Clinical Observations on Weight Loss Outcomes

Hey everyone, welcome to a sneak peek Ask Me Anything or AMA episode of the Drive podcast. I'm your host, Peter Ata. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created Or you can learn more now by going to PeterataMd. com forward slash subscribe So without further delay, here's today's sneak peek of the Ask Me Anything episode el to Ask Me Anything, AMA episode eighty six. In today's AMA, we're going to look at the effects of GLP one receptor agonist. So these are drugs like Ozempic, Bgovi, and Zepbound But specifically, we're going to look at the impact they have on muscle We're going to talk about how much lean mass people actually lose on these drugs and how that compares to weight loss by any other means We're to define exactly what lean mass is and how loss of lean mass on DEXA can actually mislead us. How these drugs impact bone mass and fracture risk The all important effects of these drugs on strength and physical function, which probably should be the most important metric The effect of these drugs on different fat depots across the body Wh's at most risk? for lean mass loss how to maintain muscle and bone strength on these drugs And the initial insights of the effects of retetatrutide, which is a drug I'm sure many of you have heard of as it's making its way through ide Cess pool at the moment, but nevertheless will be an FDA approved drug in the not too distant future. And so people have lots of questions about how will retetarueide affect weight loss, but specifically its impact on muscle mass as well. So without further delay, I hope you enjoy AMA number eighty six. C Here Welcome to another AMA. how are you doing Very well, thank you. Awesome. So four today. We are going talk GLP one on And we did our first episode on this about five years ago It was you and Bob. And back then, no one was really paying attention and no one really cared about that episode And then about a year and a half later we did a second episode on them, and all of a sudden people really started to care And so thinking back at this, what do you think it was about that? secondcond episode that got so many people's attention on this I mean, if I were to think about it through the arc of the story of these drugs, I think it was obviously the impact on weight loss. I mean first foray into GLP one agonists clinically was in twenty fourteen. So twelve years ago I started experimenting with liiralutide in patients. found it relatively. uninspiring and for that reason, given the cost and the logistics kind of abandoned it And I think when we did our first episode, we were already seeing the effects of semig gllutide and how different it was. This was now the third generation of GLP one agonists. And we realized internally frankly, I think by I recall it being in the fourth quarter of twenty twenty. that this was a step function change from the first two. And I just suspect in the answer to your question, that I think there was just there's a tight lag between when the public sort of to realize that Of course, the implications of that were that this was a drug that went from being kind of a niche diabetes drug No a drug that had far more appeal because it was now for the first time being looked at for weight loss in a non diabetic And so you know, kind of changed everything And at the time, you know, the FDA was really just looking at weight loss. They weren't looking at body composition. And so You know, I think that's sort of, that was the beginning of the story Just to kind of double quick on that win you started to use these a little more What were you seeing and what kind of jumped out? that could have been problematic Well, you know, what we saw in the early trials and I think what we were seeing clinically five and a half years ago was that people who were losing a lot of weight seem to be losing much more lean mass than we normally saw in people who were going about weight loss using the normal variations of caloric restriction or dietary restriction or even time restriction, although there's a bit of an aerisk I could put there. And it was almost a one to one ratio, which meant that if a person lost ten pounds Five of them would be fat and five of them would be lean as it's characterized on Dexa So That's that's pretty relevant, right? So if you're going to lose ten pounds and half of it's lean and half of it itss fat. That's very different than if you're going to lose ten pounds and eight of it is fat and two of it is lean We were using DexA scans, but Obviously, you could even clinically just look at people and see that something wasn't right with this form of weight loss And it seemed like around that time that kind of became a large part of the discussion of outside in the media and there was a lot of stories these drugs and some of the warnings, correct. Yeah, a lot of scientific papers began to raise that concern, and I think that's very good in terms of raising public awareness about the potentially important side effects of these drugs. I think there's also been some fear mongering and speculating beyond what the data have shown And I think I would add to that that as we learned The manner in which the drugs are used and the manner in which the patients are counseled around the other modifiable behaviors, particularly with respect to their nutrition and exercise, can change the outcomes. So You also have to be careful that you don't over interpret what you see in clinical trials which are you know, average, homogenized data when you don't have insight into how those patients were necessarily counlled So you know it's valuable to have that information, but you also don't want to be paralyzed by it and you don't want to discourage other doctors or patients from kind of experimenting with how to get better results than what the clinical trials showed Yeah, and so now that we're a few years past that What updates do we have around the story of GOP ones and muscle loss Thank you for listening to today's sneak peek AMA episode of the Drive. 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