Amanda Wilde (Host): Managing our weight is a national pastime and a medical problem for a growing number of us. New medications for weight loss have been in the news lately, so it's a perfect time to take an in-depth look at obesity medication with an expert. My guest is Dr. Verlyn Warrington, Director of the Guthrie Bariatrics Medicine Program.

This is Medical Minds: Conversations with Guthrie Experts. I'm Amanda Wilde. Thank you so much for being here, Dr. Warrington.

Dr. Verlyn Warrington: My pleasure.

Host: It seems like traditionally weight loss always comes down to dieting and exercise and possibly surgery. So, where do these obesity medications fit in? When is it right to use them?

Dr. Verlyn Warrington: So, any obesity medication is really prescribed as an adjunct to diet and exercise. So, those two things are the staples of weight loss. There are different indications. So if a person has obesity defined as a BMI of 30 or above, they can have obesity medications prescribed. Or if they have a BMI of 27, with any obesity-related comorbidity, that also would be an indication for prescribing medications. There are also some patients who have had surgery and may be long term are regaining a little bit of weight. That would also be an indication to start medications. So, think of obesity as a really long-term chronic disease, where you may need more intensive treatment at some phases of the disease or there may be some people who have more severe disease.

Host: And it can vary within one person. It can get better, it can get worse.

Dr. Verlyn Warrington: Yes.

Host: But you have said medication is an adjunct to diet and exercise, so we do have to say there is still no magic pill for weight loss.

Dr. Verlyn Warrington: No magic pill for weight loss.

Host: You still have to work at it. Now, with these medications, what are their benefits, and when you take them adjunct to diet and exercise?

Dr. Verlyn Warrington: So, let me say that obesity is a disease that we used to say was comorbidity of other diseases. Now, we're saying it's the root cause of 250 plus other diseases, including things like cancer. So really, maintaining a healthy weight can help modify those 254 other diseases, including things like cancer, cardiovascular disease, renal disease. So in terms of improving one's health, there's not a disease that I'm aware of that if you treated that one single disease, you can affect 250 plus other diseases.

Host: So, what does the medication do along with diet and exercise?

Dr. Verlyn Warrington: So really, what we're hoping for is a reduction in the amount of body fat. And the medications that we have available to us may act a little bit differently. So, we have much older medications, such as phentermine or Tenuate, that are the more stimulant type medications. We have some of the combination medications, such as Qsymia, which is Topamax, a little bit of phentermine. We have another combination medication, Contrave, and then we have the new GLP's, which has the media talking about.

Host: So, there are all kinds of medications, obviously not one-size-fits-all. So, do you use these then to cater to individual health needs?

Dr. Verlyn Warrington: Yes. So, I would look at a patient and, one, how much weight do they need to lose? Two, what other conditions are present related to the obesity? So, for example, a patient who had obesity and diabetes might be best treated with one of the newer GLP medications. Whereas if we had a 20-year-old who just had excess body weight but really hadn't developed the diabetes or the hypertension, one of the cheaper, older medications may be appropriate. So. You're really going to look at that patient and individualize the medications that you would recommend.

Host: And then, how big a role in this chronic disease does lifestyle change complement interventions?

Dr. Verlyn Warrington: The lifestyle changes are, I think, the cornerstone of any successful reduction in body fat. And I kind of shudder to use the word diet, because people think of restrictions and deprivation. When I use the word diet, I think of making healthy choices, well-rounded choices, including multiple food groups and multiple colors. So, eating in more healthful style and increasing activity.

Host: I read just the other day that our bodies are sort of geared to regain weight after we've lost weight. In your experience, what are the key factors that contribute to a patient's long-term success with medically supported weight loss programs?

Dr. Verlyn Warrington: Well, continuing to eat in a healthy manner. There is a National Weight Loss Registry. And when they look at the people who have been successful, they do a few things. They eat breakfast regularly, they don't watch a ton of TV, they exercise regularly, and they monitor their weight, so they weigh themselves very regularly. And those things, I think, between eating well, moving a lot, and monitoring what's going on, those are the key factors that keep people maintaining previously lost weight.

Host: And any idea what that adds to quality of life? That must be almost immeasurable.

Dr. Verlyn Warrington: Yes. We call those the non-scale victories. And I have seen patients come in and talk to me about anything from being able to wear wedding rings, from being able to take airplane flights and actually fit in seats, from participating in their lives with grandchildren and children. And so, it's a very wide variety of those really not easily measured parameters, but that affect really the quality of their lives.

Host: So, my takeaway from this, too, is that while obesity is thought of now as a long-term chronic disease that can lead to other serious diseases, it is manageable, if not curable.

Dr. Verlyn Warrington: It is manageable. I wouldn't say that we have cured much in Medicine, but we know very well how to manage these chronic conditions, just like we manage hypertension and diabetes. But it takes that commitment to every day think about what you're eating, how you're moving, and whether surgery or medication, or medications are indicated.

Host: It's really combining the old with the new. Because it's always been about diet and exercise, but now we do have the benefits of these other tools, such as these medical interventions that can help us stay healthy.

Dr. Verlyn Warrington: Yes. And diet and exercise have been shown to produce really small amounts of weight loss. And you do see improvements in things like diabetes and high cholesterol or even small amounts of weight loss. But when you start to add things like surgery or add medications, then you're starting to see much larger amongst the weight loss. So with diet and exercise and some of the older meds, we used to shoot for 5% weight loss. Some of the newer meds, we can get up to 22% weight loss.

Host: Wow. So, that's what we can think about as we look ahead.

Dr. Verlyn Warrington: Yes.

Host: Well, Dr. Warrington, thank you very much for these insights into obesity medication and how it helps with long-term weight loss and health.

Dr. Verlyn Warrington: And thank you for addressing this topic.

Host: That was Dr. Verlyn Warrington, Director of the Guthrie Bariatrics Program. For more information, visit guthrie.org/services-treatments/weightlosscenter. If you found this podcast helpful, please share it on your social media and be sure to check out the entire podcast library for other topics of interest to you. This is Medical Minds: Conversations with Guthrie experts, a podcast from the Guthrie Clinic.