Is Ozempic Problematic? Our Thoughts As Diabetes Dietitians

0:00
Welcome back to another episode of the Diabetes Digital Podcast.

Today we have part two of our Ozempic conversation.

If you missed part one, definitely want to check that out where we covered Ozempic and its initial indication for diabetes and some of the side effects, how to navigate those side effects, what reduction you can expect in your A1C if you’re on Ozempic for diabetes and so much more.

0:26
So check that out.

And today we’re going to be talking about Ozempic for prediabetes and impaired fasting glucose.

Do we see it in those cases? Also the the shortages that we’re seeing for people who might need ozempic for diabetes and now a lot of people are using it for weight loss and how to navigate that.

0:48
We’ll talk a little bit about the Oprah special as well as whether or not Ozempic quote works for weight loss and what are some of the long term side effects.

Yes.

And then we want to talk about the body image of it all and whether or not Ozempic has set back the body liberation movement.

1:08
So you definitely want to stay until the very end because it’s going to be a great episode.

Welcome to the Diabetes Digital Podcast.

I’m Wendy.

And I’m Jess, and we’re best friends, registered dietitians and diabetes educators.

Through our telehealth platform, Diabetes digital.co, we offer accessible and personalized virtual nutrition counseling for people with diabetes and pre diabetes.

1:28
Visit diabetesdigital.co That’s Co to book your first appointment.

We accept insurance and offer affordable self pay options.

Now let’s get into today’s episode.

We have Erin Phillips joining us again this week.

1:45
She’s a registered dietitian, diabetes specialist and private practice owner based in Seattle.

Her work focuses on the intersection of diabetes and eating disorders.

She supports both living with diabetes in both one-on-one and group settings.

She’s passionate about increasing access to weight inclusive diabetes care and also supports clinicians who are looking to increase their knowledge in this intersection through clinical consultation.

2:11
Erin, welcome back.

Thank you.

So glad to be back.

Yay, so happy to be hanging out again and we were talking a little bit about this offline, but I thought it would be great to kick off today’s episode talking about the stats behind it all.

2:28
So you know, there’s been a few different types of weight loss drugs within the GLP One category or just like weight loss drugs in general.

And I’m wondering in terms of what the research has had to say because Ozempic came out in 2017, I feel like we still don’t have really that much data for people with diabetes to see, like what are the outcomes when it comes to effectiveness, especially related to weight, because I think a lot of these conversations have been revolving around weight.

2:57
So for these other weight loss drugs that are approved for weight loss, what has been the research around that?

Is the research showing that it is effective long term?

What has been your experience with that?

It’s a really good question because I don’t think that that question is being asked often enough and that this, this idea of what happens long term other than side effects.

3:20
People aren’t talking about what the data shows in terms of weight loss long term.

So the short answer is we don’t have the long term data on weight loss outcomes.

The longest study we have I think is 104 weeks.

3:36
So that’s two years of people continuously taking.

I think it’s semaglutide.

So if we know anything, if we think about kind of weight loss studies in general, what we’ve seen is that typically two years is about where the research ends.

3:55
And if we go any longer than that, that’s when we start to see people regaining weight in the Step 5 trial, which was, yeah, semaglutide out to 104 weeks, we actually do start to see the average weight going back up among all the participants.

4:15
So the short answer is we don’t really know because we don’t have research long enough.

And the long answer is we will see.

I think we’re going to see weight regain even when people are continuing to take the medication.

Why do you think that would be the case?

4:33
I’m just curious, like I know we may not know, but is it just the body as of now adapting to this new normal and changing set points and things like that?

I think so, yeah.

Your bodies are wired to keep us alive, right?

4:48
Like that’s our, that’s our brain’s number one job.

Like is just keep us alive and and and not die.

The brain doesn’t know the difference between a intentional weight loss versus weight loss due to famine, weight loss due to starvation, and so the body will make a lot of changes to keep us alive, and one of those changes includes regaining the weight that was lost.

5:15
Yeah.

This is something I see all of the time in clinical settings even with bariatric surgery where you know, after years of getting the initial surgery, people are interested in getting it again because they have been regaining the weight or there was a sort of plateau.

5:33
And often times people think like maybe they’re not doing something right or there’s something wrong with their body.

And this is actually incredibly common, especially with medication like Ozempic, where initially they might have lost some weight and they think that it’s going to continue to happen at the same rate that it might have happened initially.

5:52
And then of course, there’s people who don’t lose any weight at all.

Yeah, yeah.

Not uncommon, for sure.

In the last episode, you also talked a little bit about some of the side effects and people who might be on Ozempic for weight loss.

6:08
Those folks might be on a higher dose and so the side effects might feel more intense.

And you kind of talked about making sure people are still eating because the initial instinct for many folks might be, oh, I don’t have appetite.

Yay, like I’m not going to eat.

I feel like everyone who is on Ozempic should be required to also meet with a dietitian who can make sure that they are doing things that are going to be most beneficial for their health long term.

6:32
Because even as we talk about this whole weight regain aspect of things, I’m also thinking of like potential muscle loss.

And I feel like there’s just so much stuff that can go wrong.

Especially people are just like, well, I’m on Ozempic, I’m on my own, I’m not eating and this is great and I’m just like in a long term that doesn’t seem like such a good idea.

6:50
Yeah, absolutely, absolutely.

And like that headline that I made an Instagram post about was something about like, stomach paralysis, right?

And when I when I was thinking about like, yeah, someone who is having this really big change in their hormone activity in their body with adding this medication and then not eating as well and this hormone that slows down digestion and plus not eating are really restricting that.

7:25
My brain was like, that’s a perfect recipe for gastroparesis and stomach paralysis.

What if we actually ate while we were on this medication?

How much would that decrease these Really severe Side problems and Constipation, too, ’cause we talked last time about the housewife Marla Hampton, who stopped taking it, ’cause she got severely constipated.

7:47
And the first thing I thought was like, oh, well, if you’re not eating, you gotta get constipated.

I mean, and if this medication is making you not eat and you’re just like leaning into that, of course there’s nothing to come out.

So I think that, yeah, people should just be required to meet the dietitian.

That’s a great idea.

8:03
Yeah, I’ll petition that.

Yeah.

So I’m curious from your clinical practice and maybe even if if there’s some research out there, does ozempic work in lowering A1C for people who have impaired fasting glucose or pre diabetes the same way that it might work for diabetes?

8:21
Like if someone has an A1C of let’s say I don’t know 6.4, will it still bring that down?

Super good question.

I recorded a course about a year ago on on these medications for clinicians specifically.

And so I like did a real deep dive into the research on this about a year ago.

8:40
And what I found then is that the data was a bit inconsistent.

I love Jessica that you ask about impaired fasting glucose in particular.

I’m someone who likes to specify when we’re talking about pre diabetes, are we talking about impaired fasting glucose or are we talking about impaired glucose tolerance?

8:58
And what one study found was that it was less effective in those with only impaired fasting glucose and more effective in those with impaired glucose tolerance.

Which is makes sense given what I see and folks with type 2 diabetes where glucose levels are going from those mountains and valleys to more of rolling hills.

9:23
I like that I’m doing these hand motions even though it’s an audio medium.

YouTube on YouTube for all the gesticulations.

Yeah.

To me that makes sense and given how these medications work, also makes sense.

And another it’s another plug for differentiating.

9:41
When we’re talking about diabetes, pre diabetes, excuse me, what are we actually talking about impaired fasting glucose or impaired glucose tolerance?

Yeah.

Can you explain the difference between the two for people who don’t know?

Yeah, yeah, yeah.

So pre diabetes is this catch all term for technically your your glucose levels are a little bit higher than the population average but not high enough to be counted as diabetes.

10:06
And a lot of people who fall into that category will go back to regular non pre diabetes and a lot of those people will just stay in that pre diabetes range for forever and a much smaller proportion according to the studies that I’ve seen, the long term studies will progress to type 2 diabetes.

10:29
And so impaired fasting glucose means that your blood sugar is elevated in first thing in the morning or first thing of like before you eat.

And that’s the only time if that’s all you have, that’s the only time your blood sugar is elevated.

And then after that you don’t have these big mountains and valleys.

10:48
And then for people with impaired glucose tolerance, that means that after after eating a meal or specifically after doing an oral glucose tolerance test where you drink this really strong juice that pregnant people do to, that’s the most common time that it’s this testing is used for pregnancy, for gestational diabetes.

11:09
What that means is that it takes longer for glucose levels to come back down after ingesting a large glucose load, essentially.

Now for providers who are prescribing Ozempic off label for weight loss purposes for people who don’t have diabetes, how is this possible?

11:31
Because I’m like OK, the the drug is not approved for weight loss.

Is it legal?

Are they are they able to do that?

Because I’m always like I know insurance is not going to cover it.

People are able to get it at the pharmacy even though it’s not approved.

Do you know how this is possible?

11:48
Is this a thing?

Yeah, yeah.

So technically, prescribers can legally prescribe off label for any medication.

I don’t know what the language is like, what the FDA language is, but as long as it’s, you know, in their clinical judgement and they can like back up why they did it, it’s legal.

12:07
The drug companies can’t promote it off label.

So Novo Nordisk can’t say, yeah, prescribe Ozempic for weight loss, go for it.

But prescribers are allowed legally to to like a doctor can write a prescription, or a nurse practitioner that’s employed by a weight loss clinic.

12:27
I love nurse practitioners, but that’s often what those weight loss clinics.

Yeah.

Yeah.

Yeah.

Yeah, yeah, Employee.

Interesting.

And what about for people who have diabetes and are trying to get Ozempic but they can’t because there is now a shortage because of the high demand.

12:46
How do you advocate for for those clients that you have who you’ve seen a benefit with diabetes, their A1C is coming down but now they can’t get it and they might have to even like change their medication regimen that?

Enrages me so much.

I’ve been seeing this for years now, and when it first started happening, it was definitely during the pandemic.

13:07
And I didn’t want to believe, I didn’t want to believe that fat phobia was the reason that my clients with Type 2 diabetes couldn’t get their medications.

But I think it, I think so it is now.

So I rage with them.

13:23
That’s one of the pros and cons that I talked to people about when they’re considering starting one of these meds is like, yeah, the all of these meds are difficult to access at some point.

I work with clients in various places throughout the country and like someone had to go off of Trulicity and went on Ozempic because of a shortage.

13:46
That surprised me so much.

So it just, you never know.

It’s very frustrating.

And yeah, it’s so stressful.

And I have a client right now who is due to refill Herman Jaro but can’t access it.

And she has some Trulicity from when she was on Trulicity before.

14:05
And she was like, should I take that one?

I don’t know.

If I can’t get the medication that I’m taking right now, should I like, take my old doses of that one?

And I was like, I don’t know, I don’t know how to do this.

That’s a really good question.

But some things that can be helpful for people who have the privilege of time is to call a lot of pharmacies.

14:28
So sometimes the pharmacy across town has the medication, even if the pharmacy in your neighborhood doesn’t.

Another thing that can be helpful is to switch to a mail order pharmacy.

Sometimes those are a little more consistent, and then sometimes people recommend like going down a dose or going up a dose.

14:49
Sometimes the higher doses for whatever reason are easier to access.

It’s sucks.

It’s really frustrating, really frustrating.

Can’t imagine because you need your meds, you know, and and also to even me, like I am on HRT, hormone replacement therapy for ovarian failure and even like having different patches, even though it’s like the same thing, but it’s like a different patch.

15:14
I’m like, no, I use this patch and like, I don’t know, you just feel like you get used to one and maybe they’re all the same, but sometimes it just feels different.

So I can’t even imagine having to then take a different whole different medication, different doses.

That’s just not cool for people to have to deal with that.

15:32
Yeah.

Speaking of the outrage of it all, I’m curious, did you watch the Oprah special on her weight loss journey in Ozempic?

I did not, OK.

I did not watch.

It that makes 2 of you.

Did you watch it, Jess?

15:49
I.

Did yeah No2 you and her yeah you and your OK ’cause I was going to ask your thoughts on that and.

What are your thoughts?

My thoughts.

Yeah, because we haven’t spoken about it.

My thoughts are, and it’s so funny because my husband’s like, he was like, Oh my gosh wait, Oprah’s doing a weight loss special.

16:10
And like, I think he was curious to watch it.

So because I wasn’t even planning on watching it.

But my thoughts are, and I said this on another podcast, I honestly feel very bad for Oprah.

Just because how old is she?

Like late 60s, maybe 70.

16:28
And you feel the need to have to like, publicly address your weight.

I just feel that she shouldn’t have to feel the need to do this.

And also it’s like she kind of had this whole vested interest in Weight Watchers.

16:46
I know she sold her shares, but it’s.

I don’t know.

I just found it honestly.

Like sad, just sad for her.

And also in retrospect, I think like with the whole Britney Spears movement, free Britney, we all kind of saw how in hindsight we were terrible to her.

17:04
I feel like same thing with Oprah.

I saw in hindsight wow, we were really terrible to Oprah about her weight.

How did this even fly?

How did she feel?

Like, you know, every other week this was something that was OK for us to talk about and then her to talk about on her show and you know, have all these different weight loss challenges.

17:23
So I just it made me feel bad, honestly.

And of course she had the the CEOSI think it was of some of these drug companies on there.

Oh yes.

And it was just weird.

So I yeah, if any of you in listening watched, I would please DM us and let us know your thoughts.

17:39
I’m very curious, ’cause I don’t feel like anyone I know has really has watched it.

I saw a clip.

I think she was like interviewing some white dude, I don’t know.

And I was just like, what?

Like he just said some off the wall stuff about weight and you know, kind of like just like shaming someone for gaining the weight and basically saying it’s, you know, it, it’s their fault or something like that.

18:07
And I was like, OK, I’m tapping out.

Yeah, I think so.

She maybe it was an interview that wasn’t part of the special, I don’t know.

It was like she was having a conversation with some white dude about weight.

Well, she also had some weight loss doctors on there too.

18:24
And she was, they were talking about how some of these drugs have been around for 20 years and she was like, where have you been all my life?

She’s like, why didn’t I get the memo, you know?

And I was like, Oh my God, she’s like, why didn’t y’all tell me?

So I just feel I would have liked to have a conversation more so about like our culture, diet, culture and how that is really the culprit in some ways.

18:51
But instead it’s a conversation which I do appreciate.

The the piece of it that was about so much of weight is outside of our control and people want to do that whole blame thing or shame people.

And she’s like obesity is a disease, which that’s a whole another podcast topic, but so I had mixed feelings.

19:09
OK.

Yeah.

Well, how long is it?

It’s not long.

It’s.

I thought it was going to be two hours.

It was like an hour, OK?

Yeah.

All right.

I’ll let you know Oprah special, please everyone let us know if you watched it.

My next question is does Ozempic actually quote work for weight loss?

19:27
Like what have you seen in your clinical practice?

And I know you’re somebody who practices from a weight inclusive health at every size philosophy.

So I’m also curious like how you even approach these conversations in general.

Yeah, that’s a really good question.

And in my clinical practice, I have seen anything and everything under the sun.

19:51
I’ve seen people lose weight, I have seen people not lose weight and I’ve seen people gain weight while taking one of the GLP one Meds like Ozempic or we go V or whatever.

So that’s also when I talk about informed when I do informed consent with my clients about diabetes meds or any meds that I have knowledge about.

20:17
That’s one of the things we talk about is that in my clinical practice I’ve seen, I don’t know what’s going to happen to their weight because I’ve seen so many different things.

Yeah, you asked like what?

How do I approach these conversations in my practice?

And such a good that we could do a whole episode on that as well.

20:38
One of my favorite questions to ask about this is, like, what are you hoping to get by losing weight?

Like how?

How will your life be different than than it is right now?

And this is something I got from, I think it was Sonia Renee Taylor.

20:57
She was interviewed on a podcast, but she was saying what?

What is it that you’re hoping to gain that you don’t already have access to?

And I think that’s a really good question.

You know, it gets at the heart of like, the problem isn’t you.

The problem is, is the world.

21:14
Maybe the world has not been built for you or this culture has not been built for you and and so how can we externalize that problem?

And if you don’t want to externalize that problem or if you know you’re Oprah and you’re like, no, I am going to lose weight no matter what.

21:30
That’s your choice, and I’m I’m going to support you and your choice in the way that I know how, without doing harm.

Exactly.

And I think it’s also important to talk about the practical outcomes like how we talked about long term, like what might that look like just so that people are making informed decisions, which is something Justin, I have spoken about.

21:52
So what happens if you decide to get off of one of these medications?

How are you going to feel if you have to get off of, you know, this medication and maybe the weight goes back up or it starts fluctuating, kind of like troubleshooting those things?

Because in my experience, the providers aren’t really, you know, unpacking everything related to the side effects, the long term implications and things like that.

22:18
They’re like, Oh yeah, go on this medication.

And there isn’t really like a full conversation about what it might mean, what it might look like, what are the different outcomes.

It’s just like, yeah, it’ll help.

And and that’s pretty much it.

And people go into it blindly not really thinking about the future and what their future might look like on this medication.

22:34
So I think that’s also another good question to think about.

Absolutely.

Yeah, absolutely.

There’s a really cool resource by, I think that they’re called Medical Students for Size Inclusivity.

They created a resource that is informed consent for these medications specifically around weight loss.

22:56
And I find that really helpful to share with folks too.

Oh.

That’s great.

We’ll link that in the show notes.

So you have to send it to us.

Yeah, I will.

I’ll make a note.

That sounds great.

So just mention in the intro the body positivity movement.

23:11
Not that we’re gatekeepers of it at all.

We do not represent the body positivity, you know.

You don’t.

You don’t Collectively.

You’re not the we’re not the committee.

Yet respect movement.

23:29
Yeah, but doing work in that space of, you know, body acceptance, I’m just wondering, like what have been your thoughts on what this all means?

You know, like is it possible to take a medication like Ozempic for weight loss and still advocate for body positivity?

23:52
Yeah, I guess it’s a really complicated question.

And we also don’t have the lived experience of being in, you know, larger bodies.

But yeah, you work in the space and you do a lot of weight inclusive work.

So I’m wondering what your thoughts are on that.

Yeah, yeah that’s a really good question And I I also I’m not the spokesperson for for this movement.

24:18
Please please God don’t say that I am the spokesperson, not because I don’t think it’s a great movement but because you don’t need a thin white lady being in the face of it.

I mean body positivity has kind of been Co opted by capitalism and sold for profit by Target and whoever else.

24:39
Sorry, Target.

I love you.

So do I I’m like.

This is the first thing that came.

We know what you’re saying, yes.

Maybe, yes.

Yeah, yeah.

I work from a fat liberation lens or a body liberation lens.

24:56
And so like when we really drill down what that means, a big part of that the core values there are body autonomy.

And so if someone is for body acceptance, for body liberation, for fat liberation and they also want to take this Med, that is their prerogative.

25:18
I have absolutely no judgement, no opinion that, yeah, about what they’re doing with their body.

Like, it makes so much sense If someone does lose weight on these meds, like the biggest thing that changes is that their body now fits better into the society that has been created for thin bodies.

25:42
You know, the built environment that has been created centering thin bodies.

So of course someone’s going to want this.

And so, yeah, I hold space for all all of that when I’m working with clients one-on-one and it’s tough, it’s.

25:58
Yeah, it’s so complex.

And I also feel that, I don’t know.

I can see a world in which two people might feel shamed and conflicted, where it’s like a well now weight loss is accessible to me.

And like, I want to be able to, like you said, fit better in the society that is built for thin people.

26:21
And it’s complex too, because I’m even thinking of this woman I mentioned her on on another podcast, Heather from Real Housewives of Salt Lake City.

She was in a larger body and now she’s on one of the shots and she’s thinner and she’s just like, I’m treated better.

26:39
Sorry.

It is what it is.

And I think that like, we ignore that part of the conversation where it’s like you will most likely get treated in a different way.

You are going to have, like you had said, more access to certain things.

And I I think that that is important to think about and include in this discussion.

27:01
And not just like, oh, this is taking 10 steps back for the body liberation movement, which you can look at it like that too.

But it’s also people want access to these things.

And who are we as people like little, you know, dots within the body liberation movement to gatekeep who gets access to living in a world that might feel a little bit easier.

27:28
And so I think that I’m happy that we’re able to have like this nuanced conversation.

I was very curious where it was going to go with a lot of folks within the health at every size movement and kind of opinions.

And I think opinions are all great.

But at the end of the day, I really like your approach of body autonomy and like, not trying to push people to do whatever your agenda is.

27:47
And I feel like the older I get, the more I’m like, yeah, I the body autonomy, like do whatever you want.

Like, who am I to say anything?

Is someone who does not have your lived experience?

Yeah, yeah, I I’ve got a lot of things that grind my gears.

But the another one that came to mind when you were talking, Jessica, is is providers who are Health at Every Size, which I include myself in that group.

28:12
Yeah, mostly Health at Every Size dietitians and therapists who have been like raging on social media saying screws and thick, like it’s so bad, ’cause then I have clients with Type 2 diabetes who are taking these meds or considering taking these meds who have now been shamed by the clinicians that they respect and look up to and yeah, that that great speakers.

28:36
As well.

And I think the problem is it’s like, I understand where everybody, not everybody, but I I get like what you’re saying, where folks are coming from.

And I think in an ideal world, absolutely.

Do we want for everybody to feel valued and for everybody to feel worthy?

28:56
100%.

But unfortunately, we don’t live in a society like, we have to be realistic with the world that we live in too, where it’s like, it doesn’t value everybody, it doesn’t treat everybody with respect.

And I can see how it’s really hard for people every single day to always be pushing up against, like the hate and the stigma and the shame.

29:19
And if this is going to make it easier to live in the world that we live in of today, because there’s the ideal world and then there’s the real world, like we need to let people make those decisions given all the information.

And I think often times people also don’t have all the info of like the side effects and like we’re talking about how to navigate them and what are the long term effects, Like, we don’t really know.

29:40
So yeah, just thank you so much.

Yeah, absolutely.

Now in wrapping, I’m sure there’s a lot of folks who are just very curious about you, your work, they want to maybe follow you or work with you.

Can you tell us a little bit of more about where they can find you?

So I can be found on my website which is Erin Phillips nutrition.com and on Instagram at Erin Phillips Nutrition.

30:05
I deleted Instagram from my phone and has been the best thing for my mental health.

But you can see my old posts and I’ll probably have things to say on there in the future.

And then I have two ways of working with me right now.

30:21
One is one-on-one and one is a group and I should have openings for both later in the summer.

So stay tuned.

And also Erin, a birdie told me that you are starting a podcast.

Can you tell us a little bit more about that?

30:37
Yeah.

So I’m starting a podcast with my good friend Kelly Six, who is also a dietitian who has lived experience of type one diabetes and is also body liberation dietitian and it’s going to be a lived experience podcast.

30:55
So we’re having people on who have lived experience of diabetes, whether it’s type 2 diabetes or type one.

We’re really wanting to feature type 2 diabetes because there’s so few stories out there about people of Type 2 who are really thriving without dieting and restricting.

31:14
And it’s not because those people don’t exist.

It’s because of a lot of other reasons.

Mostly the Internet is a mean place can be a really mean place to be.

So yeah, hopefully it’s also coming out this summer.

Oh my God.

But yeah, stay tuned.

I’m excited.

Such a great idea.

31:30
I love it.

Oh, it’s called glucose riot.

That’s what we decided to call it.

Yay.

OK.

Well, included in the show notes if it’s out.

OK.

Thanks.

Thanks for joining us for today’s episode.

If you’re interested in nutrition counseling with one of our expert dietitians to help improve your prediabetes or diabetes, visit us at diabetesdigital.co.

31:54
Also, if you found our conversation helpful, do us a favor and rate and review at this podcast on iTunes.

Plus, share with someone who might find this helpful.

You can also connect with us on Instagram at DiabetesDigital.co and Tune In every Wednesday for practical, inclusive and culturally humble diabetes insights.

32:14
We’ll catch you later.

Bye.