WEIGHT LOSS FRENZY

 You can’t escape it. Whether you’re out with friends or scrolling through social media, Ozempic, and fellow wonder drugs like Wegovy and Mounjaro, is all anyone can talk about. They’ve taken Hollywood by storm. Everyone from actress Mindy Kaling to a plethora of reality TV stars are the topic of every suddenly skinny conversation in the stratosphere. And while all that adds up to fun-chatter, there’s a lot more to it. And most of those who’ve struggled with weight will tell you, these medications not only offer a potential solution, but they also offer hope where there wasn’t any. Putting the gossip aside, we reached out to Clare K. Carney MD, PhD, and Amy McCoy, MD, two trusted sources, for a local look into this phenomenon and the inside scoop on what promises to be a big part of the future.

 By Hayley Hill

 The adored Clare K. Carney MD, PhD, recently opened a private practice, Clarity Concierge, to ensure she can care for her patients in the best possible way. A believer in the whole-body approach and that preventative measures lead to optimal health; weight loss is a big part of her platform. “Obesity is a multi-dimensional issue, so I view it from a 360-degree vantage point. I begin with a conversation and listen to a patient’s personal journey. I try to understand their relationship with food and how this plays out in their daily life to gather clues for other causes such as stressors, medications and supplements, personality, and possible undiagnosed issues. This conversation is extremely informative. I also offer a wellness laboratory panel to help paint the internal picture in terms of kidney, liver, thyroid, and hormone function, among others. Based on the results of a patient’s history, physical, and laboratories, I create a customized plan to help guide each patient to true success,” she shares. 

 In terms of success, she adds, “A patient must be in the right mindset for long-term weight loss. Like smoking cessation, many people try diets that work for a while but are not successful long- term. There are a variety of reasons for this. Perhaps they were not ready emotionally or otherwise, or the weight is a symptom of an underlying medical issue like thyroid disease or a hormone imbalance. By attacking from various viewpoints, we have the best chance of generating lasting change. I also find discussing weight loss goals to be critical. Setting realistic goals with smaller goals in between helps a patient stay focused on achieving the desired outcome.”

 As a general practitioner, Dr. Carney states what most of us know. “Obesity is a risk factor for heart disease leading to heart attacks and strokes, sleep apnea, joint pain, and degeneration, especially in the hips, knees and back, as well as slower healing from surgeries. It also causes physical deconditioning as exercise tolerance declines.” But anyone unhappy with the scale knows, it’s more complicated than risk factors when it comes to change. It’s less about weight loss and more about the person you see in the mirror. It’s about finding a balance between your emotional and physical well-being and being able to be open and express your inner most insecurities so we can come up with a solution together. Without that trust, obstacles will find a way to wedge in,” she shares.

 Expanding on the emotional aspect, she adds, “There are societal norms that place this crazy ideal in everyone’s head. Worrying about the bottom number will almost surely lead to failure. Focusing on the journey to becoming healthier day by day, despite our many falls is what makes us stronger and leads to long-term health and happiness. We must come to accept, respect, and love ourselves so we can succeed. While that’s very easy to say, we truly must love ourselves for all that we are, and all our potential, and accept that we have faults. Striving for a healthy weight is a goal of self-love. Loving yourself enough to desire and strive for weight loss to attain a healthier state rather than to appease your inner critic is essential. You will never please your inner critic. Believe me, I’ve tried many times and I always, always fail. We must be respectful and loving towards our shapes and celebrate that we are not all the same size and shape. That would be boring. There is a difference between being curvy and carrying weight that is causing health problems.”

 As for the Ozempic frenzy? “I love this class of medications. Ozempic, a semaglutide, is in a class of drugs called GLP-1 agonists (glucagon-like-peptide -1). These were meant to combat diabetes by increasing our natural insulin secretion and decreasing our glucagon secretion. They work incredibly well for this, and for weight loss. This medication slows gastric emptying, so you feel full faster. Once the pharmaceutical companies realized how diabetics were losing weight, they set about getting approval from the FDA for weight loss. I’ve been able to help countless people get to a healthier weight. The side effects I hear about most are nausea and constipation. The nausea usually gets better as you adjust, and I find the weekly injections are better tolerated than the daily ones. Also, judicial use of an anti-emetic like Zofran can also help in the beginning. In terms of constipation, patients already prone to this need to include more fibrous foods in their diet and if it worsens to consider MiraLAX or other over the counter methods to combat it,” she tells us.

 Wondering what makes a candidate, Dr. Carney answers, “When a patient is ready to lose weight, and has tried diet and exercise, and other medications, and failed. I especially encourage this if the weight is causing medical issues like increased blood pressure, elevated blood sugars, and prediabetes. I’ve had several patients that have tried everything to no avail that have made substantial gains with semaglutide. The results were not only comparable to weight loss surgery, but they were also sustained long-term.”

 In addition to Ozempic, Dr. Carney has had success with other forms of medications in the same class such as Wegovy and Mounjaro.  “I absolutely prescribe this class of medications. Many are covered by insurance companies, but not all. Naturally, I offer other alternatives to semaglutide such as diet, a nutritionist, hormone help, B12, and other weight loss medications. Thankfully, the shortages have gone down greatly, the only thing in the way can be insurance coverage. Compound pharmacies do make affordable semaglutide injections for cash. This started when there were pen shortages during the pandemic. The FDA allowed compound pharmacies to make the molecule in a draw-up vial. This is still an available option,” she informs us.

 Rounding out the conversation, we also caught up with the revered Amy McCoy, MD, of Coastal OBGYN. When it comes to our OBGYN’s, we often forget they care about a patient’s overall condition and offer treatments for all aspects of women’s health, including mental health. As for her specialties? “I do both obstetrics and gynecology. I specialize in laparoscopic and minimally invasive surgery, especially in performing hysterectomies on large uteri laparoscopically as well as newer minimally invasive fibroid treatments,” she explains.

 From medication and guidance, Dr. McCoy is very engaged with her patients whole-health. “In relation to my specialty, weight gain can cause anovulatory menstrual cycles, irregular periods, endometrial hyperplasia (thickening of the uterine lining), and endometrial cancer. Those with Polycystic Ovary Syndrome (PCOS), weight gain worsens the symptoms and complications of the disease. Overall, weight gain can affect every aspect of our lives and that is why I am so invested. Extra weight puts stress on our joints. A weight increase of just five pounds is about 25 pounds of additional force on our joints. It can also cause cartilage to deteriorate, muscle fatigue, and an increased risk of getting osteoarthritis. Cardiovascular disease and diabetes are also issues that increase with extra weight,” she shares.

 For Dr. McCoy, helping patients with weight loss is multifactorial. “First, we must rule out medical diseases that can cause weight gain. We must also look at why a patient is gaining weight by asking questions like are they stress eating, do they binge eat, or travel a lot and eat fast food on the go? To help, we must know what our patient’s life is like so we can make a plan that fits their lifestyle. Then we look at what I can do to help. From setting meal goals, encouraging hydration, and medical assistance, there are multiple medical options depending on the patient’s labs, comorbidities, and lifestyle,” she tells us.

 Lifestyle is one of biggest challenges in weight loss success Dr. McCoy sees. “One solution does not fit all because people gain weight for numerous reasons, and lifestyle plays a huge role. For example, I can get so busy with clinic and surgery that I don’t get a chance to eat lunch. This leads me to eating cookies or candy because they’re the only thing available. Also, fast food is convenient and most social events center around food and alcohol. These lead to overeating high calorie foods at times you don’t normally eat. I see a lot of emotional eating, too. When we have a bad day or are stressed out, we reward ourselves with poor food choices,” she explains.

 Fully aware that people who have struggled for years, even decades, are finding success with these weight loss drugs, Dr. McCoy shares, “Anytime I create a weight loss plan, GLP-1 agonists are in my toolbox. Other parts of their medical history as well as insurance coverage and BMI will play a factor in whether these are the best routes to go. Wegovy, Ozempic, Saxenda, and Mounjaro are injectable GLP-1 agonists. Rybelsus is an oral GLP-1 agonist. Essentially, they amplify a natural fullness signal between the stomach and the brain. This encourages people to stop eating sooner than they might otherwise. They’ve also been shown to affect the mechanisms involved in insulin resistance.”

 Explaining each medication, she shares, “Wegovy is semaglutide that was FDA approved for weight loss in adults with a BMI greater than 27 in addition to a reduced calorie meal plan and increased physical activity. In a 68-week study of adults living with obesity or excess weight with a related medical problem, they lost an average of 35 pounds, or 15% of their body weight. Studies also showed semaglutide was as effective as some surgical procedures and was also helpful to gastric bypass patients that had gained some weight back. Ozempic is also a name brand semaglutide, but it’s only approved for diabetes patients at this time, even though people have seen weight loss with it. Mounjaro is another option but currently only approved for diabetics. While Wegovy is approved for weight loss, the biggest challenge is getting coverage from insurance companies. The list of companies covering it is increasing but not as fast as we want it to. Interestingly, while not yet studied, I am seeing that semaglutide is decreasing the desire to drink alcohol, and the desire for smoking in some cases. Maybe they will study these side effects next! We prescribe all these medications if a patient’s medical history and insurance allow. There are also forms of compounded semaglutide that have helped with the surge in interest in this medicine.”

 Vanity pounds aside, for the many looking to lose weight with the help of a semaglutide, the struggle is real. There’s simply not enough to meet demand and it is causing difficulties for those diagnosed with Diabetes. And they are cost prohibitive for many. Hopefully, the practitioners and patients that experience successful weight loss continue to be considered in the conversations evolving into what treatments look like in the future. As anyone faced with a weight issue knows, the old eat less and move more advice simply isn’t a solution for everyone.

 Clare K. Carney MD, PhD | 2054 Dauphin Street, Mobile, AL 36606 | 251.273.3317 | ClarityConcierge.org

Amy McCoy, MD | Coastal OBGYN | 3290 Dauphin Street, Mobile, AL 36608 | 251.361.2595 | CoastalOBGYN.com