More Than Weight Loss: How GLP-1 Drugs Help Your Whole Body

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Ozempic and similar medications have received widespread attention for the treatment of diabetes and weight loss. There’s also growing research that they may help treat heart disease, sleep apnea, kidney disease, substance use disorder and other conditions.Demand has surged for the medications because of their impressive ability to help people lose weight. But are they right for everyone?

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Macie Jepson
I really do wonder these days who is not talking about GLP-1 weight loss drugs. I mean, whether you’re comparing notes on how best to get them. Maybe you’re amazed at Hollywood transformations. Maybe you know somebody who is healthier because of them, and not just from the weight loss, but like medical conditions are being reversed or maybe, admittedly, like myself, you’re just confused about whether or not you want to try them, like the 1 in 8 Americans who have so far.

So in today’s podcast, there is a lot to unpack.

Matt Eaves
Yeah, Macie when the news first came out about weight loss drugs, it seemed like it was just celebrities that were taking them. Then I started to hear about friends of friends, and then now I have personal friends that are taking it as well as family members. What are these drugs? How do they work? Who are they for and are they safe?

Macie Jepson
Hi everybody. I’m Macie Jepson.

Matt Eaves
And I’m Matt Eaves, and this is The Science of Health. Today we are joined by Dr. Ian Neeland, Director, Center for Cardiovascular Prevention, Harrington Heart and Vascular Institute at University Hospitals in Cleveland and the McCamon Family Chair in Cardiovascular Excellence.

So before we jump into this, might be best to explain to our listeners why we chose a cardiologist to speak on this subject. As an academic medical institution, we have clinicians that focus on all types of weight loss – bariatric surgeons, nutritionists, primary care physicians, plastic surgeons, who can do liposuction – but felt a cardiologist will be best on this topic. What makes you qualified to speak on this? And what is the relationship between weight loss and cardiovascular health?

Ian Neeland, MD
So thanks for having me today. I really appreciate it, and I appreciate the opportunity to discuss this really important topic, because it does impact many, many people here in Cleveland and across the world. So obesity, which is what we define as having excess body fat or excess adiposity, is a chronic medical disease and unfortunately leads to many different downstream problems.

Heart disease, kidney disease, metabolic disease like type two diabetes and lipid problems, obstructive sleep apnea, heart failure the list goes on and on. And so it’s really important to address and treat obesity for patients who are living with overweight and obesity. And I think that these kind of medications or should we call anti-obesity medications or AOM’s are an important piece of the treatment algorithm and treatment tools that we have for people.

And it’s become even more popular, I think, because over time the medicines have gotten better at doing their job, and it’s been safe and effective. And so I think when you see people who are using these medications and are finding, you know, ten, 15, 20% body weight loss, they’re feeling better. Their medical conditions are improving. Everyone’s getting interested and involved.

So it’s important to talk about the truths and the myths of these medications and really provide the facts for people to make their own decisions with their doctor.

Macie Jepson
You’ve got me wondering already if I was thinking the wrong thing, because I wanted to ask you about what these GLP-1 drugs are exactly. But you called it something else, so I’d like you to talk about that, but also tell us what’s out there. Because in my research, I learned that some of these things were approved for one thing and some were approved for another.

Can you give us an overview of what’s out there?

Ian Neeland, MD
Yeah. So it’s important to understand the historical context of how these medications kind of came to be. I call them anti-obesity medications because they’re actually more than just the GLP-1 and GLP-1 related therapies that exist to treat patients with obesity. GLP-1’s are relatively new in the market. There have been other medications have been tried in the past, both short term and long term management of weight.

But it’s only because the GLP-1’s have been so effective, and the amount of weight loss that one can achieve has been so great. And the fact that they do improve many different cardiovascular metabolic conditions, that now you see them everywhere. You know, these medications really started out as diabetes medications. They were identified as being able to modulate and change blood sugar control.

You know, several years ago, about a decade now, they did a trial to look at the impact of these medications on cardio vascular risk, predominantly because there was a concern that they may increase the risk for heart disease, not necessarily a decrease, but in fact, they found that beyond the fact that it’s safe for patients with cardiovascular disease, it actually reduced the risk of getting cardiovascular events like heart attacks and strokes.

So these medications then became really at the forefront of looking at more additional research to see how can they impact cardiovascular and other health conditions, you know, across the board. Now, as part of the the fact that they improved diabetes, they saw that and they improved weight, to reduce weight. So dedicated weight loss trials came after the diabetes trials.

And then we saw that they, you know, initially early generation groups such as Liraglutide reduced weight by about 5 to 8%, which was kind of the best that lifestyle could do, by itself.

And then the second generation ones like Semaglutide and now Tirzepatide, and there are many related compounds coming on the market, showed up towards of ten, 15, even 20 plus percent body weight loss, which was really unseen before with any other anti-obesity medications. And was approaching the amount of weight loss one could achieve with bariatric surgery.

So because of that, I try to avoid surgery, using medications for weight loss. Now they became really something that everybody wants to know about and find out about. Plus, the fact that many other trials have been done to show their benefits across a host of cardiometabolic conditions. Like I mentioned before.

Macie Jepson
Matt, he just mentioned compounds. We’re going to want to get into that. Before we do that, I think it’s important to learn from you what these drugs you’ve mentioned, so many in general, what do they do? How are they working?

Ian Neeland, MD
So the GLP-1’s have a lot of effects on both metabolism, cardiac function and the brain. So predominantly I would break it into two different effects. One is in the brain. So these medications reduce appetite, reduce interest in food, make people less hungry. And actually that’s part of the interest in how it can be applied for other disorders of addiction, such as alcohol, tobacco and such.

It also and predominately this is where the side effects come from, impacts the GI system, the gastrointestinal system. So it slows down the gut. Food stays there longer. The emptying of the of the stomach after meals is much slower. And so that leads to people eating less, feeling more full. And that leads to the side effects potentially of nausea, stomach upset and such.

They also have a lot of metabolic benefits because they increase secretion of the body’s own insulin, which reduces blood sugar and, impacts kind of vascular health as well as endothelium. So you we see benefits from the heart. We see benefits from the body weight and all the different things that weight loss impacts, as well as heart failure and many other conditions.

It really is a systemic drug and class, and that really can impact people with a host of conditions that are anyway interrelated cardiovascular, kidney, metabolic are all interrelated. These medications can impact all those domains.

Matt Eaves
So talk specifically about name brands because they’re the two that I see in the market the most Ozempic, which honestly, I have the jingle in my head right now as we’re talking about, because their marketing is really out there. And then we go over what are those different types of drugs that have different effects, like what’s the difference between those two?

Ian Neeland, MD
Yeah. So there’s a lot of confusion about this. Let me let me dispel some of the confusion because the medications were initially designed for diabetes and then only later were designed for weight loss. Each medication has two different brand names and one generic name. So Liraglutide is both Victoza for diabetes and Saxenda for weight loss. Similarly, Semaglutide is both Ozempic for diabetes and Wegovy for weight loss, and Tirzepatide is Mounjaro for diabetes and Zepbound for weight loss.

Now the two medications, Semaglutide and Tirzepatide were actually the same medication, same doses and same pens and just branded differently because they’re for different indications. And part of the reason that the confusion has become that, you know, originally, I would say maybe 6 to 8 months ago when there was a shortage of these medications out there, there was a lot of discussion about, well, how can we deprive people with diabetes, these medications to give it to people who don’t have diabetes and just want to lose weight with the shortage?

Now, there’s no longer a shortage. They in manufacturing has, you know, come up to the demand. I still think there’s confusion between the brand names, generics, what they are. But generally there’s three medications out there the: Liraglutide, Semaglutide and Tirzepatide at this time.

Matt Eaves
All right. That makes sense. Yeah. Thanks for clearing that up.

Macie Jepson
It seems like we can get them for more and more places these days. And that’s where that compound word came up when Matt and I were doing our digging and it concerned me because some of the research I found was that, well that’s not FDA approved, whereas others are. And yet people are really focused on where they can get it, you know, the easiest route that they can take.

So could you kind of take us down that road of the difference and whether there should be any concern?

Ian Neeland, MD
Yeah. So I definitely echo your concerns. This was borne out of two issues. One was the shortage and two is people wanting to get medications for cheaper. So the medications are for weight loss. Many insurances do not cover weight loss or weight management under their plans. So people were unable to get it through a standard, you know, prescription coverage for insurance.

So they were searching for other ideas and alternatives. So, you know, you had compound pharmacies popping up essentially overnight who were prescribing, you know, the medication. But because it’s a licensed to them. Right? It’s not generic. It’s still under brand. It’s really unclear where they’re getting it from, how they’re getting it and what dose they’re using. For example, many people will go and find that the doses do not match the same doses that you get for a prescription drug.

Plus, a lot of compounding pharmacies will add additional elements like B12, because it kind of helps people feel better. And so it’s not regulated. And in my opinion, it’s not safe. I’ve seen several situations where young people who started the medications from a compounding pharmacy have had major side effect issues. I really try to encourage patients not to go that route.

Matt Eaves
Yeah. So for companies that are adding additional ingredients like B12 or it could be many others, do you see benefit in that? Is that said a good thing?

Ian Neeland, MD
I personally don’t think it’s a great thing because it’s not really disclosed to patients what’s in there. And even when they do disclose it, you’re not really sure because it’s not regulated.

Matt Eaves
So it sounds like based on what you just said, you’re not recommending this as a first line treatment for people who are wanting to lose weight. So a when when does that occur? Like where do you think it becomes like, okay, this is an appropriate drug for you say it’s somebody who maybe on one end is saying, I just want to lose 15, 20 pounds, I exercise, I think I eat pretty, pretty healthy, not overeating, but I just can’t drop the pounds.

Is that okay? Or where where does it come? We’re say okay, the prescription is now valid or is appropriate.

Ian Neeland, MD
So I think it is first line in certain situations and certain patient contexts, lifestyle is always the cornerstone of weight loss therapy, right? My dietary modification, caloric restriction and increasing physical activity is always going to be the first thing we recommend to do. Now many people can achieve maybe 3 to 5% weight loss with lifestyle, but that’s pretty much where it goes.

And then there’s a lot of, people who regain the weight and are unable to sustain the lifestyle. So these medications can act as an adjunct to that and can help boost the weight loss for long term benefits. They’re designed for long term weight management for people who need it. So the right now for pharmacologic therapy, for weight loss medications, you, have to have either a body mass index, BMI of 30 or more or 27 or more with a comorbidity, like high blood pressure, like diabetes, or pre-diabetes.

So that’s where I think the patient, you’re using GLP-1’s as a first line agent for weight loss in patients with existing conditions such as pre-diabetes, obstructive sleep apnea, heart failure, heart disease. Excellent choice, right? Because it not only will help with weight loss, but it will help with many other conditions. I think using it kind of as a designer drug or a short term kind of thing.

I would not recommend that. The medications, first of all, take time to titrate up and get to the appropriate doses. And so they’re not designed for a kind of 1 to 2 months use and then stopping. Furthermore, we know from trials that when you stop the medication, weight regain occurs many times close to where the baseline weight was.

So it’s really not designed for, you know, quick on and off. If people try to use higher doses, you know, more to lose weight more quickly. Side effects can be really bad. Nausea, vomiting. People really could feel sick. So it’s really meant to be used in a long term weight management fashion to get to the maximum effective, tolerated dose over time.

You know, there are medications for weight loss there and for short term, but they’re not really, recommended necessarily for people with existing cardiovascular disease or high blood pressure.

Matt Eaves
And when you mentioned some of those side effects, you know, one of the concerns I hear from people wanting to get on this is say, well, I read all these things online about my face looking hollow and all that. Is that because they’re taking too high of a dose too quickly, or can that happen in any situation or if it’s managed correctly, usually those those types of side effects will occur.

Ian Neeland, MD
I think it’s a little bit of a mixed bag if you lose a lot of weight quickly, right? So both fat and muscle will reduce and you can get kind of the, you know, skin and bones look right. And anyone losing a lot of weight, well, that will happen too because people are getting more weight loss with these medications that I’ve ever seen before.

So now people are recognizing this and seeing it. So I don’t think it’s necessarily related to the GLP-1’s per se. It’s just related thing to rapid weight loss. There is a concern out there about muscle loss with these medications, and whether or not the loss of muscle, which always occurs with weight loss, is a little bit exaggerated with these medicines.

And that’s research that needs to be performed, including research we’re doing here at University hospitals. And now that remains to be seen. But I do recommend for people who are on these medications, especially older people who are risk for losing muscle and falling. And frailty is to maintain muscle mass and preserve that muscle mass, whether it’s through exercise, weight training, protein supplementation.

Make sure that you also that you eat and you feel your body because a lot of people won’t want to eat on these medicines, they feel fatigued. They feel tired. Well, if you’re not taking any any food, that’s going to happen. So you have to really be mindful and manage the side effects, manage the effects of the drugs in order to get the best benefit.

At the same time, not really feel sick.

Macie Jepson
It sounds like it’s important to make that a priority. Making sure you’re getting protein in your body and making sure that you’re building that strength to get through it. I want to go back to this compound, and I’m think I’m calling it like designer drugs that are out there. These options, well, you were ticking off some things that were red flags to me.

Like, you need to ease into these dosages and that will very slowly go up to you until you get to the right place. It sounds to me like you really need a doctor’s advice and guidance through this process. Is this other direction. Because if we if we talk about just some unexpected side effects, people are still going to want to go for the cheaper, faster route.

So my question to you is, can they go that route without doctor’s supervision and if so, how scary is that?

Ian Neeland, MD
Yeah, I would not recommend, taking the medications without a doctor’s supervision. You know, they’re not designed for people to self-manage, and there are side effects and there are side effects that people don’t know about. So I’ll give you one example. Tachycardia. Fast heart rates can occur with these medications up to 20 beats per minute more than someone’s normal.

Well, if you’re already let’s say at 90 and normal and you now you’re going up to 120, your heart’s racing all the time and you’re wondering why is that. It could be the medication. So it’s important to, you know, speak with a physician and talk about what the potential side effects are and how to manage those side effects, whether it be modifying your diet, the way you eat, the timing of how you eat, and how much you eat, those are really important things to manage the the GI side effects, especially otherwise people can really feel sick, they can vomit, you know, they can get dehydrated with these medications that can make more constipation.

And then, you know, people just don’t feel well. Just like any, any medication for a chronic disease, it should be managed by a doctor.

Macie Jepson
Yeah, Matt, you touched on something that has been in the back of my mind from the beginning. Let’s. I’m still carrying a Covid weight. No excuse anymore. But my excuses. I’m afraid that I’ll lose some weight, that it will age me. So thank you, Matt, for taking me down that road. My second concern, and it’s a fear, is that I won’t be able to get off of it.

So I do have friends who I feel have gone past the healthy weight of weight loss. Why is that? And are they, I mean, are people getting addicted to losing weight and that’s seen that scale go down? Is there a physical addiction that can come to this? Sure.

Ian Neeland, MD
Yeah. I think it’s you know, it’s certainly a concern. There are people out there that don’t need to lose weight from a medical standpoint, and yet want to do so from an esthetic standpoint, and they can get into trouble with this. I mean, there is such a thing as an unhealthy weight, as too low. And that is it is associated with, you know, problems and health pro health issues.

So that’s why it really requires supervision and understanding what your weight goals are before even starting the medication is that try to get to a healthy weight, one that is makes you feel good, one that is not associated with health issues and can help resolve your health problems. And that’s the way you want to maintain. When I hear people talk about, you know, I can’t get off of them, it’s interesting.

You can always stop them, right? The thing is, misinformation about their well, well, I have to take it forever. You don’t have to do anything right. The medications are only going to work if you’re taking them. And like I said, if you stop them, there is weight regain. Now, there is a way to try to mitigate that and to try to, you know, keep maintenance being off the medications.

And some people have talked about how high train the dose down much lower, rather than stopping cold turkey. Some people have talked about just maintaining a really low dose over time, you know, and staying on a low dose given the benefits. And some, you know, some people talk about really maximizing your lifestyle changes and potential, such as, you know, really being vigilant about diet and exercise when kind of coming off these medications.

So many people will maintain weight, but many people and probably most people will gain some back. The medicines again are designed for long term use rather or long term weight management. And they have metabolic benefits. So, you know, I think it’s as long as you’re doing it safely and as long as you’re doing it effectively and without, you know, side effects that are intolerable, I would continue the medications and the long term, much like you do your blood pressure medications.

We are cholesterol medications. People want to get off blood pressure medications, but they see when they stop at their blood pressure, then shoots up. Right. The same thing here. It’s the same idea. The weight will come back.

Matt Eaves
One of the side effects you talked about, which I’ve witnessed from friends and family that are on this, is their complete loss of appetite, to the point where they have to remind themselves to eat. And in fact, talking with somebody yesterday they said, you know, I get to the point sometimes where I get lightheaded and I have to remind myself then to force myself to eat a protein bar.

Is that a real concern in terms of the body sort of shutting off its appetite or just the reminder like, oh, I need to eat something. It’s okay. Does that does that worry you as a doctor in terms of that, that mechanism getting shut off?

Ian Neeland, MD
Yeah, and I definitely think that’s a real concern. I as I mentioned, people need to understand that their body is like a car. They need fuel and they can’t run without the fuel. So even though they’re losing weight and they’re eating less, but you don’t want to eat less to the point where you’re not getting the fuel you need.

So there have been situations where people felt lightheaded, almost passed out, super fatigued. They couldn’t get up out of bed. I mean, those are all counterproductive to what you’re trying to do in terms of making yourself healthy. That will not allow you to exercise, that won’t allow you to eat the right foods. Right. And so it’s really about changing lifestyle and and habits, eating the right things at the right times, maintaining that hydration, right?

Lack of hydration caused severe constipation. And in some situations people have talked about gastroparesis right to the stomach, not moving at all, food just staying there and causing a lot of vomiting, severe pain, bowel obstruction can occur if there’s nothing moving through. So you, you know, it’s not just, you know, inject and forget about it. You do have to manage.

You know, the side effects manage that how these drugs work for maximum effectiveness. And that requires people who know what they’re doing.

Matt Eaves
And right. Even more important to have that doctor advising and being along the ride with you.

Macie Jepson
Right? I have heard it called the paralyzed stomach. So let’s go deeper because people talk about that a lot. From what I just heard you say, that might could be mitigated if you’re staying hydrated and doing all the right things.

Ian Neeland, MD
Yes. I mean, all right, gastroparesis is an exceedingly rare event with GLP so that this paralyzed stomach, certainly people with diabetes can are at risk for and many do have gastroparesis. So taking the medication with prices already there will make things worse potentially. So that’s something to think about, right. When choosing whether this medication is right for you or not.

As a patient, it’s rare, but constipation is not rare. Constipation is pretty common. It’s the same concept that things don’t move through. You’re not getting a lot of hydration right, and things just solidify and stay there. And that can cause people a lot of pain and suffering. I always recommend, you know, that occurs consideration of a stool softener, consideration of a laxative if you need to.

You know, sometimes these other medications require you to take other medications to manage those side effects. I think, again, it’s all about the long term benefits because the benefits on the cardiovascular system and risk the benefits on weight loss, the benefits on, you know, the heart and metabolism far outweigh, I think, side effects that can be managed. But, you know, this is an active management situation.

Matt Eaves
Because of your statement on the benefits far outweigh, the negative side effects. And as a country, obesity is an epidemic. Right. And so why. And it’s sort of a silly question, but, you know, I’m asking somewhat seriously, is that similar to, you know, when we were facing a pandemic, we gave everyone a Covid vaccine. Why not give this to everyone and maybe not everyone, but for those who could actually use it, as opposed to having to go through this process, and there’s some insurance issues with cost of those sort of things.

But assuming those were, you could move those aside. Is it appropriate to to bring everyone down in weight to try to get to a better place as a country or. No? Is that that too far?

Ian Neeland, MD
I do think it’s probably too far. There’s a new, statement from the Lancet commission on Obesity that came out, this past year. And what they’re trying to do is frame obesity as a chronic disease in the context of clinical, you know, consequences. So there is such a thing as metabolically healthy obesity, people with excess body weight that don’t manifest the diseases that relate to obesity.

Now, there’s some concern that over time those people will get something. But right now they’re healthy. So I think rather than focusing on the BMI per se, you want to focus on a healthy weight for the person, right? There are plenty of people who, if you try to get them down to a BMI of 25 or less, that will make them very frail and very, you know, predisposed to falling and breaking a hip or hurting themselves.

So I don’t think this is something we should put in the water by any means. I think, you know, again, it is a kind of panacea for because we find that so many cardio metabolic conditions are improved with these medications. So I definitely think they should be on top of mind for multiple specialists, for primary care physicians, for nurse practitioners, pharmacists.

These are important medications, but I don’t think it’s yet ready to put in the water and give it to everybody. Because I think that, you know, there’s potential, harm that could occur from that. So I still think it needs to be regulated.

Matt Eaves
Yeah. You hit on one thing that I think is the society, we’ve gotten to a place where we measure someone’s health solely based on the scale. And you hit on a couple of these. But but as a doctor, what other factors are you using to determine someone’s health and who’s a person, maybe, who’s not at their doctor?

What are some things they can think about or reflect on their own selves to say, okay, I might be heavier than than I want to be, but I am in good shape and what are those factors that that someone could use to define what is healthy?

Ian Neeland, MD
Sure. So stepping back from, from a scientific perspective on what type of obesity is the, the bad type that we need to be addressing and what type is maybe the neutral or less, you know, harmful type so that a lot of that has to do with the distribution of body fat in a person’s body. So you’ve heard of the kind of apple pear shape, right.

So the apple is what’s called visceral obesity. There’s body fat that’s supposed to be in the subcutaneous tissue, the tissue under the skin. That’s where the normal storage for fat is. But it gets in the body around the abdominal organs internally. And that visceral fat then spills over into places where it does not belong, like the liver or the heart, skeletal muscle, pancreas.

And that causes a lot of disarray, inflammation, hormonal changes. And those are all the drivers of all the different consequences that we see diabetes, heart disease, heart failure, the fat that’s, the pear shaped. Right, which is under the skin. Some of it actually may be protective against cardiovascular disease because it acts as a sync. Right. The metabolic sync that things, you know, abnormal tumors and things can be stored in there and knock it out the rest of the body.

So when we think about, you know, what type of fat really is, the kind of fat we want to address is the visceral fat. Now the question is how do you identify that in individuals right now you could look at somebody if they look like an apple versus a pear, but you can’t really get an understanding body mass index.

BMI, which is how we currently define obesity, just does not define that at all. In fact, it doesn’t even define the difference between muscle and fat. So we really try to look at things like waist circumference right waist to hip ratio, and then things that happen because of the visceral fat like high triglycerides, high blood sugar, low HDL cholesterol.

Those are telltale signs that the type of fat a person has visceral fat. And that should be a trigger for intervention, whether it’s lifestyle with lifestyle plus pharmacologic therapy, and in some cases where people have, you know, a body mass index is above 40, where we know they have a lot of visceral fat, something like bariatric surgery. So it’s really trying to figure out the consequences of the obesity and how we can then improve it.

People who are fit and who exercise and eat right, and maybe a little heavy, it could be muscle and it could also be fat, but that fat might be, you know, fat. That’s not dangerous, so to speak. So it is important to have that discussion with your doctor to think about it in that context.

Matt Eaves
That’s really interesting.

Macie Jepson
We talked about long term use of of this drug. Perhaps if it’s right for you and it’s been around, what, about 20 years, a little less.

Ian Neeland, MD
Yeah.

Macie Jepson
Do we have enough science to know the long term effects of sticking with us?

Ian Neeland, MD
I do, I’m not concerned about long term negative effects like people developing cancer for example, horrible tumors or something like that. We have enough evidence to really see that the benefits are there. Now, we don’t have as much data with the newer generation ones where the weight loss is, you know, upwards of 25 plus percent. But we do have a lot of data over time with bariatric surgery.

So weight loss through surgery, we know it can be sustainable and has sustainable health benefits actually as well. So they have data now at 20 plus years for bariatric surgery and it shows sustainable benefits. And so I think that these medications really are, you know, long term management medications I think they are safe. They should be used in the right clinical contexts.

Where we really need to do is work together as a society to get the drug companies to help drive the price down and make it more affordable and accessible to people when it’s needed and when it’s indicated. I think it’s something that should be used.

Macie Jepson
I love to, I mean, love it. I’m sitting here right now. It’s we’re in the middle of, you know, fat Tuesday. I’m planning a to Fe jambalaya. I’m getting it all in. I love to eat and when I sew and I’ve not been on this drug. So I want to know, would I still enjoy eating? When you’re making yourself eat, do you do you enjoy it?

Ian Neeland, MD
Many people do. Not many people. They find their craving for food is much less. Their interest in food is much less. I’ll give you an example. You might get up in the morning and say, hey, I could use a really great breakfast, right? Eggs, toast. People get up in the morning and they just don’t want to eat anything.

They’ll they’ll actually feel queasy if they think about food. And so they go without breakfast and then it’s lunch and they maybe have, like, I know, a protein bar or something, you know, and then by the time they get to dinner, they’re either famished or they feel sick. And then, you know, they have to eat and eat a lot and that then that food stays there and then they feel sick again.

So it’s it’s not something that you can just don’t eat. And just do whatever. You have to be mindful. Small, frequent meals are really important. I think the right healthful meals are important. Do you want to stay away from big steaks? You know, very fatty foods. You know, Cristina, Alfredo or something like that.

Matt Eaves
That’s the paradox for me in this with these drugs is I love eating too, but I also want to lose weight. But taking a drug that curbs my appetite, well, that is the intended effect. I’m also taking away something that I really like to do, but at the same time it’s bad for my health. And so I’m really torn on like that aspect of it, that it just gets rid of this one aspect of your life that you really, really enjoy.

Ian Neeland, MD
I think the other thing to know is that side effects are continuum. Some people have absolutely nothing. Some people have absolutely everything at low doses. And there’s most people are in the middle. And you never know until you try it. That’s what I tell people is that you can’t know if you’re going to have side effects until you actually try it.

I mean, I’ve had people on the top doses of these medications, and you don’t feel a single side effect. Some of that actually means that they don’t lose as much weight. Right. And sometimes they do. It just depends. Everybody with these medications is kind of funny.

Matt Eaves
Everyone’s different going back to the and you may not be able to answer this because it’s probably more of an insurance question. But one of the things I’ve always been curious about. So for those that you’re treating, for diabetes, but also is a positive side effect or losing weight once it’s through the medication, they no longer are diabetic.

Does insurance at that point stop paying for the drug? And do they have to go to maybe a cash pay situation if they want to stay on it for weight loss?

Ian Neeland, MD
In vast majority cases, insurance will continue to pay for the drug because they have the diagnosis of diabetes. I have seen case situations in cases where people have switched insurances, or the insurance plan has somehow changed, and they have to, you know, re justify why they’re on the medication because their agency, their blood sugar will go down on these medications.

They’re very powerful. It’s actually the goal right is where we’d love to get to is people to normalize their blood sugar control and maintain these medications because of long lasting benefits for their heart, kidneys and such.

Macie Jepson
We promised in the beginning we would unpack a lot. Is there anything we didn’t unpack that you feel like we need to touch on?

Ian Neeland, MD
So I’ll just mention one other thing to consider because as I mentioned, you know, people have these cardiovascular, kidney metabolic issues. Many have multiple problems. And unfortunately, the way we do medical care nowadays is very siloed. People go to you go to a primary care physician, you go to an endocrinologist, they go to a cardiologist. You might go to, you know, someone who deals with kidneys, a nephrologist.

And so they see so many different doctors. What we’re trying to do, and we’re trying to do here at UH is to be much more holistic, comprehensive and multidisciplinary. And so we have a program that’s been around for about five years called CINEMA, the Center for Integrated Novel and Vascular Metabolic Disease, where we take it approach that that comprehensive approach, patients with multiple problems come see one team.

We try to address all of those issues. GLP-1’s are a big part of what we do. We have many referrals for these medications, specifically for weight loss and for other reasons. And we also partner with pharmacy. We have an excellent pharmacist who’s able to achieve access for their medications to education, dose escalation and work with the patients month by month, week by week so that they can get the maximum tolerated effect that these medications without the major side effects, we can really help them make a difference.

Macie Jepson
Fascinating topic and an incredible conversation. Thank you.

Matt Eaves
Doctor Neeland, University Hospitals in Cleveland, thank you for joining us today.

Ian Neeland, MD
Thank you for having me.