Considering GLP-1 drugs for weight loss? Advice from a doctor who’s used them : NPR

Dr. David A. Kessler is always in the business of keeping people healthy – but with his own acceptance, he has not always applied it to himself.

Kessler’s problem was with eating. French fries and salty beef meat in medical school, helped to work late at night and continue to do research. Over the years, the weight has been fluctuated. It earns 20 or 40 pounds in a relatively short period of time, then slowly loses weight by making a high -protein diet and exercise with low carbohydrates.

In the 1990s, he continued a long career, including better nutritional labels and a seven -year term of office, including the seven -year term of office of the Food and Pharmaceutical Administration.

After two years of the White House Covid-19 intervention team spent two years, Kessler gained a significant weight. The usual diet and exercise routine did not help him lose weight as in the past. Later, an endocrinologist asked if he wanted to try one of the new Glucagon Peptit-1 class or drugs containing Wegovy and Mounjaro.

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He lost about 60 pounds in seven months after he started injections. KESSLER Documents his experience in the new book Diet, drugs and dopamine: A new science of obtaining a healthy weight. It also breaks the science behind obesity and what makes these drugs so effective.

Here are eight packages of our conversation about using KESSLER and GLP-1 drugs and changing weight loss views.

Flatinal Books/Joy Asico-Smith/NPR

1. Our food environment increases weight gain

Kessler, high foods as “extremely delicious and energy intensive” “extremely delicious and energy intense” foods almost everywhere and brain chemistry pushes us to consume.

“We put it [them] We have made it available in every corner and 24/7. We live in a food carnival, “he says. What did we expect to happen? “

Kessler calls these foods as “ultra -formulated” (instead of “ultra -processed”) because it is designed to manipulate the brain’s reward system. They can activate the same award centers made by addictive drugs. “This is not the will, or he says. “Biology.”

GLP-1 drugs are very effective in opposing this pattern, he says. “They changed the view of weight loss, Kess Kessler says.

And while obesity and chronic diseases want to see the “root cause” discussed, he says, “It’s not optimistic about we will change the food environment overnight”. By the way, these are effective tools. “

2. Being overweight is not always unhealthy, but some kind of fat

BMI or body mass index has been used to measure obesity for a long time, while the KESS are among the increasing number of scientists who say that health is not a useful indicator.

Vissceral fat in and around the abdominal organs, including KESS, stomach, liver and intestines, is the driving force of metabolic disease. Viseral fat leeches, fatty acids called adipokines or chemokines that cause systemic inflammation in the body.

Kessler, “And the inflammatory condition, cardiometabolic disease, kidney disease, diabetes, some cancer forms and potentially causing some neurodegenerative changes in organ damage,” he says.

KESSLER, measuring your waist circumference, you can get a rough estimation whether you carry a risky amount of visceral oil. It is a rough indicator of a peripheral environment larger than 40 inches in men or a 35 inches in women. You can also calculate waist / hip ratio.

A body composition scanning can provide a more precise measurement.

3. Relax from being uncomfortable with GLP-1 drugs

Kessler, the best thing about these drugs is that they allow you to learn how to defeat. But this comes with some warnings.

Kessler says GLP-1 drugs are strong appetite printers. They increase their emotions, and after a smaller part than normal, they make you feel full. They do this by slowing down the pouring of the stomach into the small intestine, so that they hold the food for a longer time in the stomach.

This feeling of fullness may not be pleasant. Kessler describes this as “on the edge of nausea”. Compare that your stomach can feel when you eat a little too much at the day dinner.

If you proceed and still continue to eat, you may experience GI problems such as abdominal pain, diarrhea and vomiting. In the book, Kessler acknowledges that you cannot really separate these unpleasant emotions from the effective mechanism of drugs.

“There is a great variability,” says Kessler. Some people take drugs and lose weight without side effects.

But for most, he says it is a negative reinforcement element. “If you put something else in that stomach, you will be conditioned not to put more food in your stomach.” As a result, patients begin to eat less and avoid heavy food.

In worst, side effects such as vomiting and nausea or hypoglycemia can take you in emergency service.

Kessler, “I do not think that companies are level with the American people about how these drugs work,” he says. They can be a powerful part of a plan to gain and maintain a healthy weight, but they should do more to train drug producers and FDA, consumers about side effects.

4. Find a good doctor or better, a team

Side effects are an important reason for working with a doctor who can monitor your progress and help you find the right medicine at the right dose. KESSLER may be your doctor or intertwined. He says that it is ideal to work with an obesity medical specialist, but that finding one may be a challenge.

And taking this medicine will change your eating habits, Kessler advises you to work with a dietitian or nutritionist with a doctor.

He says that many people can enjoy food in this smaller portion size with good medical care.

5. Eat abundant protein and fiber

KESSLER, GLP-1 drugs do not change the foundations of healthy eating and it is important to be careful about your food choices in drugs.

If you are trying to lose weight, protein is the key with medication or without drugs, because it increases the feeling of fullness. And some bad things can take part in the dinner.

“If you increase the protein, you reduce the rapidly absorbable carbohydrates, you reduce fat, excess calories and sugar,” he says.

And when he’s in a GLP-1 medicine, he says it is very important to eat high foods in the fiber. Remember, the drugs slowly slow the stomach into the small intestine, which can lead to the withdrawal of things even further, says Kessler.

“People think that constipation is just constipation, but constipation can turn into intestinal obstruction that can cause perforation, and people can die,” Kessler says. “So it is essential to keep the GI path healthy.”

And stay juicy.

6. Know the risks, including those who are not on the label

Kessler, people who use drugs are increasingly worried in the other direction – malnutrition.

“Many people in these highly effective drugs are less than a thousand calories a day, some are as low as 600 to 800 and this is a semi -starvation level,” he says.

Kessler says that drug producers should do more to inform patients about eating disorders and gastroparesis – a chronic situation in which stomach ejaculation is significantly slowed down.

Kessler is also common to lose some muscle mass with fats that may be problematic in these drugs. A study in the book showed that 40% of weight loss in patients with Semagluid injections once a week comes from lean body mass. And about one -third of it meant. This is a reason to keep it above your nutrition and strength training in these drugs, “Especially for older people like me, [already] Sensitive to muscle loss. “

There are people who need to stay away from GLP-1 drugs, including Kessler, personal or familial history. Some thyroid and endocrine cancersChronic kidney disease, pancreatitis, inflammatory bowel diseases, uncontrolled diarrhea or constipation or gastroparesis or if you are pregnant.

7. Compound versions of drugs can be more risky

KESS, usually cheaper than brand drugs and can be ordered online compound GLP-1s, he says.

Kessler, “A drug approved by brand name manufacturers … There are inspections, there are standards to ensure that those who are injected are actually matches with the ones on the label. On the FDA.”

In compound drugs, active ingredients are produced abroad, sent collectively and distributed to the unification pharmacies through intermediaries. “I’m not even sure that everyone can watch the drugs where drugs are done, or he says.

8. In the case of exiting GLP-1s, there is not much guidance.

When the Kessler reached the target of personal weight loss, he was developing slight abdominal pain, so he decided to stop.

Nevertheless, after leaving the drug, Kessler says he flew blind when he comes to protect his weight. And he thinks it is a problem.

Kessler, “Companies and FDA, no one has described a last game with these drugs.” Says.

He says that there is little data on how to cut the dose from milk and tremble or to deal with how to cope, or how to set up when your appetite and requests begin to return. In addition to working to remove the medicine with your doctor, KESSLER recommends a high-protein diet because protein repeats the feelings of satiety you receive from a GLP-1 drug and can help you maintain a lower weight.

He has been on and out of the drug again for the first seven months.

“But this, we don’t have to use drugs, blind flying, find our own solutions, “he says. Companies have to examine this. FDA should require how to use these drugs safely. “