20 Questions That Will Change How You Think About GLP-1s

James Hill:
Welcome to Weight Loss And, where we delve into the world of weight loss. I'm Jim Hill.

Holly Wyatt:
And I'm Holly Wyatt. We're both dedicated to helping you lose weight, keep it off, and live your best life while you're doing it.

James Hill:
Indeed, we now realize successful weight loss combines the science and art of medicine, knowing what to do and why you will do it.

Holly Wyatt:
Yes, the “And” allows us to talk about all the other stuff that makes your journey so much bigger, better, and exciting.

James Hill:
Ready for the “And” factor?

Holly Wyatt:
Let's dive in.

James Hill:
Here we go.

Holly Wyatt:
Jim, can I ask you a question?

James Hill:
Uh-oh. Am I getting tested?

Holly Wyatt:
Actually, yes. Today, we're both getting tested, and so is everyone listening.

James Hill:
Oh, wait a minute. You didn't tell me there was going to be a quiz. I didn't study.

Holly Wyatt:
Well, you've spent over, what is it, 40 years? Are we at 40 years studying obesity? Yeah. I figured you would probably pass. But seriously, there is so much information about GLP-1 medications right now. And every podcast episode that we do on GLP-1s, it's the most popular by far, easily. Some of the information that people are getting out there and other places, some of it's excellent, some of it's misleading, some of it's just wrong. So today, instead of giving you another lecture, let's talk about GLP-1s. We're going to give everyone a quiz.

James Hill:
Oh, I love it, I think. Grab a piece of paper, keep score, and let's see how much you really know about GLP-1 medications.

Holly Wyatt:
Yeah, so why I think this is important or why we decided to do this is our listeners, patients, I mean, our friends, ask us questions every single day. Should I stay on these medications forever? Am I losing muscle? Should I force myself to eat? I get that one a lot. Why did my weight loss stop? Can I ever come off the medication?

James Hill:
Yeah, Holly. And the interesting part is that while some of these questions might seem simple, once you look at the science, maybe the answers aren't nearly as obvious as you might think.

Holly Wyatt:
I think that's true. And that's part of the confusion is people are trying sometimes to simplify something that just isn't simple. So today we're going to test what you know and explain the science behind every answer and talk about when it maybe isn't a clear cut answer.

James Hill:
So here's how we're going to do it. We'll ask a question and give you, the listeners, a few seconds to think about it. Then Holly and I will reveal the answer, explain the science, and hopefully surprise you a few times along the way.

Holly Wyatt:
And I challenge you, keep score. We're going to be curious how many you get right. So round one, how well do you really know GLP-1s? All right, Jim, you lead us off. Question number one.

James Hill:
Question number one is a true or false question. True or false? GLP-1 medications work because they give you more self-control around food. They give you more self-control around food. True or false?

Holly Wyatt:
It's a little tricky.

James Hill:
Yes.

Holly Wyatt:
All right. What's the answer?

James Hill:
The answer is, Holly, false. They don't create willpower. They change the actual biology of hunger, fullness, and food reward. So that one is false.

Holly Wyatt:
I think that's such an important one because I think people think the medication is giving them more self-control. And it's not. It's changing the physiology so they can use their self-control might be easier. But it's not really increasing willpower. It's changing physiology. And I think people get confused about that often. All right. Question number two, another true or false. The less hungry you feel on a GLP-1 medication, the better the medication is working.

James Hill:
Oh, that one may be a little tricky.

Holly Wyatt:
It is.

James Hill:
True or false?

Holly Wyatt:
True or false, guys. The less hungry you feel, the better the medication is working. I'm going to go with false on that. I don't think the goal should be to eliminate hunger. And I think that's what some people think, but I think that's a mistake. I think it's to restore a healthier appetite regulation to be able to work with, your physiology, your hunger, your satiety better, but not to get rid of it, not to eliminate it completely.

James Hill:
Yeah, I like that. I think that's exactly right. Less hunger isn't necessarily better in the long run.

Holly Wyatt:
Or getting rid of all of it, right? Eliminating it.

James Hill:
Yeah, that's right. You got to eat. You don't want to stop eating. That's not good for you.

Holly Wyatt:
Hunger is there for a purpose. It is. You may want to decrease it, but not eliminate it or get rid of it completely.

James Hill:
All right. Question three, we're still going to go with true or false. Weight loss plateaus or a normal part of losing weight, even when your GLP-1 medication is still working. Weight loss plateaus are a normal part of losing weight, even when your GLP-1 medication is still working. True or false?

Holly Wyatt:
This is another good one.

James Hill:
All right, Holly, the answer of this one is true. As your body gets smaller, your energy expenditure goes down. You're going to reach a point where your energy intake and expenditure are equal and weight loss is going to slow and stop. And that's good. You don't want to lose weight forever. So a plateau is something that you can expect with any means of losing weight.

Holly Wyatt:
Yeah, we understand that. We understand what the body is doing. And it does not necessarily mean that the GLP-1 is not working. It's normal.

James Hill:
So think about it. When you go on a GLP-1s, even if you stay on it a long time, there's going to come a point where you aren't losing weight anymore. That's expected and that's good.

Holly Wyatt:
Yes. All right. Question number four. I hope people are keeping track.

Holly Wyatt:
True or false, eating enough protein while taking a GLP-1 medication can help preserve muscle during weight loss. Yes. We've talked a lot about this on our show. It's a very popular question. So the answer, and I don't know that we have data for this for sure, but I think based on the data we have, I think the best answer would be true in terms of what we know right now. Protein, when combined with strength training, helps protect lean body mass during weight loss. That's the data we have. Although I don't think we have specifically looking at GLP-1s yet in this specific situation, but I would think that's what we should be telling people with the current data. And it may evolve or change over time.

James Hill:
Yeah, and the other thing is, we've talked about this before, but adding some resistance exercise along with protein is really the way to go. Protein needs the stimulus to really help your muscle and exercises that stimulus. So the data available suggests that protein can help some, but the combination of protein and resistance training is really better than either alone.

Holly Wyatt:
Yeah. And then I even saw a third, they're starting to talk about recovery also being important in there. So I think this is an evolving field that the GLP-1s have really pushed scientists to look at closer and to study a little bit. And I think we're going to get better information about what's really happening.

James Hill:
Absolutely. A lot of really good research going on in this area. So stay tuned.

Holly Wyatt:
All right. What are we on? Question five?

James Hill:
Question five. True or false, once you've lost the weight, your obesity is gone.

Holly Wyatt:
Oh, I think that was my question. This is such a good one. I love this question.

James Hill:
Once you've lost the weight, your obesity is gone. True or false? Holly, the answer is false. Your obesity isn't cured. Weight loss improves health, but obesity is a chronic disease that requires long-term management. And the best evidence there is once people go off the medications, in most cases, they regain most or all of their weight. So the GLP-1 medications allow you to lose the weight, but they don't make the underlying problem go away. You still have to do long-term management. So this one is false.

Holly Wyatt:
I agree. And I think this is one where people don't necessarily think of it this way. They think of it like a strep throat. You know, you have a strep throat. You take an antibiotic. In that case, you do get rid of the strep throat. It is gone. But that's not how obesity works. It's a chronic.

James Hill:
Chronic disease.

Holly Wyatt:
Yes.

James Hill:
All right, Holly, how'd you do?

Holly Wyatt:
Well, I did good. Let's ask our listeners.

James Hill:
Listeners, how did you do?

Holly Wyatt:
Did you get five out of five? Three or four out of five? You're doing great. Zero, one, or two. Don't worry. We're just getting warmed up.

James Hill:
And here's the good news. If some of those surprised you, you're not alone. These are some of the most common misconceptions that we hear every single day.

Holly Wyatt:
All right. The warm-up's over. We had five to warm people up. Now we're getting to the questions that even our listeners and patients, but even our doctors, my doctor friends, don't always get right. So we're stepping it up, Jim.

James Hill:
Oh, wow. We're going deeper, huh?

Holly Wyatt:
Yeah, going a little deeper.

James Hill:
Now we're going to do some multiple choice, Holly.

Holly Wyatt:
Okay, question six, which statement is most accurate? So you're gonna have to listen for them all, which is the most accurate. Everyone should work toward the highest GLP-1 dose available, that's A. B, the best GLP-1 dose is the highest dose you can tolerate. C, the best GLP-1 dose is the lowest dose that helps you achieve your treatment goals with acceptable side effects. Or D, the best dose is the dose that produces the fastest weight loss. Let's just get it done.

James Hill:
Wow, this one's not easy, Holly.

Holly Wyatt:
No, because it's most accurate. So you got to think about it.

James Hill:
A, B, C, or D.

Holly Wyatt:
And the answer is, I think the most accurate is C. The best GLP-1 dose is the lowest dose that helps you achieve your treatment goals with acceptable side effects. And this is where I think individualizing that GLP-1 treatment is so important. When we looked at the clinical trials, clinical trials just increase dose. They really don't allow as much individualization because you're under a protocol. But in reality, I think the goal isn't to get to the highest dose for someone that I'm treating. I mean, it may be in a clinical trial because they want to see what the maximum dose does. But for an individual, I don't think that's the best goal. I think it's to find the dose that provides the greatest benefit with the fewest side effects. Yeah, I think you're right. And that's the art of medicine, not necessarily the science is really helping that patient find that. We want to be on the least, the smallest dose that can produce the effect we want, the goal that we want with the least side effects. That's really where the sweet spot is.

James Hill:
I like that. All right, we're going to throw in another true or false one here, Holly.

Holly Wyatt:
Okay.

James Hill:
One of the biggest benefits of exercise, you know, I like exercise. One of the biggest benefits of exercise while taking a GLP-1 medication has nothing to do with burning calories. Whoa, true or false? The answer is, that one's true. Exercise does burn calories, and I'm not discounting that. That's a huge benefit. But a bigger benefit may be preserving muscle mass, improving physical functioning, improving metabolism, and supporting long-term weight maintenance. And on top of that, lots of evidence suggests that exercise improves overall health in ways that are even weight independent. So although exercise does burn calories, some of the biggest benefits of exercise aren't in calorie burning. They're in other aspects.

Holly Wyatt:
I think this is important because everybody thinks about, oh, I'm going out for a walk and it's going to burn 200 calories. Big deal.

James Hill:
Right.

Holly Wyatt:
And you're saying that's not the most important, that's not the biggest benefit. There's these other benefits that I don't think people think of as much in that metabolic flexibility that we've talked about so much, that allowing your body to be able to react and adjust to your fuel sources to help with maintenance, to me, is the key thing. And then there's so many more. You get bonus for all the other things you talked about. Okay. What are we on?

James Hill:
Number eight.

Holly Wyatt:
Question eight. Okay.

James Hill:
And keep track, listeners, and on the multiple choice, listen carefully as we go through them.

Holly Wyatt:
I think you can listen to us talk, but then when you really get a question and you have to answer it. You really get to see if you understand it or not.

Holly Wyatt:
That's why I like this. So question eight, a patient says, I've reached my goal weight. What's the next step? Which answer is the most accurate? So I've reached my goal weight. What's next? Okay, A, congratulations, you've reached your goal rate, so it's time to stop your GLP-1 medication. B, stay on the medication forever. Everyone with obesity needs lifelong treatment. C, the next step depends on your health, your goals, preferences, and risk of weight regain. This is a decision you should make with your health care provider. And D, stay on the medication until you reach a normal BMI.

James Hill:
That one's a little tricky too, Holly.

Holly Wyatt:
Yeah, a little tricky. And once again, it's which answer is most accurate. And I think the answer to that is definitely C. The next step depends on your health, your goals, your preferences, and the risk of weight regain. This is a decision you should make with your health care provider. And here's a perfect example where it's not that simple. People want to go and say, oh, this is what you need to do. And then an influencer may say, this is what I did, therefore, this is what everybody should do. But when we really look at it, I think there's lots of factors that play a role about what the next step is for you. And that's why having a health care provider there helping you make that decision is so important, in my opinion.

James Hill:
I agree. There's no single right plan. You've got to figure out the right plan for you.

Holly Wyatt:
Exactly.

James Hill:
All right. Question nine, Holly. Two friends start the same GLP-1 medication on the same day. It's like two trains traveling east and west.

Holly Wyatt:
Okay, two friends.

James Hill:
Two friends start the same medication on the same day. Six months later, one of them has lost 35 pounds and the other has lost 15 pounds. Which is the most accurate conclusion? A, the medication worked better for the person who lost 35 pounds. B, the person who lost 15 pounds probably wasn't following the program. C, both people may be having successful treatment because response to GLP-1 medications varies from person to person. And D, the person who lost 35 pounds was probably taking a higher dose. So which do you think is the most accurate conclusion?

James Hill:
Holly, I'm going to go with C. We know that the response to any weight loss program, including medications, varies considerably from person to person. Some people on the medications don't lose anyway, so we know there's a range of response. And rather than look at just the pounds lost, maybe we should judge success by improvements in health and progress toward individual goals, not comparing yourself with someone else. So we can't say the person that lost 15 pounds was a failure. Maybe that was a good response for them and they improved health. So I think it's difficult to look around and say, my friend lost this. I only lost this. It worked better for her. There's a difference in response and we can't simply just look at amount of weight loss.

Holly Wyatt:
Yeah. And this is important because when people hear the results of the pharmaceutical trials, they like to know, oh, the average weight loss was 40 pounds.

James Hill:
Right.

Holly Wyatt:
But one thing we didn't tell you at the beginning of this question was, what was their starting weight? And so if, you know, they started on the same dose at the same time, et cetera, but one person may have started at 300 pounds and one person may have started at, you know, 200 pounds. And that would be very different. That's why we a lot of times talk about percent weight loss and people don't like to think in percentages. But that's why really it's about percent weight loss. So it isn't just about even different people responding. How you look at it really is about percent weight loss. We have some data about a certain amount of percent weight loss tends to improve health. But you're right. It's also very individual. So there's many things about this question that I think could really lead you to that answer C, that it really varies from person to person. And we didn't have all the information we needed to be able to say who was the most successful.

James Hill:
All right. Question 10, Holly.

Holly Wyatt:
All right. 10. which statement would you tell a friend who's frustrated because the scale didn't move this week? Oh, this is a good one because this is what I get in my inbox. The scale did not move this week. All right. A, if the medication is working, you should lose weight every single week. B, weight loss is usually a straight line until you reach your goal. So you should lose a little bit every week. C, most people experience periods of faster and slower weight loss even when the medication is working well. D, if you don't lose weight during one week, you should probably increase your dose. Get that a lot. All right. Which statement would you tell a friend who's frustrated?

James Hill:
That's a good one.

Holly Wyatt:
The scale didn't move this week. And my answer is C. We're getting a lot of C's here.

James Hill:
We are. Yeah, it's a trend.

Holly Wyatt:
Most people experience periods of faster and slower weight loss, even when the medication is working well. Weight loss is not linear. It never is. Even on the meds, losing weight other ways. You don't lose the same amount each week. You may not even go down every week. Water weight and shifts in water play a huge role in kind of masking. Even if you are losing fat every week, you don't always see it. And this is a question I get, I got this before the GLP ones, but weight loss is rarely linear. Like I said, short-term fluctuations are normal part of successful treatment. One week of your weight not going down, do nothing. I would not do anything.

James Hill:
Got to look at the long-term and the long-term trends.

Holly Wyatt:
Yes, absolutely.

James Hill:
All right. Question 11, Holly. Which statement is most accurate about food noise? We hear a lot about food noise. A, food noise and physical hunger are exactly the same thing. B, food noise refers to persistent thoughts or mental preoccupation with food, which is different from physical hunger. C, food noise only affects people with obesity. Or D, if your food noise disappears completely, you'll never struggle again with weight. Which of those would you think is the most accurate? And again, the answer is B. Food noise is different from physical hunger. Physical hunger is your body's need for food. And food noise is this mental chatter that people talk about hearing sort of in the background about food. And one of the things about the GLP-1 medications is for many people, these medications reduce or completely eliminate the food noise. But it's important to understand food noise is not physical hunger. Those two are different.

Holly Wyatt:
Yeah. And I think the GLP-1s have really spotlight on this mental chatter are these thoughts about food that are continuously running kind of in the background has really brought that out. And now we're studying it. And I think we're going to do a whole nother episode on food noise coming up.

James Hill:
Right.

Holly Wyatt:
All right. Question 12. How's everybody doing? Hope they're keeping track. So here's a good one.

James Hill:
Our listeners are good, Holly. They're getting it all right.

Holly Wyatt:
Okay. All right. We don't even need this quiz, I bet.

Holly Wyatt:
All right. A patient tells you, I've lost 20% of my body weight. My blood sugar is normal. My blood pressure is controlled. I feel great. But my BMI is still in that overweight range. So maybe the BMI is the 28 or 29. I really think I should lose another 20 pounds. What's the most important thing to discuss next? How should you be thinking? A, increase the GLP-1 dose. B, whether losing more weight is likely to provide meaningful benefit. What do you want to discuss? Do you want to discuss whether it's going to be, you know, meaningful, additional health benefits? C, switching to a different medication. Or D, why BMI should always determine your goal weight. So what's the most important thing to discuss next? Increasing the dose to discuss whether losing more weight is likely to provide meaningful additional health benefits. C, switching to a different medication or why BMI should always determine your health goals.

James Hill:
Wow, good one.

Holly Wyatt:
And the answer that I would choose, the most important thing I think is B, to talk about whether losing more weight is likely to provide meaningful additional health benefits. This person's already lost 20%. So that's a big chunk of weight. Their BMI may not be in the healthy or normal weight category, but they've already had huge health benefits. So I think it's discussing what an additional amount of weight loss would do for them. And it may be that they want to lose some more. There may be some reasons to lose some more, but I think that's where this conversation should go. I wouldn't just necessarily talk about increasing the dose at this point or switching to a different medication. And we know that the goal is not to get your BMI to the normal range. That's not how we look at success when you're losing weight. So it's not to achieve the lowest possible weight. It's to achieve the best health. And once again, treatment goals have to be individualized.

James Hill:
Yeah, and that comes in over and over and over. You can't compare yourself to someone else's weight loss or judge your success simply by amount of weight you lose.

Holly Wyatt:
And that's why I think these questions, why it can get confusing out there is because people want a simple answer and it really has to be individualized. And that's why I think your healthcare provider is such an important resource for you to use in answering these type of questions about yourself.

James Hill:
Okay, Holly. Question 13. I've been on my GLP-1 meds for four months, but I'm hungry again before dinner. That must mean the medication has stopped working. Which is the best response? A, yes, the medication has probably stopped working. B, you should increase the dose immediately. Or C, appetite naturally changes from day to day. The important question is where the medication is still helping you meet your goals. Or D, maybe you should stop taking it. So which is the best if you've been taking it for four months, but you're hungry again before dinner? Which response is the best? And Holly, on this one, I'm going to go with C, that your appetite naturally changes from day to day. The important question is whether the medication is still helping you meet your goals. Again, a consistent theme here. You cannot look at just the short term. You can't look at weight over the short term. You can't look at hunger over the short term. Weight management is a long-term process, and you've got to look at the long-term trends, not the short-term day-to-day activity.

Holly Wyatt:
Yeah, yeah, I totally agree. I think the GLP-1s have made us think about, like, hunger is the enemy, and I don't think it is. And that's what kind of worries me a little bit about, some of what's happening out there. All right. What are we on, Jim?

James Hill:
We're on 14, Holly.

Holly Wyatt:
All right. Which person is most likely to benefit from meeting with a registered dietitian while taking a GLP-1 medication?

James Hill:
Oh, this is a good one.

Holly Wyatt:
All right. So A... Almost anyone starting treatment can benefit from learning how to meet protein and nutrient needs despite eating less. So almost anyone. I'm going to go with the next possibility is B, only someone with diabetes. C, someone who isn't losing weight. Or D, someone taking the highest dose. All right. What do you think? And the answer is A. You know, eating less changes nutritional needs. And I think everybody could really benefit from speaking to a registered dietitian, a nutritionist. Planning is important. And I think it becomes more important when you go on a GLP-1. So I know you're big on this, Jim, that you think this is a huge opportunity for people to use registered dietitians to help them.

James Hill:
I think I've told you before, every prescription for the med should come with a prescription for a dietician because they can help in so many ways to manage side effects, to make sure you're getting enough nutrition support. So these are great resources out there.

Holly Wyatt:
So there's not just one person I think anybody could benefit.

James Hill:
Yes, exactly.

Holly Wyatt:
Okay. So let's move to a different round.

James Hill:
Okay.

Holly Wyatt:
We're going to call this, what would you do? Round three.

James Hill:
Okay, question 15. You've been taking a GLP-1 for three months, and suddenly you realize you're eating less than 800 calories a day, but you feel fine. What's your next step? What should you do? A, keep taking it because faster weight loss is better. B, you should probably stop the medication at this point. Or C, talk with your health care team and make sure you're getting enough protein and nutrients. Or D, you can skip breakfast and keep your body in a fat-burning mode. Which should you do? Holly, the answer here is C. You should talk with your health care team. Make sure you're getting enough protein and nutrients. You're going to be eating less, but the quality of your diet becomes critically important. Again, and this is where healthcare professionals like registered dietitians can look at not just how many calories you're getting, but are you meeting your needed nutrients? And that's really important.

Holly Wyatt:
I think that the key here is what's the best next step. And I think the best next step is to talk with your health care team and make sure that you're getting enough protein and nutrients. It may be after talking to your health care team, if you're still consistently eating less than 800 calories, it might be you want to decrease dose or do something. But I think that's the next best step is to contact that health care team and look a little closer about what's really going on.

James Hill:
Right.

Holly Wyatt:
And I think the other point of this is the feeling fine, you know, but I'm feeling fine doesn't always mean you're getting what you need nutritionally.

James Hill:
That's right. Yeah. Again, short term, you want to look at are you getting enough nutrients to keep you going and healthy over the long term?

Holly Wyatt:
Yeah. Yeah. All right.

James Hill:
All right. Question. 16. We're rolling here.

Holly Wyatt:
All right. Your friend has lost twice as much weight as you on the same GLP-1 medication. What's the most accurate explanation? Oh, so your friend's lost twice as much. All right. A, the medication isn't working for you.

James Hill:
Okay.

Holly Wyatt:
B, everyone responds differently to treatment. C, you're not trying hard enough. You're not doing as much as your friend. D, your friend must be eating less than you.

James Hill:
Hmm.

Holly Wyatt:
This is a little tricky.

James Hill:
It is a little tricky.

Holly Wyatt:
A little tricky. I think the best answer, the most accurate explanation, although some of the others might be true, but I think the most accurate is B, everyone responds differently to treatment. And I think the tendency is to go and say something like, well, I'm not trying hard enough or my friend is eating less. But that may or may not be true because we know there's a huge variety, you know, and you're kind of seeing this theme, different people react differently to different meds, respond differently. So I think that's important to recognize so that you don't make a decision that isn't true. Oh, you know, I need to switch meds. That may not be the case. So response to the GLP-1 medication varies widely. And even among people taking the same drug, you get very different responses, outcomes.

James Hill:
Holly, I'm perceiving a theme here.

Holly Wyatt:
I do.

James Hill:
People respond very differently to these medications. And you shouldn't judge yourself against others. Judge yourself against your plan and your response.

Holly Wyatt:
And I think this is important because a lot of the questions I get are about this. And I think this is where the confusion is, because sometimes people want to come out and say, this means this, and you just can't do that.

James Hill:
Right. All right. Let's do question 17.

Holly Wyatt:
All right.

James Hill:
This is a good one. You've lost 40 pounds on a GLP-1 med, but you're feeling weaker and finding it harder to carry groceries or climb stairs. What's the biggest concern? A, you're probably dehydrated. B, you may be losing too much muscle along with fat. Or C, the medication dose is too low. D, you're exercising too much, which is probably the thing that's going on here. So think about your answer. I'm going to go with B. I think part of the problem is that you may be losing too much muscle, and you may want to think about adding some protein, adding some exercise. It's about preserving strength and function, not just about weight loss. So think about trying to do some strategies which limit loss of muscle and increase the function of your muscle. And that, the best we know right now is protein and resistance exercise.

Holly Wyatt:
And I think the key in this question was finding it harder to carry groceries, to climb stairs, to do some of those functional activities that require strength, the climbing of stairs. And so that was really, it could be that you're dehydrated. It could be that you've been exercising too much. But I think those type things would make me want to think about what's going on with my muscle. Am I losing muscle? Am I losing function?

James Hill:
Right.

Holly Wyatt:
All right. We're going to move to round four. And I called this round, Everybody's Talking. This is about the kind of social media stuff, the questions out there on social media. So we're going to try to answer a few of those. All right. Question, what are we on? 18?

James Hill:
I think we're on, yeah, 18.

Holly Wyatt:
All right. Social media is full of posts about Ozempic face.

James Hill:
I've heard that.

Holly Wyatt:
We've talked about this a little bit. What is the most accurate explanation for ozempic face? A, GLP-1 medications damage the skin on your face. B, losing facial fat during weight loss can change how your face looks. C, GLP-1 medications make you age faster. D, the medication causes your facial muscles to shrink. So what do you think? I think the answer, the most accurate, is B. Losing facial fat during weight loss can change how your face looks. And I know out there on social media, people talk about muscle loss, talk about all kinds of things. But I think right now, based on what we know, it's about losing the facial fat. Facial changes are primarily due to the weight loss, not damage from the medication, not damaging your skin. And I don't think it's from muscle loss in your face. It's like you have a lot of, some people have more than others, have a lot of fat carried in their face, and you lose that fat just like you lose fat from other places. And that impacts the shape of your face. And it impacts how your skin looks over where that fat used to be. And so I think the most accurate answer is that that's the reason why your face could look differently.

James Hill:
So it's not the medication. It's the weight loss.

Holly Wyatt:
Everything we know right now. And I know that there's on social media. That's not what everybody's saying. But I think all the data we have is we don't have any data to say that the medication is doing something to your skin. It's from fat loss, which fat loss can happen from GLP-1 medications or from other ways. When people will have the bariatric surgery, they also have similar changes in their facial features and how their face looks. I think what's brought it up is now we have a lot of people losing significant amount of weight on GLP-1s. And so a lot of people are saying, look, this person looks very different, and that's really brought it out in the social media.

James Hill:
So a lot of what may be attributed to the meds is actually an effect of weight loss.

Holly Wyatt:
Yes, of a significant amount of weight loss. So, you know, five pounds, you may not see it. But when you start to get up to 30 and 40 pounds, it starts to be more evident in more people.

James Hill:
Okay. All right. We're on question 19.

Holly Wyatt:
Yep.

James Hill:
Which social media claim about hair loss on GLP-1 medications is most accurate?

Holly Wyatt:
Oh, my gosh. I get a question on hair loss probably every week.

James Hill:
All right. A, the medication permanently damages your hair follicles. B, hair loss can happen with rapid weight loss and poor nutrition, regardless of how you lose weight. Or C, everyone taking a GLP-1 meds will lose hair. D, hair loss means you should immediately stop the medication. Again, about a question on meds versus weight loss. And the answer is B, hair loss seems to be a function of weight loss, just like ozempic face. It's not the meds, it's rapid weight loss, because we know that hair loss can happen anytime with rapid weight loss and poor nutrition. So you can't blame the meds for this. It's probably effect of the rapid weight loss and your change in nutrition, maybe suboptimum nutrition.

Holly Wyatt:
Yeah. So it could be one or the other. I think it could be, some people, it could be really nutritionally related. For others, it may be the stress, the body seeing stress of rapid weight loss may cause the hair follicles to get into a cycle that they all tend to fall out at the same time. So you notice a lot of shedding. But we don't have any data right now to say that the drug itself is doing something to the hair follicle or the drug itself is causing the hair to fall out. It seems to be the same mechanism that weight loss can cause hair loss. I mean, for many, many years, people came to me and said they were losing their hair, and this was before the GLP-1. So we don't have any evidence that the mechanism is different for the GLP-1s.

James Hill:
Right.

Holly Wyatt:
All right. Should this, this will be our last one. Then I think we have some bonus ones, do you think?

James Hill:
Okay.

Holly Wyatt:
All right. Question 20. You've seen ads for natural GLP-1, gummies, powders, supplements on social media, which statement is most accurate? A, they work the same way as prescription GLP-1 medications. B, most have not been shown to produce the same effects as prescription GLP-1 medications. C, they're stronger than prescription. D, the FDA recommends them before you go on a prescription.

Holly Wyatt:
All right. The answer to this is B, most have not been shown to produce the same effects as prescription GLP-1 medications. And I think this is important because people are spending money on these powders and gummies, and they're marketed, they use the GLP-1 name, but they are not equivalent to the prescription GLP-1 medications. They haven't been studied. If you put these, even if they say they're the GLP-1 meds, unless you have a special wrapper, we call it a wrapper around the medication, when the prescription oral pills do have this wrapper... Most things that you would just eat would be, you know, your stomach acid would disintegrate, would not allow it to go into the small intestine. So they're just not tested. They don't have the same effect. But people are spending a lot of money on these. Prescription injectable and prescription oral meds are made to and studied and are just in a completely different category.

James Hill:
Yeah, Holly, we've talked before about how these work. These medications go on receptors and sit there for a long period of time. All these other things are small in comparison. Yes, they might create a small little bump in GLP-1, but it's nothing like the sledgehammer effects of the medications. And so beware, buyer beware when you look at products that are advertised as natural GLP-1 agonists.

Holly Wyatt:
Yeah, yeah. All right. that was 20 questions, Jim. I mean, we have some more, but I think maybe that's enough.

James Hill:
We could go on and on.

Holly Wyatt:
We could. Maybe we'll have a second show on that. I think we had a couple bonus ones, though, that we wanted people to think about.

James Hill:
Okay, let's do this one. Think about what's one thing that you believe about GLP-1 medications now that you didn't believe 45 minutes ago? What have you learned in this podcast that maybe helps you think differently about the GLP-1 meds?

Holly Wyatt:
And I would love for you to send us that.

James Hill:
Yeah, let us know. We want to hear from you.

Holly Wyatt:
Yeah. You know, I think not over the last, you know, 40, 45 minutes did I learn this, but I do think what I've learned over the last months and maybe even the last year or so is this individual response that we really need to understand that better. And that's something that the listeners may not understand. So I hope that one thing maybe people realized is you really need to individualize this and that you can't just look at someone, your best friend, or look at someone on social media and say their response should be your response. That to me is an important learning.

James Hill:
And one of my favorites, Holly, is it's a long-term process. Don't look at short-term effects on weight, appetite, whatever. Weight management is a long-term game. Look at your long-term trends. It's not linear. You're going to go through periods of success and less success, more weight loss, less weight loss. Look at the long-term.

Holly Wyatt:
Yeah, definitely. All right. One more question. What's the biggest misconception about GLP-1 medications that you hope disappear over the next five years? I'm going to ask you this one, Jim. This is maybe not for our listeners as much as for you.

James Hill:
What I think, I hope that people get is the idea that the medications don't cure the problem. The medications work to affect your biology, to allow you to be satisfied on eating less food, and that causes weight loss. But the problem isn't solved. So you've got to look beyond the weight loss. I tell people, assume when you take the meds that you're going to get to a weight you're happy with, now what? And this is where you need to have a long-term plan, and that's individualized. For some people, it's continuing on the meds. For some people, it's going off the meds. For some people, it may be different ways of using the meds combined with lifestyle. The medications do not cure the problem. They give you a biological advantage in losing the weight and being happy eating less.

Holly Wyatt:
Yeah, definitely, definitely. I think for me, one of the things, I don't know if it's a misconception, but where I see us going that worries me a little bit is I hope people start to realize that hunger is not the enemy.

James Hill:
Right.

Holly Wyatt:
It's like, oh my gosh, I'm not hungry at all. This is a great thing. And I'm like, wait a minute. Oh, wait a minute. I don't know. We're going to swing too far. I worry we're going to swing too far and that we're going to want to just cut out everybody's hunger.

James Hill:
Hunger's there for a reason. It plays a really important role for humans.

Holly Wyatt:
Yeah, I agree.

James Hill:
All right, people, how did you do? How did you do on the 20-question quiz? Hopefully, you got several right. You may have learned some things so that next time we do a quiz, you'll do a little bit better. Or maybe you got a perfect score. But the problem, it really wasn't about getting a perfect score, Holly. It was about trying to communicate some things that we're learning about GLP-1 medications. This field is moving so fast. We're learning new stuff every day. And hopefully, we're going to continue bringing you those new things and helping you use these medications in the best possible way for long-term weight management.

Holly Wyatt:
Yeah. And I think that the more you understand the science, and not that it's just yes, no. I think we tried to make these questions so they were a little bit tricky, a little bit, you know, the best answer type thing, because the more you understand the science, the better decisions you can make for you.

James Hill:
Yeah. Well, thanks, everybody. We hope today's conversations leaves you a little bit more informed and maybe a little less confused.

Holly Wyatt:
Yes. All right, guys, tell us how you did and we'll see you on the next Weight Loss And. Bye.

James Hill:
Thanks for playing along. See you.

James Hill:
And that's a wrap for today's episode of Weight Loss And. We hope you enjoy diving into the world of weight loss with us.

Holly Wyatt:
If you want to stay connected and continue exploring the “Ands” of weight loss, be sure to follow our podcast on your favorite platform.

James Hill:
We'd also love to hear from you. Share your thoughts, questions, or topic suggestions by reaching out at weightlossand.com. Your feedback helps us tailor future episodes to your needs.

Holly Wyatt:
And remember, the journey doesn't end here. Keep applying the knowledge and strategies you've learned and embrace the power of the “And” in your own weight loss journey.