Uncover Impacts Of New Weight Loss Drugs On Your Health

Gina Moreno-John, MD, MPH

Thank you so much for inviting me, Beverly. I am excited to do this.

Beverly Yates, ND

I am glad to have you here. This is such a rich topic area that we are going to talk about. Everyone listening to this episode, I want you to know that here are the points we are going to cover. We are going to look at the role of obesity as it intersects with type 2 diabetes and why it is so hard for people to lose weight. It is just a real struggle; there is no faking that one. Clearly, there is a struggle going on. Why is it important to have new treatments? We are also going to review the new medications Wegovy and Saxenda and how these new treatments might change our collective health outcomes. We look at peptide therapies and other kinds of therapies; what are the differences here? Then a review of the newer medications that are coming in the future. Let us get started with our first question, which is that everyone wants to lose weight, or many people do. But why is it so darn hard to do?

Gina Moreno-John, MD, MPH

Yes, I saw a statistic once that 90% of people already know that if you want to lose weight, you should eat less and exercise more. Yet, the rates of obesity have been tripling since the 1970s. They have tripled, especially for our children. This is why we know what to do, but this is why it is hard. First of all, our weight is dictated by our genetics, between 40 and 70%. I do not think we talk about that enough. But I really want to make sure my patients know it is not their fault if there is obesity in their family, etc., if they are having trouble losing weight. Our height is dictated about 80% by our genetics, but our weight is again dictated about 40 to 70% by genetics. For a lot of people, it is really hard to change their weight or their set point because there are genes in their family that keep them at a certain weight. We do not talk about that. We blame the person. There is a lot of stigma.

Another reason why it is so hard is that our brains have evolved to keep us overweight. In the days of old, when we had to hunt for our protein and gather our own plants for food, all we did was extend our energy just to get food. Because of that, our brain is really sensitive. Any time we restrict our calories, go on a diet, skip meals, or do things that make our brain starve, it kicks in to slow down our metabolism, so we cannot lose weight. Our brains are really sensitive to that. Our brain is made to keep us overweight, not thin. Again, that was for survival. 

These thrifty genes are what they are called. Most of us have them. They keep us on the heavy side. That is how we evolved. I think that the modern world, the Westernized world, is why it is so hard to lose weight. Most of our jobs involve sitting down. We have sedentary jobs, work on computers, etc. Most of us have to drive where we go instead of walk and hike to get to our basic transportation. The Western lifestyle that is meant to be easier for us is actually making it harder for us to lose weight. Then there are finances. This is important. In a world where there is cheap food. Living at or near poverty levels is associated with being overweight. Again, if you do not have adequate money to buy healthy, nutritious food, which is very expensive, that is associated with obesity. What are you doing? You are just buying the foods that you can afford.

Usually, as you said, Beverly, those high-density calorie foods—French fries, burgers, tacos—and other things that keep you full and are inexpensive—you have to buy for survival. Unfortunately, in this country, having less access to money is a problem for many vulnerable groups, including people of color, single parents, and the elderly. Without a lot of money in places with easy, cheap food, that leads to obesity. That is a big part of why it is so hard to lose weight. You can afford to buy the foods that would be helpful.

Let me just stop there. I will do one last thing. Diet and exercise: As we said, everyone knows to make that behavior change that is consistent. It is really hard to do for humans. We know what we are supposed to do. I struggle with the same things my patients do. Learning to get up at 5 a.m. so you can exercise every morning. That is hard to do, and it is really easy to knock you off that habit. Eating salad every night for dinner with protein and organic things. Again, depending on how busy you are, what your stressors are, what your cultural habits are, and what your family does, all of those things make it hard to change behaviors long-term. That is why we struggle. I will stop there and say, Any questions or anything else about why it is hard to lose weight?

Beverly Yates, ND

I so appreciate you, Gina, for just being upfront about behavioral change, what our genetic composition is, and what it is we are set up to do. If we try to change it, man, we are salmon swimming upstream.

Gina Moreno-John, MD, MPH

Absolutely. It is really, really hard because the patients who come to us for weight management have sometimes lost significant amounts of weight; many times they have lost 50, gained it back, lost 35, and gained it back because that goes back to that. It is hard given our physiology, our genetics, and our Western lifestyle. It is hard to keep up with those changes. Unfortunately, that yo-yo dieting, as we call it, losing, gaining, losing, gaining, slows down your metabolism and makes it even harder and harder to lose weight the next time you want behavior change. I just tell my patients not to feel bad about the fact that they are working on a weight challenge. It is not their fault. There is a lot set up against us.

Beverly Yates, ND

Absolutely. I think the shaming and blaming that goes on around Type 2 diabetes, obesity, insulin resistance, and other things is really, really spectacularly misguided. It is mean, and it is not effective. It is not working. That old 1950s advice to eat less and move more in today’s busy, super-stressed, under-sleeping world is just a disaster. Plus all these environmental toxins and all these other things that have changed in the last 40 to 50 years—you look at people’s pictures from their families and you see the changes, the rapid changes in just the size of people. You go, Wow, something’s really broken. So if you could shame and blame our way out of this problem, then it would not be a problem because of the amount of stigma that goes on. I think de-stigmatizing is where we need to work to find effective tools and help people. I want to give you a shout-out as a leader and as a clinician because you have a food bank as part of your clinic, solving a root-cause issue that is often completely overlooked.

Gina Moreno-John, MD, MPH

Completely. I really like how you just said that. That people feel when it comes to obesity. By the way, doctors use the word obesity just based on a calculation of your height and weight. We are hopefully not using the word obesity as a way to make people feel bad, etc. I actually try not to use that word too much with my patients. But, again, it is a calculation that doctors use, not a judgment word, but people say that they feel stigma, number one, from their family, and number two, from their doctors. Those are the top two groups of people who shame patients. That may or may not be off topic, but it is really important for physicians, clinicians, nurses, and providers to understand that patients actually do not feel comfortable in our offices. We must also comprehend genetics. You said that poverty, lifestyle, unsafe neighborhoods, and no access to food are often the things that contribute to weight, and we should not shame the person directly.

Beverly Yates, ND

Absolutely. It is not helpful at all. Then would you share with us your thoughts about this? What are the treatments that have been traditionally used in the past? Because I would love you to build a bridge for us from what has been traditionally used for treatment, and then we can take people to what is coming up.

Gina Moreno-John, MD, MPH

Diet and exercise, of course—as I just said, the things that people know they should be doing but are actually hard to be consistent with—have been the mainstays for a long time. For people who do not have a big genetic component to their weight, that does work, at least for as long as they can maintain it. For some people, diet and exercise have been the traditional routes. A lot of people do this calculation: calories in, calories out. As long as you can do less calories in, more calories out, less eating, and more exercise, that should lead to weight loss. Again, it does, as long as you can keep that up. It only works for people who do not have a large genetic component to their weight. That has been the traditional thing to do. I will say that is not bad. We should try to move more. We should try to eat healthy. I am not going to say that we should not try to do those things. But if you do recognize that you are getting as much external support as you can to do those things, that is wonderful.

If you want to move more, by the way, we are now telling people to try to move for at least 150 minutes a week. That is 530 minutes of workouts of some sort. That is the equivalent of 150 minutes. The more you can get external support and not just rely on yourself, the better. Whether that is an exercise partner, a neighbor, walking with a trainer if you can afford it, and I know not everyone can, a YMCA class that you go to, or whatever is external to you, use those resources because it is hard to just rely on yourself. That is the traditional stuff. Move more and eat less. For people who are interested, a big study showed that it does not matter which healthy diet you use; they all work. It’s just whichever one works best for you. It does not matter if you want to do Weight Watchers, count calories with my fitness panel, or eat the Mediterranean diet, etc.; it does not matter which one suits your lifestyle; they all work. Finding the right healthy eating style for you—that is good to know; those are the basics. Do you want to say anything before I move on to the traditional forms, Beverly? 

Beverly Yates, ND

One of the things I am thinking about here, Gina, is that I am loving the fact that you are basically telling people to do what works for them because we are individuals. Even twins or triplets are individuals. We are not all the same. The same thing does not work for everyone. Sometimes, what I have observed clinically is that people really do want that one-size-fits-all approach, and it does not exist.

Gina Moreno-John, MD, MPH

That is right. We tell them, actually, at UCSF, in the weight management program, that we are going to try to tailor every bit of advice and support we give you to you and your lifestyle. Sometimes they do. But what about just giving me what I am supposed to eat? Just give me the manual. I am, but no, we have got to work through your sleep habits. Your working hours, your commute—we have to talk about all those things. I will also say that I love that you reminded me of things as we talked about how people sometimes want to know what to eat. I will say that in the past, again, doctors have been very Eurocentric, very white-centric, and we would say to eat whole grain bread, and that is great. But what if you have tortillas? Or, as we would say, do not eat white rice, but what if that is the staple of your cultural diet? We would say yams are too high in starch. But what if sweet potatoes and yams are staples of your mother country? What do I mean? We are doing a better job now, trying not to shame certain foods and say you cannot. These are bad. These are good. All cultures have healthy foods, and we are trying to incorporate that.

Beverly Yates, ND

Thank you so much for saying that. That cannot be said enough. I found that often that is where people get stuck, and then they are not able to sustain any healthy change because they feel their own culture and their own mothers and fathers. Grandparents wisdom is not welcome in their own health.

Gina Moreno-John, MD, MPH

That is another reason they do not feel that doctors understand them for sure.

Beverly Yates, ND

It is an issue. Thank you for bringing that one forward. I appreciate you. .

Gina Moreno-John, MD, MPH

Exercise has been good, and then we have had some medications in the past, but I actually have not really used them very often. They have a lot of them, or they have had a lot of them, that we know have side effects that concern me. Phentermine turned out to be a disaster because it had long-term heart and lung symptoms. To this day, phentermine is still FDA-approved, but it can cause high blood pressure and a fast heart rate. For me, those cardiac side effects that can lead to a heart attack or stroke do not apply to phentermine. There are other medications, like Contrave. Contrave is very interesting. It is an anti-addiction and anti-depressant combo pill. That makes a little sense; if you have a little less stress and a little less craving, then potentially that can reduce your eating habits. 

But again, not that many people lost that much weight with it and had side effects. I have not thought that was great. There is also Orlistat, which is also FDA-approved for weight loss. That is the fat-tracking pill. You take a pill, and you do not digest all of the fat you eat. Again, it is not that effective for weight loss. It has not caused that much weight loss. It has really, I do not want to get too graphic here, but if you are not digesting your fat, then your bowel movements and the gas you put out are not very pleasant, let us say that. A lot of people start with that one and say, I do not understand the side effects.

Beverly Yates, ND

I was going to ask you about side effects. I was thinking that if you are not just digesting those fats, this is a recipe for disaster.

Gina Moreno-John, MD, MPH

Exactly. I would say that it worked many years ago. Again, I do not use these medicines very often. But I did have a patient for whom it worked, and she had to wear a pad for the leaky oil discharge that she had. There have been, but there have not been any medications that have been useful, in my opinion. then, of course, bariatric surgery. that has been somewhat newer, obviously, in the last 20 years. But another staple that we have been using is that, by the time you are using surgery for weight loss, that is a big decision for a lot of people. It used to be an open surgery where they cut a long incision in your abdomen to cut parts of your stomach out and stuff like that. At least now they do it mostly laparoscopically. They made three small holes. They put in three very small, finger-sized instruments and a video camera. They can do a lot of that work of cutting the stomach, etc., from the outside, looking through a video camera. You heal much more quickly, and there are fewer side effects.

There is now gastric sleeve surgery, which is a little less invasive because they do not cut the stomach and then reattach it to your intestines. That was what the old bariatric surgery was, or still is. But they do cut your stomach down to a long, thin thing instead of a grapefruit. It is a long, skinny thing, maybe the size of a banana. You just digest less of the food, and you can eat less. Surgery was another traditional thing until the new medicines came along. I will stop there and say that is what we have had for a long time.

Beverly Yates, ND

Okay, that gives people a picture of where things are and where things have been. Where is the future leading folks who are looking for options around managing weight and who are looking at these various medically clear kinds of options? Can you tell us about the new injectable medications?

Gina Moreno-John, MD, MPH

Yes, I am really excited to do this because, for me, so far, it has not caused any long-term side effects that we do not know about. This is a game changer, actually. Now, actually, Saxenda was the first one and is also called Liraglutide. They have two names that were actually FDA approved for weight loss in 2014, but it is a daily injection, and it just has not quite worked as well as Wegovy, which was just FDA approved two years ago, in June of 2021, and that one is only a weekly injection, which is even better than Saxenda. So now we have these two injectables. They were designed to be diabetes medicines; they lower your sugar levels. That is how they worked. It turns out that people lost a great deal of weight. They began to research it as a weight-loss medicine, not just a diabetes medicine. It turns out that they help people lose weight, whether they have diabetes or not. As diabetes medicines, of course, they are amazing because they help you lose weight, which reduces your glucose, which reduces your insulin resistance, which helps you maintain better sugar levels, and then the weight loss drops your sugar levels even further. As diabetes medicines, they are great. But even without diabetes, they help you lose weight a great deal.

I think on this Wegovy weekly injectable, people are now losing about 15% of their starting weight. That is how doctors measure if something is successful. Say you have 200 pounds. If you lose 15% of your weight, that means you lose 30 pounds. Then you get to about 170. On the weekly injectable, the Wegovy people are losing a mean amount of about 15% of their starting weight. Maybe 30 pounds out of 200. Some people lose a lot more weight if they exercise, and some people lose a little less. But it has been incredible with my patients. Really incredible. I will say something interesting, just so people know how they work; it is very, very interesting to me. Wegovy works at the hormone level in one way, so Wegovy helps your body use your natural insulin better. The sugars you have in your body after eating those do not turn into fat. Just so, if you have a lot of sugar in your body after eating and your body and your cells are not responding to your natural insulin anymore, then all of that sugar is going to turn into fat.

But now with Wegovy, if you eat something, you have some glucose in your bloodstream. Wegovy makes your cells respond to your natural insulin really well so that sugar gets cleared away and does not get converted to fat, but it also reduces your appetite and slows down how fast your stomach empties out. You have fluid sitting there a little bit longer, and you just do not feel hungry. You do not want to eat very quickly afterwards. It works on the stomach level, the appetite level, and the hormone level. That is why it is so effective. But let me stop there, because I know that is a little involved, and see if you have any questions or comments.

Beverly Yates, ND

Yes. Okay. It brings a few things to mind. Hear me talk about gastric emptying, or the speed with which food leaves the stomach. Is this still the case? Is this something that is essential? It almost sounds to me like maybe it is the case that people are eating foods that will probably leave most people’s stomachs rather quickly. In other words, simple processed carbohydrates are ultra-processed, highly refined foods, what we would call fast foods, non-nutrient-dense foods, junk foods, etc. If someone’s eating a healthy diet, do they still benefit from this? By healthy diet, I mean it is rich with protein, healthy fats, lots of leafy green vegetables, rich in fiber, and the slower-burning, more complex resistant starch of beans, peas, and legumes.

Gina Moreno-John, MD, MPH

Yes, that is such an outstanding question. To pick up with Dr. Yates, I keep calling you Beverly because

Beverly Yates, ND

It is fine.

Gina Moreno-John, MD, MPH

What Beverly and Dr. Yates are saying is that you digest foods with a lot of fiber and complicated carbohydrates much more slowly. Broccoli is going to sit in your stomach a lot longer than pudding because there is a lot more fiber in it. So you are asking, So if this slows down, how fast does the food lay in your stomach? Would you do that anyway because you are eating a lot of fiber and vegetables? Does this work for you still? It does. I will explain why. The fact that it slows down how fast your stomach empties is not the biggest part of the weight loss outcome for this medicine. That helps. That is one of the things that helps you lose weight. But the fact that it helps your insulin and sugar levels get healthier is a bigger part of why you lose weight. Even if you are eating healthy, this will still help you lose weight.

Beverly Yates, ND

Great. Thank you for clarifying, because I know there is a portion of our audience who is here at the reversing Type 2 diabetes summit who has done a lot of smart things and is trying so hard, who eats healthy, and who exercises regularly. They are doing the standard, regular thing. I just know that the question is hanging in the air. Okay. Another question you might have hanging in the air while we are on this point is: when people take these medications, and I am sure it is different by medication, is there a risk of them losing precious muscle mass? You and I both know how important muscle mass is to metabolism.

Gina Moreno-John, MD, MPH

These are some excellent questions. whenever you are on any diet at all, or if we do not want to use the word diet because again, we do not want people to restrict too much. Whenever you are trying to eat a little less, you have to exercise, including some weight training, to keep muscle mass. Or if you lose a lot of weight and do not exercise, you can lose muscle as well as fat, which we do not want you to do. What Dr. Yates is referring to here is that the more muscle you have on your body, the faster your metabolism, because muscle burns a lot of calories just because it is an active piece of your body. The less muscle you have on your body, if you have some muscle wasting, you do not have much muscle. The slower your basic metabolism is, the more muscles you have on you, and the faster your metabolism is, the less likely you are going to gain weight back and the less likely you are going to lose strength. 

Again, whether it is by Wegovy, whether it is by Weight Watchers, or whether it is by MyFitnessPal calorie tracking, it does not matter if you are losing weight; you will lose muscle mass with your fat if you are not also exercising, including weight training. The interesting thing about Wegovy, etc., is that it does target the fat cells a little more. You are going to lose a little less muscle with Wegovy. However, whenever you are losing weight and want to keep your muscles on you and only lose fat, you still need to exercise.

Beverly Yates, ND

Great. Thank you for clarifying that. I think sometimes people miss the point about the importance of preserving and building that muscle mass, whether it is for the metabolism, to make sure you do not fall as you get older, or for all the other good reasons we want to keep our muscles around.

Gina Moreno-John, MD, MPH

Well, let me say this just as a clarification, because I really think that is a really important point. You do not have to exercise to lose weight. A lot of people go on diets and lose weight without any exercise plans. That is not the safest way to do that because you are losing muscle, but you do not have to exercise to lose weight. However, to keep that weight off that you lost, you have to exercise 5 to 7 days a week. Maybe exercise is not necessary for weight loss, but it is absolutely crucial for weight maintenance. If you are exercising 5 to 7 days a week, at least 150 minutes a week, during the holidays, when you go out for a birthday party or when you have relatives over and you are eating out every night, you have those moments in your life. If you are working out 5 to 7 days a week, you are not going to gain back the weight that you have lost. That is how you keep your weight off when you lose it. It is the exercise piece that burns just enough on a weekly basis that you are not going to gain it all back. Again, although you do not have to exercise to lose weight, most people do not. You have to exercise to keep the weight off. That is why exercise is a crucial part of weight maintenance, even though people who diet without it should not.

Beverly Yates, ND

Great. Thank you for those distinctions. That is important for people to know. When we are talking about these medications, you have talked about Wegovy. We mentioned Saxenda and the earlier other ones that are really popular in the news right now, Mounjaro and Ozempic, also known as the semaglutide. Why is it that so many people are talking about or using these medications? What makes them just common knowledge at this moment in time?

Gina Moreno-John, MD, MPH

Yes, about six months ago, my daughter was still in college, a senior in college. I was telling her, Maya, that we have these new medications that are really helping people lose weight. She said, Oh, Ozempic. You are a college student; how do you know? She said, Oh, everyone is talking about it on TikTok. All the influencers are using it, including models and actresses. Again, people who do not need to lose weight are all using it now. Everyone wants to use it because it is a way to lose weight. We have not had anything like this before. I did not know that. It would turn out that these are popular influencers’ methods. I think the reason people are doing that is because, as I said, you do not have to have diabetes for this to work. This works in a way. It works in at least three or four different ways in your body. It is really effective, even if you are not obese. Unfortunately, people who do not need to lose weight have been using it, and that has caused huge backorder issues. I do not know if you have heard, but a lot of my patients who have obesity, diabetes, heart issues, cancer, and other things cannot get the medication because the drug company obviously cannot keep up with the demand, especially because a lot of that demand is among people who do not even need it. I do not know what is going to happen to people who are not obese. take this. I have no idea what will happen in the long term, but it has been really difficult. I have had people start and stop the medicine. They get it, and then it is on backorder. For anyone who is listening. Supposedly, Novo Nordisk says there will be more Wegovy in September, and they are trying really hard to get that backorder. But it has just become a very popular—I do not know—cultural phenomenon. I actually learned yesterday that there is something called the Ozempic Face.

Beverly Yates, ND

Yes.

Gina Moreno-John, MD, MPH

Yes. If you do not have that much to lose but you are a little bit older and you lose a lot of weight quickly, you get a little more wrinkles, there is a little less filler, natural fat filler, in your face, and then you get to the point where your body is smaller but your face looks a little older. This using Ozempic and talking about it with Wegovy and all these medications as an aesthetic plan? Really, I am not behind it. Yes. My patients who need it can get it. People are worried about wrinkles and other things instead of trying to live a longer life. Anyway, that is a very interesting cultural phenomenon I learned about through my daughter.

Beverly Yates, ND

Yes, it is interesting. We both have kids the same age, so we are living through a real-time experiment. We are as a culture, but I just do not understand why people who do not have a problem want to tap into a medication that is meant for people who have a life-threatening problem. I do not understand why they treat these things like candy. It is just weird.

Gina Moreno-John, MD, MPH

Well, you can get it now online with doctor programs. You do not have to meet the criteria. If you have the money to pay for it. I will just let the audience know it is about $1,400 a month. That is how much Wegovy is if you do not have insurance coverage. It is quite expensive, and almost no one can pay for that. But if you are rich, if you are famous, if you are an actress or an influencer, etc., and you can afford it, then you just get someone to write the prescription and you do not need to go through insurance. I think thinner is better, which is the unfortunate cultural norm for unattainable beauty standards in this country. That goes back to the stigma and shame of people who are overweight and the beautification of people who are unhealthily underweight. It is all a bit of a mess. That is perhaps another conversation. But it is really too bad.

Beverly Yates, ND

That will be for the next summit, because you are right.

Gina Moreno-John, MD, MPH

That is right.

Beverly Yates, ND

This whole thing has gotten really worst. We have a culture now that wants to make people feel bad for the natural processes of aging and does not easily accept the wide variety of completely normal body types and sizes. Some people are more curvy, some people are more slender, some people are more muscular, etc. I just do not know why we want to make each other feel like freaks when it is absolutely a normal variance in the human condition.

Gina Moreno-John, MD, MPH

I know. Good point.

Beverly Yates, ND

Weird, but anyway. That is our topic. With these new medications that are coming down the pipeline and things that are available now, how can they change everything regarding weight loss? Because we can all appreciate weight loss. This is a major struggle for a lot of people.

Gina Moreno-John, MD, MPH

First of all, talk about the new medications and then what I think the overall impact will be and the implications for us. Mounjaro is Tirzepatide, and a lot of people are asking me for it already. It has not yet been FDA-approved yet for weight loss. It is for diabetes, but not for weight loss. However, according to the FDA, it is being fast-tracked for approval. I think it will probably be available for weight loss next year. That is my guess. I am just letting everyone know. Mounjaro, the tirzepatide, and others behind it work just like Wegovy, Ozempic, and Saxenda. They work the same way. They reduce appetites. They slow down the emptying of the stomach. They help adjust that insulin-glucose resistance that we see, plus they have an extra mechanism of action. It also stops what we call the obesity hormone. There is a hormone. I am not going to tell you if it has a long name. GIP; we will call it GIP. GIP is called the obesity hormone. It helps you eat more, and it slows down your metabolism. That is what it does.

Mounjaro works like Wygovy and Saxenda. Plus, it also stops that obesity hormone from working so actively in your body. It does all the things Wygovy does, plus it reduces how much you eat even further and increases your metabolism and your calorie burn a little more. You can imagine a medicine that does everything Wygovy, Saxenda, and Ozembic do, plus an extra effect. It is incredible. That one is in studies; it is helping people lose 20% or more of their body weight. Again, if you are 200 pounds, then you are losing 40 pounds or more on this medicine, whereas with Wegovy, you are losing about 25 pounds, 30 pounds, or more. It is just even more effective. I know that is why everyone is waiting for it and thinking about it. That is the new one coming down the pipe, and that is why it is even more effective. The truth is, I think our obesity rates have been going up because of lifestyle, all those things we talked about in finance, genetics, and all these things. It has been going up. Unfortunately, I have heard that our next generation, our children, are having obesity rates earlier and at higher levels than they ever have. I have not done the full research, but I have seen one article suggesting that our next generation, our kids, may be less healthy than we are. Usually every generation is healthier than the one before, but it may be that our children are a little less healthy than we are because of obesity rates and other things. I think that with these medications, as long as they prove to be safe long-term, obesity rates are going to go down.

I think that, therefore, your diabetes, high blood pressure, high cholesterol, heart disease, strokes, arthritis, and cancer—all of these things—are going to see a drop in these secondary effects of weight-related issues. I think that over the next several generations, if these medicines become as widespread as they seem to be, we are going to actually have healthier children, thank goodness, and our grandchildren will be even healthier. I think we’ll see less bariatric surgery. I think that we would probably see people living a little longer. If I really think this is quite the game changer and we have never had it, this is a revolution. I stated that we had never had medications that worked so well. These medicines are meant to be used long-term. They are not meant to be stopped after 12 weeks or one year. 

That is another important reason why these are incredible parts of our treatment plan now. I actually really think this is going to change generational health. I said the only caveat was that we do not know the effects of these medicines at 20 and 30 years of age. We do not know if children can take them safely for 50 years. That is the one thing I will say: I just withhold that little judgment about the long-term effects. Saxenda has actually been used for about 11 years. It has been FDA-approved for about nine years, and it has been used in Europe for longer. We have Wygovy and Saxenda, which have been used for 5 to 11 years. So far, there are no long-term effects, which is very helpful. That is my only caveat. We have to see if this is safe for children and if people can use it beyond age 20, 30, or 40. I do not know. But if it works that way, I really think this is going to reverse a lot of adverse health outcomes for a lot of people.

Beverly Yates, ND

That would be great. We need more tools in our toolbox, and there is a whole spectrum of opportunity. There are prescription medications, there are surgical interventions, and there are certainly things on the lifestyle side with sleep, nutrition, exercise and strength training, meal timing, and stress management. Stress is just such a wild card with all of this. The more tools in the toolbox and the more ways that people can reclaim their health, the better, because, boy, we are at a moment in time where it is really concerning. We cannot have these rates of type 2 diabetes, pre-diabetes, obesity, struggles with weight, and the mental health things that go with them. It is just not sustainable. We have got to figure this out.

Gina Moreno-John, MD, MPH

Well, I have never felt more optimistic. Actually, I really am not, saying that because I am a Western physician, everyone should have pills, meds, etc. But as you said, at least it is an incredible extra tool that we never had before with medication. Now, we have medicines for high blood pressure, diabetes, and high cholesterol. We have medicines for those things. We have never really had a safe, effective medicine for people who are having trouble losing weight. Now we do. I am very grateful to be seeing this time. Yes, my patients, who have been working really hard to lose weight, are now losing weight more easily. They just feel more confident about their ability to be healthy. I am really grateful for that.

Beverly Yates, ND

That is wonderful. I think it provides the basic support that some people absolutely need, whether it is quiet food in the mind, or whatever it might be, or the sense of just feeling satiated that they know they have had enough. It is just such a fundamental thing while we figure out all the rest of it. Dr. Moreno-John, I thank you so much for being a part of the summit. It is wonderful to get this information. I know you are absolutely on the front lines, and you are a leader in your field and doing some innovative things. I salute you. I am glad for you, your work, and the impact that it has on the community. Thank you.

Gina Moreno-John, MD, MPH

You are very welcome, Beverly. The same to you, actually. Thank you so much.