Rania Habib, MD (Host): The CDC estimates that nearly three out of four Americans are overweight or obese, and up to 49% of adults in the U.S. will try to lose weight in any given 12-month period. Millions of people are in search of the perfect weight loss regimen. And the weight loss drug that has caught the attention of Americans right now is Ozempic.

Welcome to The Healing Podcast, brought to you by Marin Health. I'm your host, Dr. Rania Habib. Joining me today is Dr. Sharleen Sidhu, an endocrinologist at Marin Endocrine and Diabetes Care, who also serves as the Medical Director of Marin Health. Braden Diabetes Center. She is here to delve into the world of Ozempic for weight loss.

Welcome, Dr. Sidhu. Thank you so much for joining me today.

Sharleen Sidhu, MD: Hi, Dr. Habib. It's my pleasure to be here and excited to talk about Ozempic.

Host: To begin, we would love for you to share a brief background on yourself, discuss your unique training, and how did you get interested in weight loss medicine?

Sharleen Sidhu, MD: Sure. So, I'm a board-certified endocrinologist. I did my internal medicine residency followed by a fellowship in endocrinology. I'm extremely passionate about food and nutrition. I follow that personally in my daily lifestyle. weight loss drugs like Ozempic, have had a lot of noise recently. So, this is one topic which is very close to my heart because I have done a lot of research, myself studying on these medications. And I practice that as part of my daily clinical practice when I see patients. So, I'm excited to delve into more details about it.

Host: So are we. We're so happy to have your expertise on this podcast. So, let's jump right into this hot topic. What is Ozempic, and why have we been hearing so much about it lately?

Sharleen Sidhu, MD: So, Ozempic is a glucagon-like peptide 1 receptor agonist, which is FDA approved for treatment of type 2 diabetes. So, the mechanism of action is basically it increases glucose-dependent insulin secretion. It decreases inappropriate glucagon secretion and slows gastric emptying. And in addition to all those mechanisms of action, it also acts in the areas of the brain involved in regulation of appetite and caloric intake. So with these multiple mechanisms of action, it causes reduction in hemoglobin A1c with the additional benefit of weight loss.

So, we've been hearing a lot about this because it has been used off-label as a weight loss drugs for non diabetics. And a lot of celebrities, tech moguls, influencers have described taking this medication to lose weight in short time frames. So, that's the reason it has gotten a lot of noise.

Host: So, how does Ozempic differ from other weight loss drugs on the market?

Sharleen Sidhu, MD: So, Ozempic is a once a week injectable. And due to the multiple mechanism of actions, as I explained just earlier, it has a robust advantage of added weight loss benefit. So, it's important to understand that we have similar to even better medications for obesity weight loss management currently. And out of them, one of them is Wegovy, which is also a once-a-week injectable, has the same mechanism of action just like Ozempic and is FDA approved for weight loss for patients who have a BMI greater than or equal to 30 or even in patients with BMI greater than equal to 27 who have at least one or more weight loss-associated comorbidities like hypertension, high cholesterol, et cetera.

It's important for people to understand that these medications are recommended as an adjunct to diet and exercise. And Ozempic, for example, the maximum dose which we can use is around 2 milligrams once a week. However, the FDA approved weight loss drug like Wegovy, we can actually go up to 2.4 milligrams once a week. So, that's the difference right there. And then recently, FDA approved another great weight loss medication by the name of Zepbound, which has a more robust mechanism of action due to the additional glucose-dependent insulinotropic polypeptide receptor action in addition to the GLP-1 receptor agonist effect. And this dual action makes this drug way more powerful, so to speak, for weight loss. And the maximum dose we can use with Zepbound is 15 mg once a week. I have seen great results in the published data, which I'm excited to try, once it's available in the market.

Host: Now, one of the statistics that I shared was that up to 49% of adults will seek some sort of weight loss treatment. And as you mentioned, Dr. Sidhu, there are several celebrities and high profile people that are really advocating for Ozempic. So in your practice, are you seeing an uptick in patients asking for Ozempic and other weight loss drugs?

Sharleen Sidhu, MD: Yes, there has been a huge increase and demand for weight loss drugs, especially this year in particular. And I think it's primarily because, as you mentioned, there's increased awareness regarding the various weight loss drug options available, plus also the access which the patients now have.

Host: Who would be a good candidate to take Ozempic specifically for weight loss?

Sharleen Sidhu, MD: Ozempic should be prescribed and is a great option for type 2 diabetics who are overweight or obese to help with hemoglobin A1c reduction and especially in patients who have established cardiovascular disease due to the added benefit of risk reduction of major cardiovascular events like non-fatal myocardial infarction, non-fatal stroke.

Host: Now, we know that no drug is without risk. So, what specifically are the risks of taking Ozempic?

Sharleen Sidhu, MD: First of all, it needs to be understood it's contraindicated in setting of personal or family history of medullary thyroid cancer or patients who have multiple endocrine neoplasia type 2. It can cause some side effects. Primarily, the most common one are gastrointestinal, nausea being very common. Others could be vomiting, bloating, diarrhea, constipation.

FDA also recently issued a warning for intestinal blockage or ileus, as there were some case reports which have been reported. I personally have not seen it in my practice, but there are case reports reported. The other thing to keep in mind is acute pancreatitis, which is also listed a possible side effect. Again, something I have never seen so far, but it's listed as some case reports. Other side effects potentially could be headaches, palpitations, hypersensitivity reaction, just to name a few.

Host: Dr. Sidhu, how can someone maximize weight loss while on Ozempic?

Sharleen Sidhu, MD: So, lifestyle changes are imperative when we want to maximize weight loss while on drugs like Ozempic. I always emphasize to patients that it's important to have a balanced, healthy diet and incorporate exercise as part of their daily well-being. Patients seen at our practice are often referred to our Braden Diabetes Center where they work closely with our diabetes educators, dietitians, and get first hand one-to-one coaching regarding diet. I always emphasize it is essential to do some form of physical activity for at least 150 minutes per week, if not more.

Host: That's fantastic. I love that you're really advocating that overall well-being for the patient and not just focusing on the medication. How long should patients take Ozempic?

Sharleen Sidhu, MD: So as far as treatment duration goes for Ozempic, I always recommend and I follow a personalized approach. Factors like baseline hemoglobin A1c, healthy target weight loss goal, and other underlying comorbidities are some of the factors which have to be kept in mind as part of the treatment plan.

When lifestyle changes are used in conjunction with drugs like Ozempic, we can maximize the effect of weight loss even more. And the dose of drugs can be reduced. It could be kept as maintenance or, in some cases, even stopped. And I have been able to do that in some subset of my patients.

Host: That's fantastic. Now, I'm sure patients are wondering, if you stop the drug, are they usually able to maintain that weight loss?

Sharleen Sidhu, MD: again, it depends. If you are incorporating lifestyle changes, then a percentage of patients are able to keep the weight off. But if the lifestyle changes are not used in conjunction with these weight loss drugs, a lot of patients unfortunately end up gaining the weight back when these medications are stopped.

Host: Dr. Sidhu, how important is it for patients to take Ozempic as directed, and what might go wrong for someone who is taking the wrong dose?

Sharleen Sidhu, MD: So, it's important for patients to see a licensed provider when being started on drugs like Ozempic, so that they're started on the right dose and the dose is increased appropriately if needed. If Ozempic is given at a higher dose from the beginning and not incrementally increased as recommended, then they can give rise to more severe side effects, particularly gastrointestinal side effects.

Host: Now, we've heard a lot of buzz on social media and in the entertainment world about people using Ozempic when they don't have type 2 diabetes. So, what should people know about using off-brand weight loss drugs?

Sharleen Sidhu, MD: So, I personally recommend using only FDA-approved weight loss drugs, which we now have multiple options to choose from. And I highly encourage patients to see a licensed provider who has experience in prescribing and using these medications appropriately. We should be limiting, in my personal opinion, diabetic drugs like Ozempic for off-label use so that It does not take away the supply of these medications for our diabetic patients who greatly need these medications on a daily basis to maintain their blood sugars. There has been a national shortage actually for drugs like Ozempic because of off-label use as the pharmaceutical companies cannot keep up the supply due to the demand of these drugs primarily because they have been prescribed off-label.

Host: Wow. So, what can physicians do to ensure that diabetics who truly need this drug as part of their treatment regimen to get the drugs?

Sharleen Sidhu, MD: If we, as providers only prescribe Ozempic for our type 2 diabetic population, then that way we are able to sort of keep up with the supply and demand the pharmaceutical companies are facing. The shortage is primarily because of off-label use. And as far as weight loss drugs go in general for non-diabetic patients, we have great options like Wegovy, Saxenda, and the newer Zepbound, which now we can choose from. And I highly encourage providers to prescribe those set of medications, which actually work great, can be used at a higher dose. And we are seeing the same amount of weight loss results or even better than drugs like Ozempic.

Host: That is fantastic. Now, Dr. Sidhu, you have shared a ton of information about weight loss and ozempic. Is there anything else you'd like to share, specifically about Ozempic or these other weight loss drugs for our listeners?

Sharleen Sidhu, MD: Sure. So, I think I would like to emphasize that weight loss drugs like Ozempic should be started under supervision of a licensed provider and should be obtained from a reliable source, which is a medical practice. Because I have seen these drugs being available online through third party sources, which again, we don't know the safety and efficacy of that. So, that is one thing to always keep in mind. Also, although we have great options as far as weight loss drugs go currently in the market, lifestyle changes should not be undermined, and these drugs should be used as an adjunct to diet and exercise to maintain a healthy body weight.

Host: Well, thank you so much for your time and your expertise, Dr. Sidhu. This has been a fantastic delve into the world of weight loss medications and specifically, Ozempic.

Sharleen Sidhu, MD: Thank you so much. It has been my pleasure.

Host: Once again, that was Dr. Sharleen Sidhu.

Rania Habib, MD (Host): If you would like to learn more, please visit www. mymarinhealth. org. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.

I'm your host, Dr. Rania Habib, wishing you well. Thank you for listening to the healing podcast brought to you by Marin Health.