Cold Case Files - You Might Also Like: The Oprah Podcast

Episode Date: January 14, 2025

Introducing Ozempic & Weight Loss Drugs: How They Work in Your Brain | The Oprah Podcast from The Oprah Podcast.Follow the show: The Oprah Podcast In this episode of The Oprah Podcast, Oprah sits down with Dr. Ania Jastreboff, an endocrinologist and associate professor at the Yale School of Medicine, to talk about the new GLP-1 medications like Ozempic, Wegovy, Mounjaro and Zepbound. Dr. Ania, who has been on the forefront of GLP-1 medication research for the past 20 years, will talk through why it is biologically difficult for some people to lose weight, maintain weight loss and why obesity is a disease. She explains how the new GLP-1 medications work, how they can facilitate weight loss, and if they are safe. Dr. Ania answers questions from people around the country who are taking the GLP-medications and have lost a significant amount of weight. We will also share an update from Amy Kane who told her story of losing 160 pounds on weight loss medications last year on Oprah’s ABC Special: Shame, Blame and the Weight Loss Revolution. Also referenced in this episode: "The Let Them Theory: A Life-Changing Tool That Millions of People Can’t Stop Talking About" by Mel Robbins, published by Hay House LLC is available wherever books and audio books are sold.SUPPORT THE SHOW Subscribe: https://www.youtube.com/@Oprah Find Oprah’s Interview with Mel Robbins Here. Follow Amy on InstagramFollow Amy on TikTokFollow Emma on TikTokFollow Emma on InstagramFollow Oprah Winfrey on Social:InstagramFacebook Learn more about your ad choices. Visit megaphone.fm/adchoices DISCLAIMER: Please note, this is an independent podcast episode not affiliated with, endorsed by, or produced in conjunction with the host podcast feed or any of its media entities. The views and opinions expressed in this episode are solely those of the creators and guests. For any concerns, please reach out to [e-mail].

Whether you are listening on the Oprah podcast or watching on YouTube, I appreciate you being with us. Last year, millions tuned into my special on ABC, Shame, Blame, and the Weight Loss Revolution. It's now streaming on Hulu if you want to check it out. We're continuing the conversation around weight loss medications like ozimic and monjaro. People still don't understand it. Is it the easy way out? It's absolutely the opposite.

I'm joined on this podcast by Dr. Anya Yastrovoff, an endocrinologist and associate professor at the Yale School of Medicine. She has been studying GLP-1 medications for more than 20 years. Obesity is not a choice. It is about biology. We are diving into the latest research on these medications that roughly 15 million

Americans are now using. Can you set the record straight on side effects? Dr. Anya is here to answer a lot of your common questions. Is this something I could taper off of? You may remember Amy, who I met on the ABC special. She had lost 160 pounds after starting a prescription of Monjaro. She's zooming in with an update. Hello, hello. Good to see you again. It's so good to see you. A quick note, my guests on this podcast asked us to show

their before and after weight loss pictures because they believe the photos are a vital part of their life's journey. It's wonderful to talk to you again. You know, that new study says that nearly 75% of American adults are overweight or obese. So what determines obesity versus overweight? Just being overweight. Okay. So in terms of that first question, right now, there aren't really great definitions. That determines obesity versus overweight, just being overweight. Okay.

So in terms of that first question, right now there aren't really great definitions. So we used to use definitions of BMI. But BMI is really a screening tool. It's not something that was actually ever designed to be a diagnostic tool. So technically, overweight was defined as a BMI of greater than 25 and obesity as a BMI of greater than 30. And that's body index. Yes, body mass index. BMI is body mass index. Now we're really starting to rethink what that means. What does it mean to have obesity?

And the indications for the medications were based on these initially, and now that's also evolving and changing as well, because we're really trying to understand what is obesity, how does it affect our health, because ultimately, when we're treating obesity, the point is not just weight reduction, it's improving and optimizing overall health. That's the goal. Yeah. The focus has been on weight reduction, but the real truth is, and we're going to hear from some people today, who tell you that what has happened to them in terms of their physical health,

their emotional health, the way they see themselves, the way the rest of the world sees them, including their family members, is the big bonus for this. Yes. Is why. Life changing. It's absolutely life changing. And I know the term life changing gets thrown around a lot, but this really is.

Okay, so let's talk about why is, this is the thing. I recognize this probably now it's almost going on two years that I realized that obesity was a disease having a discussion like this. Can you share with our audience, with every person who's listening, who has doubts, who's heard, I saw on TikTok, and yeah, why is obesity a disease? Yeah, and that is such an important and critical question. So, as you said, so many people have obesity now,

and two-thirds of Americans and half of the world population did not wake up one morning and decide to have obesity. Obesity is not a choice. It is about biology. So what is obesity and why do so many people have it? And why is it so difficult not just to lose weight but to maintain that weight loss? And so our body is amazing.

It has this amazing, beautiful biology. And basically what it was designed to do is to make sure that we stored enough energy or enough fat because we store energy by storing fat. I'm tracking that. Yeah. And so it said, okay, how are we gonna do this? Well, there are these hormones.

They're stimulated when we eat food. They're called nutrient stimulated, nutrient stimulated hormones. And they communicate with our brain, how hungry are we, how full are we, how much energy do we have? And so this beautiful biology, so hormones inform the brain.

And this is in every person's body. In every person's body, every person's body. And so basically it says, okay, this is how much energy you're storing, this is how much fat you're storing. And so you would think, ah, we have this beautiful biology, wonderful. Then why do so many people have obesity

if this is so carefully regulated? Well, it turns out that our obesogenic environment, an environment that is filled with ultra processed food, lack of sleep, lack of physical activity, all this stress on a population level, that obesogenic environment that developed so much more quickly than the biology, it basically pushes up how much energy or how much fat our body wants to store. So our body ends up defending a higher amount of fat. The defended fat mass or

the set point, these are terms that you may have heard, but that's exactly what our body's doing. So our body's doing what it needs to be doing, what it should be doing, but a little bit too much in this environment. So why does it do it for some people and not for others? Yeah, and that's a really great question and one that we're trying to sort out and figure out. What we do know is that for most people,

maybe over centuries and millennia, we evolved in this way where basically you wanted to make sure that you didn't starve, right? So you wanted to store enough energy so that if there was a famine, you would not starve. But if you think about this, this is actually very, very tightly regulated. So we all eat incredibly... We all eat a lot more than what we actually need. So our body actually figured out how to burn extra.

But after a while with this obesogenic environment, it actually says, no, store it. Maybe I need it for later, right? So when we try and lose it, our body fights back and it says, no, no, no, no, no. Okay, but that's in somebody's and not in others. That's true, okay. And so is that because in my body because I obviously have uh an issue with obesity in in my body and people who are prone to be overweight as I have been um is is that because

my hormones are different than the other person's? may be, or your brain, because obesity is a neuro metabolic disease, or neuroendocrine, hormones inform the brain. So maybe in your body, your body's like, I'm really good at holding on to that energy. I'm really good at holding on to some extra fat, just in case I need it later. And somebody else's body says, no, I don't need that. But for most people, where we started the that but for most people to you know, where we started the conversation for most people We want to store more we want to store extra and that is where our body is happy And that is what our body defends and it's because of the environment we live in and that tells us two things

One is we have to change the obesogenic environment We have to because if we don't we we're not gonna be able to prevent it. And what do you mean by obesogenic environment? An obesogenic environment, so one that is filled with ultra processed food, lots of stress, lack of sleep, lack of physical activity. All these things are built into our environment right now. But when I'm, listen, I've done every diet,

as we're gonna talk to people today, who have also done every diet. And even when I'm done every diet, as we're going to talk to people today, who have also done every diet. And even when I'm not quote, dieting, I considered myself eating healthy meals. And, you know, I'm not a person who goes to fast food restaurants or, you know, I do eat a lot of potato chips. But I'm not a person...

That's what your brain craves. Your brain is craving that. My brain craves a chip. It craves a chip or something that's crunchy or salty. That's right. And it's my go-to if there is any discomfort in my life whatsoever. A bad phone call. Yes. I have to do all of my bills. It helps with your stress.

Yeah, absolutely. I don't know why a pretzel calms me down, but it does. But it does. And here's the thing. So those pathways... And is that my hormones? It's your hormones but it does. But it does. And here's the thing. So those pathways- And is that my hormones? It's your hormones and your brain. And my brain.

And your brain. So for example, for you, maybe it's potato chips. When you consume those foods, when you eat those foods, that signals to your brain something positive. So these hormones, they communicate with all sorts of areas of our brain, including reward motivation areas of our brain, including reward motivation areas of the brain.

So we find these foods highly rewarding, our brain does. And the thing is, again, we were designed to function this way. Because let's say that we... Well, some people find them rewarding. I know other people for whom potato chips don't turn them on. Right, exactly. They don't do a thing. It's something...

And that is actually why I started doing the research that I do. Because I thought to myself, well, why is it that some people crave potato chips and other people want the cheesecake or the Crispy creams? Or Crispy creams? So why is that? And the answer is right now we don't know.

But initially I was doing these brain studies to really try and understand what that was about and what reward regions of the brain were actually responding. Let's say you saw a picture of a potato chip. How would your brain respond differently than somebody else's? And again, that has to do with genetics.

If I see a bag of Ruffles or I see a Ruffles commercial, then that's it. Listen, I've gotten up and left my house to go get a bag of Ruffles. And this is the thing, and maybe we'll talk about food noise, but that's what it is. If there is a bowl of brownies on the table, I would not be able to focus on you.

I'd be like, I want the ice cream and the brownies. And the thing is, it's different. But that wouldn't affect me. A brownie wouldn't even bother me. Wouldn't affect you, right, but the potato chips, then that's what. I would not, if there were potato chips here, it would be a battle for me to not. To not have one. Yeah, and I would not if there were potato chips here It would be a battle. It would be a battle not to not have one

Yeah, yeah, I know that if I had one yes, because I have an addict's brain I would not be able to you would see all the yeah when lays did that you nobody can eat just one I think they knew what they knew They had called you but to your point about the fact that you're eating very healthfully and you have for a majority of your life, again, the amount that we eat, and again, our body craves a larger amount of food, the amount that we eat is a lot more than what we actually need. So our body actually burns a lot. It's just that different people may hold on to less of that food than others. So you know, one of the big breakthrough for me a couple of years ago when I was doing, having this discussion,

the state of weight on O'Daly, the big breakthrough for me was understanding, oh, the aha for me was like, oh, this is like the years in the early 80s, mid to late 80s. This was like the years in the mid to late 80s, when we started the Oprah show in 1986. And I remember doing a show on alcoholism in 1987

on a whole family of alcoholics and generations passing it on. And people were outraged that you would call alcoholism a disease in 1987. Like, how dare you? They just need to put the bottle down and they're really just drunks and so forth. And over time, through education, through information, through people looking at other

people in their family, through corporations understanding what it was, people came to understand that it actually is an addiction born of disease. And I think that's where we are now with obesity. People still don't understand it. They wanna blame other people for it. They wanna say, just put your fork down and quit, you know, eating those brownies or those potato chips and what's wrong with you.

And one of the reasons why I was reluctant to use them in the beginning, when I was reluctant to use them in the beginning, when I was trying to lose weight after my knee surgery, because I also felt it's cheating, it's the easy way out, I've got to prove this one last time, I could do it by myself, and I don't want people saying I took the easy way out. And I think that that's one of the major issues that people who are now open to using the drugs

are experiencing from their friends, their colleagues, their families, and also within themselves. Is it the easy way out? Yeah. I mean, I couldn't agree with you more. And your story is one, first of all, I'm so sorry that you went through all this

and in such a public way. Oh, my goodness. When I think about it, yeah. And I just, you're so strong. And to have that so publicly and you just... I thank you for that. Yeah. Because now that I look back on it, I've said this on other occasions,

that I was publicly humiliated for 25 years every week, exploited by the tabloids, every time any comedian wanted to make fun or make a joke about it, they could make a joke about it. And I accepted it because I thought I deserved it. I accepted it. I accepted it, I was shamed by it, and I received it because I thought, well, they're right. Right, and they were wrong. And they were so wrong.

Now I know why they were wrong. When you're living it, it is so hard. Yeah, of course you blame yourself. And any person who's watching or listening to us right now, who has suffered from obesity or being overweight, you know exactly what I'm talking about. You do not have to be on television every day to experience the same level of shame and embarrassment,

and why can't I do this, and I'm so good at so many other things, and I can take charge of my life, and I can do all of this, and why can't I? So the outside world telling you that you are less than, things and I can take charge of my life and I can do all of this and why can't I? So the outside world telling you that you are less than, that you should be shamed, feels like the punishment you deserve. And it's absolutely the opposite.

And none of this is in our control. Somehow in society we think that how much we weigh is in our control. And it's not. It's not. It's in our brain is in control. It's like the alcoholic finally realizing that it's not my willpower that caused me to not to be able to pick up the next drink. And just like with alcohol, those reward motivation pathways, those regions in the brain really respond in a certain way

when someone who has alcohol use disorder is drinking alcohol. In terms of obesity, those are the same brain pathways. Now, obesity is not an addiction. The thoughts of food and the wanting of food, that is something different. And again, that's- The food noise we call that.

The food noise. It's the bi... It's a manifestation of the biology. It's the biology of... And I know that people who don't have obesity as a disease don't even know what we're talking about. You don't even know what we're talking about. Right.

Well, yeah. Because one of the things that I realized the very first time I took a GLP-1 was that all these years, I thought that thin people, those people were just, had more willpower, they ate better foods, they were able to stick to it longer, they never had a potato chip. And then I realized the very first time I took the GLP-1 that, oh, they're not even thinking about it. They're only eating when they're hungry

and they're stopping when they're full. There was a guy named Bob Schwartz who had a diet called Diets Don't Work They're only eating when they're hungry and they're stopping when they're full. There was a guy named Bob Schwartz who had a diet called, Diets Don't Work, and the whole principle was to eat when you're hungry, stop when you're full, did multiple seminars three times with him on that. And the principle is great, except if you have obesity, it doesn't work. That's right. That's absolutely right.

And to get to your question of, well, is this the easy way out? Is taking medications the easy way out? It's not. Think about it. Think about when we treat someone who has, let's say, high blood pressure. Yes. And they come to see us and we say- Lots of Americans have high blood pressure.

Lots of Americans have high blood pressure. Lots of black people have high blood pressure. Exactly. So we say, okay, low salt diet is very helpful, and here are some medications that can treat the disease biology. And we need to do the same for obesity. We need to say, yes, healthy diet and exercise are critical, and they're very important for optimizing health.

And to treat the biology, the biology of obesity. Here's a medicine or medicines or surgery or what have you that will help actually treat that biology. We do the same thing for diabetes. My mother was a diabetic. Exactly. Same thing. She was an insulin shooting diabetic for most of her life and she would be told to stay

off of sweets and every now and then because people in the South just a lot of people in the South not generalizing but a lot of people that come from my family in the South think that having a little bit of coconut cake is okay or because they used to call it sugar diabetes yes you know I have a touch of sugar and they call it a touch of sugar and never realized how really definitively bad it is for you to have a little bit of sugar when you have diabetes until you end up going blind or end up having to have your leg amputated and all the things that happen. Exactly.

And so diabetes is another perfect example. We recommend a low glycemic index diet, so less sugar. Less sugar. And here are the medicines. Yes. And for your mom, if it was insulin, right? And here are the medicines.

So we pair them together to help that person's health, whether it's to help prevent all those downstream complications that can develop, or whether it's to treat that disease in and of itself. So if you have high blood pressure, which a lot of people do, you are recommended not to have salt and here's a blood pressure medication. A DASH diet and here's a medicine. Yeah, and everybody's out there taking their blood pressure medications

and not once do they think, boy, this is the easy way out. That's right. That's exactly right. And with obesity, for whatever reason, we have this different perspective, and we need to change that. Because we don't understand. We don't understand. It's my hope that this conversation with Dr. Anya will help you become more informed

about the research and medications that are literally flipping the script on everything we thought we knew about being overweight. Stay with us. We'll be back in a moment. Hey, again to you. I'm with Dr. Anya talking about the GLP-1 medications that are revolutionizing weight loss.

Why do you believe it's so important to tell your patients that obesity is a disease? It's critical. It's absolutely critical. And when I approach this, so when I see a patient, the first thing I do is, one, I set the stage and I say, this is a no judgment zone. And the first thing I ask them after that is, tell me about your weight journey.

Tell me about your struggles. Tell me, just tell me, tell me. And then I listen. And as I listen to them, as soon... I bet you get a lot of tears for that. A lot of tears. that a lot of I mean They cry I cry it yeah, and the thing is is there's something that happens in that moment Where people begin that journey of understanding that it's not their fault

And it's not something that they chose and we're here to help them to treat that biology Because why why would you choose it and why wouldn't you change it if you could that's right? chose and we're here to help them to treat that biology. Because why would you choose it and why wouldn't you change it if you could? That's right. That's absolutely right. Why wouldn't you change it if you could? You can have the healthy foods and still our body is so smart. It's so smart that it's like, no, I want you to hang on.

And some people, your body is going to hold on to the fat. Yeah, it wants that energy. And you're just built that way. You're just built that way. And if you begin the discussion of this is really about biology and that your body's smart and that the hormones are communicating with your brain and all these organs in your body, and your body's doing exactly what it was meant

to do, exactly what it was meant to do. Exactly what it was meant to do. And then, again, patients start to let go. And there's something magical that happens in that moment because they become curious. Curious about the disease of obesity and open to treatment. That's right, because you're no longer blaming yourself for it. That's right. You're no longer blaming yourself. Okay, can you explain why these GLP medications have been a game changer for so many people?

So, as we talked about, hormones, nutrient-stimulated hormones, they communicate with our brain to let our brain know how much energy to store, how much fat to store. The medicines, they target the same receptors as these nutrient-stimulated hormones. In your brain. In your brain. And those receptors are all over the brain, including reward motivation regions of the brain. So people are thinking it's targeting your stomach, because I know some people take their shots in the stomach. It's not targeting your stomach. No. Obesity is a neuro- a neuro metabolic or neuro endocrine disease. It's literally a disease. In the brain.

Yes, and so what happens in obesity is that there's something that is dysregulated or broken in terms of the set point, in terms of how much energy we want to store. And the medicines, what we think that they do is that they re-regulate that set point, they decrease that set point. So as you start taking a medicine, during that first phase when you're losing weight, think that they do is that they re-regulate that set point, they decrease that set point. So as you start taking a medicine during that first phase when you're losing weight, what

happens is your body is trying to chase a lower defended fat mass, a lower set point. And so that's why people eat less in that first phase. Then once they plateau, once their weight plateaus out, then some of the hunger and cravings and things can return, but the weight does not. And we have to reassure our patients that that's exactly what's supposed to happen. Because once you get to a new weight plateau, you're not chasing a new defended fat mass.

So the medicines lower or reset the defended fat mass or the set point, and then basically they re-regulate it to a new place. So as you increase the dose, you... So let's say you start out, you're 200 pounds, and then you start taking the medications, and you start to lose weight, and when you say it's chasing another set point, it means what specifically?

Give me an example of what that number might be. So let, and it's different for every person, this is a really, because there's more than one type of obesity. There's many different types of obesity. We just haven't defined them yet. But let's say, so somebody starts at 200 pounds, and let's say they start one of these medicines. Maybe with the first or the second dose,

that set point goes down to, let's say, 180 pounds, right? And then they keep on taking the medicine and after some time their doctor increases the dose and then their set point decreases, let's say to 170 pounds. So with every dose escalation, you're chasing a new lower reset defended fat mass or set point. Okay.

So many of you might remember Amy from the ABC special I did back in the spring, feels like years ago now, Shane Blame and the weight loss revolution. What happened after you went on Manjaro? Immediately, almost within days, that voice that I've had in my head since I always say, my earliest memories, five years old, I remember thinking about food, when I'm going to eat food, how much I'm gonna eat food, where I'm gonna, what I just ate, how many calories was it? And all of a sudden I took this medication

and it felt like I was freed. Like I literally felt like I'd been trapped and it felt like I don't have to think about this all the time anymore. And Amy is zooming in from Naperville, Illinois. Amy, hello, hello, Good to see you again. It's so good to see you. I remember you telling us your highest weight

was around 300 pounds. And you found out that you had diabetes and your A1C number were dangerously off the charts. And then you went on Monjaro in March of 2023, as I recall, right? And you lost 160 pounds in one year. What has happened since we last spoke? So much has happened.

The one thing that's remained the same is that I've now maintained the weight loss for about a year now. And in that period of time... That in itself is huge, right? It's wonderful. That's wonderful. Yeah. I mean, I always say that it wasn't about losing weight for is huge, right? It's wonderful. That's wonderful. Yeah, I mean, I always say that it wasn't about losing weight for me. I knew how to lose weight.

It was how to maintain the weight loss. So for me now, having maintained for a year is pretty great, and I'm pretty proud of myself for that. And during that time, I have sort of established this sort of community of people on social media who are kind of feeling the same as you and I Where it's all about? you know I am so tired of feeling bad about my weight and I'm so tired of being shamed for my weight and And it's not my fault and I'm not alone in this

Yeah And I'm a shame and I'm tired of people shaming me for being on a Zempik or being on another GLP-1 medication. So it's been kind of a whirlwind since we last chatted. And I hear you're getting messages, hundreds of messages every week from people online. What is the number one question that people are asking you or comments that are coming to you? People want this time to be different.

Like I said before, I know how to lose weight. I didn't know how to sustain it. Because often when I was losing weight, I would feel that I was starving myself. I wasn't giving myself the right nutrients. I wasn't allowing myself to have a piece of my daughter's birthday cake at her party because if I ate carbohydrates, I was going to gain weight. And so this time around, people want to know how to do it differently.

So they might be on a GLP-1 medication or maybe they're not yet or they're thinking about it, but they want to know, how can I heal my relationship with food? How can I heal my relationship with my body? It goes so beyond the exercise regimen and the diet changes, but how can I really heal that part? Well, I just want to applaud you because you took what was one of your greatest pains and shames and have now turned it into a powerful movement for yourself and to help other people. What are the biggest misconceptions that people are sharing with you about the GLP-1 weight loss drugs. What are they saying?

Oh my gosh, it's all day long, unfortunately, on social media platforms. People continue to say you're lazy if you're on a GLP-1 medication, you're lacking motivation, you should just be able to go to the gym. It's only for diabetes. You shouldn't take it if it's for weight loss. People don't even know that there's a drug that's been created specifically for weight loss. And so I think a couple of years ago, people were saying,

oh, you're taking drugs away from the diabetics. That is no longer true because there is a specific drug for diabetics and a specific drugs for people who are trying to lose weight. And what else are they saying to you? You know, I think people just assume that GLP-1 medications, often they'll just phrase it as, well, all it does is make you starve yourself.

That's all it does. There's not more to it. And when you get off the medication, you're gonna gain all the weight right back. And I mean, so much shaming around these meds to the point of your face looks a certain way if you're on these medications or your body looks a certain way. But in reality- Ozempic face and Ozempic butt, yeah, that's what I heard.

Yes, exactly, I'm told I have Ozempic face and Ozempic butt and in reality, it's just blue skin from significant weight loss. It has nothing to do with the medication. But medications like Ozempic and Menjaro are, in my opinion, a perfect sort of scapegoat for the continuation of shaming people in larger bodies. Yeah. I mean, I can't agree more.

You literally can't win. You cannot win. You're shamed if you have obesity. You're shamed if you don't try and lose win. You're shamed if you have obesity. You're shamed if you don't try and lose weight. You're shamed if you lose weight. You're shamed if you use the medicines. If you don't use the medicines, there's literally no winning. So I wholeheartedly agree. You are sharing your story so vulnerably and bravely online and you're fighting for what's right. And what's right is to stop shaming and blaming people.

Just let people do what they do. You're taking care of your health. And people ask me all the time how I kind of deal with a lot of the negativity that comes my way. And to me, I mean, so many people when I talk about food noise or when I talk about obesity being a disease, they're like, I thought I was the only person that had these thoughts up here. And that outweighs the, no pun intended, that outweighs the other stuff, the negativity

that comes my way. Well, you know what else I realized too, Amy and Dr. Anya, is that the people who are shaming, oftentimes have never experienced the food noise themselves. They don't even know what you're talking about when you're saying food noise. And so that brings us to the point of, I interviewed Mel Robbins recently

who has a great book out called Let Them. You just have to let them say what they say, do what they do, and let yourself understand the power of what you're doing by creating community and building connection with people who've experienced some of the same things and are looking to improve their health. I'm so happy to know, first of all, you were telling me that back in March when we talked, that you were still trying to adjust to buying the right size for yourself because you were still thinking that you needed to get larger sizes.

Has that eased itself? It's definitely gotten better. Even though I've now been on this medication for about two years now, I've been on this weight loss journey, so to speak, for about two years, I have to remind myself that this was decades. I mean, since I was a little girl, of thinking one way about my body and about food. And so lots of progress has been made, but there's still times where I look at,

I'm folding laundry and I look at a pair of pants and I'm like, whose pants are these? There's no way these still fit your body. But I'm coming to terms with it. I challenge myself. I take pictures of myself now. I had no pictures of myself with my children from when they were little.

I take pictures. That kind of thing challenges some of that thinking, but I think it's gonna still take more time. Yeah. Yeah, and another conversation, Dr. Anya and I were talking to a woman who said she's kept herself out of every picture in her entire life with her family. Wearing dark colors.

Wearing dark colors or standing behind other people or standing to the side or trying to avoid the picture. Yeah. We're glad you're putting yourself in the picture now. Thank you so much. Thank you. Thanks, Amy. Good to see you again.

You too. Keep up the great work you're doing. Where do we Thanks, Amy. Good to see you again. You too. Keep up the great work you're doing. Where do we find you online? What is your? I'm TikTok and Instagram. It's Amy in half. Okay.

Great. Great. Keep it up. Thank you. Stay with us. I'll be back with more of my conversation with Dr. Anya. We're talking with more people who have experienced a dramatic weight loss from these medications. Hi, and welcome back.

I'm with Yale University's Dr. Anya, and we're talking with people who have lost a dramatic amount of weight with the assistance of the new anti-obesity medications. Next, Amina is a mom of two young children zooming in from Lee's Summit, Missouri. Hi, Amina. How are you? Hi, Ambra. How are you? Thanks so much for having me today.

Well thank you. I heard that the ABC special that we did, the same one that Amy was on, inspired you to make a change in your life. So tell us what happened. You were watching the special and you saw Amy. You heard her story. Yes. I was watching the special and I had actually quietly started the medication in January

of that year, earlier that year, but I just didn't want to share it with anyone. But hearing the personal stories that were shared about, GLP-1s were really helping people take control of their health and really just, you know, changing their relationship with food. It really motivated me to really give it a really true shot and hopefully, you know, it would work out for me too. I had great hope. Wow. And so, do you have a question for us today or do you want to share something?

Yeah. Yes. So, you know, as someone who has struggled with weight for most of my life and emotional eating as well, you know, food was always an escape for me just from deep emotional pain, from anxiety, you know, and the journey for to my health didn't really start until after the birth of my two children and in between that, two miscarriages as well. And so, you know, experiencing that level of physical and emotional trauma was something I was unprepared for.

And I knew that I needed to take control of my health and make a change. And, you know, I started the traditional way as well, Oprah, in terms of diet and exercise and all of those things, but I found after the birth of my son, the weight just wouldn't drop and my health markers were not improving. And so, GLP once gave me, you know, a second chance to really take control of my health and start again. And so, I started in January of this year and have lost 50 pounds, which is been incredible. You know, just my energy, everything that I have.

And the food noise stopped, right? The food noise. And the food noise stopped the constant cravings for sugar and carbs and always thinking about the next meal. All of that went away and it's something I've never experienced before. It's been incredible. What's your question? What's your question today?

I've never experienced before. It's been incredible. What's your question? What's your question today? So I'm wondering if I will still need to stay on this medication for the rest of my life, or is this something I could taper off of? Yeah. I mean, I think that's a great question.

It's probably one of the top questions, if not the most commonly asked questions that my patients come to me with. Right now, what we do know is that obesity is a chronic disease. It's a chronic disease. So let's say that you had high blood pressure and you started taking a blood pressure medicine. What would happen if you were to stop taking that blood pressure medicine?

Your blood pressure would go back up. Same thing with diabetes. If you were taking insulin, if you stopped taking the insulin, your blood sugars would go back up. Same thing with diabetes. If you were taking insulin, if you stopped taking the insulin, your blood sugars would go back up. And what we're seeing in, not just in clinic, but also in trials, we just conducted a trial, it was three years, with one of the medications, is that the weight was completely maintained

while people were taking the medicine. And then when the medicine was stopped, people started gaining back the weight was completely maintained while people were taking the medicine. And then when the medicine was stopped, people started gaining back the weight. Now, what I can say is we see the same thing in clinic. So that is the case with most of my patients. What I usually do when patients say, well, I really like to see what happens when I stop, is I decrease the dose.

I go down on the dose by just a little bit, by one step, and then I say, come back and see me in two, three months. And they come back and see me and we see how they're doing. If they're maintaining their weight and the food noise isn't back and they're not struggling, then great, we stay on that dose. But if their weight is starting to trend up, or if that food noise is coming back

and they're having a really hard time, then we go back up on the dose. And I do think that just as there's differences in how much weight people lose, we will see differences in terms of how much people gain back. So we'll see variability in that weight regain. But right now, for most patients, on average, what we see, and in the studies we've seen this as well, most people, yes,

you have to continue taking the medicine because it's targeting your biology. It's targeting your obesity biology. I think it's such a crucial thing, and I actually, I've heard you say this before, but I just had an aha moment. And my aha is, we think because you've lost the weight, you've solved the problem. Because in the past, every time you went on a diet, once you lost the weight, you thought, now this is it. I've done it, I've succeeded. And we think, and I'm sure you're feeling this,

I'm saying we, assuming that you feel the same way. That I've lost the weight now, the problem is solved. But the problem isn't solved because the disease hasn't gone away just because you lost the weight. That's right. The disease is still there. So it's just like in alcoholism, I just had this ah-ha now. It's like an alcoholism. You cannot go back to drinking because your brain, just because you've gotten sober doesn't

mean you can now have a drink. We can't go back, otherwise you gain the weight. That's right. That's absolutely right. And that is why when we, these medicines- Ah ha! I just had that ah ha. It's a beautiful ah ha. And it's such an important one because again, these medicines. Ah ha! I just had that ah ha. It's a beautiful ah ha.

It's such an important one, because again, these are not. Did you get the ah ha too? Did you get it Amina? Absolutely, absolutely. And this is why, this is actually critical when we think about the words we use. These are not weight loss drugs.

They are medicines that treat obesity. They treat the disease processes in the brain. That's another way to look at it. Because if you look at it as a weight loss drug, now you've lost the weight, so now I'm finished. But the disease doesn't go away. And that is why I think so many patients ask us that, for that exact reason. They're like, well, I lost the weight. I'm cured. I'm cured. But it's the same way with diabetes, hypertension. They're like, well, I lost the weight. I'm cured. I'm cured. Success.

But it's the same way with diabetes, hypertension. Just because your blood pressure decreases or your blood sugars decrease doesn't mean you're cured. You no longer have high blood pressure. That's right. Yes. That's right. That's absolutely right.

Oh my God. Oh good. I'm so glad we had an aha. This is so important. Well, that's also the reason why Amina asked that question and everybody, I've had that question, everybody has a question. Do I have to stay on it? Because now I've lost the weight.

Yes, the disease is not gone. The weight isn't the issue. You think the weight is the symptom of the... It is the symptom. Just like the high blood sugars are the symptom of diabetes and the high blood pressure is, high blood pressure, it is hypertension. So the analogy is perfect with diabetes especially.

Thank you for asking that and causing me to have multiple ah-has here today. So the analogy is perfect with diabetes especially. Thank you for asking that and causing me to have multiple ah-has here today. Thank you, Amina. Thank you. Thank you so much. Yeah. Thanks, Amina. Let's talk about all the different, you know, every, every, it seems like every couple weeks

or so, there is another disclosure about what these obesity medications have revealed in terms of helping people drink less alcohol and not obviously lowering blood sugar, but what are all the other health benefits that we are discovering? Yeah, I mean there are studies coming about out about heart disease, about heart failure, about improving knee pain, obstructive sleep apnea, and all of these are obesity-related diseases. I even heard Alzheimer's. Well, and that is also being looked at.

What are the effects in the brain in terms of, again, improving that? And we'll have to see that. Those studies haven't yet been, you know, been conducted out as far as these other ones. So the heart disease, the- What is it about it that makes you not want to drink as much alcohol? I mean, I used to be the tequila queen, and now it's like,

eh, take it or leave it. Yeah. So those studies are being done. We think that, again, it's similar pathways in the brain that are being targeted. So just as your craving or your hunger may come down as you're taking these medications, in the same way you're craving for other things, other things that may be pleasurable goes down. Now that doesn't mean that makes you unhappy. You can just take it or leave it.

Emma is a dental hygienist and a mother of two, zooming in from Winder, is it Winder? Winder, Georgia. Hi, Emma. Hi, Oprah. Thank you so much for allowing me to be a part of the conversation. I have been on Zep-Bound for the past 10 months

and I'm down 66 pounds. Wow. Yeah, physically I feel absolutely amazing. But what this medication has done for me mentally and given me self-confidence, given me self-worth, and given me the ability to love myself again. In the past, I have tried exercise, I have tried diets, I constantly had fatigue, inflammation, and I just didn't feel good.

After having my first daughter, those things continued and I went to multiple doctors seeking answers because I just didn't feel good. And each time I would leave and I really didn't feel like I had an answer. This past December, I went for my regular doctor's appointment and sat down with a nurse practitioner and told her all of these things.

And she said, you know, Emma, I think if we can get some of this weight off of you, you would start to feel better. And like you said, it was an aha moment for me because I feel like it was the answer to so many prayers that I had had that I was not crazy and that I really did have something wrong. And she listened. And so, you know, from the outside, I really did have something wrong. She listened. So, from the outside, I had everything going for me. I had a beautiful family, two healthy children, a dream job that I loved, but I was drowning

on the inside because I didn't love myself. So, within one week of taking this medicine, I could see that the inflammation was going away. I started feeling better. I started having more energy. And I knew I needed to share my story because I knew that there were other people that had the same symptoms.

And so I started showing up every single day for the past 10 months on social media, just sharing my story in hopes that I could help to encourage and inspire somebody else that may have been having those same symptoms. All right, y'all. It's in my I'm on a journey for a healthier, happier me thanks to ZipBound. And I have hit an all-time blow today on the scale. So that's something to celebrate. And so when you got, I'm sure you got pushback or people saying negative things on social media. How have you managed that for yourself?

You know, at first that bothered me, but along this journey gaining that self-confidence, gaining that self-worth, and realizing that it doesn't matter what the other people think because this is for me and I'm doing this for me and I feel better so that I can have a life, so my children can love their mother. And, you know, I've dropped the opinions of what other people think, because this is for me and for my health, because we only have one life to live. Absolutely. What do you want to ask Dr. Anya here today? What I would love to ask is that, you know,

with you saying that this might be a medicine that we have to be on long term, and if that's what I have to do, totally fine with that, because if I had diabetes, I would take the medicine to survive. Do we know what the long-term effects would be from taking these medications? So that's a great question, and another very common question

that we get from our patients. And first, I'll start off by saying that, as you've identified, there are risks to having obesity in and of itself, right? And when we treat patients for any disease, we say, okay, what are the benefits of treatment? What are the risks of treatment? What are the benefits of not treating or treating, right?

We really look at all that very, very carefully. And right now, all the data is pointing to the fact that these are very beneficial, but that doesn't mean that we don't have to do our due diligence, be very careful, and monitor everything long-term, because millions of people are taking these medicines and millions more will take them.

Having said that, GLP-1 receptor agonists have been used for the treatment of diabetes for 20 years. Now, all of these medications also for diabetes... We're just now hearing about it, but some people have been using them. We have been using them. For 20 years! Yes. The first one was FDA approved in 2005. So it was nearly 20 years ago that these medications were first FDA approved.

I know 20 years. So the earlier ones were a little bit different than the newer ones and they were shorter acting and they had to be taken more daily rather than weekly. So there are differences there. But the point is, is that we do have data, all the trials. That's why we do all the trials. That's why I do all the trials, that's why we do all the trials, that's why I do all the trials, right? To make sure that the FDA has the information that it needs, not only to know that these medicines are effective, but to know that they are safe and well tolerated. And if there's a signal that they're not, then the FDA says, no, we're not moving forward.

So what we have to do is keep on doing the studies. We need to gather real world data. What health impacts are these medicines having on those diseases? I know the question that Amina asked before about whether you have to be on the medication forever. Did you hear the answer when I had my big aha moment there, Emma? Yeah, yeah. Yeah.

Yeah. That it's like, I've always thought that you solve the problem once you lose the weight, Emma? Yeah. Yeah. Yeah. Yeah. Yeah. That it's like, I've always thought that you solve the problem once you lose the weight, but then when you regain the weight again, it's like the problem came back. But when you have the hormone that allows for the obesity to be prevalent in your life, then it's never going to go away. It's never going to go away. It's never gonna go away.

It's like once you have diabetes, you always have diabetes. It can be treated or controlled diabetes. Same thing with obesity. Once you have obesity, you always have obesity. Is it treated and controlled? That's the question. And so when we've lost the weight

or in the process of losing the weight, that's when you're controlling it. Yes, that's exactly right. But it doesn't mean the problem is solved. That's right. That's right. And the important thing is- Which is another way to look at it.

Yes. Isn't that an aha moment? Yeah. It's such an aha moment. And you know what? If I have to take these forever, I'm okay with that because you know what? It's fighting the disease of obesity and I'm getting my life back and I get to live. So I'm here for it.

You're getting my life back and I get to live. So I'm here for it. Getting your life back. And I'm wondering whether or not, once you reach the set point, once Emma gets to her goal, are you at goal weight yet? Not quite yet. I'd like to do about 30 more pounds, but it's kind of like what she would say and I feel like I've kind of hit that plateau.

I still have the effects of no food noise, but I feel like my weight is not maybe going down as much. I do feel the inches may be changing, but I'm just sticking the course, sticking with the process, because I know it's working, because I can feel it. It's just I'm not losing it as fast as I was.

And that's the way it works for everybody, right? Yes, and it takes time. So the more highly effective a medication is, we're seeing it may take longer to see the effects. That's why the trials are getting longer. Will you reach a point where, when you've reached the goal weight, that you may be able to lower the dosage to maintain? And that is the question that we were starting to answer

in the last thing is, for some patients, maybe, but right now we don't know how to determine that ahead of time, a priori. So basically that's why when patients, if they ask me to go off or some patients ask to go down on the dose, we try that, but then bring them in quickly because the hard part is if you start gaining back weight, that is so, people think again, it's my fault, and it's not their fault, it's not their fault. If you decrease- It's biology. It's biology, if you decrease your-

Blood pressure medication. What's gonna happen? Your blood pressure's going back up. Same thing with your blood sugars for diabetes, it's no different with obesity. Isn't that just powerful to know for yourself? Totally, and that it's not my fault. Yes.

Not your fault. Yeah. It helps getting your life back feel like redemption, doesn't it? Completely. And you know, I'm glad I'm 37. I wish I would have found it sooner. Oh, girl, please. You have got so much life left in you, so that's so wonderful that you've discovered it now at the right time for you. Thank you so much, Emma. Thank you. Thank you so much. I love the beautiful photograph of you and your daughters. That's gorgeous. Some babies. Yep, thank you. Thank you. I thank you for listening. We'll be back with weight loss expert and research scientist Dr. Anya after this. I thank you so much for listening and being with us here. We're back with Dr. Anya. Dr. Anya after this. I thank you so much for listening and being with us here.

We're back with Dr. Anya. Dr. Anya, so can you set the record straight on side effects because I've heard everything from vomiting to throwing up, to diarrhea. Yeah, that's a great question. And side effects do occur, right, with any medicine for any disease. Is there any medicine for any disease that doesn't have side effects? And I also have heard hair loss.

Yes. Is hair loss from these medications a real thing? Well, it depends how much weight someone loses and how quickly, because losing weight is a stress. It's a stress on our body, right? So we've actually seen the hair loss with things like bariatric surgery. And now with people who lose a large amount of weight in a short period of time, we're also seeing those types of effects that we saw with bariatric surgery.

But let's focus in on the most common side effects as you were asking about. So the most common side effects are gastrointestinal. So they are things like feeling nauseated, having diarrhea, constipation, and for some people vomiting. But there are ways that we can really combat those side effects, and again,

they don't happen in everybody. So number one, what physicians or providers can do is invite their patients to share the side effects with their provider and make sure that the provider says, look, I'm not gonna stop the medicine, let's work through these together. The main thing that a healthcare provider can do when they're prescribing these medications

to help avoid or mitigate those side effects is start low and go slow. Always start with the lowest dose. And then you do not have to go up once a month. You do not have to go up once a month, you go up as is right for that patient. So if a patient is having nausea, I do not go up on the dose.

I let them stay on the dose, let their body get used to the medicine. Yeah, if somebody, if you go to someone and they immediately put you on a high dose, you're going to the wrong healthcare provider, because that should not happen. Absolutely, absolutely. Then, you know, look around, see if there's another healthcare provider, because that should not happen. Absolutely, absolutely. Then look around, see if there's another healthcare provider, somebody who really knows how to treat obesity

and understands that it's a disease, that this is not about weight loss, this is about weight reduction and optimizing health. And knows to pair them with the diet, the correct nutrition, the exercise, someone who really knows. Okay, so for most people, this is a medication to treat obesity and to understand that once you lose the weight, it doesn't mean that the problem is solved.

That's correct. That's the big aha for me today. And that's a very good aha to have and take away. Thank you. Dr. Anya, it's always a joy to talk to you. Thank you so much for being here. We value your expertise on this topic. It must feel rewarding for you that this moment has finally come and that these medications

are being made available to so many people because you get to see it in your own patients. Yeah, absolutely. I mean, I always say people ask me, well, how did you know that you wanted to do this? The first time that I helped a patient lose a meaningful amount of weight for that person, I was like, I'm never doing anything ever again. This is it.

And I'm so grateful that I get to do this. And I'm so grateful that patients trust me. They trust me to care for them. And again, I couldn't imagine doing anything else. Well, I can see how rewarding it is because you have people saying, I got my life back. Yeah. I got my life back. Absolutely.

And again, there's good and bad things about everything, everything in life. These medicines are right now what we're seeing. They're helping people transform their lives in so many ways, in terms of their health, in terms of their overall life. They're just really incredible in terms of helping people. Well, I want to thank you, Amy.

Thank you, Amina. Thank you, Emma. Thank you for all of our guests sharing your stories. Go well, everybody. Thank you for making time to be with me today. I really hope that you join me for part two of this conversation as we continue to see how these new medications result in dramatic loss of weight, almost the equivalent of an entire person.

You've lost 165 pounds. Wow, congratulations. So what happens in the aftermath of that? The doctor said to me, when are you going to stop blaming yourself and let somebody help you? When you lose up to 100 pounds or more, do people treat you differently?

Everyone was so much friendlier to me. How does that impact how you see yourself in the world and even within your own family. To be honest, I feel like she kind of takes it for granted a little bit. Like she forgets where she's come from. That's my next conversation with Dr. Anya and new guests who have a lot to say about their experiences. So we'll talk to you then and thank you so much for being here. You can subscribe to the Oprah Podcast on YouTube and follow us on Spotify, Apple Podcasts,

or wherever you listen. I'll see you next week. Thanks, everybody.