The Agenda with Steve Paikin (Audio) - How Are Drugs Like Ozempic Changing Weight Loss?

Episode Date: March 27, 2025

Ozempic and other GLP-1 drugs have exploded in popularity largely due to their effectiveness in treating type-2 diabetes and, perhaps more significantly, their weight-loss effects. But what do we know about these drugs and how they work? We're joined by Dr. Daniel J. Drucker, Dr. Sanjeev Sockalingam, and registered dietician Nishta Saxena.See omnystudio.com/listener for privacy information.

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we welcome Dr. Daniel J. Drucker, Senior Investigator at Sinai Health's Lundfeld-Tannenbaum Research Institute and Professor at the University of Toronto's Department of Medicine on the line from University of Toronto. Dr. Sanjeev Sakalingam, Senior Vice President of Education

and Chief Medical Officer at the Centre for Addictions and Mental Health. He's also Professor of Psychiatry at the University of Toronto and Scientific Director at Obesity Canada. And Nishta Saxana, Registered Dietitian and Founder of Vibrant Nutrition. Thank you so much for joining us in studio and Dr. Drucker for joining us on the line. Dr. Drucker, I'm going to start with you. Your research led to the development of these drugs. How did that happen? Well, we were trying to figure out what these sequences in the DNA of the glucagon gene were in the 1980s. And we saw these glucagon-like peptide sequences. We had no idea what they did,

where they were made, if they were active. And my experiments just set about to say, what did they do? And we finally hit some exciting data when we saw these peptides, predominantly GLP-1, stimulates insulin secretion and allows islet cells to make more insulin. And those were the first biological activities described for GLP-1 in the mid 1980s. All right, you know, a lot of people are hearing the word ozempic a lot,

but they're not necessarily hearing GLP-1, like you mentioned, a lot of people are hearing the word ozempic a lot, but they're not necessarily hearing GLP-1 like you mentioned or some glutide. Can you walk us through a little bit in layman terms? Break down the science for us exactly how they work. Sure. So our body makes dozens of hormones. We're all familiar with cortisol or thyroid hormone or growth hormone. And the body also makes a lot of hormones in our gastrointestinal tract

and glucagon like peptide one is one of the hormones that our body makes and it's very sensitive to food intake its levels rise it helps us assimilate the energy it tells the pancreas to make more insulin and helps us control our blood glucose and also sends a signal to the brain to tell us when we're full. Dr. Sockaling, talk to me a little bit about what you've seen with Ozempic. You know, the research that's sort of been done. Pick up sort of where Dr. Drucker is in terms of its ability to work and work on the GI. Yeah, well I think we've seen a lot happen. We have a lot of literature from diabetes where initially it was being used. And over time we've seen how research has shown

and indications for its use in obesity and really where it works is in terms of giving that sense of satiety or fullness that we see and that's the brain gut interaction in some of the parts of our brain like our hypothalamus and regulation of hunger and those drives but also on hypothalamus and regulation of hunger and those drives, but also on aspects of reward and some of the motivations for eating and drive for eating, that wanting so to speak, that sometimes signaling. So there are receptors in the brain that also have GLP-1 that are also impacted and this is where we see things where patients tell us they're feeling more full on these medications. They may also talk about something anecdotally, not a scientific term, but reductions in like food noise or the importance of...

Food noise, what do we mean by that? Where patients tell me that they have less real estate that they spend in their brain on food and that they are not thinking about food as much. Some of those cravings come down and they're able to spend, I feel like a release of some of that energy, time and space in terms of their food preoccupations. All right, Anishta, Ozempic was originally made and approved, of course, as we mentioned, type 2 diabetes, but not everyone is using it that way.

How do people get these drugs to use for weight loss? I would say primarily, I have quite a gamut a range of patients now that are using these drugs and they're primarily going to the family physician and because there's so much awareness about them they're going there with you know the desire and the asking for these drugs in particular particularly people that have struggled with obesity you know for their entire lives they're seeing it as hopefully this kind of beacon of light and hope in the path to actually not living with obesity anymore.

So I would say the primary place is family physician, but of course clients that are working with a psychiatrist will also, as Dr. Singalum just mentioned, may be also asking for these drugs or they may be using these drugs and being prescribed by mental health care providers as well. Now with Ozempic, I'm sure a lot of people are hearing it because they're seeing celebrities using it and they're seeing a lot of people with success there. I'm curious, you know, with people with the gamut of clients, are they coming up to you and being like, I've been hearing about this, how are they approaching sort of that conversation with you, knowing that they have to go to the doctor,

but what's that initial conversations with you? Yeah, absolutely. They are kind of wanting, a lot of people are wanting to work sort of from the outside in, right? We all know that lifestyle changes, and I do want to preface this by saying, obesity is not a disease of willpower, right? It's very complex comorbid conditions that come together for people to be struggling

with this. So when they come to me, they know that things that they need to do, things they want to engage in with lifestyle, but they feel this sense of if I use this drug, it'll give me a kickstart. Maybe it will start that process and then the momentum of that and feeling different in my body, my thoughts being different will help me then engage with some of these lifestyle changes. And they absolutely are coming to me with the goal of a lot of weight loss.

So they're not really looking at it as a small thing. These are often people who wanna lose 30, 50 pounds. And so they're really approaching it with that attitude of I wanna lose this much weight. Very good. Dr. Jocker, if people use the drugs off label, obviously they won't be covered by most public or sometimes private insurance.

I'm curious, how much are people paying for this out of pocket? The drugs are very expensive and there is more and more competition in the United States where the drugs are much higher priced. We have seen prices come down now from over $1,000 a month to $500 a month.

More recently, Eli Ali and Nova Nervis are watching cheaper versions without the pens and bottles. $400 a month. In Canada, probably anywhere from around $300, $400 a month for the newer versions, maybe $250 a month for the older versions, but 250 dollars a month for the you know older versions, but they're still very expensive medicines. I'm curious about patents. Is this something when we're talking about generics? Are those available or is there some time before we get there?

So we are going to see generic loraglotide which is one of the earlier versions approved for weight loss in Canada, it was launched in 2014 and there are no generic versions on the way. So Maglutide will probably be generic in two to three years. You know, the companies always engage in legal strategies to try and prolong this. And of course then we've seen people making compounded versions of these medicines, which is another entire subject of controversy that bypasses the companies. And we'll have more competition in a couple years.

But for now, accessibility and cost are still major issues. All right. I want to pull up a study, a 2024 study from Dalhousie University estimated that around 900,000 to 1.4 million Canadians were taking a GLP-1 drug. Now 57.1% said they were taking for type 2 diabetes, 27.2% said they were taking for weight loss, 11.6% said that they were taking for both weight loss and type 2 diabetes, and then 4.1%

said other. Now I'm curious about then 4.1% said other. Now I'm curious about this 4.1%. I don't know, I'm sure there's a few things here. But Dr. Sarkolyn, do we know what else people could be using GLP-1 drugs for? Well I think you alluded to it earlier that I think there are maybe some people who are taking it maybe for weight loss, but maybe an off label for other things and cravings in other realms. There has been a lot of debate and discussion and emerging research on the use of GLP-1 for cravings

and curbing kind of addictions, for example. I don't know if that 4.1% is that group, it's still pretty early for that but I do wonder if For example some people may be using it to curb other cravings There are some animal studies and some early human studies that looked at nicotine use and alcohol use and looking at associations and reductions But larger trials are currently underway. I would say the other is other people may be using it

for these fluctuations in weight that might not be weight loss but weight cosmetic, weight modification people, cycling or tinkering with their dose, with little small doses to help with modulation of weight maintenance. So that's pretty. Hey, very interesting. All right, next up, that estimate that I gave,

$900,000 to $1.4 million, sounds like a large number, but I should have mentioned that study's from 2024. Okay. A lot of time can change. I'm curious, do we think that number could be a lot higher? Do we have a rough idea of how many people are using something like Ozepic? Well, I can definitely say in the past year and a half,

in my practice, in my clinic, the use has skyrocketed. So even if I looked at it as a percentage of patients that I would see in clients that I would serve, it's definitely quite a large percent of people for the variety of reasons that you're describing. It really isn't the majority of people that I am seeing on this drug are not actually taking it for the management of type 2 diabetes. They may already be taking medications for the management of type 2 diabetes. They may already be taking medications

for the management of that, and they've started this drug to kind of start the process of trying to manage their weight. So I do actually think the number is probably higher. I am curious, it sounds like an obvious question. The application of something like Ozemberga Rogovie, how does it apply? It is an injectable drug,

and it is something that has to be dosed properly. So it is something that you would start off with a starting dose and then you work up to a maximum dose with the physician and that does take time. And then you also have to attribute and take time for understanding how people will react. The one thing I want to say is of all of the different clients and patients that are using this drug, it's very individualized reactions and very individualized results as well. So we wanna make sure that patients are aware of that.

All right, I wanna pick up on that with Dr. Drucker, these individualized sort of reactions. I also wanna talk about side effects as well. What are some of the side effects people can experience if they are taking this medication? Well, the most common side effects are nausea, diarrhea, constipation, and vomiting. Those occur in about half the people who take them.

They tend to be transient, and we see them when people start the drug or where they increase the dose. About 90, 95% of people after a few months will not have any of those side effects. Then, you know, more rarely gallbladder disease, sometimes dehydration if you really are unable to eat and drink. So we have to counsel people about this. Then there are some more controversial things.

People talk about rare types of eye disease or rare types of kidney disease or pancreatitis and such. Those actually have not been definitively proven, but they are something that we discuss. The important thing which we've heard about is we can start a low dose and go slowly. The acronym sort of start low, go slow. We don't have to repeat the rapidity of which we increase the dose of these medicines that are done in the clinical trials. We should not increase the dose of these medicines in people who have any side effects.

We should wait until they become used to the medicines and go much more slowly. It often takes 10, 15, 20 years to gain a lot of weight. We don't have to reverse that in six or nine months. So we have to have an individualized approach to management. All right. Dr. Succulent, I'm curious. When I'm thinking of a type two diabetes medication, I'm thinking of metformin or something like that.

Something that, you know, I'm not saying, not throwing my mom under the bus when she has to take it, she has to take it every day. I am curious with something like Ozempic, do people need to take that drug, do they need to stay on it forever to be able to see it, or if they get off of it, will they see a reverse? Well, I think it comes back to Nisha's earlier comment

that obesity is a chronic medical condition, right? So with diabetes, it is a condition that we manage for the rest of our life through various interventions. It doesn't always have to be medications. It's often multi-component. And that applies to obesity as well. And even though we've accepted obesity

as a chronic disease in the medical field for some time, in society, it's still an uphill struggle with respect to that. So how does this relate to patients? I do counsel patients on this. It's the first question they ask is, how long do I have to stay on this? And I do say it is like any other chronic disease, like diabetes.

If you have high blood pressure, for example, you're going to stay on the medications to manage that and you're going to do a whole bunch of other things as well in terms of behavioral lifestyle modification and so on. And then we will reassess over time, but for many patients they do have to stay on these medications for a longer period of time and I'm committed to working with them on that and that's I think the main thing is that we reassess together It really is something we have to educate because many people see that initial benefit and want to go off the medication, right?

Because they're better just like antibiotics. Are you carry your infection? Do you want to go off it? So we do have to counsel patients with respect to that All right, Nisha our GLP-1 drugs a sustainable form of weight loss Well, that's the question of the day and And the way that I would look at it is, it's like so many other interventions we've had in the past 20 or 30 years to try to attack obesity. It is a tool in the toolbox. So it is something that can be absolutely utilized

to help with sustainable habits, but I think in and of itself, it's not a quick fix or the answer to everything because as we've heard today, there are so many factors that influence obesity and the development of it, and it's not a quick fix or the answer to everything because as we've heard today there are so many factors that influence obesity and the development of it and it's a chronic disease so it is something that people will manage over time or over many years or have been and therefore I do think it is an important tool I think it's a useful tool the sustainability really

does come into play when you look at what are the other pieces that we can help patients and clients get into place because I do think there's multiple factors that need to be activated for this drug to even have its most potent and beneficial effect. So that's the way I kind of look at it. Similar to many other interventions over the years that as soon as they are kind of on the market, people are very excited about them and they kind of think, oh, this is the quick ticket. We really don't want to do that with this time.

There's amazing benefits to these drugs, but I do think we want to think of it as one tool in a multi-tool box. All right, very well. Dr. Drucker, I want to talk a little bit about some research, research from the University of Alberta. Last year, raised some red flags about the potential for semaglutide to shrink the heart and other muscles.

Is this something people should be worried about or is this early research? Where are we at? I think you're referring to a study that was done in animals and let's remind ourselves what we know after 20 years of using these medicines in people with type 2 diabetes and about 4 or 5 years with the more modern drugs and obesity and 10 years with Leroy-Brett type of obesity. So we have fantastic studies in people with a history of heart disease that these medicines

reduce heart attacks, strokes, death from cardiovascular causes, and your rate of dying in general, and as well as reduce the symptoms and severity of types of heart failure. So although the animal studies are intriguing and we can always learn more humans, I think these drugs are among the safest medicines for your heart that we've ever seen in people with type 2 diabetes and people with obesity. I wanna pick up on that

when you're talking about heart disease, Dr. Drucker. Health Canada now says that the drug Wigovia can help treat heart disease. Break it down for us in layman terms. How does that work? So we have actions of GFP1 on our blood vessels, probably on the development of plaques that we call atherosclerosis. We know these medicines affect blood flow. They actually control the amount of blood fats that our gut releases after we eat. They reduce blood pressure and they reduce inflammation.

So all of these beneficial effects probably work together to reduce the development of heart disease in susceptible people. All right, Dr. Suckalingham, there's also research suggesting that GLP-1s could treat lots of other conditions, like Alzheimer's, arthritis. Is it too early to say this is a miracle drug? You know, it seems like we are treating

a gamut of chronic issues here with this drug. There's some excitement there. Well, I would say it's too early to call it a miracle drug. I'll just say that. I think it's very nice to have a great drug and treatment in our toolbox. I think what you're alluding to is, in addition to what Dr. Drucker just spoke about in terms

of the cardiovascular benefit, we are seeing that these GLP-1 receptor agonists are having effects beyond weight loss, reductions in sleep apnea for treatment, fatty liver disease, for example. And really, if you look at it, if you think about obesity as a chronic disease, obesity is associated with many chronic medical conditions. It's bad for our heart, blood sugars, blood pressure. It's bad for our brains. And so we're seeing that if maybe we treat obesity upstream and early, you may be able to prevent other potential medical

illnesses and diseases as well. And so this is where we're trying to figure out where this might work in addition to this specific drug having some beneficial effects on the body as well. I want to pick up on a thought that you had mentioned earlier about sort of the excitement sort of with dealing with cravings when we talk about addiction. You of course work at the Centre of Addiction and Mental Health in Toronto. How exciting is it to be sort of with the possibilities of these findings? How exciting is it to be sort of with the possibilities of these findings?

Well, I think, again, if we look at, I'll take alcohol use disorder, because that's one area where we're seeing a bit of traction and research underway for GLP-1s. We don't have a lot of great treatments. We have a lot of psychological treatments that are effective. We have a few medications that are useful. And similar to other chronic diseases, you know

Addictions wax and Wayne and if we could have another treatment that could help be quite beneficial And as I alluded to GLP ones affect that reward pathway That we see for a kind of food as a reward and especially highly caloric a dense type of food Similar to like alcohol and other substances where we're hitting those reward pathways and that dopamine kind of signaling as well and so you can see that theoretically there are some parallels and this I think the research and trials underway are going to really tell us how effective is this treatment and for how long and can this be part of the toolbox for

addictions treatment. All right Nish, do you think these drugs are changing the way we view obesity in general? Well, it's an interesting question. I think that as time goes on and sort of you alluded to Hollywood, you know, and watching a lot of celebrities who probably don't admit that they're using these drugs to maintain or even lose weight, I do think there's an interesting question at play there. If we are still in a state of looking at somebody's body size, the bias that comes, the weight bias, judging people because of the shape of their body versus what's actually happening inside of their body, et cetera, there could be a risk of if everybody is meant to be a certain size and going back to that kind of size-ism etc. I think

ultimately this type of drug and the use of this drug really has to be a conversation with a doctor and a patient about what their goals are. We really want to understand and look past just weight and numbers on the scale as a metric because as we've talked about you know the impact on the way that you're thinking about food, how you feel about food Your mental wellness your mental health your energy your ability to perform in your life the way that you want to All of these things are part and parcel of becoming healthier and controlling or managing obesity And so if we can also help people understand it isn't just about a number on a scale and a number on a scale doesn't

help people understand it isn't just about a number on a scale and a number on a scale doesn't necessarily mean that you are healthier of course it can start that pathway but we want to look at all of those pieces together because yeah we don't want to end up with a society that's looking at the on your resume at the number of your weight instead of your who you are as person all right dr. Drucker I'm curious you know because of the early research that you did I'm curious looking looking back the early research that you did, I'm curious, looking back, did you ever think that the success that the research would have and the way that it's being applied, I know there's a lot of early research that's still being done on

some other stuff, but are you surprised at how far, did you ever think that that research would be applied to what it is, what it's being applied to now? Yeah, and I want to come back to one of the previous comments. I think when we started this in the 80s, we were focused on the diabetes piece, stimulation of insulin secretion, and there was a vision that this might be useful for diabetes. But the weight loss story started in 1996,

and none of us, I think, would admit that we could have imagined this range of actions that we'd be contemplating. I think a really important message for our society is that for many years we have sometimes looked at people living with obesity and tended to blame them and ascribe the lack of willpower and say, well, you're not really trying. If you want to lose weight, you can really lose weight. And all of a sudden now, with the aid of GLP-1 medicines, these people can lose spectacular amounts of weight.

And I think it allows our friends and family members who are living and struggling with the challenge of obesity to turn around to the rest of us and say, you see, I actually can lose weight. I did want to lose weight. I just needed help, just like I might need help for cancer or liver disease or inflammatory bowel disease. And that's, I think, tremendously affirming for people living with obesity, sometimes living with some stigma from cards, et cetera.

And I think that's a wonderful aspect of these medicines. Dr. Sacklecom, I want you to pick up on that because I saw you nodding your head there. Just that idea, I think even just the way that you phrased it, treating something like cancer or something, I think, like that, how does something like Ozimbic change the game in that way? Well, I think, as Dr. Drucker talked about, a lot of people living with obesity

face tremendous stigma. And I'm embarrassed to say, as a health care provider, about 50% to 70% of weight bias and stigma that people have experienced has come from healthcare providers. And as a result of that, you know, the advent of GLP-1s and their treatment, as Dr. Drechter alluded to, has opened the dialogue about obesity as a chronic disease, having treatments available that perhaps there is a brain-gut physiological interaction and it's not about me being lazy or lacking will or not being able to make these diet

changes. You start to open this dialogue with people in society. So this has been really paramount to trying to address decades and decades of stigma that people have experienced. And now it also opens the door to think about obesity beyond weight and BMI and body mass index. Because if we think about it as health, we open this whole dialogue about people having biological, genetic, other variables, like every other chronic medical condition.

There are treatments now available. There's hope. And now people are having experiences where their physicians or other healthcare providers are actually now saying, wait, I have a tool now. I can help you. And I understand this is a medical condition and it's not your fault. And so now we can have these corrective experiences in healthcare. I am curious, are people being judged for using a drug like Ozempic? I am curious, are people being judged for using a drug like Ozempic? You know, say, taking the easy way out or something like that. So I work in a center that has medical and surgical treatment for obesity.

It's the same thing when we had people going through surgical treatments for obesity. Same thing with GLP ones that I see in my practice where, you know, certain family members are open to dialogue and see and have an understanding, but others are, well, this is the same stigma that they had before that you should just be eating better and exercising more, which we know is not the treatment for obesity. All these treatments in toolbox help us to eat better and to exercise more, which we all should do in society. But what ends up happening is really that people start,

there's a faction of people who actually still blame people and say you're taking the easy way out, you should be able to do this on your own. We need to correct those experiences and that dialogue. All right, Nishal, you get the last word here. If more and more people take drugs for weight loss in the future, look through that magical ball into the future, can you imagine a world without obesity?

That's a really interesting question. I would say no. I think because it is such a complex disease, there are multiple reasons, and we've talked about those here today, that will impact whether or not somebody is obese. The other thing I will say is the individualized response that happens with these GLP-1 drugs, it is very individualized. I have had clients who have only lost 10 pounds. Yes, there are clients who may lose more than that,

but it doesn't necessarily work the same way for each person individually. So a world without obesity, I'm not sure if we will necessarily ever see that. I also think it's very important to note that the shape and size of people's bodies where they carry weight, muscle muscle and fat is very genetic. So even if we change you know the body weight on their body we also have to look at you know shape size and

then we get into you know skin color and all of those different things that make people individuals I don't want a world where everybody looks the same and we want to make sure that we're respecting the biological and genetic differences between us and not just hoping that everybody is of equal size. All right, well we're going to leave it there. Nishta, Dr. Sakalingam, Dr. Drucker, thank you so much for joining us. I really appreciate it, great insights.

Thank you. Thank you.