WEBVTT 00:00:00.000 --> 00:00:01.000 [MUSIC FADES IN] 00:00:01.000 --> 00:00:02.000 This is "In Conversation" from Apple News. I'm Shumita Basu. Today, what to know about this new wave of weight loss drugs. 00:00:02.000 --> 00:00:03.000 [MUSIC FADES OUT] 00:00:03.000 --> 00:00:04.000 [INTRIGUING MUSIC] 00:00:04.000 --> 00:00:05.000 There is no such thing as a "miracle pill" for weight loss. But for many people who have struggled to lose weight and who've started using drugs like Ozempic, Wegovy, and Mounjaro, they're saying this comes pretty darn close. 00:00:05.000 --> 00:00:06.000 "PBS NewsHour" spoke with patients about their experiences taking these drugs. 00:00:06.000 --> 00:00:07.000 [START PBS NEWSHOUR ARCHIVAL CLIP] 00:00:07.000 --> 00:00:08.000 My name is Nancy Barnes. I live in New Iberia, Louisiana. In a year and a half, I have lost 107 pounds. And I just feel better. I mean, the whole point to me, my blood pressure's not 205 over 140. It's normal, and I can walk my dog. 00:00:08.000 --> 00:00:09.000 Hey, I'm Siah. I'm a nurse practitioner. I use she/her pronouns, and I'm based out of California. Like, a side effect has been losing weight, but that's not what, necessarily, my aim was. My aim was really to stop, like, kind of the thought patterns, and the binge-eating-like cycles that I was going through, and the Wegovy acts as kind of like a shutoff switch, I guess is the best way to describe it. 00:00:09.000 --> 00:00:10.000 [END PBS NEWSHOUR ARCHIVAL CLIP] 00:00:10.000 --> 00:00:11.000 Some medical professionals are saying these drugs could be breakthrough treatment for people who struggle with being chronically overweight. But as it gets more popularized in the media and by celebrity culture, the lines are getting increasingly blurry between who needs these drugs for legitimate reasons and who might be misusing these drugs for aesthetic reasons. And for some advocates who've fought for body positivity for decades, it all feels like a big step backward. 00:00:11.000 --> 00:00:12.000 I wanted to speak to someone who's thinking about all of this in a careful way, someone who recognizes that in our society, the stigma against fatness is real, and so are the physical and mental-health benefits that many people are seeing when taking these weight loss drugs. 00:00:12.000 --> 00:00:13.000 So, I reached out to Julia Belluz. She's a health reporter who's written extensively about nutrition, metabolism and obesity. She started by explaining how these drugs demonstrate something that scientists have known for years but that the public, and even some doctors, seem to constantly reject, and that is the fact that weight loss is not about willpower. 00:00:13.000 --> 00:00:14.000 [MUSIC FADES OUT] 00:00:14.000 --> 00:00:15.000 So, I think what's really interesting is that unlike other behaviors, we have this idea that what we eat is fully, you know, the product of willpower, of our conscious control. We're deciding every calorie that goes into us or doesn't. And when you actually take a closer look, you realize that our eating behaviors, our body weight, they're very much subject to biological systems that are nudging us in different directions every day. And I think for some people, this experience of hunger and of craving is just much more intense than it is for other people, and these drugs are sort of highlighting that. Like, you hear stories when people start taking them that suddenly, after decades of trying to lose weight through diet and exercise, they just have this loss of appetite and they're not ruminating as much about food. They don't feel as hungry. And it's not because of anything conscious or any behavior change that they were trying to will their way through. It's because these drugs are tweaking with their physiology in a way that obesity medications never have in the past. 00:00:15.000 --> 00:00:16.000 And before we jump too far into it, I just wanna ask you, Julia, do you have any financial stake, any financial connection to this issue? Any ties to any of the drug companies that you're reporting on? 00:00:16.000 --> 00:00:17.000 Zero. No, no financial stake or connection. 00:00:17.000 --> 00:00:18.000 Now, I wanna talk so much more about these drugs with you in just a few minutes. I wanna start by really talking about obesity itself. What do we know about what causes obesity? 00:00:18.000 --> 00:00:19.000 So, it's sort of a deceptively complicated question. So, there are many different kinds of obesity. There are people with kind of rare genetic disorders that cause their obesity. People can experience obesity after a head injury. There are quite a larger range of causes, I think, than people appreciate. Most people are falling under this, what's called "common obesity," category, and that's gene environment interactions. So, people have many, many different genes that have been associated with obesity that put them at a higher risk of weight gain. And I think what nobody disputes is, you know, our genes didn't change in the last half century when obesity rates began to rise in developed countries. What changed is the food environment. It was in the early 1980s when more and more people started to classify as obese. And the idea is that what changed there is this glut of calories that entered the food supply that were cheap, convenient, and really not so nutritious. 00:00:19.000 --> 00:00:20.000 [PENSIVE MUSIC] 00:00:20.000 --> 00:00:21.000 Medical professionals haven't always been very good at recognizing this connection, or treating people who are overweight or obese with respect. Many people say they feel stigmatized and judged by their doctors because of their weight. 00:00:21.000 --> 00:00:22.000 I think the stigma is real and horrendous. So, there's lots of evidence that people with obesity, people who are overweight, have been under-treated for serious conditions because the health professionals can't look past their weight and kind of ignore other symptoms and pain that they're experiencing. 00:00:22.000 --> 00:00:23.000 Now, back in 2013, the American Medical Association classified obesity as a chronic disease. But it's controversial. There are lots of people who are technically obese and, by all measures, healthy. For people who do develop health complications, from Type 2 diabetes to asthma to high blood pressure, it can be hard to know if body weight itself caused the illnesses. 00:00:23.000 --> 00:00:24.000 So, we have many, many, many studies showing that when people start to lose weight, they minimize their risks of obesity-related complications. So, their blood sugars improve, their triglycerides improve, their arthritis might improve, sleep apnea. They see this improvement on a range of health metrics. But the people on the body positivity, health-at-every-size side, and some researchers are also looking into this, say a lot of the trials we have, people are losing weight through more exercise, through improvements in their diet. How do we know that it's the weight loss itself and not just these lifestyle changes that's leading to the benefits? 00:00:24.000 --> 00:00:25.000 The skepticism toward the medical community's focus on weight loss is understandable. You might remember the last time a so-called "miracle drug" made waves fen-phen in the 90s. It was pulled off the market after it was found to cause heart valve damage. 00:00:25.000 --> 00:00:26.000 There's also bariatric surgery, which is considered effective in treating obesity, but, you know, it's surgery. It's invasive. That's why these new drugs are being called a real game-changer. 00:00:26.000 --> 00:00:27.000 [MUSIC FADES OUT] 00:00:27.000 --> 00:00:28.000 The quest in obesity was always to have a medicine that was sort of doing for people what bariatric surgery did. These medicines are the first that are coming close to that. So, most of these drugs, they're called GLP-1s or GLP-1-based, and that name comes from glucagon-like peptide 1, which is a hormone we have in our bodies that we secrete in our gut when we eat, and it sends a signal to the brain that we're eating, and that we've had enough to eat, and that we're satiated. And so, what these drugs are doing is they contain a synthetic version of GLP-1, this native hormone inside of us, and they're basically boosting this fullness signal. So, they're telling the brain, you've had enough to eat, stop eating, you're full. 00:00:28.000 --> 00:00:29.000 And from what I understand, these drugs were initially not being prescribed for people with obesity, but they were being prescribed for diabetes. Correct? 00:00:29.000 --> 00:00:30.000 Yeah. So that's really important. So yeah, you mentioned Ozempic, for example, that's still for people with diabetes. Wegovy has the same molecule semaglutide, a GLP-1, that was specifically developed for people with obesity. What's really fascinating is that these weren't developed initially as weight loss drugs. They were developed for people with diabetes because the other thing the drugs do is they lower blood sugar, and they stimulate the release of insulin. And so, these were a diabetes treatment that in the clinical trials, they noticed people losing lots of weight, and so they started to study that. And then they developed specific drugs to treat obesity as a long-term chronic condition, not as, you know, you just wanna lose 10 or 20 pounds. 00:00:30.000 --> 00:00:31.000 Yeah. I mean, I know that you spoke to quite a few people who have been taking these drugs for some of your recent reporting, and you heard a bunch of different things. Everything from this is a miracle drug to I feel kind of conflicted about this. What have people been telling you about their experiences? 00:00:31.000 --> 00:00:32.000 Yeah, so as you flagged, there's a massive range. I think what's so important to keep in mind is that there's this data that we're talking about from the clinical trials and the science, and then there's what's happening in the real world and people's lived experiences of the drugs. And what I'm hearing is that they're very different. 00:00:32.000 --> 00:00:33.000 Mm. In what ways? 00:00:33.000 --> 00:00:34.000 So, you have a minority of people who don't respond to the drugs at all, and I think, for them, it's very frustrating because they're reading about what a breakthrough this is, and not everyone responds. That's, I think, a small minority. And then, on the other side of the spectrum, you have people who are just like, this is just an absolute game changer. It worked for me. It's still working. I'm losing tons of weight and having no problem. Like, I heard one story of a woman who went on the drug for diabetes, and she was losing so much weight she had to actually be taken off the drug. And then a lot of the patients that I've talked to have had to… like, even at the highest doses of one of the GLP-1-based drugs, they start to plateau. They're nowhere near how much weight they wanted to lose. And so, they're moving on to another drug and seeing how that works. Maybe not responding to the second drug. Going on to a third drug. So, putting aside these non-responders who just don't lose any weight at all, most people are saying that they're really having this changed experience with food, and it's quite profound. So, whereas before food used to occupy a lot of the space in their mind, they were worried about what they were gonna eat next, what they had eaten last. They were quite stressed around food. They were ruminating a lot. Suddenly this quiets down as soon as they start taking these drugs, and even patients who say they haven't lost anywhere near their target weight are saying just the benefit of that food stress being eased is so great they want to stay on the drugs. So, it's really fascinating. 00:00:34.000 --> 00:00:35.000 Yeah. It sounds like there's not just a physical effect for a lot of people, but really a mental effect, a mental health difference and shift that they report experiencing. 00:00:35.000 --> 00:00:36.000 That's right. Yeah. And if you've ever struggled with weight, and I have, it can be a massive stress and hugely consuming. And so, to have, I think, this sort of relief is a reason that some people are willing to stay on the drugs, even though it's costly, even though they might have side effects. 00:00:36.000 --> 00:00:37.000 Well, so, let's talk about some of the known side effects and what are some of the, I guess, concerns about long-term use? 00:00:37.000 --> 00:00:38.000 The most common side effects seem to be things like nausea, vomiting. These gastrointestinal discomforts, I guess. And usually, if people are under the care of a medical professional, the dose can be adjusted, and you can gradually increase your dose to minimize the side effects. But even so, some people have a terrible experience of even these more common side effects and want to get off the drug as a result. But I would say most people I've talked to and what the clinical trial data shows is that it's not a reason for most people to stop taking them. I think what we don't know is some of the GLP-1-based drugs are these newer combinations, and we don't really know what the very long-term outlook is like. There's very reassuring data on… there's not only no cardiovascular risk, but there seems to be a cardiovascular benefit from the drugs. And that was always a concern that popped up in previous so-called diet drugs, like fen-phen. So that seems to be less of a concern. But like anything, yeah, the basic idea is that these drugs only work as long as people are on them, and what it means to be on Mounjaro or Ozempic or Wegovy for 50 years like, I think, this remains to be seen. The data right now looks very good, but I think there's surely still a lot to learn about what the long-term effects will be. 00:00:38.000 --> 00:00:39.000 What do we know about what happens when people stop using this drug? What does it do for their weight? 00:00:39.000 --> 00:00:40.000 So basically, they start to regain in general. So, I think this is also where there's like a divisive reaction to that issue. So, many of the clinicians will say: Hey, with just about every other treatment, every other medical treatment for a disease, if you stop taking it, of course you're gonna rebound. Like if you have diabetes and you stop taking your insulin or GLP-1, of course you're gonna see your blood sugars rise. If you have cancer and you stop your chemotherapy, of course you're gonna see the cancer come back, or whatever it is. And so, why with obesity do people expect that they should just be able to take this injection for a short amount of time and have lasting benefits? On the other side, the critics of these drugs say: Hey, this is evidence that they don't work. You should be able to just take them, lose the weight, and not regain it. 00:00:40.000 --> 00:00:41.000 Yeah. I'm sure that for a lot of people who are hearing about these drugs for the first time, they're probably curious to know whether they are a good candidate for this type of drug. How should people be thinking about it? 00:00:41.000 --> 00:00:42.000 So, first of all, right now they're only indicated for people with obesity and other obesity-related complications. So, I think even for Wegovy, which is the obesity formulation of a GLP-1 that was approved in the U.S., you have to not only have obesity, but also pre-diabetes or some other obesity-related risk. So again, this is not for people who just wanna lose like a little bit of weight before their holiday or whatever or have like 10 or 20 pounds to lose. They're really supposed to be long-term treatments for the chronic disease of obesity. So, not like a short-term fix for weight loss. There was a great story in "The New York Times" that was about a woman who just couldn't lose like the last, I think it was like, 20 pounds after her last kid. And I think these types of cases are really not what these drugs are meant for. 00:00:42.000 --> 00:00:43.000 [UPLIFTING MUSIC] 00:00:43.000 --> 00:00:44.000 This idea is exactly what many medical professionals are worried about, that people might misuse this drug. 00:00:44.000 --> 00:00:45.000 The other thing I saw a lot in my reporting is that for a lot of people's journeys on these drugs, their entire journey with GLP-1-based medication is mediated by the internet. So, they get the drug through an online prescriber, they turn to like, Reddit or TikTok and other forums like this for support, and then they don't even see a health professional. So, just to be clear, I'm not recommending this at all. It's not how the drugs were meant to be used. They're supposed to be medically supervised. 00:00:45.000 --> 00:00:46.000 Celebrities and influencers are also big drivers in this conversation. Thinness gets glorified, amplified. And many celebrities who've lost a lot of weight recently have been asked about these drugs. Some say they've used them, and they work. 00:00:46.000 --> 00:00:47.000 Yeah, I think this is where some of the misunderstandings of what the drugs are come from. I think the celebrity culture maybe creates this perception that you just take these injections, and everything is fine, and maybe you even take them if you, again, only have like a little bit of weight to lose. 00:00:47.000 --> 00:00:48.000 I will also say, somewhat connected to this, I've seen a lot of recent coverage in the media of a potential shortage of these types of medications, and some of the coverage has placed blame for that shortage on people who are taking these drugs for weight loss. Can you explain what you see happening here? 00:00:48.000 --> 00:00:49.000 So, I think that this is real. So again, doctors prescribe drugs off-label all the time. This happens every day. Like if you've ever used birth control for acne, or whatever it is, that's off-label prescribing. And what's happening now, and it is very real, is that there are people who need these drugs for Type 2 diabetes who can't access them because of both supply chain issues on the side of the manufacturers and this explosion of demand. But it's also getting at this really interesting thread in the conversation of, what do we as a society consider to be a real disease? Kind of pitting obesity against diabetes doesn't seem very productive, but it's sort of what's happening. Like, we are in this moment, for sure, of questioning obesity as a disease, and a lot of people not seeing it as such. The shortages have kind of brought that to a head. 00:00:49.000 --> 00:00:50.000 [INTRIGUING MUSIC] 00:00:50.000 --> 00:00:51.000 To further complicate things, Julia says, talk to regular patients who are taking these drugs, and many will tell you, it comes with a bunch of mixed feelings, especially when it comes to mental health. How should people think about the potential medical benefits versus the societal pressure to lose weight? Or the judgment for taking a drug to help them do it? 00:00:51.000 --> 00:00:52.000 What I'm hearing from are patients who are sort of trying to navigate both of these conversations and quite confused. They're confused about how much weight they really need to lose to see health benefits. They don't wanna, in any way, hinder the movement to decrease weight bias. So, they almost feel guilty by going on these drugs, and then they're trying to navigate, yeah, their own feelings about… like one of the patients I profiled in the "Vox" story, she really felt like she had finally come all this way to accept her body size, but at the same time, she was learning about these obesity-associated complications that could really benefit from weight loss, and really struggled for a while. I think she delayed going on treatment for a year, trying to just make improvements to her health through more movement and eating healthier. But by the end of the experiment, she still hadn't improved the parameters she needed to, and ultimately ended up taking one of the GLP-1-based drugs and seeing quite a lot of benefit. 00:00:52.000 --> 00:00:53.000 And this brings us back to the question that's really at the core of this conversation: Should obesity be treated as a disease in the first place? 00:00:53.000 --> 00:00:54.000 [MUSIC FADES OUT] 00:00:54.000 --> 00:00:55.000 I do see it as a disease. It's a condition that affects like, every organ system of the body. The more excess fat you accumulate, the more complications you're likely to have and the more health problems you're likely to have. But it is important to note there is real debate, even within the medical community, about when is excess fat problematic? How can we have a better sense of like, individual risk? And so, I think it is something to think about and debate. But I do fall on the side of thinking about obesity as a disease, in particular after talking to hundreds of patients with obesity, and researchers who work on it, and clinicians who are working on it as well. Like, the stigma is real, but it's about more than the stigma. 00:00:55.000 --> 00:00:56.000 Mmm. Mmm. I mean, what I'm hearing you say is, it sounds like there is a need to strive for both things at the same time. Both treating people with obesity and changing society's deeply held notions about what causes obesity, specifically the relationship to willpower. Do you see these two things as being possible at the same time? 00:00:56.000 --> 00:00:57.000 Oh, for sure. I think they're not mutually exclusive. The way I see it is that there's a massive gap between how scientists see obesity and how the public does. And I think these drugs may over time like, and I don't think this is happening overnight, but over time, they might help people, again, understand things like, there are these biological systems that do nudge us in certain directions and towards certain foods or not. And this isn't just the product of free will, like many, many people have imagined, or like the diet culture has sort of suggested. And I think over time, as that gap is bridged between the science and the public, I think it's possible that people start to understand this a little bit more. I don't think in the long term these drugs are gonna worsen weight bias. I think, if anything, we're having more sophisticated conversations now as a result of these drugs. 00:00:57.000 --> 00:00:58.000 [MUSIC FADES IN] 00:00:58.000 --> 00:00:59.000 You can read Julia Belluz's article for "Vox" called "Obesity in the age of Ozempic" on Apple News. We'll include a link for you on our show notes page. 00:00:59.000 --> 00:01:00.000 [MUSIC FADES OUT]