Speaker 1: Kyota.
Speaker 2: I'm Chelsea Daniels and this is the Front Page, a
Speaker 2: daily podcast presented by The New Zealand Herald. From Celery
Speaker 2: juice cleanses to infomercial ad busting gadgets, society has always
Speaker 2: been on a diet. It's a global, multi billion dollar
Speaker 2: powerhouse industry. The latest trend that you would have heard
Speaker 2: about are golp ones or weight loss injections. Far MAC
Speaker 2: is seeking advice on whether they should be funded for
Speaker 2: certain people. Australia is committed to it for certain patients,
Speaker 2: taking the cost to about twenty nine dollars per script.
Speaker 2: A drug like Wagovi, for instance here costs about four
Speaker 2: hundred and sixty dollars per script. But are they really
Speaker 2: beneficial or is it just the next get skinny quickplow.
Speaker 2: Today on the Front Page, obesity specialist doctor Gerrard mcquinlan
Speaker 2: is with us to explore whether these drugs should be
Speaker 2: funded or is diet and exercise really the only answer?
Speaker 2: First off, Gerard, can you give me a brief history
Speaker 2: of weight loss drugs, because it seems like you know
Speaker 2: they've been around for ages. Weren't the first iterations essentially
Speaker 2: just speed?
Speaker 3: Yeah, certainly back in the sixties and seventies. You know,
Speaker 3: the weight loss drugs were emphetamine based and they had
Speaker 3: that addictive component to the medication, so you know, the
Speaker 3: long term use back then sort of led to concerns
Speaker 3: about heart disease being a stimulant and sort of lost
Speaker 3: a lot of popularity when the heart issues came out.
Speaker 3: Then they reformulated that sort of appetite for presant drugs
Speaker 3: to take out the addictive part, and I guess for
Speaker 3: probably three or four decades there wasn't really much in
Speaker 3: the way of medications to treat obesity. They tried zenecaw,
Speaker 3: which was a drug that limited absorption of fat through
Speaker 3: the gut, but it wasn't very well tolerated. It work
Speaker 3: for some people, but most people didn't tolerate it. And
Speaker 3: then about two thousand and five, these new GLP medications
Speaker 3: came into existence to treat obesity. So that was they
Speaker 3: came about because of studies into gut hormones and the
Speaker 3: influence that that had on insulin and diabetes. And then
Speaker 3: the treatments for diabetes sort of came out in the
Speaker 3: twenty tens twenty fifteens, and what they noticed treating diabetic
Speaker 3: patients with these drugs is a lot of lost weight,
Speaker 3: which wasn't really seen with the diabetes treatments. So then
Speaker 3: that's how they became a weight loss strikes was because
Speaker 3: they saw the effect in diabetic patients losing weight. So
Speaker 3: now we've got this burgeoning attention in medicine about GLP
Speaker 3: medications and GAT hormones. So now we've got much more
Speaker 3: effective treatments for weight loss.
Speaker 2: So what do GLP ones actually do?
Speaker 3: Yeah, so these hormones control the sensation of satisfaction light,
Speaker 3: feeling satisfied with what you've eaten. So with a ba IF,
Speaker 3: I sort of reframe a BC as a disease because
Speaker 3: it hasn't been framed that way, but the Lancet Commission
Speaker 3: sort of looked at ABC. The World Health Organization also
Speaker 3: classified ABC as a disease back in twenty thirteen. So
Speaker 3: trying to cut through the stigma of a BC, lot
Speaker 3: of people thought it was to do a person's personality
Speaker 3: and there's a well powered failure, but it's not. It
Speaker 3: is a disease, and it used to be just tastified
Speaker 3: according to the BMI, the body mass index, but that's
Speaker 3: quite crude. So now we look at you know, we
Speaker 3: asked a couple of questions. You know, does a person
Speaker 3: have excess body tissue in their body? So that's the
Speaker 3: first question, and then the second question is is that
Speaker 3: excess back causing disease? So that's how we look at
Speaker 3: obesity now because we know that patients with obesity it's
Speaker 3: a difficult life. It affects everything day to day, movement, sleep,
Speaker 3: and it contributes to other diseases. You know, it's a
Speaker 3: direct modifiable risk factive for thirteen different canses. But it's
Speaker 3: also related to diabetes, it's related to heart disease about
Speaker 3: turns and thirteen different diseases are impacted by obesity. So
Speaker 3: that's the message that I've get through today is that
Speaker 3: obesi is a disease that needs long term care.
Speaker 2: Well, it's important to ask those other questions, hey, because
Speaker 2: the bear My scale has had its issues. I mean,
Speaker 2: you look at any of the all blacks, for instance,
Speaker 2: and they're probably all technically obese.
Speaker 3: Right, yes, based on that crude measure, But you have
Speaker 3: to ask the second question, you know, is the amount
Speaker 3: of fat in a person's body is it causing disease?
Speaker 3: So we have sort of two groups of patients. Now
Speaker 3: we have those with pre clinical obesity, so they do
Speaker 3: have excess fatty tissue, but they don't have any disease.
Speaker 3: And then you have the patients who do have excess
Speaker 3: fatty tissue and have a disease like osterearthritis, like pre
Speaker 3: diabetes or diabetes high pertension. So if they have those
Speaker 3: two things together, we should start treating that early because
Speaker 3: just take arthritis for instance. You know the arthritis, you
Speaker 3: know it's related to age, and it's related to weight. Now,
Speaker 3: if you can treat the weight part early on with
Speaker 3: orits often it goes away, so people don't need surgeries
Speaker 3: or excess painkillers or so I see that a lot
Speaker 3: people come in with knee pains, joint pains. We treat
Speaker 3: the obesity and then the pains go away and they're
Speaker 3: much more mobile.
Speaker 2: In terms of these drugs and the suppressing of appetite
Speaker 2: portion of it, What is the difference between suppressing your
Speaker 2: appetite and eating disorders, because in both you're limiting what
Speaker 2: you eat, right, but one is unhealthy and the other is,
Speaker 2: you know, being prescribed.
Speaker 3: So eating disorders is important, and that's why people with
Speaker 3: obesity need to have a consultation because some of it
Speaker 3: will be psychological. So we're talking about restrictive eating patterns
Speaker 3: and eurexia not so much, but binge eating disorder in
Speaker 3: disorder eating, So yeah, we want to sort out that
Speaker 3: because the treatments for those are different. We would say
Speaker 3: consider binge eating disorder, would use medications that can alter
Speaker 3: a person's psychology. But we have found that actually treating
Speaker 3: obesity and patients say with binge eating disorder, these treatments
Speaker 3: for OBSI are very effective because it cuts the noise.
Speaker 3: People don't think about food when they're on these medications.
Speaker 3: And I'll just come back to the point about appetite suppression.
Speaker 3: We don't use appetite suppression so that it's like those
Speaker 3: amphetamine stimulants. The glps are more about satiety, that feeling
Speaker 3: that you've had enough to eat. And that's the problem
Speaker 3: with ABC is that people don't feel full, so they
Speaker 3: overeat and that's what keeps the weight up.
Speaker 4: A friend of mine who is a very smart guy,
Speaker 4: very very rich, very powerful man actually, but he's very fat,
Speaker 4: and he took the fact I caught the fat drug.
Speaker 4: I won't give you which one. It was a z
Speaker 4: empic I won't tell you that.
Speaker 5: After I told him that the drug does not work
Speaker 5: on him, because I saw him recently he's actually fatter
Speaker 5: than ever. I said, the drug is not working on you.
Speaker 5: You're going to have to go to something else. But
Speaker 5: it does work on a lot of people. And he said, thanks,
Speaker 5: you make me feel good. I said, well, I got
Speaker 5: to be truthful. You always tell the truth.
Speaker 2: Obesity in New Zealand is obviously nothing new. We hear
Speaker 2: about how we're always one of the most overweight nations
Speaker 2: in the world. Tell me more about the common misconceptions
Speaker 2: about obesity. So number one is treating it obviously like
Speaker 2: a disease, But what are some other things?
Speaker 3: Probably the biggest misconception is that it's a failure of willpower.
Speaker 3: It's a failure of personal attribues. Highly is not a
Speaker 3: failure willpower. In fact, you know people who diet can
Speaker 3: make the obaesitly worse. So we know that diet and
Speaker 3: lifestyle just by themselves, they've worked for a short period
Speaker 3: of time, but only about one in twenty patients will
Speaker 3: actually succeed and keep the weight off. That means, you know,
Speaker 3: nineteen out of twenty patients that doesn't work. And they'll
Speaker 3: actually put on it even more weight. So a common
Speaker 3: story we get is people who've been on like three
Speaker 3: or five diets in their lifetime and over that time
Speaker 3: they just got bigger. And that's not a chance thing.
Speaker 3: That's due to the brain's hormone control of weight. So
Speaker 3: weights controlled by hormones in the brain that interact with
Speaker 3: the gate.
Speaker 2: Isn't that kind of like the fad diets though, you know,
Speaker 2: like the juice cleansers and the drinking citric acid or
Speaker 2: something and hot tea every morning, those kind of things.
Speaker 2: When you stop those we I think we all know
Speaker 2: that you do pile the weight back on. But in
Speaker 2: terms of making long, long term lifestyle changes, would that work, Yeah, I.
Speaker 3: Think if it's if it's if it's monitored by a doctor,
Speaker 3: or if the program even a dietician. So lifestyle and
Speaker 3: diet changes, we want those, but we know that just
Speaker 3: by themselves, they don't. People don't stick to them, and
Speaker 3: it's very hard to keep up with the diet. Keto
Speaker 3: diet has been quite popular. That cance diet. I've heard
Speaker 3: of diet Yeah, yeah, So diets tend to fail because
Speaker 3: the hormone control for dieting and it's overcome because people
Speaker 3: just eventually get hungry if they restrict their diet in
Speaker 3: the end. So you know, most people want a keto
Speaker 3: diet for instance, can maybe hack it for about six
Speaker 3: months before they revert back to their normal diet.
Speaker 2: In terms of I mean, there's a lot of talk
Speaker 2: about taxpayers funding drugs like over like these weight loss injections,
Speaker 2: these GLP ones. Would it be worth perhaps subsidizing gym
Speaker 2: memberships first before subsidizing something like a weight loss drug.
Speaker 3: Now I'd strongly disagree with that. I mean, if you
Speaker 3: take just say one disease related to a busy just
Speaker 3: say ostearthritis. About five hundred thousand people in New Zealand
Speaker 3: lived with some degree of osterearthropis. Probably about one hundred
Speaker 3: thousand people need a joint replacement because of osterearthritis, and
Speaker 3: we only do about fifteen thousand operations per year. Now,
Speaker 3: if you treated the obesity that's present in that population,
Speaker 3: half of the arthritis goes away. Now you also put
Speaker 3: those same group of people into gym memberships, that's really
Speaker 3: not going to help with their weight. It's not really
Speaker 3: going to help with the rights. Well to a degree,
Speaker 3: but not quite losing weight. So I see people getting
Speaker 3: much how they're much better quickly once they start on
Speaker 3: these glps, but it is a lifetime treatment. I think
Speaker 3: if the government, like Australian government, who's invested in subsidizing
Speaker 3: these medications, I think they see the benefits, the economic
Speaker 3: benefits because it reduces the harm from other co morbid
Speaker 3: diseases that a lot of people are the best that
Speaker 3: you have. So I think, you know, they've taken the
Speaker 3: bolt step to fund it. I think our government will
Speaker 3: probably follow so hopefully because they'll see that the benefits
Speaker 3: outweigh the costs. But you know, these medications are expensive,
Speaker 3: and I don't know. I think there could be more competition.
Speaker 3: I think Monjarro is coming to New Zealand and we
Speaker 3: expect that to be.
Speaker 2: Cheaper in terms of I mean, I'm just going to
Speaker 2: play Devil's advocate here. You are an obesity specialist, right,
Speaker 2: and you will get more business if these presumably do
Speaker 2: our taxpayer funded. If you strip all of that away,
Speaker 2: would you still do you reckon? Would you still go
Speaker 2: with this route as opposed to say, getting outside and
Speaker 2: going for walks and stuff?
Speaker 3: Oh? Yes, one hundred percent. Even if it was all funded.
Speaker 3: I mean probably the limiting step for patients to get
Speaker 3: access to the medications, not only the costs, but also
Speaker 3: doctors who are prepared to treat obesity as a long
Speaker 3: term disease. So my clinic, yeah, I'm prepared to trigger
Speaker 3: these patients for life. So well, just like you would
Speaker 3: with any chronic disease, whether it's high blood pressure, you
Speaker 3: need doctors who are skilled in using these medications, that
Speaker 3: are prepared to put on the effort to follow these
Speaker 3: patients long term. So I follow them long term. We
Speaker 3: do cholesterol tests, we do blood pressure tests, and I
Speaker 3: see a lot of reversal of even pre diabetes can
Speaker 3: reverse with weight loss. So yeah, I'm measuring, you know,
Speaker 3: and managing other does the other conditions that patients have.
Speaker 3: So that'll be a right limiting step is actually are
Speaker 3: there enough doctors to actually treat the population. There's about
Speaker 3: one point five million people in the Zelan have a
Speaker 3: BE study, and I would say probably half of those
Speaker 3: patients probably have significant other diseases that go with a BESTY.
Speaker 1: I read that you were initially skeptical of the GLP one.
Speaker 1: Absolutely yes, because it's like this guinea shot and like
Speaker 1: it's a shortcut, and so for years I didn't well,
Speaker 1: not for years, but for a long time I didn't
Speaker 1: do it, and I didn't want to do it. Yeah,
Speaker 1: and I thought like, I'm not going to take the shortcut,
Speaker 1: you know, I'm going to work harder. But then eventually
Speaker 1: I was like, I've tried everything. I've tried every diet,
Speaker 1: I've tried every workout. I've tried walking for hour. I
Speaker 1: would go to Europe in Paris and I would just
Speaker 1: walk for hours, the twenty thousand steps a day, like
Speaker 1: every single thing, you know, and nothing was working well.
Speaker 1: I would so this was killing me. Backstage, I would
Speaker 1: lose the weight, but my body liked to be at
Speaker 1: a certain way. So eye opening for me.
Speaker 2: Do you reckon there are still doctors out there though, Like,
Speaker 2: for example, if I use the example of going to
Speaker 2: the doctor and the doctor saying not prescribing anti antibiotics
Speaker 2: because of you know, your immune system and we need
Speaker 2: to build that up, et cetera. You know, you've got
Speaker 2: those doctors out there who are very hesitant to prescribe medications.
Speaker 2: Do you think there are still a lot of doctors
Speaker 2: out there who would be hesitant to just prescribe these
Speaker 2: medications and instead maybe sign you up to go see
Speaker 2: a nature path or something.
Speaker 3: Oh, most definitely, And we doctors need to have education
Speaker 3: to see ABC as a disease because the stigma about
Speaker 3: BC is that it's your faults, the patient's fault and
Speaker 3: if only they could diet and exercise and do those things,
Speaker 3: that that will get better. But if it's a hormone condition,
Speaker 3: if you accept that it's a disease of hormones that
Speaker 3: control weight, you know you're fighting a losing battle. You
Speaker 3: die and their size will work for some people, maybe
Speaker 3: for some of the time, but it won't work for
Speaker 3: the long term for most patients. So yeah, I do
Speaker 3: get patients who've come from doctors said no way, you know,
Speaker 3: And I think that's just really an education thing and
Speaker 3: having statements from the Lance that Commission on Obesity, they
Speaker 3: will falter through. I think students in med school will
Speaker 3: start learning about OBC and treating as a disease, and
Speaker 3: same for GPS.
Speaker 2: So there are going to be some people listening to
Speaker 2: this and they're going to be angry that their taxes
Speaker 2: might be going towards funding these in the future. How
Speaker 2: does it though, compare to funding obesity. In the long term,
Speaker 2: I think.
Speaker 3: If it's tracked well, I think the government could probably
Speaker 3: see savings less liver transplants, less patients with diabetes who
Speaker 3: then have other significant operations, less ostere arthritis, less disability,
Speaker 3: And don't forget that people with obesity, you know, their
Speaker 3: quality of life, like getting a job, performing a job,
Speaker 3: they are all quite reduced. And I'll tell you that
Speaker 3: when I treat patients with obesity, you know, I don't
Speaker 3: imagine their productivity goes up because they tell me I
Speaker 3: can walk up the steps, I can move better. When
Speaker 3: I wake up, I feel like I've had a good sweap.
Speaker 3: So it's quite life changing. Losing weight, I think the
Speaker 3: cost benefit of just treating the BC itself is key
Speaker 3: because it reduces the occurrence of other diseases like osteoarthritis,
Speaker 3: like diabetes, even high blood pressure gets better as people
Speaker 3: lose weight.
Speaker 2: Are these weight loss medications kind of like the silver
Speaker 2: bullet through obesity? Or am I just looking up too
Speaker 2: many social media profiles?
Speaker 3: Yeah, definitely not a silver bullet. It's helpful, so you know,
Speaker 3: there's a limit to what medications can do, and it
Speaker 3: sits alongside say weight loss surgery, so you know, some
Speaker 3: people surgery will be a better option than weight loss medications.
Speaker 3: And then there's other patients. We have lifestyle and diet
Speaker 3: if managed, and people need to coach for this stuff.
Speaker 3: So if they can do that and lose weight, the
Speaker 3: goal should be to reduce our weights of obesity. You know,
Speaker 3: in the last six years, you know, we've gone from
Speaker 3: thirty one percent of the population having obesity to about
Speaker 3: thirty five percent, so just in a short space of
Speaker 3: six eggs, So there's an avalanche of pre diabetes diabetes coming.
Speaker 3: That's what the epidemic's all about, is all the ill
Speaker 3: health from that stems from obesity. So we need to
Speaker 3: do something right now, sort of like on the front
Speaker 3: lines as well as public health policy. So it's really
Speaker 3: the tool for us to treat obasily right now.
Speaker 2: And in terms of I mean, I've seen these articles
Speaker 2: about you know, if you go on the weight loss drugs,
Speaker 2: you're on them for life. If you ever stop them,
Speaker 2: you're just going to pile everything back on. Is there
Speaker 2: enough research anyway to suggest that I do have.
Speaker 3: Patients who've been on these GLP medications and then stop
Speaker 3: for whatever reason, Maybe it's financial, maybe it's other Yeah,
Speaker 3: and the weight does come back on, so we understand that.
Speaker 3: We know that even with surgery. We see patients who've
Speaker 3: had bariatric surgery, so they've had most of their stomach
Speaker 3: bypassed or removed. Even those patients put on weight, So
Speaker 3: it's not just a mechanical physical part. It's really again
Speaker 3: to do with those hormones that control how much people eat,
Speaker 3: how much they think about food, whether they're satisfied with
Speaker 3: how much they've eaten. But there's always a pressure on
Speaker 3: people to put on weight. And one of the biggest
Speaker 3: triggers for gaining weight, believe it or not, is actually
Speaker 3: losing weight, and it's mediated through hormones that work in
Speaker 3: the brain, hunger hormones, the appetite hormones, and obviously these
Speaker 3: society hormones. So when I talk to patiency, I spell
Speaker 3: that out at the beginning, that these medications are for life.
Speaker 3: We need to manage your obesity for life.
Speaker 4: It might not.
Speaker 3: Be an injection. There's new tablets coming into the market.
Speaker 3: We gave these in a tablet form now, so I
Speaker 3: think with new developments, new research will be able to
Speaker 3: manage long term obsy, just like we would manage blood
Speaker 3: pressure or hypertension diabees, we manage that with medication. So
Speaker 3: I see a future where we would manage obesity with medication.
Speaker 3: Because whatever we're doing, it's the current date. It's not
Speaker 3: working right because the rates are going out.
Speaker 2: Thanks for joining us, Jared, my pleasure. That's it for
Speaker 2: this episode of the Front Page. You can read more
Speaker 2: about today's stories and extensive news coverage at enzidherld dot
Speaker 2: co dot enz The Front Page is hosted and produced
Speaker 2: by me Chelsea daniels Kine. Dickie is our studio operator,
Speaker 2: Richard Martin, our producer and editor, and our executive producer
Speaker 2: is Jane Ye. Follow the Front Page on the iHeart
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Speaker 2: next time for another look beyond the headlines.