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Chasing Life

Many of us are setting new personal goals in the new year – like exercising, eating healthier or even trying to lose weight. What does our weight really tell us about our health? Is it possible to feel healthy without obsessing over the numbers on the scale? Are our ideas about weight and health based on outdated beliefs? On this season of Chasing Life, CNN’s Chief Medical Correspondent, Dr. Sanjay Gupta is talking to doctors, researchers, and listeners to take a closer look at what our weight means for our health. Plus, what you need to know about the latest weight loss drugs and how to talk about weight and better health with others, especially kids.

Dr. Sanjay Gupta

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Is Ozempic Really A Miracle Drug?
Chasing Life
Jan 30, 2024

New drugs like Wegovy, Ozempic and Mounjaro are billed as a revolutionary new approach for losing weight. But are these actually miracle drugs? Dr. Sanjay Gupta turns to Yale School of Medicine assistant professor Dr. Jorge Moreno to explain the science behind these medications – from the benefits to the risks to the unknowns. Plus, what anyone who’s interested in taking these drugs should know.

Episode Transcript
Dr. Sanjay Gupta
00:00:00
At this point, there's little doubt you've heard about these new weight loss medications that are seemingly taking the world by storm.
New Montage
00:00:07
Ozempic. It is literally the hottest drug in the country right now.
New Montage
00:00:11
Everyone's like "ooh smaller portions." Shut the [redacted] up. You're on Ozempic.
New Montage
00:00:17
"Everybody I know is on it," a reality TV star told The Wall Street Journal.
New Montage
00:00:21
But here's the thing: ozempic is not just for famous people.
New Montage
00:00:25
It's injection day... Zephound.
New Montage
00:00:29
I'm going to tell you guys the weirdest thing about being on Wegovy.
New Montage
00:00:32
When I look around this room, I can't help but wonder, is Ozempic right for me?
Dr. Sanjay Gupta
00:00:39
I've been a medical reporter for more than 20 years, and I got to tell you, I don't think I've seen medications become household names as quickly as this in quite some time. And I'll be honest, whenever there's a new medication out there that's suddenly getting a lot of hype, I am typically a little skeptical. It's not that I don't want these medications to work. I really do. But I also know that science, at least good science, can take time. It takes a lot of rigorous testing and trials and data to truly know how effective and safe these medications are really going to be. That's why on today's show, I'm turning to an expert in obesity medicine and weight loss to try and get some answers.
Dr. Jorge Moreno
00:01:20
I remember, I remember exactly, I was in my office reading the article about semaglutide Ozempic and, you know, my first response was, it works. It really works.
Dr. Sanjay Gupta
00:01:31
Doctor Jorge Moreno is an assistant professor of medicine at Yale School of Medicine. He treats patients looking to manage their weight. And when we sat down to chat, he answered a lot of the burning questions I had about these medicines. So today we're going to go beyond the hype and talk about what anyone should really know about these medications, from the benefits to the risks to the unknowns. I'm Doctor Sanjay Gupta, CNN's chief medical correspondent, and this is Chasing Life.
Dr. Sanjay Gupta
00:02:06
You know, if there's one thing I've learned this podcast season, it's that talking about weight is still really stigmatized. Even those of us in the medical community struggle sometimes to find the right words. That's why, before I even got into the nitty gritty of how ozempic and other drugs like it work, I wanted to ask Doctor Moreno a bit of a personal question. How is your diet? Is this something that you think about as somebody who's an expert in this area?
Dr. Jorge Moreno
00:02:34
I do, I do get asked this sometimes. My diet is just as mixed as anyone. My wife is Puerto Rican. I'm from Mexico. So whenever we go to my mom's house, it's a Mexican diet. When we're home, we cook a lot of Puerto Rican dishes. But I'm not plant based. I do a little bit of everything.
Dr. Sanjay Gupta
00:02:50
I'm looking at you on the zoom call, and you look like a healthy young man. But have you gone through periods of time when you've tried to lose weight, and if so, how did you do it?
Dr. Jorge Moreno
00:02:58
Well, that's a great question. I haven't been asked that before, but yes, in college I was about 250 pounds. Right now I'm about 200 pounds for my obesity. The treatment that helped me was lifestyle and exercise. And I think that once we get into more of the conversation, we'll start to see that obesity is one entity. But I think down the line in ten, 15 years, we're going to be talking about different types of obesity, like obesity type A, obesity type B, obese type C. I say that because there are people that succeed with lifestyle changes. And many times in the media we see that these people want to replicate that same exact lifestyle in someone else, that their obesity does not respond to the lifestyle change, but they may respond to a medication. Or there's another type of patient with obesity that may respond to bariatric surgery. And so I think that that's really important to realize that we call obesity a disease and it is. But I think that there is going to be a gradation of that. And there's a spectrum of that. And we're still we're just in the beginning, I think we're still working to figure all of this out and really tailor the medications and the treatments and the management for the patient. And that's what I tell patients. I don't know how they're going to respond. I will work with them to find the best treatment for them. And it's very personalized. One on one. We try to really figure out what will work for this particular patient.
Dr. Sanjay Gupta
00:04:35
So let's start with this. Doctor Moreno believes that obesity is a disease in and of itself. And not only that, but a serious, complicated disease that deserves an equally aggressive approach. But what you just heard is still a relatively new concept in the field of medicine. For a long time, doctors thought obesity was mostly due to a lack of will power, based on someone's diet or exercise routine. But as you've already heard this season, that's not always the case. For decades now, drug companies and researchers have been trying to find safe and effective medications to try and help.
Montage
00:05:14
Friends. Here's an amazing free offer for everyone who's overweight.
Montage
00:05:18
Psst want to lose a few pounds? There's a way.
Montage
00:05:21
Good evening. A popular European weight loss technique called mesotherapy is now being used in the United States.
Montage
00:05:28
Redux and Fen Phen, two of the hottest names in weight loss.
Dr. Sanjay Gupta
00:05:33
The problem is, there haven't been that many additional treatment options that really work that can be used at a large number of patients, or don't come with some serious side effects.
Dr. Jorge Moreno
00:05:43
Obesity medications have been around for a long time, right in the 1950s. We have phentermine. We've had a medication for Orlistat. In the 1990s, all these medications had been around. The problem with some of them were that they had side effects, some side effects that did not allow them to be used for long periods of time. Some people did, some people don't. That said, the weight loss maximum of these pills was about 10%, some of them 5%, some of them 10%. So we either had medications for 10% or bariatric surgery for 25 to 30% of weight loss, like we had two spectrums. And then we had this gap, right, that medications was not addressing.
Dr. Sanjay Gupta
00:06:24
'Typically, patients options were to choose between invasive surgery or pills that had risks. Some of those medications, in fact, would later be pulled off the market. But then in the early 2000s, things started to change. Doctors and researchers found a new type of medication for treating diabetes that also happened to lead to weight loss. In 2017, the FDA approved one of these new drugs, Ozempic, for treating type two diabetes. Wegovy, Zepbound Mounjaro. Those are other names of drugs that you may be familiar with. They followed soon after, and that's how we ended up with this boom of these new medications. Now all of them contain a molecule that mimics a hormone our body produces naturally. That hormone is called GLP-1.
Dr. Jorge Moreno
00:07:17
'It's a peptide that is secreted by our intestine, and it's normally very short acting, and it's degraded by other enzymes in the body really quickly. And so the GLP- activates when you have a nutrient. So they're nutrient- stimulated hormones. So what that means is you have an intake of any food. And then these medications are activated to basically tell your body that you just had food. And so they go into the area of the brain that is the hypothalamus the energy central of the brain. And they tell your brain, you you've had food, stop eating. Right. And so it's like a stop signal. And so the pharmaceutical companies basically develop these medications that are longer acting. And so they keep this mechanism working consistently. Righ? They basically decrease your appetite by signaling in the hypothalamus that you're full. And so that's really what these GLP ones are doing.
Dr. Sanjay Gupta
00:08:12
So it's basically sending a signal to your brain in some ways tricking your brain that you've just taken in a meal. If even if you haven't necessarily done that, it has slows down your emptying in your intestines and it stimulates your your pancreas to make more insulin.
Dr. Jorge Moreno
00:08:28
Yeah. That's correct.
Dr. Sanjay Gupta
00:08:30
'As someone who studies the brain, this is really fascinating to me - that these medications basically trick your body into thinking that it is full. Some people even report that they experience less food noise or food chatter when they're taking these medications. Here's how Doctor Moreno explains it.
Dr. Jorge Moreno
00:08:49
The way that many patients describe this to me is basically they have always had this background thought process that they're thinking about their next meal, right? They're thinking about when they just ate lunch. What am I going to have for dinner? Am I going to snack between dinner, and am I going to have popcorn later? Am I going to have ice cream? And so it's a constant...
Dr. Sanjay Gupta
00:09:10
You're making me hungry, by the way, Dr. Moreno. [laughs]
Dr. Jorge Moreno
00:09:12
It's this, this constant noise and feedback, basically, that your brain is telling you keep feeding me. Right. And so these medications are quieting that noise, from the perspective of patients that have told me this. And many patients have told me this so that it's a very interesting change that can happen with these medications sometimes, per these patient reports.
Dr. Sanjay Gupta
00:09:35
So there's Ozempic, there's Mounjar, there's Wegovy. How do you everyone talks about Ozempic, that's sort of become the catchall term, I think, for all these similar medications. Ozempic itself is not approved for weight loss is my understanding. So I'm just wondering, can you talk us through then what are the available medications? How does someone sort of navigate that?
Dr. Jorge Moreno
00:09:55
Absolutely. So I think that the listener should really focus on two of the ingredients. Righ?. So the main ingredient in Ozempic and Wegovy is semaglutide. Semaglutide is the active ingredient. This is the one that we just talked about that causes all these effects in the body. And those are branded differently. For diabetes, it's branded Ozempic. And it's the brand is Wegovy for obesity. So it's really important to realize that it's really a branding situation that is the difference.
Dr. Sanjay Gupta
00:10:25
It's the same medication otherwise?
Dr. Jorge Moreno
00:10:26
Otherwise it's the same medication.
Dr. Sanjay Gupta
00:10:29
Is it the same dose? What's different about it.
Dr. Jorge Moreno
00:10:31
'Yeah. So it's the same medication. There's different pens for go Wegovy and Ozempic. And I think in one of your CNN specials, you were able to bring out some of the pens there. And I think that that was really helpful because people need to know exactly what they look like. The pen for Ozempic has some options for multi doses. And what I mean by that is you can have two different doses in one pen. The pen for Wegovy actually is a one dose and done kind of deal. The same thing for Mounjaro and Zepbound. So Mounjaro and Zepbound the active ingredient is tirzepatide and tirzepatide is a combination of two peptides. It's A dual agonist. So it combines GLP-1 and GIP. GIP is another gut hormone that also helps synergistically with GLP-1 to help reduce weight and also affect all the different things that we just talked about similarly. And so these are the two different medications. And really in terms of effectiveness they're both very effective. You lose about 15% of their weight on average. And what that means is an average I know there's people that lose more than 15% and there's people that lose less than 15%. So that's the average.
Dr. Sanjay Gupta
00:11:38
And over what period of time is that?
Dr. Jorge Moreno
00:11:41
So the studies were done over 68 weeks. So a little over a year.
Dr. Sanjay Gupta
00:11:45
Wow. Now this is pretty promising data, but as you've probably heard by now, less food chatter isn't the only side effect soome people report on these medications. So coming up in a moment, we're going to unpack the risks of taking this type of drug. Plus, Doctor Moreno shares why he thinks there's been some backlash as well.
Dr. Jorge Moreno
00:12:07
I think that there's still a stigma to calling this medication the easy way out, because many patients are like, why would I do that? I just need to be better, right?
Dr. Sanjay Gupta
00:12:17
More Chasing Life in just a moment.
Dr. Sanjay Gupta
00:12:25
Let me ask you a couple of just rapid questions. Is there anyone who shouldn't take these medications?
Dr. Jorge Moreno
00:12:31
Oh, yeah. First and foremost, the patient needs to follow the indications. In my opinion, if you are not indicated for these medications based on the current criteria, you should not be on this medication. So what do I mean by that? A BMI greater than 30. A body mass index greater than 30. You should be on these medications. You could be on these medications let's put it that way. And a BMI greater than 27 with a coexisting condition like diabetes sleep apnea hyperlipidemia heart disease. Yes. You are eligible for these medications. Now, people that should not be on these medications, despite those indications are people with gastrointestinal problems. And what do I mean by that? People with a known history of gastroparesis, which, is a slowing down of, of the GI tract. People with a history of pancreatitis should not be on these medications. People with a strong history of acid reflux or Gerd should not be on these medications, because these medications can worsen that. And anyone who has a significant gallbladder disease, they should not be on this. And then, of course, pregnancy. People that are pregnant should not be on a medication that can cause weight loss.
Dr. Sanjay Gupta
00:13:39
Is the expectation that if you start these medications, you're going to be on them for the rest of your life?
Dr. Jorge Moreno
00:13:44
We know from the studies that when the medications are stopped, there is weight regain. And so I think of these medications as long term. Now, how that long term looks can be different by the individual. And what do I mean by that? So for example if someone has reached their goal weight and we know that if we take them off, there's a potential for losing more weight. But what we don't know is what if we leave them on a lower dose? Or what if we extend the frequency of the medication, right? Instead of every seven days we go to every ten days. These questions we don't know the answer to. And so I've had a lot of patients that have lost and have met their goal. And we have conversations about what do we do now? Do you have side effects? Do you not? And so I think again, it's individual, but I think of obesity as a chronic condition. And the way that I think about it is I equate it to diabetes, right. These medications were originally made for patients with diabetes. Right like that's the initial indication for all of these GLP one medications. And so if you have someone with a hemoglobin A1C of 10%, which is a high glucose number, a very uncontrolled diabetes number, and we put them on insulin or we put them on medications, we never talk about taking them off of these medications. We never say, okay, their diabetes is gone. Let's just stop their insulin. Let's stop their ozempic. So why do we treat obesity like a different entity? It's a chronic disease. Why do we set this bar that once we get to the right weight, we're done. Their appetite sensors in the brain that are not working correctly. And so there's a biology that we're treating with these medications. So why would we stop them?
Dr. Sanjay Gupta
00:15:31
It's interesting. There's obviously a lot of stigma associated with people who have obesity. Is there also a stigma that you have seen associated with taking these medications? And I'm not even sure I'm asking the question in the right way. But yeah, okay. You bring up diabetes. I think if someone says, look, I have diabetes and I take insulin for my diabetes, everyone sort of fundamentally gets that. Yeah. If you say I have obesity and I'm taking, you know, Wegovy or whatever for obesity, are we at the same point, do you think from a stigma standpoint where it's thought of as a disease, here's the medication for the disease that's makes perfect sense.
Dr. Jorge Moreno
00:16:09
I think that there's still a stigma to calling this medication the easy way out. Right? Because many patients are like, why would I do that? I just need to be better, right? Like the holidays just happened. I need to be good. It's the New Year, new year resolutions, everything like that. And so I've had many patients I talk to them and tell them about the biology, tell them it's not their fault. Take that guilt away from them, that this is about their willpower and their ability to exercise and their ability to eat less. And I tell them the are hormones in your body that are preventing you from decreasing your weight, and these medications are there to help you so that you can become more active so that you. Work on a different diet, a plan that you wanted to do. And so I've had many patients that tear up in the room when I take that guilt away because they've been living with it. Every doctor they've seen before or other health care provider has told them, eat less, move more, right. That's the old motto, and it's more complicated than that. And taking really that guilt away helps them assess the options.
Dr. Sanjay Gupta
00:17:13
You sort of alluded to this earlier, Doctor Moreno, but a lot of people are taking these who wouldn't meet these strict criteria for taking these medications. Is that dangerous?
Dr. Jorge Moreno
00:17:25
The studies did not show how the safety profile would be in individuals without a BMI greater than 27 with these conditions. So there is, in my opinion, there's a greater chance for side effects. There's a greater chance for complications if they are not indicated for these medications, because we just don't know what the safety profile will look in. Someone that is was not part of these studies. Right. And so I think it's something to be very cautious about. And I would not encourage that practice because it could be unsafe for these individuals to do so.
Dr. Sanjay Gupta
00:17:59
You know, when it comes to the again, the side effects. And I think if I'm hearing you correctly, Doctor Marino, you're thoughtful about this, but the side effect profile you think is is pretty good for these medications if given to people who really qualify for them. Yeah. And that means a body mass index over 30 or a body mass index over 27 if you have some other, other condition alongside that diabetes or something. You do hear a lot of these reports of adverse events. You know, everything from loss of hair to to suicidal ideations, thinking about suicide. There's been these reports about intestinal obstructions and things like that. How much do you worry about that? I again, I know these are anecdotal reports, but how do you sort of approach that as a physician in this space?
Dr. Jorge Moreno
00:18:47
Absolutely. So we get questions about this all the time. As soon as there's an article about this, there's questions about it. Like I get messages all the time about this. And so yes. So what I would say about that is this: obesity management is not a one and done deal. It is a close follow up. It is careful conversations with your patient about the potential for side effects being available to them and telling them what to expect and what not to expect. Right? Nausea is different than abdominal pain and vomiting, you know, multiple times a day. And so what I mean by that is we really have to, consider this a, a long term management strategy, and we have to have close follow up, and we can, prescribe these medications and then have the patient come back in a year. That's not how this works. We have to really know how the patient is doing. And so I think that I am cautious about them, like I think about these, complications. But I'm also very in tune with, who is on what dose, what medications are they on and when do I have their next follow up. And if the follow up is not with me, it's with one of my obesity colleagues in the practice, or it's with a PRN in the practice so that they have a time to discuss how they're doing, because that's important.
Dr. Sanjay Gupta
00:20:03
'I just got a couple more questions, and I don't mean to belabor this point about long term impact, but you know, this this is something I guess I think about a lot. You know, again, my world of medicine is different. You know, if I'm putting in a cervical plate, you know, for a spinal fusion, I'm curious, how long is that plate going to last? How long is someone going to be able to tolerate that plate before it starts causing problems elsewhere in the spine? Things like that. What can we if you are, if you're giving a drug that is somehow mimicking or causing an increase in these hormones, GLP-1, which is a post eating sort of hormone. Like five years from now, ten years from now, if you give this to someone who's in their 30s and you're saying, look, this is a potentially a lifelong or a long-term, at least drug, we could be talking about decades that they be taking this medication. And I'm inherently conservative. So I just, you know, that's why I'm talking to you. Like how how much should I worry or not worry about starting someone on these medications or having you start someone on these medications in terms of the long term proposition we are now making?
Dr. Jorge Moreno
00:21:14
'So I think that that goes back to some of the, stigma and bias we're talking about before. Right? So for example, we just talked about GLP-1s that have been around for close to 20 years. Right? We forget that these were introduced into the market basically 20 years ago. And we think about obesity as this, this threshold that these medications have to meet for safety that is sometimes unachievable. Right? Like we have to make them perfect. And these medications were treating diabetes for 20 years. So why would they be safe long term in patients with diabetes and be unsafe in patients with obesity? Right. And so I think yes, we have to hold all medications to a standard of quality, but I don't think we have to set the bar higher for obesity compared to something like diabetes. Right? And so to your question, I think that we are going to continue to see any possible effects and they're going to be monitored. Just today there was a study that came out about suicidal ideations. Right? There was a huge concern about that. And this study didn't show an association with it. And it was a pretty large study. And so this is great news, but I think that there's more studies that will continue to come out and be helpful to make these decisions. Now, I will say we also don't know the positive long term outcomes of these medications long term. And what do I mean by that? There's a lot of data coming out that can help with addiction, that it could help with depression, that they could help with, reversing fatty liver disease. So it's great. This is fantastic news. So yes, there's a lot to watch out long term. But I think that there's also a lot of positives to watch out for long term.
Dr. Sanjay Gupta
00:22:54
Just looking at your story again, if we can, just because you shared even in college being 50 pounds heavier than you are now, I don't know what your BMI was at that point. But let's say you did have a BMI that would have qualified at that point. This is going back to your college days. Knowing what you know now, and if you came into your office to see you in the future, would you would you prescribe that college student one of these medications?
Dr. Jorge Moreno
00:23:21
Yeah. I mean, if we have a conversation and this is an option that we're both in agreement with, absolutely. The medication is safe, the medication is efficacious. And if it would help me get to my goals, why not?
Dr. Sanjay Gupta
00:23:35
What what do you think about the the cost of these medications? Why are they so expensive?
Dr. Jorge Moreno
00:23:40
It is frustrating to providers that we have such challenges to be able to have these medications be covered. And again, not to harp on this, but it's the stigma and bias of obesity. I think a lot of insurance companies don't consider this a condition that they want to treat. They don't consider it a disease. Even in Medicare policy, as you might know, there is a clause that says we cannot prescribe patients Medicare, this medication. Right? So if they're like 65 plus and if they are have obesity and they're eligible for these medications, we cannot do that. There's some legislation right now to try to change that. But I think the cost is high. And I think that we should really try to make these medications affordable and to reach individuals that really need them. So this is something also that I think about a lot.
Dr. Sanjay Gupta
00:24:32
'You mentioned that these GLP-1 drugs, they've actually been around a lot longer than people realize. And that that's important to know because it also means that there is 20 year or so data on the long term effects or question of side effects in these drugs as well. Good note to sort of have are there things that you see on the horizon? Some have said that look Ozempic and Wegovymay already be old news in this regard. What is on the horizon?
Dr. Jorge Moreno
00:25:03
Yeah. So like I was saying before that there's appetite is a dual agonist. In the future there's something that will be a triple agonist, adding glucagon, GIP and GLP and some early data. Close to 100% of individuals on these medications have lost 5% of their weight. And that's just 5% where there's more to come in terms of how much these other medications can do. So I think that there's going to be a lot more combination medications that are coming down the pipeline. You're right. I think this is just the beginning. And I think with more medications, there's going to be more options for patients. And the ones we start to really tailor the treatment to these individuals instead of using one medication for everybody. Right? So I think there's going to be more options so that we really hone in on who these medications will be most effective for and safest for.
Dr. Sanjay Gupta
00:25:53
These new medications Doctor Moreno is referencing have the potential to maybe be even more effective. And they might have the potential to be taken as a pill, which is understandably more appealing to some people than a weekly injection. But I have to say this: if these medications remain unaffordable out of reach for many patients who really need them, then what good are these scientific achievements really? Not to mention, as things stand now, there continues to be a regular shortage of these drugs, and I think that's really worth its own conversation. Which is why on next week's episode, I'm sitting down with my colleague and CNN medical correspondent, Meg Tirrell. She's been following the business side of this news very closely.
Meg Tirrell
00:26:39
This is expected to be the largest class of medicines, I think, of all time. The projections that I've seen, or something like $100 billion in annual revenue by 2030.
Dr. Sanjay Gupta
00:26:49
That's coming up next Tuesday. Chasing life is a production of CNN audio. Our podcast is produced by Eryn Mathewson, Jennifer Lai and Grace Walker. Our senior producer and showrunner is Felicia Patinkin. Andrea Kane is our medical writer, and Tommy Bazarian is our engineer. Dan Dzula is our technical director. And the executive producer of CNN Audio is Steve Licthie, with support from Jamus Andrest, John Dianora Haley Thomas, Alex Manesseri, Robert Mathers, Leni Steinhardt, Nicole Pesaru, and Lisa Namerow. Special thanks to Ben Tinker, Amanda Sealy, and Nadia Kounan of CNN Health and Katie Hinman.