# The Truth About Ozempic: How It Works, Side Effects & Its Role in Obesity Treatment – with Dr Namson Lau

An episode of [Project 100 with Mark Bouris](https://invisiblenetwork.ai/podcast/1767053714), 6 Jul 2025, 1 h 11 min.

Audio: https://p.podderapp.com/2544644999/traffic.omny.fm/d/clips/2fb3740d-3436-44af-8cc0-a91900716aa5/05ac4e52-79fb-46b8-849c-b305000bd6d0/cc0be9e3-2eac-4371-974b-b310006f7663/audio.mp3?utm_source=Podcast&in_playlist=ef13e652-7a19-41fd-9d0f-b305000bd6dc

All content and media by Project 100 is created and published online for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The information provided by Dr. Lau is for general knowledge and information purposes only, and not intended to replace consultation with a medical doctor or other qualified healthcare professional. *** In this episode, we're joined by Dr. Namson Lau, a consultant physician and endocrinologist affiliated with Liverpool and Royal Prince Alfred Hospitals. Dr. Lau specialises in managing complex cardio-metabolic conditions, type 2 diabetes, obesity, and endocrine disorders. Together, they unpack the science behind Ozempic—how it works, its side effects, and its growing role in treating obesity and metabolic disease. Dr. Lau also shares insights from his clinical research, highlighting why medications like Ozempic represent a paradigm shift in how we manage weight and chronic disease in modern society. Whether you're curious about GLP-1s, struggling with weight loss, or just want to better understand the evolving landscape of metabolic health, this episode is essential listening. One product I’ve recently added to my routine from the Bulk Nutrients range is their NMN Extend. It’s a science-backed blend of 10 powerful ingredients, including NMN, Resveratrol, and Hyaluronic Acid, designed to support everything from energy and muscle recovery, to skin hydration, joint health, and event mental clarity. Check out their NMN extend product here: https://www.bulknutrients.com.au/products/nmn-capsules Eight Sleep’s newest generation, Pod 5. isn’t just another bed-frame add-on; it’s a high-tech mattress cover that actively adjusts to your body temperature throughout the night, cooling, warming, and even elevating your body when needed, all based on real-time data. The new Pod 5 introduces for the first time, a hydro-powered blanket system, utilising the same technology as the cover to extend temperature regulation across your entire body, not just the mattress surface. Clinically proven to increase quality sleep by up to one hour each night, it’s basically like having an AI-powered sleep coach, personal thermostat, and advanced health tracker working for you while you rest. Head on over to eightsleep.com/project100 and use the code PROJECT100 (that’s Project one-zero-zero) and get up to $550 off your very own Pod 5. Trust me, your body will thank you for this investment in better sleep. The all-new WHOOP is here — now 7% smaller with 14+ days of battery life. New features like Healthspan show how your daily habits are affecting your rate of aging — and now you can check your blood pressure straight from your wrist. If you’re serious about performance, longevity, and actual progress — this is it. Sign up for a one-month free trial at WHOOP.com — or visit join.whoop.com/mentored for one month off your annual membership fee. See omnystudio.com/listener for privacy information.

## Transcript

[0:00] Speaker 1: Uh, doctor Namson Lao Weldo the project one hundred.
[0:03] Speaker 2: How are you going? Thank you from inviting me? Great,
[0:05] Speaker 2: thank you.
[0:06] Speaker 1: So you're a consultant physician and end of chronologist. Maybe
[0:10] Speaker 1: you could quickly and you're at Liverpool and RPA, Royal
[0:13] Speaker 1: Prince Alfred. You're a conjoint senior lecturer at UNSW and
[0:17] Speaker 1: University City. But what is an end of chronologist? Could
[0:21] Speaker 1: you just explain it that is first, and then maybe
[0:22] Speaker 1: give me a bit more background about what you're how
[0:24] Speaker 1: you've studied and what you've.
[0:26] Speaker 2: Of course achieved. So any chronologists is a medical specialist
[0:29] Speaker 2: in hormones and a lot of what we do is
[0:32] Speaker 2: in the diabetes space. So I guess we'll talk about that.
[0:35] Speaker 2: That's your specialty diabetes. Yeah, so I actually am a
[0:39] Speaker 2: subspecialist in diabetes and carting mat bolicelf that is of
[0:42] Speaker 2: weight obesity and type two diabetes as well.
[0:44] Speaker 1: Yeah, and you're maybe you could just give a little
[0:48] Speaker 1: bit of background in terms of your research areas your
[0:51] Speaker 1: current roles yep.
[0:52] Speaker 2: So I, as you said, Mark, I'm affilated across a
[0:55] Speaker 2: range of public institutions, predominantly at Leverpool Hospital and Royal
[0:59] Speaker 2: Prince Sulte where I trained. In my training, I completed
[1:02] Speaker 2: a PhD in actually some of those things we're about
[1:05] Speaker 2: to talk about, the neuroendocrine apptation of appetite and weight.
[1:09] Speaker 2: That is to say, how hormones impact appetite and weight regulation.
[1:13] Speaker 2: So that's some of my research and that's how I
[1:15] Speaker 2: sort of got into the space of these injectables and
[1:18] Speaker 2: these medications, these increts. I still do a lot of
[1:21] Speaker 2: clinical research. I'm a probably mid aged mid Korea clinician
[1:25] Speaker 2: researcher and my clinical research is in diabetes in the
[1:29] Speaker 2: hospital Diabetes food Disease at Liverpool and at the University
[1:33] Speaker 2: of Syny and Prince Alfred. It's in a way to
[1:35] Speaker 2: be city as well. Right.
[1:37] Speaker 1: So, and one of the topics you know, you and
[1:39] Speaker 1: I going to talk about today and I'm hoping you're
[1:40] Speaker 1: happy to do this, is I do want to talk
[1:42] Speaker 1: about sema, semaglutides, glp ones or zembic, which is all
[1:48] Speaker 1: the same thing, and it's a big topic. It's a
[1:52] Speaker 1: huge topic, it's a global topic. So maybe you could
[1:55] Speaker 1: just tell me exactly what is a zebic? Like we
[1:59] Speaker 1: keep hearing about it, what is it? What does it
[2:01] Speaker 1: do to the body.
[2:02] Speaker 2: Sure, so it's the trade name of samagnetite. Somaglatide is
[2:07] Speaker 2: the medication. Samagnetide is part of a group of medications
[2:10] Speaker 2: that are known as GLP one ras or now we
[2:13] Speaker 2: increasingly know them as in cretns as well. So that's
[2:17] Speaker 2: those are medications that are predominantly taken by injection, and
[2:21] Speaker 2: they have very powerful effects on or. I can go
[2:24] Speaker 2: through the history, but in terms of what they do,
[2:26] Speaker 2: they have very powerful effects on appetite. In terms of
[2:29] Speaker 2: regulation of appetite, they suppress gut and brain hunger. I
[2:33] Speaker 2: guess it's a very simple of understanding them. They also
[2:37] Speaker 2: improve the effectiveness of how you metabolize and process food,
[2:42] Speaker 2: so they slow down gut transit time as to say
[2:44] Speaker 2: that they feel food takes a little bit longer to
[2:46] Speaker 2: go through the gut. It increases the absorption. It actually
[2:50] Speaker 2: works with the body's on insulin production to make it
[2:52] Speaker 2: more effective, so you spend less time with the glucose
[2:55] Speaker 2: levels into the bloodstream and more into the cells. Made
[2:59] Speaker 2: it also as really interesting effects increasingly being researched. This
[3:04] Speaker 2: is the brain chemistry stuff actually might work on reward
[3:06] Speaker 2: centers as well, which part of Howard, it actually you know,
[3:08] Speaker 2: suppresses appetite, and it also actually might there's been some
[3:12] Speaker 2: evidence showing that actually changes the metabolic rate, perhaps by
[3:14] Speaker 2: working on brown fat that's a monobolically beneficial fat. So
[3:17] Speaker 2: it's really like the medications that have a very powerful
[3:21] Speaker 2: range of effects that go beyond what they're originally designed for,
[3:23] Speaker 2: which is actually for diabetes. They're actually originally diabetes medications.
[3:27] Speaker 1: And is that because diabetics traditionally therefore were perhaps overweight
[3:34] Speaker 1: and somehow, whoever the pharmaceutical company was it designed, it
[3:40] Speaker 1: decided that we've got to do something to suppress our appetite.
[3:43] Speaker 2: Yeah, so people have type two diabetes, which is what
[3:46] Speaker 2: we're talking about, the people who developed diabetes due to
[3:51] Speaker 2: predominantly of weight obesity causing instant resistance. And that's the
[3:54] Speaker 2: one that develops later in life predominantly. So that's why,
[3:57] Speaker 2: which also is the really really big numbers of people
[4:00] Speaker 2: with type two diabetes. And that's how gone to the
[4:03] Speaker 2: space because that's really quite linked to weight. So you know,
[4:05] Speaker 2: if you can address the weight, as you were saying, Mark,
[4:07] Speaker 2: you actually might be able to improve the glucose levels.
[4:09] Speaker 2: So you're right, you know, there was medications before the
[4:13] Speaker 2: encrednce helped treat the sugars but didn't actually make people
[4:17] Speaker 2: address their weight. And also they actually didn't seem to
[4:20] Speaker 2: make a big difference on people's you know, outcomes, you know,
[4:23] Speaker 2: the cardiac risk or their risk of developing complications. And
[4:27] Speaker 2: so obviously people keep on trying to look for new
[4:29] Speaker 2: ways between diabetes, type two diabetes and these molecules we're
[4:33] Speaker 2: actually known but for quite a long time, so people
[4:35] Speaker 2: went back to them to have a look at them,
[4:36] Speaker 2: to see whether they might have an effect for type
[4:38] Speaker 2: two diabetes. And once they've discovered that it not only
[4:41] Speaker 2: improves place sugar levels but actually dresses weight, that's when
[4:44] Speaker 2: people started to think about where they actually could address
[4:47] Speaker 2: you know, of weight obesity help without diabetes.
[4:49] Speaker 1: So when and I don't want to sort of hang
[4:52] Speaker 1: on this too much, but when somebody, through their lifestyle
[4:58] Speaker 1: apps is become obese, and what obese is I don't know,
[5:06] Speaker 1: because everyone's different, I guess, but when there's someone's way overweight,
[5:10] Speaker 1: overweight in itself is not something that can create type
[5:14] Speaker 1: two diabetes, but it's more that's sort of more about
[5:19] Speaker 1: more about causing a metabolic problem that's right, But in
[5:23] Speaker 1: terms of the amount of sugar in your system and
[5:25] Speaker 1: the relative to amount of insulin that your body's got
[5:28] Speaker 1: to produce. That's more about what you eat every day,
[5:31] Speaker 1: like every.
[5:32] Speaker 2: Moment or every occasion.
[5:34] Speaker 1: And there probably is a correlation between eating too many
[5:39] Speaker 1: sugary things, for example, and being overweight.
[5:42] Speaker 2: That's more a correlation thing.
[5:44] Speaker 1: Overweight is not causative of type two diabetes, but it's
[5:47] Speaker 1: the sort of what goes with it.
[5:49] Speaker 2: Am I correct on that? Yeah, you're right. So we
[5:52] Speaker 2: know that people naturally as they age do put on
[5:55] Speaker 2: a bit of weight. There's so there's changes that you know,
[5:57] Speaker 2: age related metabolic changes. But we also know that there's
[6:00] Speaker 2: a big tickup of weight obesity globally, firstly starting in
[6:05] Speaker 2: high income countries, but now you can see it globally
[6:08] Speaker 2: and when it sort of goes to the root causes
[6:10] Speaker 2: of that problem. There are individual factors, but I believe
[6:14] Speaker 2: that strongly, and so the evidence woul support there's this
[6:16] Speaker 2: st of global factors as well, the way that food
[6:19] Speaker 2: is made, our changes in our lifestyle, changes in our
[6:21] Speaker 2: work habits that you know, we are no longer quite
[6:25] Speaker 2: as active as we need to work. Many of us
[6:27] Speaker 2: are information workers work in the knowledge space, and so
[6:30] Speaker 2: those are sort of the factors you're sort of discussing
[6:32] Speaker 2: that contribute to someone developing of weight obesity. So there's
[6:35] Speaker 2: things that you may be able to influence yourself, but
[6:37] Speaker 2: this is the wider structural society or factors that hard
[6:40] Speaker 2: for us as individuals to change. Okay, we do.
[6:46] Speaker 1: It is not live, so it doesn't make it again
[6:47] Speaker 1: to stop whenever you want.
[6:48] Speaker 2: So, so then how do how does zemb actually work?
[6:55] Speaker 1: So the end or any of the other versions of
[6:59] Speaker 1: a ZEBI community, it's just a brand name. But how
[7:01] Speaker 1: did the semi glut eydes work. Semi glutaydes work. So
[7:05] Speaker 1: what they call the goop ones what they actually.
[7:07] Speaker 2: Do, So so the eup ones or the inn credents,
[7:11] Speaker 2: how they work is that they work on cut hormones.
[7:14] Speaker 2: So they were actually reginally discovered as part of you know,
[7:16] Speaker 2: looking at the pancres's own gut hormones, and people really
[7:19] Speaker 2: clever people actually have known about this for a very
[7:23] Speaker 2: long time, going back to the beginning of anecronology. Like
[7:25] Speaker 2: they've looked at the pancress and insulin, you know, and
[7:27] Speaker 2: they've known that reduced to the bancreas, that's right, and
[7:30] Speaker 2: so they've just also known about other hormones there. They
[7:32] Speaker 2: didn't know much about them. They knew they existed right
[7:34] Speaker 2: in the beginning of my specialty. You know, My special
[7:37] Speaker 2: is actually quite young, you know, androcologists haven't existed in
[7:40] Speaker 2: the modern form for barely one hundred years, the signs
[7:43] Speaker 2: of it, and so.
[7:45] Speaker 1: An incident just because the insuluence a hormone, instance, a
[7:47] Speaker 1: hormone one of the many many hormones, one of the main.
[7:50] Speaker 2: Ones we deal with for yes, and so people have
[7:52] Speaker 2: gone back to the other pancreatic hormones and start to
[7:56] Speaker 2: look at whether they have these effects as we're discussing earlier,
[7:59] Speaker 2: and then they credit these these medications based on seeing
[8:04] Speaker 2: that these things helped insulin. That's how the original sort
[8:07] Speaker 2: of understood them. But then they discover that they have
[8:10] Speaker 2: these really powerful effects on other things than just insulin.
[8:12] Speaker 2: So when you're asking to me how they work, I
[8:15] Speaker 2: sort of sort of explained it in this sort of
[8:17] Speaker 2: complicated way. But I guess when you do the injection,
[8:20] Speaker 2: these things work slowly. That's why the most common too
[8:24] Speaker 2: now are weekly injections. They work on the gut hormones.
[8:28] Speaker 1: As I said, so you injected into the fattiness in
[8:30] Speaker 1: your tummule on the society your body would so it
[8:33] Speaker 1: gets absorbed into the fat. And there's obviously capillaries in
[8:36] Speaker 1: those areas and they somehow grab a hold of this.
[8:38] Speaker 2: Yeah, yeah, that's right, Yes, there's small must there. It's
[8:40] Speaker 2: absorbed slowly, you know, in the microcirculation through the stomach
[8:44] Speaker 2: fat as you were saying, it's slowly. Over time levels
[8:47] Speaker 2: do build up. That's why you know they often don't
[8:50] Speaker 2: work that quickly. They do take a few weeks to
[8:52] Speaker 2: have effects in the way that they use clinically. And
[8:56] Speaker 2: then how they work in terms of the gut effects
[8:59] Speaker 2: is that the actually quite powerfully target these receptors GLP
[9:03] Speaker 2: one ra receptors.
[9:04] Speaker 1: So gop one is a receptor in your tummy, yep.
[9:07] Speaker 2: And they essentially gp one ara receptor agonets. Right then
[9:10] Speaker 2: she turned them on.
[9:11] Speaker 1: Turn them on, so and turning one does something yeah, so.
[9:14] Speaker 2: That it actually really reduces in the stomach. It makes
[9:18] Speaker 2: you feel full of when you start eating, and it
[9:20] Speaker 2: slows down the gut transit times, so food takes longer
[9:23] Speaker 2: in the gut and it's more officially so.
[9:24] Speaker 1: Before I get through the transit time, could just just
[9:27] Speaker 1: go back to the the gop one turning on the
[9:31] Speaker 1: gop one.
[9:34] Speaker 2: Chemic receptors turning turning on.
[9:36] Speaker 1: The receptors, I should say, And they called GP one
[9:38] Speaker 1: receptors are they so turning those? So in all our body,
[9:42] Speaker 1: we've got these receptors looking for some sort of molecules.
[9:45] Speaker 2: Which make them do something.
[9:46] Speaker 1: But in this case in the gut, and we've probably
[9:48] Speaker 1: got lots of receptors in the gut, lots of differents,
[9:51] Speaker 1: but this particular one does it sort of make that
[9:54] Speaker 1: receptor feel like it's full?
[9:56] Speaker 2: Yeah, it turns that receptor on, right, and then that
[9:58] Speaker 2: recept stays on. But that's how they actually have a
[10:00] Speaker 2: long duration of action. And there's also like I was
[10:04] Speaker 2: talking about brain hungers, who wasn't I, So they've watched
[10:06] Speaker 2: the discovered it. There's these two people receptors everywhere, so
[10:10] Speaker 2: it's actually the ones in the head as well. And
[10:12] Speaker 2: that's the stuff which is really interesting because it not
[10:14] Speaker 2: only makes you feel full of when you start eating,
[10:16] Speaker 2: but we actually don't feel hungry in between meals as
[10:19] Speaker 2: much too, So you actually the technical term is society fullness,
[10:23] Speaker 2: so you actually have within meal fullness. When you actually
[10:25] Speaker 2: start eating, you don't feel like you're as hungry, you
[10:27] Speaker 2: don't want to eat as much, And then between meals
[10:29] Speaker 2: you don't feel the hunger as much too. So that's
[10:31] Speaker 2: the hunger effects that we're talking about.
[10:33] Speaker 1: So you feel satiated all all the time, yes, but
[10:37] Speaker 1: both in two ways. One when the gop one receptors
[10:43] Speaker 1: in your tummy are receiving the food and going, okay,
[10:45] Speaker 1: we've got enough. And also between meals, your brain GLP
[10:49] Speaker 1: one receptors are saying I don't really want any because I've.
[10:52] Speaker 2: Actually still still fall That's right.
[10:54] Speaker 1: Yeah, in a very basic way, I'm saying, that's a really.
[10:57] Speaker 2: Good way of understanding it. The hunger part of your
[10:59] Speaker 2: brain has jopy one receptors and they get turned on
[11:02] Speaker 2: and they get so, oh we actually no, it's hungry now.
[11:05] Speaker 1: So just for a type two diabetic, the I guess
[11:11] Speaker 1: it's more about it because if that type two type
[11:14] Speaker 1: two diabetic was just eating steak, never ate fruits or
[11:19] Speaker 1: desserts or sweet drinks or anything of that, there's no
[11:23] Speaker 1: net benefit of this, is there for a type two
[11:26] Speaker 1: diabetes and that's type person because really, what it's trying
[11:28] Speaker 1: to do to someone saying when you stop at the
[11:30] Speaker 1: VP service station instead, because you've got the GLP one
[11:33] Speaker 1: receptors turned on and you're both your brain and your tummy,
[11:36] Speaker 1: you're not going to buy the kit cat, which is
[11:38] Speaker 1: a kid cat. I mean, I'm not aving to grab
[11:40] Speaker 1: a kiy cat, by the way, but the kid cat,
[11:42] Speaker 1: which has got a lot of sugar is I don't
[11:45] Speaker 1: feel like that anymore, and therefore I'm not going to
[11:47] Speaker 1: have it. Therefore, as a type two diabetic, I'm sort
[11:51] Speaker 1: of helping the insulent issue that I currently have coming
[11:56] Speaker 1: from my patres am I sort of right.
[11:58] Speaker 2: Now, yeah, so yes, right, sort of yeah, yeah, so
[12:01] Speaker 2: you're you're right the you know, you obviously don't feel
[12:05] Speaker 2: as hungry, you don't want to eat as much, and
[12:08] Speaker 2: and you do sit down and eat food you want
[12:09] Speaker 2: to eat less. People have taped two diabetes generally have
[12:13] Speaker 2: had you know of weid obees. As we're discussing before,
[12:15] Speaker 2: and we're talking about how there's a range of dietary
[12:18] Speaker 2: things that contribute to it. It's often only small parts
[12:21] Speaker 2: of over eating, isn't it like, so we know that
[12:23] Speaker 2: ourselves we can only eat a little bit more. For example,
[12:26] Speaker 2: you know I said I was mid age mid Korea.
[12:28] Speaker 2: I've also got mid children and as a result, I've
[12:30] Speaker 2: learned that if you eat your kids food to clean
[12:33] Speaker 2: the plateoffs, you actually are eating more food, aren't you right?
[12:35] Speaker 2: And made I think it's very much. It's any smarmount,
[12:37] Speaker 2: but if you do it rapidly, and my kids are
[12:39] Speaker 2: not very good to eat is at times of life,
[12:41] Speaker 2: including now with their.
[12:42] Speaker 1: Teens, especially when you've been taught not to be wasteful.
[12:45] Speaker 2: Correct, And that's my cultural background as we're just alluding
[12:48] Speaker 2: to previously, Yes, to be wasteful, right, and so that's
[12:50] Speaker 2: something you have to like cognitively shift and change that behavior.
[12:54] Speaker 2: You know, that's the first thing for me as a person.
[12:56] Speaker 2: But in terms of developing of weid obesity, small mouths
[12:59] Speaker 2: of that over time lead to this weight gain. And
[13:01] Speaker 2: so this person now may be trying to really change
[13:03] Speaker 2: their diet as you're sib alluding to, by upping their
[13:06] Speaker 2: protein content and cutting back carbs, and and it may
[13:10] Speaker 2: actually work for them. I've seen people that I treat
[13:13] Speaker 2: with type two diabetes do big dietary changes, but that's
[13:16] Speaker 2: more cognitive.
[13:18] Speaker 1: As we're talking about the people here who probably cognitively
[13:21] Speaker 1: can't adjust.
[13:22] Speaker 2: What's not to say, It's really hard to maintain those
[13:24] Speaker 2: things long term, isn't it? You know that I'm balanced.
[13:27] Speaker 2: It's very hard to maintain any dietary intervention long term,
[13:30] Speaker 2: especially a more radical one. And so therefore these medications,
[13:33] Speaker 2: you know, I have this role in treating the people
[13:37] Speaker 2: with type two diabetes in a way that both you know,
[13:41] Speaker 2: makes their bodies more efficient in terms of processing food
[13:44] Speaker 2: and makes you know, and uses their own insulin better.
[13:46] Speaker 2: But I think really powerfully by doing these brain and
[13:49] Speaker 2: gut hunger signals and changes to them, it actually facilitates
[13:52] Speaker 2: weight loss, and that actually is a really big treatment
[13:54] Speaker 2: for type two diabetes.
[13:56] Speaker 1: And is it a permanent thing? In other words, do
[13:58] Speaker 1: you have to keep taking it? Because do the receptors
[14:03] Speaker 1: turn off if for some reason? And do they turn
[14:07] Speaker 1: off for a longer period of time as a result
[14:09] Speaker 1: of not no longer turning them on? You know it
[14:12] Speaker 1: was because they're getting stimulated to be turned on. If
[14:15] Speaker 1: all of a sudden you withdraw from this, do you
[14:17] Speaker 1: go back to normal?
[14:18] Speaker 2: Do you go back some normal? What are you finding?
[14:22] Speaker 2: That's a really really good question. Actually, So there was
[14:25] Speaker 2: the clinical data that says, yes, you do have to
[14:27] Speaker 2: take these medications long term and means what we recommend.
[14:32] Speaker 2: I would say to my patients if I'm saying them
[14:34] Speaker 2: on the medications. Now, look, we're talking about using this
[14:36] Speaker 2: medication for years. Oh really yeah, especially if they meet
[14:40] Speaker 2: the clinical criteria and have high ranges of obesity in
[14:44] Speaker 2: terms of the data and how they've looked at the
[14:47] Speaker 2: medications they're actually the companies have done trials and have
[14:50] Speaker 2: been published. You know what happens if we gave this
[14:52] Speaker 2: medication for twelve, eighteen or twenty four months and then
[14:57] Speaker 2: half the group went back onto a placebo inject and
[15:00] Speaker 2: halfway onto their active treatment. Wow, what happened? There are
[15:03] Speaker 2: people who all groups lost weight up until the point
[15:06] Speaker 2: and improve you know outcomes. But once you switch over
[15:11] Speaker 2: to percebo, the ones that went on too but regained
[15:14] Speaker 2: a lot of that lost weight. Now it wasn't back
[15:16] Speaker 2: to where they were, but that study ended at a
[15:19] Speaker 2: certain time point. And know the TRICTU were still upwards
[15:22] Speaker 2: at that point. And the other example I can give
[15:24] Speaker 2: is from my real world experience. You probably want to
[15:27] Speaker 2: ask about the supply shortage or most of the listeners
[15:29] Speaker 2: we know about that, and obviously passions someone who'd done
[15:32] Speaker 2: really well in these medications, especially the ones who'd been
[15:35] Speaker 2: started on the before they became well known publicly and
[15:39] Speaker 2: were really mostly being used for people type to diabetes.
[15:42] Speaker 2: Some of them did really well in terms of weight
[15:44] Speaker 2: and diabetes control. And we had this unfortunate, sad, real
[15:49] Speaker 2: world example. What happens when we stopped this medication. Almost
[15:51] Speaker 2: everyone put weight back on. The trade actually was different though.
[15:55] Speaker 2: I saw some people put less weight on, and some
[15:57] Speaker 2: people put more weight on, and some people were lower
[16:00] Speaker 2: than their weight gain, and some people were fasting their
[16:02] Speaker 2: weight gain as well. But in the end, you know,
[16:05] Speaker 2: take them off for long enough, everyone relapsed to some
[16:08] Speaker 2: extent with their weight and diabetes control.
[16:11] Speaker 1: And is it just on just on the weight loss
[16:14] Speaker 1: side of it? Is there process of the body trying
[16:20] Speaker 1: to rebalance in other words, the body over time sort
[16:24] Speaker 1: of like a process of home mistakes. The body goes, well,
[16:27] Speaker 1: hang on, I've now got something turning these.
[16:29] Speaker 2: Geoped receptors on.
[16:32] Speaker 1: I'm going to start to adjust my galped receptors down,
[16:38] Speaker 1: sort of down regulate them to sort of turn off. Therefore,
[16:42] Speaker 1: over time, you have to take more of this stuff.
[16:45] Speaker 2: So again the haves have looked into this two in
[16:47] Speaker 2: terms of the maintenance of diabetes control and weight. If
[16:51] Speaker 2: you keep people on the medications, it looks like if
[16:53] Speaker 2: you can keep taking them regularly, at least at the
[16:57] Speaker 2: prescribed do prescribed dosages and at the proscribed intervals and
[17:01] Speaker 2: trial sittings, that's easy. But that's been supported by the trial. Clinically,
[17:04] Speaker 2: we're already alluded to the shortages, but in that'sor of
[17:07] Speaker 2: ideal setting, the vast majority of people maintained are they're
[17:11] Speaker 2: better weight and diabetes control. But it's also true that
[17:16] Speaker 2: clinically there seems to be some small group of people
[17:18] Speaker 2: who don't response so well, and as you're alluding to us, well,
[17:21] Speaker 2: some people it just seems to be less effective of
[17:23] Speaker 2: a time, and you probably know this as well. With
[17:27] Speaker 2: these two mainline versions of these incredits, there are high
[17:31] Speaker 2: dosages and that's when those conversations I had with their
[17:33] Speaker 2: treating doctors, right.
[17:35] Speaker 1: So if I get if I could just move on
[17:37] Speaker 1: to sort of metabolic health generally, there is obviously not
[17:42] Speaker 1: Obviously I shouldn't say that from what I've read from
[17:45] Speaker 1: more important for what I've learned so far doing this show,
[17:49] Speaker 1: and it's been incredible for me.
[17:50] Speaker 2: But there's a.
[17:52] Speaker 1: Correlation definitely between people who are type two diabetic and
[17:58] Speaker 1: of weight metabolic health generally. Maybe you could explain to
[18:03] Speaker 1: audience what the people in clinicians like yourself mean by
[18:08] Speaker 1: metabolic ill health. What does it mean?
[18:11] Speaker 2: Again, it's a really good question. So I say that
[18:13] Speaker 2: I'm a cutive metabolic specialist, so that already alludes to
[18:16] Speaker 2: that as a heart as hard as well. Yeah, because
[18:19] Speaker 2: we know that the of weight obesity, type two diabetes,
[18:24] Speaker 2: blood pressure, cholesterol, kidney damage, and cartak damage are sort
[18:28] Speaker 2: of part of this big continuum of disease states, and
[18:32] Speaker 2: that the root cause of a lot of them actually
[18:34] Speaker 2: is of weight obesity, not exclusively. There are obviously many
[18:36] Speaker 2: risk factors for these conditions, but like a large burden
[18:39] Speaker 2: of what we see clinically right now is driven by
[18:42] Speaker 2: of weight obesity. And so when we talk about metabolic health,
[18:45] Speaker 2: we're talking about how to look at people's holistically, not
[18:49] Speaker 2: just in one part, not just your weight, not just
[18:51] Speaker 2: but your your blood pressure or your or your diabetes
[18:54] Speaker 2: control or your cartec disease, but trying to address all
[18:57] Speaker 2: the things that contribute to it as well, including trying
[19:00] Speaker 2: to tackle you know, the weight side of it as well.
[19:02] Speaker 2: And so you know that includes things like looking at
[19:05] Speaker 2: blood pressure, looking at cholesterol, you know, looking at people's
[19:09] Speaker 2: smoking history, looking at the activity exercise levels. And the
[19:14] Speaker 2: reason why we do that is that we know that
[19:15] Speaker 2: but if we can improve all those things people's heart health,
[19:19] Speaker 2: kidney health, you know, future health will actually be a
[19:21] Speaker 2: lot better.
[19:22] Speaker 1: Yeah, and well and brain health too. I've heard that
[19:26] Speaker 1: type two diabetes is in a new form of.
[19:31] Speaker 2: Dementia.
[19:32] Speaker 1: Yeah, yes, it has been referred to that, I should
[19:35] Speaker 1: say I've learned that anyway.
[19:36] Speaker 2: Yeah, so we know that diabetes control, control of diabetes
[19:40] Speaker 2: have type one D type two poor controls does seem
[19:43] Speaker 2: to actually adverse impact on thinking and cognition. And in
[19:47] Speaker 2: these of studies looking at older people with diabetes of
[19:51] Speaker 2: both types, both main types of lists, you know it
[19:54] Speaker 2: is there's some association with poor control and high risk
[19:57] Speaker 2: of dementia and aging with more cognitive problems. That's true
[20:00] Speaker 2: as well.
[20:01] Speaker 1: Yes, so is this I mean in terms of the
[20:04] Speaker 1: overall outcomes of and I'll talk about the benefits of
[20:10] Speaker 1: some good IDEs in a second, but but the overeating
[20:16] Speaker 1: or eating and or eating the wrong things and or
[20:19] Speaker 1: carrying a lot of weight.
[20:20] Speaker 2: Is the issue that.
[20:23] Speaker 1: By doing this generally speaking, that you're perhaps you know,
[20:30] Speaker 1: at risk of clogging or creating a greater risk of
[20:32] Speaker 1: clogging in your arteries, for example, because the food you're
[20:34] Speaker 1: eating is the wrong foods, perhaps it's high in.
[20:36] Speaker 2: Cholesterol or high and ordeals.
[20:38] Speaker 1: Is it also because as a result of that you
[20:41] Speaker 1: don't need cloggi arteries the heart. You can potentially clogged
[20:43] Speaker 1: arteries in your neck, which feeds your brain, and your
[20:47] Speaker 1: brain doesn't get enough nutrients and oxygen, and therefore it's
[20:50] Speaker 1: the brain sell start to die off.
[20:52] Speaker 2: Is it? Is it as simple as that? I mean, no,
[20:56] Speaker 2: that's a that's a really good model. I mean again,
[20:58] Speaker 2: you know, to help my patient understand why I may
[21:01] Speaker 2: be talking about their weight when they're looking at glucose levels,
[21:05] Speaker 2: or why am I talking about blood pressure so much,
[21:07] Speaker 2: you know, when they want to talk to me about
[21:08] Speaker 2: their weight for example. You're quite right, you know, by
[21:11] Speaker 2: these things as you all interact with each other, that's
[21:13] Speaker 2: part of concept of kindimatter bolic health. You know, they're
[21:16] Speaker 2: not exclusive to each other. Uh And and the negative
[21:20] Speaker 2: impact is you're right, Actually it damages blood vessels, both
[21:23] Speaker 2: big and small through a range of different sort of
[21:26] Speaker 2: technical we call them pathophysological or you know, the actual
[21:30] Speaker 2: disease states that do it. But the end result is
[21:33] Speaker 2: actually damaged to big vessels and smaller vessels that increase
[21:36] Speaker 2: the risk of as you said, you know, heart damage,
[21:39] Speaker 2: stroke risks, kidney damage. You know, the leading cause of
[21:42] Speaker 2: advanced kidney disease and dalysis. You know, that's oft end
[21:45] Speaker 2: stage kinney disease. It's type two diabetes now really yep,
[21:50] Speaker 2: and one of the leading causes of of He's only
[21:53] Speaker 2: we have to you know, we're talking a little bit
[21:55] Speaker 2: about the other contributing components, you know, to to ill health,
[21:58] Speaker 2: hip hip replacements and near replacements' you're driven by overweight obesity,
[22:02] Speaker 2: you know, so you know, these are the things that
[22:03] Speaker 2: people can I just stop me on that for a moment.
[22:05] Speaker 1: So that's interesting, so to me, very interesting because I
[22:08] Speaker 1: have someone in my family who just suffered it, had
[22:10] Speaker 1: to get a hip replacement, and I kept saying to him,
[22:13] Speaker 1: you've got on you've got too much weight. I mean,
[22:16] Speaker 1: I knew what he was like when he's younger and
[22:18] Speaker 1: you're just carrying twenty five killers too much. And I
[22:22] Speaker 1: always thought to myself it was that extra weight was
[22:25] Speaker 1: just putting more pressure on the you know, the mechanism,
[22:28] Speaker 1: the hip mechanism. But you're saying that potentially that could
[22:33] Speaker 1: create hip problems.
[22:34] Speaker 2: Yeah, it is what you said, right, Like a lot
[22:36] Speaker 2: of weight just put more pressure on joints and actually
[22:38] Speaker 2: caused more wear intear. This something that I don't obviously
[22:41] Speaker 2: pretend to be expanded the area, but the data does
[22:43] Speaker 2: show that, you know, you have need for high rates
[22:46] Speaker 2: of us staff fritis and the conditions that contribute to
[22:49] Speaker 2: you know, needing these replacements, and people who are of
[22:52] Speaker 2: weight and a beast as well.
[22:53] Speaker 1: So yeah, and overweight and obese. Maybe you could just
[22:57] Speaker 1: give me a bit of an idea of that, because
[22:59] Speaker 1: over weights different absis. Yeah, so what how do you
[23:03] Speaker 1: work if? How do I work out if I'm listening
[23:06] Speaker 1: to this that if I'm obese and at risks therefore?
[23:10] Speaker 2: Yeah, Look, so that the technical terms that the common
[23:14] Speaker 2: times we use them, you know, in everyday language, but
[23:17] Speaker 2: in the medical space, the clinical space, they do relate
[23:20] Speaker 2: to something called the body mass index that many people
[23:22] Speaker 2: probably do know about. People argue about it, They say
[23:25] Speaker 2: that it's not great for individuals. But on the other hand,
[23:28] Speaker 2: it's so easy to measure. It's a simple tool, and
[23:31] Speaker 2: at a population level it does correlate ranges of body
[23:35] Speaker 2: mass indexes. So one range is normal range. We call
[23:39] Speaker 2: it normal. Perhaps it's the wrong word, but you know,
[23:41] Speaker 2: this is one range and there's media.
[23:44] Speaker 1: In this in a statistical sense, that's right.
[23:46] Speaker 2: And then there's another range, which is overweight, and then
[23:49] Speaker 2: the high ranges, you know, ranges of obesity. And so
[23:52] Speaker 2: that's when we say the term of weight obesity. We're
[23:54] Speaker 2: referring to individuals as collectively what's in the body mass
[23:59] Speaker 2: in that would be measured as of weight or beasts.
[24:03] Speaker 1: So if someone's listening to this, how would they would
[24:06] Speaker 1: they be able to self measure.
[24:07] Speaker 2: Or the self measured it. It just requires your weight and
[24:09] Speaker 2: height and people could very easily do the calculation online.
[24:12] Speaker 2: Calculats are available. It's not determinative, I guess it's the
[24:17] Speaker 2: main thing as trainia. You know, as someone at this
[24:19] Speaker 2: point in their life, if they measure and they sit
[24:21] Speaker 2: within this you know, of weight or of beese, you know,
[24:25] Speaker 2: does that necessarily mean they're going to get all the
[24:26] Speaker 2: negative things we're talking about. No, it does not mean that.
[24:29] Speaker 2: Does that mean that they can't change what the tricks
[24:31] Speaker 2: they're on? No, does that mean that they're actually unhealthy
[24:34] Speaker 2: right now? It may not actually, but we know it
[24:36] Speaker 2: at a population level. What these things have meaning.
[24:38] Speaker 1: Yeah, so like someone could be if you go online,
[24:40] Speaker 1: you can, as you just said, you can google this
[24:42] Speaker 1: stuff anyway, or go on to one of your going
[24:44] Speaker 1: to one of the jet bots and have a look.
[24:46] Speaker 1: Pretty I l tell you straight up, you know, go
[24:48] Speaker 1: to Perplexity or any of the ones you want to use.
[24:51] Speaker 1: Att four fives coming out soon, and it'll tell you
[24:55] Speaker 1: how to measure it. It's sort of a measurement between
[24:59] Speaker 1: your height and your body weight pretty much, and they
[25:03] Speaker 1: know what the universe of other humans are and they
[25:07] Speaker 1: can pretty much give you a body mass index of
[25:09] Speaker 1: MEMI based on the population the general population. It doesn't
[25:15] Speaker 1: necessarily mean you are because you could be a super
[25:17] Speaker 1: muscular guy or girl and it'll say you're too heavy
[25:21] Speaker 1: for your height. Of course, might not because you've got
[25:23] Speaker 1: fat and might be just super muscular. Correct, But within
[25:27] Speaker 1: the you know, within reason, it's sort of fairly accurate
[25:31] Speaker 1: at least to ask the question. So let's say I
[25:33] Speaker 1: do it and I look at it and it says
[25:35] Speaker 1: my body mass index is you know, like at the
[25:38] Speaker 1: wrong end of the of the graph. Next question would
[25:42] Speaker 1: be you go and see your general practitioner or something
[25:44] Speaker 1: like that, or if they're like enough to conversation someone
[25:47] Speaker 1: like you, what do you order a blood test?
[25:50] Speaker 2: Yeah, so you so a person you might know the
[25:53] Speaker 2: body mass index, and they would then, especially if they
[25:57] Speaker 2: get older, I guess, because we know that as you age,
[25:59] Speaker 2: as you move for mid life, you're more likely to
[26:02] Speaker 2: crew metabolic ill health. As we're just talking to your
[26:04] Speaker 2: blood pressure, your cholesterol, and so especially as they get
[26:09] Speaker 2: a bit older, you know, these things become more valuable,
[26:11] Speaker 2: and that's when you do talk to your you know,
[26:13] Speaker 2: hopefully have a good relationship with a general practitioner, primary
[26:16] Speaker 2: health care provider because they can actually do a lot
[26:19] Speaker 2: of this. They are trained to in their express inness
[26:21] Speaker 2: as much as you know, I am in this sort
[26:22] Speaker 2: of level of work, and you do if you're concerned,
[26:26] Speaker 2: you know, you actually will discuss it with them and
[26:28] Speaker 2: they would take a medical history see if you do
[26:30] Speaker 2: have already known conditions. As we discussed, go through perhaps
[26:34] Speaker 2: some of your family history as well. Some people who've
[26:36] Speaker 2: got more a strong family history of contact disease, for example,
[26:40] Speaker 2: to be treated differently to someone who does not have it,
[26:43] Speaker 2: whether you smoke with you've got other risk factors for
[26:45] Speaker 2: poor metabolic health. And then they can talk through how
[26:49] Speaker 2: you might want to address these things in both treating
[26:52] Speaker 2: the individual conditions we were talking about and also looking
[26:55] Speaker 2: to see whether you have got you know, clinical obesity
[26:59] Speaker 2: which is leading to consequences. And then we would you
[27:04] Speaker 2: let's say a person is.
[27:06] Speaker 1: Just muscular yep, would you say to them perassures you're
[27:10] Speaker 1: going to get a dexa scan or something of that,
[27:12] Speaker 1: because you want to see where the fat's sitting. It
[27:14] Speaker 1: could be sitting on the inside where you can't see
[27:16] Speaker 1: it because not a lot of as subcutaneous fats the
[27:18] Speaker 1: stuff that we see. But it's also about the viceral
[27:21] Speaker 1: fatal fats.
[27:21] Speaker 2: Well, that's right, and that's one of the things you'd
[27:23] Speaker 2: be worried about.
[27:24] Speaker 1: Yeah, would you put them on a dex because they
[27:25] Speaker 1: are only undred fifty bucks, I mean they're not that expensive.
[27:27] Speaker 1: But would you would you suggest they go do that
[27:29] Speaker 1: or would you put them straight into the blood blood panel?
[27:32] Speaker 2: I think that's someone who's you know, high I've got
[27:35] Speaker 2: friends who are still quite active physically right and have
[27:39] Speaker 2: maintained it through as we go or get hold it together.
[27:41] Speaker 2: And you know, they've got a pretty good awareness of
[27:44] Speaker 2: their physical health. And the body methodics for them is actually,
[27:47] Speaker 2: as you said, not as accurate because they might score higher,
[27:49] Speaker 2: but they've got decently only muscle mass and stuff off.
[27:52] Speaker 2: And you know, I'm not sure they would actually benefit
[27:55] Speaker 2: from a dexer, but perhaps a certain time points in life.
[27:57] Speaker 2: As we said, you know, most of my friends have
[27:59] Speaker 2: gone through forty so as you get through that point,
[28:01] Speaker 2: you might want to do something at that stage, you know,
[28:02] Speaker 2: and start looking and then in the next decade as well.
[28:04] Speaker 2: You know that certain time points, key time points be
[28:07] Speaker 2: worth doing that. And I think that's actually part of
[28:09] Speaker 2: something that your producers talking to about. You know, one
[28:12] Speaker 2: of the recommendations I'd say would be to look at
[28:15] Speaker 2: your health at different times of your life.
[28:17] Speaker 1: Yeah, and perhaps sort of benchmark yourself like at forty
[28:22] Speaker 1: you can benchmark yourself thirty five, bench by yourself again
[28:24] Speaker 1: at forty forty five. And then because I hear gastronologist
[28:27] Speaker 1: say to say, like if you've got a familial issue
[28:31] Speaker 1: around colin Colin Kens about cancer probably now then now
[28:36] Speaker 1: there are considering recommendations from forty start to get Colin
[28:40] Speaker 1: oscar that's for example, and then if nothing happens, you
[28:43] Speaker 1: go back in another couple of years time. But you've
[28:45] Speaker 1: got a baseline. I mean, it's important to get baselines.
[28:47] Speaker 1: So for your the people that you come across, are
[28:51] Speaker 1: you saying to people sort of create a baseline once
[28:54] Speaker 1: you get off the oz epic in other words, to
[28:57] Speaker 1: get this loose weight. So we've got a baseline today
[29:00] Speaker 1: or you know, fifty kilos overweight, and We'll put you
[29:03] Speaker 1: on this for a year. I'll look at you every
[29:04] Speaker 1: six months to see what your progress is like. And
[29:07] Speaker 1: then at the end of the period, I'll compare this
[29:11] Speaker 1: your new baseline to rual baseline. And that's for you
[29:13] Speaker 1: to try and keep yourself. How important is it for
[29:15] Speaker 1: people to understand their baselines and you know where they
[29:18] Speaker 1: should be. Should I be looking at myself and saying
[29:21] Speaker 1: I'm fifty I'm fifty kilos over where I should be
[29:24] Speaker 1: because when I was twenty five, I was eighty five kilos.
[29:28] Speaker 1: Now I'm one hundred and twenty five kilos or one
[29:30] Speaker 1: hundred and thirty five kilos to me, right, I'm obviously
[29:33] Speaker 1: way over over and over the number. So because because
[29:37] Speaker 1: people are listening to listening to this and they're trying
[29:40] Speaker 1: to work out, well, am I abese or am I oweight?
[29:43] Speaker 2: What do I compare myself to?
[29:46] Speaker 1: Look?
[29:46] Speaker 2: There are really good questions. I mean one is you
[29:48] Speaker 2: said like a benchmarking, right, yeah, and so it is
[29:52] Speaker 2: worth benchmarking when you're healthy or when you consider yourself
[29:54] Speaker 2: healthy and looking at at time points as we said,
[29:56] Speaker 2: if you already might know you have conditions and and
[30:00] Speaker 2: these cardio metabolic conditions, you know, looking at your blood pressure,
[30:04] Speaker 2: if you have hypertension, you know, it is actually important.
[30:07] Speaker 2: So you need to do it regularly, you know, not
[30:08] Speaker 2: just once every two years. It might have to be
[30:10] Speaker 2: done much more regular than that, depending on your risk status.
[30:14] Speaker 2: In terms of what you were asking about with being
[30:17] Speaker 2: on treatment and then relooking again, I actually do a
[30:20] Speaker 2: benchmark as you said, before we start them on any
[30:22] Speaker 2: of these treatments to get and you see the blood panels,
[30:24] Speaker 2: you know, blood work to look at their measures that
[30:27] Speaker 2: I'm looking into, the blood pressure, that weight, body mass index,
[30:31] Speaker 2: that waste the conference, you know, and we do look
[30:32] Speaker 2: at the progress of the time, and I do it
[30:34] Speaker 2: reasonably frequently. I think it helps incentivize people, but it
[30:37] Speaker 2: gives them some sense that look not only a my
[30:39] Speaker 2: perhaps losing weight, but look at my blood pressure is better,
[30:41] Speaker 2: my diabetes is better, or my pre diabetes is better.
[30:44] Speaker 2: If I don't have diabetes and my cholesterol is better.
[30:48] Speaker 2: And sometimes you can go off some of these treatments
[30:50] Speaker 2: if you lose if the in creds help them lose
[30:54] Speaker 2: significan amounts of weight. In terms of your listeners who
[30:56] Speaker 2: are not sure themselves, I guess if they're concerned about
[30:59] Speaker 2: their weight, they may be. They might already know, you
[31:01] Speaker 2: know that they've actually been told before I said, look,
[31:04] Speaker 2: you know, maybe they're just wait. And that's when it's
[31:06] Speaker 2: good to have a conversation.
[31:07] Speaker 1: Do you ask them do you over eat? Do you
[31:09] Speaker 1: ever say to someone like do you feel like you overeat?
[31:12] Speaker 1: Because that does take you into the ozembic conversations. It
[31:15] Speaker 1: does so and what is over eating? Like let's say
[31:19] Speaker 1: let's say let's say.
[31:22] Speaker 2: And I don't know.
[31:23] Speaker 1: Another example is, but let's say every time you go
[31:26] Speaker 1: to lunch, you're the person who eats everything on the plate.
[31:30] Speaker 1: And if you have a friend over there, did he
[31:32] Speaker 1: his or her chips?
[31:33] Speaker 2: You eat the chips?
[31:35] Speaker 1: I mean, are there's some little signs that we should
[31:37] Speaker 1: be looking at because there's no point me coming to
[31:39] Speaker 1: see you when I'm one hundred and fifty kilos and
[31:43] Speaker 1: I feel like I'm going to faint all the time
[31:45] Speaker 1: because I've got I am a diabetic. I rather get
[31:47] Speaker 1: to see you. I might not be the case but yet,
[31:50] Speaker 1: but I want I'd rather get to see you before
[31:51] Speaker 1: I get to that point. But are there some signs
[31:54] Speaker 1: that we should be looking out for early, like behaviors?
[31:56] Speaker 2: Probably better way a way of putting it, I think,
[31:58] Speaker 2: if so. One thing is that when people reach high
[32:02] Speaker 2: ranges of obesity, they often don't eat very much anymore,
[32:04] Speaker 2: because we know that fat is not metapiokeally active, and
[32:07] Speaker 2: so actually, you know, we can measure.
[32:09] Speaker 1: It in other words, doesn't need much energy and not
[32:11] Speaker 1: saying filming up with food.
[32:13] Speaker 2: Yeah, that's right, exactly, So when you actually look at
[32:16] Speaker 2: them in clinically, right or in a trial setting, you know,
[32:18] Speaker 2: in a study setting, and you look at food intake
[32:20] Speaker 2: as they measure it, or you actually can directly measure it.
[32:23] Speaker 2: I don't eat very much, but how they get there
[32:25] Speaker 2: in the first place. The well, that's part of what
[32:27] Speaker 2: we're seeing too, right, I think early in the conversation
[32:30] Speaker 2: that small amounts frequently over time make a difference. Then
[32:34] Speaker 2: that actually goes the other way around. You know, small
[32:36] Speaker 2: months away loss over time it losso make a positive
[32:38] Speaker 2: difference too.
[32:40] Speaker 1: How much does activity contribute to this?
[32:42] Speaker 2: Or it does? Lack of activity also does it? But
[32:44] Speaker 2: is it more?
[32:45] Speaker 1: Do the studies show it's in terms of being a
[32:48] Speaker 1: beese or overweight?
[32:49] Speaker 2: Do the studies show that one is more important than
[32:51] Speaker 2: the other.
[32:52] Speaker 1: In other words, it's what's going into your gob he
[32:55] Speaker 1: is more important than the amount of explosis. Because some
[32:58] Speaker 1: people say I'm going to need to whatever, w I
[33:00] Speaker 1: train really hard. Yes, these could be like old folkloric things.
[33:05] Speaker 1: I don't know if there's all bullshit or not. Is
[33:07] Speaker 1: there what Has there been any studies to say, look,
[33:09] Speaker 1: what you put in your mouth is more important than
[33:11] Speaker 1: how much exos you do?
[33:12] Speaker 2: Yeah, there is that. There's some really good soci showing that.
[33:14] Speaker 2: You know, dietary interventions lead to weight loss, but to
[33:17] Speaker 2: lead to sustainable weight loss needs to have changes in
[33:19] Speaker 2: activities and exercising. So it's certainly the case that I
[33:22] Speaker 2: think you allude to this before that if you drop
[33:25] Speaker 2: weight by changing your diet a lot, it's hard to sustain.
[33:29] Speaker 2: Then we know that's very challenging. So behaviorally and culturally
[33:32] Speaker 2: we don't want to be seen to be that different
[33:34] Speaker 2: through hard to just eat three small amounts, you get
[33:36] Speaker 2: bored of them. They're not feeling any more, you know,
[33:39] Speaker 2: behavioral cubes. Right. We also know that to maintain weight loss,
[33:45] Speaker 2: it's best to actually increase your activity level and increase
[33:48] Speaker 2: your energy expenditure as well. So both parts are true,
[33:51] Speaker 2: you know, going back to your example of the really
[33:53] Speaker 2: fit person like again, you know, when you're really metabolically active. Again,
[33:57] Speaker 2: I use examples of friends of mine who will still
[34:00] Speaker 2: both studying and and actually a good friend of mine
[34:03] Speaker 2: was a high level athlete. You know, we're still actually
[34:05] Speaker 2: working at that amate level. Right, He could obviously eat
[34:07] Speaker 2: a lot because he's really he was burning it off.
[34:10] Speaker 2: But for the vast majority of us, you are not
[34:12] Speaker 2: those people. That is not us, and I think that
[34:15] Speaker 2: you know, yeah, so for most people that is, that
[34:20] Speaker 2: is not what they face. They face the issue of
[34:22] Speaker 2: you know, smallmouths of over eating of a time make
[34:25] Speaker 2: a difference. We just talked about how you know, knowledge
[34:28] Speaker 2: based workers or living in a community. It does driving.
[34:31] Speaker 2: We just move less, you know as we age too,
[34:33] Speaker 2: don't we. You know, I have to take my kids
[34:35] Speaker 2: to and from school. I'm driving them, and I'm walking
[34:37] Speaker 2: to the train station to catch train to work anymore.
[34:39] Speaker 1: For example, Yeah, like when you and when you're a student,
[34:42] Speaker 1: you weren't driving. You probably catch the train and walk
[34:44] Speaker 1: from the railway station to the university. And you probably
[34:47] Speaker 1: had no money, so you won't spend any money on
[34:49] Speaker 1: food or either.
[34:50] Speaker 2: And enough that's the pre uber aged.
[34:52] Speaker 1: So I just couldn't get a no uber So if
[34:56] Speaker 1: how would someone know that they might be a time
[34:59] Speaker 1: to dive betta?
[35:00] Speaker 2: So like what happened? What do they get feel dizzy?
[35:04] Speaker 2: Or some how will they know? What? Are there some science?
[35:07] Speaker 2: So one thing is to just do those checks that
[35:08] Speaker 2: we said, and a good primary healthcare practitioner would check
[35:11] Speaker 2: your blood sugar's.
[35:12] Speaker 1: But I say, I don't go to the primary. I'm
[35:14] Speaker 1: just sitting home. I sort of feel alright, but like, yeah,
[35:18] Speaker 1: I'm just maybe a few occasions something happens to me.
[35:21] Speaker 2: What would I be looking before it?
[35:22] Speaker 1: Before I get into their primary here promic healthcare.
[35:25] Speaker 2: But it happens. Type two diabetes happens slowly, you know,
[35:28] Speaker 2: the weight cruise on by and large, and it slowly
[35:31] Speaker 2: moves to them through a stage of pre diabetes where
[35:34] Speaker 2: they were first the instam insistence, so their body makes
[35:36] Speaker 2: more insident to try to control glucose levels within a
[35:40] Speaker 2: normal physiological range.
[35:41] Speaker 1: To try and bring it back down a balance yep.
[35:43] Speaker 2: And then it brings to escape a bit, so they
[35:45] Speaker 2: get pre diabetes where they get a little bit of escape.
[35:48] Speaker 2: The gluquis levels are not quite as high, but I'm
[35:50] Speaker 2: no longer normal, and they're still in slim resistance and
[35:53] Speaker 2: that's generally reasonably be pre clinical. They don't have many symptoms.
[35:57] Speaker 2: It's very common to me I hear this story. You know,
[35:59] Speaker 2: especially why work in software Sydney, which is a different
[36:01] Speaker 2: demographic people have. You know, they drink a lot, right,
[36:05] Speaker 2: they should start losing weight because they're passing the sugar
[36:08] Speaker 2: out and the WII. Right, they pee a lot, they're
[36:11] Speaker 2: vision changes because their lenses in the eye actually startsworbing
[36:15] Speaker 2: the sugar and the lens swells up, so they get
[36:17] Speaker 2: blurry vision. And of course they can feel fatigued and
[36:19] Speaker 2: tired a lot too, So they might have symptoms of
[36:22] Speaker 2: you know, not just one of them, but often it's
[36:25] Speaker 2: many of these things. They say to me, I'm drinking
[36:26] Speaker 2: a lot of water. It's very common, right, you know,
[36:28] Speaker 2: I'm peeing so much. I'm losing weight. I don't know why,
[36:31] Speaker 2: and i can't see. It's a bit blurry, and I'm
[36:32] Speaker 2: really tired a lot of the time. And you know,
[36:34] Speaker 2: their glucouse levels can be dangerously high, and they actually
[36:36] Speaker 2: some of them come into our service and have to
[36:38] Speaker 2: be treated acutely because of their very high range blood sugars.
[36:41] Speaker 1: When you say drinking, you're not fee abt booze, you
[36:43] Speaker 1: do abir.
[36:43] Speaker 2: Water, water, juice, you know, other things.
[36:45] Speaker 1: Yeah, also like fizzy drinks and stuff of that.
[36:48] Speaker 2: And that obviously then you can see that perpetuates. It
[36:50] Speaker 2: doesn't it is they're to get really high sugars from
[36:52] Speaker 2: the fizzy drinks they have or the juice they have,
[36:53] Speaker 2: and then it boy's still trying to desperately get rid
[36:56] Speaker 2: of that glucious levels, right, it's peeing of morbid out So, yes,
[36:58] Speaker 2: it's a vicious sloop. I mean, presenting some of the
[37:02] Speaker 2: more severe symptoms more subtle than that, but those are
[37:05] Speaker 2: the things that people describe because.
[37:06] Speaker 1: Pre diabetic is pretty important. Again, there's probably a lot
[37:10] Speaker 1: of people potentially in pre diabetic.
[37:13] Speaker 2: Stage more than that. We type two diabetes more than yeah.
[37:16] Speaker 1: And those people are sort of walking around sort of
[37:22] Speaker 1: completely unaware of the fact that think they're okay. So
[37:26] Speaker 1: pre diabetic is when you want to get to them,
[37:30] Speaker 1: when the medical system needs to get to the health
[37:32] Speaker 1: system is to get to these individuals. A pre diabetic person,
[37:38] Speaker 1: can they be prescribed some good mines?
[37:42] Speaker 2: Yeah, So now we go into this isshear how you
[37:43] Speaker 2: use these medications, right, and in terms of what the
[37:47] Speaker 2: evidence shows, what the guidelines are, you know what the
[37:49] Speaker 2: different bodies that I belong to your diabetes specialists, OBC specialists.
[37:54] Speaker 2: You know, these medications do have a role in treating
[37:57] Speaker 2: of weight obesity as a disease, these without type two diabetes. Right,
[38:03] Speaker 2: and it's if have the actual criteria it's actually listed
[38:07] Speaker 2: in our regulatory criteria suggests that we should use it
[38:10] Speaker 2: for individuals who have got overweight as determined by body
[38:15] Speaker 2: body mass index and may have a weight related complication
[38:20] Speaker 2: that that includes pre diabetes or blood pressure, could be
[38:22] Speaker 2: blood pressure.
[38:24] Speaker 1: It might be one hundred and fifty of a really
[38:26] Speaker 1: high yeah yeah yeah, boat off writers. For example, we
[38:28] Speaker 1: just talked about to throw as another indicator because of
[38:31] Speaker 1: the weight. Weight, but there's something you were taking account
[38:35] Speaker 1: slip up now okay, yeah, yeah, because usually the weight
[38:38] Speaker 1: around the gullet there is causing a problem.
[38:42] Speaker 2: Yeah.
[38:42] Speaker 1: So that's interesting. So under your rags, because you just
[38:46] Speaker 1: can't say, oh, you're weight, I'm going to give you,
[38:49] Speaker 1: but you've got to have other things associated with it.
[38:51] Speaker 2: And also you've tried other forms of weight loss liestyle
[38:55] Speaker 2: interventions and not achieve meaningful weight loss. So what about then?
[38:59] Speaker 1: What would you say, doctor to these people who buy
[39:04] Speaker 1: you know, various brands GLP one agonist, who would you say?
[39:12] Speaker 1: What would you say these people buying this stuff online?
[39:14] Speaker 2: Yeah? So you know, firstly, what are you doing it for? Right?
[39:18] Speaker 1: You know?
[39:18] Speaker 2: Are you doing it for your health? You're doing it
[39:19] Speaker 2: for cosmetic cosmetic reasons. There is no clinical indication for
[39:24] Speaker 2: cosmetic reasons. And so I don't I mean, I'm a
[39:28] Speaker 2: an a chronologist and a physician. You know, I prescribe
[39:31] Speaker 2: as what the data shows to me and what I
[39:33] Speaker 2: you know, and what is actually beneficial for people's clinical
[39:36] Speaker 2: state health as it were, right, So that's what I do.
[39:41] Speaker 2: And so yeah, I mean it's it's a contested area.
[39:44] Speaker 2: It's really you know, it's it's hard to balance off
[39:48] Speaker 2: very effective medications with a really big need to for
[39:52] Speaker 2: people to try to you know, use them clinically. Right,
[39:54] Speaker 2: Because we just talked about people of type two diabetes.
[39:56] Speaker 2: We've talked about people of void obesity without diabetes, and
[39:59] Speaker 2: that's much bigger.
[40:00] Speaker 1: But nonetheless they've got there are risk for other things,
[40:03] Speaker 1: you know, cardio problems or all sorts of other issues,
[40:06] Speaker 1: kidney problems, cardio problems, you know, structural problems, et cetera.
[40:11] Speaker 1: And those assessments are made by professionals like yourself, like clinicians,
[40:15] Speaker 1: but it just sort of takes it down the track
[40:18] Speaker 1: to I mean, I don't know if there is any
[40:20] Speaker 1: study has been done on this, but maybe you could
[40:24] Speaker 1: proffer a you know, an opinion is could that be
[40:28] Speaker 1: the could the reason there is now a shortage of
[40:32] Speaker 1: various some good eydes available for those people who do
[40:37] Speaker 1: need them, for example, are type two diabetics? Is it
[40:40] Speaker 1: because that people are being prescribed this stuff and they
[40:43] Speaker 1: don't really end or buying it somehow, then they don't
[40:45] Speaker 1: really need it. Or is there that many people who
[40:48] Speaker 1: are pre diabetic.
[40:50] Speaker 2: There's both. There's that many people with weight obesity who
[40:53] Speaker 2: you know, have been trying to access to medications by
[40:57] Speaker 2: so the government says you can use this in this
[40:58] Speaker 2: space clinically, but as you probably know that, the government
[41:02] Speaker 2: doesn't support the finding of it. So these people are
[41:03] Speaker 2: buying it privately.
[41:05] Speaker 1: And so if you prescribe it as supported under the PBS.
[41:08] Speaker 2: For people with type two diabetes and it's in criteria, yep, okay.
[41:11] Speaker 2: But outside of that, so if the people that I
[41:14] Speaker 2: treat with old way obesity without type two diabetes, they
[41:17] Speaker 2: won't be able to purchase them right on the PBS,
[41:19] Speaker 2: even if they saw me.
[41:20] Speaker 1: Right well, and even if you're convinced that they're going
[41:23] Speaker 1: to have arthritis and blah blah blah, they still don't
[41:26] Speaker 1: get it on the PBS. They have to pay full
[41:28] Speaker 1: freight for it. But outside of those people who sound
[41:31] Speaker 1: sound to me to be have legitimate reason to have it.
[41:36] Speaker 1: In the sense that I'm not saying no one people
[41:39] Speaker 1: are illegitimately getting I'm saying in the sense that given
[41:43] Speaker 1: the constraints to supply that's right. It's more important to
[41:46] Speaker 1: get it to the ones who really are in demand.
[41:48] Speaker 1: So so I would say the universe of people or
[41:51] Speaker 1: the population of people who should be taking this, who
[41:54] Speaker 1: have demand of the people that you've just discussed, Yes,
[41:57] Speaker 1: those people with you know, some net effects of being obese,
[42:01] Speaker 1: whether it be diabetics or other issues, so they should
[42:07] Speaker 1: be getting At first, it's just a sort of a
[42:09] Speaker 1: personal view. But is is there a so outside of
[42:14] Speaker 1: your practice, do you hear about or talk about this
[42:17] Speaker 1: predominant people are using for cosmetic reasons?
[42:21] Speaker 2: Yeah, I mean you probably your researchers also told you
[42:24] Speaker 2: as well. You know, there's a lot of telehealth clinics
[42:25] Speaker 2: have been set up purely just to drive a model,
[42:28] Speaker 2: and you know that's not the recommended model of care
[42:30] Speaker 2: where you have a single consultation that's asynchronous, as you say, And.
[42:34] Speaker 1: They're not within the chronologists either. They're there with a GP.
[42:36] Speaker 2: And that's they're not even at the same time. Asynchronous
[42:39] Speaker 2: means that someone's given some information, someone's reviewing that information, right,
[42:43] Speaker 2: And that's not right in my head. And and I
[42:47] Speaker 2: believe the data suggests that. I believe the data shows
[42:50] Speaker 2: that most prescriptions are private actually, so it is what
[42:52] Speaker 2: you said about and with people who buyd them privately
[42:57] Speaker 2: for the reasons of over obesity meeting the CLI guidelines
[43:00] Speaker 2: we discussed, but you have to wonder whether the majority
[43:03] Speaker 2: actually have not mean those guidelines. They may be cosmetic reasons,
[43:06] Speaker 2: as we said, right, so if someone so there is
[43:10] Speaker 2: I don't know.
[43:12] Speaker 1: Whenever you interfere in the balance in your body of
[43:15] Speaker 1: any chemic chemistry, there's always a you know, Newton's law,
[43:19] Speaker 1: there's for every action as an eagle and opposite reaction,
[43:24] Speaker 1: and it still applies, irrespective of the fact that a
[43:27] Speaker 1: lot of new things that Newton said probably have been superseded,
[43:31] Speaker 1: but that one's always applies. And once you introduce a
[43:34] Speaker 1: chemical into your body in the form of similardoids, what
[43:39] Speaker 1: are the side effects that could affect people? Because particularly
[43:42] Speaker 1: those people who are not getting it for a actual
[43:45] Speaker 1: net clinical benefit, numbers are getting it for cosmetic benefit.
[43:49] Speaker 2: So there will be prone to the common side effects
[43:51] Speaker 2: of these medications then anyone else would be. But you know,
[43:54] Speaker 2: they're not going to get the clinical benefits for their health,
[43:57] Speaker 2: and often they're using a very short term gains. But
[44:00] Speaker 2: once they stop it, they'll lose those minor benefits to
[44:03] Speaker 2: their weight that they've achieved or and all the cosmetic benefits.
[44:06] Speaker 2: So you know, I'm not sure that's actually really good
[44:08] Speaker 2: use of potentially scarce resources.
[44:11] Speaker 1: Is a side effect? It can it affect your kidney
[44:13] Speaker 1: is going to cause? Is there any anything that's known
[44:16] Speaker 1: about it?
[44:16] Speaker 2: Or is it relatively speaking safe the class as a whole,
[44:20] Speaker 2: the GLP one ras, these in credits have been actually
[44:22] Speaker 2: been used clinically for a decade, so the first iterations
[44:25] Speaker 2: of them actually quite old. As I was going through
[44:28] Speaker 2: my training, I was learning that these things were coming
[44:30] Speaker 2: and as I started my specially training there, they actually
[44:33] Speaker 2: were available. In the first iterations, these were daily injection
[44:37] Speaker 2: that weren't quite as effective. But what that means is
[44:42] Speaker 2: that we've actually had more than a decade of clinical
[44:44] Speaker 2: experience of these medications even here in Australia, and as
[44:47] Speaker 2: well as the manufacturers keep on studying their medications to
[44:50] Speaker 2: see whether there's anything that occurs, you know, at a
[44:53] Speaker 2: population levels, you keep on giving them medications there, so
[44:55] Speaker 2: their side effect profile is quite well known as well
[44:57] Speaker 2: as a long term effect profile as well, and there's
[44:59] Speaker 2: no I think there are no major things that have
[45:02] Speaker 2: come up to say that these things are potentially harmful
[45:04] Speaker 2: to use in a long term. So and as you've
[45:08] Speaker 2: got some benefits and heart risking kinda rest, it's cristally
[45:10] Speaker 2: being discovered as well.
[45:11] Speaker 1: But unless say somebody is not a beese, they've just
[45:14] Speaker 1: got a n inch of extra fat around. They tell
[45:16] Speaker 1: me they worry about what they gonn look like when
[45:17] Speaker 1: they go to the greg Islands this August and they
[45:23] Speaker 1: start taking this and they're going to take it for
[45:24] Speaker 1: a period of time.
[45:27] Speaker 2: Is there a risk of not having enough nutrition? Well, actually,
[45:36] Speaker 2: as you move into normal weight ranges, especially when people
[45:39] Speaker 2: have got not even be of weight, right, I mean
[45:42] Speaker 2: I think you probably know the term oceenpic face right,
[45:45] Speaker 2: and there's race in the gold. Is that mean, well,
[45:49] Speaker 2: if you lose if you don't have significant over weight obesity,
[45:52] Speaker 2: if you've got normal weight ranges. People you know, we
[45:55] Speaker 2: see in front of each other, if we strip off
[45:57] Speaker 2: our weight, we might lose a little bit here, but
[45:59] Speaker 2: we'll just start losing fat in our face and that
[46:02] Speaker 2: actually doesn't come back. And so as really they may
[46:04] Speaker 2: not come back now once, especially if you've been on
[46:06] Speaker 2: it for a long time, right, and so when you
[46:09] Speaker 2: were talking about some of the unintended consequences of using
[46:12] Speaker 2: it without many in the clinical criteria, as say, people
[46:15] Speaker 2: are not of weight obese, that can be one of
[46:17] Speaker 2: the issues. You know, you do you already said that
[46:20] Speaker 2: you can lose weight, and you can lose weight in
[46:22] Speaker 2: your face and your face might change and change your appearance.
[46:25] Speaker 2: You can suppress your appetite a lot. And you know,
[46:27] Speaker 2: given that you don't have much weight to lose, we
[46:29] Speaker 2: talked about how you lose it different parts. You might
[46:31] Speaker 2: lose some muscle mass as well. That can be an issue.
[46:34] Speaker 2: And you're right, you know, the profound side effects. You
[46:37] Speaker 2: can get some of the common side effects, and you
[46:39] Speaker 2: know there are five percent of people who get really
[46:41] Speaker 2: bad side effects when they use these medications. The nause
[46:43] Speaker 2: and vomiting is really quite profound, or they might have
[46:46] Speaker 2: other gut problems like you know, constipation, diarrhea. These are
[46:48] Speaker 2: not pleasant things to experience if you didn't need it,
[46:51] Speaker 2: if you were going to benefit from a clinically, I'm
[46:53] Speaker 2: not sure why it necessarily put yourself up, you know,
[46:54] Speaker 2: for that chance to getting the side effects for example.
[46:57] Speaker 1: Yeah, so that's interesting what you said about the losing
[47:00] Speaker 1: the fat in your face, which basically gives us part
[47:03] Speaker 1: in part, in some part other than your jaws, you know,
[47:07] Speaker 1: your bone structure. It gives you face shape. And you
[47:10] Speaker 1: mentioned that you could lose it and does come back.
[47:13] Speaker 2: Yeah, So I mean that fat works if fat cells
[47:17] Speaker 2: is cell. So they I don't know the answer to this.
[47:20] Speaker 2: I'd like to know.
[47:22] Speaker 1: Do we have fat cells sort of somehow genetically deposited
[47:26] Speaker 1: all very parts of our body, but but they're sort
[47:29] Speaker 1: of not active or they're not full, and they're sort
[47:31] Speaker 1: of only part full. And when you supply them with
[47:34] Speaker 1: sugar and other things that you can, you make them bigger.
[47:38] Speaker 1: How does a fat cells work?
[47:40] Speaker 2: Yeah, so so you ask me to adi pates out
[47:43] Speaker 2: of sites fat cells? Do they come and go? They do, right,
[47:45] Speaker 2: you know so obviously Yeah, but the ones that they
[47:48] Speaker 2: generally add stuff into them, so you're right, Actually they
[47:51] Speaker 2: actually do become fat cells. These things actually just storages
[47:54] Speaker 2: of of you know, fat, basically, right, they're there to
[47:58] Speaker 2: store fat.
[47:59] Speaker 1: They're still fact well, they're there to store energy, yes,
[48:03] Speaker 1: in the form of fact that you haven't used once
[48:06] Speaker 1: you've taken the sugar in correct, And that's sort of
[48:09] Speaker 1: what inchulin does for you. It actually, yeah, it puts
[48:13] Speaker 1: it does in grab the excess, you can put it
[48:16] Speaker 1: into liver and deliver there.
[48:18] Speaker 2: Actually you actually obviously does do three such so you're right.
[48:21] Speaker 2: It actually has many actions, and part of it is
[48:23] Speaker 2: to move glucose away from you know, from bloodstream into cells,
[48:27] Speaker 2: so there's instant receptors and cells that get turned on
[48:29] Speaker 2: and so forth. It has effects on the liver as well.
[48:32] Speaker 2: As you said. You know, fat is so glucose is
[48:34] Speaker 2: used as a storage form called glycogen in the liver.
[48:39] Speaker 2: We talked about how fat works too, so excess glucose
[48:43] Speaker 2: in the bloodstream is then diverted into pathways that storage
[48:47] Speaker 2: as fat. It's really interesting. I don't want to diverge
[48:50] Speaker 2: too much, but you know, what I learned to my
[48:51] Speaker 2: PhD was that the human bodies designed to store energy
[48:54] Speaker 2: because you know, for our existence, most of our existence
[48:58] Speaker 2: as hunter gatherers was in energy scarce environments. So we
[49:01] Speaker 2: tried our body tried to hold onto any extra energy.
[49:04] Speaker 2: We have come very efficient at it. Yeah, it becomes
[49:06] Speaker 2: really efficient at it. That's why it's so hard to
[49:07] Speaker 2: lose weight because most of the hormones actually try to
[49:10] Speaker 2: get us to protect the weight we've got. And you know,
[49:12] Speaker 2: there really some elegant studies to show that you lose
[49:15] Speaker 2: weight in your body, which is the set point, then
[49:17] Speaker 2: just try to put the weight back on. That's what happens.
[49:19] Speaker 2: And that's why you're going to One of your other
[49:21] Speaker 2: questions was you know, if you just change your diet,
[49:24] Speaker 2: can you just staying the weight loss? And the reason
[49:26] Speaker 2: why you can't is that your body then actually starts
[49:28] Speaker 2: come to regulatoring because we've.
[49:30] Speaker 1: Just been through a drought or a starvation period. That's
[49:33] Speaker 1: some famine that's your body is Wow, you've been on
[49:36] Speaker 1: a diet. Mark, Yeah, he doesn't know I'm on a diet.
[49:39] Speaker 1: I haven't done unconsciously thinks I'm in a famine. Correct,
[49:42] Speaker 1: And it says, well, next time you get a few
[49:43] Speaker 1: good meals, dude, I'm going to store that.
[49:46] Speaker 2: I'm going to be more efficient and storing it. That's right,
[49:47] Speaker 2: I'll start putting back into fat.
[49:50] Speaker 1: Because I've wandered about this, would have this is probably
[49:53] Speaker 1: a different issue, maybe not your expertise, but would it
[49:56] Speaker 1: be fair to say that a person who puts on
[50:00] Speaker 1: way quickly is a very efficient person?
[50:03] Speaker 2: I mean in terms of story energy. Yes, that's probably
[50:06] Speaker 2: one way thinking about it. Yes, very very reasonable.
[50:08] Speaker 1: But they probably wouldn't like to know. They would probably
[50:10] Speaker 1: like to know that because because a lot of people
[50:12] Speaker 1: who won't really years ago, Oh my god, I put
[50:13] Speaker 1: away it so easily. Dude, you're just really efficient at Yeah,
[50:18] Speaker 1: you're very very good. Like actually you're quite in an
[50:21] Speaker 1: evolutionary sense. Yes, you're better than me.
[50:24] Speaker 2: That's but to say actually in terms of you know,
[50:27] Speaker 2: the hunter gave says that of humansistance has been on
[50:31] Speaker 2: this person's generically, you know, I got one blessed. That's right.
[50:35] Speaker 1: So anybody listening, you're blessed. Okay, that's that's that's the truth.
[50:39] Speaker 1: And what we're going to do is we're gonna what
[50:41] Speaker 1: a zembic does, or what these particular drugs do is
[50:45] Speaker 1: class of drugs that you'll p one.
[50:49] Speaker 2: Impressions.
[50:49] Speaker 1: Yeah, what they do is they actually stop your efficiency
[50:55] Speaker 1: in some respects.
[50:56] Speaker 2: Yes, two. Okay, so it's big counterintuitive.
[50:59] Speaker 1: But so we were talking about a moment ago about
[51:05] Speaker 1: the effects on people who don't need this.
[51:09] Speaker 2: Especially when they don't have of weight actually got.
[51:12] Speaker 1: Weight, and so we went through a number of things
[51:14] Speaker 1: that they would anyone would be at risk of that is,
[51:17] Speaker 1: you know, like guts problems, et cetera. But what about
[51:20] Speaker 1: things like as a result not eating enough, you're missing
[51:25] Speaker 1: out on some nutrition. For example, you don't get enough calcium,
[51:28] Speaker 1: you can end up getting bone issues. Is that something
[51:32] Speaker 1: has been seen because there's been around for ten years
[51:34] Speaker 1: and you're saying, so maybe the scene is already in
[51:36] Speaker 1: the research.
[51:37] Speaker 2: So we know that if you lose a lot of weight,
[51:40] Speaker 2: including people got normal weight ranges, and you know there's
[51:43] Speaker 2: been sad studies looking doing famine periods, so people looked
[51:47] Speaker 2: at what happens to people's bodies, you know when they
[51:49] Speaker 2: get don't get much energy and lose a lot of weight.
[51:52] Speaker 2: You lose muscle when you lose bone and obviously if
[51:54] Speaker 2: you've starting off with a normal weight range and you
[51:57] Speaker 2: do it by medication for the purposes of course this
[52:00] Speaker 2: cosmetic benefit, you know, you might lose some muscle mass
[52:04] Speaker 2: and you might lose some bone mass. And you know
[52:06] Speaker 2: the question is whether you get it back when you
[52:07] Speaker 2: stop taking it. I'm certain how effective it is, you know,
[52:10] Speaker 2: and if you lose a lot of it, you may
[52:11] Speaker 2: not get it all back. And your body is we're talking.
[52:14] Speaker 1: About eficiency a moment ago and one thing I'm pretty
[52:16] Speaker 1: sure I learned this but in one of my interviews.
[52:18] Speaker 1: But your body is selfish in that if it feels
[52:21] Speaker 1: as though it is starving or is in this famine
[52:24] Speaker 1: sort of state, it actually can start to convert your
[52:27] Speaker 1: bones into energy. It's one of the areas it goes to,
[52:31] Speaker 1: apart from the muscles as well, it'll lead its own muscles,
[52:34] Speaker 1: but your bones as well, So you're actually attacking your
[52:36] Speaker 1: own body. It's nearly like an auto immune disease.
[52:39] Speaker 2: Yeah, yeah, your body is really like you've got profiled
[52:42] Speaker 2: appartite suppression from these powerful medications. Your body needs energy,
[52:47] Speaker 2: as you said, just to tick along, right, and it's
[52:49] Speaker 2: not getting it from you. You have few fat stores
[52:51] Speaker 2: because you start off being a normal weight. Really, if
[52:54] Speaker 2: he's aurced to them already lost in your face, you
[52:56] Speaker 2: start looking much older. So actually, in some ways it
[52:58] Speaker 2: walks against rage, doesn't it, right, Sorry, it works against
[53:01] Speaker 2: the cosmetic benefit position you're older than you are. If
[53:03] Speaker 2: you lose the face, you know, the fat your face
[53:06] Speaker 2: and you're talking about, yes, it starts then converting your
[53:09] Speaker 2: muscle and starts breaking that down to trade correct clickors
[53:12] Speaker 2: and the extreme end, especially as you lose muscle mass,
[53:14] Speaker 2: you're not protecting your bones as much. You can start
[53:16] Speaker 2: reducing your bone mass as well.
[53:18] Speaker 1: It's really interesting because that sort of sort of takes
[53:21] Speaker 1: down the terriator of longevity. Because I was just thinking,
[53:25] Speaker 1: as you're speaking in terms of longevity, if you don't
[53:28] Speaker 1: need to take well, there's two parts and they're equal
[53:32] Speaker 1: and opposite. If you don't need to take ozambic, for example,
[53:38] Speaker 1: and you are taking for cosmetic reasons, not only are
[53:41] Speaker 1: you're looking potentially on the risk of not looking so great,
[53:45] Speaker 1: but if it starts to put you in a position
[53:48] Speaker 1: where you know your bone mass and your muscle mass
[53:51] Speaker 1: starts to get reduced in terms of longevity, you might
[53:54] Speaker 1: be starting to put yourself at risk of falls, correct
[53:57] Speaker 1: and or any other number of things that could create
[54:00] Speaker 1: a problem for you. You could full break you hip,
[54:02] Speaker 1: you good full break and do you risk hands create arthritis.
[54:06] Speaker 2: There is just there's just a whole plethora of things
[54:10] Speaker 2: going to go wrong with you.
[54:12] Speaker 1: And in fact, and ultimately you know, well statistically at
[54:15] Speaker 1: least those those sorts of injuries not only set your back,
[54:20] Speaker 1: but they actually translational in relation to in terms of
[54:26] Speaker 1: studies as to how long you might live.
[54:28] Speaker 2: Correct, that's you're right. Actually, so you know you're more
[54:31] Speaker 2: risk of force, you've lose certain degrees of muscle mass,
[54:34] Speaker 2: and if you've also then reduced pelle mass, you're more
[54:35] Speaker 2: risk of fracturing. And as you're already saying really correctly,
[54:39] Speaker 2: a hip fracture is a known risk factor for an
[54:41] Speaker 2: early death, you know, and it stops your movement.
[54:44] Speaker 1: You do something bad and like a hip, let's say
[54:48] Speaker 1: you get hip replacement, breaking sake, but you're out of
[54:50] Speaker 1: action for a long time.
[54:51] Speaker 2: You're not moving.
[54:53] Speaker 1: Everything is starting to deplete even more and more and
[54:55] Speaker 1: more and other things can happen to you.
[54:56] Speaker 2: Correct, and it sick.
[54:58] Speaker 1: Yeah, you get sick and you're and you're actually reducing
[55:01] Speaker 1: your longevity. So ultimately, cosmetic is important, I guess. But
[55:05] Speaker 1: ultimately is the longer you live and the better you
[55:08] Speaker 1: lived that period. Yes, that's really what our game is about,
[55:11] Speaker 1: trying to live as long and as good as possible.
[55:15] Speaker 1: And if you don't know this medication, then you are
[55:18] Speaker 1: shortening that potentially shortening the period running a risk of it,
[55:21] Speaker 1: at least statistically. But maybe if you could just go
[55:24] Speaker 1: on the positive side too, because if you're way overweight
[55:26] Speaker 1: and you are obese, yes, you know, these drugs actually
[55:30] Speaker 1: may well increase longevity.
[55:32] Speaker 2: Yes, so people we've got high ranges of obese city.
[55:35] Speaker 2: We talked about how you can develop these conditions, and
[55:37] Speaker 2: these conditions are all known to shorten your life, your
[55:40] Speaker 2: free kardiact disease or kidney disease, and addressing the way
[55:45] Speaker 2: part of it as well as treating the conditions would
[55:47] Speaker 2: actually help you have a lower chance of heart disease,
[55:51] Speaker 2: a lower chance of events kin your disease, and that
[55:53] Speaker 2: therefore have a better and longer quality of life and
[55:56] Speaker 2: a longer duration of life as well. And these medications
[55:58] Speaker 2: actually are now known to reduce heart risk. There's really
[56:02] Speaker 2: been some really powerful studies and in people with diabetes
[56:06] Speaker 2: and and I weight obesity, and with the two main
[56:09] Speaker 2: medications that that are currently available here, I'm showing that
[56:13] Speaker 2: actually reduce heart risk. You know, the people actually get
[56:15] Speaker 2: less heart failure, which is a great thing. And you
[56:18] Speaker 2: know and with with with I was and people with
[56:20] Speaker 2: smag lietide, they get less kidney damage as well. That's
[56:23] Speaker 2: interesting you should say that because my good friend at
[56:29] Speaker 2: Newer the Sea of.
[56:32] Speaker 1: Matthew Ken and doctor Matthew Keen and Professor math Kin,
[56:34] Speaker 1: and I went to him about my mother died from
[56:37] Speaker 1: a new disease and or complications as a result of
[56:39] Speaker 1: M and D. And so I was, but she was
[56:42] Speaker 1: quite old when she happened, and I was quite interested
[56:45] Speaker 1: to see. You know, you know what my predisposition is
[56:50] Speaker 1: to that, apart from getting genetic testing, et cetera. And
[56:53] Speaker 1: I went and saw Matthew about it, and he said
[56:55] Speaker 1: to me something very interesting when it comes to just
[56:58] Speaker 1: general brain diseases. He said something to me, what's good
[57:01] Speaker 1: for your heart is good for your brain, and and
[57:05] Speaker 1: if if overweight is bad for your heart, ultimately bad
[57:08] Speaker 1: for your brain. And I said to him, well, one
[57:10] Speaker 1: of my Uncaels has got dementia at the momentaries is
[57:13] Speaker 1: in that early stages of dementia. And he had a
[57:16] Speaker 1: number of strokes and he and I said to him
[57:20] Speaker 1: that he's had vas had vascular has a vascular dementia.
[57:24] Speaker 1: And the first thing that Matthew Tommy to go and
[57:27] Speaker 1: get is go and get my crowd has checked to
[57:29] Speaker 1: make sure through lifestyle.
[57:30] Speaker 2: And you know, my uncle's fit, fit looking guy.
[57:33] Speaker 1: But some people have this ability to clog their arteries
[57:37] Speaker 1: or the crowd is going into your brain, which, as
[57:41] Speaker 1: I said earlier, actually sort of limits the amount of
[57:45] Speaker 1: blood nutrition oxygen. It said, he goes into your brain
[57:48] Speaker 1: cells and your brain still started to off. And that's
[57:49] Speaker 1: what vascular dementia is. And I mean if you're if
[57:52] Speaker 1: you're wanting to, you know, improve your longevity and the
[57:58] Speaker 1: way you live, because live because no one wants delivered
[58:00] Speaker 1: Dementchio's worst fear family, especially this process of losing weight,
[58:07] Speaker 1: if you're at risk from weighty zambic and all it's
[58:12] Speaker 1: various brothers and sisters, would be a bloody great idea. Yes, yes, yeah,
[58:18] Speaker 1: and I think that so given has been around ten years,
[58:21] Speaker 1: but we only started to talk about why do you
[58:22] Speaker 1: think all of a sudden were just talking about the
[58:24] Speaker 1: last eighty months.
[58:26] Speaker 2: What the hell is that about? So first I was
[58:28] Speaker 2: and pikers as an iteration as to say, it's a
[58:31] Speaker 2: it's an advancement on the previous ones. And so it
[58:34] Speaker 2: was much more effective and it's in terms of its
[58:37] Speaker 2: diabetes effects and weight effects compared to the early and
[58:40] Speaker 2: easier to deliver to. Yes, that's right. The actual device
[58:45] Speaker 2: itself is easy to use needle. You don't have to
[58:48] Speaker 2: withdraw anything out. It's a pen device. You you touch
[58:50] Speaker 2: a small work called mentally but small fine gage needed
[58:54] Speaker 2: onto the pen device. You don't at the dose in
[58:56] Speaker 2: you inject, so it's actually relatively simple. And it also
[59:02] Speaker 2: you're asking him why is it popular right now?
[59:04] Speaker 1: Yeah?
[59:04] Speaker 2: Yeah, I think it actually came about during the pandemic
[59:07] Speaker 2: because I know in Australia it was proved in the
[59:09] Speaker 2: late twenty tens, right, and we had about one or
[59:12] Speaker 2: two years to use it before twenty twenty and so
[59:14] Speaker 2: we were, you know, starting people with type two diabetes
[59:17] Speaker 2: on these medications and suddenly I think, you know, the
[59:21] Speaker 2: lockdowns and then the increased focus on yourself and your
[59:25] Speaker 2: health there and the research. Your research people were on
[59:28] Speaker 2: the internet a lot, and it really picked up overseas,
[59:31] Speaker 2: and that's those things. I think it took Farmer by
[59:34] Speaker 2: surprise as well, you know how powerful it really was.
[59:37] Speaker 2: A I think it's the first example of a of
[59:39] Speaker 2: a viral trend affecting a prescription medication. People know the
[59:44] Speaker 2: word iz and pick, who wouldn't know the name of
[59:46] Speaker 2: any other form of diabetes medication, you know, Yeah, so,
[59:49] Speaker 2: and so that's just really just took off like a rocket.
[59:52] Speaker 2: And and then it was obviously the used. You know,
[59:55] Speaker 2: people were promoting it on their shelal feeds and stuff
[59:58] Speaker 2: forth like that, and so that just as the vice.
[1:00:00] Speaker 1: So it's more it's more about how much we share.
[1:00:04] Speaker 2: I think it's also about our culture, isn't it how
[1:00:05] Speaker 2: much we care about what we look like. I think
[1:00:07] Speaker 2: that's got a big part of it. And we did
[1:00:11] Speaker 2: talk about this before the show started.
[1:00:12] Speaker 1: But I thought, and you've corrected me, but that the
[1:00:17] Speaker 1: injection or the injectables have been I thought had been
[1:00:21] Speaker 1: replaced by potentially replaced by a pill. But you you
[1:00:25] Speaker 1: mentioned there's always been a pill around, and it has
[1:00:27] Speaker 1: been a pill around for a while.
[1:00:28] Speaker 2: Yep.
[1:00:28] Speaker 1: So what could you just give us a bit of
[1:00:31] Speaker 1: a background on those two things, pill versus in an injection?
[1:00:35] Speaker 2: Why take one not the other? So I think you
[1:00:38] Speaker 2: were just asking this to markame that the by availability
[1:00:40] Speaker 2: the ideala, that's the term technical terms to say that
[1:00:43] Speaker 2: is the medication absorbed. And what we do know that
[1:00:46] Speaker 2: is that with these medications, if you take it in
[1:00:48] Speaker 2: tablet form, the body breaks it down very quickly before
[1:00:51] Speaker 2: you can get to the bloodstream. You know, the gut
[1:00:53] Speaker 2: breaks it down, and the gut processes break it down.
[1:00:55] Speaker 2: So they were just really trying to create some type
[1:00:57] Speaker 2: of coating that would allow those medications to absorbed from
[1:01:00] Speaker 2: the gut. And they haven't quite got the B yet
[1:01:02] Speaker 2: they coded, so it stays in the gut or goes
[1:01:05] Speaker 2: through the system and then goes through the jewsy in
[1:01:07] Speaker 2: it where it gets absorbed. So it gets through the stomach,
[1:01:11] Speaker 2: through the tummy into the to the lower intestine. It's
[1:01:14] Speaker 2: right where they can start being absorbed, that's right, yeah, absorbed. Yeah,
[1:01:18] Speaker 2: well we know that you asking me about how they work, right,
[1:01:21] Speaker 2: you know, they're quite stable and you inject them and
[1:01:24] Speaker 2: they and there's a you know, your your own fat
[1:01:26] Speaker 2: access that could delivery device for the for the medication.
[1:01:29] Speaker 2: So they're just very effectively absorbed that way too by injection.
[1:01:33] Speaker 2: So that's why the injectable forms have been the dominant
[1:01:36] Speaker 2: way that these medications are used.
[1:01:37] Speaker 1: Did you think when you did your specialty and then
[1:01:40] Speaker 1: chronology that you would.
[1:01:44] Speaker 2: Ever be doing.
[1:01:46] Speaker 1: Be moving into stuff that's really mainstream. You know, it's
[1:01:50] Speaker 1: got something to do with heart, it's got something to
[1:01:51] Speaker 1: do with you know, saving people's lives, have something to
[1:01:54] Speaker 1: do with longevity. Do you ever think that the endochronology
[1:01:57] Speaker 1: world would start to be really important in terms of
[1:02:00] Speaker 1: the metabolic world.
[1:02:01] Speaker 2: I think I'm young enough to know that to be
[1:02:04] Speaker 2: at the time point when that was.
[1:02:06] Speaker 1: Beginning to evolve, and older than a caronologist never got
[1:02:08] Speaker 1: into this territory.
[1:02:11] Speaker 2: I think. And one of the paradigm shifts for endocrinologists
[1:02:15] Speaker 2: in the diabetes space that we're saying that I do
[1:02:17] Speaker 2: a lot of diabetes is that we're not just treating glucose.
[1:02:20] Speaker 2: We are treating the holistic whole health, the metabolic health.
[1:02:22] Speaker 2: And I think that's really a big paradigm shift. You're
[1:02:24] Speaker 2: not just treating someone's blood sugar levels. You're treating their
[1:02:27] Speaker 2: blood sugar levels as it impacts their health, the heart risk,
[1:02:31] Speaker 2: the kidney risk, and their metabolic health. That's really important
[1:02:33] Speaker 2: and one of the I actually had a number of
[1:02:36] Speaker 2: mentors at the early stages of my career, including out
[1:02:39] Speaker 2: Prince Alfred, and actually they taught me that they sort
[1:02:41] Speaker 2: of knew that as well, and that's one of the
[1:02:44] Speaker 2: benefits and I think it's one of the honors. I
[1:02:45] Speaker 2: had actually been told by people who saw that really
[1:02:48] Speaker 2: early on in the process, the future of it. Yeah,
[1:02:50] Speaker 2: it's the future of it really. Yeah. So would it
[1:02:52] Speaker 2: be is fair to say that.
[1:02:55] Speaker 1: You're sort of like maybe an end of chronologist, but
[1:02:58] Speaker 1: you're sort of metabolic specialist.
[1:03:00] Speaker 2: Yes. I always call myself cardio metabolic physicians. Well, and
[1:03:02] Speaker 2: that's what you call yourself, Yeah, so.
[1:03:06] Speaker 1: A cardiac meta metabolic physician, physician, So metabolic metabolism relative.
[1:03:12] Speaker 2: To your heart, that's right. Heart health. You know again,
[1:03:16] Speaker 2: that concept of heart, kidneys, weight, diabetes, it's all part
[1:03:20] Speaker 2: of you know, the u uh uh, part of the
[1:03:23] Speaker 2: part of the underlying conditions that you're treating. When you
[1:03:26] Speaker 2: treat you're trying to treat someone's diabetes as well. So
[1:03:29] Speaker 2: that's one of the things I would call myself yes.
[1:03:31] Speaker 1: Because one of the things I learned also in this
[1:03:33] Speaker 1: in this journey, is that still the biggest killer in
[1:03:37] Speaker 1: the world is heart by far, actually by far. Second
[1:03:40] Speaker 1: place is cancer, but there's a long bit, fair bit
[1:03:43] Speaker 1: distance between cancer and hearts, And third is brain disease,
[1:03:49] Speaker 1: and fourth is metabolic related diseases, which could be heart
[1:03:53] Speaker 1: could be anything, could be kidneys, could be whatever any
[1:03:55] Speaker 1: one of those things are.
[1:03:56] Speaker 2: And it's it's interesting that.
[1:04:00] Speaker 1: Those you know, some people refer to those as the
[1:04:02] Speaker 1: four horsemen, but in relation to where medicine is going
[1:04:07] Speaker 1: today and what you're doing and you've currently given us
[1:04:10] Speaker 1: your time and expertise and intellect and et cetera today.
[1:04:15] Speaker 1: But what's interesting is that those four territories are sort
[1:04:19] Speaker 1: of the most talked about from a medical practitioners and
[1:04:24] Speaker 1: a clinician's point of view today. That's the most relevant
[1:04:26] Speaker 1: to anybody. And you're sort of in a very sweet
[1:04:31] Speaker 1: spot because you actually cover a lot of that you
[1:04:33] Speaker 1: come hard as well as everything else. You're covering quite
[1:04:37] Speaker 1: a number of areas. And they do you ever feel
[1:04:39] Speaker 1: to yourself.
[1:04:42] Speaker 2: A bit of a burden?
[1:04:43] Speaker 1: That's you know that you feel as though I'm responsible
[1:04:46] Speaker 1: for something here and I really should make sure that
[1:04:48] Speaker 1: the literature is good, that my research is up to
[1:04:52] Speaker 1: date from not just as being a clinician, but also
[1:04:56] Speaker 1: being ahead of the times or alongside the times.
[1:05:00] Speaker 2: And what do you do? What are someone like you do?
[1:05:02] Speaker 2: How do you keep abreast of what's going on? I
[1:05:06] Speaker 2: think I was fortunate to see this coming on early,
[1:05:09] Speaker 2: so I've had a long term interest in this area,
[1:05:11] Speaker 2: and so I do keep on top of the literature
[1:05:13] Speaker 2: and as it evolves and the treatments, and I've been
[1:05:17] Speaker 2: really pleased to see these treatments come through as I
[1:05:20] Speaker 2: graduated and moved it into practice and then moved into
[1:05:23] Speaker 2: specially practice. You know, these things have really come about.
[1:05:26] Speaker 2: I've alluded to that they've been around for ten years,
[1:05:28] Speaker 2: isn't it right? And talked about Ozenbek's been there since
[1:05:30] Speaker 2: the late twenty tens, and this has really changed the
[1:05:35] Speaker 2: way that we can actually manage these conditions. And is
[1:05:37] Speaker 2: it revolutionary then I would say yes. I mean, there's
[1:05:40] Speaker 2: quite a few of my colleagues and I think that
[1:05:41] Speaker 2: this thing has changed the way we manage O weight
[1:05:44] Speaker 2: obesity and how it impacts on diabetes risk and heart
[1:05:46] Speaker 2: risk and kinnity risk. And actually increasingly see fellow career
[1:05:51] Speaker 2: cardiologists and real physicians who actually say, look, we the
[1:05:54] Speaker 2: three of us are treating very similar conditions. Was the
[1:05:56] Speaker 2: root cause of a lot of it? You were still
[1:05:58] Speaker 2: seeing heart disease, right. I've read somewhere that they predict
[1:06:01] Speaker 2: that overvoid OBEs will actually overtake the impact of smoking
[1:06:04] Speaker 2: on heart risk. If it hasn't already done so, it's
[1:06:07] Speaker 2: set to do so, you know, in the near future,
[1:06:09] Speaker 2: so if you could we talk. You know, people try
[1:06:11] Speaker 2: to reduce smoking for a range of interventions, right, but
[1:06:14] Speaker 2: this is one way we can. This is a tool.
[1:06:16] Speaker 2: It's not the only thing, right, but it's a really
[1:06:18] Speaker 2: powerful tool that helps us to address ovoid of BC,
[1:06:21] Speaker 2: which is a risk fact of heart disease, you know,
[1:06:23] Speaker 2: and we're talking about how that was. You know, the
[1:06:26] Speaker 2: big burden on health spending is dalysis, right, and the
[1:06:28] Speaker 2: biggest drive for dialysis type two diabetes, and again the
[1:06:31] Speaker 2: sain thing driving type two diabetes is over to b C.
[1:06:34] Speaker 2: So it really can go into a space now where
[1:06:36] Speaker 2: we can if we can catch patients when they're younger
[1:06:39] Speaker 2: and before they have advanced conditions, we may be able
[1:06:42] Speaker 2: to actually pause their disease state and reverse it, you know,
[1:06:45] Speaker 2: potentially if they can do really well with these medications.
[1:06:47] Speaker 2: And I think we're alluded to it's still important to
[1:06:50] Speaker 2: focus on lifestyle changes and diet and exercise because the
[1:06:54] Speaker 2: studies and my real world experience shows that people who
[1:06:57] Speaker 2: engage with the lifestime divension A should do better on
[1:06:59] Speaker 2: these medications. So the ones who rely on the medications
[1:07:02] Speaker 2: to be driving their weight changes.
[1:07:04] Speaker 1: In other words, team medication, being sedentary or something like that.
[1:07:08] Speaker 1: And that's you know, from my point of view. You know,
[1:07:12] Speaker 1: I'm like, I'm not in the category. But and I
[1:07:14] Speaker 1: guess some of us got to do with genetics, et
[1:07:16] Speaker 1: cetera and choices. But I feel as though what these
[1:07:22] Speaker 1: drugs are doing now is that they have finally put
[1:07:27] Speaker 1: put a full stop after all these crazy diets that
[1:07:30] Speaker 1: people try to talk other people into getting onto. I mean,
[1:07:33] Speaker 1: it is a diet. It effectively creates a diet for
[1:07:36] Speaker 1: you because it stops it from being hungry, but it
[1:07:38] Speaker 1: actually puts a full stop and all the quacks out
[1:07:41] Speaker 1: there promoting this diet and that diet and blah blah blah,
[1:07:45] Speaker 1: and and you know people because people so often are
[1:07:48] Speaker 1: frustrated trying all these things. And it might work for
[1:07:51] Speaker 1: three months, but that's it. As you said, it comes
[1:07:54] Speaker 1: back after three months and get frustrated and they get
[1:07:57] Speaker 1: upset with themselves and the bad about themselves, and then
[1:08:00] Speaker 1: they probably started eating again.
[1:08:02] Speaker 2: You know, like it's like it's a bit of a
[1:08:04] Speaker 2: vicious cycle.
[1:08:05] Speaker 1: And unfortunately there are people who you know, that just
[1:08:08] Speaker 1: go through this process and so you know, like a
[1:08:11] Speaker 1: lot of as lot, a lot a lot is being
[1:08:13] Speaker 1: said about as zen pig et cetera. And you know
[1:08:16] Speaker 1: a lot of people like to put you jump on
[1:08:18] Speaker 1: it from above. But even if it's a you know,
[1:08:21] Speaker 1: if there are going to be some people take the
[1:08:24] Speaker 1: piss in relations to whether they should shouldn't have it,
[1:08:26] Speaker 1: they're I guess they're taking their own risk. But ultimately,
[1:08:29] Speaker 1: the overall benefit is so great, it's so important and
[1:08:34] Speaker 1: old people.
[1:08:34] Speaker 2: Yes, it does. And I think it also it's put
[1:08:37] Speaker 2: a full stop on the idea that a weight abst
[1:08:39] Speaker 2: is purely a failure will part. But it's not that
[1:08:41] Speaker 2: we're talking about how this our society actually encourages us
[1:08:45] Speaker 2: to gain Wait through this, you know, we live in
[1:08:47] Speaker 2: a besagenic society, and one society is one that promotes
[1:08:49] Speaker 2: weight gain because of the things we've discussed, right, you know,
[1:08:53] Speaker 2: the impact of aging makes it harder for us to
[1:08:55] Speaker 2: address that too. And you know, our mental health has
[1:08:57] Speaker 2: been impacted by a range of things that I'm one
[1:08:59] Speaker 2: life that make it harder for us to resist the
[1:09:02] Speaker 2: temptation and the you know, the comfort that comes from
[1:09:04] Speaker 2: eating and nothing. That's the word, it's comfort.
[1:09:08] Speaker 1: And we feel I think as society today feels much
[1:09:12] Speaker 1: more discomfort today as a result of just being a
[1:09:16] Speaker 1: member of society apart from the pressure and the speed
[1:09:19] Speaker 1: and et cetera of society. And discomfort can get cured
[1:09:23] Speaker 1: by comfort eating, correct, And I just and don't I
[1:09:26] Speaker 1: don't blame anybody for putting weight on as a result
[1:09:30] Speaker 1: of what they're putting into their mouth. And a lot
[1:09:33] Speaker 1: of times socio economic reasons decide what you're put in
[1:09:37] Speaker 1: your mouth.
[1:09:37] Speaker 2: To where I'm working stuff with sending, I see a
[1:09:39] Speaker 2: lot more of it than where I work in Central
[1:09:41] Speaker 2: City because people can't afford to eat.
[1:09:43] Speaker 1: And this is you know, like I hate to be boring,
[1:09:48] Speaker 1: but this is a lot to do with the cost
[1:09:50] Speaker 1: of living crisis we currently are undertaking, both here in
[1:09:52] Speaker 1: America and other parts of the world. And the cost
[1:09:55] Speaker 1: of living in crisis always affects the lower end of
[1:09:59] Speaker 1: the social economic scale, it does, that's true. And the
[1:10:02] Speaker 1: and the options for the lower end of the socioeconomic
[1:10:05] Speaker 1: scale a Hamburgers or whatever. And they just need to
[1:10:10] Speaker 1: be associated for the moment and the kids as well.
[1:10:13] Speaker 1: And it starts with the parents, that ends up with
[1:10:14] Speaker 1: the kids. And if we can get you know, if
[1:10:17] Speaker 1: these people are clinically unwell as by someone like yourself.
[1:10:22] Speaker 2: Then the PBS should be paying for those people in
[1:10:25] Speaker 2: my view.
[1:10:26] Speaker 1: Because because ultimately it helps society, because it means they
[1:10:30] Speaker 1: are going to be less reliant on us fixing them
[1:10:33] Speaker 1: up later on down the track, so we'll be better
[1:10:34] Speaker 1: forget them into a better style of behavior. Now that's
[1:10:39] Speaker 1: just that's just an overall economic view. But look, I
[1:10:41] Speaker 1: really appreciate Nebsen, and I've had a I've learned a lot.
[1:10:47] Speaker 1: For a start, You've you've cleared up a lot of
[1:10:49] Speaker 1: things that I have no idea about, and in fact,
[1:10:51] Speaker 1: a lot of stuff I was confused about. You know,
[1:10:53] Speaker 1: there's a lot of stuff in the social media world
[1:10:56] Speaker 1: about this big et cetera. And your generosity today is
[1:11:02] Speaker 1: much appreciated.
[1:11:03] Speaker 2: Not really, again, thank you for the opportunity to talk
[1:11:05] Speaker 2: about this. That's been fantastic, that's great. Thank you.

Shows are listed from Apple Podcasts' charts and directory, and Podcast Index where it is used. Every show and episode belongs to its publisher and plays from the publisher's own feed; this site hosts none of them.