Episode 74: Weight Loss Drugs, Beyond the Phen-Fen fiasco

Weight Loss Drugs, Beyond the Phen-Fen fiasco

Is weight loss really just a matter of willpower? Is it true that all you’ve got to do to lost weight is just measure ‘calories in, calories out’? What if your body does not respond the way you expected it to – despite trying everything everyone suggested? Today, let us delve into the topic of seeing obesity as a disease that needs to be treated, not just with diet and exercise, but sometimes even with real medications. In this episode, let us shed some light upon the misconceptions and the significance of obesity treatment using medications.

I am delighted to have Dr. Alexandra Sowa on today’s episode of the Decoding Obesity podcast. Dr. Sowa is a dual board-certified physician of Internal Medicine and Obesity Medicine specializing in metabolic health and is a clinical instructor of Medicine at NYU Langone.

She is also the founder of Sowell Health, a consumer metabolic health company. Sowell Health’s foundational product, the Weight Loss Biology Kit, is the first at-home lab kit to test for insulin resistance and other metabolic factors that make up your weight biology. She has served as a health expert for national media outlets.

Key Highlights: 

Tune in to this very informational conversation with Dr. Alexandra Sowa and learn:

• When and how drugs for obesity management started
• Common medications available now for the treatment of weight loss
• The confusion between the drugs Phentermine and Fenfluramine
• Some misplaced fears and inaccurate notions towards Phentermine and other obesity medications in general
• Society’s wrong perception about weight loss and taking medications
• What Saxenda is and how it helps people lose weight
• All about the newest FDA-approved drug, Wegovy
• The process of getting medicated or receiving obesity treatment in clinics 
• How medication works in conjunction with a personalized diet plan
• All about Sowell Health Company’s biology kits (weight biology kit, PCOS kit, etc.)

Six Medications Available for Weight Loss Treatment:

Approved for:

• Obese patients (BMI: >30) and; 

• Overweight patients (BMI: 25-30) with comorbidity (ex: sleep apnea, hypertension, heart disease, type two diabetes, etc.):

1. 1. Qsymia
   2. Alli
   3. Contrave
   4. Saxenda
   5. Wegovy

Approved for: 

• Obese patients (BMI: >30) and; 
• Overweight patients (BMI: 25-30) with or without comorbidity

1. 1. Plenity – This is not classified as a drug because it does not act on any central mechanisms. It’s just a fiber that ‘expands’ in the stomach and helps fill you up (or make you feel full). This is also approved for people who are overweight. 

The Difference between Fenfluramine and Phentermine:

• Fenfluramine – was a weight loss drug that was released in the market but was eventually pulled out since some people who took the medication experienced heart valve problems later. This was because fenfluramine acts on receptors that are in both the heart and lungs, causing heart failure. This incident has then set the path for more extensive study of weight loss medications.
• Phentermine – is also a weight loss drug that is technically only approved for short-term use for weight loss. However, logically speaking, it is part of Qsymia which has been approved for long-term use. Phentermine has already been studied extensively and is relatively safe for long-term use.

Medical conditions that Must be Considered before the use of Phentermine:

1. Heart Disease
2. Uncontrollable High Blood Pressure
3. Extreme Anxiety or Insomnia

All about the Drug, Saxenda:

• It mimics an ‘anti-hunger hormone’. It affects both the brain, stomach, guts, and pancreas.
• It is a daily injectable medication.
• It primarily works by decreasing your stomach emptying time. Food sits in your stomach longer. 
• It tells the brain to stop sending hunger signals.
• Weight loss with Saxenda is about ten percent (10%) of total body weight. Combined with personalized nutrition, one could achieve a much higher percentage. 
• It’s approved for long-term use. 
• One of the side effects is that it can make people feel nauseous.

All about the Drug, Wegovy:

• It’s not a new medication. The drug itself has been around for quite a while it was approved under a different name called Ozempic, for the management of type two diabetes. 
• Ozempic, like Saxenda, are all in the same class.
• Wegovy goes to much higher doses
• It is a once-weekly injection. 
• Studies show that there are people over 12 to 18 months losing about 15% of their total body weight. Again, even higher when combined with lifestyle.

Quotes:

“It’s not one size fits all for obesity care. It has to be individualized to the person who’s receiving the care.” – Dr. Avishkar Sabharwal

 “Food and lifestyle is at the core of any successful weight loss.” – Dr. Alexandra Sowa

 “This is not about willpower; this is about biology.” – Dr. Alexandra Sowa

Links:

Dr. Alexandra Sowa: Get So Well

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