Hi Friend!
You may or may not have heard about the recent FDA directive to compounding pharmacies to cease producing GLP-1 weight loss medications.
As a board-certified obesity medicine provider, these medications are a central part of my clinic and the success of my patients. While discussing the FDA decision with various people, I realized that many people may not understand WHY these medications (compounded or brand name) are crucial to my patient population.
I created a video on my clinic’s Facebook page that briefly discusses some of this information, which you can find HERE. However, I wanted to delve deeper into the complexity of obesity and explain why GLP-1 medications play such an important role for my patients.
Oklahoma ranks as the third most obese state in the nation. Medically, you are considered overweight if your Body Mass Index (BMI) is between 25 and 29.9, and you are classified as having obesity if your BMI is 30 or higher. Managing weight involves more than just balancing calories consumed and burned; it is a complex issue unique to each individual.
the science of it all.
If you have never struggled with weight, it may not be easy to understand that simple dieting and exercise aren’t always the solution to losing weight. Sure, in theory, it seems simple, but it’s not.
“While healthy eating and physical activity are important when trying to manage weight, it’s also important to understand a process that’s happening inside the body that can make weight management difficult. This is where a team of appetite hormones comes in. These hormones signal to the brain to help manage appetite, including hunger and the feeling of fullness. The body’s response to weight loss can make weight management as challenging as actually losing the weight.”1
Understanding what the appetite hormones are and the role they play in weight loss is crucial:
Ghrelin
Ghrelin is a hunger hormone known for initiating your appetite and is highest when you haven’t eaten in a while or just before a regularly scheduled meal (breakfast, lunch, etc.) Your Ghrelin levels may increase after weight loss from reducing caloric intake. Higher Ghrelin levels may lead to increased hunger and weight regain.
Peptide YY (PYY)
Peptide YY (PYY) is a hormone the intestines release after you eat and tells your brain that you are full. After losing weight by limiting calories, PYY levels may decrease, increasing hunger and leading to weight regain.
Cholecystokinin (CCK)
Cholecystokinin (CCK) is a hormone released by cells in your gut after eating that suppresses hunger by telling your brain that you’re full. After losing weight by limiting calories, your CCK levels can decrease. In turn, your hunger increases, which can lead to weight regain.
GLP-1
Glucagon-like peptide-1 (GLP-1) is a hormone primarily made in the gut (small intestine) but can also come from your brain. It is released after you eat and helps determine when you feel full. After weight loss from limiting calories, your GLP-1 levels may go down, which increases hunger and can lead to weight regain.
Amylin
Amylin, like insulin, is released by the pancreas after you eat. It affects specific areas in your brain to tell your body that you are full. After weight loss from limiting calories, your Amylin levels may go down, which increases hunger and can lead to weight regain.
Insulin
Insulin is a hormone made in the pancreas and allows sugar to enter cells for use as energy. Insulin is critical for your body to fuel itself and telling your body when to stop eating. After weight loss from limiting calories, your insulin levels may decrease, increasing hunger and leading to weight regain.
Leptin
Leptin is a hormone made by fat cells and released to tell the brain when to stop eating. After weight loss from limiting calories, your leptin levels may decrease, increasing hunger and leading to weight regain.
stigmatized.
While the medical community is aware of the increased health concerns people with obesity face, it’s hard to say whether the broader society is. Unfortunately, there seems to be a negative stigma attached to people who struggle with their weight. That they are lazy, unmotivated, lack discipline, or any number of other harmful labels. It’s important to acknowledge the stigma and realize the lasting negative impact it has by prolonging untreated health concerns. To address this issue, we need to be open-minded and willing to learn about the complexities of obesity.
Weight stigma also undermines health behaviors and preventive care, causing disordered eating, decreased physical activity, health care avoidance, and weight gain2, and over the long term, it even increases the risk of mortality.3
Perhaps ironically, weight stigma leads to a decrease in health-seeking behaviors—and an increase in weight—over time. Regardless of their BMI, people who face weight stigma are more likely to engage in disordered eating or unhealthy eating behaviors, such as binge eating.4
It’s worth mentioning, too, that peers like family, friends, and coworkers are not the only ones who perpetuate weight stigma. Physicians can also stigmatize individuals, which leads to distrust between provider and patient. “Every bit of weight stigma a person encounters from their doctor makes it less likely that they’re going to go back, and that is a bad outcome,” said Traci Mann, PhD, a professor of psychology at the University of Minnesota.5
So, on top of health problems that can be related to obesity on their own, the stigma associated with obesity only further compounds them.
It’s a double dose of all the wrong things.
comorbidities.
Obesity extends beyond just a person’s weight and scale measurement. It is associated with numerous known comorbidities (related medical conditions), some of which you may be surprised to learn correlate so closely to weight, reinforcing the need for effective and accessible treatment and management options.
Cardiovascular Disease
Obesity can be associated with risk factors like hypertension (high blood pressure), Dyslipidemia (abnormally high levels of fat in the blood), and Type 2 Diabetes.
The risk factors coupled with obesity can lead to cardiovascular diseases like coronary artery disease (reduces or blocks blood flow to the heart), myocardial infarction (heart attack), and heart failure (the heart can’t pump blood like it needs to).
PCOS
The number of women with PCOS who are overweight or living with obesity is as high as 38%-88%.6 Symptoms can include menstrual irregularities, excess androgen levels, enlarged and/or dysfunctional ovaries, and metabolic problems like increased fat distribution, leading to higher insulin circulation and insulin resistance.
Obesity can influence gonadotropic (GnRH) production (a hormone central to fertility), and imbalances can lead to ovulation dysfunction and menstrual abnormalities.
The exact link between PCOS and obesity isn’t definitive, but the incidence of one affects the other.
Knee Osteoarthritis
Obesity can cause a significant increase in the risk of Knee Osteoarthritis (OA). Mechanical stressors can be structural damage (joint failure), abnormal cell activities, or increased synovial membrane inflammation (joint lining) that causes pain when moving and creates swelling and fluid buildup in the knee.
Metabolic impacts are from the irregular function of adipokines (cell signaling proteins related to inflammation or other metabolic syndromes) that can cause increased inflammation, cartilage degeneration, and bone remodeling.
Type 2 Diabetes
Obesity increases the risk of prediabetes, which can lead to a diagnosis of type 2 diabetes. 70% of patients with prediabetes— an A1C from 5.7% to 6.4%—often go on to develop type 2 diabetes.7 For patients already diagnosed with type 2 diabetes, a higher BMI is related to higher A1C levels.
Weight loss may prevent or delay the progression of prediabetes, with an average loss of 6.7% (of body weight) showing to reduce the onset of diabetes by up to 58%.8
Obesity desensitizes your body to the action of insulin. Insulin is the hormone that regulates blood sugar levels, and prediabetes develops from the body’s inability to use insulin to regulate the sugar levels properly.
Sleep Apnea
It is estimated that nearly half of all people with obesity also have obstructive sleep apnea (OSA).9 Fat deposits in the upper respiratory tract are associated with obesity and these fatty deposits can lead to various negative effects.
The mechanical load increase on your respiratory tract can lead to respiratory stress (tension can contribute to airway narrowing). Increased oxidative stress (imbalance of free radicals and antioxidants in your body) can lead to decreased upper airway functions, and higher levels of proinflammatory cytokines can reduce central nervous system and upper airway activity and control.
Idiopathic Intracranial Hypertension
Idiopathic Intracranial Hypertension (IIH) refers to increased pressure inside the skull around your brain. The increase in pressure can cause varying degrees of symptoms.
The buildup of cerebrospinal fluid can cause an ache in the back of your head that can range from mild to debilitating. Vision changes like blurred vision, double vision, or even temporary blindness can also occur. Pain in the neck and shoulders, poor peripheral vision, nausea, vomiting, ringing in your ears, and a ‘whooshing’ sound like your heartbeat can all be related to IIH.
Weight loss is a first-line treatment for IIH; losing 5-10% of body weight can alleviate or eliminate the symptoms.
how does glp-1 fit into all of this?
We all have glucagon-like peptide 1 (GLP-1) in our bodies. These are naturally occurring hormones that our gut releases after we eat. The function of GLP-1s is to boost the amount of insulin our bodies make to keep our blood sugar within a normal range and provide the sensation of fullness after a meal.
Patients who take GLP-1 agonists can expect the same effects of feeling fuller after and between meals, having improved blood sugar levels, and experiencing less ‘food noise’ (thoughts that make you crave or obsess over food).
The GLP-1 simulates the natural hormones that curb appetite and slow digestion, creating longer-lasting satiety (feeling full). These medications, combined with a balanced diet and some exercise, can maximize weight loss success.
Most of my patients take Semaglutide or Tirzepatide, which are long-acting GLP-1s with a longer half-life, meaning they stay in your system longer. These medications are not intended for someone looking only to lose a few pounds but instead want to shed 15-25% of their body weight.
My clinic offers three affordable monthly membership options that include one of the GLP-1 medications, monthly weigh-ins, and bi-annual blood draws. The blood tests monitor critical health markers like A1C, cholesterol, and Vitamin D levels. Semaglutide and Tirzepatide are injected under the skin (in the thigh, stomach, or upper arm) once every 7 days and are intended for long-term use.
Once you have ‘graduated’ to a maintenance dose, you pay for the medication by the syringe and have annual blood draws and weight check-ins.
In addition to weight loss and lowering of blood sugar, GLP-1 agonists may provide additional health benefits like lowering blood pressure, improving lipid disorders (like cholesterol HDL and LDL), improving fatty liver disease, and reducing the risk of heart and kidney disease.
Some studies even suggest that GLP-1 may lower the risk of severe neurological and behavioral health concerns like seizures, substance disorders, suicidal ideation, bulimia, self-harm, dementia, schizophrenia, and Alzheimer’s. “Interestingly, GLP-1RA drugs act on receptors that are expressed in brain areas involved in impulse control, reward, and addiction — potentially explaining their effectiveness in curbing appetite and addiction disorders,” said Al-Aly, the director of the Clinical Epidemiology Center at the VA St. Louis Health Care System.10
WHAT’S MY POINT?
I have personally benefited from the use of GLP-1 medications and lost 70 pounds. My blood pressure is under control and no longer requires medication to manage.
Why is that significant?
Because I am real-life, in the flesh, proof that GLP-1 treatments do so much more than just reduce the number on the scale. In fact, I would argue that my actual weight is a secondary achievement compared to the other improvements I’ve experienced, such as better lab results, getting off of medication, a clearer mind, and the ability to meet and exceed my personal goals.
The best news I can share is that we do not have to change anything we do with the medications and services at the clinic because the FDA decision does not apply to my patient population, meaning I get to continue helping patients become the best, healthiest versions of themselves.
That is something I will never take for granted.
I would be happy to meet with you to discuss whether a GLP-1 prescription might be a good fit for you. If you’re interested in alternatives to GLP-1 medications, I can also provide those options. Understanding your history and circumstances is crucial in determining the best path forward. Medical weight loss has become a passion of mine, and I believe that personalized care is essential for your success.
It’s why I share my story so openly.
It’s why I got certified in Obesity Medicine.
It’s why making these medications affordable for everyone is incredibly important to me.
Please call the clinic at 405-701-6717 to schedule a time to come in and talk about how I can help you achieve your goals.
With love,
Dr. Ronni Farris
- https://www.truthaboutweight.com/the-science-behind-weight-loss/how-hormones-affect-appetite.html ↩︎
- Tomiyama, A. J., Appetite, Vol. 82, 2014 ↩︎
- Sutin, A. R., et al., Psychological Science, Vol. 26, No. 11, 2015 ↩︎
- Vartanian, L. R., & Porter, A. M., Appetite, Vol. 102, 2016 ↩︎
- https://www.apa.org/monitor/2022/03/news-weight-stigma ↩︎
- Barber TM, Franks S. Obesity and polycystic ovary syndrome. Clin Endocrinol (Oxf). 2021;95:531-541. Balen AH, Conway GS, Kaltsas G, et al. Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod. 1995;10:2107-2111. Legro RS. The genetics of obesity: lessons for polycystic ovary syndrome. Ann N Y Acad Sci. 2000;900:193-202. ↩︎
- Rett K, Gottwald-Hostalek U. Understanding prediabetes: definition, prevalence, burden and treatment options for an emerging disease. Curr Med Res Opin. 2019;35:1529-1534. ↩︎
- Ryan DH, Yockey SR. Weight loss and improvement in comorbidities: differences at 5%, 10%, 15% and over. Curr Obes Rep. 2017;6:187-194. ↩︎
- Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest. 2010;137:711-719 ↩︎
- https://neurosciencenews.com/glp1-drugs-brain-health-28372/ ↩︎
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