How GLP-1 Medications Changed the Science and Art of Sustainable Weight Loss with Arne Astrup

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, we talk about GLP-1 medications a lot on this show. It really is something everybody wants to know a lot about. We get a lot of questions. But today's episode isn't about how to use the medications, how much weight people lose, whether they work or not. It's about why they were needed in the first place.

James Hill:
Yeah, Holly, for decades, people have really gone through the same pattern. They lose weight, the hunger increases, and the weight comes back.

Holly Wyatt:
And for a long time, medicine didn't have a clear biological explanation for that experience. We talked a lot about willpower, but we really didn't understand the biology behind it.

James Hill:
Yeah, and today we're going back to the science that helped explain why the body responds this way after weight loss and how that understanding changed the way we treat obesity.

Holly Wyatt:
This episode is about where the GLP-1 story really began and why that history matters for anyone trying to lose weight or keep it off.

James Hill:
Holly, we continuously get awesome guests on this show. I don't know why people keep joining us, but they do.

Holly Wyatt:
From everywhere, too.

James Hill:
From everywhere. And we get the best in the world. And let me tell you, we've got the best today. We've gone across the pond to Denmark for today's guest. And we're joined today by Dr. Arne Astrup. Arne, when people say, oh, he's a leading researcher. Arne is one of the world's leading researchers in obesity and nutrition science. And he's been that way for many years, Holly. He's almost as old as me. He's a little younger, but not. He's very, very close.

Holly Wyatt:
Wow, Jim, that's up there.

James Hill:
I know. We got to get the elderly in here, you know. But Arne, he spent more than three decades at the University of Copenhagen. He served as department head of nutrition, exercise, and sports, and he has just published an enormous body of research. But in the mid-1990s, he was working closely with Professor Jens Holst, and together they really developed the foundation of how GLP-1 plays a role in appetite regulation and satiety. This was work that laid the foundation for everything that's happening today with the GLP-1 medications. And in 2020, Arne sort of crossed over and went to work for the Novo Nordisk Foundation. So rather than applying for grants, he was actually giving out grants and was able to sort of lead their work on global nutrition challenges and obesity prevention. Arne has seen the full arc of the science from early physiology to real world treatment. Holly, he knows a lot about this area and we're thrilled to have him with us today.

Holly Wyatt:
Yeah, and I think it's so interesting that this spans almost 35 years. We're going to see he started studying this in the 1990s, and here we are in 2025. And I think that's important for people to realize how long sometimes it takes for science to understand something and then how it gets placed into now a medication that millions of people are using. So Arne, welcome to Weight Loss, And. We're so glad that you're here.

Arne Astrup:
Oh, thank you so much. And thank you for this flattering introduction.

Arne Astrup:
It's a great pleasure for me to be with you.

James Hill:
So, Arne, take us back to the 1990s. Sort of set the stage. Where was the obesity field then in sort of understanding and treating obesity?

Arne Astrup:
I think that was really in the old days where still people were looking at people living with obesity as somebody who was missing the willpower really to keep the food intake down. And probably they were also regarded as being lazy. And even though that there's still some people who have this stigmatizing view, but I think at that time it was mainstream. And I think it was also due to the fact that we had a very poor understanding of the physiology of weight gain and obesity and really did not understand much about how appetite regulation was taking place physiologically. So at that time, I think appetite and satiety was something where when the stomach was empty, you was hungry due to some probably some nerves that were sending signals from the stomach to the brain. And when some food came down to the stomach and filled it up, you would, again, get some gastric distension, and that would also send signals to the brain that now it was full. So, I think at that stage, it was probably also this idea all calories are the same, and you have some food down in the stomach, it's good. So, we didn't really know anything about appetite hormones, hunger hormones, satiety hormones. And at that stage, we were really, yeah, it was a kind of black box what was going on there.

James Hill:
Well, you know, I love to hear stories about how these things start. So tell us the story of how did you form the collaboration with Jens and why did you look at GLP-1?

Arne Astrup:
I think the story behind this is that we were both working at what was called at that time the Department of Physiology at the University of Copenhagen. And Jens is about 10 years older than I am, and he was an associate professor, and I was just doing my PhD thesis on energy metabolism in humans and had started to be more interested also in appetite regulation. But Jens, he was not working in the obesity field at all. He was really a kind of a diabetologist. And what he was doing, he was chasing the incretin hormones. If you inject 100 grams of glucose into the bloodstream, you get a certain increase in glucose and in insulin. But if you eat, instead of injecting it directly into the bloodstream, if you just ingest it or eat it, you get a much bigger insulin increase.

Arne Astrup:
And, you know, everybody knew that the only explanation for that extra insulin production was due to some factor that must be released from the intestine, from the gut, and stimulating the pancreas to produce some more insulin into the bloodstream. And many scientists, they were chasing these incretin or some factors or hormones that were stimulating insulin because they had the idea that that could actually be an important tool in the management of diabetes. If you could get a better understanding of that hormone, it could be a drug target too. And so, you know, Jens Holst and Joel Habener from the U.S and a couple of others, they were actually the first one to isolate GLP-1, to identify GLP-1 as a peptide hormone that was released from the small intestine. And they showed in isolated pancreas that when they infused this GLP-1 into the pancreas, there was more insulin coming out. And at that stage, there were also a lot of animal studies on this, of course. But there was a lot of discussion whether or not it was also having some effect on the brain, on appetite.

Arne Astrup:
But there were some early indications also that this GLP-1 could work back on the stomach to slow down stomach emptying. So when he was working with this I simply told Jens that but you know if this peptide is coming out from the gut and it's coming out when you eat. It's particular when you eat protein and fat that stimulates the release of GLP-1 into the bloodstream from the gut. So I said, you know, we don't understand how the brain have information about how much food we have in the stomach and in the small intestine. So maybe some of these hormones you're identifying and GLP-1 could actually be, don't you think it could be a hormone that is also telling the brain that now there's food and you should stop eating? So we said, well, that's a good idea that it's been suggested, but let's do something about it. So I had developed in my lab at that time a setup where we could measure appetite based on visual analog scales. And we had done some big studies really to validate this methodology. We had also set up a lab where we could serve a lunch buffet for experimental subjects, a lunch buffet where we had all dishes were on scales. So when people were eating something, you know exactly how much they have taken from different and how much they had consumed.

Arne Astrup:
So I felt we had the methodology. So we actually got GLP-1 synthesized commercially, and then we infused it in a drip. And, you know, another day it was saline instead of a kind of placebo. And we did this double blind. And so we could, in normal human valence as young people, we could show that the day when we infused GLP-1 and they got a breakfast meal, they got much faster and more satiated and felt more fullness.

Arne Astrup:
And when they were allowed to have the ad libitum lunch, eat until you feel full, they were eating, I think, about 12 percent fewer calories that day. So I think that was really the first time that it was shown in humans that that GLP-1 is actually a satiety hormone.

James Hill:
That's how it started, Holly. That's amazing.

Holly Wyatt:
Well, I didn't realize. I knew it kind of started as a diabetes medication. And when it when it came out, it was first as a diabetes medication. But I didn't realize that early you already were seeing GLP-1's effect on appetite regulation. That was early.

Holly Wyatt:
Why did it take so long? You already had made the GLP-1, not the analog, but the GLP-1. Why did it take so long for it to become a medication?

Arne Astrup:
I think, you know, GLP-1 is a hormone that is released from into the bloodstream, but it has a very short half-life of a couple of minutes because it's broken down by an enzyme, DPP-4 it's called, that is circulating in the bloodstream. So it means that if you should use it as a drug, you should have a pump or a drip you should carry around, or you could use an insulin pump. But it means it should be supplied to the bloodstream all the time. So it was not really suitable for being a drug. But then the companies, the Nordisk and Eli Lilly, they started to manipulate a little bit with the GLP-1 molecule by adding a small group to the molecule. They could actually prevent the enzyme and slow down the degradation, so it would last longer. And I think the first drug they came up with was liraglutide. It had a half-life of not minutes, but I think it was 14 hours. So it meant that you could take that as a daily injection. You couldn't eat it because it would be, you know, being a protein, it would be treated like a part of a beef or steak. It would simply be digested. So you needed to take it as an injection.

Arne Astrup:
And liraglutide was the first one that they came up with. It was a daily injection. And then later on came semaglutide or Wegovy Ozempic, that is a weekly injection. And now I think there are different compounds out there that can be taken once monthly even.

James Hill:
Wow.

Arne Astrup:
But of course, all this takes time and you need to go through all the regulatory phases, phase one, two, three of different studies, of course, to show that it's safe and does not really have adverse effects and also the efficacy and all this. It takes time.

James Hill:
The three of us have been involved in looking at a lot of medications over the years. Why are the GLP-1 receptor agonists, why are they so much more effective than any of the other medications that have been developed to treat obesity?

Arne Astrup:
It's a good question, Jim, but I must say that we were actually working with a couple of other compounds that was almost as effective, but, and I think that that's really the key issue. We worked with a compound named Tesofensine, and it was what was called a triple reuptake inhibitor. So it was working on both noradrenaline, serotonin, and dopamine, three of the major signal substances in the brain as well. So it was actually producing 12 or 14-kilo weight loss over three to six months. But, you know, because it was working on all these neurotransmitters in the brain, it also produced a lot of side effects. So, you know, people, they got memory loss and there was stimulation of their blood pressure and heart rate. And, you know, there were all kinds of cognitive and memory and also the emotions, et cetera.

Arne Astrup:
And, you know, I think that's really the story about all the old fashioned obesity drugs that were essentially discovered by a coincidence. That when they were chasing some other indications, whether it was for psychiatric diseases or Parkinson's or Alzheimer's, they discovered that some of these centrally acting drugs, that they were also producing weight loss. Apart from the weight loss, they had multiple effects on the brain.

Arne Astrup:
And that's, of course, if you want to lose weight and it's not acceptable that you have so many side effects and you know everything about that, Jim. Also, the Rimonabant, where you also had an increased risk of depression and suicidal ideation, et cetera. And that's, of course, completely unacceptable. And I think here with moving into something that a physiological peptide, which made major function essentially is to slow down gastric imaging and work directly on the brain so you feel more fullness and satiety, is a much more clean drug. Because it does not have a thousand different effects on the brain. And what it's doing on the cardiovascular system is mainly secondary to the weight loss. So what we see is it's actually doing all the good stuff you see from a weight loss at decreased risk of type 2 diabetes, even reduction in cardiovascular events, and maybe also some reduction in dementia and other things. So you don't really see all the side effects that because it's a more clean drug that seems to be working mainly or only on the appetite regulatory system.

Holly Wyatt:
But this is always interesting to me because you're right. I always thought we had some drugs that when they got powerful enough to produce a significant amount of weight loss, they had carried a lot of side effects with them and that wasn't acceptable. And here, these new ones don't, the GLP-1s don't seem to be doing that. But at the same time, they're increasing the amount of GLP-1 that the analog to drug is supra-physiologic, right? Very much higher than what we produce in our bodies. And there's receptors all over our body, not just in our brains. And we're seeing, I think we're just uncovering all the things that this drug might produce, the GLP-1s. So why, I still wonder, you know, why is it so clean? Why is there no downside to sitting on this GLP-1 receptor all over the body?

Arne Astrup:
Well, it's a good question because you could say biologically, it's a little, I think we got lucky here. You're right there, there are GLP-1 receptors. For example, if you look at the GLP-1 receptors in the pancreas, it's true that it's mediating increased insulin secretion. But when you take GLP-1 analogs, you actually see the opposite, that insulin secretion is decreased.

Arne Astrup:
And that's because GLP-1 has such a powerful effect on gastric emptying. So it means when you eat your meals, it takes much more time for the food to come down to the small intestine where it's absorbed. So it means that the blood sugar response is really suppressed and delayed. And that's really what triggers insulin secretion. It's the blood sugar increase. So because it's flattened down and much more, much lower and slower, insulin secretion is actually lowered dramatically when you are using GLP-1. And that's good because hyperinsulinemia is not a good thing for your appetite regulation and for diabetes, etc. So in some way, they were chasing an incretin hormone they suspected would stimulate insulin. But actually, what they found was a hormone due to other effects that was lowering insulin. So, there are many coincidences in this world. But now you also alluded to that that might be other effects because it's also, for example, there's been GLP-1 receptors in prostatic tissue.

Arne Astrup:
But it actually looks like that for those using GLP-1, that there is a lower risk of developing prostatic cancer. So, you know, some of these effects, I would say by a biological coincidence, because nobody knew anything about it. But it turned out to be an upside, not a downside. So, of course, we have too little evidence. And it's something that has been observed in the big cohorts of people now have been using these GLP-1 analogs, and they have compared with other diabetes medications that can see that those who get the GLP-1, they have much lower cancer incidence in different tissues.

James Hill:
It's really amazing how clean these medications are turning out to be. But one of the areas that there's a lot of controversy around with the medications, Arne, is are they producing more loss of muscle mass than anticipated? What's your thought about that?

Arne Astrup:
Well, this is clearly a topic that have got a lot of attention, I think, for very good reasons. But after analyzing all the data we have available, first of all, I think that there's no evidence that it's the GLP-1 in itself. It's not the GLP-1 molecule in itself that is having a direct effect on muscle or bone. I think what is the most likely explanation is that when you start treating people with obesity with GLP-1 analogs, you will see there is major differences in the sensitivity between people. So there are some people who will respond at the lowest dose. They will respond with a huge satiety effect where they actually almost completely stop eating the first week or so. Whereas other people, they can't feel anything. And they really need to go up to a very high dose before they start to see any weight loss. And most of the people actually within between these two extremes. But I think the problem is that if you suppress your food intake that much that you come down to almost nothing or maybe just five, six, seven hundred calories per day. And it's your usual diet. And so, you can easily calculate that it will reduce your protein intake and intake of calcium, vitamin D and other essential vitamins and minerals to a degree that where you actually get too little.

Arne Astrup:
I suspect that this is a protein malnutrition as a kind of side effect that the drug is so effective in some people that they actually get a huge suppression of their food intake. And nobody really, if you go back and look at the history of all the other obesity drugs that we have been seeing over the last 40 years, it's never been an issue really that they were too effective because what we normally saw was it was a weight loss between three or six kilos over three to six months. And with that rate of weight loss, there was no risk really to get any nutrient deficiencies. So I think it's a new phenomenon because these drugs are so effective, and particularly in the subset of the patients, you could call them hyper-responsors, they essentially stop eating. And I think the mitigation strategy should probably be that we need to be much more focused on also have dieticians to instruct the patients about this. And today, I must admit that most physicians are not aware of it, and we see too many clinics who just order the right prescriptions over the web, where they essentially don't see the patients. So I think this is a risk that we need to take much more serious than we have done so far.

Holly Wyatt:
I agree with you. I was just in a little bit of an argument with a couple of physicians who were using this drug and saying, we don't need to do anything. It's just an algorithm. And I'm like, whoa, whoa. You know, I love the science of medicine, but there's an art to it too. And that's part of it. Not everybody responds the same in terms of side effects. Some people have nausea and vomiting and that needs to be treated. And some people lose different amounts of weight and need. And I think this is perfect because people are saying, “Oh, do I need to eat more protein or not?” I think it depends. It's not just one size fits all. You really need to have somebody who understands and can help you maximize the benefits of these drugs without the side effects. Get the biggest bang for your buck in the safest way. And I love what you're saying because I think it makes sense.

Arne Astrup:
But I think another part of the story is also if you, of course, if we look at the clinical trials that have been published in New England Journal of Medicine, all the, you know, part of the package to be submitted to the FDA and the European authorities. Of course, all these trials where it's really strictly controlled, it looks like that there's no problem. But in real life, when we started out, there are many studies that have used registers to see how it's working in real life. I think after three months, it's almost half of the patients who stopped taking the medications. And after six months, it's even worse. And I think it was never the intention that it should be working and be taking it that way because so all the benefits are gone. And I think part of the story is also that many people, they are not well informed about the completely harmless side effects as you will get some nausea. You can also get some reflux, particularly if you are plus 50 years old. Reflux is quite a common phenomenon.

Arne Astrup:
But you know it means if you by coincidence have eaten too much for your dinner you should be sitting up in your bed and sleeping. There are some problems where people they don't understand this and don't know how to cope with that because nobody told them that this could happen and you know there's a lot of way how to deal with it so you could get rid of it because it's quite harmless. But of course, it's an issue for a patient if you don't know what to do and nobody told you. And you say, I don't tolerate GLP-1 analogs. Patients have told me. So what do you mean you don't tolerate it? Is it a rash or, you know, no, no, no. I get this reflux and nausea and it's really unpleasant. And some of them were titrated up in dosage and they should be kept on a lower dose because there is tachyphylaxis which means, you know, that most of these side effects will go away over time and it will be better tolerated and still, it will have the effect on your appetite. So I think there is a need for dieticians and nutritionists to assist the patients. Also, if they want to stop taking the medication, they also should be fully aware of, unless they have changed their dietary habits and started to do more exercise training, et cetera, they will simply start to regain the weight because there's no drug that is working beyond its taking.

James Hill:
Yeah, and we always recommend working with dieticians. I mean, they can do so much to help with the side effects, help avoid nutritional deficiencies, et cetera. But you raise a good point. In this era of such effective medications, is there still a role for lifestyle, for diet and exercise?

Arne Astrup:
Definitely, definitely. Because you actually only have two options in reality. If you start taking a GLP-1 analog, these medications, and you lose 20 to 30 kilos, and you get a huge benefit in terms of quality of life and what you could do, and also all your comorbidities are improved or have disappeared. You should either continue taking the medication for the rest of your life. The only alternative is probably to reduce the dose and see how much you can do without. But you cannot do without unless you have removed some of the cause of your weight gain and your obesity problem.

Arne Astrup:
And we know it's really difficult. But we also know that if you start doing more regular exercise and if you make some changes in your diet and your lifestyle, it is possible actually to prevent some of the weight gain. And it's been shown in a study actually from the University of Copenhagen where they randomized it was with liraglutide, the first GLP-1 analog.

Arne Astrup:
It was a one-year trial where they showed that people were random. They all got the drug but half of them, they got a much more regular exercise reinforcement program that was running for a year. And then when they stopped the trial after one year, they did follow up another year later. And those who were engaged in that exercise program, they had much less weight regain. So I think this is a very good study that really demonstrates that there's a huge benefit from an exercise program which is it was actually it was not a big deal. It was two or three times a week they were supposed to do half an hour and also use their step count or more etc. So it was simply emphasizing the importance of increasing your your physical activity and energy expenditure by this means and I think if you do this you can achieve a lot. And of course with diet on top of that you would probably do even more. But this is really required. Otherwise, I think and inevitable, you will regain most if not all of your weight.

Holly Wyatt:
Yeah.

James Hill:
See, that's an important part, Holly, and we've emphasized it over and over. If you stop the medications without a plan, the medications aren't working anymore, and you're very likely to regain the weight.

Holly Wyatt:
And I think you can have both. There may be some people that can dial back the medicine but need to stay on the medicine for longer periods of time. There may be somebody, there may be people that can make some changes, significant enough changes in their lifestyle that they don't need the medication for some period of time, then they may need to go back on it. I think we're just starting to kind of understand this balance between the two. And I love that Arne was like, yes, lifestyle is still important because I think it really is. The question I want you to answer is how do you respond to people that say these GLP-1s are the easy way out? You don't have to do the lifestyle to get the weight loss, right? We talk about how it's better and you could and all of this, but you don't have to. You could just take the GLP-1 and not exercise and not change your diet and not work on your mind state. We talk about the mental side of things and get success. So is it the easy way out or how would you respond?

Arne Astrup:
Well, I think for your mental and your physical health, it's rubbish. It's really completely wrong because all the beneficial effects of exercise on your brain and on your body cannot be replaced with GLP-1. Even though the GLP-1 is producing weight loss and there's all the benefits of weight loss.

Arne Astrup:
But, you know, the benefits of weight loss is because when you have obesity, you have an increased risk of all kinds of diseases, cancer, cardiovascular, diabetes, dementia, whatever.

Arne Astrup:
And you can reduce a substantial part of that increased risk by the weight loss. But, you know, exercise and also a diet where you get sufficient amount, you know, a Mediterranean diet will reduce your risk of cardiovascular disease by 30% and your breast cancer risk by maybe 40% or more. So all the benefits of combining a healthy diet with physical activity, that's a trick if you want to become a healthy 100 years old. So you need really the exercise and and your diet. so I think if you want it all, the quality of life and and the healthy and being really vital, you need the exercise and the healthy diet on top of it. So I think it's really a misunderstanding if you believe that you could do the trick alone by the GLP-1.

James Hill:
I love that Arne. We often say that, you know, when people start out, they look at the number on the scale as their measure of success. But that's not what really people are really after, right? They're really after a higher quality of life and they're after a healthier life. And weight loss can be part of that. But physical activity does so much more for mental health and so forth. So we talk about why you're losing weight. look at other aspects of your life, that weight loss alone is not going to get you where you want to be, but weight loss can be part of that.

Arne Astrup:
Absolutely. Absolutely.

Holly Wyatt:
I want to ask, I know that you've done a lot with the food environment. I know you've researched a lot of things. So one question I've been thinking about, and I thought you'd be the perfect person, is do you worry that these GLP-1s could distract us from kind of fixing the food environment, working on the food environment, making it a better food environment for everybody?

Arne Astrup:
Well, in some way, yes, but I think in the early expectations with, drugs came out on the market, I think that that was the impression that we have fixed the problem. And everybody, just like statins if you have a high cholesterol in the blood you can reduce it by statins and essentially there are very few side effects. If any, you don't really feel it. It's just fixed. But I think all the real life data we see now that it's not really working in the way that we expected. There are too many patients who, for some different reasons, will not continue using it.

Arne Astrup:
So it's definitely not the solution. But I think the GLP-1 have a very important role in helping people living with obesity, but they really need to be used by physicians and dieticians who have knowledge and expertise and have the experience in using it and understanding what is needed to become a successful patient. Because you need the diet, you need the exercise on top of it. And then I think the option is that after some time, after a year or more, maybe you could discontinue or reduce the doses and maybe you could do without for six months and then you perhaps need to start again. And I have patients who are running quite successful on a very low dose and even stop taking it for some months, and they start with the low dose again. But they can feel and have, of course, discovered when they are really doing their exercise and trying to stick to a more healthy diet and be disciplined, they are quite successful. But of course, sometimes it can be difficult for all of us. And then, you know, if they are traveling much, have a lot of representation, etc., Then they start to regain, but so they know to come back and get down in body weight and what is needed.

Arne Astrup:
So I think it will still be a struggle, but now at least we have some tools that make it much more easier and safe. And I also foresee within a couple of weeks the pricing issue of the GLP-1 drugs, the price is coming down because there will be more on the market and some patents will expire, etc. And I think that's also something where it would be more available, probably, to those who need it most, which, of course, we have this social inequity in health and also in obesity. But again, here, it's difficult probably to get all the healthy habits implemented, but we should never give up.

James Hill:
I worry, though, Arne, sometimes that, you and some of the other physicians that are trained in weight management certainly manage this very well, but it's going to be used a lot by primary care physicians that aren't trained in obesity and don't have a lot of time. And I think we're going to have to do some serious retraining to get some of these physicians to understand how better to use the medications.

Arne Astrup:
I think we need training of primary care physicians, just as we did with, for example, if they should treat hypertension, where there was a plethora of different new drugs with different mechanism of action. So there was really a need for training how to use them, etc. And I think we see the same now here for the obesity drugs. And because it's such a prevalent situation, you know, half of the population that essentially could benefit from a weight loss. So we really need also to ensure that those who can help the patients, that they're also trained and know exactly how to deal with it because there are these risks we have discussed today. And so we miss an opportunity to use the drugs in the optimal way.

James Hill:
Okay, Holly, now it's a time where we put Arne on the spot with a couple of different segments, starting with the rapid fire. Why don't you do that?

Holly Wyatt:
So you always make me do the rapid fire. I think it's because you're like the wise one that sits back.

James Hill:
If they get upset, they blame you.

Holly Wyatt:
And I have to be the rapid fire question person. That's okay. All right. So just off the top of your head, quick as you can. First question. One misconception about GLP-1 medications you wish would disappear tomorrow.

Arne Astrup:
Well, it could be that it is a quick fix that you just need to take that and then all your weight problems will go away. We have discussed today that there are some roadblocks and we can see in real life experience, the majority of the patients, they stopped taking it after months, which was unexpected. So I think this is a misconception that you could just take it and then you don't care about nutrition and exercise. And we need primary care physicians and dieticians who can assist the patients.

Holly Wyatt:
Okay. Second question. One thing clinicians still misunderstand about appetite or weight regulation.

Arne Astrup:
Well, I think still a lot of physicians, they believe that if you use weight loss medication for six months and you have lost weight, then you can stop taking it. And in some way, it's strange because no physician would believe that if you have a high blood pressure and take a blood pressure medication and treat patients down to a normal blood pressure, they wouldn't say, “Wow, now your blood pressure is normal, so you can just stop taking medication.”

James Hill:
We want to do one more segment with you. It's what we call our vulnerability segment, where we sort of ask some personal questions. And I've got a good one for you. So you have done it all, my friend. You have contributed so much. You have succeeded at all level. We're not going to talk about age, but you and I are both closer to the end of our career than the beginning. What do you want to accomplish now? You don't need another paper, you don't need another grant, what do you want to accomplish in your remaining career?

Arne Astrup:
Well, I think, we have spent a lot of time of our career to create new knowledge, actually to do research, to improve our knowledge about energy balance, appetite regulation, weight management, and I think we have actually achieved a lot. And I think the entire research community, we know much more today. But I think what I really want to spend time is trying to get a lot of this knowledge we have established implemented. I think this is half of the if you look at all the needs among patients and in the population, there is a lot of knowledge that is never reaching those who really need it. You can say we don't need more research in certain areas, but what we need is really perhaps research to find out how we can get it out to those who really need it and get it implemented. And I think we're touched upon that a little bit here where we, for example, discuss how primary care physicians and dieticians, they're not really involved all the time in patients who take obesity medications and use it. So I think there's a lot of misconceptions. There's a lot of myths and presumptions about this where we really need to get rid of them and ensure that there are very good guidelines and the guidelines are being used by all. And I think this is really a major problem. You and I, we have produced popular books and cookbooks. When I did some of the cookbooks in Denmark with the New Nordic diet and worked with some of the the biggest retailers here, I think we reached more than five percent of the population because these cookbooks were done by some of the gastronomy stars and the price was really low and there were popular programs even the television that was using it. So some of these success stories where you can see that you can reach a lot of people and using a lot of the information and knowledge we have today so you in some way you can educate and train normal people how to be better to cope with there and have a better life. I think that's where probably I will spend more time.

James Hill:
Love it. Arne, thank you so much for joining us today. Holly, we've heard from one of the giants in our field who has made major, major contributions. And what we talked about really was why we need these new medications. And we heard it from someone who was there at the beginning and played such a tremendous role in where we are today with the medications that actually work for weight loss. But I love it because he still understands the importance of lifestyle and he's not afraid to go out and take information to the public. So great episode today, Arne. Thank you. Thank you so much for joining us. And we'll see everybody next time on Weight Loss And.

Holly Wyatt:
Bye, everybody.

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:
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James Hill:
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Holly Wyatt:
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