Simple Nutrition Insights
Welcome to Simple Nutrition Insights, your practical guide to understanding nutrition in less than 30 minutes. Join us as we break down the science of healthy eating into digestible insights and actionable tips. Whether you're a busy parent or just short on time, our goal is to provide you with straightforward advice to enhance your well-being. Tune in for expert interviews, evidence-based advice, and quick, easy-to-implement strategies for nourishing your body and living your best life.
Simple Nutrition Insights
Beyond the Scale: Unpacking the Role of Medications in Obesity Management
Unlock the complex world of obesity and discover the transformative role of GLP-1 medications. Hear from the esteemed Dr. Raghid as she breaks down why obesity is labeled a chronic illness and the various factors contributing to its prevalence. From genetic predispositions to environmental influences and lifestyle habits, understand why tackling obesity goes beyond the simplistic advice of "eating less and moving more." Dr. Raghid's holistic approach addresses everything from stress and sleep to home life and physical activity, providing a comprehensive guide for those struggling with weight management.
Ever wondered how medications like Wagovy and Ozampic could revolutionize weight loss? Learn about the anti-inflammatory benefits of GLP-1 medications, not just for shedding pounds but also for managing conditions like IBS and rheumatoid arthritis. Dr. Raghid sheds light on the long-term safety and potential side effects of these treatments, emphasizing the importance of personalized care plans. We'll also explore alternative weight loss medications such as Phentermine and Contrave, discussing the need for extended consultation times to ensure thorough patient understanding and care.
Finally, bust the myths surrounding weight loss medications and gain a fresh perspective on weight management. Dr. Raghid stresses the importance of a supportive and respectful approach, highlighting the significance of addressing the root causes of weight gain. Understand the connection between physical well-being and mental health, and how beginning a conversation about health can set you on the right path. With practical advice and heartfelt encouragement, this episode is a must-listen for anyone interested in taking the first step towards better health. Check out the show notes for more information and resources to connect with Dr. Raghid.
Dr. Raghid's Practice: WiseCare
IG: WiseCare
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Hey, welcome back to another episode in the Simple Nutrition Insights Podcast. I am your host, leonila Campos, registered dietitian, and in today's episode I am so excited to have a special guest, dr Ragged, and I am going to give you a little bit of introduction about her. She is originally from Long Island, new York. Bit of introduction about her. She is originally from Long Island, new York. She was born in the field of medicine.
Speaker 1:For as long as she can remember, being a physician has been a lifelong pursuit. After high school in Hewlett, new York, without a doubt, she enrolled in Dow University of Healthy Sciences in Karachi, pakistan, and it was here that she began to understand the disparities of women's health, from a rural to an urban setting. With a passion of comprehensive care, dr Ragat completed her residency at Western Michigan University in Kalamazoo, michigan, where she served as a chief resident. The multidisciplinary training allowed for her to pursue further patient-centered social care. Dr Raggett's passion for female well-being led her to fellowship in advanced women's health and high-risk surgical obstetrics at the University of Tennessee in Memphis. Here she honed on her skills as an advocate for comprehensive reproductive health and neonatal care. Dr Ryad then moved to the Central Valley, where she resides with her husband, and she also has now her own private practice, wise Care, and so I'm really excited to have her with me today.
Speaker 1:We're going to talk all about obesity right, and the GLP-1 medications. It is important that we get the information from reputable resources from your doctor and know. You know there's a lot of noise about, specifically, the GLP-1 medications for weight loss. Sometimes the information is not accurate, and so you want to make sure that you get your information from the professionals that have the background and they know what they're talking about. So welcome Dr Raga to the episode.
Speaker 2:Thank you so much. Yeah, thank you so much. I'm so excited to be here and talk about something that I'm so so passionate about and I feel like, just like what you said, it's so important to go to a reputable source, because there's so many fad diets, so much misinformation out there that any person would get really confused with all that data and information.
Speaker 1:Yes, absolutely so. Thank you so much for joining me. So let's start first by explaining the underlying causes of obesity and why it's such a complex condition to treat.
Speaker 2:Sure, absolutely so. Yes, you know. It's interesting that the American Medical Association actually didn't even recognize obesity as a chronic illness up until pretty much the last 10 years. And it's mind blowing because obesity is, it is a chronic condition and we know that the pathogenesis of it is multifactorial. We also know that, you know, having obesity also, you know, increases your risk of other medical conditions like diabetes, hypertension, cancer and other conditions.
Speaker 2:So why obesity is such a difficult condition to treat? And underlying things that kind of increase your risk is, you know, genetics. It could be a higher occurrence in families. You can have a genetic predisposition to obesity. I have a lot of patients that tell me that their parents are overweight, their siblings are overweight, they're overweight. This can be related to genetics. It can also be related to environmental lifestyle right, the food that we eat in our cultures or even the day-to-day food that we eat from the grocery stores that are processed, our lifestyle, if we didn't grow up, you know, with our families emphasizing physical activity and exercise, you know if kids are more put in front of the TV and less stress of going outside, and especially with now with social media and you know the television and things like that, that also increases the risk of obesity.
Speaker 2:There's other medical conditions that increase your risk of obesity.
Speaker 2:So, let's say, if you have hormonal issues, or if you have sleep apnea, pcos, which is a very, very common thing that I find in women, metabolic syndrome, where you just have multiple other conditions related to weight, and then, not to mention stress, right, that's a huge, huge trigger for weight gain as well.
Speaker 2:So you know, it becomes difficult to treat because there are so many issues and the interplay of them, like what we just discussed, and so, in order to treat obesity, we do have to address all of those issues. And so, whenever I have my patients, we're not just talking about weight loss, we're talking about you know, let's talk about what your home life is. How is your stress? How is your sleep? What are the conditions at your work? How do you eat your meals in front of the TV? What kind of forms of physical activity do you have? So you know it becomes difficult to treat because a lot of clinicians are not addressing all of these aspects that contribute to obesity. And then, you know, patients are also not understanding that you have to address all of these things, because they do contribute to being overweight. It's not just and what I try to explain to my patients. So it's not just about you eating less and moving more, because otherwise I think we would all be thin right, but we know that's just not the case.
Speaker 1:Yeah, oh my gosh, I love everything that you just said, because it's absolutely true. Right, obesity is very complex because of all those factors, right, and it's not like, just like you said, oh, let's just focus on eating less, moving more. It's not the case, right, there's so many things that affect the way that we eat, right, our environment, either our environment at home or at work. Right, stress and sleep, which is oftentimes is not something that, like you mentioned, it's talked about.
Speaker 1:Right, but it plays a huge role and like everything else, and so not not addressing everything, right? Um, it's definitely a challenge and so, yeah, we have to focus on every single one of those things which can take time, and that is, you know, something that is done.
Speaker 2:Yes, absolutely.
Speaker 1:Absolutely so. Let's let's focus more so as well on the role of weight loss medications, right? I think it just blew. You know, within the last year or so, how did weight loss medications work and what role did they play in the overall treatment of obesity?
Speaker 2:Sure. So you know, we know that the gut and the brain are connected and, to simply put it, you know, when you're upset it does affect like mentally upset, something sad happened to you, you went through something traumatic it does affect your appetite, right, you are either a person who uses food as a crutch and a coping mechanism or you're someone who loses their appetite. But why does that happen? Why does our mental health affect our brain? And it's because we know that there's connections, neurological connections, between the gut and the brain. And so one of the medications, the GLP-1s, which, like you said, have literally blown up in the last couple of years GLP-1 is a natural hormone that's produced in our gut. Okay, it affects and it regulates our appetite. And so the GLP-1 medications, they kind of act as an agonist, they increase that action of the natural hormone, okay, and so, naturally, that hormone's job is to slow gastric emptying. And so when you're taking an additional aspect of that hormone, that kind of works on that receptor in our in our stomach, it increases gastric emptying which leads to, you know, the feelings of fullness and decreased appetite. Decreased appetite is, you know, also stimulus where it? You know whether gut and the brain are talking. If your stomach is not feeling hungry, your brain is thinking also oh my, you know I'm not hungry, I don't really need to eat right now. So all of that leads to a decreased appetite. It also helps, you know, lower blood sugar levels, which also leads to weight loss.
Speaker 2:And one of the biggest things that I also see with my patients, it's anti-inflammatory properties. We're not exactly clear on how that really works, but it definitely has anti-inflammatory properties. I have a lot of patients on GLP-1 medications that have inflammatory conditions, like you know IBS, rheumatoid arthritis, lupus arthritis and so they often tell me that for some reason, their joints feel better and it could be a combination of losing weight. But I do think that the medications also have some type of anti-inflammatory effect that you know affects some long-term. So you know, I know a lot of patients are kind of a little bit nervous with taking the medications. But you know the GLP-1 medications as a class. They've been out for about 20 to 25 years already. It's just recently we've been using them for weight loss, but we were in the past using them for type two diabetics. So yeah, yeah, awesome.
Speaker 1:Thank you for explaining that. Oftentimes it's not knowing that right, like hey, that's not something new, no, we just learn about it, it's just news. As you mentioned, they've been out for years and years, and so, with that specifically right in terms of the efficacy and safety, what are the most effective weight loss medications currently available and what should patients be aware of in terms of potential side effects?
Speaker 2:Right. So yeah, like I mentioned, I think the GLP-1s are the most effective medications right now. They are increasingly safe where I think you know because the amount of patients that are on it, the FDA, the USDA, everyone is performing a lot of studies in terms of safety and long-term use. Certainly, we had type 2 diabetics on them for many, many, many years. I think one of the common things that patients hear is you know, the risk of thyroid cancer. I think one of the common things that patients hear is the risk of thyroid cancer. So in some studies, which were only done in rodents and rats and stuff, I showed an increased risk of a specific type of cancer which was medullary thyroid cancer. So that cancer in itself is extremely rare.
Speaker 2:We have looked at the data in humans and we have not been able to see those same you know risks of cancer. But you know, obviously we have to. That is a you know black box warning. We do definitely want to warn patients of that risk. We are very cautious in terms of prescribing those medications to anyone that has had a history personal or family history of medullary thyroid cancer. I honestly have maybe come across at one time a patient had a mother with a history of medullary thyroid cancer.
Speaker 2:And you know we weren't able to use the GLP-1s. But you know that's definitely a screening question that we ask for safety reasons. More common side effects are things like, you know, nausea, diarrhea and constipation. Uh, very rarely it can, you know, increase your risk of getting gallbladder stones and pancreatitis. But of course there's all things that we kind of talk about, you know, with our patients, um, to better understand hey, are you a good candidate for it or not? Like with any medication, not everyone is a good candidate. But overall the medications are super safe and their side effect profiles are pretty low, with the nausea, diarrhea and constipation being the most common.
Speaker 1:Thank you. Yeah, that's really helpful to understand that the safety of these medications, the side effects and, like you said, not all medications are going to be for every person, and so having that screening, making sure that each person is the right candidate for it, is helpful. It's in terms of personalization of treatment, right? How do you determine which weight loss medication is best suited for a particular patient? Are there specific factors you consider when you know, when it comes to that decision?
Speaker 2:Yeah, of course, definitely. You know, most of my initial appointments are about 45 minutes to 60 minutes long and we really it's really important for me to understand kind of the background of the weight gain. So it's about understanding their history their, you know, really is a waking related to trauma, depression, some type of mental health thing that happened pregnancy, postpartum understanding the interplay of co-related diseases. Right, if we can't fix your sleep and your stress, the weight loss is going to be difficult to treat. So I tailor it to also, like you know, what worked, what didn't work in the past. So addressing everything in a comprehensive approach is, you know, very, very important. I ideally love to start my patients off with a GLP-1 medication and, like I said, the class of medications are pretty much the same, but sometimes one injection can work better for the one person than the other. But, yes, usually I love to use GLP-1 medications because I do think that they are the most effective. However, sometimes we do have to tailor it to patients specifically based on insurance and costs and things like that.
Speaker 1:I think we jumped right into the GLP-1 medications, but for the listeners that maybe have no idea what they are, what are some examples of GLP-1 medications?
Speaker 2:maybe have no idea what they are. What are some examples of GLP-1? Yeah, so GLP-1 medications are like you know. The brand names are Wagovi, ozambic, zepboun, manjaro. There certainly are other medications that we can use for weight loss. That and I do, which I do daily, and those are a Phentermine, a Contrave, which is bupropion and L-trexone, and then Metformin Topiramate. So there's certainly other options and stuff. Absolutely.
Speaker 1:Thank you so much for that. I also love that you mentioned that you spent a really good amount of time with your patients right 45 to 60 minutes, which sometimes that's unheard of. Yeah, because it's usually like when you think about seeing your provider right, it's okay 15,. Because it's usually like when you think about seeing your provider right, it's okay 15, 20 minutes. But it's so true, right, you really have to understand the root causes right Of obesity per se or weight loss or whatever the goals of the patients are, in order to really assist them right and giving them that holistic approach. So that's amazing that you're able to do that. Yeah, thank, you.
Speaker 1:Yeah, awesome. So when we think about long-term use of these medications, right. Can weight loss medications be used long-term and if so, what are the implications for maintaining weight loss?
Speaker 2:Yeah, so you know absolutely, Obesity is a chronic disease and, like I said before, we should be treating it as such. You know, when a patient has hypertension, we don't just start the medications and then their blood pressure gets better on the medications and say, okay, you're cued, now right, we try to put them on the lowest effective dose and that's really. You know my personal approach as well. You know, there's sometimes patients they don't want to take injections for the rest of their life, or they don't want to take injections for the rest of their life, or they don't want to take additional pills, and that's totally understandable. I really try to work with my patients and understanding, you know, what is the best thing that's going to work for them. Certainly, I've been able to get patients off the injections and they've been able to maintain, but there are some patients who actually like taking it and they want to continue it.
Speaker 1:So again, it's really individualized, but yes, absolutely, the medications can be taken for long term Awesome, so we know that combination with lifestyle changes right, how important it is for patients to combine weight loss medications with lifestyle changes such as nutrition, exercise, as you mentioned, sleep and stress management.
Speaker 2:Yeah, great question. It's so, so important for them for us to address it with them and then for them to actually work on these things. So that is something that I talk about with my patients on every single visit. We try to work together to increase their you know physical activity. So I have a lot of patients that come in that say we really don't do anything outside of going to work, maybe walking around at work and then coming back home.
Speaker 2:And while that is great, we have to dedicate a certain amount of time, focus time, that this is going to be my workout time. Not only is it important for your mental health to kind of just separate everything else and dedicate and focus that time to yourself because you deserve it, but it's so important to develop good habits, right, and so absolutely it's so important for patients to, you know, work on their diet and their exercise, because the medications are only, you know, they're not a magic pill, they're not going to work. To do all the work and substitute what your diet and your exercise would be additional supplements to losing weight.
Speaker 1:Yeah, I love that you definitely are mentioning that right, because it has to be, again, a comprehensive approach. And so, yes, we're using the medications, right, but we still have to make these meals balanced right. We still have to get the nutrients because we want to be able to feel our bodies properly, we want to be able to move our bodies for long-term health, right.
Speaker 2:Yep.
Speaker 1:And all that. So, yeah, also, I'm glad that you also mentioned that to your patients. So I think it's important to talk about the stigma right when it comes to like taking some of these medications. And so how do you address the stigma around using these weight loss medications, both within the medical community and with your patients?
Speaker 2:Yeah, so you know there is a huge stigma about using medications for weight loss in general. I think you know some clinicians, unfortunately, who are not very well versed in obesity medicine. See that it's a quick fix. Definitely there are some patients that you know don't understand that this is in conjunction with lifestyle changes, right? So having that conversation and making that conversation normal you know that's something that I do on the very first visit that, hey, the injections are only going to work as good as you make lifestyle changes. That is really when you're going to see the most amount of the benefits. Okay, and then, you know, having that conversation with other physician colleagues, like you know, educating them on weight loss medicine. So I do have a lot of colleagues in the community and you know, whereas maybe they don't have enough experience or feel comfortable with managing weight loss medications because of the side effects or the dose titrations, having that open door in terms of hey, you can call me anytime or send your patients to me and I'd be happy to kind of help with that weight loss process has been really great.
Speaker 2:And then I find that, you know, most patients want to talk about their weight. They just want it to be in a very respectful and a kind way and not accusatory. They don't want it. You know most patients, you know most people know they're overweight. Right, it's really about having someone to talk to in a nice and understandable way and not being condescending and demeaning. So I find that, as long as you approach it in a nice way, I've never had a patient give me pushback about well, you know, don't? I don't want to talk about my weight. I find everyone wants to talk about their weight. It's just really how you approach it.
Speaker 1:Yeah, that is extremely important, right, and and that you do that, that work with them, because it's so true, right. Oftentimes and I hear this from my patients too, right, like you know I feel so nervous when I go and see my provider, when I going to do take, when they're going to take my weight, because you know either, there hasn't been that connection where they feel comfortable talking to them about it or because it's always like, okay, you haven't lost weight or you keep gaining weight right, it's not more.
Speaker 1:So, okay, let's figure out why this is happening, right, let's talk about these things. And so, yeah, of course, they're going to feel like, oh my gosh, I don't even want to go to the doctor anymore because I feel like I just it's so triggering, right?
Speaker 2:so, yes, yes, that's a perfect word.
Speaker 1:It can be so triggering for so many of my patients, absolutely right, yeah, especially if they've been, you know, struggling with that all their life um and it's something that they're like.
Speaker 1:You know I've tried everything, uh, and you know I'm thinking I'm considering this weight loss medication, but there's so much information out there, you know, stigma about it. I don't want it to be seen as lazy, and sometimes I see that too in like mommy groups. You know they moms ask about these questions, right, like I don't want judgment, you know I'm not. It's not that I'm being lazy, right. It's just that I struggled with this for so long and, as we talked about, obesity is not just like oh, you just eat less and move more.
Speaker 1:There are so many other underlying reasons, right, and so I think you know the more that we learn about it and just removing that stigma, right, is probably going to get a little easier for people that are wanting to consider these medications too yeah, absolutely, I totally agree with you yeah, and I love also too that you that you have an open door right for other providers, other colleagues that maybe don't feel comfortable right with these weight loss medications, that they can reach out to you, and I think that that is a great approach, because if a provider right is not so comfortable, they can always either refer the patients to you or, like you know, ask you, because that is, you know, they're helping the patients further as well. So that's very nice that you do that too.
Speaker 2:Yes, thank you Absolutely.
Speaker 1:Yeah, so let's talk about maybe some of these challenges and misconceptions, right, like what are some of the common misconceptions about weight loss medications that you often encounter in your practice or that you hear often?
Speaker 2:Yeah. So probably you know that it's a quick fix or that they need to be on it for the rest of their lives. So I do encounter some patients who, you know, just want to take it for a short period of time and want to lose the weight that they need to. And you know, the biggest thing first is understanding. You know not everyone is a candidate for the medications. You have to be over a certain BMI and you also have to, you know, have some comorbid conditions if you're not over a certain BMI to qualify for the medications. So is that something that I discussed early on? That you know it's not. You know it's it's not. You know you have your brother's wedding coming up and you need to lose like five or 10 pounds to fit into your dress. It's really not about that.
Speaker 2:Thankfully, most of the patients that you know do come to my practice, do understand, have really been struggling from for with their weight Okay, and they are honestly ready to make change. So you know that's great to see. It's not a lot of me having to convince them about the process. I think they've done a lot of the research and that's how they've ended up. Coming to me is because they're either have tried with their PCP or have tried with themselves and they have failed. And so majority of my patients have been fighting with their weight for a long time. Majority of my patients have been fighting with their weight for a long time.
Speaker 2:And so you know, I think one of the common misconceptions is you know, that you know nothing is going to work and that they're going to end up needing bariatric surgery. And while there are indications for bariatric surgery, you know we as a medical society are moving away from bariatric surgery because we do understand and see, and I'm sure you've encountered patients like this too, where they've had the gastric sleeve and they've had the gastric bypass and they regain the weight back right. And so it's so essential in understanding how obesity works, in terms of understanding why is that happening? Right, if we're cutting out portions of their stomach and making it smaller, why haven't we fixed the weight problem? You know, and so we are understanding bariatric surgery is not the you know end all for that. And so, just going back to lifestyle changes, understanding why are they gaining weight in the first place, like what is going on at home, what is going on at work, what are the mental stressors that are involved in in all of that yeah, absolutely, and I think it's.
Speaker 1:Again, it goes back to really investigating, right, that root cause and addressing it. Uh, versus like, okay, let's just do that particular thing right and see what happens, because then we know what's going to happen essentially in a couple years or a few months or whatever. And so, um, yeah, that's a good point there. What in terms of future obesity treatment right, what do you see that that future obesity treatment heading to, particularly with regard to medication and integrated care approaches like, how do you see that change?
Speaker 2:Yeah, so it's been really great in the past few years in terms of some of the insurances finally covering the medications. It's still been a struggle, though, getting medications for patients. They want you to be really overweight or really sick to get coverage, so that's a constant battle that I'm finding. So I really hope that we're heading in that direction as well as insurance being more open to cover weight loss visits. That's kind of another, you know, huge issue is that they don't cover weight loss visits, so hopefully insurance is going to kind of understand that. You know weight loss is kind of related to every other condition a person can have, that you know weight loss is kind of related to every other condition a person can have.
Speaker 2:I hope that the future is going to involve understanding the need for a multidisciplinary team. You know I've been practicing obesity medicine for a while now and it's always been me just talking about their nutrition and their fitness and you know everything and I love doing that, but you know some patients do need more help and we do need. You know everything and I love doing that, but you know some patients do need more help and we do need, you know, dietitians like yourself on our team. So, understanding that it's a multidisciplinary approach, it would be amazing if they would cover gym memberships, you know, as an incentive, or offer patients discounts or reimbursements if they lose, like you know, 10 or 15% of their body weight and maintain it over the course of the year, I think, or gift cards or something. I mean.
Speaker 2:I think that the potential is endless, so really hoping that would have is going to happen. I think also there are new medications that are going to come out, hopefully. You know, zepan just came out this year and a lot of insurance picked it up for weight loss, so that's been great, but that is an injection. I do hear that some oral medications, similar, like GLP-1s, are going to be coming out, so that'll be a little bit more easier to get coverage and, hopefully, for patients to take. And then the biggest thing also that happened this year in January 2024 was Medicare started covering the weight loss medications, which is amazing because this was a huge population that needed coverage. So they do have some criteria for the medication coverage, but I mean, usually when Medicare starts something that other insurances follow. So I think that this was a huge thing to happen in the weight loss sector, so really excited to see what's going to come next year.
Speaker 1:Awesome. Yeah, that is wonderful. I didn't know that Medicare is doing that now. So it is absolutely true, right. Oftentimes insurances follow what Medicare is doing, and so just that change there can bring a lot of positive things. I love, obviously, that you mentioned that multidisciplinary team right, with having dieticians on board. Right, and just working with the patient holistically. Right, encourage them to exercise right, but you know, either helping them with that specific you know, gym or trainer or whatever the case may be right, because it does help. As we mentioned, the root causes is not only, you know, eat less, move more.
Speaker 1:It goes beyond that, right stress management and sleep, which you know your husband is an expert in that area and so I guess it's so amazing that we do see the patient as as a right and not only like parts and we can continue to see those changes in just obesity treatment, right, yeah, I'm excited to see that as well, and just the changes and obviously for better health for patients in general, because we know, as you mentioned right, even losing, even losing that five, seven, ten percent of their body weight can make a huge difference in their health. So that's exciting to see for sure yes, yes yeah, dr ragged, I know you're short time.
Speaker 1:Thank you so much for your time, but I want to make sure that the listeners know where to find you if there's a potential patient. Right, do you see only patients in the Central Valley in California?
Speaker 2:Right, yeah, so I'm happy to see patients via telemedicine as well, but, yes, I am located in Madeira, california. You can put my office name and address and phone number there. But I am accepting new patients and, yeah, you know, this is something that I'm so passionate about because I think it affects all facets of your life. When you feel good physically, you feel better mentally, you are able to put more positive energy into the world, and that is my entire goal.
Speaker 1:Absolutely, I think that's a mic drop there. We have nothing else to say. Absolutely, I think that's a mic drop there with nothing else to say. Yeah, definitely all your information in the show notes. So if you're driving or if you're busy, but you can always go back to the show notes and uh, and reach out to dr ragged and just sometimes, just talking to you, you know, to you dr ragged is a great start and then you know you can start. Dr Raggett is a great start and then you know you can start moving the needle after that. So any final thoughts, anything else that you want to say or anything else that you want to add?
Speaker 2:No, but thank you so much for having me. It's, you know, like I said, it's I love talking about this stuff, so it's been a great experience, but thank you so much.
Speaker 1:Yeah, absolutely, thank you. Well, thank you so much, everyone. Have a wonderful rest of your.