The Power in Motion Podcast

The Straight Goods on GLP-1 Agonists: A Comprehensive Overview of Weight Loss Drugs with Dr. Michelle Tubman

• Kim Hagle • Episode 131

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In this episode, Kim welcomes back Dr. Michelle Tubman to the podcast for an in-depth discussion on the popular GLP-1 agonists, such as Ozempic and Wegovy. 

Dr. Tubman, a physician specializing in emergency, obesity, and lifestyle medicine, breaks down everything you need to know about these medications: 

  • How injectable weight loss drugs work 
  • Side effects - both short and long term
  • Their effectiveness in facilitating long term weight loss and improved health outcomes
  • Misconceptions surrounding GLP-1’s. 

This episode is a must listen for anyone considering using these drugs and will help you make a truly informed health decision.

You’ll walk away with key considerations about using these drugs and how to foster a healthier body image and relationship with food.

Be sure to download Dr. Tubman’s free resource “Understanding GLP-1 Medications” for more information on this subject.


About Our Guest

Beautiful, healthy, fabulously fulfilled, you don't need to change your weight to have it all. You just have to change your mind. 

Body acceptance advocate Dr. Michelle Tubman is the founder of Wayza Health and the host of the popular podcast, Thrive Beyond Size. 

Her coaching programs are designed to liberate women from the dangerous diet culture that's dominated their lives since they were old enough to understand a world in which their weight determined their worth. A now-reformed chronic dieter who struggled with shame and low-self-esteem, Michelle set out to find the answers. 

She is certified in eating psychology, binge eating treatment, intuitive eating and life coaching. As a physician, she is triple board certified in obesity, lifestyle, and emergency medicine. 

Listen to Dr Michelle’s episode on Weight Neutral Medical Care

https://www.instagram.com/wayzahealth

https://www.facebook.com/wayzahealth/


About the Host

Kim Hagle (she/her)  is a Size Inclusive Fitness Specialist,  Non-Diet Nutritionist,  and certified Health and Life Coach specializing in body image.   

She is passionate about helping women develop a trusting and respectful relationship with their body so they can feel healthy, happy and confident while leaving  food rules, torturous exercise and body dissatisfaction behind and confidently create their best life - right now!

Offering cognitive behavioural coaching and weight neutral personal training, Kim supports her clients to feel their very best, both IN and ABOUT their body.


Want to learn how to support your body without obsessing over the scale?  Register for our FREE mini course. Learn simple, sustainable habits and mindset shifts so you can feel healthy, energetic and confident without rules, deprivation or willpower

Ready to take the next step? Visit our website to learn about how we can work together  

Let’s stay in touch! Kim is on Instagram, Facebook, TikTok, YouTube and LinkedIn @radiantvitalitywellness.  

Disclaimer.  The information contained in this podcast is for informational purposes only and is not a substitute for medical advice.  Always consult a health care professional about your unique needs.

Support the show

Hi, welcome back. As you know, we've been deep diving into the topic of health at every size here on the Power in Motion podcast over the last few months, really exploring how we can create our healthiest lives by focusing on health seeking behaviors rather than simply the number on the scale. And we've met some amazing experts along the way. And today I've invited one of them back for a follow up episode. So on a super hot topic, which is GLP 1 injectable weight loss drugs like Osempic, Wigovi, Manjaro, and the others. I know that there's a lot of talk about about these medications these days, a lot of information and misinformation being circulated, and a lot of controversy too where some folks are claiming that they're a miracle drug that's changing lives and improving health and others who are very strongly against them. So I wanted to talk about these drugs on the show, but I wanted to make sure that the expert I brought on was highly knowledgeable. About them and would also present as close to an unbiased overview of them as possible. And I knew exactly who to ask to have that conversation. So today we're welcoming back Dr. Michelle Tubman, who was with us for episode one 20, speaking about how to advocate for weight neutral medical care. Dr. Michelle is the founder of Ways of Health and the host of the popular podcast Thrive Beyond Size. Her coaching programs are designed to liberate women from the dangerous diet culture that's dominated their lives since they were old enough to understand a world in which their weight determined their worth. And now, reformed chronic dieter who struggled with shame and low self esteem, Michelle set out to find the answers. She's certified in eating psychology, binge eating treatment, intuitive eating, and life coaching. And as a physician, she's triple board certified in obesity, lifestyle, and emergency medicine. So she is the expert on this topic. And on this episode today, we talked about it all. Dr. Michelle explained exactly how these injectable weight loss drugs work, the side effects that are common and less common with them both in the short and long term with using these drugs, and we also talked about their effectiveness in facilitating long term weight loss and improved health outcomes, and some of that might be surprise you. And of course we also dug into the common misconceptions that are out there circulating around the GLP 1 drugs. So this episode really is a must listen for anyone who's considering using these drugs and will really help you make a truly informed health decision. You're going to walk away Knowing exactly what you need to consider before saying yes or no to these drugs and also how you can foster a healthier body image and relationship with food, whether or not you decide to use them. I also want to let you know that Dr. Tubman has created a brilliant resource that's free for all of you to download about understanding GLP 1 medications. It's 29 pages long. It is the most comprehensive manual, for lack of a better word, that you will find in the world. out there that tells you everything good, bad, ugly, in between about these medications. So if you're at all considering using them, please download that free resource. The link is in the show notes and take it along with you when you're having a conversation with your medical provider so that you're, you're well informed. Okay, let's get right into it. This is a fantastic episode. I hope that you enjoy it as much as I did.

Kim:

Oh, Michelle, Dr. Tubman. It is so, so great to have you back on the podcast today. And I'm thrilled to be digging into this topic that I know is on a lot of people's minds. And, um, I'm looking forward to this conversation. I know you're going to bring a really, um, honest, truthful, and nonjudgmental point of to this topic. So welcome back.

Michelle:

Excellent, Kim. Thank you. I'm so glad to be back. Great.

Kim:

And I know you've been on the show before, so my guests may be familiar with you, but for those who aren't, can you give us a quick and dirty rundown on who you are and what you do?

Michelle:

Sure. My name is Dr. Michelle Tubman and I wear two hats. I am a physician. I am board certified in emergency medicine, but also obesity medicine and lifestyle medicine, which makes me as close to an expert on GOP1 medication. Transcripts provided in order to facilitate communication and may not be a totally verbatim record of the proceedings. Um, what weight loss means, what some of the harms associated with some of the ways in which we do lose, lose weight can cause us and really empowering people to understand that there are other ways to reach health goals without having to turn to diets or, or or medications, but also understanding that, you know, people do have to make the decisions that are best for them when it comes to their, their weight, their bodies, their life, their wellness. Um, but it's important. I think that people are really armed with. All the knowledge that they need to make a truly informed decision for themselves.

Kim:

Yeah, I think that's so important, right, is having all the information and there is a lot of information and misinformation circulating, circulating on GLP 1 inhibitors specifically. So that's why I really wanted to bring you on here to get the whole picture and looking at all the different sides of it because there are many sides. Um, and just back up for a second and say that if you are interested as a listener in hearing more about Dr. Michelle's philosophy on the weight neutral approach to healthcare, um, we have had another episode on that, so I'll link it in the show notes and people can certainly go back and hear about what that's all about. But for today's show, we're going to specifically be talking about GLP 1 inhibitors, which includes drugs like Ozempic and the like. Um, so let's start there. I know there are a few different. drugs in this category, three or four different drugs. So can you tell us a little bit about the different ones? Are they like all the same thing, different doses, different names?

Michelle:

Sure, sure. The first clarification and common misconception is that they are not GLP 1 inhibitors. They're actually GLP 1 Agonists agonist means that it actually mimics a hormone in the body called GLP 1 or glucagon like peptide. Okay. So it actually mimics a hormone that our body already makes. And we'll, we'll talk about what that hormone does in a minute. But when we talk about the GLP 1 as a class of medication, yeah, there's currently four of them on the market that are sold for Um, people to use as as medications, and each of them are the same class of medications, just slightly different. And of course, for each of those medications, there are two different pharmaceutical companies that are making that medication and selling them under different brand names. So, The market is we've got a few right with Ozempic is common. Um, what Govi is the exact same drug, um, but a different brand name. Both of those are made by the pharmaceutical company Novo Nordisk, right? And some of Glutide. is the compound. Okay. So, um, semaglutide is the drug name. And then this pharmaceutical company makes two. It's exactly the same drug, just slightly different doses under two different brand names. Likewise, you know, we also have, um, terzapatide, which is a common one now. Um, It, and it also has two drugs that are the same, the same. So it's, uh, Zep Bound and Monjoro. And so Monjoro is quite, um, popular in Canada right now. Zep Bound is not actually licensed in, in Canada. Health Canada has not approved it, but it's very commonly prescribed, um, in the States. And there are a couple of other medications in the system. Um, the same class that we're also seeing, um, succenda and trueplicity being, um, the, the more common ones, but they are all GLP 1 agonist medications. They all do the same thing. The only thing that differs is slightly different dosing and the brand name that they're marketed under. And that's it.

Kim:

Okay. Thank you for that. That was a really good clarification on that. And am I right in, um, What I heard is that the difference, the reason why like Ozempic and Wigovy, for instance, have a different brand name is because they're approved for different purposes. Is that right?

Michelle:

Correct. So all of the GLP 1 agonist medications were initially development, developed for the treatment of type 2 diabetes. So people with type 2 diabetes would be prescribed them to help manage their blood sugar levels in the body. Doctors saw that weight loss was a side effect in many of the people with diabetes taking this medication. And so they did some additional research and chose to develop specific medications of the same drug class, but mark it specifically for weight loss, which is the side effect. of these drugs. So in the case of Ozempic and Wagovi, Ozempic was the original semaglutide compound manufactured for the purpose of treating type two diabetes. Then they went and made Wagovi, same drug but marketed, um, and FDA approved specifically for weight loss.

Kim:

Okay, so, we have been using these drugs for a long time in the treatment of diabetes, right? And can you, in layman's terms, explain how the drug works in managing blood sugar? Sure.

Michelle:

So, as I mentioned initially, uh, It's because they mimic a hormone called glucagon like peptide one. And this is a medication that causes the pancreas in your body to release more insulin when you take in sugar or simple carbohydrates that are broken down. into sugar. And so what that does is a couple things. It delays the emptying of your stomach. So when you do eat a meal, um, it goes through your stomach and through your digestive tract, just a little bit slower, which means you feel full faster and ultimately end up eating less through the course of the day. So that's one mechanism by which it helps with weight loss. Another thing is that it does actually help you feel less hungry. It does directly affect the hunger centers in your brain. We're not exactly sure the mechanism of how that happens, but we know, um, we know, we know that it does happen. So it's the, these two things together. the slower digestion through your tract, your GI tract, as well as the hunger centers in your brain that contribute to decreased intake of food, which is why we see the weight loss.

Kim:

Okay, initially noticed as a side effect, but this is the reason why it's effective in that way is the food stays in your stomach longer you feel fuller longer and you don't feel hungry as much. Yes. Okay.

Michelle:

Okay,

Kim:

good explanation. So, then, I've also heard there's quite some side effects to these drugs and some of them can be pretty debilitating can you run us through some people experience when they take them. Okay.

Michelle:

So we can look at, short term side effects and long term side effects. So the most common ones that people talk about are the immediate side effects and the ones that are probably most distressing to the people who experience them. And these are the GI symptoms. So nausea, vomiting, belly pain, Diarrhea, constipation, um, and these tend to correlate with the dose that you're taking, right? So for all of these medications, um, they, the doses get a little bit higher, um, every few weeks until you reach the recommended dosage, okay? And that's to allow your body to get used to these side effects. So if you remember that these drugs, when used for weight loss, were aiming for a side effect of the medication, not the actual primary result of taking the medication. So when we increase one side effect for weight loss in this case, right, we're also going to increase the other side effects that come along with it, right? So we start at the lower dose and most of the time people who experience these symptoms will see improvement until they go up to the next dose and then they might have some side effects again until their bodies adjust. So in one of the original semaglutide studies they did show that close to 70 percent, seven zero percent of people did experience these side effects, but for most people they do go away. For a certain proportion of people they're severe enough and last long enough that people actually Um, can't tolerate taking the medication and, and they do stop. So these, these side effects are not so serious maybe, um, but they're definitely uncomfortable and sometimes debilitating for, for patients. But then there are some more serious side effects associated with these medications, right? One is that, um, there is a potential risk of a certain type of thyroid cancer. And for this reason, we recommend that if you have a family history of thyroid cancer, um, to really talk to your doctor about whether or not this is, this is safe for you. Um, to be fair, this has only been seen in animal studies, not in human studies, but because of a potentially very serious effect that, that, that warning is there. There's also some newer studies suggesting, um, pancreas cancer can be a risk with, with these drugs. So there's actually what we call a black. box warning on many of these drugs for the risk of this, this type, this type of cancer. Other things related to your digestive tract that can be a little bit more serious are gallbladder disease. And so, you know, we do know that whenever there is weight loss, particularly rapid weight loss, we're at higher risk, especially as women to develop gallbladder disease. And so we, of course, see that, too, um, with the use of these, these drugs. medications. Um, because one of the ways this medication works is by slowing down food through the digestive tract, we can have some complications related to that. And so if it slows down too much, we can get a medical complication that we call ileus, which essentially means that the bowels are moving so slow that you get obstructed, that food is no longer moving. Moving through and that results in lots of pain and vomiting and sometimes even requires surgery to fix. So, um, those are, are some of the more serious things that we can see in the short to medium term use of these drugs. Now, there's also concerns about long term use. And unfortunately, the longest study we have is only two years. And we are now kind of reaching this point where people who are not diabetic, who are taking this specifically for weight loss are coming to this two year mark of, of taking this drug. And so now we're starting to see, um, what, what people are experiencing. And again, this comes back to how these drugs work and the slowing down of food moving through the digestive system. So one of the things that happens with that is things aren't getting absorbed. And that means medications. And also food. And so you may have heard in the news that there's been lots of unwanted pregnancies, um, related to using ozempic and other drugs because the birth control pill is not absorbed in the same way. And so it's not, um, providing the same birth control that we're expecting when we take it. The same is true for some other classes of, of medication as well. And sort of related to the pregnancy topic is there is a risk of harm to the fetus. If you're pregnant while taking these medications, and so two recommendations are, if you're planning on becoming pregnant, um, you should not be taking these, these medications to stop about two months before, um, you plan on, on trying for pregnancy. And then to also really be aware of what you're using for birth control that, um, the birth control pill might not be enough if you're, if you're using these drugs. So that's the one piece. And then on the other side is we are seeing risk. of malnutrition, actually, specifically certain vitamin deficiencies, um, because again, they're not being absorbed properly because of that delayed transit of food, um, through our system.

Kim:

Wow. I, I wondered about the nutrient deficiencies because of that, right? Because people are eating so much less and because of the lack of absorption, I did not know about the medication lack. Yeah,

Michelle:

so it's, um, it's some, there's some heart meds and it's birth control and a few other things that we're, we're starting, we're starting to see now. And then there's, and you're right, it's the absorption and also the fact that we're, we're eating a lot less. And this, this. particularly affects older women. So if you're kind of in the 50 plus range, the initial studies that were done for weight loss with these medications didn't actually include women of that age. And so we don't have any data to tell us if it's safe, but what we do know is that it can actually be dangerous for older women. Um, to lose weight in their, in their golden years. And part of that reason is because our muscle mass is so very important, um, to keep us healthy, not just for bone health, but for metabolic health too. And what we also know with these medications is that you lose a lot of muscle mass, not just fat, um, with, with, with it. Right. And so, um, that is another complication is, is you lose a lot of, of muscle mass with it. And this is especially true in older, older women. And

Kim:

that's concerning. That's concerning. And there's enough things going on in our bodies at that age with hormone changes and that too, that yeah. And so I'm glad you brought up that we, we don't know a lot yet about the use of these drugs in the longterm for the purpose of weight loss. And I've been using these drugs for, I think, 20, 30 years. Am I right? For the treatment of diabetes. However, we're using them at higher doses for weight loss. So that does mean that there's going to be different long term effects. And like you say, that hasn't been studied because we've only been using it for this purpose for a couple of years.

Michelle:

Right. And it's also not just the doses that are different, but the physiology and our body are different if we don't have diabetes, right. Yeah. Yeah. So, and if you look historically speaking, like if you remember, you know, back in fen fen days, right? When the fen fen drug, you know, came out and everybody was super excited, just like people are excited now about the GLP 1s. And it took about nine years before they started realizing that people were dying from heart disease. Um, heart problems with this drug. And then it was, it was taken, taken off the market. And it's always kind of between the eight to nine year mark when we start to see these. And fenfen was the last one, but it's not the only drug that has been taken off the market because as time goes on, we, we start to see, um, we start to see more complications because studies don't go on that long. Right, for us to know for sure.

Kim:

Yeah. And then, apart from the side effects and the complications, what do we know about sustained weight loss, um, with long term use with these drugs?

Michelle:

So even the studies that have been done have shown that weight regain is the norm, right, that this is what we can expect. And so right from the start, these drugs were marketed as requiring to be a lifelong commitment when you take them for maintenance of weight loss. And this was said before longer term studies were done. Now, again, the longest term we have is two years. And what those studies show is at about the 18 month mark, that is when weight starts to, to come back on. And certainly if you stop the medication, almost always that weight rebounds right back to where you were sometimes even higher and. pretty darn quickly as well. Um, and then the other thing that I think it's important to point out is that all the studies that were done that showed weight loss with these medications did them in combination with a low calorie diet and exercise as well. And so I think one of the common misperceptions is that you can just take this drug, eat whatever you want, and you know, the pounds will, will melt away. And that's not actually true. You still have to be mindful of what you're eating and what you're exercising. And that contributes to this whole, this whole process as well.

Kim:

So do we know anything about people who don't make a lifestyle change? Like have they studied that group? If like people who just continue to eat and don't exercise or do whatever they were doing before?

Michelle:

No, they haven't studied that. And certainly anecdotally, when I look at patients, um, who I know who are taking this drug. There's both, right? I see patients who are very intentional um, about what they're eating and we kind of might talk about that, that whole food piece in a bit, um, and other people who aren't and there are people who are losing weight and people who are not losing weight in both of these groups. Um, so I think it's largely Um, highly, highly individual. Um, I also, you know, I spoke with a patient not so long ago who has been taking this drug, um, for two years straight and about six months ago, all of her weight just, you know, came, came back on and this was with her still trying, um, to, to eat according to a diet that she had been given. Um, and so it really does seem to be highly individual. And, you know, this, this also reminds me of another side effect that's maybe worth. worth, um, bringing up. Some people say they feel fantastic on this drug. It's true. More people, in my experience, say that they just feel very tired and fatigued, um, taking this medication and that they don't actually have the energy, um, to go out and exercise. And because of the muscle loss that comes along with using these medications, exercising while using them is actually pretty important, um, if you want the health benefits. um, associated with all of this. So, um, it's, it's, it's pretty complicated and it's not the miracle drug that, that people tend to think it is.

Kim:

Yeah. And that brings up an important point too, is like most people that I talk to anyways want to lose weight to improve their health, or they, there's the assumption that losing weight will improve their health. And I'm curious about that. Like, have we noticed improved health outcomes?

Michelle:

No, we haven't. We haven't. And this, this is another misconception, um, because there have been studies done that have been, um, really exaggerated when the media gets a lot of hold of them. And I think this is largely because, of course, these studies have all been funded by the drug companies themselves. And so they have a vested interest in making them look as, um, awesome as possible. So doctors keep prescribing them and patients keep asking for them. But in reality, we're actually not seeing, um, tremendous benefit. So a great example is they did look at. Um, hemoglobin A1C levels, which is a marker of where we are in terms of prediabetes, diabetes, normal sugar levels, et cetera. And some other cardiac, um, heart health markers. And they changed by like 0. 1%, like little tiny, um, amounts that are not actually, um, significant. Um, but because it went down that little 0. 1%, the media got ahold of it and says, well, it has all of these benefits when it doesn't really. And so that's one piece of that. The other piece is that we also don't know if it's the weight loss that is related to any health benefit or not. So a number that's often floated out there is if you lose just 5 to 10 percent of your weight, then you will see all of these benefits. Health benefits. And here's, here's the, here's the thing, like, we, we don't actually know if weight loss causes all of this because we also know that when you live in a bigger body and you're experiencing health shame, you know, um, fat shaming or health discrimination and, um, healthcare, or if you're weight cycling with some yo yo dieting, all of those things actually contribute to to these chronic diseases that we always worry about for people living in bigger bodies. And so is it removing those pieces that are helpful, or is it actually the weight loss? We just, we just don't even know. And, and so it's, I think it's a little bit misleading, um, when we're saying take these drugs, you're going to lose weight and you're going to be healthier.

Kim:

And also the adoption of healthy Supporting habits, right? Like sometimes when you lose weight, it's because you have adopted, you know, more movement and eating more nutrient dense food. And like these things, positive effect on your health. Yes. It's related more to the behavior than the weight loss itself, right? Right.

Michelle:

And it's, it's so, it's so true. And this is one of the concerns while I have several, but one of the concerns I have with. The use of these medications is that it doesn't actually help promote healthier behaviors that are going to have a long term effect on not just our physical health, but our mental health and our general wellness as well. One of the other risks with these medications, and this is, you know, fairly well documented now, is there's a higher risk of suicidal thoughts and behaviors with the use of these medications. We also see this in bariatric surgery, right? So after surgeries, we see this and also increased rates of alcoholism. And although nobody's studied the reasons why, I think a likely explanation is if we have been using food, um, as a way to cope with difficult things in our life, and we're not recognizing that. And if a medication or a surgery takes that away from us, we've lost. We've lost the thing that's allowed us to, to get through life. And so now, now what do we do? Right? And so, um, I bring, I bring that piece up because one of the most common reasons why I hear women in particular want this medication is not just for weight loss, but they think the reason why they can't lose weight is because they're thinking about food all the time, that the food chatter. It's just nonstop. And it is very true that these medications take away the food chatter. But the question is, why is the food chatter even happening? And we absolutely know that it's happening because our bodies are not getting fed the nutrients that it actually needs. And this is a very normal biological response. This is our body and our brain doing everything it can to get us to just eat. So that's The body can be fueled properly, right? And so we're, we're, we're, we're actually doing the opposite of what the body is asking for by, by taking these medications. We're just numbing the voice, but not giving the nutrients that we need. And so that is not contributing to our health and wellness by allowing ourselves to just go on in this. Um, extreme calorie deficit for, for years on end, if that makes sense,

Kim:

it does, it does. And I, I'm glad you brought that up. It's been several months now since the Oprah big special on, but, and I remember that being a big theme on that special was like, I just don't think about food as much as I used to. And yeah, because it's taking away your hunger signal and, and it's an important point you bring up, you're not thinking about food all day long because you're addicted to it, you're thinking about food all day long because you're not getting

Michelle:

enough, right?

Kim:

Yeah,

Michelle:

yeah, but, but, but, but you know what, it's so difficult because so many people living inside diet culture for decades have, gotten so very used to under eating that to them they actually wonder am I still eating too much, right? Because they have just become so, so used to it but their body, their body actually hasn't, right? And so um, I can understand why people feel so compelled to take these medications, not just to Be thin in a world that wants you to be thin, but to also just have some peace from all of that, um, that food chatter. But, but there's other ways to, to get around, to get around that. Yeah,

Kim:

100 percent there is. Yeah, for sure. Okay. So let's switch gears for a second and talk about body image. There's certainly a wide held belief that when you lose weight and change your body that you'll suddenly feel great about your body that and that these medications are the finally the magic tool that's going to allow you to lose weight, keep it off and feel confident and feel good in your body. And Well, there's another question, but I'll come back to that one. Let's do this one first. What have you noticed in your experience around body image with people taking these drugs? I think this is

Michelle:

complicated. Yeah. So, um, I watch people, and Oprah is a great example, who kind of got on TV and is feeling so empowered. because of this medication. And, you know, what Oprah had said was, I'm told that this is not my fault, which is actually one great thing that, you know, she's starting to understand that, um, it's, it's not her fault, but she's calling it the obesity medicine. realm of medicine likes to call obesity, a chronic disease. And I, you know, we could have a whole other episode to talk about why I don't agree with that languaging, but for many people, Oprah included that has made them feel like, okay, well, this is not my fault. And now this is something I can treat. And that feels, that feels somewhat empowering. However, having said that is I have never met anyone who has lost a bunch of weight and has felt it actually felt any better about how their body looks, right? This, uh, how we view ourselves and how we view our body comes from a place that goes so much deeper than how our body actually physically looks. And, you know, tied in with all of this is there is now so much shaming for people who choose to take Ozempic because now they're cheating, right? They're taking the easy way out. Um, they're not addressing it. their laziness, their lack of motivation, their lack of discipline, which is what people like to shame, those of us living in bigger bodies, say, of course, we know it's not true, but it's, you know, you take all of this in and it's really hard to feel good about yourself. If you know some of the world is still telling you that, um, Yeah, you have to take this drug because you're, you're lazy and you're undisciplined and you have no motivation and you don't care about yourself, right? And so I, I think, I think it's complicated. I think also people get so many compliments from the world once, you know, you've lost weight and, and then those compliments stop, right? And then, and then what, right? And I find that's the point in time when, when people start to feel like, you know what, I've lost all this weight, but I don't feel any better. Right. And what's next? Right. And it's, it's kind of funny when I talk to patients, they'll come in and they'll start and they'll say, I feel so great. I have more energy. I, you know, I have a little bit more ability. I feel so good. And then, you know, five minutes later, the tears come because I'm miserable and I still don't actually feel any better. And I thought my life was going to be different and, you know, et cetera. And so I think, I think it's really difficult to be stuck in this place where you think you're looking in a way that, uh, Society and our culture as a whole, um, accepts much more easily, but then also this other side of, you know what, maybe I didn't get, um, emotionally or personally what I thought I would get from this weight loss.

Kim:

Yeah, because acceptance and confidence is such a deeper issue, right? I think it brings to light that it was never about your body in the first place. Exactly. I've never taken these drugs, but I have lost weight, lots of it. Um, through dieting and obsessive exercise and all of that. And I, I know that feeling very, very well, like leaving those compliments, but still feeling not good about my body and like thinking that I have all this confidence and I I'd accept myself and I'd feel really great about who I was. And I never, ever did, but I do now. I didn't the largest I've ever had. I do think about my body.

Michelle:

Yes. I can say the same story for myself.

Kim:

Yep. Um, and then you touched on the stigma that those of us in larger bodies face and the stereotypes about being lazy and undisciplined and not caring about ourselves and the stigma that we may face when we go to our medical providers. Like these are very real things that folks in larger bodies face. And I've heard it said that these drugs. are the cure to weight stigma, that we can avoid all of that by using the drugs and changing our bodies. Yeah. Where does that land for you?

Michelle:

I, I don't think this is true. I don't think this is true because first of all, people are still getting um, criticized for taking these drugs as, as the, you know, as, as we just talked about. But I, I think it's, it's sending the message that like how many millions of people are on these drugs and all these millions of people are getting the message that I'm not okay the way I am right now. I'm not beautiful the way I am right now. I'm not valuable the way I am right now. I'm not worthy or deserving of anything, um, unless I take this drug and, and get skinny. And I, I think that's horrible. I think that's horrible. And since we know that weight regain is horrible, the most likely outcome, regardless of whether you stay on this medication for life or choose to stop it anyway, then, you know, people are going to end up back in their bigger size bodies. And, you know, all we've done is, I like to say people rent a smaller body for, for a period of time, right? And so it doesn't actually, it doesn't actually address the issue. If we want to end stigma, then we, we need to actually start educating. Doctors like myself and my colleagues and everyone else that just because you're in a bigger body doesn't mean You're unhealthy. Um If you choose that health isn't even a You know something that's important to you. That's okay. Also that is your choice And, you know, we need to stop assuming value is related to the size and shape of our body, right? And I don't think the medication is going to, um, is going to change that at all. And, you know, I think, I think there's lots of people out there who probably feel some pressure to take this medication because their doctors and their families and Oprah and, you know, the media in general is kind of telling them, right, right. We have this miracle solution. You've got to be crazy not to use it. Um, But I don't, I don't buy into that.

Kim:

Yeah, you know, I think even, let's pretend it was the miracle drug and it did, like, cause long term weight loss forever and ever. I still, I still don't buy it as a means to end weight stigma because I think like any social justice issue, we don't solve the issue by changing the individual, we solve the issue by changing the culture, right? Like, we don't, we don't end homophobia by turning people straight. And we don't end racism by turning everybody white, let's say, right? Well, no, and

Michelle:

this is also a 100 percent culturally driven phenomena, right? In our part of the world, there's a certain body shape that is considered ideal. And in another part of the world, it's a completely different body shape. And even over the decades, what we've considered Beautiful and attractive has changed, right? I mean, we've gone from the Marilyn Monroe times to the Twiggy times. And now we're in the Kardashian, you know, times where having a tiny, skinny waist and a big butt is what everybody, um, is after. Right. And so you go and you'll, do you take these medications to make your body look a certain way and then, you know, Next generation down the line, all of a sudden, we're expected to look, um, look, look differently. And, and so this, this idea of we're expected to have bodies that look a certain way, that's, that's what needs to change. That we all just need to be accepted for what we give to the world, not how we look in the world.

Kim:

Such a powerful note to finish on. Oh, thank you so much. This has been a real, I knew it would be, a very informative conversation, um, to summarize. What things should people consider before deciding whether they want to use one of these medications?

Michelle:

Oh gosh, like how much time do you have? I think, I think before you go and talk to your doctor about starting these medications, you have to get honest with yourself first and really ask, what do I want? Like what, what, what do I really want? Because it's, it's like, Is health important to me, or is it how I look? And if it's how you look, and if losing weight and looking different is truly important to you at this point in your life, then great. Listen to this episode again, understand how these drugs work, what some of the side effects are, and, you know, decide if, if, If that's the way you want to go, right? Um, but if it's not, right, if health is your primary goal, maybe, you know, sit down and talk to your doctor. It's like, what else can I do to help my blood pressure? What else can I do to help my diabetes or my pre diabetes? Um, like, just ask. If, if If weight loss were not an option, how would you help me with these things? And see what those options are for you, and see how those land, and if those feel aligned for yourself. Also, you know, keep in mind that you will only be renting a smaller body, that at some point in time, um, the weight will almost likely come back on. And how do you feel about that and also understand and maybe go back and listen to, um, the episode that Kim and I did, you know, previously, where we talk about what some of the harms of the yo yo dieting and weight coming up and down can actually, you know, do, do for your body. Um, also keep in mind, you know, are you planning on getting pregnant soon? Right? Like what are your longer term goals for your life? And how does this medication help you? fit in with those goals. And also think about that food chatter and your relationship with food. It's like, do you want to permanently fix your relationship with food? Like, do you want to change the way that you relate to your body? Um, do you want to be able to finally put this issue aside and move on to, to, you know, bigger, bigger goals for your life? Well, there's ways that both Kim and I, um, and others can, can help with that without having, having to use, uh, um, to use medications. And then, you know, the final thing is be sure about what you want before you go to your doctor, because most doctors out there have been trained right inside diet culture, just like everybody else. And we'll make the assumption, one, that you want the medication and two, that you need to take the medication to be, to be healthy. And neither of those things are necessarily true. So be, be prepared to hold your ground, um, and get your questions answered. I think that's, That's what my advice would be.

Kim:

It's really good advice. Thank you. Thank you. Thank you so much for this brilliant episode. I know this is going to help so many people. As we wind down today, can you just remind our listeners where they can find you and follow up with you? Because I know they're going to want to stay in touch.

Michelle:

Sure. Um, you can always find me on my website, waysahealth. com. It's W A Y Z A. I am also on Instagram and Facebook under the same name. And I also host my own podcast called Thrive Beyond Size. And you can find that on iTunes. Spotify and at ThriveBeyondSize. com.

Kim:

Amazing. And you are creating a free resource for our listeners to, to download and print out after this episode as well, right?

Michelle:

I absolutely am. So all of the information you've got in this episode, plus a little more, including some common questions. questions that come up with this medication will all be in a lovely little PDF document for you. So, um, I don't have the link for that at the moment, Kim, but you'll have that in the show notes. So, um, just click on that link and I'll happily share with you this, this document and you can use it to take to your doctor too, if you have, um, specific questions.

Kim:

Michelle, thank you so much for taking the time to share your expertise with our listeners today. Of course. Of course. Thanks for having me, Kim.

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Kim Hagle

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