Just As Well, The Women's Health Podcast - GLP-1 Weight-Loss Drugs Explained: Benefits, Risks and Reality. A Doctor’s unfiltered guide.

Episode Date: January 13, 2026

Ozempic. Wegovy. Mounjaro. Miracle drugs — or a health red flag? . Dr Zoe Williams joins Gemma Atkinson and Women’s Health UK editor-in-chief Claire Sanderson to reveal what GLP-1 drugs really do to your body and brain. From side effects and muscle loss to NHS eligibility, weight regain and menopause risks, this episode cuts through the noise with real medical insight. . If you’re taking a GLP-1, thinking about it, or just wondering why everyone suddenly looks different — this episode is for you. . Hosts:  https://www.instagram.com/glouiseatkinson/  https://www.instagram.com/clairesanderson/  Wellness video producer: https://www.instagram.com/chelia.batkin/  Learn more about your ad choices. Visit megaphone.fm/adchoices

Hi, I'm Gemma Atkinson. And I'm Claire Sanderson, the editor-in-chief of Women's Health UK. We just had a fascinating chat with Dr Zoe Williams. You may know her from this morning, and the whole conversation was about GLP-1s. Now, this was an episode. We have had a lot of messages from people actually wanting to know more about this, because to some, it's a miracle drug.

To others, it's a red flag. So we wanted to delve deep with Dr. Zoe. And she gave a really insightful, I think, talk about, it because she told me things that I didn't have a clue about. She really opened my mind to the reasons why for some it can work, why for others, it's not a one size fits all. It was quite a fascinating chat, wasn't it? And she also spoke about what she thinks the future holds for societal health and wider public health with GLP ones in the future. So it's future gazing as as well as looking at the current situation,

the science into how they work, why they work, the side effects, the negative side effects, but also how they genuinely can help the people in most desperate need for them. And she said they'd been around since 2015, was it? A long time. She said they've been on the market

for at least 15, 20 years, but it's only now we're hearing about it or seeing them because people are using them to lose weight. Maybe people who shouldn't be using them are using them to lose weight. and we did a bit of an exploration into that as well. So enjoy this.

If you're thinking of or you know someone who is using them, let's be honest, we all do, then this episode is for you. So please enjoy it, like, subscribe. And here's our chat with Dr Zoe Williams. Before we get started, I'd like to stress that all of the opinions coming up belong to myself, Gemma, and Dr Zoe Williams.

Viewers should always conduct to their own research and seek independent medical advice and consult a GP before starting any medical treatment. So they've been called miracle drugs, game changers, the biggest medical story of the decade, and depending on who you ask, they're either saving lives or symptomatic of everything wrong

with how we now think about our bodies, our health and quick fixes. So if you've heard whispers about a Zenpick at dinner parties, or you've seen the term on the pen floating around social media, or suddenly wondered why half of Hollywood looks really, really different, you're witnessing a cultural and medical shift happening in real time. And here with us now, we're so, so pleased to welcome TV zone, Dr Zoe Williams. Thank you for coming.

Thanks for having me. You're going to delve deep into the world of GLP-1s, and it's something that we're all so, so interested in. We have to start by asking, for those of us who don't know, what exactly is a GLP1? Yeah, so GLPT-Sands for Glucagon-like peptide. So peptides are small, chains of amino acids, long chains of amino acids are proteins, so they're like miniature proteins

in a sense. And this glucagon-like peptide is something that we naturally produce in our bodies, but the GLP-1 receptor agonist, which is the medications we're talking about, these are structures that mimic those natural hormones in our bodies. So when we eat food, we naturally release GLP-1. So with these injectable medications and sometimes now oral medications, we're mimicking that and the impact that has on the body it has a number of different effects and I think the easiest way to explain it is you can almost think that there's a the reasons we eat there are two main reasons we eat one because we need to eat to survive so our body gets hungry because we need food and the other one is we eat for pleasure it lights up the reward systems in our brain and it's

pleasurable so sometimes we eat when we're not hungry because it's pleasurable like a birthday cake even though you've just had dinner for example just get with a cup of tea just because it goes together just because it's nice right it's pleasurable we enjoy it so these medications kind of impact on both of those so the sort of physiological need to eat they reduce the hunger hormones they slow down digestion so you feel fuller for longer so they actually make you less hungry but interestingly what we're discovering more about now is they also impact the brain by stopping that reward system in the brain so if you're somebody who you know it's the same with alcohol as well this is why people often report they drink less.

You know, you have a glass of wine and it's like, oh, yes. It takes that away. You don't get the pleasure in the same way, so therefore people stop drinking or stop eating as much food. So it also reduces cravings. So it works in a number of ways to essentially make people eat less. So there's a few brand names that we're familiar with. They become very common vernacular.

Well, Zembek seems to catch all, but it's not the only one. No. There's Monjaro. Yeah. There's a few others. So there are two main drugs that are used these days. One's called somagliteide. OZempic and Wegovi are both somagliteide.

They're both the same. But a Zempic is actually licensed for type 2 diabetes and Weigovie is licensed for a weight loss drug. So actually, unless you have type 2 diabetes, you shouldn't be taking a Zen pic. And there were some issues a couple of years ago and that diabetics couldn't get their medication because people were misusing it.

So Azempic and Wagovi are somagliac. And the most recent drug is Tezeppatide and that's Mungaro. It's called Zep bound in the USA, but here we call it Mungaro. And are they the same, they're different drugs? They're different, yeah. So the smagliteide, the Azempec and Wagovi, that's a GLP1, which is what we've spoken about. But the Mamjaro, the Tazepatide, also has a second peptide in there, something called GIP. And that kind of helps further with the regulating of the glucose in the blood and sort of supports the glp one so what we've seen in the studies is that people tend to have slightly more weight loss with the manjaro than they do with the um wegovi certain some of them like you say were designed specifically for people with

diabetes yes to help treat diabetes and the side of one of the side effects was you lost weight yeah so then they went ah okay we can now remarket this yeah as a weight loss tool as well is that how which officially come around. Yeah, so in the UK, the first GLP1 drug that was licensed for tattoo diabetes, that was back in 2010, so it's 15 years ago. So people talk about them as if they're brand new, but they've actually been licensed for 15 years. And that was called exenetide.

And since then, every sort of two, three or four years, there's been kind of an upgrade. So there's been sort of a new iteration of what's the best GLP1 drug over the years and the most recent one being Mungaro, which is the most effective and likely to have a slightly better side of profile than some of the earlier ones. So these drugs are really made for people who are very overweight. They're not made for people who just want to lose seven pounds of stone, you know, bikini body brigade. They are for people who are living with obesity and have other life limiting,

complications as a result of their obesity. And certainly if you're going to access any of them on the NHS, you need to fall into those categories. Yes, absolutely. And we can talk about, so licensing, there's licensing, and then there's what's nice approved, and then there's what you can actually get on the NHS. So these GLP ones are actually licensed at the moment for type 2 diabetes and for weight management on an obesity in people with a BMI above or equal to 30, or, a BMI.

or a BMI above or equal to 27 with a comorbidity because of obesity. So things like type of diabetes, cardiovascular disease, sleep apnea, abnormal lipid profile. So that's what's licensed. So that means that the MHRA, which we might all be familiar with from the COVID days, they've assessed them and deem them safe and effective in that group of people. So nice is one step further. So nice, they look at also, cost effectiveness and then make recommendations to the NHS. So it's slightly stricter criteria.

So the nice criteria are BMI above or equal to 35 or 32.5 for those in non-white groups because we know that the health complications start a slightly lower BMI plus one comorbid condition. But that would mean that 3.4 million people in the UK will be eligible and that is just not, the NHS cannot deliver that. So the NHS has in place, they've agreed with Nice, a stepwise approach over several years. So actually, you can, if you're referred to a weight management specialist program, which some people might know of as Tier 3 or Tier 4, then if you fulfill those criteria, so BMI above 35 plus one condition, then you may be eligible.

But now for Moundjaro, we can prescribe in primary care as well. GPs can prescribe, but the criteria are very limited. So it's only at the moment for people with a BMI above or equal to 40. It's always 2.5 lower if you're from a non-white ethnic group. And they've got to have four obesity-valate conditions, and that's four out of five of high blood pressure, high cholesterol or triglycerides, so high blood fats, obstructive sleep apnea,

cardiovascular disease, or type two diabetes. So it's a very small proportion of people who are eligible according to the nice guidelines that fit those current guidelines. And over three years, it's going to open up more and more each year so that more people can be prescribed it from their GP. The people you just described, to me, already seem very unwell. Yes. Yes. Your BMI is over 40.

I can't even imagine what that translates to in terms of pounds. But we're talking people whose mobility is impacted. Probably lots of other things going on as well outside of those criteria. I agree with you. Someone's got a BMI over 40 and they've got high blood pressure, they've got type 2 diabetes, they've got obstructive sleep apnea and either high cholesterol or cardiovascular disease. You know, you can start to see how they are going to benefit hugely, massively from losing weight because it's going to impact positively on all of those conditions as well.

And therefore it's, you know, it's a no-brainer in terms of cost to the NHS. And actually, I would argue for all of the 3.4 million people who fulfill the original nice guidelines, it is a cost benefit. That's what nice have determined. But it's just not logistically possible to roll it out to everybody all in one go. If I was playing devil's advocate for it, would, like the, so the way you've described how it works in stopping the hormone receptor for being hunger and hungry and stuff, which is brill. Yeah. To help more people like the million. who need it, who can't get it.

Is that not what happens when you do like intermittent fasting? So say you just at between 6am and 12pm or 12 and 6pm. Obviously when your body's in a state of fast, there's no blood sugar spikes, she's no insulin spike. Is that not doing the same thing? But obviously without any side effects. So I think all of the various lifestyle approaches that we have for weight loss, and usually before it's also written into the rules that they should,

should have tried other methods, you know, lifestyle approaches for weight loss. Something like intimate fasting is different for different people. So I think if we take it back a step to who's affected by obesity in the first place, like what means that some people have obesity and real issues and really struggle to lose weight and others always find it easy and never really have problems with their weight in the first place. Well, there are over 100 causes of obesity, so it's really complex. but by far in a way the most important cause is our genetics

and our genetics really kind of indicate how well we're able to tolerate the change in the environment the abysiogenic environment so really the cause of obesity the main cause of obesity is the changing environment but go back a hundred years obesity was very very rare so the the accessibility of foods of food our inactive lifestyles all of that literally now you just dial it in, don't you? And whatever you want is delivered to your door. So that's the main cause. But our genetics determine how well we've been able to sustain this change in our environment.

And there are now, like there are certain genes that have been mapped to obesity that if you have a certain phenotype of a gene, you're much more likely to gain weight because you're going to be just more hungry. Your hormones work differently. Your digestion works differently. Also, your metabolism, like your ability to burn fat, whether your body chooses to burn fat or store fat is partly based on your genetics. But even if we think of, I often explain it to people as just thinking about typical phenotypes that are really easy to understand. So if you compare somebody who goes to a buffet, it can eat three plates of food and still eat more compared to somebody who has one small plate and they're stuffed, that's partly driven by your genetics, how much your

society regulation. And the second one I talk about is your food preferences. So if you're, some people just actually really enjoy eating vegetables and salads and whole grains and lean protein and that's what they want to eat genuinely. They'll have a bit of cake every now and again, but it's not, they don't have as much of a drive to eat those fatty, sugary foods. Whereas for some people it's the opposite, you know, they've got this real drive to eat high sugar, high fat food.

So again, your genetics predetermined that largely. So you can see how with the change in the environment, how some people are much more likely to be able to sustain a healthy weight compared to others. And the third one's called food responsiveness. And this is you go to a petrol station, you put your petrol in your car. One person goes in, they pay, they come out, they get in the car. Another person goes in, they scan every chocolate bar, every packet of Chris. They could come out

and list like 20 different types of food that they've seen because their brain is so responsive. This is like the food noise that people talk about. So you can start to see if your genetics make you somebody who can eat three plates of food at a buffet, your preferences for high fat, high sugar foods and you're hyper responsive to food. Your ability to maintain a a healthy way in today's environment compared to 100 years ago. It's very different to somebody who doesn't have those genetic traits. So when we think about things like intimate and fasting, I think they're all excellent tools for the right person. But if I think about my friends and I think about myself and I think about my partner, you know, we've sort of extended our fasting

window a little bit. And apart from when we're on holiday at the weekends, we're sort of now I'm not really engaging that much in breakfast, and we find it easy to do that. But then I'm someone who's always found it relatively easy to manage my weight, largely probably due to my genetics, also due to other factors, privilege, etc. For my, I think about my typical patients, introducing this concept of intimate and fasting and not having breakfast or stopping eating early in the evening, there are often lots of reasons where that's just not going to happen. It might be that they already have extremely difficult lives,

and eating outside of the home is too expensive, so that's their only opportunity to eat. You know, they've got children, they're managing a job, single parent, and preparing, doing extra work in the mornings to what they've already got to do is just not feasible. So there's a lot of societal factors come into it, but also some people are just really, really, really hungry.

And willpower comes into it, and this is why fad diets work in the short term, because we can all activate willpower for a few weeks, a few months, maybe even six months, but you can't use willpower to override genuine hunger for your whole life. It's just not possible. It's like part of being human. Our biggest drives, like once we've got shelter, the next thing we need is food to override our biology with willpower. It's not sustainable. So intimate and fasting will work for some people, but often people who have this subset of genetics and then possibly difficult life factors, possibly emotional factors coming in as well,

especially if they've been battling their weight their whole life, something like intimate fasting will work for a proportion of people, but for lots of people, it just won't work. You'll get a lot of patients in your practice. How many of them, is there a lot asking for it? And if you're a female taking it, does it have any impact on your cycle? Yeah, really good question. So lots of patients inquire about it, but I think the guidelines within the NHS, are so, so strict and so set,

but it's, you know, it's usually a short conversation. In my experience, I don't often get patients coming in purely asking if they qualify for it. It's more, oh, at the end of a consultation, oh, by the way, doctor, you know, these GLP ones, is that something that could help me? And unfortunately, often the answer is, yeah, it probably could help you, but you're nowhere near yet what, reaching the criteria for me to prescribe. And often, you know, we do have these tier three, tier four weight management services,

but the weight in this are now very, very long and some areas of the UK don't even have them. The way I sort of came to this as an interest, the obesity as special interest, was I was working in a really busy practice in a central London GP surgery. Because I've always had an interest in lifestyle medicine, in particular the physical activity side of it, and weight management became part of that, my colleagues would typically refer patients to me if they'd showed an interest in weight management losing weight. So I was getting all these patients, and I had a 10-minute consultation, and, you know,

it was very limited what you could do. So it would often be looking at, you know, I'd be getting them to do food diaries and helping them to understand their eating and their triggers for eating, etc. But really, it wasn't, I couldn't achieve what they, I couldn't do what they needed. And even though we were in central London,

we didn't have a Tier 3 weight management service. So I kept putting pressure on. There were CCGs at the time, sort of our local commissioning services, to say, what do we have? And in the end, they brought me in to help develop these services. So that's kind of where my interest in obesity started. And there were some colleagues that I met and worked with that have been highly influential

and I really look up to, one of which was Professor Rachel Batterum, who actually led the landmark study for the first GLP-1s, which in 2021, for weight loss, meaning they've been rolled out in the way that they have. but in terms of affecting your hormones, there's not a lot of evidence. We don't have really any evidence to say that they cause a shift in the sex hormones, so that they affect the cycle or that they affect ovulation or anything of that nature. I'm not aware of them interacting in that way. But the biggest interaction is if for people who have PCOS or for women who are struggling with fertility because of obesity,

they can be really, really effective at sort of increasing their fertility. But it's a bit tricky because you actually can't get pregnant whilst you're using them. So you kind of therefore, for people using it for that purpose, you need a regime where you're using a GLP 1 alongside contraceptions so that you don't get pregnant, and then you have to stop the GLP 1s for two months or one month for Manjaro before you start trying to get pregnant. So you can use it as a way of losing weight,

but then you have to stop it before trying. Talk about maybe the elephant in the room or not, the fact that these drugs are now so widely available. As you mentioned, you work in a GP surgery in a deprived area, I'm assuming from the way you were speaking. And these people in the lower socioeconomic sectors of society are in the most desperate need for this because obesity over indexes in deprived areas. But they probably can't get their hands on it because they don't have 200 pounds. north of £200 a month to spend on it, yet women and men are getting their hands on it if they can afford it and those who are far away from the 40 BMI, even 30 BMI. So I want to dive a bit deeper into that.

What are the dangers, or are they dangers of taking these drugs? And are you particularly vulnerable to these side effects if you're, you? you are of a lower BMI. So if you are sub-28, which is the bottom BMI to make you eligible to legitimately get hold of these drugs, are you making yourself more vulnerable to the side effects? Some people reported, and it's not everyone, obviously, for some, it's been incredible, but some, Claire mentioned side effects, some reported cramping, diarrhea, headaches, nausea, hair loss, vomiting.

And there was a study, a five-year study, and 17% of patients. participants in one five-year study 17,000 of them had to stop taking it. Yeah. Due to like more serious things like with kidney issues and thyroid. And again, that's not for everyone. But is that the case with all treatments and medicines that some it will work for? Yeah. No, no medication is completely safe. Even paracetamol, you know, even paracetamol, some people, if they use it or misuse it. I think to go back to your point, Claire, about it is

completely unfair because you're absolutely. right. You know, we know that there's a huge separation in health inequalities, depending on how much money you have. And if you have a BMI of 27 or above with one condition, you can pay for these legitimately through a pharmacy or through a doctor and get them, they are expensive. And like you say, people who are living in the more socially deprived areas or that's their circumstance, they're much more like to have obesity, they're much more likely to have all of the other conditions associated with obesity as well. They're much poorer access to good quality food and opportunities to be physically active and they can't access them because they can't afford them. So it is driving these health

inequalities further at the time being until we can catch up with that 3.4 million people who would likely benefit from taking them. In terms of are they risky? Well, every drug has its risks, even paracetamol and the GLP ones have a risk profile that whether you're somebody who has, you know, slight issues with overweight or you have extreme obesity, the risks are kind of similar, but the benefits are completely different. And when we're considering whether somebody should be prescribed of medication, it's always a case of weighing up the risks and the benefit. The benefits outweigh the risks, then it's sensible to proceed if the risks outweigh the benefits. then it's not. So you take somebody who's got a BMI over 40, who's got all those conditions that

we spoke about, the benefits are massive. So therefore, comparatively, the risks are low. But if you take somebody who just wants to take it for a few months for their holiday for aesthetic reasons, then there's no health benefit. So the risks therefore outweigh the benefit. So in terms of side effects, things that are common are nausea, vomiting, headaches, fatigue. and actually if it started in the right way which is you start low and build it up gradually people do tend to sort of those side effects do tend to wane after a little while so again if you're somebody who's got a lot to gain from this then some side effects initially if they're manageable then we'd often encourage someone

to continue at that low dose until there are no side effects before stepping them up but there are some serious side effects as well so gallstones pancreatitis and then anyone who's losing weight quickly, there's a risk of malnutrition. So you've got to have a very well thought out diet and most people will need supplements as well. The risk of bone loss and osteoporosis, which is particularly important for women who are menopausal who already are losing bone density at a rapid rate and muscle loss as well, which is really important. And this is one of the things that I think people don't talk about enough is that if you lose

five stone. So say you start off 20 stone and you lose five stone over a year, which is a brilliant result. That's great. That's three quarters of your body weight lost. You've probably lost three stone of fat and two stone of muscle thereabouts if you haven't taken steps to try and maintain your muscle so resistance training. If you then stop taking it and regain four stone, so you end up a stone lighter than when you started, you're now 19 stone over the following year, which is not unlikely, that's what we've seen in the study is a lot of people when they stop, they do regain a significant proportion of the weight. If you've regained four stones, say over six months, almost all of that four stone will be fat because it takes a long time for your body to rebuild

the muscle. So even though you're stone lighter, you now have one more stone of fat on your body than when you started and two stone less of muscle, meaning that metabolically you are much less healthier than when you started. So typical use of these drugs in my experience through friends mostly who are taking it is that they just think this is great. I struggled all my life with this weight. I've had to like hit the gym really hard and restrict my diet and now I'm taking this injection once a week. The weight's coming off. I feel great. I've got no cravings. It's wonderful. I don't need to go to the gym. I don't need to eat that. I could just eat what I want because I'm not even hungry. So I'll just have a pizza on one day and a Chinese the next day and a

an engine take away the next day and I'm satisfied with that. So I get to eat exactly what I want. Well, that person's health, even though they're losing weight, could be deteriorating from the malnutrition, from the loss of bone, from the loss of muscle. So it's a real responsibility that I give to my patients to say, this can really help you, but you have to do it in conjunction with muscle building, strengthening exercises with making sure that you focus on getting enough of the nutrients that you need. So getting those fruit and veggies in, getting that protein in and using a supplement for most

people and making sure that you're putting some tension through your bones. Because if you don't do that, there is a real risk that you'll end up in a less healthy metabolic state than when you started. It's very hard to build muscle if you're in a significant calorie deficit. It is. But if you've got a good regime of of resistance training, you'll still lose some muscle, but you limit how much muscle you keep hold of more of the muscle. So, yeah, it's unlikely that somebody is going to increase their muscle mass, but you shift the proportions so that you're losing more fat and less muscle, but you will still be losing some muscle. What's interesting to me is I'm coming at it from, I look at this list of some side effects and instantly go,

oh, absolutely not, you know, but I'm coming at it from a. place of someone who does love training. For me it's the best thing I can ever do who does love cooking healthy meals who's had the privilege of being able to have a gym membership now as a gym at home and like yourself Claire you have access to women's health to men's health so you have all the information but if I was someone who felt so low in my self-esteem in my appearance in my relationships in my workplace because of how I looked and felt and someone said take you this everything will go away you you I think you would because I think a lot of people come at it from a place of being desperate as a last resort and despite seeing

this list they go okay but I've already got heart disease I'm already struggling to go up the stairs what the hell I'll just do it so there is well this is it's a lifeline because they might have been battling with their weight for 40 years since they were a child and they've literally tried everything and they've lost the weight but it comes back and they've lost the weight and then it comes back and like I spoke about with willpower willpower you can't use willpower for all of your life it just won't work so they've been waiting and physicians and specialists who work within this specialty within metabolic disease within bariatrics who have been waiting and praying and hoping for a medication to come along

that does what these medicines do. Essentially, they do what bariatric surgery does, but without going under the knife. But they're not perfect because they don't work for everybody. If you stop taking them, then their effects disappear. So, you know, those hormones that make you want to eat, the hunger comes back. How long can you be on them for for that? Like, do you have to be on them for life, then in that case? Well, probably. So at the moment, they're licensed for two years, and that's based on these initial studies where people were on them for two years and they lost this weight. And these were sort of put in place before they then followed people up to see what happens when they come off them. But, you know, the experts are the obesity experts. My colleagues would say, you wouldn't

start somebody on blood pressure medication and then say, but we're going to take you off it in two years because the blood pressure will go back up. And so obesity is a chronic disease. And I think that's another benefit of these medicines. They've kind of proven that. They've sort of really helped us understand more the pathophysiology of how this disease pans out. So it's a chronic disease. We have a medicine that can treat it. That medicine is cost effective because it prevents that person going on to develop heart disease and joint disease and all of these conditions that were known associated, kidney disease, liver disease. So it's cost effective. So why would we stop giving it to them at two years? And I believe, I hope and I expect that by the time we would,

reached that point that the people who first went on them on the NHS are reaching that two-year point I think that guideline will have likely changed and they have made changes within that because you'd like to think people would make lifestyle changes as well yes you know kind of which can make some difference some difference yeah do you wish as a GP that like all the money at the minute that's being put into GLP ones was firstly putting into educating everyone in every area about nutrition about movement about how their body works hormonely you know because that would then there's a ripple effect isn't there and if all that was done first the the ripple effect of obesity probably wouldn't go but it would become a lot less yeah well it needs to be it needs to be across the board so when

I was talking before about these tiers of obesity management that's where those tiers come in so tier one is preventative strategies that everybody should be subjected to so this is you know we should have healthier diets the government should be subsidising healthy food looking at what children are fed in schools looking what people are fed in hospitals so making access to healthier food so that should be that's a tier one so something that affects everybody to prevent the issue of obesity tier two is more targeted approaches so that's kind of like your weight watches and things that are still sometimes prescribed so you know your intervention your dietary interventions or your exercise on referrals so often 12-week programs that give somebody the tools the

education and some support to try and make some lifestyle changes. Tier three is then for people who have obesity. So these are usually, they should be a multidisciplinary approach where you have the nutrition input, the physical activity and the psychological input, usually a 12-month program to support somebody. And this is where GLP ones come in. And then tier four, which is bariatric surgery, specialist obesity services. So you need all of it. And I absolutely agree. You know, if we're saying the number one cause actually of obesity is the change in environment, we never gave the food industry permission to put all those additional, you know, to put all that sugar into our food, to put all that fat into our food.

We never said they could do that and that they could market it to us that way, but they've done it because it makes a lot of money. So, you know, the sugary drinks levy that came in quite some time ago, some people are opposed to that, say, oh, it's Nanny State, you know, saying that we shouldn't be advertising food. they're unhealthy before the watershed. You know, we shouldn't be advertising cocoa pops to children.

So people say, well, that's Nanny State, you know, Nanny State, Nanny State, blah, blah, blah. So, well, we never gave permission in the first place for all of this crap to be put into our food. So, yeah, absolutely, I think the government should be tightening on restrictions, especially when it comes to an area that I'm really passionate about, which is child of obesity.

We know that children living in, even where I used to work in London, within that borough, there was a bus that went from one side of the borough to the other. and if you lived in Dulwich versus the most deprived area, you could expect to have nine years higher life expectancy. If you were a child starting primary school, if you were here, you had double the risk of starting primary school

or ending primary school with obesity. You can't attribute blame. This is a child, and you can't blame the parents either. This is largely down to where they live and their social circumstances. And you've probably had a food deserts. My GP practice used to be in a food desert. So if I wanted to get lunch, I had to walk probably about, well, maybe about 10, 15 minutes, which isn't very far for me on my own in good health, to get healthy food.

In the immediate vicinity, there were chicken shops, greasy spoons, a couple of off licences that sold, you know, your crisps and what have you, but to get to M&S or wait a child or even Sainsbury's to get something reasonably healthy was quite far. Now, if you're a parent, single parent, three children under the age of five. No chance, is there? You've got no chance. your children are hungry, you've only got a fibre, you're either going to get some microwave pizzas for them,

or you're going to take them to the, they can get some chicken and chips for £1.50 each. Of course you're going to do that. We really need to, I think at every level, this problem is only going to get worse. I mean, GLP-1s have come along as a bit of a lifeline, to be honest, because the projections were previously before GLP-1s, and I think they've changed it,

that by 2035, 40% of the adult population will be living with obesity. Oh, wow. We went for lunch, Zoe. I think it was two or three years ago in Soho, not far from here. Very nice lunch as well. It was a very nice lunch, yes. We wouldn't say the name of the place we went, but it's all reliable, isn't it?

And I remember you saying to me that in a generation or two, we won't have obesity, because we were talking about these drugs. Do you still stand by that? I do, because, you know, every three, four years has been a new iteration of the this drug. You think of it like the iPhone every couple of years. The iPhone gets upgraded and they're getting better and better in terms of their safety, their effectiveness and their side effect profile. There already is an oral version of somaglite, which again is the Azempegobie one, and it's all for Glypron is the new one that we're expecting next year. And once these come off

license, which means they get much cheaper because other drug companies can manufacture very, very similar drugs, the price will go down. So, it's a bit, I think this is maybe what I said to you, but I see this vision for this world in the future where we've created this obeseogenic environment. And in order to tackle that, practically everyone will be taking a GLP1 in some way, shape or other. Also, they're looking at now licensing it for cardiovascular disease. So in people who have established cardiovascular disease, the studies have shown that it significantly reduces the risk of those people having a heart attack stroke or dying. from their cardiovascular disease. So for people who have overweight,

so just the BMI over 25, that may be licensed soon for those people. The next group of people, chronic kidney disease, because it is a treatment for chronic kidney disease. We've seen it, like the research showing that it helps with other things of fertility. Addictions, gambling addictions, alcohol addictions, drug addictions because of the way in which

it affects that reward center in the brain. So I think in the future, many, many people, will be using this drug. If they can nail the main risks of it, if they can find a version that means you maintain muscle as well and you maintain your bone mass and they get rid of some of the downsides, then I do see a world where maybe we will really see

a significant reduction in obesity because of the way that the medical world is going. And now, I think with new technologies like AI, I mean, medicine's going to completely change over the next 50 years. It'll be unrecognizable. I think life expectancy, for people who are very, very wealthy and can engage fully with all of the tech.

People being born now, you know, I might live to 150. I think we're going to see like, it's like, would you want to? But yeah, the world of medicine is changing rapidly. And I think, you know, this is a really important drug. And I know some people criticize it and are down on it, but you can't deny it. It's a really important drug. You touched on obviously the children, the kids and the future generation. That for me is my biggest. It makes me really sad when I see a young child seven or eight who is so overweight through no fault of their own.

And it goes through my head now as a mom. I think it's going to affect the school when it comes to playing sports. It's going to affect them when they have to sit on those little chairs. When they go to dating, it's going to affect them in the workplace because people judge how you look. We're in that naive, horrible ignorance of a world where you judge someone on their appearance before getting to know them. So I always look at that. child will think, oh my God, your future now is practically mapped out because of your size, which is no fault of your own. Do you think there will be a version of GLP ones for children in the future, or is that still too much of a risk? Well, I mean, some people underage 18 are being prescribed

GLP ones now. Right, okay. In extreme cases. In extreme cases. Will there be an option for children? I hope not. I hope that's not necessary. But yeah, I think we have to. We have to, actually had a case of a we had a girl on this morning it was in America and she was I think she was maybe 14 when she first started taking it and initially and her mom was taking them and she started using them and initially I think when I read it I thought I feel uncomfortable with that but as I got to know her story and understood her story and it was that risk benefit it was kind of, yeah, benefits for her outweighed the risk. So will we see children using them in the future?

We may well do. We may well do. It may be that in the future there's a better alternative. But that will always, you know, it always has to be in combination with support and with lifestyle. So currently these would only be prescribed to children by usually a very specialised paediatrician who specialises in probably weight management

or children with certain genetic conditions, which mean that it's practically impossible for them to not have obesity. There's a couple of things I wanted to cover. Firstly, I wanted to tap into your PT backgrounds. I know you're a qualified personal trainer. Gladiator. Aren't you a gladiator? A gladiator.

Real-life gladiator. And you touched upon the muscle mass loss when you're on this drug. And the reality is women are taking this drug. So I'd like to dig a little bit deeper into how can you main. maintain and maybe build muscle mass while in a calorie deficit. And I know that you need to lean in your nutrition as well as your training to try and action that muscle growth. And then secondly, I'd love to quickly discuss the societal return to skinny being better. Because I feel like we've undone a decade of good work in the body positivity movements where different body sizes were accepted.

and celebrated and I feel like that has been undone rapidly before our eyes but maybe let's discuss the the muscle because it is a real concern because especially for menopausal women and perimenopauseal women where we start depleting muscle mass exponentially and therefore it's not inevitable but it's easier to put on weight at that time of life absolutely and therefore you might be more middle-aged right yeah more inclined to go for the pen at that time of life to ward that off. So how can women of different generations preserve their muscle mass if they are choosing to take these drugs?

Yeah, well, in order to build muscle, the simplest equation, you need three building blocks. So you need sufficient energy. So it's very difficult when you're in a calorie deficit because you kind of need to have enough calories to be able for your body to focus on building muscle. Because if your body, your body's not going to focus on building muscle. It's not priority until you've, you know, initially you've fed your brain, you've fed your organs and all that.

So it's going to use the calories available for the most important stuff. And building muscle is way down on the priority list. So it's difficult if you're in a calorie deficit. But if you're in a phase where you're eating sufficient calories, that's number one. You need enough energy. Number two, you need enough protein. So protein is the building blocks for building muscle. So this is why, you know, your bodybuilders are, I remember when I did gladiators and we had these incredible.

chef who would just bend over backwards to help us. And before we started filming, he sort of said to the production crew, what will these guys eat? And the guy said, well, you know, some of them might just eat a whole chicken for lunch. So on the first day, we had 20 chickens plus everything else in kids, we all wanted a chicken. But, you know, protein's kind of had its moment, isn't it? But I think the praises of protein have possibly been over some point. You do need sufficient good quality protein if you want to build muscle. And the third major component is you need to stress the muscle. You need to put the muscle under enough duress, make it work hard enough, that you signal to it, okay, that was really hard work. The next time I'm challenged in that way,

I want it to be easier, so I need more muscle. So you encourage the muscle to, you encourage your body to build muscle in that way. So the types of exercises people can do, and I always sort of start off at the very, very basics. I mean, this is women's health, so I'm assuming most of the listeners here probably have a decent basal level of fitness. But with my patients who were starting from doing absolutely nothing in the chair opposite me, I'd just say to them, right, can you stand up without using your hands? Sometimes they need to push up. So, Claire, maybe I'll get you to demonstrate. Can you stand up without using your hands? There we go. Okay, brilliant. Well done. Now sit down again. Now sit down again. Now sit down again. Get you squatting. And I get, and there we go.

It's a sit stand. It's a, you know, it's a squat. Orda, Zoe, all dear. when you get to the point where you can do it without sitting and just touching your bum. So I say, look, try and do that. Every time the adverts come on, try and do 10 of those. And if you can do that three times a day, literally within two months, they feel better, they're stronger, their joint pains have been improving. So that's kind of a baseline. Anything that makes your muscles feel a little bit sore, whatever that is for you,

doing it enough, that will signal to your body that it should build more muscle. And they'll feel better mentally. as well that's why I mean I've not trained now it's coming up to nearly two weeks it's the longest I've gone actually without training I know it's insane I've still been doing my stretches and stuff but I've not physically lifted weights and I'm aware of it like mentally I'm like you can't wait to just go and have some heavy weights you never regret a workout do you no no you feel so much better unless you've run a marathon or something like that you then you're like have you done marathes no I've done half all of our guests have done

We can't do more than 10K. Oh no, no, I did the marathon last year, thank you. You did it last year? Yes, yes. I've done it twice and before that. So what are you one about saying you can't do high rocks then? You could do a high rocks. If you've done 20 odd miles, you can do it.

26.2 miles. You can do eight kilometres in a high rock. I couldn't do a marathon. I hated it. I hated it. I ran the Great North Run and I got to the end. I thought, God, imagine. Having to turn around and run all the way back.

No, thanks. Oh my God, no. Are there any supplements you can take to encourage muscle growth. I'm thinking creatine. Everyone's obsessed with creatine. I'm taking creating and I do think it has helped me. Yeah, I think creatine's the one, isn't it? It's, yeah, there's really good, well-established evidence that if you've got those one, two, three, the main building blocks in place, then you're going to add something in extra than creatine, so creating can help. But I think with women, you know, as women, we are much more complex beings than men. So even thinking about cycles,

sinking and for women who still have their cycle, the time that you're best able to build muscle is when you're in the follicular phase. So that's after your period and before you ovulate. So it's usually in the typical person, maybe from day five to day 14 of your cycle, day one being when you get your period. That's when you're both the muscle adaptation is different and you're more able to build muscles. So now with the, think about the women's, England women's rugby team or football team. They all have different training schedules now based on their menstrual cycle. That's brilliant. And the time that you're most likely to get your PB is just before you ovulate, we have a little surge of testosterone. So if you're doing something like Hirox and there's those to

choose from, you want to choose the date that's just before your ovulation date because that's when you'll, that's when you have your peak. Is that going to make you do it then? Well, no, because I'm thinking now, because I'm on my period, no, aren't now? I've been moaning about it all day. So in like four or five days, I'm going to be raring to go in the gym, which is good. Yeah, yeah, yeah. Just little things like that. They make a difference. Make it your superpower.

So before we ask you some quick fire questions, which we do before all our guests leave, for anyone listening now who is considering going down the GLP 1 route, what are the top three bits of advice you would give them first and foremost? Okay. The most important one is this is a prescription-only medication. So if it's not being prescribed by a doctor, a nurse or a pharmacist prescriber, then don't do it. There's loads of counterfeit products out there. We've had stories of people who've been buying it on the black market and they've actually been sold insulin and they've ended up in A&E, almost dying.

Because insulin comes in a similar looking pen, but it's much, much cheaper. So if you're going to get this, it needs to be prescribed by a prescriber. And it's a massive red flag if you get it. it in any other way. Number two, understand the risk benefit profile for you as an individual. So if you are somebody who does have an elevated BMI and you've tried everything and it's not worked and you have comorbidities, then this is likely that the benefits will outweigh the risks. Understand your own risk benefit equation because that's all that you care about. You don't care about everyone else. You need to know what that is for you. And if you need to see a healthcare

professional to help you figure that out, then do so. And the third one is, these are amazing drugs, but as you're, as the patient who has taken them, it really is your responsibility to look after your bones, to look after your muscle, to make sure you don't get malnourished, you know, signs like hair falling out, which I know was mentioned, that's probably a sign of malnourishment. So this drug can really, really help you. But if you don't do what you need to do to look after yourself from a nutrition, a strength training point of view, then you could be doing yourself more harm than good. So that's, I always say to my friends who are thinking about taking it, that's on you. That's your responsibility.

I think the fourth thing can just add, specifically for menopausal women, I think that bone loss thing is not talked about enough. So you can see your GP and ask for a frax score where they can assess your bone health. And if your bone health, if you already have osteophenia or osteoporosis, you may, need to take medication to support your bones alongside this. In fact, there's, you can go online and do your own score. There's something just launched, I think just launched recently from the British Osteoporosis Society.

It's called the Great British Bone Check. So you can go online and do a three minute questionnaire to assess your own risk of osteoporosis. And if that says, you know, you're absolutely fine, don't worry about it. Fair enough. But if it says you're at risk, you might just want to give that. some more consideration well thank you for coming in zoe we found this fascinated and i'm sure our listeners have as well before we finish we do have our quick fire questions if you if you're a regular listener you might know what they are but if not it's going to come as a surprise to you so

jama and i have invited ourselves to your house for dinner what are you going to cook us Oh, probably a lasagna. Nice. Because if you guys are coming around for dinner, I don't want to be in the kitchen doing stuff so you can prep it all beforehand, whack it in the oven, whilst we have a little glass of wine in the ketchup

and then just serve it with a nice big salad and some garlic bread. Nice autumnal winter dish as well. Great bread's beautiful, isn't it? A tip I once got from my friend's mum, actually, is when you're making the bolognais for lasagna, put a couple of pieces of dark chocolate and half a teaspoon of coffee in it.

Oh wow. Makes it taste yummy. Lovely. I try that one. And some bacon as well in your lasagna if you're being naughty. You're going to a desert island for 12 months but you can only take one item.

What would it be? Can I take my son? Is he an item? Yes, you can. Gemma chose her dog. Can I take his dad as well? No. You chose.

I chose my dog and Claire said anyone but her kids. So shows what love on me and you were at at when it comes to our kids. Claire. What's the last thing that made you belly laugh? Oh, my son, for sure. He's absolutely hilarious at the moment. Four years old, just started school. What was it?

Said, we picked him up from school the other day. And he said, we were taught, you know, as we were doing, what did you have for lunch? What did you do? He was your best friend today. And he just went, stop. I just need some space. Brilliant.

So dramatic. Yeah, he's just coming out with all sorts of the moment. Coffee or wine? Wine. Wine. We're coffee girls, aren't we? As long as I can have tea, then wine. Wine.

But yeah, probably wine. What's one thing people watching or listening today can do to make themselves feel a little bit better? Do you know, smiling, even if you don't feel like it? If you smile, you stimulate the muscles in the face, the zygomatic muscles. And when those muscles are stimulated, your brain believes you're happy and releases happy chemicals. so even if you feel really dreadful just forcing yourself to smile or forcing yourself to laugh

you can go one step further can actually make you feel better and I think if you smile the world smiles back at you and that's good for your mental health even if you are in London and you walk around smile and people think you're a little bit on on the tube maybe not you want to try being a northern and walking around

and say no to people they look at you like you're going to batter up or in Wales everyone says hello in Wales and yeah not up here well we've loved that haven't we Yes, and we will do a follow-ups genuinely. If you all like and subscribe and please send this episode to anyone who you think, well, anyone will benefit from this episode. I think it's such an on-topic, you know, chat that we've had with the GLP ones.

And any questions do send them in. And we'll definitely get you back to answer all the listeners' questions. We'll go through them all. But thank you very much. Thank you so much. Thank you for having me.