and other stimulants have a side effect of appetite suppression. So this was based on the idea that weight gain was solely due to overconsumption of calories. Is that medically accurate? Not necessarily. Everybody has very different bodies. And so the cause for weight gain can be varied. It can be medical. It can be a medication that's causing it.
Health Chatter
Weight Loss Meds
interaction with another medication, certain types of foods. So it's really dependent on each person, but the original types of weight loss medications were stimulants. So they would make people feel very energetic. They might move around more. It would raise their heart rate and blood pressure, but also it might make them feel like eating less food.
Health Chatter
Weight Loss Meds
And that's kind of been the main sorts of therapies we've had. There's a lot of over-the-counter weight loss medications that use the same exact concept, including ones that are still around today. I never recommend them to my patients because I think they're trash.
Health Chatter
Weight Loss Meds
They have a lot of side effects that are really problematic, especially for patients who already have risks for heart disease or where high blood pressure can cause a lot more health issues for them. So then came in the Other therapies like bupropion, topiramate, fentramine, these are ones that, again, are meant to suppress craving or suppress appetite.
Health Chatter
Weight Loss Meds
So then we have diabetic injectables, which are called GLP-1s or glucagon-like peptide 1 receptor agonists. It's just a fancy way of saying it gloms onto a certain receptor in our body that tells our body to make more insulin to bring down our blood sugar. And it also can get that same receptor in our brain, but it tells it, hey, we're actually full. We don't have to eat more.
Health Chatter
Weight Loss Meds
So it has a dual action to make us potentially lose weight. This was not developed as a weight loss drug. The first JLP1 that was approved in America was Biada, which was a two-time-a-day injectable. It's still used today, but less often just because adherence isn't great, right? Not many people want to inject themselves twice a day if they have the option of once a day.
Health Chatter
Weight Loss Meds
So then in comes Victoza, which was a once a day dosing drug. And that seemed to show more efficacy for certain types of important health issues that many diabetics face. And that includes, you know, heart health and potentially kidney health. And then you got once a week ones as well. And the big one that we hear about is Ozempic, right?
Health Chatter
Weight Loss Meds
That's the trendy one that you've been hearing about with Hollywood stars injecting Ozempic to lose their seven extra pounds or whatever. And that has really been a trip in retail pharmacy because my patients who are diabetic need that medication. And there were months where I could not get that medication in the correct dose to my patients.
Health Chatter
Weight Loss Meds
There is first a period of time where the fancy special needle they used for that one, because Ozempic uses a different needle than the typical diabetes pens do, they couldn't get that needle in. So the medication was in stock, but they couldn't get the medication out to patients because they didn't have enough of the needle because of shortages.
Health Chatter
Weight Loss Meds
So I already got to see that shortage impact my diabetic patients. But then we got Hollywood stars starting to talk about how they're using Ozempic to lose weight. And I do have friends who live in the L.A. area who said everyone's talking about Ozempic. This is whether they're in health care or not, they're talking about it. So it really has become a trend.
Health Chatter
Weight Loss Meds
And I think part of it is social media, which is a double edged sword. Right. People can become aware of really important things like some people may find out, oh, you know, that health problem I've been having that sounds exactly what this like what this person is describing. I'm going to talk to my doctor about it. That's great.
Health Chatter
Weight Loss Meds
But when it comes to, oh, this person has lost weight using this drug, I want to lose weight using this drug. That's where we get a really big problem. And Ozempic technically is not meant to be used for weight loss. It is meant to be used for diabetes.
Health Chatter
Weight Loss Meds
But of course, when the drug manufacturer realized there was a larger weight loss component than many other medications in that same class, they applied for a patent to have it approved for weight loss specifically and created a separate product called Wagovi, which is literally the same thing, but in a slightly different dose. Eventually.
Health Chatter
Weight Loss Meds
Three of the doses are actually the same between Ozempic and Wegovy. And so those have really taken flight. But Wegovy is on constant shortage. And in case anyone's wondering, no, my pharmacy does not have it in stock. Please don't call. We literally field 10 plus calls a day just of people asking if we have certain types of Wegovy in stock. We don't. This is a nationwide shortage.
Health Chatter
Weight Loss Meds
And then there's one other injectable that came out more recently that people were really excited about both for the weight loss aspect, but also for the glucose control aspect. And that was Terzepatide or Munjaro. And Mujaro is a dual action medication. It is a GLP-1, just like Ozempic or Victoza or Biada, but it also contains GIP, which has like seven different technical names.
Health Chatter
Weight Loss Meds
But essentially what it does is when the blood sugar is getting too low, it taps on the liver and says, hey, can you just produce a little bit more sugar just so we can stay balanced? And so it's cool because it responds to what's actually going on in the body and tries to prevent really, really low blood sugar, which in diabetics can be very dangerous. It's called hypoglycemia.
Health Chatter
Weight Loss Meds
And if your blood sugar gets too low and your liver is not being responsive and pumping out more sugar, you can pass out or have other health issues. So manjaro is really interesting, but also has much higher weight loss than sugar. you know, Ozempic did. And so that's now like the, the star when it comes to weight loss meds.
Health Chatter
Weight Loss Meds
And again, we also are dealing with a shortage of Moonjaro and please do not call my pharmacy to ask if I have it in stock because no.
Health Chatter
Weight Loss Meds
Yeah, so I mean, in terms of the why this now for weight loss specifically, because they work. Right? They work with caveats. They work in certain patients with certain types of obesity and levels of obesity.
Health Chatter
Weight Loss Meds
They also work really well for people with diabetes or prediabetes and for some people with insulin resistance, which is a kind of umbrella term for people whose bodies don't, the cells in their bodies aren't responding to the message the insulin is sending, which is, hey, here's sugar, store it, use it as fuel. And the muscle cells will go, okay, we'll take in more sugar and use it up.
Health Chatter
Weight Loss Meds
Well, if someone's insulin resistant, the body, the pancreas is sending out all this insulin being like, hey, there's a lot of sugar in the blood. Let's bring it in. And their body isn't doing it. So for some people who are insulin resistant, drugs like this can potentially be somewhat helpful. Although I do have one medication I'll talk about that is much more helpful with that later.
Health Chatter
Weight Loss Meds
That is sometimes used for weight loss. But it works and it works relatively quickly. And when it comes to weight loss... It's very difficult for people to see results from weight loss when it comes to doing lifestyle remedies like changing your diet, exercising more. Those are things that are important, but they take a really long time for you to notice something.
Health Chatter
Weight Loss Meds
Whereas with these injectables, a lot of people are seeing results much more quickly, like say in a month or in two months, they're noticing, oh, I have way less of an appetite.
Health Chatter
Weight Loss Meds
So for people who, I would argue that a prescriber who's doing their due diligence and really being picky about what patient they're giving this to, they're choosing patients whose BMI is very high because technically I have a BMI of 30 right now. So I qualify for Wigovi. I'm not going to do it, but I technically qualify.
Health Chatter
Weight Loss Meds
But doctors and nurse practitioners and PAs who are being more diligent will do it for people who are a certain size. whose health would likely support it, who don't have pancreatic issues or thyroid issues that potentially might be concerning with these kinds of medications.
Health Chatter
Weight Loss Meds
And also for patients who have diabetes or prediabetes, then the Ozempic side of things might be considered appropriate because, again, Ozempic is supposed to be for diabetics, right?
Health Chatter
Weight Loss Meds
Unfortunately, what I'm actually seeing in practice is very different from that. I am seeing patients who do not have diabetes or prediabetes being prescribed, you know, Monjaro and Ozempic and When I get these prescriptions, I have to call the doctor and say, you know, this isn't really, that's not what this is prescribed for.
Health Chatter
Weight Loss Meds
I have patients on my wait list to get this medication who are actually diabetics. So I'm going to reserve this for my patients. And that's kind of a tough discussion to have with prescribers because some prescribers don't like when pharmacists contradict them, but I'm going to prioritize my patients first.
Health Chatter
Weight Loss Meds
So they're definitely, whenever there's an opportunity to make money, there will be a small number of people who will take advantage of that because they don't care about patients the way most prescribers do. And unfortunately, that small group is then prescribing to people who just want to lose a small amount of weight. Well, I shouldn't say small because everything's relative, right?
Health Chatter
Weight Loss Meds
An amount of weight that isn't necessarily representative of what kind of weight loss these medications were
Health Chatter
Weight Loss Meds
Yeah, so it really depends on the person, of course. But if the person comes up to me saying, you know, I've been doing all these things to lose weight and nothing's working, I really want to try one of these injectables. Obviously, the first thing I say is you need to talk to your doctor about it.