Health Wanted: Weight Loss

The Episode

The topic: Weight loss! It’s one of the most common resolutions to make, which means it’s also one of the most common resolutions to break. But a new class of drug is making a significant impact on a traditionally challenging journey. This week on Health Wanted, host Laurel Bristow and guest Meghana Anugu, MD, talk about GLP-1 agonists, their role in weight management, and their social implications.

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The takeaway:

• Only about 20% of adults who manage to lose a significant amount of weight are able to keep it off long term. Despite these challenges, 45 million Americans go on a diet every year, fueled by the widespread belief that being thin is equivalent to being healthy.
• In recent years, GLP-1 agonists have exploded onto the market. Initially developed to help manage type 2 diabetes, GLP-1 agonists are a class of drugs that mimic the hormone our intestines produce to stimulate insulin release and suppresses glucagon production, two things that the body needs to reduce your blood sugar.
• GLP-1 agonists interact with signals in the brain that control appetite and hormones in the gut that influence the rate of digestion. This makes the feeling of being feel full last longer, which can decrease food consumption and quiet cravings, eventually leading to weight loss. In clinical trials, people who took semaglutide lost an average of 15% of their body weight after 16 months of weekly injections.
• These drugs have some negative side effects to watch out for. Nausea, diarrhea, and constipation are all fairly common when starting these medications. Some people also experience pancreatitis and gastroparesis, which is when the stomach is paralyzed and cannot move its contents to the intestines. Each person needs to weigh their individual risk vs. benefit when considering taking these drugs.

The Interview

The guest: Meghana Anugu, MD

The key takeaways:

• Unhealthy weight gain is a medically complicated issue that involves hormones, neurotransmitters, genetics, and environmental factors. When individuals have obesity, there is often dysregulation in the hormone pathways that tell your brain you’re full, as well as the processes that regulate the feelings of pleasure you get from eating. There is also a concept of having a “set point,” where your body and its systems of regulation may get used to operating at a certain weight, which then makes it harder to lose weight and keep it off.
• Body mass index, or BMI, is not a perfect tool for classifying someone’s health, as a person can be categorized as “overweight” or “obese” by the BMI scale and still have good cardiometabolic fitness. Things like body composition and abdominal circumference, along with other health indicators, used in conjunction with BMI can give primary care doctors a more accurate picture of overall health.
• Average BMI has gone down for the first time in years, and there could be a variety of factors at play. Better weight management medication, like GLP-1 agonists, are part of the story. Medical providers may also feel that they now have more tools and actionable resources to give patients to manage their weight, as well as more knowledge about the science of weight management.
• Online compounding pharmacies have made GLP-1 agonists accessible to the masses, but they also lack regulation. If you are using medication to manage weight loss, you should work with a medical provider to ensure that you are getting the correct medication tailored to your needs, still getting enough nutrition, and managing any side effects.

The Listener Questions

Does exposure to fluoride lower kids’ IQ?

A study was just released that examined whether there is a link between fluoride exposure and IQ in kids. It was a meta-analysis of studies (none of which were conducted in the U.S.), and it found potential evidence that when kids are exposed to certain levels of fluoride, their IQs decrease slightly.

It’s important to note that the levels of fluoride the studies looked at are higher than the recommended limit for fluoridating water in the U.S. The study also was not looking at the fluoridation of water or its impact on public health, it was looking at fluoride exposure through any source.

There are a lot of limitations to this meta-analysis: 70% of the studies included were rated as having a high risk of bias, and when they just analyzed the 12 studies with low risk of bias, the effect of fluoridation on IQ was negligible. Also, most of the included studies were in China and India, which have different levels of environmental exposure to fluoride through things like pollution and tea consumption (because tea plants can have high levels of fluoride from the soil).

There is no meaningful evidence that water fluoridization in the United States leads to cognitive development issues.

What are the latest updates on bird flu?

In recent weeks, there have been many new H5N1 bird flu developments.

First, California declared a state of emergency for bird flu. California has the most infected dairy herds and the most human cases, largely from exposure to those herds or poultry farms. Declaring a state of emergency means that the state will have more flexibility to allocate resources to addressing the issue. It does not mean that the threat to the general public has changed—that is still very low.

We also had our first severe case of bird flu in a person in the U.S. in Louisiana. Unfortunately, it was reported on January 6 that this person has died, making it the first bird flu death reported in North America. This person was exposed from their backyard chicken flock, which had been infected by wild birds.

One concern is that both this person in Louisiana and the teen in British Columbia who was critically ill were found to have mutations in their virus that could improve the virus’s ability to bind to cells in the upper respiratory tract of humans. This could make it easier for people to get infected. For person-to-person transmission to happen, the virus would also need to develop a mutation that allows it to replicate in the upper respiratory tract, but increasing its affinity for human hosts in any way is not great.

The best thing to focus on right now is prevention. The fewer cases in humans, the less opportunity the virus has to mutate. It’s not too late to get your flu vaccine, and handwashing and masking are great habits to practice. It’s also best to avoid eating raw poultry and drinking unpasteurized milk.

Catch all the listener questions and Laurel’s answers on the full episode of Health Wanted by:

• Streaming at wabe.org or the WABE app
• Subscribing on Apple or Spotify
• Watching on WABE's YouTube channel