Maggie McKay (Host): There is so much news now about weight loss medications, but is it right for you? And what about surgery as an option? Today, we'll find out more with Dr. Erik DeAngelis and Dr. Eleisha Flanagan. Both are General and Bariatric surgeons at UM Charles Regional Medical Center. Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System.

I'm your host, Maggie McKay. Thank you both so much for being here today.

Eleisha Flanagan, MD: Thank you for having us.

Erik DeAngelis, MD: Yes. Thanks for having us.

Host: Absolutely. Dr. DeAngelis, let's start with you. Over 40% of American adults are obese, according to the CDC, and this condition increases the risk of Type 2 diabetes, high blood pressure, heart disease, stroke, and certain cancers. A lot of people have tried dieting at home without success. When should someone reach out to a medical professional like yourselves to learn more about losing weight and keeping it off for good?

Erik DeAngelis, MD: Anybody struggling with weight loss, in particular, if they have any other medical conditions that can be related to having extra weight, such as high blood pressure, cholesterol, diabetes, they should reach out to their doctor or to a weight loss professional. More and more, obesity is recognized as a disease that can be treated and people should feel comfortable talking to their providers about options to help them with weight loss.

Host: Dr. Flanagan, two options that we hear a lot about are getting a weekly shot or taking a pill to help. How do these weight loss medications work and what are the most commonly prescribed options?

Eleisha Flanagan, MD: The most common weekly injections are Wegovy and Zepbound. They work by altering hormones produced in the GI system that control when you feel hungry versus when you feel full. There are also oral medications that are taken daily. The most common pills are called Qsymia and Contrave. These medications also alter hormones and signals to your brain that help you control appetite.

 Qsymia contains a stimulant that can increase metabolic rate, and Contrave contains medications used to treat depression and addiction, that can also help to control food cravings.

Host: Dr. DeAngelis, let's talk about the possible side effects of medical weight loss. How effective is it?

Erik DeAngelis, MD: Each medication has its own potential side effects that can be unique to that medication. So it is important to have a discussion with your provider before starting any medication. But in general, most medications will have GI side effects like nausea, vomiting, abdominal pain, and bloating. In terms of effectiveness, everybody responds differently to medications, but in general, people will lose about five to 10% of their total body weight taking pills.

They can lose 15 to 20% on Wegovy and 20 to 25% on Zepbound. People who are the most successful will also work with their providers to develop a diet and exercise plan in addition to medication to have the best effects.

Host: Are Wegovy and Zepbound the same thing?

Erik DeAngelis, MD: They are similar medications, and work on similar signaling pathways, but they are not the same medication.

Host: Dr. Flanagan, how does weight loss surgery work? What are the risks and the benefits and the success rates?

Eleisha Flanagan, MD: There are a few different surgical weight loss options, but the two most common are the sleeve gastrectomy and the gastric bypass. Both work by making the stomach smaller so you feel full faster. And the bypass also causes you to absorb fewer calories. Both surgeries can also alter GI hormones, like the medication, that can affect your hunger and help to treat other medical conditions such as high cholesterol or diabetes.

 Surgery has been studied for several decades and the gold standard for weight loss. It has also been shown to help people live longer, resolve weight related medical conditions, as well as decrease the risk of some cancers. Weight loss amounts can vary, but in general, people can lose about 30 to 35% of their body weight. So surgery is more powerful for weight loss than medication overall.

But everyone does respond differently and it is still important to develop a healthy lifestyle, to be successful in the long run. There can be complications related to surgery and anesthesia, so surgery is more invasive than medication.

Host: And Dr. DeAngelis, who would be an ideal candidate for medical weight loss and who might need surgery instead?

Erik DeAngelis, MD: It can be a complex discussion to determine if surgery or medication might be a better option for a person. It can depend upon their medical history, how much they weigh, what other medication they're on, and what surgery they have already had in the past. So again, it is best to discuss your options with a weight loss professional.

In general, people at a lower body mass index, which is the BMI may be able to be helped with medication. While people with a higher BMI may need surgery, but some patients may even benefit from both. There's also insurance requirements that determine which treatments a person may qualify for.

Host: I understand some of these weight loss medications are very expensive, so, what does it take to get insurance to cover it? You have to have a medical condition that warrants it?

Erik DeAngelis, MD: Each patient and their individual insurance will vary. Any weight loss office will have some expertise in navigating the insurance landscape and will help to get the patients the medication covered, if it's possible under their plan. That's usually the most cost effective manner in which to get medication is if it can be covered by insurance. If that's not an option, then there's oftentimes ways to get the medication directly from the drug manufacturer at a reduced cost. Or there's certain mail pharmacies that will deliver the oral medications to patients for a reduced cost as well, to try and minimize people's out-of-pocket expense.

Ultimately, the medications aren't going to help patients if the patients can't get them. And so again, speaking to your weight loss professional, they will be able to help navigate the insurance landscape because you're absolutely right; it can be prohibitively expensive to pay out of pocket, but there are options available out there.

Host: That's good to know there are choices. Dr. Flanagan, you touched on it a little bit, but what lifestyle changes are necessary for both medical and surgical weight loss to be effective?

Eleisha Flanagan, MD: Whether a person is treated with medicine or surgery, a healthy lifestyle is important to help with weight loss and to maintain that weight loss over time. People need to keep track of what they're eating and make healthy food choices. Avoiding sugary drinks as well as fast food and processed foods are the simplest way to start.

 Exercise is also important. At least 150 minutes of cardio per week and two days of strength training are the general guidelines. But again, it is important to discuss with your provider to determine a lifestyle plan that will be sustainable in the long run for you as an individual.

Host: Dr. DeAngelis, are there certain medical conditions that make one approach better than the other for individuals?

Erik DeAngelis, MD: The short answer is yes. There can be certain medical conditions that make surgery or medications for weight loss a better option for a person. Ultimately, the best way to determine the right option is to discuss with a weight loss provider. But just like any other medications, there are certain things in a patient's medical history that may make a medication not an option. And likewise with surgery, there may be concerns along with side effects from surgery or anesthesia that may make surgery not the best option for a patient. So ultimately, you should always discuss the options with a weight loss professional.

Host: And Dr. Flanagan, what are some common misconceptions about weight loss surgery and medication? Because, you hear people everywhere today saying, let's say a celebrity lost a lot of weight fast, and they're like, oh, they must have taken Wegovy or Ozempic. What are some misconceptions?

Eleisha Flanagan, MD: Exactly. The most common misconception about medication or surgery for weight loss is that it's cheating or taking the easy way out. That's why they look at celebrities like they do. But losing weight is much more complicated than the old wisdom of eat less and move more. Our bodies are adapted to gain weight and to regain weight after we've lost it.

 Humans didn't always have a grocery store at every corner, so our bodies are made to survive famine. Losing weight is a long-term journey that requires diet and exercise every day. But oftentimes people need extra help with medications or surgery. Also, remember, obesity is a disease just like high blood pressure or diabetes. Those things that can be helped by diet and exercise too. But people still need treatment or medication or surgery to help improve their health, and no one should feel bad about trying to be healthier.

Host: Exactly. Dr. DeAngelis, what advice would you give to someone struggling with weight loss who isn't sure which option to pursue?

Erik DeAngelis, MD: I would tell them to reach out and ask for help. Ask their doctor for help or ask for a referral to a medical weight loss professional. There are many options out there, some of which we've discussed today, and there are people who have the knowledge and the desire to help you on your journey to losing weight and to becoming healthier.

Host: Thank you both for joining us and sharing your expertise on this important topic that affects so many people. Again, that's Dr. Erik DeAngelis and Dr. Eleisha Flanagan. Find more shows just like this one, at umms.org/podcast and on YouTube. Thank you for listening to Live Greater, a Health and Wellness podcast, brought to you by the University of Maryland Medical System.

We look forward to you joining us again, and please share this on your social media.