358-Ozempic: The Conversation We Need to Have First with Dr. Natalie Gentile

Ozempic: The Conversation We Need to Have First with Dr. Natalie Gentile

Stephanie: This is episode 358 of The Beyond the Food Show, and today we're gonna talk about the drug called Ozempic, and this is the conversation you want to listen to first, are making your own decision or having your own conversation about Ozempic. You ready? Stay tuned.

Welcome back, my dear sister, and today is the day we're having a conversation about Ozempic. This podcast was born from all of you reaching out to me and asking me, or have, wanting from me my personal opinion about Ozempic and I have refused to give an opinion because of two things. Number one, I am no longer in clinical practice. I no longer see patients one-to-one. I'm now into working with clients under a coaching structure, so I cannot formulate ethically an opinion on ozempic. However, what I did is I found a prescribing physician, so someone who sees patient day to day and has prescribing right, has actually work with real people and a medication called Ozempic, and I asked her a bunch of question.

So we have a guest today on the podcast. Her name is Dr. Natalie Gen. She's a board certified family medicine and lifestyle medicine physician who owns a primary care practice in Pittsburgh in the Us. She, as you will hear in the interview, practice medicine very differently. She has a weight neutral practice and interact with her patient under a different formulation, which is what we call primary care practice. I discovered that lifestyle medicine while doing the interview with her. She is an amazing person, and we kept the conversation neutrally because I want this to be a resource for years to come on Ozempic, that it is for you to formulate your own opinion, or that is for you to contribute to a friend, to a sister, to someone who's considering ozempic, that you can have an educated decision.

The second reason why I don't formulate my own opinion is I'm a coach and I want to empower the people that I work with to make their own decision because I trust that you can make your own decision. I trust you. I am handing out my belief in you. So this conversation's gonna be very neutral. We're gonna explore every side of Ozempic and other medicalized treatment for weight loss in order for you to make your own decision. And if you are in Pittsburgh, I would highly recommend you reach out to work with Dr. Natalie, and she also has this amazing website called Rebel Wellness, which is a weight neutral facilitator of healthcare that you should look up to. And my last thing, before I roll you the interview in the show note, we've put the link to the directory, to find a practitioner or physician or your medical team in the US that are under that same structure of primary care practice. If you are in other country, I cannot advise you, if you're on Canada, that doesn't apply to us. And in Europe, I'm not sure about the healthcare system there.

I titled this podcast Ozempic, the Conversation we need to have first. Let's roll in the interview and hope this serves you well.

Dr. Natalie: Welcome to the show, Natalie.

Dr. Natalie: Thank you so much for having me, Stephanie.

Stephanie: I'm so grateful for you to be on the show today because we're gonna talk about a hot topic around my podcast listener, my client, which is the medication call ozempic. So I'm gonna go right into it because I have so many questions and I want to start by first laying out the base, what it is, what it should be used for, what it should not be used for, and then we can get into more conversation around it. Is that good for you? Absolutely.

Stephanie: So what is Ozempic?

Dr. Natalie: Ozempic is a medication that is an injectable, so it's something that you are injecting into a part of your body, a solution that's in a pen. And it is indicated for people with diabetes as a way for them to help control their diabetes. It's generic name is Semaglutide and it's of a drug class that's been used for a long time for treatment of diabetes.

Stephanie: Oh, long time.

Dr. Natalie: Yes. So the ozempic itself with the injectable form is newer, but using this type of drug class for diabetes is not a new thing.

Stephanie: Is it similar to what many people know as metformin? Is it the same class of medication?

Dr. Natalie: It's different than Metformin and it works at a different, physiologic way. But metformin tends to be our first line for diabetes management. And then these medications like ozempic tend to be something that we add on or use for different indications depending on the patient.

Stephanie: Perfect. And so the reason why I am bringing this up on the podcast is because many people that are not diabetic have encountered ozempic, but not as a diabetic medicine, but instead as a weight loss tool or medication. Is that a use of ozempic as well for weight loss?

Dr. Natalie: So as of right now, specifically, Ozempic is diabetes. It has a effect of weight loss as well. We govie is a brand name of the same medicine as Ozempic, the same generic medication, different brand name. That is indicated for weight loss. But same drug, just different approvals right now between those two brand drugs.

Stephanie: But the same [effects], the, the same effects.

Dr. Natalie: It's same effects, different dosing for each of them. So the amounts that you're getting for Wego V versus Ozempic start at different levels, but the literally the same drug, just branded with different names and currently, one is diabetes and one of course also will treat diabetes, but has been branded as a weight loss medication.

Stephanie: Okay. I'm gonna come back to the conversation around marketing and pharmaceutical [Yes.] because I think that's a one thing. But in most layman terms, how is a diabetic medication, I'm assuming was created for diabetes management create a weight loss result, [mm-hmm] in the most simple term.

Dr. Natalie: Yes. So, to break it down, when we eat, there are so many different hormones released in our body that go all over the body to have different effects, including going to your brain, so tell us about satiety or fullness. Going to your pancreas to affect insulin secretion. Going to your gut, your GI tract, to slow things down and affect the way that you process the food that you're digesting. Those are just a few of the examples. It's a very multifactorial, very intricate process when we eat and all those hormones that are excreted.

Dr. Natalie: When we take these medications like ozempic for diabetes, it's affecting your pancreas and insulin secretion. So it can be helpful for the way your body responds to blood sugar. What's other effects of this medication include slowing the way that food moves through your GI tract and affecting what your brain is signaling as full. So in a sense, you are feeling full off of very little food, and food really isn't moving as quickly through your digestive system as it normally would without this medication.

Stephanie: Okay, so therefore this medication sends signal to your brain to say you're full when you're not really full. And the food stays longer in the digestive system, again, increasing feeling of fullness. Is that it?

Dr. Natalie: Correct. Yes. And it's interesting because this has happened throughout ages with other medications. I think a great example is the medication wellbutrin. It's an antidepressant, but then we also found that it can be really helpful with motivation and it can be a second line for A D H D and you know, la, la, la, la, la, there's all these other things that it can do, and that's science, right? We find different effects of medications that maybe weren't what we were initially looking for, and that's what appears to have happened with this medication ozempic, because now it's showing to be on par in some people with bariatric surgery, these medications with their weight loss effect.

Stephanie: Okay, so let's go back, while you take the medication, you mimic the signal to the brain that you're full, the digestion moves slower, but if you stop taking the medication because you don't have type two diabetes, therefore it's not a long-term lifelong treatment, you're taking it for weight loss. When you stop taking it, then you will go back to normal satiety signaling. [Correct.] I want everybody to be clear on that. This is a, the effect is only present while you take the medication.

Dr. Natalie: Right? So think back to what I think a lot of us are more comfortable with, knowing about and hearing about, bariatric surgery. It's been around for a long time, okay, also known as weight loss surgery. And there's different ways to do weight loss surgery, but in the end, how can we make it so that less food makes it feel fuller? [Mm-hmm.] Right? [Mm-hmm.] It is a lot of what that is mechanically. And this is doing that in a sense, but [yes] with bariatric surgery, you eat more than what that, you know, mechanical pouch can hold. You're gonna get stretching of it, you're gonna be able to eat more again and more, or you might get sick from it. With these medications, we take away the effect that we're giving with the medication, we're going to go back to what our body was doing before. It may not be to the full extent of weight regain, for example, as you had loss, but it can be close. And a lot of times with these meds, we do counsel patients, you might be on this forever. It's possible that you will be on this forever if this is something you wanna sustain as an achievable, you know, outcome.

Stephanie: Got it. So what you're saying is, let's say the patient wants to have a zenix for weight loss and they wanna be sure to maintain the weight loss, they would have to take a Zix, quote unquote, for the rest of their life. In the same way we think of diet. if you lose weight with a diet, you're gonna have to be on the diet for the rest of your life. [Yes.] Same pH is there side effect. Now I'm sure there is side effect, but in the case of diabetes, the side effect are less than the long term benefit for diabetes patients. But what about weight loss people?

Dr. Natalie: That's a great point, right? Because yeah, for that category of diabetics who, who very well should have access to this med as an option, [yeah] the benefits of controlled diabetes are high. When we're just talking about our patients with weight loss, it desire, it's possible that the risks outweigh the benefits for some people. And again, this is such a personal choice, right? In our country, we have this obsession with, if only we could get everyone thin, then all would be well, right? So like, here's yet another tool or way that diet culture can help you get there. This med is not without risk. This is not like, I'm gonna restrict calories for a few weeks. This is, I'm gonna take a medication that I inject long-term for weight loss. So it's something that needs to be taken very seriously. I'd say the most common side effects that I see in clinical practice and that are reported in the clinical trials are nausea, very decreased appetite, almost to the point of discussed around eating at times, like lack of desire and you have to force yourself to eat, in some people. Constipation, you see thatslowing of the GI tract. It's, it can be uncomfortable. And those are the main ones that are most commonly talked about are very much gi, gastrointestinal issues. There has been discussion about pancreatitis. It's questionable if that's really something that we can put a stamp on yet. Again, this, these are new uses. We're gonna have to have years of data before we can see that. And then there also is discussion about people with histories of thyroid cancer not taking this medication or strong family histories of thyroid cancer not using meds like Ozempic. And that also is, that's on the box kind of warnings, but again, it's gonna take time for us to collect that kind of data.

Stephanie: So I want people to understand, because in my brain it's evident, but I want people that are not in the science world to understand this drug was tested for diabetic patient with type two diabetes, I wanna be clear on that, type two diabetes. It was not tested for weight loss in a patient that doesn't present diabetes. Is that what I'm hearing?

Dr. Natalie: Yeah, that's, we don't have great evidence for it just being a weight loss med. Wego V is indicated for that and has trials out there and papers that are out there on that, but,there's so much to, T B D, right, [Yes] like to be determined. Because just like with every weight loss thing we've got in this world, things work in the short term. You know? [They work until they don't work.] Exactly. They work until they don't work. Look back at Fen F. Look at all of the diet meds that have been out there over time that in the end we're looking back like, oh, crap, you know, maybe,

Stephanie: did we do that

Dr. Natalie: Right. And I'm not saying that that's gonna be the case with Ozempic. We go the, even the newest one, Manjaro, like, I'm not saying that's gonna be the case here. These truly, if you are practicing medicine and helping people with their desire to lose weight, this is the best option we have right now, the most [at this point], correct. At this point, this is the most effective medication option that we have.

Stephanie: Because when we think about Fen, that is, I'm assuming, is no longer prescribable, correct? That's been taken off the market because of the side effect?

Dr. Natalie: Yes. Because of the cardiovascular effects, yes.

Stephanie: And that's, when you say it's the most valuable offer for weight loss, [yes] it's because there's not a lot of choice out there for medication because as soon as we find one, we find side effect and we pull it out. People have to be clear about that.

Dr. Natalie: Yes. And there are other medications that are out there, oral type medications for weight loss that are effective. But again, we're not talking substantial weight loss. Right. We're not talking to the degree of these injectable meds. And there are some people who desire that amount of weight loss. And so if we're going to help our patients with shared decision making, we've gotta show them the different options that are out there.

Stephanie: So one of the question that some of my clients and listener have asked is, knowing that this medication was created for type two diabetes, very little research on weight loss, how can physician doctor ethically prescribe this drug for people not knowing of the result and not knowing about the weight loss side effect of it.

Dr. Natalie: Mm-hmm. The fact is, it's F D A approved right now through the brand name Wego V to be a weight loss drug. So first of all,We know it's working. If not, you know, let's define what short term is versus long term. Right. We know it's working from the data and the clinical trials that we have now, and it's approved to be that. So it's not even off label with something like W Wbi. With Ozempic, technically until it's approved also for weight loss, we are prescribing it technically off-label, you could argue. Even though it's the same exact medication as webi, like let's remind ourselves again, it's the same med at a lower dose than Webi, and I will say it's working. I see it in patients all the time. The weight loss is very clear. The side effects are there though. And what are we gonna do in the long term with this? Are we gonna stay on it forever? And that's a tough conversation to have with patients because honestly, there's very, very few meds I can think of that I would be comfortable with prescribing forever.

Stephanie: For life, lifetime.

Dr. Natalie: Exactly. I mean, think about the population that is starting these meds. It is people probably thirties to fifties, [Yes] maybe, who have theoretically another 30 plus years to live. And so we're committing someone to long-term medication use, with, which in itself is not without risk. It's not just the side effects. There's the cost. There's the fact of being on a med and medication burden and potential for interaction with other medications and on and on and on.

Stephanie: Just so that you can maintain the amount of loss of weight you've lost during the first few weeks and months of taking the medication, [correct] then the weight loss all, and then you have to maintain the medication if you wanna maintain the weight loss. [Correct.] Is that something that the physician have to outline clearly to the patients?

Dr. Natalie: I believe. So it's our job to do no harm. We've gotta have that very clear decision and discussion with a patient, you know? I think that just to say, we'll have you tried Ozempic, you should try it, is not enough. There's gotta be a big conversation and arguably multiple conversations, about all of the different options. And another thing that we aren't touching on here is the counseling around everything other than medications when it comes to weight.

Dr. Natalie: And it's interesting when I talk to my patients who have gone through counseling prior to weight loss surgery, bariatric surgery, and whether they went through it or not, but they tell me about some of the counseling, and there's mandatory counseling you have to go through. And they've, the resounding information I've heard from them is like, it didn't really tackle my underlying issues. So then I got the surgery and then I was still having those issues, you know, my disordered eating, my body image disorder, et cetera. It's the same thing with these meds. I mean, we're about to enter a medication that might drastically reduce your weight. It is going to significantly impact your relationship with food because now we're gonna have to force you to eat. Like you have to force people to eat and get the amount of nutrition that they need to not have, you know, nutrient deficiencies in this case. So, hey, we're gonna mess with your relationship with food a little bit more. So I think that there needs to be discussions around that, not just around medication side effects.

Stephanie: Is there, I mean, that's my world. What you just outlined is my world, right? Dealing with the real problem. So I'm in it [mm-hmm] a hundred percent of the time I took myself out of clinical practice to be just in that world. [Mm-hmm.] But is that the world you live in, where people are counseled at that level?

Dr. Natalie: I, I don't know what it's like in every other clinic. I'm gonna be honest with you. [Yeah] I, if I had to venture a guess, when you only have seven to 15 minutes with a patient in primary care and have a ton of other things to cover, I would guess it's challenging. One so time. Two, even if you were to see a specialist in these specialty settings, like for example, there are clinics that are straight up weight loss clinics within some of these big health systems. I don't know what the counseling is like. I'm, I'm assuming it's great. I'm hoping it's great, right? [Mm-hmm.]But time is always an issue and so is education around these medications. So if you're gonna be prescribing them, you've gotta know how to have that conversation and not every primary care doc might have gone through the, you know, reading, training, understanding of it to comfortably have it.

Stephanie: How do you address it in your clinic?

Dr. Natalie: So I have an interesting setup. [please] I have a direct primary care practice. So in my practice, my patients pay a monthly membership and have full access to me. So they have hour long visits if they need it. We have multiple touchpoints. And it's not like concierge medicine, so it's not exorbitantly expensive. It's a, I see every walk of life. I see every body, everybody who comes in is welcome here. Different socioeconomic statuses, different backgrounds in general, different neighborhoods, communities. Therefore every conversation has to be tailored to that person. And so I take the time to have those conversations and a lot of time we touch on disordered eating behaviors that they never had a name for before. They never really were given the opportunity to feel comfortable talking about some of their relationships with their body image. And it's interesting when you start to have these conversations, it's like, man, we gotta tackle those first. You know, we've gotta tackle those things. However, I always try to be cognizant of an empathetic cord. If you have looked in the mirror for 20 years and hated what you saw, that is huge. [Yes.] That is deep and we cannot discount that and we cannot belittle that down to like, then let's get rid of that problem now by talking about all of your history and your relationship, you know, relationships with food and six months of therapy. Like some people really want something that's gonna help them now. So it's a, it really is such a tailored individual discussion.

Stephanie: So your formulation of your practice, I'm Canadian, so we have social healthcare, we have people from Europe, we have people from the state. It doesn't seem to be as problematic for my client unless they're in the state, then state medication and medical care is a big puddle. So your formulation of your practice, is that something that can be accessed in any city around the us, you just have to look for it?

Dr. Natalie: Pretty much. So we, direct primary care movement, which operates outside of the insurance system. So like I don't bill insurance, therefore I have control over what I'm doing with my patients. It is happening across the country, across the United States. So you just, if you just look up direct primary care in my city, you can likely find a practice

Stephanie: Direct primary care. I'm gonna put that in the show notes.

Dr. Natalie: Yeah. It's harder in rural settings, just because rural health access is challenging. But honestly direct primary care thrives in rural settings too. So I wouldn't, you know, even discount those in rural areas to, to look it up.

Stephanie: Because that's widely different from when I have to coach client that go into doctor's visit, like this is not the kind of visit they're getting with their physician or their medical team. They're getting five, 10 minutes of consultation and it's all about losing the weight. So I sent you a reel of one of our client. I sent you, like people walk into their doctor's office and the first thing on the list is how we're gonna help you lose weight.

Dr. Natalie: Correct. Think about a general primary care clinic and how huge it is and all of the bells and whistles and how everyone's behind. It's like you're always late, you're always running behind. It's a nightmare. It's challenging to work in that and you get hustled in, you get your vital signs taken immediately, and one of those things is always the weight. And in my practice, like I'm the one greeting them when they walk in the door and they aren't waiting and we walk them back to my consultation room and sit on a couch and talk. I don't weigh my patients most of the time. If I'm planning to, I ask them first. And so it's a very different vibe where all of a sudden the front and center is not your weight, it's all of the other things.

Stephanie: So what I'm hearing is that it's possible to practice medicine in the United States without centering weight. [Correct.] Huh. Interesting. Because my clients are being told they don't have a choice. They, the doctor have to center the weight as they're protocol or process to help them, which is not true.

Dr. Natalie: So when you operate outside of the insurance-based model, [yes,] you are not having to bill insurance. If you have to bill insurance, you are going to be talking about weight a lot of the time and trying to treat it with some kind of medication if possible, because it's hard to get appropriately paid for lifestyle medicine counseling. It's hard to, bill without putting diagnoses down. And, you and I talked about this word, obesity and [yes, that is a diagnosis, that is a medical diagnosis that you can bill for. So like, boom, right there, I can bill for that. And so all of a sudden we're just, we're trying to bill for things, we're trying to do things that are gonna get the clinic paid, because that's what the higher ups are pushing you to do. And oh, by the way, doing lifestyle counseling, it takes a lot of time. So if you don't have that kind of time, it's really hard to get someone to wanna invest the time to learn it, to be able to do it right, if it's not gonna like realistically be part of your practice in a general insurance-based primary care setting.

Stephanie: I wanna get into the business side of this because we kind of put aside the marketing of Ozempic and Vigo V, but people have to understand medication in the United States is a business, the same way medical care is a business. So they're taking the same drug ozempic, they're slapping a new label on it, and now that becomes a weight loss drug, which was in the first case, a diabetes drug. So that, because they know if they put weight loss on it, it's gonna sell more and then it's gonna be prescribable. So now it gets into the medical care, like there's a whole business behind weight loss and physical care.

Stephanie: Am I correct?

Dr. Natalie: Absolutely. You can't ignore that at all. There's a whole business around it and I, the side of me that loves practicing medicine so much and believes in humanity, wants to think that there is more to it than that. That there are people out there making medications to hopefully help people, you know, but I start to get itchy when I, when, you know, the big craze around this ozempic situation has been all of these celebrities, you know, in this like whole push in Hollywood of people being like, I wanna lose not that much weight in the scheme of things. You know, when we look at the rest of our country and the majority of people being at a size that is higher than what we consider normal weight, quote unquote, normal weight, right?

Dr. Natalie: These people are what would be called small fat. Right. [Yeah.] Right. Like, like not [very small fat], exactly. And they're taking these meds.

Stephanie: Well, and that was one of the question that I had was how does a, as a doctor, you deal with Influencer and Kim Kardashian being behind this ozempic to fit an address at the Met Gala. How does that impact you and how do you deal with that in your practice?

Dr. Natalie: It's a lot of breaking the news to people that there's more behind it, you know, than what we see on TikTok. Just trying to tell them like, this is why they are called influencers because they're influencing things that a lot of times they don't know anything about, but they've got the money to do it. And think about all the other things that go around managing somebody's weight, personal trainers, access to fresh food that's cooked for you, access to all of the other things that help your mental health, including therapy and acupuncture. The list of things when you have money is endless to keep your body the way it quote unquote should look. What's, [a full-time job] it's a full-time job. It's a full-time setup and system. And oh, by the way, for those of you who are working two jobs, good luck. You know, for those of you who are just trying to make ends meet, like probably not gonna happen.

Dr. Natalie: It's really the gap here in our society is so big and when that's who you're seeing on TikTok is those people who have all those resources and they're like, it's just the ozempic, that's a load of crap, frankly. And that's what I tell my patients because I'm not gonna sugar coat it for them, and I'm not gonna prescribe something just because they saw it on TikTok and think that it's gonna help. We're gonna have a full-blown conversation about this.

Stephanie: So another question that was submitted to me that goes into the line of that is Weight Watcher. Weight Watcher has bought a telehealth company that is connecting Doctor, and I'm assuming in an attempt to lose weight, and prescribing Weight Watcher as a way to lose weight. Has that hit you yet? And, and how are we proceeding with that from your perspective?

Dr. Natalie: I think this is being done in so many different settings. I mean, we saw it with a D H D. Like some of the, especially with the pandemic, when things, you know, we had limited access to mental health, a drastic need for it. We saw a big emergence of telehealth, psychiatric companies that then could just prescribe meds over a computer. And we're seeing this with weight loss in a bunch of different companies. So Weight Watchers, which is now WW by the way,

Stephanie: Yes, wellness that works, I think it's called.

Dr. Natalie: Yeah. So, it's not shocking,that they're bringing this into things and I wouldn't be surprised if medications are being prescribed along with these WW plans.

Stephanie: Well that's what these, the person said, there's also a medication soon that will come out, or weight watcher bot share in a company.

Dr. Natalie: Why not? I mean, it's the wild, wild west. Really? Why not? I'm not surprised by that. And again, it's all back to, we've gotta get your body looking like we want it to as a society. That is the ultimate goal. We cannot put in the time to make things more accessible to people of different body sizes. Why would we do that? Right? Like, that's the thought here. It's like, we just are gonna keep coming up with ways to get you smaller instead of addressing the underlying actual societal, cultural, socioeconomic issues that are at hand.

Stephanie: Yeah, because adapting life to fit all bodies is this expense and selling weight loss as a revenue. Like I'm from the corporate world, so that's a clear reason why, like expense versus revenue. We live in a cap society, we're gonna pick revenue.

Dr. Natalie: We're gonna pick revenue and can I bring something else up that, that has been really remarkable for me as a physician and I'm a young physician, right? I'm not super far out from training. I've been in practice long enough now that I have an established practice and, have learned a lot but I'm an, I'm an ever learner as we always should be. And something that has been challenging for me in the best way possible for my journey as a doctor thus far is challenging my weight bias and challenging weight stigma in healthcare. And when you said that changing things is an expense, it's not only a money expense, but it is a, now I've gotta sit and think about this. Now, I, as a physician, need to think about how I treat patients. And, I've had this conversation before. I, I had it on a podcast with Dr. Maggie Lambda, which was, we both had gone through a transformation of that, where we all of a sudden said, Man, all I've learned is kind of going out the window now, and how I've approached patients, I look back and I'm thinking, it's not that I was blatantly being disrespectful, rude, hateful, ever. It was, I didn't know any better that the things I was prescribing and recommending were not enough and they weren't through a lens that was gonna actually help my patients.

Stephanie: They were through the lens, I always say that they were through the lens of our training. My training was extremely fat phobic, right? All I learned is to prescribe calories and macros. I never learned a concept of eating Q and I'm a freaking nutritionist. Like think about that. Three years of post-graduate where, and never one time did we talk about eating cues. [Wow.] Like, so, it's not quote unquote your fault, it's the lands of your training.

Stephanie: Let's ask this question. I asked this question to Maggie on the podcast, but I'd love to hear your perspective. For a patient that goes into a doctor that wants to weigh them, that wants to tell them to lose weight, what could they say? What is the best way of approaching that fat phobic doctor who doesn't know any better.

Dr. Natalie: One question you can ask is, how would you treat somebody who is of a, a thinner weight, a smaller weight? So what would the prescription be for them? That would be an interesting answer. I'm sure and also you can advocate for yourself. It's hard, I would imagine it is challenging, but can you say, I don't wanna be weighed today. Period.

Stephanie: Yeah. You have the right not to be right. You have the right for anybody. Like it's a right. You're not forced to go on the scale, but you have to have the emotional courage [yes] to stand for yourself. You shouldn't have to, but you have to.

Dr. Natalie: Yeah. And all the emotional courage it took you to even show up in the doctor's office in the first place may have been just about enough, you know? And you're kind of tapped out at that point.

Stephanie: And that's the many of the question came in is, Doctor prescribing or suggesting ozempic and people being at their with him and thinking they have to take the ozempic medicine to comply with their doctor so that they can get the care that they want for the other issue they have. [Sure.] That's a pretty sad situation.

Dr. Natalie: It's a very sad situation, I would imagine. It's not, out of the realm of possibility.

Stephanie: Well, specifically for my audience, which is women 35 to 55, that have dieted most of their life. So there's a lot of weight conversation because they've stopped dieting, they've gained the weight back, and now everything is centered around the weight.

Dr. Natalie: Mm-hmm. And it's interesting because I talk about this a lot on my social media is, we go by b m I, you know, we're, we just love B m I and healthcare as a way that we can stratify people and identify people who are at risk for certain conditions. And when we go by that we are missing a big part of the population that need to be screened for issues that could come up. I always think about how, as somebody who struggled with disordered eating for most of my life at this point, I never was screened for that. Are you kidding me? Because I was an athletic thin white female. Why would anybody think that any could, anything could be wrong? I'm conforming to exactly how I should look. So how could I possibly have disordered eating that was tearing away in my mental health and could have potentially gotten worse. And so we're missing that population talking about these things.

Stephanie: And even if you are like, I am in the range of B M I that's supposedly very dangerous for my health, to all the other metrics, I am like in the top tier, right? But the only thing, if I let my physician do what she wants to do, that's the only thing, we're, we're gonna disregard everything why I class on like the top percentile and we're just gonna focus on this. [Mm-hmm. Oh yeah.] That's fat phobia at play, [it is] everybody.

Dr. Natalie: It's, it's fat phobia and or complete ignorance to the other factors that are important to someone's health and what is considered healthy. Right? It's not just the body shape that you have. It's not just the weight on a scale. It's, are you able to get down and play with your kids? Are you able to carry around groceries, from your car to your house without feeling winded, painful joints. How is your cholesterol panel, what's your a o b? What's your, H S C R P, like all these labs? What's your glucose like? Let's, let's get a little bit broader here on our definition of one's health. And I think that people would find it fascinating to then see how many people that are considered fat are exercising very regularly and kind of killing it and very much engaged in their life and comfortable. And how many people have significant disordered eating behavior that are not fat, and we're not even talking to them about this, right?

Stephanie: So it is, I know that from my lived experience, but I want to hear it from you and help women get that message reinforced. It's possible to have the conversation about your help with your physician in a fat body and not make it about the weight. There's plenty of other things we can talk about and assess your health on beyond the weight.

Dr. Natalie: Yes. I think one interesting thing would be, before you go into a doctor's visit, is writing down your activities of daily living and how does your body, whatever it looks like, play into that. Do you find that you are comfortable? Do you find that you're doing the things that you love to do and feeling well with that? And just to say to somebody, listen, you're talking about my weight, I'm doing fine. Like, I'm doing well, so can we stop talking about my weight and start talking about these other things that I wanna discuss, and these other things that I think should be reviewed and kept an eye on.

Stephanie: Well, and then specifically again, for my niche, the whole perimenopause and menopause and all the side effects. That comes along with that, but that gets brushed away [yes] to make room for the wait conversation, unfortunately. But you can, as a patient, redirect the conversation to where you want it to be.

Dr. Natalie: And I think there will be, if somebody hears what we have just said, [yeah] they might say, why isn't my responsibility to do that? The doctor should do that. And I, I hear you. And so another route, if you're not comfortable with the redirecting or you think it's not, your problem to do it, it's not your thing to have to do, finding in your community a doctor who is comfortable with health at every size. And finding a resource through the grapevine word of mouth is a powerful thing. And people talk about healthcare settings where they feel safe. And so asking around about that is absolutely okay as well.

Stephanie: I wanna come to a NA of the conversation. We're gonna close back on this whole ozempic and wait, I think we make the case that health is possible beyond the weight and how to manage our conversation with our medical team on this Ozempic Vigo V, which people will hear about shortly, I'm sure, through advertisement in the us, what would be your parting word for somebody who hears about that and think, oh, maybe that's the solution to my weight issue.

Dr. Natalie: I would recommend having an educated conversation with a healthcare professional whom you trust and talking about all of the options that are out there medication wise, outside of just these two specific or three now that are out there, medications. And having a discussion even with a mental health professional about your relationship with food, about your relationship with your body, because regardless of taking these medications, that is something that's gonna need to be addressed most likely, and the medications are not going to fix those issues. So having a trusted physician, having a trusted dietician, a trusted mental health professional in your court will give you a better chance of long-term success regardless of what medication you do or do not choose to take.

Stephanie: That's brilliant. Thank you very much Dr. Natalie for having had this very good conversation with us and helping forming ideas and brains of people and then they can take the next step, more educated from a neutral perspective instead of an engage on either side perspective.

Dr. Natalie: Thank you.

Dr. Natalie: