Metabolic Health Expert Slams 60 Minutes Segment on Obesity Drug Semaglutide - aka Wegovy / Ozempic

Doctor Tom Refai here, metabolic health expert and diplomat of the American Boards of Lifestyle Medicine and Internal Medicine. I'm going to critique the 60 Minutes show that came out on the 1st of January with host Leslie Stahl, well intended as she was with Two obesity experts, Drs. Stanford and Apovian, who I respect. But I'm going to give some feedback here that I think is going to be some tough medicine for them to accept. That show was largely a commercial for Novo Nordisk's drug Semaglutide. Semaglutide being an injectable metabolic drug that helps both in terms of blood glucose control through some of its mechanisms and weight management through others, and is marketed under two brand names, Ozempic for diabetes, and that is no different than Wegovy, which is for obesity. It's just that the FDA approval for each of these drugs is separate and therefore given a different brand name. And the dose is being slightly different potentially and most many of the times not even the case, because the recent increase of the acceptable dosing for Ozempic has made it pretty much pretty close, except for the maximum dosing or close to the maximum dosing for Wegovy, the same thing. So this is Semaglutide, a drug that is also available in oral form, but doesn't have the same power in the oral form called Rubelsis, as it does in the injectable form, Wegovy or Ozempic. There's also Tirzepatide, which is Mounjaro, which is a drug that wasn't even mentioned on the show, which makes me a little bit suspicious regarding the. The focus on Novo Nordisk's offerings only, which at least they clarified. CBS did that the. That Novo Nordisk was a major sponsor of this station. And then of course, we weren't provided any information regarding the conflicts of interest from either Dr. Stanford or Dr. Apovian regarding Novo Nordisk drugs or any of the other metabolic drugs in the space. Now, let me just cut right to the chase as far as the problems I have with the show. Now, the biggest problem I have was Dr. Stanford saying that it's genetics, that it's primarily genetics, and that obesity, which is really a crude way of looking at cardiometabolic health, because we have plenty of people with prediabetes and even diabetes, as well as blood pressure and other more challenging, frankly, hypertension, clearly the biggest metabolic killer of all. And there's many people whose BMI is normal who have hypertension, prediabetes or diabetes. A minority in the Pre diabetes and diabetes realm, but still a significant minority who can't qualify for a weight loss medication because they don't have diabetes, they just have pre diabetes. It doesn't make any sense. The drugs that we're talking about here are essentially what are called GLP1 analogs. They're a similar hormone that is synthesized to a gut hormone called GLP1 or glucagon, like peptide 1 and this hormone. And therefore these drugs have the multiple effects of us getting full on less calories, staying full longer, and also enhancing insulin production by the pancreas only when necessary rather than chronically elevated. With you are doing insulin injections or pushing your pancreas to make more insulin chronically, irrespective of whether you just ate or not with drugs such as sulfonylureas. And so I don't deny that these are phenomenal medications, don't get me wrong. But the idea that the issue, which should not be couched in shame at all is genetics is completely misaligned with the facts that the Human Genome Project has proven that our genetics are essentially the same as 10,000 years ago. What has changed over the last 40 years that they curiously said we're not sure what's happened over the last 40 years? There's now almost 40% obesity. Experts aren't sure. Sure we're sure. We are sure. Those of us that know we're darn sure it's the food environment, and I used to say the physical activity environment. But phenomenal studies from hunter gatherers of the Hadza and the Tsimane, led by Herman Poncer and Michael Girvin, respectively, for instance, have shown us that there really isn't that much to do with weight loss when it comes to physical activity. Sure, it's helpful and you should do it for multiple reasons, whether it's your blood pressure, your mood, your bone health, maintaining what a modest amount in terms of metabolism and what it does contribute to calories by maintaining muscle over time. Absolutely. But when it comes to weight loss, for sure, and even weight maintenance, it's really the food. And we are living in a corporate food Inc. Crap food saturated environment. And crap is not a pejorative. It's just an acronym for calorie, rich, refined and highly processed. Okay. CRR ahp. Wonderfully trademarked. And I will say that with full disclosure by my company, CRAP crrhp. Calorie, rich, refined and highly processed foods and beverage calories are everywhere. Look at the food consumption analysis 1970 versus now. I mean, it's about 400 calories more per day and in some dramatically higher. Anyone who's not gaining weight or having a tendency to gain weight in this environment is a genetic mistake. They're only, they only survive based on the generosity of modernity and this freely available caloric environment, rich calorie dense environment which we know drives even population growth, right? Let alone of course growth of human beings. Now that doesn't mean these drugs aren't helpful. They are because they can actually decrease the impulsive eating tendencies we have as human beings. For this chronic temptation environment, you go to bye bye baby, you go to the gas station. Some of these movies, theaters and gas stations wouldn't even survive without selling crap food because that's how they break past into the block for their margins. It's a tentacle talent and tentacle embedding in our food environments and our cultures that is going to take generations to turn around. And if there's any genetics involved, it's epigenetic. And that is based on even in utero exposure to high calorie intake and cardiomet, insulin resistance and cardiometabolic disease. And yet still epigenetics are the enhancement or turning on and off, or tweaking up and down genes we already have. Genetics may load the gun, but it is our collective lifestyle and food environment that's pulling the trigger. Okay, that's the number one message I want to get across and that you can do something about it. You don't have to send the message it's your fault. I mean that idea that you have to send a message that it's your fault or we have this drug for you because it's just, there's no explanation, there's nothing you can do about it. Except for this drug, of course. Then they mix message by saying, well, the person still has to diet and exercise. Well, okay, let's use the word approach. Food and physical activity rather than diet and exercise. Because we all know that diet invokes the images of torture. And Jillian Michael, speaking of how they bashed biggest Loser, you know, screaming at people while they're vomiting on a treadmill and so forth, etc. Now let me get into some details I really had trouble with when it came to the 60 Minutes last segment of 60 Minutes January 1st on obesity, okay, the one thing I did like was when Dr. Stanford talked about how the lockdown, essentially the lockdown policies in the United States have led to a significant amount of aggravation in terms of obesity and metabolic disease. Hypertension, worse. Diabetes, worse. It's all worsened because basically people were stressed and depressed, locked in their houses and of course not even moving as much. Overall, we definitely saw data showing a trend down in physical movement. We shut down gyms while we opened bars. At least that's the case here in Michigan. It was a big learning lesson of what not to do. We essentially really drove people's metabolic health worse. And she did make the point that the set point, the physiology, the hypothalamus, the inner brain level for where a body would like to stay based on food availability in the environment went up. Because we are physiologically set up to think that food availability is very rare and happens as food feast and mostly famine. And therefore when available, eat when you can. Our genetics are still set up for 10,000 years ago. And of course we don't have famine anymore, we just have eternal spring. And actually we have eternal spring. And the harvest turned into highly refined and highly processed, calorie dense, low satiety and easy to trigger, overeating foods everywhere. So small in size that people think, well I didn't eat much. I mean it's just a little brownie. But that little brownie had an entire, a plate worth of plants and some fish or antibiotic free grass fed land animal meat or whatever you want to say. And all the rest had massively high calories versus the very small amount of food. And therefore people will judge how much of crap they're eating based on the weight or the size of it when they're not realizing how calorie, compressed and concentrated or calorie dense, these light foods that are calorie packed are. Diet Coke was demonized. I mean, give me a break, people. Listen, I'm so tired of, of people not understanding, frankly, randomized controlled trial evidence number one priority. All these associations and gut microbiome studies are all, I'm sorry, they're, they're, they are weak at best. And you look at randomized controlled trial evidence, when you replace sugar with low calorie sweeteners, people get better in terms of metabolic health and weight loss. There is a International journal of Obesity MEGA study, a meta analysis of over 200 randomized controlled trials. That's the fact. I'm not promoting Diet Coke. But if you're going to tell me that it's better to drink Coke classic than Diet Coke, going to tell that to a type 1 diabetic. See how far that gets you. If you can't connect the dots on that, I have no other help for you. But that's a ridiculous thing to demonize no calorie beverages. It's caloric beverages that are the issue. Sure, water is great, but frankly we all have a sweet tooth. And if a little diet 7 up will do it for you with the citric acid that's included, that might help you dissolve some kidney stones. Please put the priority on beverage calories. All right, let's see here. They didn't even really, by the way, explain the mechanisms of glp. One drugs like I did quickly know the fact that they reduce gastric emptying time, so they help you stay full longer. They also enhance the sensitivity of stomach stretch receptors, so they help you get full faster and stay full longer. And they enhance insulin production, but only when you need it. So we don't have chronically high pro weight gain insulin running around the body, whether through insulin injections or medications like pills called sulfonylureas like glipizide and glimepiride and other sulfonyl sulfonylurea, oral drugs that cause chronically elevated insulin levels and actually can cause your pancreas to burn out faster as opposed to insulin, which at least if you inject insulin, you're giving your pancreas a break. These drugs actually give your pancreas a break, the probably the smartest way ever. So I am not against them at all. I agree that there certainly isn't long term data and we have to learn that they're just a tool to help kickstarter lifestyle, not as an alternative. Same thing with bariatric surgeries, a surgery that for which there's over 10,000 people that qualify for every surgeon that can perform it. So just like these drugs that are super expensive, these are not going to be the answer. The answer is going to be a heart to heart discussion among all of us in society that we've got to change this. And if you're talking about massive financial incentive, self insured mega companies have major issues in, in terms of their health costs that are driven largely by corporate food. So as much as corporate food's trying to make good money and corporate pharma saying hey, keep pumping it because they've got more drugs to try to neutralize your crap food and you kind of end up in cahoots with corporate food and corporate pharma, maybe, if not in a smoky room, but certainly maybe corporate food, maybe just read Salt Sugar Fat by Michael Moss and see what you think about that. But at least by convenience, by, by sad irony. But now there's a big beast. King Kong's coming to town saying this is just costing too much money. We've got to find a way to incentivize people to eat healthier, still tasty, not eliminate anything, but start to shift the food availability so that we're not going to bury ourselves in debt in a, in a really shooting self and foot approach. And then there was a statement about propping up anti obesity drugs and kind of demeaning erectile dysfunction drugs. Well, I'm sorry, but they're both legitimate. Sexual health is an important issue. I don't consider frankly erectile dysfunction drugs, which by the way, erectile dysfunction can be mitigated, potentially even reversed and certainly prevented with lifestyle as well because it's essentially a vascular obstructions phenomena of the blood supply. The arteries to the penis are small and the cholesterol blockages that occur there may manifest. They may be the first organ in the body that manifests cholesterol blockages before the heart, before the stroke. There you go. So I don't know why do you have to beat up on erectile dysfunction drugs? And the expense of, or I should say obesity drugs being promoted at the expense of erectile dysfunction drugs. They're both the same issue. We have an environment that promotes erectile dysfunction, that promotes obesity. We need to address it all. And everybody can use health. Look at the American Heart association simple 7, now called the essential 8. But basically 1% of people at best, maybe less over 50, have ideal metabolic health. It is unbelievably for everyone, no matter what your weight. I don't like looking at things just in terms of the obesity lens because it's just one window to a big metabolic house that's essentially on fire. Now the American, the Association for Health Insurers perspective that there's no evidence for long term weight management is not entirely unfounded. I mean these drugs have long term randomized control data for what long term is. But even a couple years we haven't had discussions like I have and I've been having discussions with the American College of Lifestyle Medicine. Understanding how to deprescribe in a careful manner as you prescribe lifestyle as medicine. Right. The Flex 5 lifestyle I think is the best system. So skills and knowledge in five key areas. Psychology, nutrition, physical activity environments, that's food, social physical environment and accountability, both external and provided in a compassionate way and then eventually evolving to internal accountability. The Flex 5 psychology, nutrition, activity environments and accountability. And skills and knowledge in that weave of the mixed martial artistry of longevity made doable. That's the drug. Do we have physicians that know how to prescribe it as often as they should know. There was a point made that doctors have frankly crap, and in this case crap levels of education in terms of nutrition, let alone comprehensive lifestyle and behavior modification methodologies. All right now in this point about saying that the doctors are pushing that it's your fault, well, it's different when saying it's your fault versus there's something you can do about it. The idea though that you take away that ability for a person to have agency and have some ability to manage their own destiny and then putting it all on a drug that's going to give a temporary effect. And for all we know, just like bariatric surgery, its benefits will wean over time, wane over time, and we don't have a plan on how to wean somebody from the dependency on the drug in a concomitant parallel manner where you provide the support and as a kickstart for lifestyle change. But then begin the journey, like getting a PhD or a black belt of learning the skills and knowledge in the key areas. And I would say there are five again, psychology, nutrition, physical activity environments and accountability that help sustain a true journey to health and well being that's not reliant on, although might use as a secondary adjunctive factor, medications. All right, now the one thing I absolutely did agree with is this whole repugnant idea of fat shaming. I'm so sick of it. As someone with binge eating disorder who almost lost my life to it, who lost my youngest brother Basil, God rest his soul, to binge eating and I would say really fat shaming at its core, that's it. That is just the most ignorant and lacking in compassion oppression approach to how to help somebody change. And the real way we're going to do that is by changing the environment so that the default choice is the healthy and well being related choice. And that can be as it relates to blood pressure because you might be thin as a rail but have sky high blood pressure. And as I wrote in my article, why Weight Loss Methods Don't Help with Self Loathing. Go ahead and google that. Why Weight Loss Methods Don't Help with Self Loathing Tom Refai, you'll find a great article. My perspective on how we should really treat everybody the same and that is work on their values, work on their behaviors that serve those values and those the what, their why, their why or their whys. Maybe they have more than one why and let everything as a side effect improve. Whether it's the blood sugar, whether it's the insulin the blood pressure, the cholesterol or the weight, it's a side effect. It's not the primary goal. No discussion in any of the 60 Minutes show about what was it driving these two people that, what was it that made them want to be healthy? What are their values? That's really the story. And this whole idea of genetics. Just look at Weight of the Nation, right? That was a PBS documentary and you saw the two identical twins right next to each other, one in the Diabetes Prevention Program, the lifestyle change trial, and then the twin that was not. And look at the dramatic differences there and tell me that it's genetics. It's not genetics alone at all. If anything, all of us have genetics that, that are prone towards cardiometabolic risk. And therefore, whether it's weight, whether it's blood pressure, cholesterol, blood sugar, insulin, or all of them, or none of them, if there are none of them, you're eventually going to likely be faced with it or you're lucky and good for you. But ultimately, I'm sorry, 60 Minutes, you totally failed on approaching this in a way that was truly, truly transcendent and understood that cardiometabolic health and the environment is for everybody. It's the environment that's driving it. It's our crap corporate food, profit driven environment and it's costing us dearly. That crap food environment, crap beverages, caloric beverages. That is what's driving it, period. PFAs and artificial sweeteners are absolutely distractors. They are tertiary at best. The primary issue is adjusting our environment so that we can have one that doesn't drive people to have, to have willpower. Couldn't agree more with that part. As I said on, on Fox when I was representing Pritikin many years back, I think 2010 or 2011, and, and I said willpower sucks. You know, that is not the way to go about it. You one place you have control most, more than anywhere else, is your home. Set up your home for healthy food. Other than, you know, your birthday or you know, Christmas or Hanukkah or whatever, Those are exceptions. 345 days out of the year, okay, I'm not worried about it. 365, 345 days out of the year. Keep your home a therapeutic food zone that serves your. Why, okay, just don't take all 20 days off in a row and you'll find where reality meets science. And then in your car you bring food with you and then at your work environment environment, you make sure that you bring food with you or that you work in a place that supports healthy food. The food is where it's at with all of this. Doesn't mean don't use the medications because we're not going to change the totality of our food environment in the west overnight. It's going to take time. I think I do see signs that it is changing though, but it's going to take time. We're still way, way off. So don't buy into this. You can't do anything about it or that it's just will parts way more than that. In fact, you want to set up your environment so that you don't have to have willpower so you can use a less of your willpower so you don't always have to be mindful. That's exhausting. Save your willpower for when you're outside the house. Don't set up your your house for a willpower setup, temptation and so forth. So that's my summary regarding the 60 Minutes interview. I'm not against. Not at all. In fact I prescribed oodles of GLP1 drugs since the first ones that came out byeta. Then after it Victoza. Here we are now with Ozempic and Wegovy which are Semaglutide. Enter Zepatide with Mounjaro. Phenomenal. Great. But they are just adjuncts. Just like bariatric surgery is to lifestyle. They're not a alternative to lifestyle. They're kickstarts for and supportive of establishing skills and knowledge in the five key areas of health and well being. The flexify psychology, nutrition, physical activity environments and accountability. And with that I wish you all well. I wish you a wonderful, happy and truly healthy 2023. Feel free to make a comment. Click like Please don't forget to click that notification bell for when new videos come out and I'm happy to serve you. I am Dr. Tom Refai your Flex MD helping you find where reality meets science when it comes to health and well being.