The Five Minute Prescription: Online GLP-1 Meds and the Future of Obesity Care

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.

James Hill:
Holly, imagine you're a new patient looking for help with your weight, okay?

Holly Wyatt:
Okay.

James Hill:
You answer a few questions online, no office visit, no physical exam, no phone call, and a few minutes later, a GLP-1 prescription is on its way to your house. Would that surprise you?

Holly Wyatt:
Wow, Jim. Honestly, a little. Maybe not surprise me, but it would disappoint me. Not because telemedicine can't work. I mean, that was incredibly convenient. And I do think there's a role for telemedicine. But because these GLP-1 medications are powerful, and I have a lot of questions I'd want answered first.

James Hill:
Interesting, Holly. A Yale research team also had a lot of questions. So here's what they did. They created a fake patient, okay?

Holly Wyatt:
So this person's not real. It's on paper.

James Hill:
They made up information about a non-existent person, okay?

Holly Wyatt:
Okay.

James Hill:
So they sent that non-existent patient to 49 online direct-to-consumer GLP-1 websites. Number one, 49. Holy cow, I didn't realize there were that many out there. That’s a lot.

Holly Wyatt:
I think there's more than that. I'm not even sure they picked every one. I don't know how they chose those 49, though. That's a good question. Yeah.

James Hill:
And what happened surprised even them.

Holly Wyatt:
Wow. So this episode, I think, is really important because this is what's happening right now. This is what a lot of people are deciding, should I get a GLP-1 medication online? Because it's, I mean, that's kind of convenient, Jim, to be able to just get a medication quickly. But this isn't really going to be a podcast about that online prescribing. It's going to be a conversation (and I think this is more important) about what obesity care should look like.

James Hill:
We've talked to some of the best obesity medicine docs in the country about how they prescribe and everything, but that's a tiny, tiny percentage of people getting the meds. Most people are getting them in other ways. So this is a podcast about what's happening out there in the real world. And before we start, Holly, let's be clear. We're not against telemedicine.

Holly Wyatt:
Right.

James Hill:
I think telemedicine is a wonderful step forward. And for many people, it's opened doors that were closed for many, many years. It's improved access. It's reduced stigma. And it's helped people get treatment they couldn't get otherwise.

Holly Wyatt:
Totally, totally agree with you, Jim. But obesity treatment isn't just about access to a prescription or convenience in getting a prescription. It's a chronic disease and it requires ongoing care. It's not just a prescription. So this study gave us a chance to talk and to ask, I think, a much bigger question.

James Hill:
Yeah. When does convenience actually improve care and when does it replace or diminish care? Interesting question.

Holly Wyatt:
Yeah, and that's what today's episode is really about, not whether online prescribing is good or bad, but what every patient, I think, deserves when they start one of these new medications.

James Hill:
All right, Holly. So what did these Yale researchers actually do?

Holly Wyatt:
All right. Let's just start at the beginning and say kind of how did they set up this study?

James Hill:
Yeah, how did they set up?

Holly Wyatt:
I like this study. I like real world.

James Hill:
It's really cool to study real world experiences.

Holly Wyatt:
So they called this a secret shopper experiment. And so I think people can relate to what a secret shopper is. They kind of go out on the Internet and they shop without saying anything, but they're really observing what happens, right? They're really evaluating kind of the whole experience. So it was a secret shopper type study. They had that one simulated patient profile that you talked about, meaning it was a fake patient.

Holly Wyatt:
The fake patient, the profile, had a BMI that was in the obese range. So the BMI and the medical history was designed to qualify for treatment. And I think that's important. This wasn't someone who who was at a healthy, normal BMI or a low BMI trying to get the medication. This was someone who was obese, who was living with obesity, and, you know, it was designed to qualify from that aspect. I think they had hypertension and prediabetes, so some common comorbidities. There was no obvious contraindications, meaning the profile didn't say I had had pancreatitis in the past. It didn't necessarily say they didn't, but, you know, it didn't have any obvious contraindications. They submitted the exact same profile to 49 of these online companies. And they looked at semaglutide and tirzepatide, both branded and compounded. We'll talk more about that a little bit later. And they followed the process from intake through the prescribing, through shipping. Did they ship it? How did you get the prescription? And then even into follow-up.

James Hill:
So they used the same patient information for every website, right? They didn't change that.

Holly Wyatt:
I think that's important, yes. Same. And it was a patient that, by what they described, would qualify. You know, there's rules. FDA and how the doctors think about who kind of the risk benefits. This patient potentially had the benefit being that their BMI was in a range that was impacting their health and weight loss would be good for them.

James Hill:
All right. So let's talk about how easy it was to get a prescription, Holly.

Holly Wyatt:
Yeah.

James Hill:
45 of these 49 companies (that's 92%) issued a prescription.

Holly Wyatt:
So that's easy. That's convenient.

James Hill:
Easy to get a prescription.

Holly Wyatt:
Yeah.

James Hill:
Okay. 34 of these, which is almost 70%, actually shipped out the medication.

Holly Wyatt:
Also convenient. Like you just go there and boom, you get it and it's shipped to you.

James Hill:
The median time to prescription. Get this, Holly. The median time, one day. One day.

Holly Wyatt:
Yeah.

James Hill:
And two of these companies were approved within five minutes. You go online.

Holly Wyatt:
Boom.

James Hill:
You're approved within five minutes.

Holly Wyatt:
You got a prescription.

James Hill:
All right. Now, two-thirds of these required zero phone or video interaction with the clinician. You didn't even talk to somebody by text or video or anything. No interaction with a clinician. Okay, so speed, yeah, this is great. Man, you want a prescription you get right away. However, you and I have talked about this before, just getting the prescription without some support or a medical evaluation. Remember how our obesity docs talked about all the evaluation they do before they put a patient. Here, you get it quickly, zero evaluation.

Holly Wyatt:
So let's be clear, though. There is something about speed and access and not easy access. Some people talk to me, I can't get in to see my doctor for months or I don't have access to an obesity specialist. There's that stigma that's still associated with this that kind of gets rid of. It lowers that bar. So there's some good things. But when I hear that it didn't require any interaction with a clinician, how did they assess risk versus benefit? And that's what any drug I'm thinking about as a clinician. I want to make sure that the patient understands what the risk is for taking this medication and what the potential benefit is. And that's a very individual discussion. Yes, there's some general factors, but you really need to, go in and understand that individual and make sure that individual understands that. To me, that is part of medicine. That's what we do. You can't just, to me, that's a scary part. I don't know.

James Hill:
Yeah, well, it's sort of the difference between obtaining a drug and getting obesity care. These people weren't getting obesity care. They were getting medication, which is absolutely part of obesity care, but they weren't getting complete obesity care.

Holly Wyatt:
So it's almost speed and access versus adequate medical evaluation at this point even. I would just say adequate medical evaluation for some of these at least, where a large percentage of them didn't seem to happen.

James Hill:
Let's dig a little deeper into some of the things the study found, Holly. What was required to get a prescription?

Holly Wyatt:
So looks like about 13 or 27 percent did require a video visit. So we said about two thirds didn't. So, about about a third did. Six percent required a phone call. So there were some of them that were requiring that interaction, but there were still about 66 percent that required no interaction with a clinician. And I think they miss a lot with that.

James Hill:
Like what? What are some of the things you think are missing in this sort of procedure?

Holly Wyatt:
Well, so I think in the study looked at this, only about half of them ask about diet or physical activity.

James Hill:
That's a little troubling.

Holly Wyatt:
Only, I think about 55%, so a little bit over half, screened for eating disorders. Fewer than two thirds ask about previous weight loss attempts. So you're not understanding the whole situation if you don't ask these questions. Here's one more. Only 37% requested patient reported clinical values, things like blood pressure or blood glucose, which are really important.

James Hill:
Yeah, Holly. And one of the things that surprised me is only 18% of these ask, even ask whether the patient had a primary care provider.

Holly Wyatt:
Right. So on one hand, you could say if they were going to prescribe the medicine and then let the primary care doctor kind of do, more of the eval and ongoing long-term treatment, okay, I could see that easy access to the medicine, but they have someone who can help with it. That might be a model that could work, but I don't think they're thinking that with only 18%, you know, even asking, is there someone that can help with this long-term plan that we're coming up with? So which of these, we've given the listener a lot of stats, but this is kind of what that study was designed to kind of show as a seeker shopper. Which one of these surprised you the most? Or which do you think is maybe the most important for people to focus on?

James Hill:
Well, I am actually not surprised that it was pretty easy to get a prescription, pretty easy and pretty quick. What surprised me a little bit is how little they seem to worry about getting other information, having the patient talk to a clinician, looking at previous history. So they seem focused on, here's a med, let's get the med out without worrying about, are we maybe giving this to people that we should have evaluated a little more closely?

Holly Wyatt:
Yeah. I guess I'm an old-fashioned doc or something because I don't understand how we can give out a powerful medication that has the power to do a lot of good, but also has the power to cause some side effects, some serious side effects. And we see those. How do we do that with just, it's almost like an algorithm without really talking to the patient and understanding the individual patient. I don't see how we do that. But that's where I think we're moving, unfortunately, in my opinion.

James Hill:
Again, I don't know that it was specific here, but the way without any interaction with the clinician, et cetera, I doubt these people oftentimes really understood what to expect in terms of side effects. And that's important in a medication, right? If you take this and you have no idea what's going to happen, I mean, my God, you can freak out at everything. But if you tell people, look, you're going to likely experience nausea, diarrhea, et cetera, you can prepare for it.

Holly Wyatt:
You can prepare for it and therefore have a better experience. So there's just so much in this. And I think it tells us, I think, a little bit of where the current state of obesity care is headed. And I don't know if I like it. And that's really what this episode is all about.

James Hill:
So it's set up to get the meds, but not to provide comprehensive care.

Holly Wyatt:
Yeah.

James Hill:
So one part of this we like, right? We like the fact you can get these meds without hassle, etc. But the part we're concerned about, and I worry about this, just giving people the meds without care, we know how easy it is for people to discontinue these anyway. I just worry that we're setting these people up for failure, giving them a drug that works, but not enough support to know how to use it, to stay with it, to look at long-term impacts.

Holly Wyatt:
You know, when I hear you talking, there's really two kind of different pieces. And I think I go back and forth a lot. There's this risk, and I think I'm always about do no harm. That's something I think about all the time. And then there's, is this really good obesity treatment? Is giving someone a prescription enough? And I think we would agree access is important, and I do want people to, you know, not think we're against access.

James Hill:
No, but you and I, I mean, we have talked about this for decades. We cannot focus on short-term. We've got to focus on long-term. And to me, this is just a huge example of focusing on short-term. What do people want? They want weight loss. How do you get it? You get a medication that produces. But the rubber hits the road on the long-term. Getting the weight off is only one small step towards success. And I worry that this is a step towards success without a follow-up of leading people to the next steps that are gonna be associated with long-term success.

Holly Wyatt:
Yeah, so for our listeners, Jim, let's talk about what are the risks of treating obesity with a prescription alone? Okay, you're saying risk, Holly, but okay, so what is the risk? Maybe I'm willing to take that risk. That's what they could be thinking.

James Hill:
Well, one of the things we know, the medications are very powerful because they actually change the biology. They work on receptors in your brain. We don't know exactly how, but at the end of the day, you eat less and you're satisfied eating less, right? We've tried to get people to eat less for years and years and years. And the problem is they get hungry and can't stick with it. With these medications, you're actually very content eating less. It works on real biology.

Holly Wyatt:
Well, and I think that's the important part. It's changing your biology. That's the good part. That’s the risky part, too.

James Hill:
It's changing your biology. But the other thing that we know from decades of study, obesity care is more than that. There are other aspects. You've got to look at behavior. You've got to look at the environment. You know, one of the areas I've been very interested in is people on these medications oftentimes eat about a third less. Wow. That means you have to pack adequate nutrition into far fewer calories. So without any advice on how to do that, we're seeing people with nutritional deficiencies because they eat less.

Holly Wyatt:
And that's a real risk, a real risk.

James Hill:
A real risk. Physical activity and its role in metabolism and preserving muscle, really, really critical. So just getting the drug affects biology, but there are so many other things that can work positively and synergistically with the medications. Behavior still matters. A prescription is not a treatment plan.

Holly Wyatt:
Exactly. I'll add to that. Risk-wise, people do have side effects. People do have vomiting and severe nausea. They get dehydrated. People can have pancreatitis. There is a list of known side effects that happen to certain individuals. And that is a real risk. And certain individuals may have more of a risk based on their history. So that's why you need that interaction. And these medications, people have ended up in the hospital. We're not giving out something that does not have the potential to do some harm. I think the benefits outweigh the harm for most people, but not for all people. And I think then you can try to minimize those risks with the appropriate interaction, with the appropriate obesity treatment plan.

James Hill:
Yeah. And I keep coming back to the medications are great for getting the weight off, but you and I know there's more to it. Can someone really lose weight and keep it off without learning the right skills?

James Hill:
Meds are effective, but are they enough?

Holly Wyatt:
Right. So in this case, you get the prescription, but has anyone talked to you about what happens long-term? What do you do long-term?

James Hill:
You and I talk about that all the time. We ask people, what's your long-term plan? And they don't think about that. And if I could change one thing, it would get people just to think about that. Assume the medications are going to work and you're going to lose weight. Now what? Because the now what is the critical part.

Holly Wyatt:
Right. I think you need that from the beginning to understand that and to recognize if you're going to stay on these medications long term, what does that mean? That's one possibility. If you are thinking you're going to be on them short term, understanding what that means. I mean, that's part of this chronic treatment of obesity.

James Hill:
Here's the reality, Holly, I think. It's going to be easy to get these medications. That's not going to change. Part of it is good. But how do you get people then the other care they need? If there's somehow a way to say easy to get a prescription, but along with that prescription, you get a comprehensive care plan. Who does that? You and I are talking now to a lot of primary care docs and they don't even know how to provide that support. So getting the meds is one, it's a big part, but it's only one part. Where do people then get the support they need long term? Because they're going to need support throughout weight loss, weight loss maintenance. This is a huge missing part right now.

Holly Wyatt:
It is. And it's a bigger missing part. Like you said, is it going to be your primary care physician? There are obesity specialists, but there's not enough obesity specialists to treat everybody that might want to be treated for obesity. So this is a big, big question. And can the online companies step up and fill this or not? And I think this is what this study was showing. Right now, the majority, there could be some that are, right? This is not every single company, but the majority of companies, in my opinion, aren't stepping up to this level of treatment.

James Hill:
So we aren't necessarily saying these companies should go away. We're saying they should realize they're only dealing with a part of the problem, and they need to think a little bit more about where their responsibility is in helping with complete care. And we're not saying they have to provide it, but I think they have to realize that just giving the meds without support may not be success for very many people.

Holly Wyatt:
I agree. Which, you know, I want us at some point to kind of come back and talk about what does that look like? What does every patient deserve to receive? But maybe let's take a step back and say, why did this happen? You know, I don't think these online companies just decided to appear.

Holly Wyatt:
There's always some reasons why certain things develop so quickly. So why did this happen? Why have online GLP-1 companies grown so quickly?

James Hill:
Well, I think one of the things is when these medications came out, and again, the first one was semaglutide from Novo Nordisk, and the demand was so high that the companies couldn't keep up. So people who wanted it couldn't get it. Okay, there is a demand in a capitalistic society. Somebody said, “Wow, there's a huge demand that isn't being met. I'm going to step in and meet it.”

Holly Wyatt:
Huge need. A need.

James Hill:
The compound pharmacy said, you know what? We can fill this need.

Holly Wyatt:
Yeah. The compound pharmacy said, we can prescribe the meds. And then online companies said, well, we can provide a mechanism for people to get the prescription, you know. And so I think it did. It was like everybody was hearing about this. A lot of people wanted it and it wasn't easy to get. So that was part of the, I think, why this happened. And there was even some drug shortages at the beginning. Now we don't have the drug shortages, but there was drug shortages, I think, that kind of caused this to happen.

James Hill:
But still the convenience issue. I mean, if you can get prescription in one day, I mean, you have to make otherwise an appointment with your physician. And they say, we'll get your appointment in three months. We're going to evaluate you, come back in two weeks. And, you know, it's going to take a while. Here you get it tomorrow. You start.

Holly Wyatt:
And I have people who told me, you know, told me stories. they even waited three months to see their primary care doctor or to see their physician. And then the physician said, I don't believe in those meds or I don't feel comfortable prescribing them or, you know, something. And they didn't even get it then and they had to try to figure out another way. So, you know, that's better access is important. And I understand that.

James Hill:
So in a way, these companies are solving part of the problem, right?

Holly Wyatt:
Yes. Yeah. I mean, better access. What we talk about rural communities, Jim. These companies help in that area, and they have trouble with access. I also think, we didn't talk about it too much, but stigma and bias.

James Hill:
Yes.

Holly Wyatt:
To go in and talk about your weight, there's still huge stigma and bias.

James Hill:
You don't have to do it. You didn't even have to talk to somebody to get it.

Holly Wyatt:
Yeah.

James Hill:
So, Holly, one of the things that came out in this research was that most of these prescriptions were for compounded GLP-1. What does that mean?

Holly Wyatt:
Right. So compounded means that these medications were prepared by what we call a compounding pharmacy, rather than sold as the kind of FDA approved branded product from Novo Nordisk or from Lilly, you know. So these pharmacies get the ingredients and they put them together and it's regulated, but it's not regulated the same way, that if you get them from the companies like Novo and Lilly. Often the compounded pharmacies, they are using the same active ingredients, but you don't know for sure what you're getting. Meaning the process of the dose and the whole kind of chain of command isn't as regulated as it is if you're going through an FDA approved kind of branded product. So that's what, when people do online, what was the number, Jim, I can't remember was it you think you just said it 92 percent? So the majority were for compounded medications.

James Hill:
Oh, I don't know that's the total number of prescriptions. I don't know. I mean but most were… let's see...

Holly Wyatt:
Yeah, I think 39 of the 45 prescriptions were for compounded.

James Hill:
Most of them were coming from compounded pharmacies.

Holly Wyatt:
Yeah, so that's an important thing to realize what you're getting and that it's regulated differently. And I think we want to do a whole episode on this because this is complex.

James Hill:
It's not necessarily negative, but it's a little bit more of a you don't totally know what you're getting. And you hear, you know, stories of people that do this and things go bad, but that's rare. I think probably in most cases it's okay, but there is that little don't know.

Holly Wyatt:
Yeah, you don't know for sure. You don't know for sure. And definitely there have been some cases reported. I think this deserves a whole episode because when I was trying to kind of dig into this…

James Hill:
Let's do an episode on compounding.

Holly Wyatt:
I even got confused on some of it. It's interesting.

James Hill:
We'll get a pharmacist on who can walk us through it.

Holly Wyatt:
Yeah.

James Hill:
But why did they add things like B12 or glycine to these?

Holly Wyatt:
Yeah. So when you look at these compounded medications, a lot of times they have semaglutide or tirzepatide and something. One of the really common things is B12 that's added. And at first you're like, why are they doing that?

Holly Wyatt:
And it's because how these compounded pharmacists started is kind of making individualized prescriptions. So they started for other things before we had the GLP-1 meds. And they said, you know, for an individual, we need a little bit of this and a little bit of that. And the doctor would write the prescription and the compounding pharmacy could kind of put it together and they could individualize it. And that was one of the ways they were allowed and regulated to produce medications. And so they continue to do that. They're also allowed, and this is really how I think it started with the GLP-1s, if there is a shortage of a medication. They are allowed to produce that medication, even if it's not generic, even if it's, you know, not to the generic stage yet. So when the GLP-1s first started, there was a shortage. The compounding pharmacies then were allowed to produce the medication. Now there's not a shortage, but how they can still produce the medication in some, the way I'm understanding it, is by individualizing it or putting it with something else, making it not just the active, you know, not just the GLP-1 medicine. So you would add the B12 to it. And I think you're seeing that a lot of them have added something to it probably for that reason, for personalizing the formulation because that was a traditional role of compounding.

Holly Wyatt:
Although I think we would say now, Jim, it's not always clear if the added ingredient is medically necessary. So it's kind of evolved here.

James Hill:
Right. All right. So we've talked about the pluses and minuses here.

James Hill:
And I think we agree there's some good stuff here, but there's also some concerns. Holly, how do we fix this? How do we fix the problems we've identified here?

Holly Wyatt:
Oh, my goodness. Jim, you want me to fix all the problems? You're the fixer.

James Hill:
I always look to you to fix the problems.

Holly Wyatt:
No, I identify. I don't fix them. No, I think there's so many different things that have to happen. You know, one of the reasons why people are going out to compounding pharmacies and going out to online to get these drugs online is cost. They tend to be cheaper that way. So one of the things is insurance, you know, fixing insurance so people can afford it or making these drugs more affordable. There's a lot to that, right? Because there are lots of money that went into developing these drugs, and I don't, pretend to understand the whole financial model behind this. But, you know, the cost of these drugs is something that's driving people to look for them more affordably in a way they can afford it.

James Hill:
So is there anything we can provide to our listeners that would help them think about what to look for if they're going to an online provider?

Holly Wyatt:
Sure. I think a lot of the things that we've talked about today is, you know, are they talking to you about your medical history? So find one that does have that interaction. Do they understand your medical history? Do they have a plan for follow-up, Jim? Some of these start shipping you the meds, escalating the dose, don't even ask you how you're doing, don't follow up with you, and you may not need a higher dose. In fact, a higher dose may be the opposite of what you need. So is there a plan for follow-up, not just, you know, for refills? Do they help manage your side effects? If you're having nausea, can you call and talk to somebody about what to do? I know so many people said, “Yeah, I'm having side effects, but I don't have anyone to discuss those with.” So if you're choosing an online GLP-1 provider, I would ask those questions. What else would you ask, Jim?

James Hill:
Well, the other thing, you know, that bothers me a little bit is they don't even ask about a primary care physician. What I would say to our listeners who are looking to do this online is, okay, go and talk to your primary care physician about this and let them help you with it. Hopefully, they're not against you taking the GLP-1 meds that they would actually provide support. But I think a lot of people worry, Holly, they don't want to tell their primary care physician because they won't approve of them taking the meds. But this is an important conversation to have, I think. And you've got to involve your health care. You can't do everything online.

Holly Wyatt:
Yeah. So part of what we need is to continue to have the healthcare system, the clinicians be able to prescribe and treat this and have, you know, better access through that method in addition to hopefully the GLP-1 online companies stepping up a little bit more and doing that.

Holly Wyatt:
So what do you think that great obesity care looks like? I want them to have this in their mind, Jim, so they can then say, am I getting this?

James Hill:
I think it's really important, Holly. Medication is a powerful tool, but it's only a tool. You've got to have a treatment plan. I think about it. Here's a great tool, but do you know how to use that tool? You have a hammer, but you know how to use the hammer.

Holly Wyatt:
That's a great analogy, yeah.

James Hill:
So to me, comprehensive obesity care involves nutrition. If you're taking the meds, you better think about what you're eating. It involves physical activity for your metabolism to preserve muscle. It involves behavior change, sleep. We oftentimes talk about the importance of sleep, mental health, ongoing clinical support. You and I talk about all the time, people have support for losing weight, but keeping it off is where the long-term issue is. I think you need comprehensive care permanently.

Holly Wyatt:
Because it's chronic. It's chronic.

James Hill:
It's a chronic condition. It's forever. Whether you stay on the drugs, don't stay on the drugs. And the best care is individualized. We're learning more and more. It's not one size fits all. And you go on a website. Well, it's one size fits all. Here's the med. With comprehensive clinical care, you take into consideration you're an individual. And obesity is a chronic disease. The meds are only working while you take them. They aren't fixing you. When the meds go away, the problems come back. And again, we talk oftentimes about success is not just the number on the scale. You take these meds, you are going to lose weight, but success is improvements in health, function, quality of life, and the ability to sustain weight. It's so depressing to see these people to lose 30, 40, 50 pounds. They're just wonderful and they're excited and then they regain it. How depressing. So the goal isn't just to lose weight, it's to build a healthier life and maintain those improvements over time. Great obesity care in my mind is built on a great therapeutic relationship, shared decision-making and continued follow-up as needs change.

Holly Wyatt:
It makes me a little bit, I guess, sad because here we have this great new tool that's changing the field, Jim. And we haven't had a tool like this in my whole career. This is big. And we have with this tool an opportunity to really do something good in terms of obesity treatment.

James Hill:
Awesome.

Holly Wyatt:
And the study made me think, but look what we're doing. Look what we're doing with it. You know, for a lot of them, people aren't going to be getting what they really need. And we have this great new tool. We've got to turn this around in some way.

James Hill:
And what I believe with my whole heart, Holly, it's people that just get these without any support are not going to succeed long-term. They're going to take them. They're going to lose weight. They're going to have problems. They're going to stop and they're going to regain. And that's my worry. That doesn't have to happen.

Holly Wyatt:
Yeah. Great obesity care isn't about writing a prescription. It's part of it, but that's not, you know, that's become the thing. Just get me a prescription. And we've got to move away from that. All right. I'm depressed. Let's move to listener questions. Maybe that'll make me a little bit happier.

James Hill:
All right. I'll do the first one. My online provider never asked about my diet or exercise before prescribing a GLP-1. Should I be concerned? Well, we're saying you should, right? You should.

Holly Wyatt:
Absolutely.

James Hill:
Because you don't have to make behavior changes for the medications to work, in the short term. But in the long term, it's essential. Nutrition, physical activity, mental health, muscle preservation. The best providers treat obesity comprehensively, not just prescribed medications.

Holly Wyatt:
And so this question was about online providing because this is what we've been talking about. But I would say this for any provider. This is for your in-person provider. If they're not asking these questions, then that also says that you should be concerned. You should look for another provider or you should prompt them to ask these type of questions. because this to me is basic, obesity care. This is what you deserve.

James Hill:
All right. Do one, Holly.

Holly Wyatt:
All right. My online visit lasted less than 10 minutes. Is that enough time to decide if a GLP-1 is right for me? Well, I don't know. You could do a lot in 10 minutes if you were asking the right questions, perhaps. So I don't know that time alone, I'm not going to say, oh, let's look at the exact time to determine whether, let's not look at the time to determine the quality of the valuation. So I would say, did they ask the right medical questions? Did they explain the risks? Did they talk about the benefits? Did they talk about the side effects? Did they discuss what happens, you know, long term on these medications?

James Hill:
Oh my gosh, that's so critical.

Holly Wyatt:
I wouldn't go on the time, but I would go, did we talk about those things?

James Hill:
All right, here's a good one. My provider never asked if I had a primary care doctor )and again, we saw most of them don't). Should I tell mine I'm taking a GLP-1? Holly, the answer is yes, yes, yes. Okay?

Holly Wyatt:
Yes.

James Hill:
Your primary care provider should know every medication you're taking. GLP-1s affect your overall medical care, not just your weight. If your provider says, “Oh, I don't want you doing that,” he should either justify that or it's okay to seek out another provider. These are legitimate medications. And unless there's a real reason you shouldn't be taking them, for most people, these are an option.

Holly Wyatt:
And one thing to point out, and we haven't, I don't think we've said this, is you really need that coordination because these medications need to be stopped before surgeries, even minors, even colonoscopies. You've got to address this. Yeah. New medications added. You need to know what you're on. There are other medical conditions. So the coordination of care is really important. So absolutely, yes. Even if they didn't ask you, you should tell your primary care doctor.

James Hill:
Yes.

Holly Wyatt:
All right. Oh, here's a good one. I get asked about this a lot. My online provider automatically ships my medication every month. So, you know, the way these medications work, you start on a low dose and then you can progress up. And so a lot of it sounds like, and I've heard people tell me this, I get the next dose without even asking. Like I automatically ship to me and it's the next dose. And a lot of times you can't adjust it. It's depending on how they give it to you, you've got to kind of go up on the dose. And that really worries me. I do. That may be normal what they're doing, but I don't like that. I think you need to decide whether you need the next dose instead of just it being automatically shipped to you. It's convenient. Once again, very, very convenient, but you need that follow-up care. Your treatment needs to be reassessed every time. What kind of side effects are you having? Are you losing weight at an appropriate rate on the current dose? Then I wouldn't go up. Why would you take more medication than you need? And so if it's automatically happening, you're not able to have that individualization that I think is critical. I want you losing the appropriate rate of weight loss on the smallest amount of medication possible. Not the maximum.

James Hill:
So, Holly, after seeing the study, if one of your family members came to you and asked whether it's okay to use one of these online services, what would you say?

Holly Wyatt:
I would say, I'm not against them all, but I would say you need to be careful and you need to understand. I'm not sure, I'm not going to say there's no, you know, online companies that aren't providing good care. This study showed us that the majority of them are doing some things that I don't approve of. I think it just depends on the quality of care. And you have to think about it's not just about getting the script. I think a lot of patients are saying, “I don't care about anything but getting the script.” And so that's driving the need, you know, the companies to do this. So I would say you could, but you deserve to have excellent obesity care. And that needs to be comprehensive. So I don't think the goal is going to be to avoid online care. And I think we started saying we're not against telemedicine. But it's also to expect high quality obesity care and to demand that. Maybe easier said than done, but that's what I would tell somebody.

James Hill:
And these companies aren't likely going away, right? Even though there's not a shortage of medication out there. The convenience, the cost, etc. make these a viable option for a lot of people.

Holly Wyatt:
And I like that part. And I know it's going to happen, Jim. You know, we're going to get emails about this saying we're anti, you know, telemedicine.

James Hill:
We're not anti-telemedicine.

Holly Wyatt:
And I live in a rural town. And I, you know, I mean, we're going to get and I understand that and I've never been. And then there's going to be the emails that say I feel uncomfortable talking about obesity, you know, the stigma, the bias and all that's true. And so I think I'm not wanting to get rid of this. I'm wanting to make it better.

James Hill:
I agree. I agree. All right, Holly, I'm going to ask you a vulnerability question.

Holly Wyatt:
Okay. I'm ready.

James Hill:
Has there ever been a time when convenience led you to make a decision you later wished you had slowed down and thought through more thoroughly?

Holly Wyatt:
Oh, I love this question, Jim, because really that's what's happening, right? This convenience is driving things. So when in the past have I had an experience where convenience kind of came back and wasn't a good thing? Oh, I know one, Jim, and I think me and you've had this, we've both experienced this together. When I've been trying to hire someone in a position, and there's been just convenience, meaning there's someone working in, you know, I can hire someone easily, into the role, and I haven't really taken the time to do the due diligence to ask them, is it a good fit? What do they want? What do we need? You know, it's just convenient. I need someone really quickly to fill this role for a study, for instance. And I didn't do background checks or I didn't call references. I think me and you before have been burned by not taking the time to call references and just make sure it's really a good fit.

James Hill:
You want to move quickly because there's a good part, but sometimes it backfires.

Holly Wyatt:
I need this now. And this is the convenient way. And you kind of don't go through all the questions and process. And I can say that has come back to bite me multiple times, almost every time, Jim, we're like, why didn't we make sure this was a better fit? And I think that's exactly like the medications. Let's make sure the medication is a good fit for you getting the best, you know, the best treatment, the treatment you need. And that's a very individual thing. And that might take some time. It may not be a one day and I have a prescription.

James Hill:
Yep.

Holly Wyatt:
What about you, Jim? Anything where you can think about convenience?

James Hill:
Well, I think, yeah, your example is a good one because, you know me, I want to get things going. I want to move, move, move. And oftentimes you move a little quickly because, again, I'm not a big fan of having a committee and thinking about it and over and over. But at the same time, if you move too quickly, you make a bad decision.

Holly Wyatt:
Yeah, it's a balance.

James Hill:
It's balance.

Holly Wyatt:
It's like anything.

James Hill:
All right, Holly. Wow. This was a really interesting conversation. And to summarize, we are not saying do not use these. What we're saying is getting a prescription for these meds, and these are wonderful tools. This is not obesity care. This is one step toward obesity care. And we're not telling you not to use these, but to recognize that getting the meds is only one step toward long-term weight management. So if you're taking a GLP-1 or want to go and take one, don't settle for just getting the prescription. Look for the care that comes with it. And I wish, Holly, we had a great way of telling people, here's where that care is. It's missing. We need it. But recognize that the GLP-1s without comprehensive care, aren't likely to be a long-term solution. The prescription may start the journey, but it isn't the whole journey.

Holly Wyatt:
Yeah. And I would just add, don't settle. I like that. Don't settle for just getting a prescription. Demand more. And I do believe there will be more online telehealth companies that will give that to you. It is a supply demand. So demand more. And I think we will get better care. And part of it is understanding what better care looks like and why you need it. So I hope this episode was helpful for that.

James Hill:
So let us know your questions, comments, send them to us, and we will possibly talk about them in future episodes. So thanks for listening and see you 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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