Breaking Down the Latest Study on GLP-1 Medications for Weight Loss

**Jim Hill:** Welcome to Weight Loss And, where we delve into the world of weight loss. I'm Jim Hill.

**Holly Wyatt:** And I'm Holly Wyatt. We're both dedicated to helping you lose weight, keep it off, and live your best life while you're doing it.

**Jim Hill:** Indeed, we now realize successful weight loss combines the science and art of medicine, knowing what to do and why you will do it.

**Holly Wyatt:** Yes, the “And” allows us to talk about all the other stuff that makes your journey so much bigger, better, and exciting.

**Jim Hill:** Ready for the “And” factor?

**Holly Wyatt:** Let's dive in.

**Jim Hill:** Here we go. Today, Holly, we're going to have an update of the GLP-1 medications. Today, we're going to talk about Wegovy, Ozempic, Mounjaro, Zepbound. These are familiar terms that are now being discussed around the dinner table nationwide. So why don't you tell our listeners why we're revisiting this topic?

**Holly Wyatt:** Well, I think that this episode, we already did one episode on this, we're revisiting it. I remember that. Yeah, it is our most popular episode. So it's been downloaded, listened to the most. So we thought it's probably time to do an update. I don't know if it was the topic or if we just did a really good job.

**Jim Hill:** I think we did a really good job.

**Holly Wyatt:** I do too. I think it's all about us, but probably not because these drugs are amazingly popular and we can start to talk about that, like how many people are actually on these drugs. Huge, huge numbers. So this is just an update, some new stuff has come out recently and thought it would be a good time to update our listeners.

**Jim Hill:** Good, I'm excited about that. Holly, you and I have been really advocates for healthy lifestyles our whole career. I think a lot of people were surprised that we supported use of the drugs.

And think we both said if we had a BMI of 30, yes, we would certainly consider taking the medications. But that surprised a lot of people. And I don't see a conflict. I see this as another tool that can do some of the things that lifestyle has trouble doing. And I think lifestyle can do some of the things that the medications have trouble with.

**Holly Wyatt:** I think that's a great way to look at it. But I agree, people were shocked. I got several texts and said, I'm on the drugs. I didn't want to tell you because I didn't think you would support me, which is crazy. We do talk a lot about behavior and lifestyle, but I believe that we need as many tools in the toolbox as possible. So I am all for learning about these drugs and using them in the appropriate situations.

**Jim Hill:** What are we going to talk about today then to update? What do we have? What new information do we have?

**Holly Wyatt:** Well, first off, we have some study was just published in May that has some new data for, I think it's for Wagovy and it's four-year data. So this is data with people who've been on the drugs for four years, really the longest amount of time we've been able to study the drugs. We also have some interesting data from Blue Cross Blue Shield. So one of the insurance companies, which we thought would be good to share.

And then there's a big question I want us to ask. I'm I'm we're not going to answer it now, but this is what I really want us to talk about is, is it the easy way out to use a weight loss drug?

**Jim Hill:** You're taking the easy way out. You're not doing the hard work. Interesting.

**Holly Wyatt:** Some people have gone on record to say that's how they feel, that the medications are the easy way out, that, you know, some people feel like they work really hard to stay at a healthy body weight or to have their body state and that taking the medication is cheating.

**Jim Hill:** So it's no fair if you don't have to work hard at it.

**Holly Wyatt:** Yeah.

**Jim Hill:** Interesting. Well, I can't wait to hear your point of view on that one.

**Holly Wyatt:** Yes, definitely. All right, let's get going.

**Jim Hill:** All right. What do you want to, if why don't you tell people about the new study, the SELECT study and what we learned from that?

**Holly Wyatt:** OK, we can start there. But I also, I thought maybe we should start with how popular these drugs are, Jim. The newest numbers, because to me, that really shows just how many people are interested and how many people are thinking about this.

So some new numbers came out. I think it's one in eight people have tried a GLP-1 drug. Now, this may not just be for weight loss.

I think this is probably diabetes and weight loss. But really, one in eight people have tried one and think you translated to about 33 million people with about half of them or 15 million currently on a prescription. So 15 million people.

**Jim Hill:** OK, but let's put that in perspective. How many people would qualify for these medications?

**Holly Wyatt:** Well, I think we have close to 80 million. Is that the right number? 80 million people with obesity?

**Jim Hill:** Let's see. Let's do our math. So what? There's about 350 million people in the US and about 40% of those are obese.

**Holly Wyatt:** Ah, did I do a good job?

**Jim Hill:** All the math majors. What is that?

**Holly Wyatt:** Getting out your calculator, Jim.

**Jim Hill:** I'm getting out my calculator.

**Holly Wyatt:** Goodness, I don't know if I did a good job or not. I think I did. I think I'm close.

**Jim Hill:** 140 million people.

**Holly Wyatt:** Oh, I didn't do a good job.

**Jim Hill:** No, you're way underestimated. So here's where we are. Just over 40% of US adults. So this is actually a bit overestimate because that's the entire population. But just over 40% are obese. That means they have a BMI over 30. 70% are overweight or obese. So you add another 30%.

That's overweight. Enough of those 30%. Remember, you qualify for these medications if your BMI is above 27 and you have a comorbidity. So So lot of that 30% would qualify. So literally, way over half the US adults would qualify for this medication. So even though that's a big number, it's still low in comparison to all the people that could qualify for it. So two ways of looking at it.

**Holly Wyatt:** I guess there's two ways of looking at it. I think more people would be on the drugs if they could find them. Right now, there's still a major shortage and there was lots of things. Would they? I think so. Novo Nordisk came out and gave a stat and said around 25,000 people, 25,000 are start, Wegovy, so just one of the drugs every single week. That's the current stat. So I think they're pretty popular. I think they're growing. Definitely a lot of people are interested, even though it sounds like we have a whole lot more that could be on the drug.

**Jim Hill:** But still, in terms of obesity medications, this is hands down the most popular medication that's ever been put on the market for obesity.

**Holly Wyatt:** No doubt. No doubt about that. Which I think brought me to the second question is why are they so popular?

**Jim Hill:** Well, because they produce weight loss. Duh.

**Holly Wyatt:** Well, we have drugs. People are saying this is the first weight loss. I'm like, no, no, these are not the first weight loss medications. We have other medications that are still out there, Orlistat, Contrave, Qsymia, Saxenda. We've had other weight loss that are still available. You can still get those.

**Jim Hill:** But it goes back to work we did as a follow-up to work years ago that our colleagues Tom Wadden and Gary Foster did. And it was simple. They asked people before they started a behavioral weight loss program, they asked them how much weight they wanted to lose. They gave them several questions to set goals. You can set your happy weight, your dream weight, your disappointed weight. And if you look at the happy weight, which actually is a pretty good measure, the happy weight, a weight loss that would make people happy. You know what it was? It's almost 30% of their body weight.

Guess what? These medications can produce 25% to 30% in a lot of people. So the reason they're so popular is people that never dreamed of getting to this weight or getting to this weight on these medications.

**Holly Wyatt:** Right. And I think the other medications that I listed just for comparison, I think 3% to 10% max.

**Jim Hill:** We were in this scenario where on these other medications, the physician would say, oh my gosh, you lost 7%. That's wonderful. Well, if your happy weight's 30%, it may not look so wonderful from your point of view. And so you had this discrepancy between what we were telling people success looked like and what they thought success looked like. And these medications are sort of closing that gap. Now, the amount of weight loss that people really want is an amount of weight loss that for many people is achievable.

**Holly Wyatt:** And I think that it's an important part, point to think about that. We knew as medical professionals that 5% to 10% weight loss produced health benefits. But that was not enough for the general population. They were not interested. It is this happy weight that's really driving it more than the health.

**Jim Hill:** That's what you and I said all along. The reason people want to lose weight, some of it's health, but a bigger reason is happiness. They want to get to a happy weight.

**Holly Wyatt:** But people will do lip service. So I want to be healthy.

**Jim Hill:** Yeah. That's not the real reason. They want to be healthy, but it's more than that. We've talked about that, the different goals. The number on the scale, a lot of people will say that's the goal. That's not really the goal you need to think about. That's a way of getting there, but it's way more than just that number on the scale. It's really a new life.

**Holly Wyatt:** So these drugs are producing weight losses in the range of really 15% to 20%. Some people losing more than that. So getting really closer to that 25% to 30% that's associated with that happy weight. So more people are experiencing that amount of weight loss. And you're right, that amount of weight loss is associated with how they feel different, you know, how they're living their life different. So I think that's what we're seeing. And what is really kind of crazy is that these weight loss medications are starting to approach the amount of weight loss we get with bariatric surgery.

**Jim Hill:** Yeah. You know, we had Dr. Schauer on to talk about bariatric surgery. And his thought was that's still an option. There are a lot of people that are going to choose that as a more permanent way. But once you get up into that 30, 35% drug surgery, you're getting a pretty similar outcome. And it does give people a different choice on how to get there.

**Holly Wyatt:** Right. I think once again, more tools. There are some individuals where I still think bariatric surgery is the best option or is a really good option they should consider. But man, you know, this is starting to push that envelope. It's really starting to give, you know, big amounts of weight loss, especially if you're in that subset that loses that 25 to 30%. So it's really changing how we look at things and the options that people have. All right. Do we want to move on to the new four-year study? Give a little bit of that stuff.

**Jim Hill:** Yeah. Talk about the SELECT study, Holly. That's one that just came out. And I love it because it's four years. I mean, most of the time we get a one or two-year study. And we're talking about medications that many people will potentially take for life. And even four years is, you know, that's not a lot. But four years is pretty good.

Think about it. It takes a long time to do a study. So you're investing four years into the study. So I give the company's credit for beginning to do these longer-term studies.

**Holly Wyatt:** Yeah. And part of the reason they're being forced to do it, this study was a cardiovascular outcome trial, which means they needed to look at things like heart attacks and all kinds of cardiovascular and heart outcomes, basically. And this has been something that FDA has been requiring to make sure that these medications don't cause more heart attacks because we had some medications that actually made these cardiovascular outcomes worse. So the FDA started requiring these cardiovascular outcome trials on weight loss medications, and these trials require longer periods of time to be able to get to that, you know, to that answer.

So this study, it's called the SELECT Study, has four years of data. It was in over 17,000 adults, 17,000 adults in the US. They all had a preexisting cardiovascular disease of some type, and they were all either overweight or obese. None of these had diabetes though. So this was all people who had some type of heart disease, and they were overweight or obese, and they were randomized to being on, this was a Wegovy trial, so Semaglutide.

**Jim Hill:** So this is the part of the drug that's marketed for people with obesity, but not diabetes.

**Holly Wyatt:** Yes. So the people in this trial did not have diabetes.

**Jim Hill:** Ozempic would be the other one. If you had diabetes, you might get Ozempic. If you have obesity, you get Wegovy. They're the same compound marketed for different purposes.

**Holly Wyatt:** Yes. And sometimes the dosage can be different, but you're right. They're exact same drug. So this was, they were on the drug that we, they did get weight loss. The weight loss was they lost weight for about 65 weeks. Jim, that's how long they saw weight loss.

**Jim Hill:** Which is really interesting with these medications, because with lifestyle and with, even with the previous weight loss drugs, you see weight loss only happening usually for three months at, you know, in the best cases for six months. And then it stabilizes with these medications. Weight loss is continuing past that six month period.

**Holly Wyatt:** Yeah. So that's, that's unusual. So about, you know, 16 months of weight loss and then the weight that they, the people lost as long as they stayed on the medications in the trial, they were able to sustain it. So there was no regain over that four-year period.

**Jim Hill:** And that's what we've thought, right? That these medications will keep working. They're not, you're not going to lose weight forever. We've talked about that. Your body adjusts. So So lose weight. Eventually you reach a plateau, but as long as you're taking the medications, it seems like people are pretty successful at keeping their weight down.

**Holly Wyatt:** Yeah. So they didn't see any regain. Like I said, the study was about cardiovascular outcomes. So, you know, what was the risk? And was there any major cardiovascular events? They actually saw a 20% reduction in major cardiovascular events.

So a reduction. There were really one thing to look at is do no harm, right? You know, was it not going to make it worse, but it actually improved it. So these drugs may in the future have an indication related to this, if they can gather enough data and put that in.

**Jim Hill:** But Holly, do you think that's due to the weight loss or is it something specific in the medications?

**Holly Wyatt:** You know, that's hard to untangle, isn't it? I think you know that. But either way, you take these medications, that's what you get.

**Jim Hill:** Well, I think it really attests, and we're seeing more and more, these medications improve just about everything. Diabetes and cardiovascular disease and fatty liver disease and on and on and on. And I think a lot of that's due to weight loss and it shows the power of weight loss. If you can lose weight, it's going to have such a dramatic impact on your health. Maybe the medications have an additional effect. We don't know that. But I think we do know that weight loss itself is a powerful, powerful way to improve your health.

**Holly Wyatt:** Well, and not in this trial, but some other trials have been published. They're starting to see impacts in other areas with with these GLP-1 drugs that may not be related to the weight loss.

So it's interesting, this GLP-1, this hormone that this drug is mimicking, has lots of receptors and seems to have lots of actions. But let's talk about the weight loss. So the average weight loss was 10.2 percent. This was lower than in the previous trials. Previous trials were closer to 15 percent average, which means some people lost more, some people lost less. But this trial was 10.2 percent, which is interesting.

I we can talk about why we think that, why that might be in a minute. Looking at what we call the categorical weight loss, though, I like to look at it like what percent of people lost greater than 25 percent, you know. And for this trial, five percent of the people on drug lost greater than 25 percent of their body weight. 11 percent lost greater than 20 percent.

Twenty three percent lost greater than 15 percent and 44 percent lost greater than around 10 percent. So not as big a weight loss, but still a good amount. And And lot of people lose a significant amount of weight. One of the things that they talked about is because this was a cardiovascular outcome trial and not a weight loss trial, they were not given as a diet per se. They were not given as strict of lifestyle changes.

**Jim Hill:** Maybe that's the difference. Maybe the lifestyle along with the medications is what gives you the extra weight.

**Holly Wyatt:** So this trial was not as focused on weight loss as the other trials. Well, Jim, I love this because what does this mean for us? What is what's the message here? If you're going to go on these drugs and you want to get a big weight loss, which that's what you want. If you're going on these drugs, if you want to get to your happy weight, you need to combine it with lifestyle. You need to combine it with a behavioral program, a diet, exercise, mind state, all the things we talk about to get the maximal results. If you just take the pill, just take the medication and you don't really focus on reducing your calories, chances are you won't get as much weight loss, or at least that's one possibility.

There's probably some other reasons too, but interesting to think of it that way. And if I were taking these medications, I would definitely combine it with diet and physical activity and really make, you know, biggest bang for my buck that I could get to.

**Jim Hill:** Holly, I was just looking through the paper and they didn't report any body composition results. And you know, that's something we've been very concerned about, is whether on the medications you lose more lean body mass than you might with lifestyle. And I think it's telling that they didn't report it. I'm sure they measured it and my suspicion is it'll be in another public.

**Holly Wyatt:** Yeah, I don't know. You think they measured it on that many people? I would have to look in the method section of the paper to see if they measured it.

**Jim Hill:** Doesn't mean this isn't a good study, but it's still something we really are keeping an eye on, more information about the composition of the weight loss.

**Holly Wyatt:** Yeah, and it may be that they are going to report that in the future. The other thing I love about this study is that there was no, they followed these people for four years and there was no new signals for safety. So I mean, everything looked the same. There was nothing new that came up to say, oh, this is a potential problem for these drugs.

**Jim Hill:** And that's another thing we've been looking at with the long-term use of these medications. Are we going to see problems arise? And this is reassuring because it suggests that over four years, they certainly didn't see anything. It doesn't mean that longer term they couldn't, but it's a little gratifying to see that there were no really problems over four years.

**Holly Wyatt:** Yeah, it makes you feel a little bit better that nothing jumped out. And And was, you know, this is a large trial.

**Jim Hill:** Did they report the dropouts in this study, Holly?

**Holly Wyatt:** Yeah, I think they did. I want to say 17% discontinued treatment. I don't know, there may be some other numbers in there too. They also reported, I think this had some overweight individuals in it, because if you had a cardiovascular disease, you could be overweight and be on the medication. So this was a little bit different population than some of the other studies that have been done. All right, moving on to this Blue Cross Blue Shield paper that came out that really kind of was talking about real-world trends. And, you know, they have access to some of the, you know, how many people are taking these drugs and how many people are staying on them, which was really the focus of this paper. You know, how many people are interested, how many people are taking them, and then how many people stay on to get what they're calling a meaningful weight loss.

**Jim Hill:** Yeah, keep in mind that Blue Cross Blue Shield is an insurer that's covering the cost of these medications. So they're very, very invested in sort of the cost-benefit. They're paying a lot of money to reimburse for these, so they want to know about usage, and eventually they want to know about outcome. So what can we learn from this report?

**Holly Wyatt:** So first off, they kind of set some background. They gave us some background numbers and I thought this was an interesting number. 1.1 billion, yes, that is billion dollars in sales for anti-obesity meds in the second quarter of 2023 in the US.

**Jim Hill:** So multiply that times four, it's over 4 billion a year.

**Holly Wyatt:** Yeah. I mean, assuming that it's not going up. I mean, I don't know, but yes.

**Jim Hill:** So this is big business. The companies are doing well. Probably the pharmacies are doing well. Yeah, big impact on the economy.

**Holly Wyatt:** And then they report that half of US adults are interested in taking GLP-1 drugs.

**Jim Hill:** Well, I believe that, don't you? Because we said, you know, you've got maybe 60% of people who could take them. And it's not hard for me to believe that half of US adults would consider taking them. It doesn't mean they would, but they're considering it. And I don't think that's ever been that high for the other medications that have been out before this new round of medications.

**Holly Wyatt:** Right. So what this paper really was all about was how many people stayed on the drugs. And they were specifically looking at to 12 weeks. You know, 12 weeks is when they had kind of calculated when they thought they would achieve a meaningful weight loss. I don't think they had weight data. This was just looking at prescriptions, right? How many people kept prescribing and so forth.

**Jim Hill:** So what they did is they looked at their own database and they looked at 169,000 people. That's quite a lot of people. And they looked at who was being prescribed the drug, who stayed on the drug, who dropped off the drug over time. And what did they find?

**Holly Wyatt:** So at the 12-week mark, they found that only 42% of people stayed on the drug or 58%.

**Jim Hill:** Now, wait a minute. So half the people didn't even stick with it for 12 weeks.

**Holly Wyatt:** No. Actually 30% dropped out in the first four weeks. And I think that's important before you even titrated it.

**Jim Hill:** And it's important to say this is real-world data. This isn't a clinical trial. These are just people that go to the doctor and get a prescription and go to the pharmacy and get it filled, who have Blue Cross Blue Shield as their insurance. So this is real world, very different from a clinical trial. And so in the clinical trial, the dropouts were pretty low, but they do a lot of things to keep people in. In real life, it suggests that there are a lot of people who have a lot of problems initially with the medications. Do we know why they stopped taking them?

**Holly Wyatt:** We don't know. Not from this study. I mean, we can kind of think about it. But like I said, 30% dropped out in the first four weeks before they even got to the maximal dose, because you got to build up to the maximal dose that really produces the weight loss. Probably there were some side effects, I would assume, in that. And then when they looked at the 12-week mark, like I said, only 58% of the patients had stopped by the 12-week mark. Now, they also looked if it mattered whether these drugs were prescribed by an obesity specialist or not. And if it was prescribed by an obesity specialist, that number did go up, I think, to close to 50%.

So it did change a little bit if you were getting some help. I think, yes, it has a little bit to do with if you are seeing your doctor, I think a lot of people are getting these drugs many different ways, and they don't have the help of the physician to, if you're having nausea and vomiting, what do you do about it? They may not have help in escalating the dose correctly. I know in the clinical trials, like you said, we do not see this big a dropout. So people can stay on these drugs, but sometimes you got to work with them.

Sometimes they do have nausea and vomiting, and we have to kind of work with them to get them through that. Some people just don't tolerate them, though. There's just some people who are not going to be able to be on these drugs. But I think in this case, cost may be playing a bigger role than they know, you know, and access. So people stop taking them, but did they have to suddenly pay out of pocket? What was really going on?

**Jim Hill:** They listed the average price for the drug in this group was about $1,000 a month. So that's $12,000 a year. If your insurance covers it great, if it doesn't, that's a huge out-of-pocket cost. And that could be a reason that people drop out. It could be that they couldn't get it, too, because a lot of people with a prescription can't find it, because there's not enough to meet the demand.

**Holly Wyatt:** Yeah. So I think, you know, while this is interesting, and it's kind of interesting their conclusions on this, it's not going to be that effective or that helpful. And I'm like, wait a minute, you know, even if it was true that we couldn't improve these numbers and only 42% stayed on the drug at 12 weeks, that's still a huge number of people.

**Jim Hill:** If we could treat 40% of people who had obesity and get them down to a normal weight, my gosh, that would be the biggest improvement in health we've ever seen. So that's a good point. We don't have to be 100% successful. If we could successfully treat 25% of the people with obesity, the impact on overall health and health of the population would be immense.

**Holly Wyatt:** Right. And this is why you need multiple tools, because there's going to be some people who are not going to tolerate these drugs. This is not going to be a solution for them, but a different drug, bariatric surgery, an intensive meal replacement program or intensive behavioral change program. That's why we've got to have multiple tools, because no, I don't think 100% of people are going to be able to lose weight on these drugs.

**Jim Hill:** So have you changed your mind on recommending use of these drugs for weight loss? Has any of this changed your mind?

**Holly Wyatt:** No. If anything, I feel a little bit more comfortable, you know, especially with the four-year data. I still say I don't know what it means to be on this drug for 10 years, but I don't know what it means to be on a lot of drugs for 10 years.

I mean, I don't have that data for, you know, so I don't see anything, so I'm feeling a little bit more comfortable. I do think if I were going on this drug, though, I would make it, I would combine it with everything. I would try to help the drug. I wouldn't just take the drug and see what happens. I would combine it.

I would get my biggest bang for my buck. And then I might try to figure out if I could stop it. Now, what do you think happens, Jim, when you stop these drugs?

**Jim Hill:** You want to hear my analogy? I've been working on this one. Okay, all right. Here's the analogy. See if you like it. So let's imagine you're at a river that's flowing downstream very rapidly, and your goal is to get from point A to point B. Let's say you need to get a half mile up the river. Okay? If you just go in and start swimming, a lot of people get swept down.

Okay? That's weight gain. Now imagine you get a motorboat that pulls you up that half mile, then they let you go, and you got to fight the current. And if you don't have the tools to do it, as long as the boat stays there, you're okay. And the boat's the medicine, right? The boat's the medicine, but if the boat goes away, you're going to get swept downstream unless you've got good swimming skills, and that's lifestyle. Lifestyle can teach you to be a good swimmer, and that's going to help you. Even if the boat's there, you may actually gain a little bit with those skills.

**Holly Wyatt:** I like it, Jim. I'm going to add to it. I'm going to add to it even more. So, I get it. The medications take you up the river, and then you're going to let go of the medications. You're going to stop the medications. You're going to let go of the boat. You don't have to swim upstream. You just got to stay where you are.

**Jim Hill:** That's right. Yeah, you're already at your goal. Your boat takes you where you need to be. You don't have to swim anymore. You have to not get swept downstream, and the stream really is our environment. It's the food noise. It's the food everywhere. It's the inexpensive food.

It's the lack of activity. All that is the current in the stream that's pushing you downstream to gain the weight back. All you got to do is push against it enough to stay where you are. You don't have to gain anything. You're already there.

**Holly Wyatt:** So, you don't have to be a really good swimmer, which takes a lot of energy. You just got to be good at treading water, keeping yourself in the same place, which is a little bit easier than actually swimming upstream. But I love the analogy. You got to do something. If you do nothing, boom, you're regaining.

**Jim Hill:** And see, that's why I agree with you. I haven't changed my mind on the tools. I think they're wonderful tools. Quite frankly, if I were going to do it, I might think about losing weight on the medication and then trying to keep it off with lifestyle. But you got to have a plan.

If you go into it and say, hey, I'm going to stop the meds and see what happens. Boom, you're downstream right away. You're going to sweat down and you're right back where you started from.

**Holly Wyatt:** I wouldn't do that. I know what would happen if I did that.

**Jim Hill:** Got to have a plan. And that plan is to teach you to stay in the same place in the stream.

**Holly Wyatt:** Yeah. And the plan's got to be a good one, right? It's got to be an effective one.

**Jim Hill:** But I actually think we have a good bit of science that can help people do that, Holly.

**Holly Wyatt:** I do too. But you got to find it. You got to do it. You can't just say, let me see what happens. That is not a plan.

**Jim Hill:** And it's forever. That current isn't going to go away. You got to find a way that you're comfortable with forever staying in that place. But I think it can be done. And that's why I'm excited about how we might figure out how to help people use the meds for weight loss and maybe now and then for weight maintenance when you need them.

But being able to maintain this happy way without the meds, I think people would love it if that could happen. I agree. I agree. All right. Last thing we're going to talk about is, is it too easy? You know, all you got to do is take a med. That's not fair. You ought to be able. You got to suffer some pain here.

**Holly Wyatt:** Yeah. So, you know, I've been listening to people who kind of have said, you know, don't use the weight loss medications. And I'm looking at them that they don't say this, but I think that's what's really behind some of them. Some of them work really hard, you know, they go to the gym a lot. They don't like it that there could be a medication that they feel like someone could take and they wouldn't have to work as hard as them. However, what I would love to tell these people, I would love for them to understand is that it is not an even playing field. That most people who struggle with their weight and have struggled with their weight their whole life.

And I'm going to put me in that category because I can relate to this. How hard it is to lose weight or to even maintain a healthy body weight is different than other than someone else. You know, it's not the same as just what they're doing. So, so I just don't even think that's an analogy that people can can think about, right? It's not the same. And so why wouldn't you give someone a medication that can help them with those changes?

**Jim Hill:** No, I agree with you. You know, it's like these, uh, disgustingly thin people that say, oh, we have to do it. Just eat a little less. I mean, come on, you know, that's not the issue. And there's people that are genetically fortunate and maybe don't have to worry about it. But there are lots of people that it's not easy for them. They're biologists working against them. So why not get a little bit of help in pushing back against that biology?

**Holly Wyatt:** Yeah. And I think the being on the weight loss medications and I have not been on a GLP one, but I have been on weight loss medications in the past. Everybody knows I've, I've lost weight, gained weight.

Finally now have been able to maintain my, my reduced weight for a long time now, but struggled in my younger days, you know, with my weight was on medication at one point. And I really did understand when I was on these medications for the first time, I understood how someone who didn't think like I thought about food. I thought about food a lot. I had a lot of that food noise. I was constantly planning what's my next meal. I constantly knew that the chips were in the cupboard. I constantly knew that there was ice cream in the back of the freezer hidden, you know, I knew and thought about all this time.

Took the medication that went away. And suddenly I was like, if this is how someone else feels, I get how they don't understand. How difficult it is. I get why they say, just don't do it. Because suddenly for me on the medication, it was really easy not to eat the food.

**Jim Hill:** Well, that's why we talk to people who are taking these GLP one meds and they say, oh man, it's easy. I, you know, I can manage my weight and, and, you know, because the medication is overcoming all that. You know, we've laughed before about we need a med for these people who don't experience this to allow them to experience it and see what it's really like to have to struggle with your weight.

**Holly Wyatt:** Put them on a med that makes them think about food 24 seven. Give some that food noise. Yeah, just for a couple of weeks. And then let's see what they say when they say it's cheating. Let's just see if they really now feel like it's cheating or it's the easy way out.

**Jim Hill:** So we agree. We don't think it's cheating. We think it's a wonderful tool that you need to help you manage really biological forces that are pushing you toward weight gain.

**Holly Wyatt:** And anybody who, you know, if anybody's been someone said this is cheating, that, you know, they just don't understand the biology involved. They just don't understand that there's physiology involved.

It's not just willpower. There's it's way more complex than that. And it's, and, and, and, you know, how hard someone works, you just don't even have that insight. You just don't know.

**Jim Hill:** But I do think it's very prudent to, I encourage people to do the lifestyle changes too. Don't just take the pill. You can take the pill and sit on the couch and do nothing and everything.

That's not going to get you where you want to go. And we've talked about that before is that success is more than a number on the scale. It really, it's really achieving a happier life and the medication can't do all that. It can get the number on the scale, but it can't produce the things, the positive things in your life that some lifestyle changes can do.

**Holly Wyatt:** Right. So that, and I think you want to get as much weight off as you can. Like you want to be in the 25 or if you, I mean, assuming you have that much weight to lose and most people who go on these drugs do, if you can get to that 25% or 30% and the way you're more likely to get there is with combining the medication with lifestyle changes.

**Jim Hill:** All right. Let's take a couple of listener questions. Holly, you can take this first one. Why are the new drugs so expensive?

**Holly Wyatt:** Oh my goodness, Jim. That sounds like one, that's one for you. But I mean, I know people think that the pharmaceutical companies are overcharging, but look at these studies, guys. And I'm not saying that they're not making some money because I think they are making some money. But this one study that we just talked about over 17,000 people enrolled for four years, that study took a lot of money to do. And realize also, there's a lot of times that medications, you go through the process of studying them and getting, collecting the data that's required for them to be approved by the FDA and they don't make it. So you spend a lot of money on drugs that don't make it. And then to get a drug approved, there's a huge amount of money that's spent on the trials. I know that they're making some money. It's hard for me to understand, are they making too much money or where's the balance? What do you think?

**Jim Hill:** Yeah, I think it's going to come down. I agree with you. I think the drugs are really blockbusters. I think they're making a lot of money. I think it costs a lot to develop these medications, but I do think the costs are going to come down over time.

I just think they're too expensive to make financial sense right now. But I think that'll change. And I think with more drug available, we're going to see more companies with similar drugs on the market. I think you will see the cost come down.

**Holly Wyatt:** Okay. I agree. I hope it comes down soon, but I don't know. Got a question for you. Here's another listener question. Why do you need a BMI of 30 or I think it's 27 if you have one of those comorbidities? But why do you need a BMI of 30 to be able to take the weight loss medications?

**Jim Hill:** Oh, what a great question. And that's when you and I discuss a lot. The rationale there of a BMI of 30, remember, that's the definition of obesity. Overweight starts at the BMI of 25, obesity starts at a BMI of 30. And traditionally in the obesity medicine field, people have talked about giving drugs to people that have serious metabolic consequences of their obesity. And so they use that cutoff of a BMI of 30. Now, it doesn't mean that everybody above 30 has metabolic problems, but they're more likely to do it.

So it's a bit of an arbitrary cutoff. And in fact, there's no reason why it couldn't be used for a lower BMI. What you don't want are these Hollywood actresses with a BMI of 22 taking the meds to get to a 21. So there's a too low of a BMI, but I think it raises an interesting question. Do you have to have a negative metabolic condition in order to effectively lose weight? I think it's a mistake to just limit it to people with metabolic disease.

**Holly Wyatt:** Kind of thinking that too. I think that medical professionals in the field has somehow or another decided they were going to go in and draw the line. And these people are at a risk that they can take the medications and these people are not. And that's just not that clear. And I don't know who gets to decide that. I really don't like that aspect of who gets to decide that for me.

If I am at an elevated body weight and it's not exactly 30, but it's elevated, and I would benefit from some weight loss for whatever reason I feel like has meaning to me, I don't know if I like someone telling me I can't.

**Jim Hill:** Yeah, I agree. I think we're going to have more of these conversations now that we have effective medications. Before, we didn't have very effective medications and it wasn't that big a deal. Now we know these things work. They work if you have a BMI of 40. They work if you have a BMI of 25. So I think we're going to be discussing this question more and more.

**Holly Wyatt:** Well, I'll tell you the other side. And I can tell you we had Dan Bessison on and I can tell you kind of what his idea on this is. Well, right now, Holly, we have a limited amount. And if you allow everybody that wants to be on this drug to be on this drug, then people who really need it, diabetics who have, you know, won't be able to get it. So that's what a lot of people say, you know, you've got people who don't need it taking the drug. There's a limited amount of drug and I really need it for my diabetes and I can't find it.

**Jim Hill:** We're not going to answer that question. And I think it's something we're going to talk about more in the future. All right. Last thing, what new drugs are coming down the pipe?

**Holly Wyatt:** Oh my goodness. There's so many. You can't really even keep track of all of them. You know, there is an oral GLP-1 for weight loss that is in the pipeline. We have an oral GLP-1 medication for diabetes.

Rybelsus is already out there, but we don't have one that's been approved for weight loss, but there's one in the pipeline. So that's coming. There's a triple drug coming. You know what that means, Jim? A triple drug.

**Jim Hill:** Three mechanisms of action.

**Holly Wyatt:** Yeah. It's going to actually go after three hormones. So it's going to go after GLP-1, GIP, and glucagon. So it's going to target all of them.

**Jim Hill:** And it's probably going to get more weight loss.

**Holly Wyatt:** And it looks like it might be.

**Jim Hill:** And I think there are a ton more coming, Holly, that use different mechanisms. All these are based on GLP-1 at some level. There are a lot of companies that are looking at completely different mechanisms that work not through GLP-1, but through other things. So this field is burgeoning. And I think next year you're going to see a lot more medications on the market than you do right now. So good news. More tools coming.

Okay. We revisited the drugs. We still think they're great tools.

I think we're learning more and more how to use those tools. They can produce a lot of weight loss. They seem to be safe over four years. They seem to work better if you combine it with lifestyle. But again, it's good news because we have tools that can get a lot of people to their happy weight.

And that's where we all want to be.

**Holly Wyatt:** All right.

**Jim Hill:** All right. Well, thanks, everybody. We will see you next time on Weight Loss And.

**Holly Wyatt:** Bye, everybody.

**Jim Hill:** Bye. And that's a wrap for today's episode of Weight Loss and. We hope you enjoy diving into the world of weight loss with us.

**Holly Wyatt:** If you want to stay connected and continue exploring the “Ands” of weight loss, be sure to follow our podcast on your favorite platform.

**Jim Hill:** We'd also love to hear from you. Share your thoughts, questions, or topic suggestions by reaching out at [weightlossand.com](http://weightlossand.com/). Your feedback helps us tailor future episodes to your needs.

**Holly Wyatt:** And remember, the journey doesn't end here. Keep applying the knowledge and strategies you've learned and embrace the power of the “And” in your own weight loss journey.