Why GLP-1 Feels Different at 1, 3, and 6 Months (Obesity Doctor) — Transcript

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1. 0:00What really happens month one, three,
2. 0:03and six on a GLP-1 medication? Hello and
3. 0:06welcome. I'm Dr. Megan. I'm a
4. 0:08board-certified obesity medicine
5. 0:09physician and weight loss coach, helping
6. 0:11you cut through the pseudocience and
7. 0:13confusion in weight care. My approach
8. 0:15combines evidence-based medicine with
9. 0:17real behavioral change so you don't just
10. 0:20take medications, you actually transform
11. 0:22your health. Today we're talking about
12. 0:24what really happens month one, three,
13. 0:28and six on a GLP-1 medication. Let's go.
14. 0:31I'm going to walk you through what I
15. 0:32commonly see as an obesity medicine
16. 0:34physician who treats this all the time.
17. 0:37I've helped hundreds, if not thousands
18. 0:38of people lose weight. And I'm going to
19. 0:41tell you about what typically people
20. 0:43experience. Now, of course, everybody's
21. 0:45different, so this is not going to apply
22. 0:46absolutely the same to everybody. But I
23. 0:49think it'll if you're thinking about
24. 0:50starting a medication, if you're already
25. 0:52on a medication and you just started,
26. 0:54this will give you a good idea about
27. 0:56what can potentially happen in the
28. 0:58future. Also, I've heard from a lot of
29. 0:59you that it's very helpful to know that
30. 1:01there's not just one experience on these
31. 1:04medications because it's true, different
32. 1:07people are going to respond differently.
33. 1:09And I think it is very nice to know that
34. 1:11especially if maybe your experience
35. 1:14isn't so typical that it's actually
36. 1:17something that a lot of other people are
37. 1:18going through as well. So let's get
38. 1:20started. Month one, what to expect, what
39. 1:23really happens. So month one, if you
40. 1:27haven't started yet, you're probably
41. 1:28really excited, really nervous, a little
42. 1:31unsure about what's going to happen. And
43. 1:33really, month one is just about learning
44. 1:36how your body is going to respond to
45. 1:38this medication. Now, some people take
46. 1:41the medication for the first few shots
47. 1:42and they're like, "Did I actually take
48. 1:45anything? Is this thing working?" They
49. 1:48really feel nothing. And some people on
50. 1:51the other end of the spectrum have a
51. 1:52very exaggerated response. Every once in
52. 1:55a while, somebody calls me and they're
53. 1:56like, "Did I get food poisoning? I can't
54. 1:59tell." And most people are somewhere in
55. 2:01the middle. they have mild side effects
56. 2:03that are kind of annoying but manageable
57. 2:05as I like to call them. And then also
58. 2:07you're really learning about what foods
59. 2:08are on your nofly list because you are
60. 2:11going to find out pretty quickly how
61. 2:14much your stomach capacity can handle
62. 2:17and what foods definitely are not
63. 2:20agreeing with you on this medication. In
64. 2:23terms of weight loss, if I have a
65. 2:24patient, they've completed month one and
66. 2:26they've lost zero pounds, they've lost
67. 2:30five pounds, that's pretty standard.
68. 2:33Most people the needle moves a little
69. 2:36bit. Um, some people it doesn't move at
70. 2:38all and that's actually okay. It doesn't
71. 2:40worry me. Uh, some people that's just,
72. 2:42you know, again, these initial doses are
73. 2:45really just to help your body get used
74. 2:46to the medication. So, if I have a
75. 2:48patient and they haven't lost any
76. 2:49weight, it's not a big deal. In very
77. 2:51rare cases, the needle moves a lot. Um,
78. 2:55I do have some patients that they not a
79. 2:58lot, but I have some, but they just take
80. 3:01the lowest dose of their GLP-1 and they
81. 3:04never need anything else. They lose all
82. 3:06the weight on that on that first dose.
83. 3:08And so, the first month for those people
84. 3:10can be they can lose more than 5 lbs.
85. 3:12And those are the people I'm keeping an
86. 3:14extra close watch on because I never
87. 3:17want to overshoot the mark for anybody
88. 3:18either. and I want to make sure that
89. 3:20people are eating. Okay, month three.
90. 3:23You're getting the hang of it now. Maybe
91. 3:25you have more of a routine. Maybe you've
92. 3:27noticed the day or two after your
93. 3:29injection, you have more of a tired day.
94. 3:32Maybe you've noticed the day before you
95. 3:34inject, you have more of a hungry day.
96. 3:37That's all pretty normal. Overall,
97. 3:39you're just more familiar with how your
98. 3:41body responds to the medication. Some of
99. 3:43you, those side effects that you had
100. 3:45initially are really starting to fade.
101. 3:47And then for some of you, you're still
102. 3:50grappling with the side effects and we
103. 3:52still are trying to figure out what
104. 3:54we're going to do because in some people
105. 3:56the side effects really don't go away
106. 3:58and then we really have to if the
107. 4:00patient wants to continue and most
108. 4:01people do, we have to figure out how to
109. 4:03manage them. So month three, a lot of
110. 4:06times we're still in that hm trying to
111. 4:08figure out the right nausea regimen,
112. 4:10trying to figure out the right bowel
113. 4:12regimen. That's all pretty normal.
114. 4:14Sometimes it also means you have to slow
115. 4:16down the pace of progression and that's
116. 4:19fine. Like I always tell patients in 3
117. 4:21years you you really won't care if it
118. 4:24took 12 months if it took 15 months. You
119. 4:27won't care how long it took you to get
120. 4:28where you wanted to be. All you'll care
121. 4:30about is do can you be on this
122. 4:32medication? Does it work with your life?
123. 4:35Is it improving the quality of your
124. 4:36life? Is it a net positive overall?
125. 4:38That's what you'll really care about in
126. 4:40terms of weight loss. Of course, some of
127. 4:42you, if you've had a lot of side
128. 4:44effects, you're going to notice that
129. 4:45your pace of weight loss has been
130. 4:47slowed. And again, that's totally fine.
131. 4:50Some of you, I do have patients that
132. 4:52have only weight loss and no side
133. 4:54effects. So, some of you are moving
134. 4:56along at a pretty good pace and every
135. 4:58after every fourth shot, you feel good
136. 5:02and as long as the pace of the weight
137. 5:04loss itself is appropriate, we can go up
138. 5:07to the next dose. So, some of you are
139. 5:09now in the middle range of doses, and
140. 5:12it's not surprising to me if by this
141. 5:14point someone has lost maybe 10 lbs,
142. 5:16maybe 20 lb. And again, some people have
143. 5:19lost more. Very rarely, uh, very, very
144. 5:23rarely. Some people have lost none. Now,
145. 5:26if this is a patient who has tolerated
146. 5:29the medication well, they don't really
147. 5:30have any side effects and we've been
148. 5:32advancing at an appropriate kind of
149. 5:34regular intervals and they haven't lost
150. 5:37any weight, that's always somebody that
151. 5:39I want to do more of a deep dive in
152. 5:41what's going on and make sure we're not
153. 5:43missing any external circumstances like
154. 5:46they started a new medication or all of
155. 5:48a sudden they stopped going to the gym
156. 5:50or we want to make sure that nothing
157. 5:51else is going on that could be um
158. 5:54interfering with their weight loss cuz
159. 5:56for some people rarely the weight loss
160. 5:59medication isn't going to work. So if
161. 6:02there's no weight loss at the end of
162. 6:03month three again I am always checking
163. 6:05in with people about every four to 6
164. 6:06weeks especially in the beginning but I
165. 6:09would always encourage somebody to make
166. 6:11sure they are checking in with their
167. 6:12doctor um if they're not noticing any
168. 6:15weight loss and they really have had no
169. 6:17issues with the medications up until
170. 6:19that point. Okay, month six. This is now
171. 6:22really a part of your everyday life,
172. 6:25kind of a normal part of your week. Um,
173. 6:27for many of you, the side effects are
174. 6:29gone or really not a big deal at all.
175. 6:32For some of you, they're a distant
176. 6:33memory. Lucky you. Um, for some of you,
177. 6:36you're also probably noticing that your
178. 6:38appetite, if it was really suppressed in
179. 6:41the beginning, it's kind of maybe not
180. 6:43how it was before, but it's somewhere in
181. 6:45the middle, maybe a little more quote
182. 6:46unquote normal, not as extremely
183. 6:49suppressed as it can be for some people
184. 6:52in the beginning months. Also, you may
185. 6:54notice if the food noise was really,
186. 6:56really suppressed in the beginning, you
187. 6:58may notice it's come back a little bit.
188. 6:59That does that's okay. It doesn't
189. 7:02necessarily correlate with you gaining
190. 7:03weight, but for some people, the food
191. 7:05noise does come back a little bit.
192. 7:07Usually, not to the extent that it did
193. 7:10previously, but just like appetite, it
194. 7:12can kind of find somewhere in the middle
195. 7:14where it's not tot. It's not the same as
196. 7:17it was, but it's not completely gone.
197. 7:20And then overall, if you've had side
198. 7:21effects and they're really significant
199. 7:23by this point, usually if you're still
200. 7:25on the medication, we found a way to
201. 7:27manage them. So that's always a good
202. 7:29sign if somebody's on the medication by
203. 7:31six months. They usually have if they've
204. 7:33been had a lot of nausea, if they've had
205. 7:35a lot of bowel issues, usually by that
206. 7:37point we've tried enough things that
207. 7:39usually they have a good idea of what's
208. 7:41going to work for them. By 6 months when
209. 7:43patients are more in the swing of
210. 7:45things, it's also when they tend to
211. 7:48start to notice, hey, maybe I can work
212. 7:51on these other things as well. Now, this
213. 7:53isn't everybody. Some people kind of as
214. 7:56soon as they start the medication, they
215. 7:58change everything for the for the
216. 7:59better. They change how they're eating.
217. 8:01They change how they're exercising. And
218. 8:02some patients, you know, that happens
219. 8:04before they start the medication. But
220. 8:06for a lot of patients, they're
221. 8:08distracted by the initial weight loss
222. 8:10and then several months in, they're
223. 8:12thinking, "Oh, you know what? I think
224. 8:14this would actually this is working
225. 8:16well. it's probably going to work even
226. 8:18better if I have a bit of more of a
227. 8:21system with my food or if I have more of
228. 8:23a regular exercise routine. So, that's
229. 8:26also a good time to address that when
230. 8:28things have calmed down a little bit in
231. 8:30terms of side effects and what you can
232. 8:33expect because a lot of people can then
233. 8:34turn to, okay, how can my lifestyle
234. 8:36changes support this medication as well?
235. 8:40Maybe I don't want to be eating in my
236. 8:41car. Maybe I want a more regular
237. 8:43exercise routine. And that's actually
238. 8:45when a lot of clients reach out to me is
239. 8:48they've made it past that initial stage
240. 8:50and they're like, "Okay, I'm ready to
241. 8:52take the next step. I don't want to
242. 8:54leave results on the table. I want to
243. 8:55make sure I'm getting the most out of
244. 8:56this medication." By six months, people
245. 9:00are generally, it's not surprising if
246. 9:02they've lost between 10% total body
247. 9:06weight or maybe closer to 15% depending
248. 9:09on if they're on WGOI or if they're on
249. 9:12if they're on simaglletide or if they're
250. 9:14on tzepide. Um, that's generally what
251. 9:17the studies show and typically that's
252. 9:19what I see in real life as well. In
253. 9:22addition to side effects slowing that
254. 9:24progress down, the other thing that can
255. 9:26really slow progress down is insurance.
256. 9:28As many of you may have experienced this
257. 9:30last year, either your insurance stopped
258. 9:32covering it and you had to really change
259. 9:34things around drastically, or your
260. 9:36insurance said, you know what, that
261. 9:38medication that we were covering, now
262. 9:40we're going to cover the other one. And
263. 9:42so, you've had to change. And that can
264. 9:44really slow things down for people as
265. 9:45well. because when I am switching people
266. 9:48from WGOI to zeppbound or zepound to
267. 9:50WGOI, I never start them at the
268. 9:52equivalent dose because these are
269. 9:54they're different and so and I never
270. 9:56know how somebody's going to respond and
271. 9:59I always want to make sure that we're
272. 10:00being safe and keeping the patient as
273. 10:02comfortable as possible. So I'll usually
274. 10:04back down the dose a little bit to make
275. 10:07sure that that initial switch isn't a
276. 10:10really bumpy road for people. But
277. 10:12overall at 6 months, most people are
278. 10:14getting the hang of it. they have a good
279. 10:16idea of what their weight loss
280. 10:17trajectory is like, how their body
281. 10:19responds to the medication, um what the
282. 10:22side effects are, and they're really
283. 10:24getting in the groove of things.
284. 10:26Overall, a lot of people are just really
285. 10:28starting to see tangible progress by
286. 10:30then. I would love to hear, does this
287. 10:32line up with your experience month 1, 3,
288. 10:35and six? Tell me all about it. Um if you
289. 10:38have questions afterwards, leave them on
290. 10:39this video and I will find them and add
291. 10:41it to the list. If you're one of those
292. 10:42people who's like, "Yeah, I do want to
293. 10:45start working on my lifestyle changes. I
294. 10:47do have food noise. I do need to know
295. 10:49how to deal with it now." Uh, click on
296. 10:52the website below, schedule a call, and
297. 10:55I will tell you how I help people just
298. 10:56like you. Um, thank you so much for
299. 10:58watching. If you're not subscribed
300. 10:59already, subscribe because this is the
301. 11:02place for medically based answers to
302. 11:04your weight questions. Thank you for
303. 11:05watching and please be well.