What Have We Learned About GLP-1s?

**Sasha-Ann Simons** (0:12)
Hey Chicago, I'm Sasha-Ann Simons, and this is In the Loop.
Stick around to the very end of the episode to get a rundown of the latest news. But first, for as long as I can remember, if you wanted to lose weight, health experts and nutritionists would tell you to change your diet and exercise more. But more recently, GLP-1 medications like Ozempic and Wegovy have sort of changed that conversation. They started out as meds for people with type 2 diabetes, but have since exploded in popularity for people living with obesity to quickly shed pounds. And researchers have been uncovering even more health benefits to the medications. So what do we know today about the long-term side effects? Is the medication changing the way that we think about obesity, health and even body image? And who can actually access these drugs? In this episode of the pod, we'll take stock of what we know so far, what we still don't know and how GLP-1s are reshaping the way that we think and talk about our diets. A panel of health experts will help us separate the hype from the science. At the table was Dr. Micah Eimer, a cardiologist and clinical assistant professor of medicine at Northwestern University's Feinberg School of Medicine.
David D. Kim, who's assistant professor of medicine and public health sciences at the University of Chicago. And Rachelle Lacroix Mallick, who's a registered dietician, nutritionist and founder of The Food Therapist, specializing in fertility, pregnancy and women's health.
Now, these drugs shifted to mainstream popularity back in 2021, without many of us actually knowing about them. It's when the FDA approved the diabetes shot for obesity. Now, Dr. Eimer at the time was an early skeptic. So I started the conversation by asking him why.
Here he is.

**Dr. Micah Eimer** (1:59)
It's a funny story. I mean, I think if you look, it's a sordid history of weight loss medications in this country. And, you know, I could list five or ten over the course of history, FenFen being a great example, that eventually get taken off the market because of cardiovascular side effects. So when you talk to a cardiologist about weight loss medication, they're like, no way. We've seen this. I've seen this before. This is a very bad idea.
So, yeah, when people started first talking about it, I wasn't one of the early adopters. But I think as I started to think about the way that they could help my specific patients, meaning patients with diabetes, coronary artery disease, chronic kidney disease, I asked myself, why am I not prescribing these? And are they really weight loss medicines, or are they really medicines for cardiovascular disease?

**Sasha-Ann Simons** (2:52)
So that's what changed your mind when you saw that there might have been a connection there with helping your patients.

**Dr. Micah Eimer** (2:57)
Yeah, I think I needed to switch mode from, this is a weight loss medicine, to this is a metabolic medicine. And once I made that switch, it became obvious. Like I would never withhold cholesterol medicine, right?
So if I have something, a tool in my toolbox that can reduce the risk of dying from heart disease or stroke, why am I not using it?

**Sasha-Ann Simons** (3:18)
Rachelle, tell me your initial thoughts when you learned that GLP-1s were being used as a weight loss tool.

**Rachelle Lacroix Mallick** (3:25)
I have similar thoughts because they're like, like you said, there are a lot of a history of weight loss medications that have then been pulled from the market. And I specialize in reproductive health. So I primarily work with folks who are trying to conceive, pregnant, postpartum, also managing conditions like PCOS and endometriosis. So the population I work with, where I'm primarily seeing people on it is for PCOS or what's now been renamed as PMOS, because it's a metabolic condition that impacts fertility and reproductive health. And so I agree, I had some skepticism or just caution, right? Anything that's going to impact appetite so significantly, I want to make sure that people are well nourished and getting adequate nutrition.
And then again, going back to the PCOS or PMOS situation, the drugs were originally developed for type 2 diabetes. And with PMOS, PCOS, there is usually some underlying insulin resistance or a higher likelihood of getting type 2 diabetes. So the drugs can be really helpful in situations like that.

**Sasha-Ann Simons** (4:24)
Yeah, and so we're clear. I mean, how would you say GLP-1s are different from other weight loss drugs?

**Rachelle Lacroix Mallick** (4:30)
So, well, because they work on the receptors that impact appetite. So again, these were developed for type 2 diabetes to help lower A1C and improve blood glucose regularity.