We would never tell a patient with a sky high blood pressure of like 1 over 100 and known heart disease to first try lifestyle changes, maybe a low salt diet and exercise, and if it doesn't get better, then we'll start a medication. We would never do that. So why do you do that exact same thing for the disease of obesity? Well, according to the American College of Cardiology and their latest guidance, that era is officially over. In today's podcast, we going to break down exactly why we need to rethink the way we treat obesity. Let's get started. And welcome back, team, to the Building Lifel Athletes Podcast. Thanks so much for stopping by. I really appreciate it. If we haven had the chance to meet yet, my is Jordan Ren, and I a dual board certified physician in family and sports medicine. And the goal of this podcast is to keep you active and healthy for life. Through action Edmonton's form education. And today we're talking all about understanding obesity and the disease that it is and how we should go about treating it. So let's go right now. To really talk about this, this is, I want to kind of think about this as a paradigm shift, right? So, really kind of understanding why this paradigm shift is happening and why we need it. We kind of first need to understand the scale of the problem, right? This isn't a niche issue. Obviously, obesity is a global pandemic. We know it, it affects so many people. It affects more than a billion adults worldwide, and obesity rates have doubled in the last three decades. Here in the U, over 40% of adults have obesity and nearly 10% have severe obesity. So it is very prevalent. And for years, this was framed as a crisis of willpower, right? Or a failure of willp. But the medical consensus has kind of shifted now. And the leading bodies, like the AMA, a couple of years back, have now officially classified obesity as a chronic. Relapsing into these, viewing it as a complex pathophysiologic process, not simply a failure of personal choice or discipline, right? That used to be the old mantra: like, oh, calories in, calories out, just work hard. You're not working hard enough, work harder. And we've really kind of moved away from that. That's the big thing. And obviously, make no mistake, it's not simple. I'm not saying that by any means, like, oh, it simple, you know, it's a disease, like, there's no personal accountability, and we can't, it's like. It's a very, very, very complex topic. And so we're not going to just necessarily completely shift saying, hey, there nothing you can do about it, but it's very important. Also, it's important to make no mistake that it is, obesity in itself, is a primary threat due to cardiovascular health, directly increasing the risk for heart failure, coronary artery disease, stroke, all those things. And in fact, severe obesity is associated with a significant reduction in life expectancy as well. You know, there's two sides of the spectrum. Some people say, hey, like, you, this new obesity that's okay. It's not, it's not metabolically an issue. That's not the case at all. And so This is the scope of what's going on. I just want to make us aware of that. And so, first of all, how do we diagnose obesity, right? So, diagnosing is important. For decades, the goal-to tool has been the body mass index, right? Or BMI. Everyone knows that. And it's calculated based on a person's height and weight. And you've likely seen the standard charts where a BMI of 30 or greater is typically classified as obese. And that's typically where we're at. But There's a big issue with that, right? So, the standard thresholds were largely developed using data from pretty mod populations, a lot of the time, like European ancestry or white populations, and don't necessarily reflect the entire health risks for everyone in the spectrum, right? On top of that, a big issue is that BMI is a proxy, but not a direct measurement of body fat, right? So nobody's measuring anything. They're just saying, hey, height and weight, and this is generally what you are, but it doesn't necessarily distinguish anything. It can't distinguish between fat. In lean mass, nor does it tell us where that fat is stored, which is a critical piece of information, right? So we know that visceral fat or the fat packed around our internal organs. It's far more dangerous and linked to things like insulin resistance and cardiovascular disease than subcutaneous fat or the fat right underneath our skin. So we know way different disease progression there based on where your fat is. And this is why modern guidelines are starting to push for a more nuanced approach, right? That's kind of the big thing here: a more nuanced approach. And it's hopefully looking beyond a single number. We should be incorporating lots of other things. We can add on, you know, if a BMI is elevated, you can add in things like a waist circumference or a waist-to-height ratio, which gives us a better sense of If that person has that harmful central ad, central ad is just having a lot of fat tissue around your abdomen. A lot of times, that is a marker for that fat around the viscera or the organs, and that's usually not good. So you have a big Ad around the central side of things, you, big belly, that a lot of times that can be an issue and problematic. And ultimately, though, what we're trying to say is: hey, if someone doesn't elevate a BMI, hopefully, we're getting to the point now where we start to. Assess them, maybe do things like a waist circumference or waist to height so we can get a better understanding of what's going on. And it's a modern diagnosis, right? So we should have modern understanding and not just conforming to BMI. Although BMI can be very helpful, I think a lot of people say BMI is worthless. It's certainly not worthless. The way I typically think about this is BMI is a screening tool, right? If someone screens high on a BMI, then that should be looking for you: okay, do I need to do another test, like anything like that? You know, a of times you'll see BMI. And it's very elevated, and that person has lot of ad. You, yep, that is concordant. That works. But other times, you'll get every once in a while, especially in the military athletes. Where you have a pretty high BMI, and you look at, you like, oh, that dude's just incredibly shredded. He's jacked. And that's very rare. That's the thing. Most people think, oh, BMI doesn't count because, like, oh, I'm shredded. Like, that's very, very rare. I'm just going to tell you that right now. Usually, actually, what's the other way is. People have a quote-unquote normal BMI, but carry too much fat. So, that's a very common thing, too. So, that's another reason why BMI can be an issue because it actually underestimates the amount of people who actually are at a higher risk. Someone who's you know in a normal kind of area 24-2 but has a certain amount of fat and they have really no muscle like that can be an issue and that's actually potentially dangerous and we missing that. So BMI for multiple reasons. Can be an issue, and I think that's important and worth mentioning. And so, understanding the biology of this, right? So, if the eat less, move more mantra isn't the whole story, like we've been told, right? What are we up against? Well, the answer Lies in our own physiology, right? Our bodies have a complex neuro system that is designed to kind of defend a specific set point, right? So, when you get to a specific body weight, this is called a set point. Your body likes to stay there. Kind of, it's the survival mechanism to prevent starvation. And I'm not talking all about starvation mode. That's like a whole other thing people talk about in social media, but we won't go there. But It's a kind of idea that it kind of prevents you from losing weight. So when you're at a weight and you lose weight, your body interprets it as: hey, like, I don't like that. I want to go back to where the thermostat is set and it goes a It kind of helps you trying to get back there. So it makes it harder for you to lose weight. So, this counter to kind of get you back up to where you were kind of happens on two different fronts, right? So, first, Your metabolism actually slows down more than it would be expected when you lose weight. So, you are when you lose weight, you will have your metabolism go down. That's like what happens. But sometimes we'll see like a more dramatic slowdown. And so that can happen. body actually becomes more energy efficient and doesn't need to burn as much. So you've lost weight. And then your body says, Hey, actually, we're going to calm it down even more. So it harder to lose the subsequent weight. And so That is important. But then, second, and this is a key part: a cascade of hormonal changes is working against you this whole time. Level of satiety hormones that make you feel full, like leptin and GLP-1, they also go down. And so, at the exact same time as that. Levels of hunger hormones like ghrelin go up, which powerfully increases your drive to eat. And so, this puts the patient in an almost impossible situation where they're constantly, you know, fighting biology, right? This biologically driven hunger with a slower metabolism is not a fun place to be in. And we know. Time and time again, that's why people have issues, and this is precisely why long-term weight regain isn't a failure of willpower necessarily or discipline, it's almost predictable at this point and almost a robust physiologic phenomenon. Like, we almost expect that. The real clinical challenge, though, isn't just losing the weight. It's finding a way to overcome the body's powerful defenses of this elevated set point and help weight loss be maintained for a long, long time, right? You know, we've known that diets work, right? Look at the biggest loser. If you just cut out calories extremely and you do it, you'll lose weight. But then, some huge percentage of them regain like almost all their weight. And so it is very, very hard to maintain weight. Losing weight relatively easy for a short term. Long term can be very, very challenging. And Talking about lifestyle, though. So that the big thing, right? We talk about: hey, if you want to lose weight, lifestyle, lifestyle, lifestyle. And I will be the first person to say lifestyle is incredibly important. And so this is not me saying lifestyle is not It's very, very important. But there's some nuance to that, like most things, but it's critical to understand. That lifestyle, when we talk about diet, exercise, behavioral therapy, it is and always will be the foundation of obesity management. Like, absolutely. Almost everything from a health perspective, any chronic condition should be treated with lifestyle things and on top of other things if we need to. So. We know intensive programs absolutely work for short term. They can lead to 5% to 10% weight loss, and that's clearly associated with improvements in risk factors like blood pressure, triglycerides, blood glucose, pretty much everything. The overwhelming challenge, though, as we discussed, is sustainability. Because of these powerful biological drivers for weight regain, the vast majority of individuals who lose a lot of weight. With lifestyle changes alone, it will regain most of it within two to five years. For about 80% of patients, the try and fail model is essentially what it is: not try and succeed. It's really try and fail or try and regain because it happens over and over again. And so we looking at 80%. So I do want to mention we have 20% of people who are able to sustain that. What makes up those 20% of people? That's probably a whole different podcast, but it can be done. And so this is not me saying, hey. You know, it big pharma for life, you just gonna have medications, so it can happen, but it takes a lot. And so, for four out of five people, they're not gonna have success. And so, that the thing for 20% of people. We can't just focus 100% of our efforts on trying to get 20% results. We have to figure out: okay, for the people, the other people who fail, the other 80%, what do we do? And that's just something to mention there. On top of this, there's some really interesting evidence from a trial called the Look Ahead trial, which followed over 5,000 high-risk patients with type 2 diabetes for nearly a decade, so almost a decade. And despite achieving greater weight loss in this specific intervention group, the intensive lifestyle group had no significant reduction in major adverse cardiovascular events. And the trial was actually stopped early for futility, saying there was not an efficacy gap between the two, saying that the amount of weight loss from lifestyle alone was often insufficient to prevent major events, which is, I'll be honest with you, this is kind a head scratcher, right? If you losing weight, We think a lot of your risk factors will get better, right? Blood pressure, blood lipids, blood sugar, all that stuff. But we're not seeing improvements in major adverse cardiovascular events, things like heart attacks, stroke, and deaths from all those things. If we're not seeing that, why is that the case? Well, it's complicated, right? I'm not entirely sure on that, but it kind of meant to scratch our head: like, okay, if we just having people lose weight for the sake of losing weight, but not actually helping to improve outcomes. What's happening? You can definitely argue that they're having improved outcomes, right? From an orthopedic specialist here, my world is if I see lose weight, they probably going to feel a lot better and they're going to move better. And so, like, it's not without any benefits. But they're just saying in this study, this big study, they didn't see any cardiovascular ones. And this is once again in patients just with type 2 diabetes. So a lot to see. But it got us questioning: why would they lose weight but not necessarily have improved outcomes? That's just something we have to think about. And so, this efficacy gap left by this look-ahead trial is exactly where this new generation of medications kind of comes in. So, instead of fighting against the body's drive to regain weight, these drugs work with the patient's physiology. In mind, by directly targeting its neuro pathways that regulate appetite and energy balance. So, the new class are kind of known as encretin-based therapies. And so, I think everybody's probably heard of these by now. But they work by mimicking or augmenting our body's own natural gut hormones, specifically gluca, like peptide one or GLP, and glucose-dependent insulinot polypeptides, say that three times fast or GI. The main players you've probably heard about are Semig, which is a GLP-1 ag, and Terz, which is a powerful dual GLP-1 and GIP ag. By addressing the core biology of hunger and satiety, these agents are able to bridge the long-stand gap between the modest results of lifestyle changes and the more. Invasive options of bariatric surgery. This represents kind of a fundamental shift in our ability to medically manage the chronic disease of obesity. It really, really is. We'll talk more about that, but. You know, the levels that we're seeing before could only be seen by bariatric surg. Now, medications are kind of giving a bridge for that. There's issues, we'll talk about them there, but this is kind of where we're saying: hey, this is how we can help augment. And fight against obesity that we haven't been able to previously. So, pretty darn sweet. And so, I do want to talk about the numbers. So, let's look at the numbers that are causing this paradigm shift. First is semig, right? Which was studied in the STEP clinical trial program. There's multiple steps: step one, two, three, four, bunch of them looking at things. Step one, so the key in step one: patients without diabetes taking semi-glutide, 2.4 milligrams, saw a mean weight loss of about 15%. In 68 weeks, and that's pretty impressive compared to just 2. 4% with place. So 15 % versus 2.4%. That pretty darn good. So to put that in perspective, over a third of the participants on sem-glutide lost more than 20% of their body weight. A result previously only associated with bariatric surgery. Like I mentioned before, we're getting crazy levels here, completely not seen before with medication. And then came Terz. So we look at another amount of levels of trials called the Surmount Trial Program. And the pivotal Surmount One trial. Patients on the 15-milligram dose of Trez achieved a staggering mean weight reduction of nearly 21% at 72 weeks. And that's pretty crazy. So 21 %. And on this dose, An incredible 91% of patients lost at least 5% of their body weight. So before weight loss medications, it was like, okay, if we lost 5% to 6%, 7%, that's pretty good. That's pretty darn impressive. So we went from lifestyle changes getting us maybe that 5%, right? So, like, maybe we'd get that 5-7%. That's great. And now we're seeing 15 to 21% on average, which is crazy. It's a seismic shift. And You know, we had some medications before. We had a couple of different ones. We still have some more ones that can work okay. You know, we talk about different ones. We have combination medications and isolated ones. And they can still get you there. But we, hey if you've lost 5%, that's like a win. And then here they're just saying, no, 21%. So we're just blowing it out of the water. That's why everyone's talking about these medications. They seem to be very, very helpful for weight loss. And as impressive as the weight loss numbers are, they're not even necessarily the only big thing they talk about in this study. I think the real game changer was the select trial, one of them, the landmark. Study here, this ele for design to see if people with obesity and treating it with saline glut could actually prevent cardiovascular events, right? So it enrolled over 17,000 patients who had a pree cardiovascular disease. But importantly, did not have diabetes. So, these are a high-risk population, have you know pre-existing cardiovascular disease, so very high risk of it happening again or having an incident, but don't have diabetes. And the results were pretty impressive. Over the follow-up of about 3. 3 years, treatment with semi-glutide of 2. 4 milligrams led to a 20% reduction in the risk of major adverse cardiovascular events. That's a composite of cardiovascular death, non-fatal heart attacks, non-fatal strokes, stuff like that, compared to place, right? So 20 % better than place. And this is the first time an anti-obesity medication had definitively shown to prevent these hard outcomes in a secondary prevention population. Without diabetes. So, hey, this people who are just do not have diabetes but are high risk seem to reduce events, and that's pretty impressive. And what's even more fascinating, though, is that Further analysis suggested that the cardiovascular benefit was independent of the magnitude of weight loss, which is interesting. And it implies that maybe these drugs have some other benefits, right? So maybe pleiotropic effects. Things like reducing systemic inflammation or having beneficial actions on the heart and vasculature. Not entirely sure what's going on, but it kind of recategorizes these agents potentially from just weight loss drugs to Cardiovascular risk reduction agents, potentially similar to how we think of statin medications. And I know you're saying, oh, Jordan, just talk about medications. Once again, if you can do this without medication, I will always chew that, right? Because there's no side effects really to working out other than maybe, you know, have an injury, whatnot, or, you know. Very, very safe in general. But for the vast majority of people, like I mentioned previously, that 80% of people who can't effectively lose weight on their own and do that, like This is where this comes in, right? So that the big thing. And so, yeah, I'm not saying, oh, cool, cool. We have another medication. I'm saying cool medication because it can help a lot of people. So I'm never going to be someone who like, oh, like, you't do it my way. Sorry, can't do it. Obviously, there's certain things where I won't compromise and whatnot, but. Yeah, at the end of the day, this is very, very impactful, and I think it's really cool. And as I mentioned, though, side effects: no effective medication is without side effects, right? And it's crucial to understand the profile of these drugs. The most common adverse effects for any of these medications are gastroint in nature, right? So, this includes things like nausea, vomiting, diarrhea, constipation. Occ, rarely see like gastro, and these are usually mild to moderate and occur most frequently during the initial dose and dose escalation periods. So, a lot of times, these kind even out, patients don't feel good, and they get used to it, and they can handle it. If they go too high, sometimes they have to pull it back. There's lots of things we can do. But for most patients, this is manageable with slow dose escalation and proactive education. You know, let them know: hey, maybe this is going to happen. So, advising smaller meal portions, something like that. But there are more serious, though more rare, risks that could happen, including potential risks of pancreatitis and gallbladder-related disorders. So, crucially, both drugs carry a box warning as well. Regarding a risk of thyroid C cell tumors. This warning is based predominantly on rodent studies, but because the relevance in humans is uncertain, the drugs are saying, hey, if you've ever had a history, a personal history or family history, Of medullary thyroid carcinoma or multiple endocrin pl type 2, this isn't for you. And so, those are the big ones, like the people who wouldn't qualify for this. Obviously, there's other reasons potentially as well. But if you've had the history of thyroid cancers, they're saying, hey, Based on the rodent studies, like we may want to hold off on this, but even then, it's not on hard human data. But the other two points I want to talk about that are vital for long-term management is first, Like any form of weight loss, these drugs can cause a reduction in lean body mass along with fat mass, which highlights the critical importance of incorporating resistance training. To preserve muscle, I've talked previously on other podcasts about myostatin inhibitors and trying to combine myostatin inhibitors with these medications of the future so you lose weight and hold on to muscle. We're not there yet. But it is pretty well known. Specifically, semig, it seems like more than tr seems to lose a lot of lean mass. And so we really want to hang on to that. So, resistance training and eating enough protein is very important. And second, when all these medications are not a short-term cure, right? Studies have shown that when these medications are stopped, patients tend to regain about two-thirds of their lost weight within a year. So two-thirds within a year, reinforcing that obesity is a chronic disease that requires chronic sustained therapy. The way I look at it here is people go, Oh, you to be on it for life. Well you got to be on something for life, right? You can't just like eat whatever you want for as much as you want, for as long as you want, like, and not expect to gain weight. Like, that's just life in our current society. Unless you have a very locked-in diet where, hey, I can eat as much broccoli as I want, or I eat, you, you're probably going to be okay there. But I tell everyone, you're going to do something for the rest of your life. Whether that is being conscious about what you're eating, you know, conscious about the time in which you eat, being on this medication, something you're going be doing for life. And so it's not just this quick fix philosophy, even if it's taking a medication. It's on it for life. So, this is why getting on it, I'd love to not have to get on this medication, right? Because you're going have a medication, it's going to cost you something, it's going to have potential side effects for life. So, I'd like to not do that, but it is worth mentioning that some people need that. But if you're on it, you most likely are going to need it. Now, there's lots of cool research coming out about timing, meaning, hey, once we pull off, can we do every other week? Can we do once a month? Like, we're going learn lots and lots of things as we move forward. But currently, right now, as it shows, when you stop it. You regain that weight and almost all of it back pretty darn quickly within the year. And so, have to be on, that's the bummer about these medications. And so, when you put all this evidence together, the limited cardiovascular benefit of lifestyle al versus the proven reduction with these agents. The old fail-first model kind of becomes clinically indefensible. And so, just in my opinion, and that's kind of what the big ACC, American College of Cardiology, is talking about here. As I mentioned before, we would never tell someone with severe hypertension to, hey, you got to trial a change in diet in your lifestyle first before start medication. We would treat concurrently, right? We 'd do it right away. This fail-first approach is a relic and it's unique only to obesity. It's based on an outdated understanding of biology. That's the big thing I see all the time. For whatever reason, obesity has a stigma, right? Because we can see it. You can't see when someone's hyper. You can see when someone has obesity. And so a lot of times we think, hey, this is a failure of willpower and you should just do better. But we would never, ever, and that person who has sky high blood pressure be, hey, have you tried lifestyle first? Like, oh, and you come back and talk in six months and say, oh, well, like, you know, try something new. No, we would treat them, we would treat them. At the same time, we would treat them. We'd say, hey, by the way, to help make this even better, let's talk about exercise, let's talk about nutrition change, let's talk about a low-sodium diet things. We would do all that stuff. So, why are we not doing that? And I think we're kind of in that point now where we're starting to think about that, right? So, the American College of Cardiology does have a 20 clinical guidance paper that went out, and it formally has kind of dismantled this old model, at least in their opinion. Their statement is. Pretty unequivocal, and I'm quoting directly here. It says patients should not be required to try and fail lifestyle changes prior to initiating pharmacother. Nonetheless, Lifestyle intervention should always be offered in conjunction with obesity medications. So, once again, they're saying we should do both. It's not either and, it is both for the patients who need it. And this is a new paradigm, right? It's not about replacing lifestyle changes with drugs. We're not saying that it's about using them together synergistically right from the start for the appropriate patients, right? The medication helps manage the underlying biology of hunger and relapse. Which can in turn make it easy for patients to adhere to the benefits of lifestyle changes. I hear it all the time where they just patients say it just like turns things down. Like, I'm not constantly thinking about food and I'm losing weight, and so I can move more. And so it's, once again, very synergistic. And I think a lot of people will have a judgment around this for whatever reason. It's still there. I know people who aren, don't want to prescribe these because they think it shouldn't happen. And that's fine. That's fine. I just trying to make an argument here for those clinicians to say like don't want to do it. Once again, if we treat this like a disease, if we think about it, would you ever do that for someone who doesn't have hypertension? I don't think you would. And so you can start these medications. Hey, and maybe it's possible where, hey. They have terrible lifestyle habits, like they don't ever work out, they eat terribly. And being less medications let them eat less, right? A little bit less, start to lose weight. As we're doing that, they're going to talk with dietetics, they're meeting with a trainer, and they start to learn these skills. And then maybe we could even come off it one day. Who knows? That's a possibility. I don't know. But would you say, hey, like, I, I, you know, I'd rather a patient just continue to be at their weight. Not ever exercise, hey, I took this medication and now I'm feeling better. Now I can exercise. We know exercise does so many good things. And so, once again, it's just kind of helped lowering the barrier for getting treatment. And getting improvement. That's kind of how I think about those. And though, I do want to address a concern, though, here that many people are going to have that this lifestyle-only approach is inherently better, right? So I kind of hinted to it before. Some people on the internet will say, hey, like, It's a moral failing to be to have obesity, and you need to just do lifestyle, and taking medication is absolutely like the end of the world. And I get it, as I mentioned before, in an ideal world, I'd prefer not to use medication for anything, but we have to look at the evidence. When we're dealing with this biological disease, and the lifestyle-only approach has been shown to be insufficient to prevent heart attacks, strokes, and the vast majority of people don't have success. And so, in my opinion, I feel like we have the obligation as a medical community. To use the most effective tools we have to help our patients. Not just the patients we agree with, meaning, hey, the ones who really want to exercise, can do this on their own, did it quote unquote right way. All of our patients. If they're to see you, then they deserve to have all the tools available. With that being said, though, the single greatest obstacle to this new standard of care is the system, right? It's systematic. These medications are prohibitively expensive. They're ridiculous. List prices can exceed $13,000 a year, placing them far out of reach of the vast majority of patients who need them or who are going to pay out of pocket for them. And so it's created a huge, severe health equity crisis as well. So, the problem is compounded by insurance coverage as well, which is notoriously inconsistent. Many insurance plans still have the fail-first model, right? That is the Vast, vast majority of them. Like literally on a prior off the sheet, you have to go through and say, Hey, how old is this patient? Have they done this? Have they tried six months of therapy? Oh, have they tried another medication? Yep, until they get to these medications. So they're kind of the gatekeepers there. And I understand that these cost a lot. So paying for them, and that's a whole issue there. But it takes a long time. You have to kind of fail, do all these things. And it's different from what I think the approach would be the most beneficial approach. But At the end of the day, I clearly can't blame anybody when they cost this much money. The big thing is, how do we get them into the hands of patients more earlier in their disease process to help them with that? That'd be the big thing. So. Having them, the price then should be lowered is the big thing. Obviously, we know our healthcare system is jacked up, it's going to be a big issue, but that'd be a big one. If we could get them out earlier for people, that could be helpful. But yeah, we'll. Wishful thinking, I guess, but that's a big thing. Really, the most realistic problem right now is it's just so darn expensive. And so, to wrap it up, the evidence is pretty darn convincing. The old fail-first model. Of obesity management, I think, should probably be obsolete. Obviously, it's going to depend on lots of things and medication coverage and all that stuff. But the new standard of care, I was outlined by the article in the ACC, is of consistent and concurrent use. Of intensive lifestyle interventions first and pharmacotherapy if necessary for the appropriate patients, I think is probably the way to go moving forward. Until the call to action from the ACC is for the entire cardiovascular community to embrace this medical Management of obesity as the primary strategy preventing heart disease. So they say, hey, we've seen reductions in those cardiovascular ev. There 's no longer a weight and C, these medications are no longer just weight loss medications. They can essentially be cardiovascular risk reduction agents that should be used in our higher-risk patients. So, and I do want to point this out. They're not saying, like, hey, every patient should be on this. Like, hey, if you come see me and you have some obes, like, you should be on it. No, they saying, hey. If you have a high-risk patient, like we should treat these as a potential adjunct for these patients to reduce cardiovascular disease. That's what they're saying. And looking ahead, the future is bright though, with an exciting pipeline as well, with even more potent therapies like triple agonists on the horizon, which may be more beneficial. But the most immediate challenge is in clinical, it's system it's systematic, right? So we need to figure out how to get these medications into the hands of the people who need them, which would be the most beneficial thing. And so that's kind of The overall take there. And once again, my take home is lifestyle always going to be important. Like, I will never say it's not important until we have a medication that can do everything exercise can do, or eating well, or sleeping. Like, that's going to be a long, long time. And so the pillars are still the pillars, right? Sleep, eat, exercise, the big things. But once again, if we had any other condition that would require immediate Treatment, we would do that, right? We wouldn, hey, just try, try, try again. And that's kind of what patients who have obesity have been experiencing. And so, this is just my two cents. Maybe you disagree with that, and that's okay. This is the more I've thought about this, this is kind of where I've come to almost like a harm reduction, right? We want to reduce the harm we have in these patients by treating them earlier and more aggressively. So that's kind of my thought. If you think different, let me know. I'd appreciate your Your perspective on things. But that is going to be it for today. Thank you so much for stopping by. I really appreciate it. If you enjoyed this podcast, it would mean the world to me if you either shared this with a friend or left a five-star rating on your podcast platform of choice or subscribe on YouTube. But either way, thanks so much for stopping by. Now get off your phone, get outside, have a great rest of your day. We'll see you next time. Disclaimer, this podcast is for entertainment, education, and informational purposes only. The topics discussed should not solely be used to diagnose, treat, or prevent any condition. The information presented here was created with an evidence-based approach, but please keep in mind that science is always changing, and at the time of listening to this, there may be some new data that makes this information incomplete or inaccurate. Always seek the advice of your personal physician or qualified healthcare provider for questions regarding any medical condition.
