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Asher:
To lose that much weight in such a short period of time, your body must be shitting itself. Because your body is not your body is not happy. With even a small a much smaller amount of weight loss in a short period time to lose that much is going to cause a great deal of stress and panic within your body and it is going to respond to that that your body does not take that like your body does not understand. I’m fat and I’m trying to lose weight your body thinks you’re starving and you’re dying, your body thinks you’re sick and it’s going to try and fix it as quickly as possible.

Summer:
This is eat the rules, a podcast about body image self worth, anti dieting, and intersectional feminism. I am your host summer Innanen. a professionally trained coach specializing in body image self worth and confidence and the best selling author of body image remix. If you’re ready to break free of societal standards and stop living behind the number on your scale then you have come to the right place. Welcome to the show.

This episode of ether rules is brought to you by you on fire you on fire is the online group coaching program that I run that gives you a step by step way of building up your self worth beyond your appearance. With personalized coaching from me incredible community support and lifetime access to the program so that you can get free from body shame and live life on your own terms. Get details on what’s included and sign up for the next cycle at summer innanen.com forward slash you on fire. I’d love to have you in that group.

This is episode 297 and I’m with Dr. Asher larmy transmasculine weight inclusive GP and leading expert in weight stigma. Asher is here to break down everything you need to know about weight loss medications like ozempic and Wigo V. We talked about what the research says about the long term effects of these medications, their side effects how much weight you might lose and then gain back and what the health benefits might be and so much more. You can find the links mentioned at summer innanen.com forward slash 297.

I want to give a shout out to Latin Ken who left this review great podcast this has helped me in this journey of getting comfortable with my body so much keep it up. Thank you so much for leaving that review can be short and sweet just like that. You can go to iTunes or Apple podcast should I say search for eat the roles, then click ratings and reviews and click to leave a review. You can also subscribe to the show that helps other people to find the information that you’re learning here. Don’t forget to grab the free 10 Day body confidence makeover at summer innanen.com forward slash freebies with 10 steps to take right now to feel better in your body. If you’re a professional who works with people who may also have body image struggles, like if you’re a therapist or a dietitian or a doctor, get the free body image coaching roadmap at summer innanen.com forward slash roadmap. If you can’t spell my last name, you can always go to the body image coach.com to find everything mentioned here.

We are gonna get right into this episode because it is on the longer side because there’s just so much to talk about when it comes to weight loss medications like ozempic and wood govi. They’re different medications by the way. Same thing but different dosages. And that’s the good stuff that we’re getting into today. We’re getting into all the details about it. I have listened to so many different things on this topic and having this conversation today I learned even more than I thought I knew. So I think you’re going to take away so much. I’m extraordinarily grateful for all the time and energy that Asher has put into researching this topic and for taking the time to be here today. Dr. Asher larmy He they is a trans masculine weight inclusive GP and leading expert in weight stigma. He is a fat activist and the founder of the No Way campaign with over two decades of medical experience and a lifelong journey as a fat person sure is combating weight stigma and promoting weight inclusive care as a self styled fat doctor. Let’s get started with the show

Hello Asher Welcome to the show.

Asher:
Thank you so much for having me I’m very excited as I said just now I’m going to try and be sensible and not be a child and immature like it’s getting to that stage in the day where I am feeling a little bit reckless

Summer:
well I will try not to stoke the fire but we’ll see we’ll see if maybe people want right maybe people want a reckless episode about weight loss medication

Asher:
yeah might be that’s what we’re gonna give them

Summer:
I was I was saying to you before we hit record I went to your weight loss medication masterclass, back In the fall, and it was so good at you delivered the information in such a helpful and practical way. And ever since then I was like, Oh, we have to have you on the podcast. And I’ve been trying to, you know, refer people to wherever you’ve been speaking about these types of things, and just weight and health in general. Because it’s just, it’s so great to have someone with your background and experience, actually be able to look into, you know, the medical side of things and be able to offer a perspective that is perhaps not being offered in the in the dominant mainstream. So I’m super happy to have you here today.

Asher:
Thank you, thanks for…

Summer:
What are first of all for for because I think most people will call it like ozempic or Wigo V, but they really fall under the classification of, of GLP ones is that right? So what what are GLP one medications.

Asher:
So actually, they are like mimicking a natural hormone that we make inside our gut to our intestine, and that we call these particular hormones incretins or incretin, I don’t even know how you say it to be honest, and GLP one is one of them. And so the manufacturers, which are not just never noticed, but as Empik is, nobody is created by never notice, they just made a kind of an analogue, it’s just like a mimic. It’s just like, you know, a similar compound, it’s not quite the same, but it binds to the same receptors. And what it does is it basically increases the amount of insulin you produce. That’s the role of the acquittance is to make you produce insulin. So it increases the amount of insulin that you produce. It reduces insulin resistance. Those are the two main things, but as a side effect, it just happens to reduce your appetite. So it acts on the brain to reduce your appetite. It also slows down the emptying of your stomach. And all of these things are these two last things especially leads to weight loss. It’s It’s It’s inevitable part of the process of of giving people these supplementary increases or you know, the GLP one analogs. So the the manufacturers in particular Novo Nordisk, who are making these drugs, realize pretty quickly how, wow, look, people are losing quite a bit of weight on this medication, maybe we could do something about that and make some money.

So they took the medication, which I should have said is used predominately to treat diabetes, I think most people know it’s used predominantly treat Type two diabetes. And the generic name was some magnetite, you go up to one milligram to treat diabetes, which you give one milligram as an injection. Once every week, what Novo Nordisk was realized was, if you almost triple the dose, or two and a half times the dose, there’s not a word for that, but 2.4 milligrams rather than one milligram, it actually induces quite a bit of weight loss. So we can just rebrand this thing, give it a new name, we go, the pen that you can get is 2.4 milligrams rather than one milligram. And will give us that to people instead of for diabetes, we’ll give it to people to lose weight, and it will work and it does it does make people lose weight to begin with. The problem is that there’s a huge demand, as you can imagine, they cannot meet that demand, you know, there’s an issue with a supply chain. And so nowadays, really, people are taking ozempic, the one milligram injection, for the purpose of weight loss, whereas the one milligram addition is actually meant for diabetes. It’s not that great at weight loss. If you look at the studies, they actually did a study where they compared we go V and ozempic for weight loss, and found that yeah, that’s okay. It’s not that great, you really need to be on the high dose for it to be effective. So there’s a whole bunch of people taking us Empik, for something it’s not licensed for it’s it’s licensed for diabetes, not for weight loss, those who are taking we go V or at least taking the medication that is licensed for weight loss, but actually it’s very difficult to come by because of supply issues. That was a very long answer.

Summer:
I don’t think I realized that last point. And maybe I just missed it when because when you did the master class, it was like so much information. That was great. I didn’t realize that ozempic is only one milligram and isn’t really the diabetes medication. The one question I had just as a follow up from that is, the diabetes medication has been around for a long time, like has that been around for a long time? Like, is that like an effective diabetes medication?

Asher:
Yeah, yes. In the history of diabetes medications, it’s still the new cover. There are drugs like Metformin that had been around for decades. And there are drugs that are perhaps slightly less fashionable now because of these new comers that came along. And there are two new comers, the GLP, one analogs and one of them and yeah, I mean, I’ve been prescribing it for many years. I’m trying to think when we first started prescribing, it was probably about six, seven years ago. I can’t remember it was released, it was 20. It was later than 2010. And before 2020. So somewhere in that in that decade, and yeah, they’ve been around for a while. Most of my patients actually never go up to one milligram, a lot of them but just on the northbound five, because you don’t really need to go that high, it doesn’t really good job for some people. For some people, it’s not very effective. For others, it’s really effective. And I want to make it very clear, I’ve got no problem with people using ozempic. For diabetes, I don’t think there’s an issue there is, as far as I’m concerned, a relatively safe drug as far as drugs go for diabetes. But what we have to remember is that people who are diabetic are already that there is already lots of processes going on in their body that require that insulin resistance being one of the main ones. So taking this injection, is going to reduce your insulin resistance so that that’s going to be a good thing for diabetics, people who aren’t diabetic that necessarily have insulin resistance, and if they do, it’s not become a pathological problem yet. And so there are questions around how this is going to affect those people. And also, one milligram is very different to 2.4 milligrams, the more you take, the worse the side effects, and the higher the risks of long term complications. So the problem is, we don’t know what 2.4 milligrams does. It’s not it’s literally been around since 2021. And as I said, there’s such a supply issue that most people are taking it. So yes, fine, fine for diabetes, really, I don’t have any concerns about it. Although I will say like, it’s got a lot of side effects, and not everyone can tolerate those. So nowadays, and those are so obsessed with prescribing as MP because all diabetics need to lose weight, right? Because most diabetics are fat. And they’d rather us thin and sick than they would fat and not having side effects. So they push as epic because they want you to lose weight. And for some people, it’s just not possible. And it was epic is not the only medication. I’ve just had a client telling me that they were told if they can’t, if they can’t tolerate as epic, the next option was insulin. And I was like, no, there are seven, six and a half different groups of medications for diabetes is I think is one of them, or five others, at least that we can try before we even consider insulin. So this is this idea that it’s ozempic or nothing like this diabetic.

Summer:
So wow, that’s super interesting. And so I had a follow up from that, but I’m sort of blanking on it. So I’m gonna go to come back to that. Oh, I know what I was gonna ask you. So I know a lot of people and I don’t know if this is necessarily in other countries, because I’m in Canada, you’re in the UK. You’re in the UK. Right? Did I get that? Right? Yeah, okay. Yeah, I just want to support. But in the US, like, I know that there’s places that are just kind of compounding it right? Or you can even just kind of buy it on line like through, like, I don’t know where, but it’s it’s like off brand. With those people we getting? Do you know, would those people be getting like the sort of ozempic knockoff? Or would they be getting the will go V knockoff.

Asher:
So as far as I know, you can’t get this drug without a prescription. I’m not aware that you can get it without a prescription. I am aware that people are getting it from pharmacists. I don’t know how that works legally. I don’t know how that FDA does things here in the UK, no way you can get it without a prescription. But here in the UK, we have pharmacists that can prescribe things. So you know, you also have like telehealth doctors, I have concerns about taking we go V I can’t even begin to go into taking Knock Off we go v if that’s such a thing. That’s desperately worrying. I mean, drugs like this, it’ll be very hard to copy them. You know, it’s not like fast fashion. You can’t just copy a person’s drug that’s legal to do that. So I would be very interested to find out what’s going on. But as I said, like I know you’ve been doing Weight Watchers WW Weight Watchers has, has now bought a telehealth company that prescribes predominantly ozempic. And we go V so you can get this really easily now. But as I said, I think even in the States, we got these hard to come by

Summer:
Yeah. So I was talking to one of my colleagues yesterday and she works in the fitness industry. And she was saying that a lot of the gyms in the US are having, like an onsite I guess it’s a doctor like but somebody who is now like situated inside the gym. Who is it’s part of it’s like part of the facility. And I think I can’t remember they named one particular chain that I don’t think we have here in Canada. So it’s it’s not sticking to my brain. But were they you know, that’s just part of now whenever you go in one of those particular facilities, like that’s going to be a part of it. So I think it’s pretty prolific, especially in the US is from what I’m hearing, like more so I think, at least from what I’ve seen here in Canada, but

Asher:
yeah, I also think and this is not meant to be a criticism of the US, but I think that their laws are a lot more relaxed than our laws like we in Canada and I think in the UK as well. And most of Europe we have very strict rules about things like that. And I think the FDA is slightly more relaxed about you know, what can I tell you this is big business and it’s like we refuse to learn from history, how many weight loss drugs, can you name that have existed in your lifetime that were taken off the market? A few years later, because people were dying from them, what you have to understand is drug companies put money aside to deal with the lawsuits from the people who are going to die from their drugs, that they have put the money aside already, they have said yet, even if this cost us 50 million, 100 million does not matter, we’re making billions. And so they are they need to cash in quickly. Because it’s only a matter of time before we realize that a these drugs are dangerous, and B, they don’t actually do what they said they were going to do. So then, you know, they’ve got like a finite amount of time to make as much money as possible. So it doesn’t surprise me that that you can buy them in gyms now. And you can get them over the telephone. And it’s become so prolific because this is a money making exercise. And it you know, they must make as much money as possible in the shortest amount of time. It’s possible, it was 430 billion 450 billion that has been predicted, I think something like that, from this, this one drop would go me. I mean, that’s too many zeros for me to get my head around. But that’s only if it’s successful. So they will do whatever it takes to be successful. And if people die along the way, that’s a cost they’re willing to pay literally pay as in financially pay. They don’t really care about the actual lives. It’s just the money that they worried about.

Summer:
Absolutely. I remember you talking about the parallel between this and what happened with Oxycontin, and, and it? Yeah, I mean, having watched those documentaries about OxyContin and having seen the way that it was rolled out so quickly and pushed and it really does, you know, there’s a lot of parallels that you can that you can see there I don’t know if there’s those Olympic stuffed animals but like

Asher:
oh, I don’t know if there are but it’s already the marketing to doctors thing that’s that’s well known that’s that’s already been exposed, especially here in the UK where no one audit Scott a massive slap on the wrist. And this is what happens to drug companies. They get a slap on the wrist, they don’t care. So what slapped me on the wrist and they’ve got a two year ban from the ADPi because they have been like offering training and course materials, etc. to doctors, pharmacists, pharmacists, etc. Nurses without disclosing that those materials were written by Nova Nordics. Now in the UK, you can’t do that if you’re going to if you’re going to produce materials, you can but you must say this was written and produced by Nova Nordisk so that people like clinicians are able to say, All right, I’m gonna take what you say with a pinch of salt, because it was produced by a drunk commute, because they didn’t do that they did it sneakily, and illegally, they got a slap on the wrist. So we’re already watching them in real time behaving exactly the same way as poorly behaved 20 odd years ago, it’s just, it’s exactly the same. And I think they know that they’ve got like, even the evidence, and I’m sure, you know, we can go, I don’t want to sort of take us off on a tangent, but the evidence is showing that these drugs are not, they’re not there for the long term. This is a short term solution. It’s not a long term thing. And they know this, I’m sure they know this, because they’re reading the same data that I’m reading.

Summer:
Yeah. So let’s get into that. So what does the research say about its, its effectiveness? Like how much weight do people lose? Yeah, let’s start with that. And then we’ll, we’ll kind of go from there.

Asher:
So the first study is the biggest one, they did lots of studies on some magnetite, and they’re called the step trails. And that stands for some magnetite, something, something something B S is cement, I forget and the rest. And so the first trial was big 5000 People were recruited, and they were basically assigned to two arms, you’re either going to take the drug, or you’re gonna take the perceiver. And alongside that, you had a 500 calorie deficit. So whatever you will, your calculated calorie requirement is just your resting sort of energy expenditure, you take away 500 calories from that, and you can assume that every day for a year, you have to exercise 150 minutes a week, and you saw a weight loss counselor basically once a month. So there was the kind of diet elements you already kind of carried deficit exercise, you know, seeing a weightless Calcium Plus, taking this medication as well. And you’re either taking the placebo, or you were taking the weight loss medication and the people who were just taking the placebo and on the diet, and nothing else, lost about two and a half percent of their way over the course of the year. And the people who were taking the the semaglutide last, I think it’s between it’s let’s we’ll we’ll call it 15% for kind of, you know, for simplicity sake, about 15, one 5% of the body weight, which is a dramatic weight loss, which a lot of people say well Wow, it’s amazing. It’s so successful. I think it’s horrendous to lose that much weight in such a short period of time, your body must be shitting itself, because your body is not your body is not happy. With even a small a much smaller amount of weight loss in a short period time. To lose that much is going to cause a great deal of stress and panic within your body and it is going to respond to that, that your body does not take that like your body does not understand. I’m fat and I’m trying to lose weight, your body thinks you’re starving and you’re dying, your body thinks you’re sick. And it’s going to try and fix it as quickly as possible. So this thing that they’re praising are 15%. Isn’t that amazing? In such a short period of time, which will be the year nothing. It’s nothing. That is actually to me quite concerning if, you know, slow and steady surely is better than dramatic and not long standing. So yes, you can ask the next question, because there’s so much more that I don’t want to get ahead of you.

Summer:
Yeah, wow, that is, that’s it? Well, it just makes me think because I work with a lot of people who are, you know, kind of, like, over 40. And, you know, you get to a place where you start to lose like muscle mass. And, and so you think about, like, the combination of those two things, you know, co occurring for somebody who is already going through, you know, like the menopause transition, like that can’t be good. Like that is probably even worse for them to be, you know, thinking about like bone density, muscle mass, because obviously, it’s not just fat loss, it’s those changes that are happening as well.

Asher:
And that’s such a good point. And actually, if you look at step one, they did take a subgroup of people and study them in more detail and actually look at their fat composition, their body composition, how much fat they lost, they lost significantly less fat than they did on weight, the majority of that weight was water, and muscle and lean mass, it takes five times the amount of energy deficit roughly, to lose one kilogram of fat than it does to lose one kilogram of muscle mass. So the first thing you lose is lean mass. So I keep saying muscle mass, I mean, lean mass, the first thing you’re gonna lose is lean mass, which is the last thing you want to lose. Because, as you said, especially as you’re getting older, that’s the thing you need to read, you want to keep, and don’t forget, these people were exercising, so a lot of people were but if they just exercise, they were already exercising. So that doesn’t stop them from losing. And there is literally not a single paper out there that’s that can prove that if you just do this, that and the other you won’t lose muscle mass, you will lose muscle mass when you go on a dramatic weight loss diet like this, it’s it’s insane. The numbers 15% is huge. And people just you know, because they look so much smaller, and everyone is just like, oh, we care about thinness, we don’t care about what that’s doing to the body. But the body cares the body.

You know, I was saying this to my to my group, I’m teaching a course called on shrinkable at the moment, and I was talking about this today. So you know, we, we forget that our body’s only job is to keep us alive, right? It has one job to keep us alive. And it does a really good job of it. It keeps us going through so much. And we are so quick to praise the shrinking of our body. Whereas actual fat when our bodies shrink, our bodies are panicking. It doesn’t it doesn’t feel healthy to our body. Our body thinks something is wrong. So actually, just even the first part, which is like, oh, yeah, the benefits are you lose a lot of weight you do, but you lose a lot of weight in a fairly short period of time, which is not great. A second thing that happens, of course, is as we all know, whenever you lose weight, you hit the peak, call that the nadir, and then you start to restore your weight. And the the fifth study, step five showed that people who took this drug for two years, they hit the media around 68 weeks, and by week 102. So that’s the second of the second year, they had gained back some of that weight they were already regaining even in the study. So this idea that oh, you just need to stay on this medications. Once you’ve lost the weight, you’ll just stay like you know, you’ll maintain it. That’s not true. Their study proved otherwise. Their study showed, you know, weight started to creep up. Now they stopped it at two years. We don’t know what happens beyond two years, three years, four years. We haven’t seen the data yet. But if you follow the trajectory of the curve of the line actually by about the fifth year you’re gonna probably have restored most of the way if you keep following that line. Now of course we don’t know we have to wait and see. But this idea that Hi, just look for off it’ll stay off forever. No. And as I said Novo Nordisk knows this, they seen the data just like I have, and so they can spit it however they like. The reality is we’re going to see people regaining weight. And for the for the viewers, Empik folk who’ve been on ozempic for diabetes, let’s start at 10 years ago, they’ll say I lost some weight, but I gained it. You know, it didn’t last forever. We’re gonna see the same thing. I’m sure you know, I’m willing to hear I am on a podcast. I might be wrong, but I have a good feeling that we’re going to see the same thing.

Asher:
Yeah. Wow. And so and that’s with people staying on the drug. Like that’s not somebody coming off the drug. So what happens when somebody comes off the drug? Like did they look at that?

Asher:
Yes. So the step four trail is exactly that. So what they did with Step Four was they took everyone And they put them on semaglutide. Now everybody in the first 20 weeks got we Goby, everybody, and then half the group stayed on we going, and the other half the group got switched on to a placebo. Of course, you don’t know that you’re being switched on. Because you know, it’s all blind, that we call it a double blind trial. I just realized how offensive that is actually. But anyway, that’s what we call it. So they sue the the non, to the ones who stayed on we gave me obviously last week, the ones that were switched on to the water medication. Remember, they’re still dieting, they’re still exercising, they’ve got the kind of placebo effect because they think they’re on the medication. They’re doing the weight loss counseling, they’re committed to this as you possibly could be, the moment they switched onto water, they started regaining the weight, and they almost regained it all within such a short period of time. In fact, what they found was the weight, what they call weight regain, I like to call weight restoration, because like I said, your body’s just trying to get you back to to like, you know, level, it just wants to bring you back to where you were, it doesn’t want you to be dropping weight. So as you’re restoring the way the the speed at which you restored, the weight is actually much, much faster than we’ve ever seen with any other weight loss drug. So we all know that when you stop any weight loss drug in the history of weight loss drugs, you start to regain the weight, but the speed at which you regain this has never been seen before. So here we have a drug that causes an incredibly fast, rapid amount of weight loss, how short period of time, and then the moment you stop it a massively like a rapid weight gain a large amount of weight gain and a very short period of time. And that is also really bad for the body. Because what we know and studies have shown is that your body composition of your body changes the composition of your fat, your muscles and your gut will change. There’s also all sorts of inflammatory pathways that get triggered by this insulin resistance goes up your your cortisol levels go up, it messes with your reproductive hormones like that, a lot of things happen when you lose a lot of weight. And then you regain that way a recent study came out that said, the metabolic consequences of weight regain far outweigh any sort of negative consequences, I should say that the negative metabolic consequences of weight regain far outweigh any short term benefits from weight loss.

So here is a drug that is going to make you lose a large amount of weight, put your body through an awful lot of stress. And either you keep taking it and then it slowly creeps up, or you stop taking it and it creeps up quickly. But either way, it is going to cause huge amounts of long term metabolic damage that you will be paying four years from now. And the problem is we don’t know what that is yet. How do we know we haven’t studied it now. And the sneaky thing is kind of like Purdue did actually they blame the individual. You know, when when it was becoming obvious that these drugs were addictive. The first thing they said was it’s not a drop? Yeah, there there are people who are taking it there, the addicts. What they’re going to do with the Gobi mark my words is that if we begin to see negative consequences, they’re going to say what started our drug. It’s the fat people, of course, they’ve got this, of course, they’ve got that like they’re fat, that’s what happens. And so once again, they’ll blame me individual before, eventually, I’m sure things will come out, and then it’ll be taken off the market where it’s still in the market forever. There’s nothing if I do name a weight loss drug that’s lost.

Summer:
Yeah. Wow. Wow. And doesn’t even improve health markers.

Asher:
No, it doesn’t. And they collected the data for the step one, the big study, the first one, they collected the data, but they never presented it. And I think that says everything. Like why spend all that time and money collecting the data and not present it? It would they would only do that if it was statistically insignificant so there is no evidence that improves health markers at all is possible that it makes them worse. We don’t know we’ve not seen the data.

Summer:
So what can we , sorry, I don’t mean to cut you off there but just don’t like maybe are unfamiliar like what health markers do they do you know what health markers they measure?

Asher:
So blood pressure, HDL cholesterol, LDL cholesterol, lipids, like triglycerides them I mean, HB one C, leptin? I think they probably did I think they did CRP they did the usual was blood pressure. lipids and a one C are the main ones and and markers of inflammation as well. They may well have measured. You may we even have measured insulin, I don’t know. But my point is that they didn’t study it. And also, we know that rapid weight loss puts stress on the body. And we know that actually that can, for example, drop your levels of antidiuretic hormone which you produce in the brain, and as a result can have an impact on your blood pressure. So what if taking this medication actually makes it worse? We don’t we don’t have the data. So it potentially could. I’m not saying it does, but it potentially could we Just don’t know, because no one studied it. And in terms of the long term effects, well, of course, we’re not going to know about that for another 1015, possibly even 20 years. So, you know, what’s the space, take that risk, you know, like, imagine, you’re 25 years old, you live in, you know, you live in the age of as Empik. It’s on Instagram, your favorite celebrities are using it. They even talked about it at the Oscars, as Olympic this as Olympic that you go into a gym because you want to start your healthy lifestyle kick, and then they offer you as Olympic and then you take it and you take it for a couple of years. And then 10 years from now you find out oh crap, you know, that’s done this to my pancreas. Well, that’s done that. And then what like, there is no going back. And there’ll be anger, and there’ll be resentment, and there’ll be bitterness. How could we let this happen? Well, you’ve let it happen over and over and over again, and you’ve done nothing to stop it from happening. So of course you let it happen. At the end of the day, profits will always be more important than people, especially in the healthcare industry. So we can but warn people and hope that they heed the warning.

Summer:
Yeah, wow. It really is, you know, scary to think of, and then I think like you mentioned before, it’s the self blame, right? Like, it’s gonna be people who think that they failed it and who, or who are mad at themselves for, you know, opting into it, because maybe they, you know, just didn’t have all of the information like you are presenting here. The other question I have, that we haven’t talked about is the side effects. Like, because obviously, I think we’ve heard quite a bit about how there’s some horrific side effects. What are some of those,

Asher:
so the main ones are like gastrointestinal. So you know, the sickness, the nausea and the vomiting are so common abdominal pain, diarrhea, constipation, and anything that kind of has to do the gut. A lot of people complain of headache, dizziness, some people just feel really kind of just generally unwell with it, you know, just, but there are some more serious, more, less, less common, those, those side effects are so common, that 2.4 milligrams, it’s really hard not to have this side effects. As I said, a lot of my patients can’t make it to one milligram with their diabetes, because of the side effects. So to get to 2.4 milligrams, that’s quite hard. And I should point out, of course, that the results are for 2.48. You know, it’s people who couldn’t manage to get there like they weren’t included in the results. So that’s obviously if you can do it. But the common ones are common that the less common ones are more serious of pancreatitis, which is inflammation of the pancreas. That’s, that’s potentially life threatening. So that is a risk. They excluded anyone from the study who was at risk of pancreatitis, or had had pancreatitis in the past excluded them from the study. So we don’t actually know the data about how many people will get pancreatitis there is a the FDA has a black triangle, I think is about fibroid medullary cancer, there’s a type of cancer of the thyroid that this has been shown to increase the risk of again, it’s rare. I don’t want everyone who’s got like, if you start taking as I’m picking, I’m gonna get canceled for it now. But it is possible. And then of course, we said the ones we don’t know if gastroparesis is the one that like really worries me, because this medication almost intentionally induces mild gastroparesis. So I said, it slows down the movement of food from the stomach into the intestine. And that can give you like, a lot of symptoms, a lot of discomfort, and it can be it can last much longer than you’re on the drug for. So it can cause long term problems with it. Heartburn, abdominal pain, vomiting, nausea, all of that stuff. That really worries me.

And again, I just feel like, we’re led to believe that we must suffer to be thin as well. It’s not just that we should be thin, but we should, you know, we should suffer at all costs to be thin. So people genuinely like if someone said to me, Hey, I’m gonna give you this medication that will, you know, maybe helped you to lose some weight for a short period of time, then you will regain it again. Oh, and the side effects include, and they gave me this long list of side effects. I’d like to know, why is it going to benefit my health? No, we don’t have any evidence of that. Alright, then we’re going to do it that you know, but because we’re so invested in getting thin, we just think, oh, a bit of nausea, a bit of abdominal pain, a bit of vomiting. I mean, do you want to live the rest of your life like that? Not me. So, you know, people need to take that much more seriously than they do.

Summer:
It’s wild to see I was on threads this morning. And there was I’ll read like comments when there’s conversations about it. And it’s wild to see people be like, Yeah, I have really low. I’ve been on it for four months. And like I feel terrible. Like I have brain fog. I have no energy, but the weight loss is amazing and totally worth it. And it’s like, this is our culture. Like it’s horrifying to see that it really is just like, thin at all costs. And I mean, I was like that too. I would have been like, Yeah, I’d rather I’d rather be not functioning. I’d rather be thin and not functioning than functioning and like, you know, have more like be in a larger size. Like it’s just wild.

Asher:
And I think that’s really important. I wanted to say that actually but but And especially if you are in a higher weight, you are treated so much better when you lose weight. And actually, there are some people and rightly so who are people who are being denied access to treatment, people who, you know whose lives are so awful right now they feel like they don’t have a choice. And I just want to make it very clear that I support these people fully. And if they want to take this drug, I 100% support that I’m not anti, I’m not anti people doing anything, to be honest, like everybody has the right to decide what to do with their own body. And I don’t like the idea of making people feel ashamed or guilty for making a very sensible choice. For me, it’s always been about everybody having all the information, if you have all the information, and you make your own informed choice, I 100% will support whatever that choice is. And there should be no shame, no guilt, there’s nothing wrong with pursuing weight loss. And there are so many reasons where people pursue weight loss. And I understand you know how appealing it is nothing else, you know how appealing even if I’m not just talking about because people will be nicer to me. But for some people, it’s like because I could get the job I need or I could get the IVF that I need or I can get I get it, I do get it. So really important to hear that the issue here is not the people taking it again, let’s not blame individuals. The issue here isn’t even the people prescribing it, although I’d like to have some talk or talk with them. But they’ve probably been duped just like everybody else. The issue here is the drug manufacturer. They are the villain in this story. And they are ruthless. And they worry me they genuinely this particular drug company worries me all drug companies are bad. But this one, like it’s really bad. And they are very good at what they’re doing. They’re very clever. They have created the perfect storm over the last 10 years with all their PR to turn this into a frenzy and it’s just become a frenzy, hasn’t it? This is epic frenzy. Right?

Summer:
Absolutely. Absolutely. Yeah. So to prepare for this conversation, I watched like just some of the clips from for example, like the Oprah special I didn’t watch the whole thing. And one of the things that I noticed was that they featured a child right and they’re talking about is this drug safe for children? What are your thoughts on the city

Asher:
American Academy of Pediatrics already made moves? When they brought out their guidelines, which I think was about 18 months ago, they made moves, or they made it very clear that the plan was that they were in cahoots with Novo Nordisk this, it’s very clear, they even hung around and waited for Novo to, to finish one of their trials, before they made the guidelines is crazy stuff. But they already in case they want to push this drug to children and no vote, as I said, they need to make as much money as quickly as possible. So they are going to push it to children, obviously, all adults for adults, but they will be pushing it to thinner fat adults. So at the moment, it’s like, here in the UK, like you have, you know, it’s it’s really you have to have a BMI of 35 or over to access it. You know, I hate BMI. But still, that’s but you know, they want to push it down to 30. In an ideal world, let’s push it down to 27. Actually, in an ideal world, let’s not have a BMI limit that’s have anybody be able to take this drug, so they want to push it to as many human beings as possible, they will push it to psychiatric patients, they will say Our psychiatric patients are on these medications that make them gain weight they should be taking we go to a standard, they will push it to people who have had cancer so that we can prevent you from having your recurrence of your cancer even though there’s no evidence to show that it will work. It doesn’t matter. They’ll push it, they’ll push it, they’ll push it to everyone that they can and we’re watching it in real time. You just have to look at who Novo Nordisk, is spending money on to figure out what their next play is. I’m convinced mental health. I mean, we saw them do it with children. I think I think that they’re going to try and tackle mental health next.

Summer:
But But yes, it’s like binge eating disorder, right? Like something like that. Or they would say, Oh, well, this can help you stop binging because it reduces the hunger.

Asher:
Can you imagine I mean, this this drug should not be it should be contraindicated to treat people with an eating disorder with this medication. Just like it should be contraindicated. I think it probably is. To do bariatric surgery on a person who has an eating disorder, it should be contraindicated in eating disorders. And don’t forget there are people with undiagnosed orders.

Summer:
They don’t go green, right? Because only six are actually underweight. So there’s so many people that are probably getting this who already have an eating disorder or really disordered relationship with food that would probably this would probably tip them over the edge to have a full blown, right,

Asher:
let’s just say worrying like if, yeah, we I mean, you could argue that by prescribing a drug that makes people lose their appetite and not want to eat and feel sick when they do eat. Like one could argue that we are prescribing at the very least disordered eating or unhelpful disorder. eating behavior. But I would argue with essentially prescribing eating disorders in our own way, we’re basically say, Here, take this drug, take it for a couple of years, we have no idea. What’s that’s gonna do to you in the long term, but fingers crossed, and it’ll just reduce your appetite. But if, if there was a thin person who was deliberately not eating, and was losing weight, as rapidly as this or even, even not thin person, if somebody lost weight this rapidly, if someone came to me and said, I’ve lost 50% of my body weight in the year, I would be thinking, either eating disorder or you have something seriously wrong with you, this is a pathological problem. It’s not normal to lose that amount of weight. So, you know, I just wondered again, how we’re so you know, how we’re so clueless that we would actually prescribe this to people, for example, with eating disorders without any care in the world as to their long term, mental and emotional well, being

Summer:
anti fatness is really, I mean, it’s just that’s it, right. Yeah, exactly.

Asher:
Yeah.

Summer:
So how so I’ve had, you know, clients have had a lot of questions that I’ve been working with, right, rightfully so. And what’s your advice to someone who, who has a doctor that’s trying to push this on them? You know, how do you suggest they handle that situation? If they if they don’t want to take the drug?

Asher:
If you don’t want to take the drug? If you don’t want to take the drug? You make it very clear, I refuse my consent to discuss this, put in my notes. never discuss it with me again. He very, no, I’ve read about it. I know the side effects. I’ve read about the benefits side effects the risks, it’s not an option for me, it’s not what I’m willing to do. I refuse my consent to discuss it, put it in my notes, do not discuss it with me again, and just be really firm. And I love using the term refuse my consent, because if you refuse consent, you’re telling a doctor do it again, and you’re breaking the law. So that usually does come up.

Summer:
Okay, so what if, what if it’s like, what if they are with the doctors pushing on them? And they’re like, you know, this sounds kind of intriguing to me, like, what? What’s your advice to them, then in that situation?

Asher:
Yeah. So you have to remember what you as a human being are entitled to from your doctor, your doctor must do what’s in your best interest, they must make sure that they do no harm, they must practice medicine fairly and without discrimination, and they must respect your autonomy. autonomy means you get to decide what happens to your body, you can only make a decision about what happens to your body. If you know all the facts, we call this informed consent. The informed part is really important. When your doctor is informing you in order for you to make to consent to a treatment, they must explain the benefits, they must explain the risks, they must explain the long term implications. And if they don’t know what their long term implications are, they must say, we don’t know what the long term implications are, we don’t know if this is going to have any long term issues for you. And then they must give you all the other treatment options. One of the treatment options is always going to be do nothing. And I remember learning this in medical school, if you’ve got a patient whose appendix is about to rupture, and you have to consent them from surface surgery, you still have to give them the options. The options are, I’m going to take you to surgery, remove your will, your appendix, so it doesn’t rupture, or we could do nothing. And your appendix will rupture and you’ll become septic. And you’ll probably die. You still have to tell them that I remember at medical school being like, really? Do we really need to tell them that and I remember my ethics and law professor going? Absolutely. That’s the law. So your doctor must give you all the treatment options. So if they start talking about we gave you and you think, Alright, I’d like to have a chat about this. Make sure that you’re asking them. Okay, what are the benefits? What are the risks and risks include short term risks, like side effects and long term risks? You know, what are the risks? I need to know the risks? And then what are the long term implications on the answer should be what we don’t know. And then and this is the key part. Okay, what are my other options, one of those options should be you don’t attempt weight loss, right? Because just like with a person who doesn’t have the appendix removed, one of the options is nothing, you do nothing. So they should be saying that. And if they’re not saying that, then red flag, you know, if they are like, you have to lose weight, there is no option, then that’s not consent. And all of us know what consent looks like, like we’ve explained, explained consent on many occasions, as somebody is coming up to you and saying, I want to put my hands on you, and you don’t have a choice. We all know what that is. That’s a salt. So the same thing applies to doctors, it’s medical assaults, always make sure to ask benefits, risks, and even if they’ve done all of that stuff, what are all of my options, all of them, and if they don’t give you the option of not losing way, then that’s a red flag. And you can just be like, but I don’t want to lose weight or now and and the sad thing is consent must be free from coercion. So if a doctor says As to you, if you don’t lose weight, then you’re gonna die in the next five years. That’s coercion. If a doctor says to you, if you don’t lose weight, I’m not gonna give you the medication you need for your condition. That’s coercion, That’s blackmail. If a doctor says, Oh, I understand that you want IVF. But you’re too fat. So you can’t have it. Unless you take we gave you that’s coercion. And so that’s again, illegal. Know, your rights is what I would say to people. Yeah.

Summer:
And you’re so good at helping people decipher those things and try to advocate along those lines, like, Why do you think like, Are there more doctors who are like, yeah, no, I’m not prescribing this or, because from what I see, just, you know, kind of in the news and social media is that there’s doctors are like this. It’s a miracle. Like, this is amazing. There’s like the lowest risk and I’m just curious, like, you’re probably more enmeshed in the medical community, like what are you seeing?

Asher:
Well, I mean, they wouldn’t tell me because I’m probably not the best person to ask. I think we’ve all been wooed. We’ve been weird for years like Novo Nordisk has been, has been doing its due diligence and has been, has been around for a few years. Now. They pay for our lunches, they pay for our dinners, they take us out to fancy hotels, they have these amazing conferences. They do all of this free training, you know, like doctors, doctors, maybe well, yeah, we’re quite stingy. It’s interesting how that we earn quite a bit money, any episode, Stingy. But doctors will often go Oh, free trading. Okay, cool. I’ll take it. And it’s sponsored by now and all this. So they have been flirting with us and, and courting us and dating us essentially for years. So yeah, like when they kind of finally went, here’s the drug. You know, we’re like, cool. And again, watch. If you read the books or watch the programs all about Purdue and Oxycontin. oxycontin is a middle of the road, crappy little drug. There are way better drugs out there for pain relief for cancer patients for noncancer patients for back pain, you name it. oxycontin oxycodone, like, middle of the road at best opioid VA it was the it was the individual drug reps causing the doctors in these little towns who just will Okay, cool, like you’ve sold me? And yeah, we are salt. We all think it’s great. It’s been talked about at the Oscars. I mean, it’s fashionable, if nothing else, and sometimes you forget that doctors, like a real people. And they’re, they’re also very much swayed by the media, social media, etc. So it’s coming at us from all angles, I would not be surprised if all of my colleagues were happy to prescribe it. Of course, in the UK, you can’t. So I don’t know what’s happening in the US in the UK. We can’t GPS can’t prescribe it. So it’s sort of it’s very much kind of hypothetical.

Summer:
Yeah, that’s super interesting. Wait, so then who prescribes it in the UK then.

Asher:
So it has to be specialist, what we’d like basically the bariatric, the weight, what they call the weight management? Oh, interesting. Okay. So it should and it probably will change. But as I said, we don’t have access to this right doesn’t exist in the UK, we can’t even get as Olympic level and we go v. And you won’t be able to get as MP for weight loss here in the UK. Not on the NHS anyway. So you’d have to get we go v. And since we go, we just it’s not there. It’s all hypothetical at the moment. But from what from what the current guidelines say it has to be prescribed by a specialist team. And you have to have basically gone through like this step by step. And you have to have gone through like the Weight Watchers Step. Before you were allowed to enter the bigodi step. Those are the rules in the UK, but this is NHS, health, you know, free health care stuff. It’s different, I guess, to help.

Summer:
Yeah. Wow, interesting. So the last thing I want to ask you is because I work with a lot of other professionals in like providers in this space, and one of the questions that they have had is like how do you suggest they navigate these conversations with clients who are interested in GLP? Ones? Because that’s, I mean, I’m experiencing it too. And I’m curious, like, because we’re not doctors, I mean, I’m not a doctor, and most of these providers aren’t doctors, they’re dieticians or therapists or other coaches. How can we best navigate these conversations to help people?

Asher:
It’s interesting, isn’t it? Like as someone who’s like, I graduated medical school in 2003. And so people just assume I know what I’m talking about. Because I’m a doctor. I don’t I don’t know if you want to finish the podcast. I mean, like, I know what I know. Because I’ve gone and done the research. I didn’t automatically know like, before I went and read all about the step trials. I knew nothing about this drug apart from what I’ve heard in the media, and what the press release, said. So, you know, it seems foolish to me that somebody like yourself who may not have the MD, but has actually done their due diligence done, the research has looked into it like you know, more than most doctors. I hate to say it because they haven’t read the studies. Do you think doctors especially general practitioners have the time to read For the studies that come out in every journal like that, of course not, we read the guidelines, we read the press release, and we don’t read the whole press release, we read the bit at the top, like, you know, just the first two lines, because that’s all we’ve got time for. So don’t assume that the doctor knows more than everyone else. And as a dietician, or as a coach, or whatever it is that you do in the space, actually, you probably know a lot more. And I think all of us just have a responsibility to put the information out there. And I think we do that in the in the, in the kindest, most compassionate, non judgmental way, with factual about it. And we say, Look, this is what we know about these medications. And now you make the choice.

And our, you know, I know what doctors are supposed to do. And I also know that doctors don’t do that the vast majority of the time when it comes to consent when it comes to doing no harm. When it comes to practicing fairly. And without discrimination, I would argue that doctors are terrible at that. And most of the other people that you mentioned, are really good at advocating for their clients, because their plant clients are not getting what they should be getting from their medical professionals. And not just doctors, but also nurses and nurse practitioners nowadays, and midwives and physical therapists, like you’ll see more and more that healthcare professionals aren’t necessarily doing what’s in their patient’s best interest are actually causing harm are not respecting their autonomy, not allowing them to consent fully. And you are being unfair and discriminating. So you are actually best placed, I would have to support your clients. So my biggest thing would be like, don’t worry that you’re not a doctor. So what you probably know way more than most doctors about this issue. So just tell him what you know. And if you’ve got access to good literature, given the literature Reagan testing has like this, so much, he’s done so much on this. So like, just she just just got it’s all on substack. But you can even read it for free. Just go read it and then just take Reagan’s information, you’re welcome to do my masterclass. You’re welcome any information I have, you’re welcome to use it with your own clients, but he gets his information now read it and make your own choice, and I will support you 100%. And if your client says, You know what I’m gonna go for we go via I’m gonna do it, then all you can do is be there to support them and be there for the fallout because the fallout will probably come. And, yeah, a lot of my clients. Yeah, a lot of my clients don’t do the thing that I’m hoping that they’ll do. But I’m not here to tell them what to do. So if they make choices that I think, probably not the best choice, or I probably wouldn’t have made that choice. I’m still 100% there for them. And then if they turn around and go, Oh, that was a bad choice on my arm. You know, fair enough. I understand why you made it. Let’s move on. So yeah, I think we’re the best at that. Let’s not worry about doctors too much.

Summer:
Well, I appreciate that a lot. And I will refer I refer people to your master classes all the time. They’re, well, first of all, they’re probably too affordable. They’re really affordable. And they’re there. Yeah, there you have such an amazing way of delivering information as people have heard you here today. And so where can people find more of you and find those master classes that you’re talking about?

Asher:
So come to fat doctor.co.uk. And you can find the master classes, and I’m doing one every month. So you might find one that suits you. I offer a couple of courses, one’s called on shrinkable, which is basically there that the how the body is unthinkable. And one is called Take your bow power back, which is all about taking your power back in the doctor’s office. I also see my own clients. And if you’re thinking to yourself, you know what, I’m really struggling with something. And a wonder if it actually can help like, you know, I’ve been denied this particular treatment, and I don’t know what to do, or my doctors refused to believe me, or I have this condition and nobody seems to know what’s wrong with me. And I just, I need a diagnostician, I need somebody who can help me who’s gonna listen to me, he’s gonna believe me, he’s gonna validate me. Yeah, I can do that, like for all clients around the world doesn’t matter where you are. And you can book like a free consultation with me just see whether or not we’re a good fit. Again, do that through my website. And yeah, I’m always keen to work with people who are struggling to get the right treatment from their doctors because I can be the doctor that goes, right. I see what’s happening here. I hear you. And here’s things that I think that you could do to overcome this situation. I help people, challenge decisions, clinical decisions all the time. I help people write complaint letters, for all sorts of things. So yeah, it’s all on my website. And I’m going to plug something else really quickly because I’m really excited about this. I have another website called No way dot o waistbelt. W e IG h, this is a free website. All the resources on this are free. And I’ve just literally I’m in the process today and have been for the last few days are kind of giving you a revamp. And all I really want you to do is go on the website and then message me and say oh my gosh, I love the new I love the new look. Because I’m one of these people that hyper focused sometimes, and I’ve been hyper focusing on Canva for the last few days. I’m gonna need someone to kind of pat my back and go oh, wow, that’s so beautiful that I could let thanks And it’s, it’s all about just give me a couple more days give me like don’t next week, I don’t know when this comes out, but like, just give me a few days and then we’ll get and the resources on there all about why we shouldn’t be weighing patients and we shouldn’t be prescribing weight loss. And if you’re somebody that wants to say no to being weighed, no way dog, that’s what it’s all about. So lots of information there and for health professionals, if there happens to be any healthcare professionals out there, and they’re like, what’s all this about? All the information is on there, all the resources and everything?

Summer:
Fantastic. I love it. And it will be it’ll be this podcast will go live in May. So it’ll be live by them because we’re recording this in mid mid April.

Asher:
Oh, amazing. They’ll be done. Fantastic.

Summer:
Well, you are a gift. Thank you so much for being here. I really appreciate you giving so much away and helping us and yeah, people are gonna love this episode.

Asher:
Thank you so much for having me on and letting me spread the message. It’s like spreading the gospel for me. So this is such a such a pleasure. So thank you so much. I thought we were very grown up and respectable the whole time by now I tried. It’s never too late.

Summer:
I hope you learned as much as I did today. I feel like this is one of those episodes that you could probably listen to over and over because you would take away a new nugget of information each time. I hope you share it with people in your life too, who might also have questions about weight loss medications, again, as Asher said, like there’s no judgment towards people who use these medications or who decide to take these medications because we live in such an anti fat world. That said, I think it’s really important that we have the full scope of information in terms of what the research really says. And hopefully it answered all the questions that you had. You can find the links mentioned at summer innanen.com forward slash 297 Thank you so much for being here today. Rock on.

I’m Summer Innanen. And I want to thank you for listening today. You can follow me on Instagram and Facebook at summer Innanen. And if you haven’t yet, go to Apple podcasts search eat the rules and subscribe rate and review this show. I would be so grateful. Until next time, rock on.