Maggie McKay (Host): Obesity is a disease that can lead to other serious health conditions. Like any medical problem, obesity can be managed medically. Today, we'll talk with Dr. Anila Chadha, Obesity Medicine Physician with Dignity Health Medical Group, Bakersfield, who will discuss Wegovy, a new weight loss injection medication.

 Welcome to Hello Healthy, a Dignity Health podcast from Dignity Health. I'm Maggie McKay. In 2019, the CDC said that new statistics in the United States show that 42 percent of Americans have obesity. So we are going to find out more about that, as I said, with Dr. Chadha. It's great to meet you and hear more about Wegovy. Thank you for being here.

Anila Chadha, MD: Thank you for having me, Maggie.

Host: Dr. Chadha, as an Obesity Medicine Physician, when should patients consider medications for weight loss?

Anila Chadha, MD: So patients with body mass index of 27 and with obesity related comorbidity like Type 2 diabetes, hypertension, heart disease, or patients with body mass index or BMI of more than 30. When these patients have failed the lifestyle changes and are not able to adequately lose excess body weight, then they should seek help with the Obesity Medicine Physician or with primary care provider for anti-obesity medications.

Host: Can you talk to us about the role that medications play in weight loss management?

Anila Chadha, MD: To answer this question, Maggie, first we have to understand what exactly is obesity. Obesity is a complex, chronic health problem. It involves a lot of neuroendocrine hormones. It is no longer calorie in, calorie out. So when we have to treat obesity, we have to tackle those hormones. Currently there are approximately five anti-obesity medications that are commonly used and FDA approved for chronic weight management. These work through the biology of our body and through the brain because as I said, brain plays a huge role in obesity.

Host: And Dr. Chadha, how do you implement new drugs and treatments for your patients?

Anila Chadha, MD: So when patients first come to our office, we take a detailed history about how they gained weight and what could be the contributing factors. After the history, we form a comprehensive plan for the patient with diet, exercise, and behavioral modifications. Then we talk about the anti-obesity medications.

So depending on whether the patient is struggling with cravings, whether the patient is struggling with fullness or is hungry all the time, or has binge eating disorder, we prescribe medications according individual to every patient. Currently the five FDA approved medications are phentermine and topiramate, then we have wellbutrin and naltrexone, then the new generation anti-obesity medications, liraglutide, semaglutide, and tirzepatide.

Host: And how long have all those been around?

Anila Chadha, MD: So phentermine has been around for approximately 40 years. It has been there. It used to come with another medication called fen-phen, the other component gave a lot of side effects with respect to heart. So it was taken off the market, but phentermine stayed.

Phentermine is mostly approved for weight management for three months. We no longer tend to use it for longer period of time, but in combination with topiramate, it can be used for chronic weight loss. This combination has been there for approximately seven years. Then wellbutrin and naltrexone have been there for around 10 years.

But, the new generation anti-obesity medications like semaglutide or Wegovy got FDA approved in June of 2021. And that has been game changer. The reason is that it gives approximately 15 percent weight loss. The previous medications were only giving 7-10 percent at the max. Now, just in November of 2023, which is 3 weeks ago, another new generation medication got FDA approved.

It's called tirzepatide, and it promises to give weight loss of 22%, which kind of rivals with metabolic or weight loss surgery, which usually tends to give 30 to 40 percent weight loss.

Host: Wow. That's very encouraging for people who need it, I would think. So, Wegovy, as we've been talking about, a weight loss injection for long term weight management. That's become really popular for patients with obesity. Dr. Chadha, can you tell us more about Wegovy and how this medication works?

Anila Chadha, MD: So Wegovy got FDA approved for chronic weight management in June of 2021. The reason it became very popular is because it is giving 15 percent weight loss to patients. The prior medications only give 7 to 10 percent weight loss. Now, 15 percent is huge. For example, in a patient who's struggling with body weight of 200 pounds, can give approximately 30 pounds weight loss.

So, that helps patients in combating many of the weight related comorbidities. So, that's why these medications gain so much attention. Secondly, these medications work through our biology. They are part of medications called GLP-1 receptor agonist. These medications, they stimulate the POMC pathway in the brain, which is an orexigenic pathway. That means patients taking Wegovy, they will have less of hunger hormones and less fat storage.

Normally, when patients try to lose weight on their own, after approximately 5 percent weight loss, body tends to go into metabolic adaptation and patients are not able to lose more weight. That happens with approximately 70 to 80 percent of the patients, 20 percent of the patients are still able to lose weight with lifestyle changes. So these medications, they help patients lose weight after combating that metabolic adaptation, which was not letting patients lose weight on their own.

Host: Well, that's interesting. So, when we hit a plateau, that's what that's all about?

Anila Chadha, MD: Exactly. So that plateau is basically metabolic adaptation of the body. That body does not want to lose more weight. We have evolved, but there is a whole genetic theory behind it. Because of the industrial revolution and the food industry revolution, our brain biology hasn't caught up to that. So when we try to lose weight, brain thinks that we are in some starvation or body is in danger.

So it starts producing more hunger hormones and more fat storage hormones. So that's why body goes into metabolic adaptation. That's where the role of these medications come in.

Host: And how does Wegovy differ from Ozempic?

Anila Chadha, MD: That's such an interesting question. Wegovy and Ozempic have the same ingredient or the drug semaglutide. Semaglutide got FDA approved for diabetes and it was called Ozempic. That happened around 2018. Now, semaglutide got FDA approved for chronic weight management in 2021 with the label of Wegovy. So they are the same medications wearing different clothes kind of a thing.

Host: Okay. Aside from weight loss, what other benefits can patients experience while they're taking Wegovy?

Anila Chadha, MD: There are multiple benefits of taking Wegovy. Most of the benefits are related to weight loss, but recently a study was shown and the results came out in second week of November of this year, 2023. It's from SELECT Trial. It was a study for 17,000 patients who had obesity and they didn't have diabetes, but they had a known cardiovascular disease like coronary artery disease.

So, half of the patients were given Wegovy and half of the patients were given a placebo. After 3 years, approximately 3 years; 39 months, the studies showed that there was 20 percent reduction in adverse cardiovascular outcomes in patients taking Wegovy. That's huge. So that was independent of weight loss. So those patients did lose weight, but the studies show that it was independent. So the benefit is not just by weight loss. The benefit is also of combating this heart disease.

Host: So are there any side effects that patients may experience while they're on this drug?

Anila Chadha, MD: There are side effects of every medication, and just like that, Wegovy also has some side effects; 40 percent of the patients may experience nausea, especially when the dose is titrated up. But that nausea should remain for one or two days. It should not persist longer than that. And it should only happen when the dose is titrated up.

And the dose should be titrated up very slowly. Some patients may have constipation. Some patients may have diarrhea. The medication is contraindicated if there is a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia. The medication also should be used cautiously if there is gallbladder disease or known gallstones as it can exacerbate that. If there is a prior history of pancreatitis, then after reviewing the individual patient, it should be used very cautiously as there were some reports of pancreatitis from these medications.

Host: So if patients are struggling with obesity, what recommendations do you have for them?

Anila Chadha, MD: If patients are struggling with obesity, they should be enrolled in a comprehensive obesity management plan, which includes lifestyle changes and individualized suggestions on lifestyle changes, like personalized diet plan, exercise counseling, behavioral changes, and medications for the patients with body mass index of 27 or with comorbidity or body mass index of 30 and more. They should seek help with their primary care physician or with Obesity Medicine Physician or an Endocrinologist.

Host: Thank you so much for your time, Dr. Chadha, and sharing your knowledge with us. I'm sure it's very helpful to a lot of people struggling with obesity. So we appreciate your time.

Anila Chadha, MD: Thank you so much.

Host: Again, that's Dr. Anila Chadha, and if you'd like to find out more, please visit dignityhealth.org/bakersfield/weightloss. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.

I'm Maggie MacKay. This is Hello Healthy, a Dignity Health podcast presented by Dignity Health. Thanks for listening.