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Speaker 0: This is Scott Beck with the Becker Health care podcast. I'm thrilled today to be be joined by Doctor Daniel Na. Doctor Na with the ge Health. System. And as an expert. He's a he's a very attrition. So he works with people weight loss. They're gonna talk today about the various different weight loss drugs and and what he's seeing how we've seen patients respond in a lot more. Doctor Did, Na, Can you take a moment to if you're introduce yourself, and it tell a little bit about yourself and your practice? Speaker 1: Absolutely. Thank you so much, Scott. So good morning, everyone. My name is Daniel or doctor Ad as Scott said, currently, working as a very attrition at ge her Medical center in Dan Pennsylvania. Said I spent about the last half 15 years of my life for so helping people lose weight. Speaker 0: It and and it talked us about the world of weight loss. Today. What what is... Mean, it seems like there's been tremendous changes with the... All the g Gl 1 drugs and so forth... What are you seeing today as a bariatric pediatrician Speaker 1: Absolutely. Well, that's a great question. So I like to start off by saying that, you know, weight loss medications have been around for a long time now. So medications like Oz, which were originally prescribed for the treatment of type 2 diabetes. They've been around for many years now. It wasn't until recently a couple years ago or so where medications like Leg, which had just been approved for weight loss, they were brought out on the market. So since the last year and a half or 2 years or so, I've noticed a an uptick in prescriptions of Gl 1 medications and patients coming in inquiring about them as well. Heard about the success stories. They know friends that are taking the medication. They've read about it on social media, and they're very interested in learning more about them. So I've been... They've prescribing them very often here in, Pennsylvania actually. Speaker 0: It it talked us about the success of these drugs What does that look like? Do they continue to work for people to have to up the doses to state on these? How is this working? What are you saying? Speaker 1: Right. No. I mean, the the medications work great. The data has shown that, and the patients are coming in with extravagant results. I mean, losing maybe up to 20, 30 percent of their body weight after being on the medication for less than a year sometimes. Now, ideally, you know, before last year, before 20 22, we didn't very... We didn't have very many options for pharma options for obesity treatment. We had oral medication. We had pills, like ph or contrary you may have heard of as well. And these medications didn't work as well as these injections that are now in the market, the injections are working much better. Now the issue with getting... Patients to be able to take this medication, mostly revolves around insurance coverage and affordability. Now the Gl 1 medications without insurance coverage, can cost up to 1500 a month, something like that. So even if you have a patient coming in who is overweight who has multiple comorbidities associated with their weight gain, and you wanna do something to help and lose weight. The insurance coverage is what becomes a barrier. Now, if somehow you are able to get insurance coverage, get the patient to start the medication, The protocol is usually the same. For all the injections that are available, you may have heard of names such as Oz, Leg go, Moon jar, and Z bound is another new 1 on the market. The the protocol is same for all the shots. So if you start the patient at the lowest dose, it's a once a week injection that you administer yourself at home, It comes in a pen form, so it's very easy to use. After 4 injections or a month at the current dose, the patient is able to increase their dose to the next step, and that depends on what medication there is some some of that more doses than the other. But as long as they're not having bad side effects on the current dosage of medication, We are able to increase the strength every month or so. Now the medications work well, because they actually slow down gastric motility. That is how they cause weight loss. So the Gl ones, you know, Gl stands for glucagon like, peptide 1, receptor agonist. We create this this hormone inside of our body naturally, the injections themselves are just agonist at the same receptor that works in the stomach and in the intestines as well. And it basically slows down your gas motility. It slows down your digestion. It makes you not want to eat, it makes you sick if you over eat, it gets rid of hunger cravings and how these medications I've been working to to cause weight loss. So most of the side effects that we've noticed, will include gastrointestinal side effects. Like nausea vomiting, diarrhea abdominal pain. All these are possible, and you do notice them you know, at the beginning when you start the medication, but then they tend to wear off over time. So if patients are able to tolerate the side effects, they're able to get the medication. And, of course, change some dive and, you know, lifestyle modifications as well, we see very good results in terms of weight loss for these patients. Speaker 0: And in your bariatric attrition. So you've watched this with sort of a bariatric and so forth, what what does this mean for bariatric surgery, what's the impact so far? You seeing a big impact yet? Speaker 1: I think that's a great question, Scott. So I do both. I do pharma options as well, but I also... Refer patients over for bariatric surgery, and then I'm I'm involved in their care after the surgery itself. So I may not be in the operating room doing the actual procedure, but I take care of these patients often. And, you know, I was also a little concerned about this these pharma options coming on the market and how that would affect surgery rates. But I will be honest with you. We haven't really noticed much of a decline in our patient's interest in bariatric surgery. So the number stayed, pretty much the same over the last year or 2. Think most of this has to do with the availability of the medication. So insurance coverage is not the only barrier. Say you do get approval from the insurance, they'll cover the medication and your c pays is affordable now. The next issue is finding a pharmacy that has this medication in stock. So I would say, almost there's too many people on the med medication right now. Even the people that needed like diabetic, for example, they're unable to get this medication. So people are still interested in weight loss surgery because They know they either can't afford the medication or they can't find it, and their weight is becoming an issue. So we haven't noticed too much of a difference in the rates of bariatric surgery. Speaker 0: Thank you. What about the cost? And we're still talking about a thousand dollars a month for these crimes, which leaves them if insurance are covering them, make them inaccessible to lot of the population. What what what do you see in the future? The trend gonna be the prices to come down? What do you expect there? Speaker 1: That's a very good question. I think I'm I'm hoping, and I do think that the prices will come down as there are more generic available on the market. Nowadays, you do have, compounding pharmacies that are willing to, you know, formulate the medications themselves, pre preclude the need for going through insurance. So there are... I think there's gonna be more options available as well as time goes on. Right now, the medications are still new. They were just recently approved for you know, treatment of obesity. That outbound, for example, just a couple months ago came on the market. So I think it's still a little too fresh. Though too a little too new. We need to give it a little bit more time, but I do anticipate there'll be more options available, more affordable options available with with due time. I do think that. Speaker 0: Thank you. And what... If you listen to the payers, there are all these horrendous side effects you know, Quasi independent studies that seem to be funded by payers saying that there is these horrible side effects of the Oz and stuff like that. Should we take all that with a grain of salt? Is that sort of really driven by not wanting to pay for stuff or any thoughts on that or or Hitting a political nerve with some people on that? Speaker 1: No. I think you bring up a fair point. So I've been prescribing these medications frequently over the last year and a half to 2 years, I would say now. Since they've came out on the market, I've been prescribing them. So for me, it is... I do have patients who have side effects on the medication. That's not uncommon. Now, depending on the severity of side effects, that that's... That that differs from case to case. So you have the gastrointestinal side effects that I mentioned, the nausea of vomiting diarrhea abdominal pain, You can have constipation. Now, these are the common side effects. These tend to happen with the introduction of the medication, diarrhea and these side effects tend to go away as you take more and more of the medication. Once you adjust the dose to maybe increase it monthly as I mentioned, It's possible side effects do come back again. But again, they tend to wear off the more you take the medication. The more severe side effects now that we're talking about would include things like pan or gas or even this risk of med thyroid cancer. Now those side effects are possible. They are most certainly possible, especially because they are they're directed correlated to the mechanism of action of how the medication works in the first place. What I tend to do is I warn my patient that it is quite possible that you can have these mild side effects, and is also certainly possible you could have these serious ones that would nec you going to the emergency department, for, for example, if you develop pan. So I tell my patients, you know, make sure you're drinking enough water on these medications, eating enough protein, it's gonna... The medication is gonna make you not want to be. That's... That just means it's working. But I do tell my patients to still, you know, try to get their protein and taken in daily. Try to drink enough water, if they can and alert immediately if they develop any side effects at all. Because then I need to decide if they need to go to the emergency department if the medication needs to be stopped or if the dose needs be adjusted. Now it's only been a year or 2 since they've been on the markets since I've been prescribing them. It's hard to say what the long term side effects of these medications are. I do have patients who do develop gas on the medication. I need to stop it, and then the side effects tend to go away more often than not. But it's it's too soon to say what the long term studies might show or what side effects these patients may develop. Some people do have bad reactions to the medication Usually just end up either switching it to a different agent. So if they're on Oz zen, for example, I will switch it to Wig or Mon, if they continue to have the bad side effects, I will just stop the medication and you know, at least we tried it. So it's still, I think a little too soon to they stuff. Speaker 0: What what percentage of people have tried these medications so far for weight loss. But we at 10 percent so far? And and where do you see that topping out. I mean, can we get to 40, 50 percent of people that trying some medications? Speaker 1: I think right now, the biggest issue is it's the supply. It's definitely not the demand. So people want to take these medications. People, you know, we have about 1 in 8 adults is what I would say had taken a Gl 1 agonist. So I mean, that's quite striking. That's pretty significant rate. And I know that I still see patients as new initial consults in my clinic who are coming in who are interested in starting these injections. I will do, and whatever I need to to complete the prior authorization. But at this point, you, I've gotten so good at it. I know already which insurances we'll cover it, which insurances completely deny the medication, which insurances need, proof of a, something like sleep apnea or type 2 diabetes or fatty liver example, those are the threes some insurances look for. So I know there's people that want to be on these medications that want to take control of their help. And me as a very attrition. I would love to prescribe these medications But the rate limiting factor of course, is the the supply. So right now, I have patients who have been without the medication for 2 or 3 months now. They're unable to get it no matter what pharmacy they call there is a national back order on With adobe. So these patients now unfortunately have been gaining weight, and that's another problem we're seeing once the medication is stopped, which would be for a variety of reasons. It could be because the patient's developing adverse effects. Number 2 it could be because they've reached their weight loss goal, and they're no longer appropriate for injections anymore. Now these patients we've noticed are steadily increasing. They're gaining their weight back, and that's another issue we've we've come across recently. Speaker 0: Like they go back to the metabolism and operates as normal Their intake goes back to normal, which was no good. So they gain weight back. At the end of the day. Got it. Anything else Doctor Nadine redeem that you'd like to share with you audience it's about the weight loss drugs and what you're see in the future. Speaker 1: So, this is my third year in practice and I was as a specialty position as a very attrition. When I started my fellowship training about 3 years ago. That was around this the time where we didn't really have any prescription injection medications to offer our patients. So we had very limited options. At the time of my fellowship, most of my my visits were spent counseling these patients on healthy diet, lifestyle interventions doing a little bit more exercise, you know, portion control, focusing on the my plate method. So it was a lot of lifestyle changes. Now with the injections coming on the market, everyone using them, they're being so popular on social media, I know people are looking for a quick fix. They want something that works rapidly, that's easy to do that doesn't require a lot of time and effort. And I'm not gonna lie. I'm not gonna beat around the bush the medications work well. It works. But the issue that we see is what happens when the medications are either not available when they're stop when they're not affordable anymore or when you can't find them, what happens to our patients. And as I mentioned, they're gaining the weight back. So what I've been emphasizing to my patients at my visits, my Emphasizing that my coworkers as well is we need to get on top of healthy diet and lifestyle interventions. We need counsel our patients on how to eat with or without the medication, increasing protein, cutting down on our carbohydrates, exercising at least 3 times a week These are all recommendations that have been there since the beginning of of bariatric and they will continue to be, you know, the biggest pillar when it comes to weight loss. So I encourage all my patients. Everyone listening to this podcast who was interested in losing weight and potentially starting a weight loss injection remember that diet and exercise is about 80 percent of it, you need to be able to eat healthier. You need to do some type of physical activity to really bring these medications to to the top of what they're able to do. So that's Speaker 0: may it really has to be a well rounded effort at the end of the day. May the medications plus diet and exercise plus, you know, drinking water doing the right things. Speaker 1: And that's what the study show as well. It was a injections coupled with died in lifestyle interventions as well. Need could be part of a comprehensive weight management program to really see how these medications can work for their fullest potential. Speaker 0: Doctor. I wanna thank you so much for joining us sand the back to Health your podcast. What a pleasure to visit with you. Thank you so much for joining us. Speaker 1: You're me today. Thank you so much.