Defining Obesity

Name: Ozempic & Mounjaro | Everything you need to know! | Dr Amrish Mithal & Dr Juhi Agarwal
Uploaded: 2026-04-05T00:19:37.318774+00:00
Duration: 1 h 36 min 20 s
Channel: Soha Ali Khan
Description: Summary and key takeaways on Defining Obesity, covering Obesity is now classified as a disease of the brain rather than a purely cosmetic issue. Excess
Soha Ali Khan
Apr 05, 2026
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96 min video
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2 min read
YouTube video ID: IZVWjh45bw8
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Obesity is now classified as a disease of the brain rather than a purely cosmetic issue. Excess adiposity signals a higher risk for diabetes, hypertension, heart disease, and fatty liver. In India, the “Toffee” syndrome—thin appearance on the outside but fat accumulation around internal organs—illustrates how visceral fat poses the greatest health danger. Losing just 10 % of body weight delivers meaningful health benefits even if the result does not meet aesthetic perfection.
GLP‑1 Drugs: Science and Mechanism

GLP‑1 hormones, naturally released by the gut, stimulate insulin, slow gastric emptying, and tell the brain to increase satiety. By silencing the “food noise” that drives cravings, GLP‑1 receptor agonists such as Semaglutide (Ozempic) and Tirzepatide (Mounjaro) treat obesity as a brain‑based condition. Semaglutide consistently breaks the 15 % weight‑loss barrier, while Tirzepatide, which also activates the GIP pathway, often yields slightly higher reductions. These drugs act as “bridges” that work best when paired with lifestyle changes.
Clinical Application and Safety

The right candidates typically have a BMI between 30 and 40 and may carry comorbidities like diabetes or hypertension. Treatment must be overseen by an endocrinologist or internal‑medicine specialist; self‑prescribing is a major danger. Common side effects include nausea, reflux, and constipation, which can often be mitigated with nutritional adjustments. Rare but serious concerns involve non‑arteritic ischemic optic neuropathy and severe gastrointestinal distress. Contraindications cover a history of thyroid cancer, pancreatitis, and active eating disorders.
Nutrition and Lifestyle

“Eat right, not eat less.” Rapid weight loss can erode muscle, so a protein intake of 1–1.5 g per kilogram of body weight and regular strength training are essential. Patients should view treatment in years, not weeks, using the medication to suppress cravings while they build sustainable habits. When weight loss stabilizes after about 12 months, muscle mass typically stabilizes or improves if nutrition and activity are adequate. The ultimate goal is health gain, not merely a lower number on the scale.
Future Outlook

Oral GLP‑1 formulations and triple‑receptor agonists such as Retatrutide are on the horizon, promising more personalized obesity therapy. The emerging focus is on nuanced, individualized treatment plans that combine pharmacology with lasting lifestyle modification. Medication remains a tool, not a replacement, for prevention and long‑term health maintenance.
Takeaways

Obesity is now classified as a disease of the brain, with excess fat acting as a warning sign for diabetes, hypertension, heart disease, and fatty liver.
GLP‑1 drugs such as Semaglutide (Ozempic) and Tirzepatide (Mounjaro) lower appetite by acting on brain pathways that silence “food noise,” achieving around a 15 % weight‑loss threshold that improves metabolic health.
These medications are intended as tools or “bridges” and must be prescribed by an endocrinologist or internal‑medicine specialist to avoid misuse, especially in people with thyroid cancer history, pancreatitis, or eating disorders.
Sustainable results require high protein intake (1–1.5 g per kg body weight) and strength training to preserve muscle while the drug suppresses cravings, emphasizing long‑term habit formation over rapid weight loss.
Emerging oral GLP‑1 formulations and triple‑receptor agonists like Retatrutide promise personalized obesity treatment, but the core principle remains that medication complements, not replaces, lifestyle change.
Frequently Asked Questions

How do GLP‑1 drugs reduce appetite and promote weight loss?

GLP‑1 hormones, naturally secreted by the gut, stimulate insulin, slow gastric emptying, and signal the brain to increase satiety, thereby silencing “food noise” and lowering cravings. The resulting reduced appetite allows patients to achieve roughly a 15 % body‑weight loss, which improves insulin resistance and lowers cardiovascular risk.
What are the main safety concerns when using Ozempic or Mounjaro without medical supervision?

Unsupervised use can lead to severe side effects such as persistent nausea, reflux, constipation, and rare complications like non‑arteritic ischemic optic neuropathy or gastrointestinal distress, especially in individuals with a history of thyroid cancer, pancreatitis, or eating disorders. Proper medical oversight ensures dosing, monitoring, and management of these risks.
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Helpful resources related to this video

If you want to practice or explore the concepts discussed in the video, these commonly used tools may help.
Digital Body Weight Scale With Body Fat Recommended
Measures body composition beyond just weight, helping track visceral fat and muscle mass changes.
Amazon →
Adjustable Dumbbells For Home Strength Training
Essential for strength training to prevent muscle loss during rapid weight reduction.
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High Protein Cookbook For Weight Loss
Provides recipes to meet the 1-1.5g/kg protein requirement needed to preserve muscle.
Amazon →
Food Scale For Accurate Portion Control
Helps track nutritional intake to ensure the user is eating right rather than just eating less.
Amazon →
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Full Transcript YouTube

In 1997,
WH classified obesity as a disease.
[music]
>> Is obesity on the rise in India? Of
course. And even childhood obesity right
now. That's the scary part.
>> Obesity is a disease of the brain.
>> Right.
>> And their mouth gets zipped. Then they
dramatically lose weight.
>> 70% of my clients are mostly women
[music] and 30% men.
>> And I wanted to ask you as a
nutritionist, can you prescribe these
drugs? I am a doctor so I could but as a
nutritionist you cannot.
>> On the pen for Munjaro there's a red box
there which says to be prescribed taken
under supervision of an endocrinologist
or an internal medicine specialist.
>> Society does judge a lot more in India
as compared to the western world.
>> This is the danger of the popularity of
these drugs. The downside is the misuse.
[music]
>> These drugs are a bridge. There are some
people who can lose weight with
lifestyle changes and there's some
people who need surgery. Selena
Williams, the fittest person in the
world, just couldn't lose weight.
>> What are the benefits from taking these
drugs?
>> Every time you're losing weight, you're
losing some muscle.
>> If you're on a crash diet during which
you lose a lot of muscle, you're not
going to be able to keep that weight
off.
>> Semaglutide, which we commonly know as
omp is the first one that broke the 15%
barrier.
>> I did read somewhere [music] about
blindness.
>> That can cause vision loss. The drugs
will work only as long as you take them.
The world is divided into deciding
whether it's a hero or a villain. Nobody
understands that it's neither. It's just
a tool.
After COVID 19, I think that one of the
most talked about medical terms today is
probably OMIC and Monaro. They have
become household names. so common that I
think almost everyone feels like they
know exactly what they are or at least
they think that they do and that is
where the danger lies because most
people don't really understand what
these drugs are doing to the body who
should be taking them what the side
effects are and how or even they should
be used safely and appropriately.
Nearly one in eight adults, which is
about 12% in America, report that
they've tried a GLP-1 drug such as Ompic
or Marjaro for weight loss. And that
trend is continuing into 2026. In India,
sales of Mjaro alone jumped from 13
crores in March to around 50 crores in
just 3 months, which is showing a very
strong early demand. So what started as
medication for diabetes has entered the
weight loss conversation often without
context without guidance or
understanding. And that's where things
are getting tricky because weight loss
is never just or shouldn't be just about
numbers on a scale especially for women.
It's about our hormones about our health
sustainability and a long-term impact.
So today we're asking the questions that
everyone is thinking but that very few
are answering properly. Initially, we
really hoped to have a phenomenal woman
speak with us, someone who's personally
used ompicaro for weight loss, someone
who would share her lived experience.
But the truth is that while many people
are using these drugs, very few women
are willing to share or talk about it
openly and that's exactly why we wanted
to have this conversation today. Hello
and welcome to All About Her, a space
where we have honest and meaningful
conversations about women's health,
wellness, happiness, and self-care. And
today we're discussing a favorite topic,
OMPIC and MARO. So we have two
incredible guests joining us today. He
is one of India's most respected voices
in endocrinology, obesity and diabetes
care. As the chairman and head of
endocrinology at Max Healthcare, his
work has shaped how obesity and
metabolic health are understood and how
they're treated in India. He has been
recognized with India's highest medical
honors including the Padmabushian and
Dr. BC Roy Awards. We're honored to be
joined today by Dr. Amish Mittal. Thank
you so much.
>> Happy to be here.
>> And we also have someone who works very
closely with individuals navigating
weight loss, navigating nutrition, and
long-term lifestyle changes. She helps
people build sustainable habits. I think
more than just quick fixes. As a
nutritionist, she sees firsthand how
medication and medications intersect
with real lives, who benefits from them
and who doesn't, and why food and
behavior still remain so central to our
health. I think her perspective bridges
science with everyday reality,
especially for women dealing with
weight, with hormones, and with body
image. Joining us is Dr. Juval. Thank
you both for being here today. I'm so
excited to have this conversation
because whenever I go out and I meet
people you notice in India especially we
notice people's appearances all the time
and normally you say oh you've lost
weight you put on weight and we've
noticed that a lot of people in the last
couple of years have lost a lot of
weight and not everybody is telling us
how and normally in this seat we have
somebody not two experts like we have
today but we have someone who's had a
personal journey with the issue that
we're dealing with. It was hard to fill
the chair with a woman who wanted to
talk perhaps about losing weight through
ompic and mangaro and I understand why.
Um but I do know that both of you treat
a lot of people and this is a medication
a drug that has become a household name
and the danger of that I think something
that is medical becoming a household
name is that everybody has an opinion on
it but some of times those opinions are
not backed by real knowledge and the
idea today is to maybe have a sensible
conversation about what these things are
what they do to our bodies who are the
right candidates for them and whether
they're safe or not. These are some of
the questions that I wanted to ask the
both of you. Um, and I thought that I
would ask because Dr. Mittal, you've
written this lovely book which is called
the weight loss revolution and I've read
it. It's also easy to read because as I
said, it's not a it's not a very big
book.
>> Not a to
>> it's a it's not a tome. Um, but it it
does highlight a lot of the things but
some people may not have read it. So for
their benefit, I wanted to start by
asking obesity.
What exactly is obesity? It's become a
rising concern in India. Of course there
was a time when being overweight was
considered to be a sign of social status
and health and you know we look at
paintings from the middle ages and um
you know a lot of the people are quite
fullfigured and this was something that
people aspired to be at some point it
became something that firstly of course
was not attractive and then I don't even
know if people are thinking about the
fact that the health issues that are
linked to obesity. So can you enlighten
us a little bit about exactly what is
obesity and why some people become obese
even though they may be leading
lifestyles that are similar to people
who are not.
>> So I think uh that's a very good start.
So we need to understand why obesity was
regarded as healthy in the earlier ages.
And the reason was that when there is
shortage of food, when there is
deprivation,
when people are undernourished and dying
of under nutrition,
>> then anyone who's you know overweight or
or or has to be affluent. Yes.
>> You know that category. So it was some
some something that people aspired for.
>> But then obviously people realized that
it doesn't lead anywhere. And then the
concepts of beauty changed and
development happened especially in the
western world. That's how it changed. At
the moment obesity is defined as excess
adiposity
to put it simply excess fat.
>> Right?
>> So excess fat in the body
is called you may call it overweight or
obesity. The problem is that the excess
fat in the body that we look at
cosmetically
actually is the harbinger of a disease
process.
>> And this is not new.
>> So in 1997,
>> who classified obesity as a disease
1997.
So what's happened? I mean, you know, as
exactly as you're saying, everyone's
talking about it. The thing is that we
didn't have the tools to handle it. M
>> we had nothing to offer other than diet
and lifestyle which is the still remains
the keystone of treatment but we didn't
have anything other than that. So we
have to think of obesity as excess fat.
Excess fat that leads to what?
>> Type 2 diabetes.
>> Direct correlation.
>> If you were had a magic wand and you
sort of waved it and you just abolished
obesity, eradicated obesity, then
diabetes would also disappear.
hypertension,
heart disease,
fatty liver, you we all talk about fatty
liver,
>> some kinds of cholesterol problems.
>> Yes.
>> Even some brain issues.
>> Yes.
>> Uh even some cancers.
>> So, obesity for modern non-communicable
disease,
obesity is the starting point. It's the
mother of all NCDs as we say.
>> So, that's why it is very important.
That's interesting because you know
again in your book you talked about the
fact that way back there was knowledge
about the fact even though we didn't
have the ability to test in the way that
we do today there was a knowledge that
things like infertility uh things like
sudden premature death
>> were linked um to being overweight.
>> I wanted to ask you because as a
nutritionist of course you come across
so many people
>> is obesity on the rise in India
>> of course and even childhood obesity
right now I think u that's the scary
part. Yeah,
>> but it it is of course on the rise right
now. And actually what we're seeing at
the clinic is people who have there's
like this u let's say thin fat obese
obesity coming in where women and men
are thin but internally they're fat.
That means their visceral fat levels are
higher and their body fat percentage is
higher.
>> But you have to explain what visceral
fat is.
>> So visceral fat is around all your
organs like around your liver. Fatty
liver would be counted as like the fat
around the li liver which is the
visceral fat. visceral organs are all
the organs in the abdomen.
>> So the fat that is deposited there is
actually one of the main culprits of all
of these diseases that Dr. Mittal has
just mentioned. And this comes from
years I mean I would say like decades of
people trying to lose weight.
>> Yes.
>> So we have a lot of women and men
between 35 and 60 coming to us eating a
lot lesser than they should.
>> So they're not eating their meals
nutritiously at all
>> with the goal of losing weight. And what
that actually does is if you're not
balancing your nutrition, you're losing
muscle mass.
>> So you're in this constant cycle of
eating less, eating less protein, losing
muscle, losing weight, but then when you
go back to your normal eating habits,
you're gaining fat because your
nutrition has never been balanced.
>> So you may be the same weight as you
were 10 years ago, but the body
composition has changed. That means your
body fat percentage has gone up by about
5 to 10%.
>> Right?
>> And that is the real problem I feel
right now. Right. Do you feel Dr. Mitt
that people are understanding now that
obesity is a health concern or is the
focus still that I don't look good and
it's a cosmetic issue?
>> So the truth is that it's largely the
latter because people who approach us
for weight loss and she would testify to
that. For her it'll probably be 100%.
For me also it's it's pretty high. the
proportion of people are only looking at
cosmetics.
>> Yeah.
>> So the thing is that there is a fine
balance here. So let me tell you who
caught it disease so many years ago
>> almost 30 years ago. The issue is that
you don't want people to feel diseased.
>> Yes.
>> So I am a bit concerned about using
obesity as a disease kind of thing. I
see these advertisements. I mean you
know you can't like half of India is
diseased. You know the people already
struggling with so many things in their
mind. you tell them you've got another
disease
>> because your BMI is a little high. So I
think but it is very important for
people to understand that it's a health
condition
>> right
>> and when many times when we are talking
of obesity and weight reduction we're
looking at something else
>> and the patient is looking at something
else
>> so we do try to convince but it doesn't
matter so long as they're listening to
us it's all right so long as they're on
the path to weight reduction it's all
right so I think we really have to
understand obesity as or even overweight
as a force runner of so many disorders
rather than pure cosmetics and this is
important important because not just a
perception but when you're trying to
lose weight also sometimes people want
perfection
>> yes
>> physical perfection visual perfection
>> right
>> whereas for us if someone loses 10% body
weight they've gained a huge health
benefit so we are very happy this guy
was 100 kilograms and and and now he's
like 87 great
I want to be you know 70 and it doesn't
work like that.
>> Yes.
>> So that is why the concept is important
and I'm very glad you brought up the
point of two important points which I
will reiterate that it is the toffee
syndrome thin outside fat inside
Indians.
>> It's called the toffee syndrome.
>> So which means that we look like uh we
body weight if you go strictly by BMI is
okay but there's fat
>> the all fat is not the same. there is
bad fat inside her abdomen as already or
around her organs. Yeah,
>> that is one. The other is which is a big
concern and we'll come to that with this
medications also or the newer
medications is exactly what she said. If
you lose weight and give up the
medication, comes back, lose weight
again, every time you're losing weight,
you're losing some muscle,
>> right?
>> And every time you're putting it back
on, you're putting on predominantly fat,
>> right?
>> So few cycles of that and you know, it's
>> No, it's true. And of course, because of
the the drugs that we're going to talk
about now, what happens is that you lose
weight and people have lost weight in
the past and these issues have arisen in
terms of your body composition changing.
So I will come to that. I wanted to ask
uh you know when you said obesity and
the fact that most people see it as
cosmetic. I wanted to ask you Ji people
come to you do more women come to you to
lose weight. Do men come to you?
>> Uh women for sure women for sure.
>> My my question being that appearances
seem to be things that women
>> are more preoccupied with. Um and I
don't know I mean you can correct me if
this is uh true or not. And that's why
earlier when we were discussing also a
lot of men seem to be more comfortable
um discussing what they're doing to lose
weight. Women perhaps a little more
guarded about these things for various
reasons.
>> But um is it so most of your clients
tend to be women?
>> I would say there would be a 7030%
split. So I think 70% of our uh 70% of
my clients are mostly women and 30% men.
Women also um I do believe yes society
puts a lot of pressure on them
>> and um they don't realize that you know
we we're going through different phases
right women
>> have like they go through puberty there
is pregnancy marriage there's pregnancy
post pregnancy per menopause menopause
and there's such a complex interplay of
hormones
>> um and these hormones change on a
monthly basis I mean daily basis but
yeah there's like a cycle every month
>> so it changes how your body is
metabolizing the food that you eat
>> just to relate it back to weight and
relate it back to nutrition.
>> So it is a lot more complex for women
and um that's why we I think we see also
that 70% of the people who come to us
are women for two reasons. One is
because of the societal standards and
one the second is because of the complex
hormonal changes that make it difficult
for them to lose weight
>> right
>> or like make them gain weight very
quickly
>> right and I want to come to all of that
a little later in the discussion in
terms of all those stages
>> predominantly because it's called all
about her in a woman's life and how much
of that can be addressed through
medication and how much can be addressed
through lifestyle uh to perhaps take it
to the beginning ompic mjaro the GLP-1
drugs why when were they created did I
just want to ask also the difference
between them for some people who may not
know.
>> So uh these are GLP1 drugs. GLP1 is a
natural body hormone. It's
>> it's secreted in our body from our gut
and it's uh it goes to the pancreas to
stimulate insulin secretion. So when we
eat food we need to metabolize it. So it
goes to the pancreas to stimulate
insulin secretion. It also goes to the
stomach the intestine itself and the
receptors for that and the stomach
movement slows down slows down gastric
empty. But a third point in that is that
it also goes to the brain.
>> Yeah.
>> And there it impacts our appetite and
satiation. So so appetite and satiety
both are impacted by this. So so this is
a natural body. So why can't we just use
this hormone? Because if you give this
hormone to anybody, it'll break down.
Even if you give it by by injection, it
takes 2 three minutes to break down.
>> So for 20 years, we've been using
products derived or developed from this
hormone to treat diabetes,
>> right?
>> Because it stimulates insulin secretion
and even slowing of stomach emptying
also helps sugar levels. But we always
noticed that there is a reduction in
appetite also and people are losing some
weight. So 3 kilograms, 4 kg, 5. We
published work on that. It's a well
established
global fact. So scientists were really
intrigued and that's when the brain
action was better understood as work you
know kept going on in this direction.
Amazing science which is why I get
excited about the science part of it.
and the gradually developed molecules
that will have a predominant action.
they'll continue to have the the glucose
action and the other actions but which
will have you enhance the brain action
>> right
>> and that is the GLP-1 like drugs
>> right
>> which predominant brain a well not
predominant that's wrong with a stronger
brain action
>> right
>> and that is the change that has happened
so the drugs have been there the
predecessors have been there
>> right
>> but
semaglutide
which we commonly know as ompic is the
first one that broke the 15% barrier.
>> So 15%
>> 15% like holy grail you know you
actually you cross that because no tool
had been able to do it. Yes. Of weight
loss if you're starting baseline weight.
>> Yes.
>> Right. So that became big news all over
the world and also for us for
endocrinologists for nutritionists is
big news because you have suddenly got
something that is able to do that and
15% 18% 14% but you know in that zone.
So that became very exciting. So that
shifted the focus a little bit because
when for us once you once you're losing
that much weight you're getting more
benefit in your diabetes. You're
reducing your heart risk by 25%. You're
reducing your kidney disease
progression. You're squeezing out the
fat from the liver. You know the fatty
liver is just melting away. So very
exciting
>> but it caught the public eye because of
the uh degree of weight loss and people
suddenly thought you could do that. And
then that is GLP1 that is semiglutide
also known as ompic.
>> Before you come to maro I just wanted to
ask you the predominant um effect that
it's having is it more that it is
slowing down the emptying of the stomach
or is it more on the brain or do we
know?
>> So when we talk of weight reduction as
an effect that is primarily to the brain
>> right
>> and you have said also in your book that
weight and weight loss have a lot to do
with the brain. Yes, absolutely. Because
obesity is a disease of the brain,
right?
>> I'm sticking my neck out, but that's how
it is,
>> right?
>> Because some people's brains are wired
in a way there are neuroendocrine, neuro
hormonal changes that they have such
intense cravings
that genuinely despite genuinely trying
they cannot they cannot uh control them
and there are people like that we meet
every day. Yeah.
>> So that is not
>> for lack of better world it's not their
fault.
>> Well in some sense it isn't but you need
discipline of course but you can't take
that away. But despite that some people
can't do it. It's a challenge.
>> We call it food noise sometimes
>> because you know the people who when
they land in a city the first thing
they'll be finding out is which are the
good places to eat and where should we
have and the other guy who's traveling
with them is probably saying huh we'll
manage something we'll do something. So
these drugs act at that level that is
the action of GLP1
>> right
>> semiglutide
>> right and mjaro is different
>> so mjaro is
>> apart from a little costlier [laughter]
>> and you you can lose a little bit more
weight is my understanding
>> so mjaro by its actions has of course
GLP one is the central pathway there's
also another hormone called gip
>> right these are incritin hormones so it
acts through both so it's for us again
it's very it's quite remarkable that you
have single molecule that acts through
two pathways. I mean that's
>> right
>> science wise against the hope is for it
to act more pathways
>> now we already have those molecules you
know studied and all but munjaro is the
one so you get greater weight loss with
maro
>> a little bit more
>> so ific was 15%
>> 20%
moic 15% m
broad figure the important point is it
does not always translate into greater
health benefits
>> right
>> there multiple factors that determine
that the anti-inflammatory action of the
molecule so many things. So it may or
may not be we don't know yet but for the
public for weight reduction per se
Mojaro is a tad superior to someone.
>> When did these words enter your
universe?
>> I would say just at the tail end of co
so around 2022 cuz we have a lot of
clients overseas as well. So I think in
India it wasn't licensed or it wasn't in
the guidelines um as the plan of action
for weight loss.
>> This is sorry to interrupt you but it
was basically it America and Denmark
came up with these drugs.
>> Yes.
>> But these two
>> these so America uh the U clients in the
US Dubai a little like basically not
India yet. That's when we started
hearing of it and people asking us
questions about should I go on it?
Should I not go on it? my doctors told
me to go on it. What are going to be the
side effects etc. And um I think in
India it was a year and a half.
>> No actually not even a year.
>> Not even a year.
>> Yeah.
>> It's been since it's come to the
guidelines right to for weight loss.
Earlier it was just for type 2 diabetes,
>> right?
>> Uh but yeah. So
>> how I mean maybe if you can give us a a
best case scenario of one of your um one
of the people one of your patients uh in
terms of how much weight that they've
lost and how long it took them to lose
this weight.
>> So uh I don't know if it's the best case
scenario or not but people who lost a
lot of weight there are some people
who've lost amazing amounts of weight.
>> Yeah.
>> I think those who were quite careless
>> Yeah.
>> and they've tried a few times and given
up and now they're just all over the
place.
>> Yeah. when they start this and their
mouth gets zipped.
>> Yeah.
>> Then they dramatically lose weight.
>> Right.
>> And that's the that's a bit of an issue
because such people shouldn't feel and
they do sometimes feel that now we on
the medication. I don't want to do diet
and exercise that I've been doing all my
life. It never worked.
>> Yeah.
>> So why should I do it now?
>> Right.
>> They come and tell me that why should I
do it now? Right?
>> Then it requires explanation and the
reasons why diet and lifestyle will
always diet and exercise sleep will
always remain these drugs will also work
much better.
>> Yes. So uh I have had patients for
example let's take a diabetic patient
who if I'm not wrong lost about 30
kilograms
>> over
>> over about
about a year
and all his anti-diabetic drugs were
stopped
>> insulin everything he was only on one of
these drugs just just this
>> right
>> and and he was like
really excited and you know because
everything is gone he's He's never seen
an HBA1C which is a measure of 3 months
diabetes control at below 8 and now it's
6.1 5.9
>> right
>> so that is one good example uh I think
the the issue with him was also I'll
point out something so he was very happy
but also concerned about it of course he
had some nausea and we'll talk about the
side effects
>> but he said that the biggest the
funniest part he said and the strange
and bothering me also that I used to
love my my halwa and my and my kachori
and my puris and all that and jellybe I
used to dream about that
>> and made him happy
>> and that is what I was looking forward
to in my day
>> you know and suddenly I can't see them
>> it's very strange I can't understand
what's happened to me I just can't stand
the sight of those things
>> and that made and that upset him
>> initially but then he realized the
results so you know but yes he was very
concerned that something's gone wrong
with Yeah, but it's true. And I have to
ask you this again because food is your
world and nutrition is your world. And
for a lot of people, food is not
nutrition. It's not I mean it's not just
calories and it's not just nutrients,
but it means so much more. It's a
blanket. You know, somebody who come on
to this show also said that the first
thing we have is our mother's milk.
>> And so there's love, there's emotions.
Now it may be good, it may be bad. You
know, the idea is not to attach some
kind of value to it, but it is that way
for so many people. So when people come
to you also and these are things that
again I wanted to ask you as a
nutritionist can you prescribe these
drugs?
>> No. So I am a doctor so I could
>> right
>> but as a nutritionist you cannot.
>> So not every nutritionist has a doctor's
degree.
>> Yes. Yes.
>> And it is
>> she's an MBS doctor.
>> Uh but not every nutritionist is
>> so nutritionists are not uh allowed to
prescribe these because these are
medical drugs. So these have to be uh
you have to go through a your your
endocrinologist
and I would actually say a specialized
endocrinologist not like an MBBS doctor
because I feel like an endocrinologist
has spent not only five and a half years
in MBBS after that studied a
post-graduation of three years an MD and
then studied a three more year super
specialization of DM. So I feel like
they are so much better and well
equipped to be able to advise exactly
what the dose should be when you should
start look through your family history
look through if it is contraindicated
for you um check your reports understand
whether the side effects would work for
you or not and counsel you
>> right
>> so I feel like your expert to prescribe
these drugs should
120% be first with an endocrinologist
>> I feel like that's not always happening
>> no It's not and that's one of our sort
of concerns
>> and I agree with her 100%.
>> And even if it's not an endocrinologist
uh at least a senior internal internal
medicine person I mean actually if you
look at the label on the pen for Munjaro
tipide
>> there's a red box there which says to be
prescribed taken under supervision of an
endocrinologist or an internal medicine
specialist. So
>> quite clearly there is a logic in saying
that
>> right? So the reason is that uh you
understand obesity better, you
understand the nuances better, you
understand the side effects better,
you're not looking it at it as a
cosmetic thing. So I think this is the
danger of the popularity of these drugs.
The downside is the misuse,
>> right?
>> Which is bound to happen
>> and and people are taking it by
themselves.
>> I have many patients who first started
and then they trouble you know I'm
throwing up. I don't know what I've done
but I started. Why did you start? I see
I'm a regular patient. You didn't come
for you and started this. Well, my
friend came back from US and he said you
started.
>> So they do those kind of things. So
>> it's not recommended. We should strongly
through your program discourage people
from self-prescribing. Absolutely not.
>> At least one opinion
>> yes
>> from a qualified indiction will go a
long way in keeping you safe.
>> I feel like there's two sides to uh
this. There are some people who are
perhaps not seeking the required advice
and selfdosing. And then there are some
people who perhaps might require this
drug who out of fear um and that might
be just social media has created quite a
lot of panic and anxiety and
misinformation, word of mouth and
they're perhaps not exploring a very
valid route to losing weight. Um you you
know before we started rolling you were
saying you spend half your day
convincing people who need the drug to
take it and then half the rest of your
day convincing people who do not need it
not to take it.
>> Absolutely. So I think the the second
half the people who don't require it is
obvious. I mean there are people who
want it for cosmetic reasons want to
lose a couple of kilograms before their
daughter's wedding or want their
daughter to lose that much before her
wedding. All those things and that of
course you have to turn away at least
endocrin knowledge will turn you away
isn't sorry I mean I can't do it. It's
not.
>> But the other one is very bothersome
because there are people who are ideal
candidates for this
>> whose health will dramatically improve.
>> Yes.
>> And they are so scared by all the
nonsense that misinformation that's
going on in the media
>> because there's no perspective to it,
you know. It's like saying you can't
travel in India on roads because they
are so bad. It's something like that,
you know. So the thing is that the
perspective uh is not there but some
little anecdote or some little warning
is taken up and blown out of proportion.
So there is if not a day goes when there
is someone who is an ideal candidate
textbook candidate for the drug say
>> and I said you're already taking it I
mean you're only taking previous
versions of that
>> right
>> we have now a better version why don't
you say
>> because weight loss side effect
>> right
>> I think the world is divided into
deciding whether it's a hero or a
villain nobody understands that it's
neither It's just a tool and you need to
use that tool in the right manner. You
need to use it for the right people in
the right way at the right dose and
that's what people don't understand. I
feel
>> I think because it's entered with such
an explosion and because again it is
something related to losing a massive
amount of weight and that is something
that immediately attracts a lot of
attention but uh I just wanted to ask
you Dr. because there were two things uh
side effects that you touched on which
make people weary and um also the
benefits that are so important. Um so I
can ask the both of you in terms of
firstly the benefits.
Why is it that some people who struggle
to lose weight and I think you've
already touched on that um find a lack
of success but then with these drugs
they find success and that is of course
connected to the signal that goes to the
brain.
>> Absolutely.
>> Um which reduces your cravings. What are
the benefits that one sees
from taking these drugs? Because we are
talking about health and as I said and
then I want to touch a little bit on
with you Ji perhaps in terms of health
aside.
>> People come to you
>> to look and feel good.
>> Um so we can talk a little bit about
that.
>> Yeah, I mean I think the health benefits
of these drugs are quite striking
actually. Uh it's also not clear if all
the health benefits are related just to
fat reduction. they will be having other
benefits, other mechanisms of action.
>> Yes.
>> So let's start with diabetes and I just
give you that patient example. Diabetes
improves dramatically and that's
universal. Almost all patients who are
on the correct doses with correct
monitoring of these drugs that diabetes
improves dramatically.
>> So that's a huge benefit. If you're
struggling with your sugar and
struggling with complications related to
that, you'll you'll get lot of benefit.
>> The second is the heart. The data on on
cardiac protection with simaglutide is
quite strong. 20 25% even more reduction
in cardiac events which is a big thing
which is a big thing.
>> Third is the data on kidney disease
progression. So progression of kidney
disease particularly in diabetics or you
know people who have a propensity to
that kind of thing that is clearly
reduced. So that's another huge thing.
>> Fourth is fatty liver.
>> Yes. The fatty liver is very common now.
Everyone knows about fatty liver. Now we
call it M A S L D. Forget that. But
let's say just fatty liver
>> and this is a lot of lot of people who
look right. It'll only show up on a
blood test.
>> She was talking about fat inside. So
>> So fatty liver. So it's approved for
treatment of fatty liver. Forget
prevention. It's approved for treatment
of fatty liver. So we didn't have any
drugs to treat fatty liver.
>> Right?
>> So this is so that's a huge thing. So
you know I mean there are numerous
advantages and then of course there are
advantages linked to people feeling much
better.
>> Not all feel much better but some feel
dramatically better.
>> Some of that is a maybe just an action
on the brain but by and large it is
because of their body image.
>> Yeah.
>> Once you know so many people who
couldn't walk are walking now.
>> Yeah.
>> So many people who used to shun social
activities are happy going out now.
Yeah.
>> So it's a huge boost for them
>> and there is also there are studies on
Alzheimer's and Parkinson's which are
sort of still underway.
>> So there may be brain actions also which
are so there are lots of benefits of
blood pressure improves.
>> Yes.
>> Lot of lot of benefits of these drugs
the medical benefits.
>> Dr. you referred to women and the
different stages that we go through in
terms of the benefits perhaps at these
stages that women might experience. Um
for example the hormonal changes that
one uh encounters during puberty then
post pregnancy per menopause and
menopause. This is the time when a lot
of women would come to you.
>> Um I'm assuming that the weight gain
that happens at this point does not put
them in a category that qualifies them
for a drug like this to lose weight. But
is there ever a situation where that
arises?
>> Yeah. Okay. So something really
interesting is that the 70% of people
who do come to us for weight loss and
that's a lot of people um we get a
specific blood test done for them. India
we are seven times more likely than the
western population to develop diabetes
type 2 diabetes and our genetics like we
have someone or the other in our family
who does have type 2 diabetes. So
genetically we are more prone to
developing that. Now there is something
that comes before you hit type 2
diabetes or you reach that HBA1C where
you are classified at someone as a
person with diabetes u which is
pre-diabetes between 5.7 to 6.4 4 of
your 3-month blood sugar average. And
there is a stage before that called
insulin resistance,
>> right?
>> And it is that insulin resistance which
is something we get tested or we send
our uh clients to doctor to an
endocrinologist or their doctor to get
tested for
>> to be able to understand whether that
insulin resistance is something that's
interfering with the rest of their
hormones because it does have a huge
role to play in PCOS.
>> Yes. And um because of our genetics we
could be predisposed but eventually it
is our lifestyle which is diet and
exercise that push us over over the edge
to developing it and making weight loss
very difficult or making weight gain
very easy.
>> Right? So it I feel like it is those
subset of people that could benefit from
um starting maybe one of the GLP-1 drugs
but they need to be of course we need to
we refer them out to an endocrinologist
at the end of the day to assess whether
they would be the right candidate or
not.
>> So two pe two women at the same stage in
their life could have different
experiences with gaining weight with
with an inability to lose weight because
of some of these markers in their blood.
>> What I would say is I'll give an analogy
to explain this. So think of like two
identical cars um and both of your two
you're like this person's driving these
two cars and both of them are
accelerating at the same speed but for
one of them the handbrekes are a little
on the like they're pulled up a little
bit. So those are your hormones sort of
hijacking your progress
>> and that is the people who have that
normally are the ones who have insulin
resistance
>> and for them weight loss becomes
difficult. their hormones go out of go
up and down. I'm not getting into the
details
>> and it it is something that pushes them
towards diabetes in the future. So the
correct timely action of recognizing
>> making them aware of it, sending them
out to their endocrinologist to know
that okay this is a condition that you
should treat at this point because 10
years down the line it could develop
into diabetes and that's when you know a
large part of um the damage to your
health is already done. M
>> so we want to reach we want to be able
to educate them at that stage and make
them realize that okay we need to treat
the weight gain or we need to treat
these hormones for you to feel much
better now and prevent diseases from
touching you in the future. So that's in
addition to probably helping people who
come to us with diabetes and obesity we
want to prevent this from for them as
well.
>> And for people who are taking things
like osic and majaro then you've been
able to see a noticeable change in for
example things like PCOS.
>> Yes of course. So we had actually I'll
give you an example. There was I'm not
going to take names but there was um
client this young girl who came to us
and she's dropped about 30 kgs since she
began the medication and this was a
while ago. It's been a year I think and
she's been able to keep it off as well
also
>> after having stopped the
>> the medication after having stopped the
medication and she's her hormones have
dramatically improved in the sense her
menstrual cycle is a lot more regular.
She doesn't need to be on any other
medication for it. So, which is a huge
win again because you're feeling so much
better. I also had someone else I I want
to sort of circle back to what Dr. Mal
said about um you know why someone feels
so much better cuz this was sort of eye
opening for me.
>> Um the she didn't have a lot of weight
to lose has been insulin resistant for a
while has is aware about it. She was
able to drop weight on our program which
is diet and exercise as well. Um, but
there came a time where she's like, "You
know what? I want to try this out. So,
I'm going to speak to my
endocrinologist, get on the right dose."
We said, "All right." She tried it out.
And after about a couple of months,
that's when she's called me up and she
told me, "You don't understand how good
I feel."
>> Yes.
>> She's like, "All that noise, the food
noise has gone. Like, I I am not
constantly thinking about what I'm going
to eat next. I'm not constantly hungry,
irritable. I'm able to manage a healthy
nutritious diet while losing weight and
feeling great.
>> Right. So
>> I have another client who dropped 8 kgs
with it but um the gut issues, gut
inflammation.
>> Yeah. So all of that sort of pushed her
back off to getting off the medication.
>> Yeah. So there are some people who've
been especially with gut sensitivities.
I will ask you because you know you said
there are people who
>> may not be the right criteria for this
drug and there are some who are.
>> So if somebody comes to you who is
overweight,
>> yes,
>> how do you differentiate between two
overweight people? One person is
>> right for this drug and one person is
not.
>> So can I add one point to what she said
because it's it's really important. uh
people don't understand that uh younger
people in their you know 20s and all
with PCO who are struggling for
fertility struggling with all the stuff
she said you just can't sometimes get
the weight off I mean they they're
getting depressed their social life is
gone their family life is gone they're
not able to find suitable partners so to
speak I mean all those things are
happening
>> and use of these drugs has opened up new
avenues for them so that is quite
dramatic I completely agree with you but
there is a caveat there. The caveat is
in these patients, we don't have the
correct answer as to how long to go and
when to stop and what to do because the
drugs can't be taken during pregnancy.
Like for us, people come to us a lot for
you know infertility and all those. So
you give the drug and they're fantastic
and they've lost weight, periods have
become regular.
>> Now
you have to stop the drug when they're
planning pregnancy.
>> So then the weight starts coming back a
little bit on. We can come back to this
later but I'm just saying so the
challenge with young patients and
especially with the PCO patient then
become pregnant put on more weight.
>> Yes.
>> And then in lactation again they're
scared to use it.
>> So so that is still an unanswered area.
>> Right.
>> So while at that point we are clearly
helping them no question about it.
>> But if my patients ask what after that I
say I don't know we'll probably start
the drug again.
>> Yes.
>> No. So I can add on to that. So what we
have noticed actually and at the clinic
is if you are uh eating well around this
time while getting off the medicine as
well if you are taking care of your
nutrition rather than just eating less
uh while you're on the medication you're
able to combat this
>> 100% you're right there's a huge
difference it makes
>> and build healthier habits while you're
on the medication because all the noise
is gone so that's the best time to build
your healthy habits to carry it on for
the future. I will ask you about the dos
and don'ts of taking the medication. Uh
but first I wanted to ask the both of
you in terms of why this has suddenly
become especially when it comes to
social media
>> but we also haven't answered your
earlier question.
>> Yes. And then I will come to about who
is the right candidate. Um but because
this conversation goes into so many ways
I want to just um like social media
there are some people a lot of them are
rumors in terms of who's taking OMPic or
not. Um I think only one person Oprah
Oprah Infrey I think has talked about it
a little bit. Um, Chrissy Tyen has
talked about it a little bit.
>> Elon Musk.
>> Elon Musk has talked about it a little
bit.
>> Serena Williams.
>> Serena Williams has really
>> Oh, interesting.
>> Yeah. She said, "Everything I did,
>> the fittest person in the world, I just
couldn't lose weight."
>> Interesting. I didn't know. Yeah.
>> And she's lost weight. Um.
>> Yes. Yes. She said, "I'm feeling much
better. I'm good."
>> So, why though has it become an
obsession in the influencer and
celebrity world? So can I so I feel like
you know I feel like first of all what
the media paints is something we will
still not know both sides of the coin
right like if we see celebrities taking
it we don't know whether it's just for
aesthetics or whether it's for their
health cuz nobody's going to
>> be vulnerable and speak about their
health so openly. So I feel like we
don't know which one it is. So we can't
really be judging
>> as to why they have taken it.
>> That's number one. Second, I feel like
more than understanding like why it's
become so big, I feel like what we need
to address is this medicine has actually
changed the narrative of
why weight loss is so difficult. Because
if you have celebrities who have
>> the time, who have the access to fitness
instructors, chefs, uh nutritionists,
doctors, etc. if they're not being if
they're struggling and you suddenly see
them lose weight, you look at this med
medicine as like a magic wand, right?
>> You know, and that's when I feel like
the rest of the world is like, okay, how
can I take it? Should I take it?
>> I want to take it,
>> right? And then it raises that whole
issue about um beauty and health being
equitable.
>> Correct.
>> Or is just something that you can
purchase.
>> And a lot of, you know, my friends also
sit and and and you know, we say, "Oh,
but this person can just afford to lose
weight and I can't and I'm struggling."
I know again and I I will ask you about
how these costs might come down but
firstly if we just address that to
people who come to you who are
overweight what differentiates one from
the other in terms of being a likely
candidate for a GLP-1 drug
>> so the first uh thing we need to keep in
mind is associated conditions health
conditions again we're looking at health
>> yes
>> is it just weight gain or excess weight
without any negative impact as yet maybe
it'll happen in the future but as Yet
you know the person just has excess
weight but is healthy otherwise you know
good all parameters are normal sugar is
normal blood pressure is normal heart
testing is normal everything is healthy
but he's struggling so that's a
different category
and the other ones are who already have
health issues like a fatty liver
diabetes early diabetes pre-diabetes as
she talked about all those things are
already happening so we are much more
liberal with the second lot the those
who have associated conditions where
losing weight will will get rid of that
condition or help control that much
better
>> they are clearly candidates. So even at
a BMI of 27
>> BMI is a very crude criterion but that's
what is easy and used. So even at a body
mass index or BMI of 27 if you have what
we call in medical parliament
co-mobilities
>> right everyone learned of that during
during so then you can be a candidate
right
>> and everywhere there's a caveat provided
you have tried lifestyle simple
lifestyle measures and they haven't
succeeded and you haven't succeeded that
is one but if your BMI goes above 30
then you may be a candidate for these
drugs even without any accompanying
problems
>> right but you know when I was talking to
you about a friend of mine who was about
145 kilos and he said it's interesting
because these drugs are a bridge.
There's some people who can lose weight
with lifestyle changes and there's some
people who need surgery and there was
nothing in the middle until these drugs
came along and now there's something
that may help you. uh but there might be
people um who are of a certain weight
where these drugs may not actually
achieve the effects that they're hoping
and for them surgery would be the way to
go.
>> Absolutely. So uh I think a bit of
oversimplification but let me say a BMI
of 30 to 40 where people don't go for
surgery
>> right
>> these drugs are very useful but if your
BMI is over 40 drugs will still work but
if you're let's say [clears throat] 140
kg
>> you take
>> yes
>> tipide
>> yes
>> and you lose okay even if you lose 20%
of your body you lose 25 kg let's say
>> you are still 115 kg Yes.
>> So you really are in the category who
should consider beriatric surgery.
Buriatric surgery is is amazing if used
in the right patient in the right way.
>> Right
>> now the other interesting part about
buriatric surgery is that our surgeons
are now saying help us prepare this
patient for biatric surgery because this
guy is so heavy the surgical risks are
high. Can you make him lose 10 15
kilograms so it makes my job easier? But
how wonderful this fascinating
fascinating we could never we had
nothing. And then the other part is
those who had buriatric surgery in the
'9s late '9s that's when it really
picked up in India early 2000s are now
putting that weight back on. It's 20
years 15 years later after buriatric you
tend to put on weight.
>> So again don't don't want to go for a
second surgery and they're not at that
level yet or whatever.
>> There also we're finding it very useful.
So we work in close coordination with
our buriatric surgery colleagues. I want
to come to the side effects but before
that I just want to ask you um Dr. J if
somebody comes to you uh and they want
to take um a GLP drug what is the first
thing that you would ask them
>> what is the reason behind it what are
you trying to achieve
if their goal is just weight loss
because they want to get there faster or
they have some their expectations of
weight loss are very quick then that's a
red flag. if their aim is weight loss
and in addition to that better health as
Dr. Matel said whether it's diabetes
whether it's managing your sugars blood
pressure cholesterol levels any other
co-orbidities I would be like okay let's
discuss it further
>> and let's get a couple of tests done if
there aren't enough and let's send you
back to your endocrinologist so
>> we like I would say I'm not the one to
advise them saying okay this is going to
be the right path for you for sure I
think I would try to find what Dr. Metal
is saying the middle ground try to
understand what comorbidities whether
they're a good candidate and then slowly
like gently nudge them towards their
endocrinologist to have this
conversation
>> right um so as again to oversimplify
just to wrap up that part of the
question is what is the right BMI for
you to take a drug like this whether it
is not high enough for surgery and
higher than what is required for
>> 30 to 40
>> so 30 to 40
>> so the side effects um I've heard a few
like nausea being one and the reference
that you to the fact that somebody who
might be have issues with the gut this
medication may not be appropriate for
them. So firstly if you could tell us
the side effects and a little bit I'll
ask you both in terms of how one can
manage those side effects. What are the
ones that at what stage should you say
this drug is not for you because there
will be a process of adjusting to the
drug.
>> So I think it's very important in the
same way as Julie is saying that we
should involve endocrinologists. It's
very important to involve nutritionists
in your team right from the beginning
>> and not when they're trying to go off
the drug or something.
>> Yeah.
>> So it's very very important because side
effects are significantly attenuated
with proper nutritional advice.
>> That's crucial. So anyway, so the side
common side effects these are gut
hormones. So the common side effects are
as we said nausea, reflux in some
people, bloating in a lot of people,
sudden bouts of diarrhea,
>> uh constipation, Indians get very upset
about constipation sometimes even more
than diarrhea they get very upset about
constipation. So these are known side
effects. So we have handouts for example
these are managed the common ways for
constipation you take some goal or you
take you know uh lactolo very normal
things but these patients should know
like we set expectations for weight we
also have to prepare them for this
>> yes
>> you're going to have some of these
issues very likely not 100% some people
don't even notice that they're taking
the
>> is that that also happens that some
people do not experience
>> nothing nothing at all nothing at all
>> and they wonder whether it's working on
them
>> yeah and they say you told me so many
Nothing has happened [clears throat] but
I said you've lost 3 kg but you know I'm
not feeling anything.
>> But are there ways to you know like
having it on a full stomach are there
ways to mitigate the effects of the
nausea and the
>> there are there are little little tips
that we give call it tips and tricks of
using GLP1s. So for example with GLP1
you may not feel hungry all day and
there may be a escape from the effect
for a little while and then suddenly you
might may want to go sort of binge on
the food
>> disaster. You have to have small meals,
>> right?
>> Regardless of how you feel.
>> Important to have small meals. Important
to be a little physically active after
meals. Not vigorous, but not sink into
the sofa and go to sleep because if
you're sort of upright, then you're
helping your food to move a little bit
better.
>> Right.
>> Right. Uh even water, we recommend
hydration very strongly, but at one
sitting, don't gulp in like several
glasses of water. So these little little
things and I'm sure Joey can add more is
what my team advises people who are who
are uh you know going on these drugs
from day one
>> right
>> so that they're aware and obviously we
do recommend that eating out reduce it
you know like eating out meaning
certainly don't risk street food and all
for that period because if you got get a
gut infection
>> then everything goes for a toss because
then it flares up and you know it
becomes a complicated issue so we should
avoid sometimes we use probi biotics
sometimes you use laxatives depending on
the sometimes you use antidarals
>> if the diarrhea is there so those kind
of things
>> so symptomatically you treat
>> symptomatically you treat you may want
to add about what you do with the diet
>> so I'll uh what we do when we plan when
it specifically comes to the gut first
is of course discussing the effect side
effects what they're facing at this
point in time
>> but the main goals or the primary
treatment first needs to be that timings
of meals we need to tell them that even
if you're not hungry, you need to be
eating at least three to four times
through the day. Even if you eat small
meals, then you look at more like um I
call it one pot meals, but basically
lesser volume and more nutrition. So
look the Indian diet kit,
>> right? diabal or like something just
lentil soups and toast if you had to
something that you feel that you can
consume without you feeling very uneasy
or bloated like where it doesn't look um
stressful to eat that plate of food
which is roti dal sabzi you know so that
additionally hydration is very important
again we also mentioned that you should
be hydrated throughout the day not just
at one time
>> but your normal amount of hydration
>> normal not more than necessary um when
it comes to bloating. There are some
natural remedies we could suggest. One
is ginger. Ginger does help as Dr. ML
said, it slows down gastric emptying. So
what ginger does is it can help with
nausea and also speed that up so it
doesn't make you feel as bloated and
uneasy.
>> Um the the standies old remedies on a
piece of gingerious then that awaner
soft water that really helps with
bloating as well. When it comes to
constipation, I think something that's
really working well other than laxatives
and which at least I use as the first
line is a magnesium citrate tablet.
>> So, it's a supplement and specifically
[clears throat] the citrate salt of it
will help relax and move your
peristalsis. It's not going to be in
that shock that it is
>> and constipation gets better.
>> So, just a few that I can think of at
the top of my head. But um oh switching
out let's say di with Greek yogurt
because again it's higher in protein.
>> Yes. You get more
>> yeah more nutrition from it. Can I spin
back into another client story?
>> So this man he was on the medication. We
planned his nutrition plan but he was
just not feeling hungry through the day.
So he's like if I'm not feeling hungry I
won't eat because if I eat less I'll
lose weight.
>> But what happened is at the end of the
day he would sit with a tub of ice cream
and finish that. And those ill effects
of those of eating that ice cream
wouldn't show right now because you're
not eating any food.
>> So it would show after he would stop the
medication and that is
>> like the counseling comes in there.
>> So that's what you're saying when you're
on the medication not when you get off
it is when you actually need somebody to
tell you and also a little bit of common
sense. I think I could have even told
him that's not a good idea.
>> Yeah. I mean common sense [laughter] of
course
>> but everybody thinks eating less is
losing is equal to losing weight and
that is the problem. You need to eat
right not eat less. Yes. And that's why
I think um having a nutritionist is very
important also because people will be
eating less because as if you're getting
that signal to the brain that you're
full, you're not eating. You're thinking
you're losing weight but you're also
losing vital nutrients. Yes.
>> And I think one thing that people
immediately
>> stop eating and anyway I believe India
is protein deficient as a country. So
protein, how can one ensure that we're
getting enough such that we're not
having the muscle loss which I believe
is also a side effect of taking the drug
because a whole part of weight loss is
muscle loss and I think you had said if
you're losing 10 kilos out of that
>> 2 kilos is going to be muscle muscle and
that's just part and parcel of losing
weight. Yeah. So the strategies we use
first it's really important for us to
understand why protein. I mean everybody
thinks of it as like um at least the
population above the age of 50 that I
deal with thinks of it as just an
ingredient needed if you're going to the
gym or a macronutrient needed if you're
going to the gym. Nobody actually
realizes that it is your building block
for almost all tissues in your body.
Whether it's your hair, skin, your
nails, your digestive enzymes, other
enzymes, hormones, immunity
>> and then muscles. But it has so much
other than just muscles that it does
help with. And if you're not consuming
enough of it, because you're constantly
breaking down your body's protein and
it's being excreted. So if you're not
consuming or replenishing the lost
amount of protein, you're not going to
be able to maintain any of these
tissues. And that that's when you start
>> looking frail.
>> That's when you start where your hair
starts falling. Your skin looks very
dull. Um digestion all all your gut
inflammation begins. Um and your
immunity drops.
>> Is this when you're on osmpar is what
they refer to as the ompic face and
ompic.
>> Yes. Yes.
>> So I think it's good that you brought
those terms up. Basically it means
you've not followed advice. There's no
reason for anyone to have an either
you're losing weight too fast.
>> You're not taking enough protein. You're
not well hydrated. Otherwise if your
skin shows the slightest signs of saggy
you can reduce your dose. Talk to your
doctor. Adjust your diet.
>> I mean so it makes no sense. But people
sometimes get fixated on hitting a
certain weight target number.
>> A number.
>> Yes.
>> And for that they'll do anything.
>> Yes.
>> And then they look haggarded and
everyone say, "Oh, this guy has got an
Olympic face or big butt and all that."
>> And then they meet that target and then
they want to go further. I think what's
important to tell them that the target
shouldn't be weight, it should be body
fat percentage. So you have now
specialized scales at a lot of gyms,
nutritionist clinics, doctor's clinics,
hospitals where you stand on the scale
and it gives you accurately what your
body composition is, whether it's your
fat, muscle, water, etc.
>> Right?
>> And what your aim should be is to reach
an ideal body fat percentage. So for men
between 8 to 20% is ideal, between women
it is on the higher side. So between 21
to 33%. So it's always better to stay
let's say for women below 30, men below
20. That should be our goal. So if you
hit that ideal target, your likelihood
of gaining weight even after stopping
the medication reduces a lot.
>> So I mean I think these body composition
analyzers should be part of any program
>> the regimen
>> a good one should be I mean you cannot
go on these drugs without measuring your
body composition. You should your doctor
or maybe yourself should have and it's
none of them are very accurate let me
tell you but they are good for
longitudinal followup
>> you'll be able to say even if the 20 and
30% which which has been mentioned and
rightly is not accurate 19 21 it doesn't
matter but if you can see where you are
going
>> that's very important
>> and and one point about diet that I was
wanting to emphasize is that because
there is a lot of popularity of diets
that are high in fat
>> right and high in protein. So while we
emphasize high protein diets and high
fiber balanced fiber diets, you cannot
use highfat diets when you're on this
right
>> there certain popular diets which are
highfat diets.
>> Highfat diets cannot be because you'll
get lot of reflux gastric motility is
going down.
>> So do not opt for a high fiber diet,
highfat diet if you're going to use
these drugs. this one.
>> And again to further on in that high
protein, not always do high protein
diets work cuz at the end of the day,
high protein eventually still has
calories, right? 1 gram of protein or 1
gram of carbohydrate, both of them have
4 kilo calories.
>> So if you are exceeding your calorie
intake while you're following a
nutrition plan, whether on the
medication or not,
>> it's not going to be effective.
>> It's not going to be effective.
>> Yeah. So the the muscle loss and doing
that properly I'm assuming then strength
training becomes a huge part of
mitigating the effects of losing muscle
mass and is there when you start the
drug um do you have to wait before you
can train or you can train you should be
doing it anyway
>> these drugs don't cause muscle loss
muscle loss is a part of weight loss
these drugs cause weight loss so
>> I just gave a talk on that 3 hours ago
>> that GLP1 drugs action on bone and
muscle are positive if anything
>> right
>> but it the fact is that whenever you
lose weight rapidly you lose muscle also
now why wasn't this this discussed
earlier because people weren't able to
lose weight rapidly
>> right right
>> so once that [clears throat] tool has
come in you're losing weight rapidly
you're also losing muscle you lose
muscle for the first 6 months after that
the muscle actually improves or
stabilizes but you continue to lose fat
>> right
>> so the muscle fat ratio improves at 12
months the hand grip strength actually
improved, right? It's just the first
study on this, but it's amazing. So, we
need to explain to our patients all the
time that this drug is not harmful for
your muscle,
>> right? But which makes me also ask them
there should be a minimum period that
you should be on this drug for.
>> Yes.
>> Which should be about a year.
>> Okay. When I talk to my patients about
using this drug and many of them come
for quick fixes and you know I have to
explain that it doesn't work like that.
I say think in years.
How many years? I said we'll see.
>> Yeah.
>> But I say go in with a sort of mental
makeup of two years at least.
>> Right.
>> Because but generally what what is
happening is we don't have that many
years experience. I have about 3 years
experience if I include those who had
started it before it was available here.
Right?
>> So what we do if patient is doing really
well then they're quite happy to remain
on a very tiny dose.
>> Right.
you know like micro doing.
>> Yes. Yes. Well, not classic micro doing
usual dozing but the lowest level of
usual dozing
>> and they're able to manage quite well.
>> Right.
>> Several of my patients who lost uh
weight with the highest dose are now on
close to the lowest dose
>> right
>> and maybe even given one every alternate
week which they love
>> because if you can give one less
injection they're really happy. So there
are lots of uh strategies for that.
There's a whole lot of research. In
fact, the one of the primary uh focuses
of research right now is the fact that
how to get off the best way to get off
the drugs.
>> Interesting. Um I will come to that but
uh just before that I wanted to ask um
because you've done the the key dos and
don'ts the serious side effects. I know
and I can see the excitement in both of
your eyes when we talk about these
things because I think you've also said
in the last 40 years this has been one
of the biggest
>> most exciting yes
>> um and rewarding changes that have
perhaps happened in the medical industry
and there I think everybody recognizes
that um but apart from the people who
require surgery some people who may not
be candidates for this or situations
where you feel this might be dangerous
to take can we touch on those
>> yes of course there are there some very
clearcut. If you have a family history
of thyroid cancer, not the usual thyroid
that everyone seems to have, thyroid
cancer, particularly medularary thyroid
cancer, it's a rare type of thyroid
cancer. So then you're not a great
candidate. You should stay off it. If
you have a history of pancreatitis,
>> while the evidence in humans that these
drugs are causing either the thyroid
cancer or even the pancitis is very
flimsy,
>> still there is
>> there is an action on the pancreas. So
you want to be super cautious. So if you
have a history of pancreatitis, don't
don't don't go for these drugs, right?
>> Personally, I'm also very cautious in
those who have major gastrointestinal
issues initially. It's not smart. I mean
again common sense. Why would you you
know use a drug like that? So these are
people who are not great candidates.
>> In addition to that, people who have
active eye disease, active retinopathy,
diabetics.
>> I did read somewhere about blindness.
>> Yes, we'll come to that. So one is the
one that is known for a long time that
is if you have active retinopathy,
>> right?
>> Uh it's a complication of diabetes
active retopathy and proliferative
retinopathy then you're not a candidate.
Now this has been known for all these
three applied to all the predecessors of
these drugs they've been using for 20
years right
>> nothing new in that
>> now the one that is sort of the only one
that has emerged unexpected is still
questionable a lot of data showing it
doesn't happen some showing it does
happen but you always flag something
when you hear something and that is a
kind of optic neuropathy
>> right
>> right non-eskeemic arritic so
nonartritic eskeemic optic neuropathy so
That is not a great thing to have,
>> right?
>> Because that can cause vision loss,
>> right?
>> And sometimes it may not respond very
well,
>> right?
>> So how should we? First we have to
understand that is exceedingly rare if
at all. Right?
>> Because there are equal number of
studies saying it doesn't happen,
>> right?
>> Number one. Number two, there is uh the
issue of at least getting a proper
opthalmic exam before you start. Now we
don't know the benefit of that exam.
There is no longitudinal study to say
that those who had a good exam had were
able to prevent it. you know all those
but you don't but intuitively again
common sense
>> if someone already has changes so it's a
rare condition maybe that person has it
>> already yeah
>> or is beginning to have it so then you
don't you know don't start the drug
>> right
>> so I think an opthalmic exam
>> for for diabetics it's a no-brainer you
always need to have that even for
non-diabetics and again sticking my neck
out it's not part of a protocol but I do
think that it may be sensible to have it
till we understand more about this nion
business and then maybe we don't won't
need it. But at the moment, it's
probably just safer. There are certain
signs in the retina or near the optic
nerve that tell you maybe he's a little
bit more prone then you may want to
avoid it.
>> Right. But the the link that people are
drawing to these drugs perhaps in the
future um because also there seems to be
a sense that these drugs have not been
studied for long enough and I will come
to that because you've already referred
to that in your book that we do know it
for about 20 30 years. uh and they've
been in clinical use since 2005. Um
which is enough to say that they're
safe. But what I want to take away is
that there are risks in any drug.
There's no drug that has been invented
that doesn't have a risk including
aspirin. Very safe drug that lots of
people use.
>> So just because there risks
>> that you're required to list out should
not scare you.
>> Absolutely. I totally agree with you.
But patients need to understand it's a
drug. People need to understand it's a
drug.
>> Yeah.
>> Should be taken under medical
supervision. Agnosium. I'm saying that.
Sorry. That's the right thing.
>> And like with every drug and I give the
aspirin example often people understand
it. People are popping aspirin for their
heart prevention of their heart
condition or or just for pain and they
take painkillers like anything without
worrying about the kidney. So every drug
when used inappropriately can have side
effects and rarely even when used
absolutely correctly
>> no one can say 100%. Our professors used
to say never say never and never say
always in medicine.
>> Yeah. because you'll get
>> because [laughter]
that's true. From a nutrition
standpoint, I just wanted to come to you
and um also to ask you about certain
case studies that you might have come
across in terms of things that have
worked or not worked, things that might
have excited you most perhaps, you know,
one of the stories that you feel this is
why I enjoy doing this or something that
didn't work out the way that you expect
it to work out. Um and then from a
nutritionist voice because I feel like a
lot of Indian diets are very carb heavy
you know for example roti and rice are
staples. So when somebody starts
>> uh a GLP1 drug do they have to rearrange
their plate
>> and how would how would you do that?
>> Um you should already be rearranging
your plate before [laughter] you started
but yes I'll come to it. I just um I
wanted to quickly just talk about two
more contra indications I feel that
should be on this as well which is
>> um anyone with eating disorders I mean
it's a no-brainer again but eating
disorders which are hard to understand
when you're speaking to the patient so
spending some time digging into why they
want to take it
>> uh is important and their eating habits
prior also women with hypothalamic
aminora I feel should not be on this
hypothalamic aminora basically means
women who do not have not been getting
their period.
>> Okay?
>> Um and that could be because of
undereating and that because of which
like undereating fat because of which
their hormones are not working the way
that they should and that's why they
lose their period. So putting them on a
medication like this would possibly be
more detrimental than good. And the
eating disorders you're referring to um
you're saying that because there's a
complicated relationship with food and
um this drug might trigger
>> dependence
>> and eating disorders also switch you
know.
>> Yeah. Yeah. You can go from one extreme
to the other
>> to binge eating to anorexia and and and
they use these drugs you may trigger off
you know
>> should not should not
>> um coming back to your question yes when
it comes to protein when we plan a
nutrition plan for someone the normal
recommended daily intake is about 0.85
to 0.9 g per kg of body weight. What we
use for our clients is we push it up to
between 1 to 1.5 g per kg of body weight
protein for them.
>> Uh and that is primarily to preserve the
muscle mass.
>> Secondly, what I would say when you need
to rearrange your plate is you need to
look at it as 50% protein. Uh the rest
can be fiber and carbs,
>> right? Because if you're going to focus
just on the foods that are making you
feel better at that point in time, which
is going to be lesser protein, in the
long run, that's going to affect your
health.
>> Um, when it comes to clients, there was
one client that I feel like I want to
discuss. He came to us many years ago um
above 120 kgs and tried to lose weight
with us and was also advised beriatric
surgery. decided okay no I'm going to
try give it one shot and he started
falling into the pattern of feeling low
avoiding social interactions not
enjoying like having a low mood
altogether
>> even though he was on the program
because his weight loss was slow and
fluctuating cuz his life demanded him to
be out like
>> traveling a lot or eating out a lot. So
after a couple of years he came back. We
spoke to him, advised him to visit his
endocrinologist, especially since this
had come back about a year ago, he went
back and was started on um OMIC,
>> no Monjaro was started on Monaro. And
since then, he instead of him meeting me
on a weekly or once in two weeks basis,
he comes once a month. He's very happy
with his progress. He's enjoying his
food. He's building those sustainable
habits and enjoying them at the same
time because that noise is not there
around food and he's able to portion his
plate without feeling overwhelmed or
feeling like he has that fear of missing
out on that certain food that he wants
to eat,
>> right?
>> And he's enjoying his exercise and I
think that's also key because when you
build that habit while you're taking
this medication
>> that is the biggest gift you can give to
yourself for the long run. So when we
consult a client, we don't tell them you
need to exercise to lose weight. We tell
them you need to exercise for your
long-term well-being, right?
>> If you want to take care of your knees,
you want to take care of your heart, you
want to take care of your kidneys, your
brain, every single thing requires you
to exercise regularly. And if you're
able to build that habit during this
time because you don't feel that
lethargy anymore, I think that's the
biggest win.
>> Yes.
>> So for with him, that was amazing. And I
feel like his win becomes our win when
we meet them more often. And we keep
seeing his progress in terms of muscle
mass and it's just touchwood.
>> Surprisingly, as Dr. Mal said, it had
dropped in the beginning and then it's
been going up.
>> Yeah.
>> Which is amazing.
>> Which is wonderful. I think you know
coming off it becomes a concern for a
lot of people because they say oh and
that again
>> the noise is that the minute you come
off it the weight comes back. Um and I
wanted to ask you how does one come off
it in a way that you can keep the weight
off.
>> So uh as I was saying this is the
primary focus of research now large
studies are ongoing
>> but the first thing we have to
understand is if you're thinking of
obesity as a health condition
think of diabetes as a health condition.
If you think of blood pressure fatty
liver even sleep apnea
to talk about that yeah
>> I mean diabetes requires lifelong
treatment right? Yeah,
>> blood pressure requires lifelong
treatment. So at some conceptual level
>> the drugs will work only as long as you
take them. That's the harsh reality. So
it's not that how long if you take it.
People often well when we start diabetes
medicines even then they ask the same
question right
>> but then they gradually understand that
you really can't go off the medicine. So
those who have considerable
co-orbidities along with this multiple
other they will remain on the drug as
they were on their predecessor drugs.
>> They'll continue to have it for
diabetes. I mean if you're having the
one sweet dulaglutide or laglutide you
would you would continue to have it. I
mean you're not asking me now what is
the problem there in having it because
you're concerned about long-term side
effects.
>> I mean just if somebody says you have to
take this for the rest of your life.
>> We never say that initially because we
don't know and if you say that you're
ensuring the patient will never start
it.
>> Right.
>> So their perspective changes when they
use the drug.
>> Right. Right.
>> Some of them we need it for all their
life. So as I'm saying someone who has
all these multiple co-obidities is
likely to need it all you what are they
scared of? They're scared of
>> they just want you to we want you to
tell us that it is safe to take for the
rest of your life.
>> So it can be safe. You have to maybe
adjust the dose. You don't want weight
loss all the time.
>> You're using it for other benefits. So
reduce the dose so that you're not
producing much weight loss.
>> Right?
>> So it can be used. Yes. Number one.
Number two is the young patients I
talked about where it's a challenge. The
very elderly where there's already
muscle mass loss that's also a
challenge.
>> So at the moment the strategy is to
really focus on the diet, exercise,
sleep and other lifestyle measures from
the beginning. Right?
>> Use this as an opportunity to correct
your lifestyle which you were not able
to. We're giving you assistance to do
that
>> so that by the time you're coming off
it, we're thinking of bringing you off
it. You have are well tuned to it.
>> Yes.
>> Having said that, it is true that most
people will put on some weight when you
try to take them off,
>> right?
>> So the current strategy for those who
are in the significantly overweight zone
or obese zone is to maintain them on
very low doses,
>> right?
>> And many of them will succeed with that,
>> right? And as we get more and more
research we'll know uh you know that
that what proportion of people can be
taken off right
>> we don't have those figures yet
>> and typically if somebody's taking it
once a week then you could increase the
gap
>> yes we could sometimes increase the gap
also that strategy is also being looked
at and has shown some encouraging
results
>> right
>> but you know again the fundamental truth
that people have to remember is that
every drug works for as long as you use
it
>> right
>> you know so it's not like an antibiotic
>> which you're killing the infection and
sending it way. It's a chronic
condition. You will need the drug for
>> but it's it's an opportunity certainly.
Yes.
>> Um and I think what was interesting I
think we were discussing it off camera
was keeping a diary which I thought was
very valuable that you said which is
just what you are doing while you're on
the drug
>> try and continue doing
>> for the rest of your life and that would
also be helpful. Micro doing is
something that people are referring to
now in parties and they're saying when I
come off the drug then I will micro do
and that's how I'll maintain my new
weight.
>> I don't think there are any guidelines
for micro doing but I think Dr. MTA
would be the best to answer this
[laughter] question as of what I know.
However, I know some uh of my clients
who have said they tried micro doing and
it worked for them.
>> Yes.
>> So,
>> so exactly same answer.
>> Uh that we don't know yet because we
don't have trials. Micro doing is not
recommended. Okay. If you ask me
medically, it's not recommended. But I
do have some patients who have done done
that without my knowledge and actually
they they're doing okay. So I think we
require data and I'm sure I'm not
directly aware of a study but I'm sure
this will be a subject for very active
study right now right
>> and maybe it is true that some people
see when you're using micro doing for
maintenance that that part will be
figured out earlier
>> but when you're using micro doing for
losing a couple of kilograms that I
think is a bit of a gray area we we
wouldn't recommend we would recommend
>> um the safety element also refers to the
fact that people feel that has this drug
been studied for long enough and I know
that you've referred to it in your book
but if you could just tell it for our
audience in terms of whether it's been
covered for long enough you say
>> uh see we are still discovering or at
least assessing or discussing potential
side effects of metformin
>> right
>> metformin is 60 years so these things
will happen when you use the medication
like in food every day you hear
something new
>> that this is good for you this is bad
for you this you can't have suddenly
everyone
We never talked about magnesium 10 years
ago.
>> So these things will happen.
>> So that's number one.
>> Some little things may emerge after a
long time, right? We're still not sure
where to give aspirin, where not for for
blood thinning. There's that controversy
is always on.
>> So similarly uh for these drugs, I think
the predecessors of these drugs have
been in clinical use since 2005,
>> right?
>> Which means they've been studied for at
least 10 years earlier. of 90s maybe
even late 80s. So that's since that
since then they've been under study.
>> The difference of course is that these
drugs are more potent for weight loss.
>> Even then summer glutide was approved by
the US FDA in 2018. I think
>> that's already 8 years.
>> Yes.
>> And Munjaro are 3 years later probably.
So I think uh this semiglutide and
tensipetide of course no one can rule
out that you'll find out something 20
years later but that's true of all the
medicines that you take
>> but drugs are not licensed so easily.
They are not made part of a W who
essential drug list. They so they
they're not talked of reducing prices
worldwide,
>> right?
>> The president of the United States is
saying he's going to trash the prices. I
mean and and even in Africa, I mean
there's so many attempts to make them
accessible to more people.
>> So that only happens when the benefits
far outweigh the risks. So that's how we
have to look at it.
>> I do want to talk a little bit about the
price because a lot of people say that
this is relatively expensive as a way of
losing weight. Um and then there's a
whole discussion what we were referring
to earlier in terms of this creating
inequity in the world. Um one thing is
that we can look forward to the prices
coming down but can you just highlight
for us what the current prices
approximately are? I'm assuming they're
about 20,000 rupees a month.
>> So uh I think the lower doses around 12
it's come down I think to almost 10 now.
>> So and the higher doses around 20 22. So
uh they're expensive but this when we
say this figure it's per month not per
injection per not per injection. So you
can say 12 to 20,000 per month is the
current cost.
>> It used to be the cost per injection
maybe 2 years ago
that was even higher crazy people are
still
>> and these costs are because these are
patented drugs.
>> Yes. Yes. Yes. Now you cannot really
fight about the costs. Yeah,
>> till the parent company brings down the
cost if they have a patent they will
they will use it. It's for them it's
also a business and they have to invest
more in their research and do whatever
>> and it's a farmers have their own ways.
Yeah. I mean you know
>> now the truth is however that injectable
semaglutide has as I said caught the eye
of the WH and all the governments plus
the patent is in India is due to expire
in March or April
>> right
>> and people even told me 22nd March or
some you know companies and I know for
sure
>> so there are people waiting
>> yeah yeah so [laughter] so I know for
sure that we'll have at least at least
half a dozen Indian companies
>> ready to go to flood them they're just
waiting waiting for a yes from the
government and they're ready to go.
>> So 22nd March 22nd.
>> Yes. So so I think uh the and I I don't
know the price they're going to come out
with but it'll be less than half for
sure. Definitely less than half. So I
think there is there is these things
happen. We should not get frustrated
about the prices in this environment of
drug discovery when drugs come out for
the first time. Every drug you're using
now, simple drugs, even the glarine
insulin or sitagin or dpaglyposin
commonly used drugs in diabetes was were
out of reach of most of our patients,
>> right?
>> And now they're they're within reach of
almost everybody. They're even part of
the prime minister's general shi
program,
>> right?
>> So fantastic. So this is a matter of
time. So
>> and as as you said like for example in I
think the NHS has already brought these
drugs under under its umbrella. um we
can look forward to these being more
accessible and therefore
>> I'm certain they'll become more
accessible
>> and do you think that they'll come under
insurance and things?
>> Well, in India that's a challenge
because outpatient insurance is very
weak here.
>> We don't pay for prevention of heart
attacks but we pay for the heart attack.
>> Yeah.
>> So that is a strange system but those
who have OPD coverage, outpatient
coverage would I'm sure they'll be
covered. Um I just want to talk as we
come towards the end of this a little
bit about people who want to try and
lose weight without the medication. How
do you advise them to do that best?
>> Okay. So the So are we going are we
speaking about the people who don't want
to be on the medication at all?
>> We can break it up but let's talk about
first about people who have now come off
the drugs and they want to lose weight
not on the drugs.
>> So we both have multiple times we've
mentioned how protein is really
important and how your muscle mass is
really important. So the most metabolic
tissue in your body is your muscle. That
means it's being able to utilize
whatever food you are eating to be able
to break it down and create energy from
it.
>> And if you do not have enough muscle in
your body in the long run, your
metabolic health suffers and your
metabolism starts to drop. So if you do
not preserve your muscle during uh
during the time you're on this
medication after you get off the
medication you will not be able to keep
the weight off. Right?
>> And this is the same thing that holds
true for any weight loss program. It
doesn't just mean it's for mangaro or
ompic. It's for any weight loss program.
If you're on a crash diet during which
you lose a lot of muscle you're not
going to be able to keep that weight
off. It's as simple. So I think that is
your key to managing your weight after
getting off this medication. And I do
believe that there are a set of people
the same way um the younger population
at least how uh they start metformin for
prevention and then as soon as they
reach their ideal body weight or their
ideal body fat percentage they're able
to get off the metformin.
>> There could be maybe an opportunity in
the future where um
>> for some people don't know what
metformin is can you just tell them a
little bit? uh so it's the first line of
treatment for diabetes type 2 diabetes
but it can also be used for treating
insulin resistance. The aim of metformin
is as an insulin sensitizer that means
your body needs to be able to insulin as
a hormone is used uh to shift your
glucose which is your blood glucose into
your tissues. That's its main role. If
there is a block in the action by your
own body due to high body fat, genetics,
unhealthy lifestyle etc. This block in
action would not allow the glucose from
shifting from your blood into your
tissue and you require um an additional
your brain thinks that there's not
enough insulin. So it tells your
pancreas to secrete a lot more and when
that excess insulin comes into your body
that's what creates the havoc where it
leads to suddenly opening the floodgates
allowing the large amount of glucose to
enter and that's why you end up
developing more body fat rather than um
using that food or the energy you have
consumed to be used up for energy
instead of um as
>> yeah and metformin treats just that so
it fixes that block in action
>> yeah I want because it's called all
about her and we did refer to various
issues and various times when women put
on weight. Again, a friend of mine who
had a baby and uh of course has put on
perhaps a little bit more weight than
she wanted to breastfeeding when she
comes off the feeding. Would she be a
candidate for a GLP1 drug?
>> Well, there's nothing against it, but
again, we'll have to map out some plan
for her,
>> right?
>> We'll have to map out some. But
otherwise, yes, if she's not
breastfeeding and she's overweight and
the obesity is in a zone which fulfills
the criteria we are talking about, then
she could be candid. Of course,
>> do a lot of people come to you
postpartum.
>> Yes. But very few people have actually
asked about uh GLP during that.
Absolutely right.
>> Yeah. Very few people postpartum because
I feel that the during the time you're
breastfeeding, you're all your body's
metabolism like you're requiring a lot
more energy. So I feel like we're able
to bounce back pretty quickly.
>> Does it affect your hormones? And I know
that has a positive effect on fertility
because a lot of infertility is linked
to obesity. But does it have any side
effects in terms of your hormones? I
know you said that women who don't get
their periods perhaps should not be
taking it.
>> Uh but for somebody who's getting their
periods but as you said our hormones go
up and down. Um thyroid, insulin, PCOS,
all these things come into play. So I
would say the people who develop a
gast like any gut issues or gut
inflammation during this time could have
then could then develop like a
hypothyroidism or could have a skewed
thyroid or their hormones go up and down
which could be a result of your body not
being able to absorb the nutrients from
the food you're eating whether it's B12
whether it's zinc whether it's iron
selenium to name a few. So if your body
is not being able to absorb those
nutrients and your body is deficient in
them, that could affect the making of
your thyroid hormones, which would then
affect your metabolism,
>> right?
>> As a very it's a very nuanced like it's
not something that's going to be loud on
your blood report,
>> but it's something that we need to
understand when we speak to the client.
>> Even pmenopause because that's something
that is personal to me. Um and uh
annoying weight gain that happens around
then. Do people come to you for that?
Yes, actually a a lot. Yeah,
>> in that I mean I feel like your 40s is
an age where things start to stagnate a
lot of Yeah.
>> and a lot of people struggle with that.
So if done properly again I'm assuming
that the criteria is met.
>> So so one little point again about the
period it's not that people who don't
have periods can't use it. A particular
kind of amoria she was talking about.
>> Yes. Yeah. People get Yeah. That's
common. That's not common. not the PCOS
kind of
>> uh
menstrual cycle loss. I just wanted to
ask you philosophically the both of you
in terms of the idea of I know that
you're very deeply talk about the health
benefits of these drugs but they do come
hand inhand with a beauty image and I
just wanted to ask you your thoughts
philosophically in terms of whether you
think that these drugs not what they've
intended and that the intent was
something else altogether but one
wonderful side effect is that people
lose weight and now that has become a
primary focus for the drug but do you
think it reinforces any kind of
negative beauty stereotype in the way
that it's being used or in the way that
people are taking it.
>> I think it's more in the way people are
taking it rather than the way it's being
used because I feel like doctors are
using it correctly
>> but the way that people are looking at
social media or reading things online
the way that they their narrative about
the drug is wrong. You need to change
the narrative back to health rather than
weight just as you said.
>> How would one do that? [laughter] aware
this
>> keep saying the right stuff as you are
doing that's the whole thing
>> also I mean you know these this body
image issues
>> yes
>> uh are are a big issue now they always
were but with social media being so
influence influential and so many
influencers uh and you don't even know
if the image is sort of uh AI generated
or whatever and so people start craving
or hoping or aspiring to have bodies
like they see on that they want to be
like that
>> those are challenges of modern of the
modern world I mean that's and they're
often totally unrealistic but
>> I do believe in India I feel like uh
society judge
a lot more in India as compared to the
western world someone a friend um had
recently told me when she lived in
London she didn't feel as judged if she
was overweight but the moment you come
to India you're like whether you're
eating your meal walking on the street
>> whatever you're doing you're just there
are always eyes on you being and people
are judging that oh god she's overweight
>> yeah she must be uh
>> I think culturally we are tuned to
getting into others lives
you live in Bombay maybe you don't
realize it so much [laughter]
but culturally we are all you know we
don't look at what we are doing we're
more concerned what the other person
>> and we're comparing ourselves to other
people and we like to we're very tactile
we like to touch and feel and comment on
people's appearances all the Right.
>> Um I'm saying we but I don't mean we you
like to do that. [laughter]
>> The other thing that maybe I feel like
you want people to shed is the stigma
because I said it's difficult and you
said that
>> a lot of men are happier to talk about
their journeys with ampic. This book is
peppered with testimonials
>> and a lot of them are from men.
>> Yes.
>> Um who are happy using their names but a
lot of the women did not want their
names to be used.
>> Um we found it hard to find a woman to
come and talk about her journey today.
Um so this stigma of I'm onic if
somebody could actually come and
authentically tell their story and how
it helped them um how can we shed that
also
>> it's a matter of time it's a matter of
time so I think it'll go away
>> but I also think it's the right
information right now there's so much
misinformation where the world is
divided back to thinking either or majes
are heroes or they're villains they're
not understanding the the fact that it's
just a tool to get you where you need to
>> yeah and I think if you
>> and if you do it you're not going to
come in the eye of anybody like no one's
going to look at you and say, "Oh my
god, you have the ompic phase."
>> Right. Last couple of questions maybe
for you like the key dos and don'ts for
people who are on GLP1 drugs if you
could just highlight and then I wanted
to ask you Dr. ML about the future um
and what you see in terms of there was a
reference to oral pills for example. So
first perhaps some basic dos and don'ts
that you would encourage people
>> first follow up with your doctor because
I feel like when you start getting the
symptoms of um the gastric distress you
don't they don't go back to that doctor
they say I'm going to just stop it on my
own
>> and what the what your doctor could
actually do is bring your dose down to
something that's acceptable to you or
stop it altogether for you because they
realize it's not working for you and
give you another solution. Um that is
number one. Second, I would say that
protein, protein, protein, very
important. Taking care of your gut,
taking the right kind of multivitamins
and the vitamins that you would possibly
not be getting enough if your gut is not
okay. Need to supplement with that.
Hydration,
um, exercise is key. And the intent with
which you're taking, you need to
reassess the intent with which you're
taking this medication.
>> Your intent needs to be right. Your
expectations need to be right. and your
support needs to be good where you have
a doctor, your family and uh friends
whoever's close to you and you have a
nutritionist on your panel.
>> Lovely. Wonderful. Um the future of
obesity treatment for you Dr. Mita.
>> So I think these uh uh these two
molecules have actually opened up a
whole new path like their predecessors
did for these two.
>> Now uh scientists are more and more
ambitious and doing all kinds of stuff.
So the first thing that will happen is
that you'll have oral pills probably
this year.
>> Really?
>> Yes. Which will be almost as effective
as the as the injectables because
>> the injectables are tough for some
people who are scared of
>> need and some may prefer oral you know
some may prefer injectables. So that's
okay but oral pills will be there.
Initially there will be oral pills that
are to be taken on an empty stomach and
nothing after that etc. But subsequently
there might be pills where all these
restrictions don't apply. So oral is one
big area. There may be injections that
have that have to be taken less
frequently,
>> right?
>> So less than even once a week. There may
be other drugs that may help preserve
the muscle while you're on these drugs,
>> right?
>> So multiple approaches uh will be there
and not the same drug won't be the right
drug for everybody. Then we'll be
talking of very nuanced approach who
goes to what molecule,
>> right? And I think uh the most exciting
for people to hear is of course because
it's about weight loss is the fact that
you have a triple receptor agonist in
the making and even more than that but
triple receptor agonist is already tried
it is called detaide and retride will be
used uh uh I think will be in use very
soon
>> and just explain triple receptor means
that now it is these have been double
receptors
>> so so GLP1 uh semiglutide Yeah.
>> Acts through GLP-1 pathway.
>> Dual receptor Tzepide or Munjaro acts
through GLP1 and GIP. There's another
dual receptor another of a different
kind which is glucagon and GLP1
>> right
>> and then there is a triple receptor
>> right
>> which acts through three pathways
>> right
>> so reta tide so which which has already
been tried
>> right
>> and that actually uh produces weight
loss of maybe 25%.
>> Right. So it's mindboggling. I mean
these things would be considered
unimaginable 10 years ago.
>> Yeah.
>> So we are in for very interesting times
and our patients will have lot of
choices. We'll all have more choices so
that if one doesn't suit you, one
doesn't work for you, you have other
options. So this is not going to go
away.
>> Yeah.
>> This is going to be there and newer
newer molecules are going to come.
>> Lovely. I'm so glad I had the both of
you because I really do feel and
especially after this conversation that
a nutritionist and endocrinologist and
all the knowledge that both of you have
are both very important ingredients for
somebody who is starting their weight
loss journey through GLP1 drugs. So,
thank you both for taking the time
>> uh and for being on the show.
>> Thank you for having us.
>> Thank you.
>> Thank you. Great discussion.
>> Thank you. Thank you. So I think my
takeaway from today's discussion has
been that ompic and mangjaro are
definitely not some kind of miracle drug
and they're not to be used as shortcuts.
They are medical tools like Dr. Ji said
and like all medical tools they need
context. They need caution and they
definitely need the right guidance. For
some people these drugs can be genuinely
lifechanging and for others they may not
be appropriate at all. What matters is
understanding that obesity is a complex
medical condition, not a moral failing
and that no medication really works in
isolation. And I think the basic
fundamental building blocks of wellness
remain to be your exercise, your sleep
and your nutrition. Weight loss is not
just about what you take uh but it's
also about how you eat, how you move,
how you manage stress and how
consistently you care for your health
over time. So, if there's one takeaway
from today, it's this. Please do not
make health decisions based on trends or
on social media timelines. Have informed
conversations. Ask questions. Seek
professional advice. A big thank you to
Dr. Mittal and to Dr. Jui for bringing
science and clarity to a very important
conversation because the goal is not
just to lose weight, it's to gain
health. Thank you and until next time,
stay informed, stay healthy and we will
see you in the next episode.
>> [music]