Speaker 1: Hello, I'm Francisca Udkin and I'm Louise Area. And this
Speaker 1: is season three of our New Zealand Herald podcast, The
Speaker 1: Little Things.
Speaker 2: The podcast where we talk to experts and find out
Speaker 2: all the little things you need to know to improve
Speaker 2: all areas of your life and cut through the confusion
Speaker 2: and overload of information out there.
Speaker 1: So join us today as we explore a topic that
Speaker 1: has come up a couple of times this season from
Speaker 1: two different healthy experts. From I suspect two different points
Speaker 1: of view. Weight loss drugs, whether a zempic or any
Speaker 1: other brand. They've been labeled miracle drugs. Are these the
Speaker 1: answer to obesity and all the associated health impacts? Or
Speaker 1: have they been appropriated by perfectly healthy people seeking to
Speaker 1: shed a few kilograms?
Speaker 2: And I have a funny feeling the answer is yes,
Speaker 2: both of those things. It's been more than six years
Speaker 2: since ozimpak first became sort of this global phenomenon, or
Speaker 2: it came onto the market. Celebrities who were bigger became slim,
Speaker 2: Celebrities with slim have become impossibly thin, and we're hearing
Speaker 2: all these sort of phrases like oceenpick face. They're all
Speaker 2: being banded around. So these drugs have been used to
Speaker 2: manage conditions like diabetes for many years, but suddenly it
Speaker 2: is everywhere as a weight loss drug. It has been
Speaker 2: said it could be as significant as the introduction of contraception,
Speaker 2: or as revolutionary as the invention of the mobile phone.
Speaker 3: God, it's a bit tiring, isn't it.
Speaker 2: I know, well, it is a really intriguing topic because
Speaker 2: I believe it could completely and utterly change health systems.
Speaker 2: It could allow them to work so much better and
Speaker 2: so much more efficiently. It could give New Zealanders with
Speaker 2: an obesity problem a much better quality of life. It
Speaker 2: could have a huge impact on people who really need it.
Speaker 2: Not worried about them, worried about the ones that probably
Speaker 2: don't quite so much need it.
Speaker 1: Yeah, and look, you know, not judging anybody. Do what
Speaker 1: you need to do for your I am as intrigued
Speaker 1: as you are, and I'm really on the fence. I
Speaker 1: just I personally wouldn't take a drug I don't need.
Speaker 1: That's for me because we still you know, there's probably
Speaker 1: still a lot to find out.
Speaker 3: I'd want to know a lot more about it. I
Speaker 3: want to know, you know.
Speaker 1: I just sort of think and we have talked about
Speaker 1: menopause await game. We're not either of us are fans
Speaker 1: of it. No, but we have also had expects on
Speaker 1: the show who have shown us the way there too,
Speaker 1: to you know, what we actually need to do to
Speaker 1: kind of get rid of that middle tummy fat. But
Speaker 1: if I was pre diabetic, that could be a different story.
Speaker 2: Yeah, No, Okay, So we are going to get to
Speaker 2: the bottom of kind of what is available in New Zealand,
Speaker 2: how you access it, who it's for, who should take it,
Speaker 2: what the risks are we going to get all this
Speaker 2: information from. Professor Jeremy Krebs now Doctor Krebs is an
Speaker 2: intercrinologist with a specialist interest in obesity and diabetes. He
Speaker 2: is the clinical leader of indo Chronology and Diabetes at
Speaker 2: the Capitol and Coast District Health Board, where he leads
Speaker 2: the research. He's also professor at the University of Targo
Speaker 2: and part of the Edgar Diabetes and Obesity Research Center.
Speaker 4: He joins us.
Speaker 2: Now welcome, Professor Krebs. Thank you very much for joining
Speaker 2: us on the little Things.
Speaker 5: Thank you very much for asking me to join you.
Speaker 5: It's a very interesting topic.
Speaker 2: It certainly is, and maybe we should start with the
Speaker 2: medical application of weight loss drugs, who they're aimed at,
Speaker 2: who they're right for, and who they're help with.
Speaker 4: Looking at what's been available up to.
Speaker 5: Now, sure, well, I think probably the first thing to
Speaker 5: go back to is why would you want to prescribe
Speaker 5: someone a weight loss drug? And that really stems from
Speaker 5: the fact that being over weight or obese increases your
Speaker 5: health risks for a number of outcomes, including diabetes, cardiovascular disease,
Speaker 5: joint problems, fertility, all manner of health outcomes that are
Speaker 5: related to being overweight, and increasingly it's been realized that
Speaker 5: actually trying to help people to lose weight is very
Speaker 5: fundamental to reducing those risks and improving those people's outcomes.
Speaker 5: So that's the why of what we'd want to do.
Speaker 5: The difficulty has been over the last forty or fifty
Speaker 5: years while people have been trying to achieve that from
Speaker 5: a medical perspective, is finding a medication or a drug
Speaker 5: that is effective and is safe. And we have a
Speaker 5: legacy of weight loss drugs that have come and gone
Speaker 5: that have either not met either of those bars. And
Speaker 5: I think why there's so much excitement around this new
Speaker 5: class of medications is because it does really appear to
Speaker 5: seem to meet both those briefs, which is great.
Speaker 1: So we produce glucagon like peptide ourselves, right.
Speaker 5: That's right. So glucagon like peptide one is a hormone
Speaker 5: and it's made in the lower small and testine and
Speaker 5: it's released when we eat food and that does a
Speaker 5: number of important biological functions. And it was discovered that
Speaker 5: GOLP one was important in terms of glucose regulation in
Speaker 5: the body, and that was how these agents were first
Speaker 5: discovered and developed up because what they do is they
Speaker 5: stimulate the release of the hormone insulin, which people will
Speaker 5: be very familiar with from the pancreas when food is
Speaker 5: eaten and is passing by the pancreas and through the liver.
Speaker 5: And so it was realized that this hormone GLP one
Speaker 5: wasn't doing its job properly and people that had type
Speaker 5: two diabetes, and so trying to harness that biology was
Speaker 5: how these medications were first developed. And they're very effective
Speaker 5: at that and they're an important part of our armory
Speaker 5: for managing type two diabetes.
Speaker 1: So this development of something that mimics it is that
Speaker 1: something that in them is in the most recent weight
Speaker 1: loss drugs. That is news. Se glue tide is that
Speaker 1: the new innovation and weight loss.
Speaker 5: Drugs, that's right. So sema glue tide is the name
Speaker 5: of one of these drugs and they belong to a
Speaker 5: class of drugs called GLP one agonists. Now, what that
Speaker 5: means is that they work in the same way as
Speaker 5: our natural hormone GLP one. But the important difference about
Speaker 5: these medications is that they have been altered in the
Speaker 5: laboratory so that they don't get broken down by the
Speaker 5: enzyme in our body that normally breaks down our natural
Speaker 5: GLP one. And that's very important because the GLP one
Speaker 5: that we all make is broken down very very quickly
Speaker 5: by an enzyme in the body, and so to bypass that,
Speaker 5: the clever drug companies have altered the protein structure and
Speaker 5: made these this class of medications and they're all very similar,
Speaker 5: but they do have some differences. In semi glue tide
Speaker 5: is one example of that.
Speaker 2: Jeremy, you mentioned before the issues that come with obesity.
Speaker 2: So here we have the strug that could work. Could
Speaker 2: this be a game changer for the health system?
Speaker 5: That's the burning question, really, isn't it? I think what
Speaker 5: we know is that not only at an individual level,
Speaker 5: but that at a societal level, the cost of obesity
Speaker 5: is enormous. It places burden on individuals, on their well being,
Speaker 5: their productivity, It places enormous burden on the healthcare system.
Speaker 5: And therefore, anything that can turn around this juggernaut epidemic
Speaker 5: or whatever you want to call it an obesity would
Speaker 5: surely seem to be a good thing. And so if
Speaker 5: we have a class of medicines which are safe and
Speaker 5: effective in that, then yes, it absolutely could be a
Speaker 5: game change. I think there's a few thorns in that potentially.
Speaker 2: And that's probably a good moment to actually find out
Speaker 2: what we do have available here at the moment in
Speaker 2: New Zealand.
Speaker 5: So, as I say the GLP one hormone or agonists,
Speaker 5: there is a class of them, and semi gluetide is
Speaker 5: one that's perhaps received the most attention, and that's because
Speaker 5: it has been used widely in America, particularly by celebrities
Speaker 5: and people like Elon Musk. But there are earlier forms
Speaker 5: of this class of medication, ones called gelaglatide. The other
Speaker 5: is called leraglatide, and they have been licensed in New
Speaker 5: Zealand for the management of diabetes, and in the case
Speaker 5: of liraglatide has been licensed for the management of obesity.
Speaker 5: Semagluetide has been licensed here for diabetes but not for
Speaker 5: weight loss, but simply isn't available in New Zealand. The
Speaker 5: two medications in this class that are available are laaglotide
Speaker 5: and dula glutide, but they are very difficult to get
Speaker 5: hold of anyoney.
Speaker 3: Sorry, So the brand ozen pic is that which is
Speaker 3: which one.
Speaker 5: Is slues IDEA. So I get very confusing, doesn't it.
Speaker 5: Because medics, like me, we like to talk use the
Speaker 5: actual proper drug name, and of course they get marketed
Speaker 5: under a brand name, and that brand name can even
Speaker 5: be different in different countries. And in the case of
Speaker 5: the ragulatide, for example, it's branded as sex Ender is
Speaker 5: a weight loss medication, but as a Victosa for a
Speaker 5: diabetes medication, same drug, just branded differently.
Speaker 1: Yeah, I think we're getting to the point where it's
Speaker 1: going to be like band aid or one of those
Speaker 1: you know those, if it was going to just calling
Speaker 1: it ozen pic when it may have some of the
Speaker 1: same active ingredients but it's a different product.
Speaker 2: And to clarify, do we have ozempic available in New
Speaker 2: Zealand at the moment.
Speaker 5: No, okay, no, it has been licensed for diabetes management,
Speaker 5: not funded, but it's not even available. The company is
Speaker 5: simply not even bringing it into the country. Corst Why not, Well,
Speaker 5: it's because of Elon and his mates in in America. Basically,
Speaker 5: there is a worldwide shortage of this whole class of
Speaker 5: medication and that's had massive impacts for us. Actually because
Speaker 5: the people with type two diabetes have waited for over
Speaker 5: a decade to get access to funded medications of this class,
Speaker 5: which are incredibly effective, and because they're all made in
Speaker 5: the same factories. Basically that there is a shortage of
Speaker 5: even these older agents which we can't get our hands
Speaker 5: on enough of them for those with diabetes.
Speaker 2: So, Jeremy, if I went into my GP and I said, look,
Speaker 2: I'm seriously concerned, I'm obase. What are the drugs that
Speaker 2: are available to help me? What are the names that
Speaker 2: they will offer me? The brand names that's available in
Speaker 2: New Zealand at the moment.
Speaker 5: The only medication of this class that's a licensed for
Speaker 5: prescription for ob city management is Saxender, which is leraglatide. Now,
Speaker 5: the other medications so juda glue tide. It could be
Speaker 5: used for weight management, but it would be off license.
Speaker 3: So you'd be paying privately for it, do you mean or.
Speaker 5: So, yes, you would be paying privately for either of
Speaker 5: those medications. There is no funded weight loss medication in
Speaker 5: New Zealand.
Speaker 2: And then if are okay, So even if you your
Speaker 2: GP prescribed you the sex cender, you're still paying for.
Speaker 5: That, absolutely, and it's about five hundred dollars a month.
Speaker 1: And we didn't even go past this. It's not a pill.
Speaker 1: Is that it's an injection?
Speaker 5: Correct? Yeah? So all of these medications, because they are proteins,
Speaker 5: if you take them by mouth, they rapidly get digested
Speaker 5: by the stomach acids and so therefore they are almost
Speaker 5: always given as an injection. The companies are working on
Speaker 5: ways of giving it as a tablet, and indeed semi
Speaker 5: glue tide is available as a tablet internationally, but you
Speaker 5: have to give something like fifty times the dose of
Speaker 5: it to get it through the through the stomach acid.
Speaker 5: So essentially these are all injectable agents.
Speaker 2: So what are some of the known side effects when
Speaker 2: it comes to the weight loss drugs that we know about?
Speaker 5: What I didn't say earlier, is that in terms of
Speaker 5: the mechanism of GLP one agonists, which is why they
Speaker 5: are used as weight loss medications, the two principal actions
Speaker 5: are feeding back to the hypothalamus in the brain to
Speaker 5: turn off appetite. That's its fundamental action. And the second
Speaker 5: thing is to slow down what we call gastric empty
Speaker 5: in other words, how quickly food is emptied from the stomach.
Speaker 5: And so you could imagine that one of the most
Speaker 5: common side effects therefore of this class of medications is
Speaker 5: nausea or vomiting or abdominal discomfort. Those are really the
Speaker 5: principal side effects of this class of medication.
Speaker 1: I have heard somebody describe it as feeling in those
Speaker 1: early stages of pregnancy like morning sickness quite a lot
Speaker 1: of the time, which I could say, yeah, is quite
Speaker 1: hard to eat through morning sickness, isn't it?
Speaker 2: Absolutely Yeah, I wouldn't want to go back to morning sickness.
Speaker 4: Long term impacts do we know what they are?
Speaker 2: I mean, obviously there's been a lot of study around
Speaker 2: these drugs to do with diabetes, but is there any
Speaker 2: difference when it comes to weight loss?
Speaker 4: Using them for weight.
Speaker 5: Loss, Yeah, that's where things get tricky, I think, because
Speaker 5: the short answer is no. All of the clinical trials
Speaker 5: that have been done with these medications, in what are
Speaker 5: called randomized controlled trials, were you're comparing it to a
Speaker 5: placebo or a dummy drug, which is the gold standard
Speaker 5: of testing. These things only go out as far as
Speaker 5: two years or five years at most, and therefore we
Speaker 5: simply do not know what the implications of someone taking
Speaker 5: this medication for ten years, twenty years, which is conceivably possible,
Speaker 5: We don't know that at all.
Speaker 1: So and on that note, do you have to keep
Speaker 1: taking it to keep it? Doesn't do any permanent change
Speaker 1: that we're aware of that would help you keep weight
Speaker 1: off once you stop using it.
Speaker 5: That's an extremely good point. The short answer again to
Speaker 5: that is no, you do need to keep taking it.
Speaker 5: But I think individuals people that struggle with weight struggle
Speaker 5: with weight for all manner of reasons, and so I
Speaker 5: think there would be some people who might find that
Speaker 5: after a year two years of using one of these
Speaker 5: medications they've been able to reset all of the things
Speaker 5: that are contributing to their weight being high and might
Speaker 5: be able to keep that off in the long term.
Speaker 5: But I think what's critical is that if you made
Speaker 5: a choice to go onto these medications to control your weight,
Speaker 5: you shouldn't expect that that would be the case. This
Speaker 5: is not a I can take it for a month,
Speaker 5: six months, fix the problem, and come off them and
Speaker 5: it's gone away.
Speaker 2: Because we had a friend who said to us, can
Speaker 2: you just find out if I take it for like
Speaker 2: a year or so and I use it really to
Speaker 2: sort of kickstart my new regime, and when you dart
Speaker 2: my new exercise program and then I come off it,
Speaker 2: will it work.
Speaker 5: Yeah, So that's the point. Yes, it will help you
Speaker 5: to get to that goal. But unless you fundamentally are
Speaker 5: able to change the behaviors that have driven the weight
Speaker 5: in the first place, then it's going to come back on. Now,
Speaker 5: that's not necessary to say that that is a totally
Speaker 5: wrong thing to do. Now, let's you know, for example,
Speaker 5: if you are a person that it has pre diabetes,
Speaker 5: you're in that stage where you're almost going to get diabetes,
Speaker 5: and you can get fifteen kilograms of weight loss, that
Speaker 5: diabetes is going to go away. It's going to go
Speaker 5: into remission. It's going to stay away. Now, it might
Speaker 5: still come back ten years later, but you've bought yourself
Speaker 5: a lot of good health in that process. So I
Speaker 5: don't want to give the impression that we shouldn't do this,
Speaker 5: But it's just that you mustn't go into taking these
Speaker 5: medications expecting that it's a quick fix and a permanent fix,
Speaker 5: because it's not.
Speaker 3: Yeah, and I do worry a little bit.
Speaker 1: I think you know, it depends on the soup piecewomen, Right,
Speaker 1: If you're living in an environment where access to healthy,
Speaker 1: good nutritious food is difficult, or you're working a couple
Speaker 1: of jobs, you know, to keep the family afloat, you
Speaker 1: can't necessarily change everything about your life to engineer a
Speaker 1: better result for your health. So there will be people
Speaker 1: for whom this is the potentially the perfect answer if
Speaker 1: they can, if it can be funded, and if they
Speaker 1: can get it.
Speaker 5: Look, I totally agree with what you're saying, and I
Speaker 5: think that's the essence of These are expensive drugs, and
Speaker 5: you know supply and demand under such the drug companies
Speaker 5: aren't going to reduce the costs anytime soon. They can't
Speaker 5: keep up with the demand, and so they're going to
Speaker 5: remain expensive probably, I think until they come off patent
Speaker 5: and you get companies elsewhere in the world that are
Speaker 5: able to make them in bioequivalents.
Speaker 1: It's also that investment thing, isn't it If it's costing
Speaker 1: us heaps? If obesity is costing us and the health
Speaker 1: system a hell of a lot of money, are we
Speaker 1: better to front end it with something like this?
Speaker 5: That's right. I mean you only have to think, you know,
Speaker 5: you prevent one hip replacement event, one person developing diabetes
Speaker 5: and going onto dialysis. You reduce the whole kind of
Speaker 5: metabolic risk that's happening for women during pregnancy that then
Speaker 5: gets translated into the next generation. You know, there's there's
Speaker 5: lots of good arguments you can make for it, but
Speaker 5: you know, gosh, health systems are pretty creaky at the moment.
Speaker 5: Heading on, what about.
Speaker 3: Compared to the cost of beriatric surgery though.
Speaker 5: Yeah, so that's that's another interesting we I often have
Speaker 5: this conversation with patients because the crossover point is at
Speaker 5: about ten years. If you if you've fund these self,
Speaker 5: fund these medications at about ten years, you will have
Speaker 5: been better to have paid for the full cost for
Speaker 5: your bariatric surgery.
Speaker 2: Okay, but what about also the nature of bariatric surgery
Speaker 2: as an intervention compared to taking an injection in a drug.
Speaker 5: Yeah, so it's horses for courses, isn't it. I I
Speaker 5: think yeah, bariatric surgery as the best long term evidence
Speaker 5: for sustained weight loss and improved health outcomes, and that's
Speaker 5: because we've been doing it for longer and we've got
Speaker 5: better long term data. It fundamentally changes a person's life.
Speaker 5: I mean, I don't have to tell you guys, and
Speaker 5: your listeners will know that. If you suddenly have a
Speaker 5: stomach that's the side of your little finger, then that
Speaker 5: changes your whole life in terms of what you can eat,
Speaker 5: when you can eat, who you can eat, with all
Speaker 5: of those social things as well. Whereas with an injection, yes,
Speaker 5: it reduces your appetite, but you can generally speaking eat
Speaker 5: a normal type of diet and socially interact in that way.
Speaker 5: You're just not as hungry and you eat less of it,
Speaker 5: so there's less impact I think in some of those ways.
Speaker 5: But again, as I say, what we don't know, We
Speaker 5: simply don't know what the outcomes for people taking a
Speaker 5: GLP one. Again it's for ten years, fifteen years, twenty
Speaker 5: years are Whereas we do have those data for directric surgery.
Speaker 1: Maybe by the time it's funded in easialinal who have
Speaker 1: better data.
Speaker 2: Possibly Jeremy, Is there anyone who shouldn't take a weight
Speaker 2: loss strike?
Speaker 4: Are there any risk factors that we should be aware of?
Speaker 5: So when it comes to this class of medicines, there
Speaker 5: are two groups of people that we need to be
Speaker 5: very careful about. There's a very rare form of thyroid
Speaker 5: cancer called medullary thyroid cancer, and it was found in
Speaker 5: the early development when the rodent studies were being done
Speaker 5: with this class of medicines, that rats were more likely
Speaker 5: to develop this type of cancer, which is very strange.
Speaker 5: It is no particularly good biological reason why that would be,
Speaker 5: and it needs to be remembered that in those early
Speaker 5: stages they are exposed to ten twenty one hundredfold doses
Speaker 5: of compared to what we use for humans. Nevertheless, there
Speaker 5: is that slight concern probably more commonly because that's a
Speaker 5: very rare condition. More commonly is the issue of pancreatitis,
Speaker 5: so that's an inflammation of the pancreas, and there has
Speaker 5: been some data to suggest that this class of medications
Speaker 5: can cause pancreatitis. It's quite debatable, controversial, but nevertheless, if
Speaker 5: someone's had a history of pancreatitis, particularly recurrent pancreatitis. We
Speaker 5: would be very nervous about prescribing these medications for them.
Speaker 2: You're listening to the little things and I guess on
Speaker 2: the podcast today as Professor Jeremy Krebs, DTOR. Crebs is
Speaker 2: an interocronologist with a specialist interest in obesity and diabetes.
Speaker 2: We'll be back shortly after this break. As middle aged women,
Speaker 2: we're quite keen on our lean muscle mass.
Speaker 4: What does it do if you've got.
Speaker 2: On a weight loss drug and you're losing all this
Speaker 2: weight and I know that ozen Peck promotes that you
Speaker 2: lose up to fifteen percent of your body weight.
Speaker 4: Do you lose muscle?
Speaker 5: Whenever someone loses weight, they lose both lean mass and
Speaker 5: fat mass. OK, so yes is the answer. You do
Speaker 5: do some lean mass. What you want to do is
Speaker 5: to try and preserve that lean mass as much as possible,
Speaker 5: and the best way to achieve that is to maintain
Speaker 5: your physical activity. And you know, one of the bonuses
Speaker 5: I think for people who are trying to lose weight
Speaker 5: and struggling is that it's quite hard to exercise when
Speaker 5: you're overweight. Absolutely, and as your weight comes down your
Speaker 5: capacity in your enthusiasm and your enjoyment of exercise actually increases,
Speaker 5: and so therefore that makes that possible. So that's the message,
Speaker 5: really is that as you're losing weight, really work hard
Speaker 5: to maintain your physical activity.
Speaker 1: Hey, maybe again I'm just grasping its straws here, but
Speaker 1: I have also heard that the drugs that mimic GLP
Speaker 1: one can reduce the release of the dopamine we get
Speaker 1: when we eat but also when we drink alcohol.
Speaker 3: Is there any can you talk to that at all?
Speaker 5: I can't talk to it. And two of the quality
Speaker 5: of the science around it, but certainly there is some
Speaker 5: there's a small amount of evidence and certainly anecdotal reports
Speaker 5: of that. And that's probably because the GLP one is
Speaker 5: acting in the same areas of the brain where the
Speaker 5: positive effects of alcohol are working, and it interacts with
Speaker 5: that path those pathways in the brain. So certainly I've
Speaker 5: seen that that information and there has been some evidence
Speaker 5: that that's the case.
Speaker 1: I'm listening to you, and I'm still always fascinating because
Speaker 1: we know this. We've talked to lots of experts about
Speaker 1: this as well. Over the course of the three seasons
Speaker 1: of the little things, but that relationship between the gut
Speaker 1: and the brain, it's undeniable.
Speaker 5: Right, absolutely absolutely. I mean there's we could go off
Speaker 5: into a whole different tangent around the microbiome and you've
Speaker 5: probably had had sessions on this, but that's another very
Speaker 5: fascinating area where there's a link between the gut and
Speaker 5: the brain. There's these hormonal links that include g'll P one.
Speaker 5: There are other hormones as well, but it's a very
Speaker 5: strong and very potent interaction and relationship.
Speaker 2: Absolutely so aside from just finding a way to drink least,
Speaker 2: which is something that Louise is often interested in, I'm not.
Speaker 3: I'm not that much of a better I'm just he
Speaker 3: protests us too much.
Speaker 2: The other thing you're quite interested in, Louise is micro
Speaker 2: dosing as well.
Speaker 1: Oh well, no, I just people have when we've talked
Speaker 1: about this, a monkstands and so do you reckon? You
Speaker 1: can microds o zempic and I don't know because it
Speaker 1: comes in a vial, right, presume you have to use
Speaker 1: the whole thing or just a little can you use
Speaker 1: a little bit of it?
Speaker 3: It seems like a very expensive exercise to me.
Speaker 5: Yeah, yeah, look, I probably don't want to get drawn
Speaker 5: in on that. That's that's extending out towards witchcraft as
Speaker 5: far as I'm consented, right, the I mean the clinical
Speaker 5: trials has been done for a reason that these drugs
Speaker 5: are developed up with dose ranging studies to find out
Speaker 5: what the men are effective doses are, what the maximum
Speaker 5: effective doses are, and then finding the sweet spot of
Speaker 5: all of that, and that's why we end up with
Speaker 5: the regimens that we end up with.
Speaker 1: She's not at all dodgy, I promise you no, I
Speaker 1: don't know. I'm not microdizing mushrooms or anything, Jeremy.
Speaker 2: I think what it comes down to it is we
Speaker 2: hear so much about how much good this can do.
Speaker 2: You know, we had doctor Kara Wozziwitch on Cardiologists talking
Speaker 2: about how it could revolutionize healthcare when it comes to
Speaker 2: health in New Zealand. But you know, it's not funded,
Speaker 2: so I worry about access for those who need it
Speaker 2: and could hugely benefit from it. At the same time,
Speaker 2: if you've got the money and you want to pay
Speaker 2: for it, there's potentially people who don't need to be
Speaker 2: on a drug for the rest of their lives who
Speaker 2: are accessing it.
Speaker 3: It's a bit dystopian.
Speaker 4: Really, yeah, it is.
Speaker 2: I can't quite work out how I feel about these
Speaker 2: drugs because I think that they could be just play
Speaker 2: such a major part and us having New Zealand is
Speaker 2: having healthier lives and us having a better health system.
Speaker 2: But at the same time, the way it's all kind
Speaker 2: of unfolding, it's kind of creating this two tiered health system.
Speaker 5: It's a really interesting philosophical discussion, this isn't it, I think.
Speaker 5: And we're caught up as a country and a global
Speaker 5: market for this. And as I mentioned before, finally farmac
Speaker 5: are funding these agents for people with diabetes who for
Speaker 5: whom there's enormous evidence of the benefit of them, or
Speaker 5: not only diabetes control, but also heart health and kidney
Speaker 5: health and all of these things. And yet we can't
Speaker 5: even get them for those people for whom we are
Speaker 5: prepared to fund them. And that's because of this global pressure,
Speaker 5: which is exactly what you're talking about, where people who
Speaker 5: can afford, who do have the means, are paying for
Speaker 5: them and you know, questionably may or may not be benefiting.
Speaker 5: You know, I think there's real benefit for people who
Speaker 5: are significantly obese to lose weight with these drugs, but
Speaker 5: you'd have to really question the use of them for
Speaker 5: people who are of normal weight or close to normal weight,
Speaker 5: using these agents just to get into their you know,
Speaker 5: one size less stress for their daughter's wedding type concept.
Speaker 3: Oh yeah, yeah, exactly.
Speaker 1: So in terms of prescribing it, who can prescribe these things?
Speaker 1: Like a like frontis much of the GP before, But
Speaker 1: do you are they able to prescribe it?
Speaker 5: So any any medication that's licensed in New Zealand can
Speaker 5: be prescribed by the health practitioners. So absolutely we can
Speaker 5: prescribe them. As I say, at the moment, the problem
Speaker 5: is that even if I gave a person a prescription
Speaker 5: for semi glue tide, they wouldn't be able to get it.
Speaker 5: It's not actually in the country.
Speaker 3: That will frustrate them.
Speaker 1: Men a pausal woman trying to lose some weight because
Speaker 1: you can't get a right shirty.
Speaker 5: I was going to say, they'll be learning about the
Speaker 5: pharmacy with swords for the hid as well.
Speaker 2: We'll all be sharing it like we do with the
Speaker 2: HRT cutting up patches.
Speaker 4: Here's half I share my injection with you. I mean
Speaker 4: we really shouldn't laugh.
Speaker 2: About it, but I mean we have heard of menopausal
Speaker 2: women who are using it to help weight.
Speaker 3: Gain in life.
Speaker 4: Would would you recommend that from a medical point of view?
Speaker 5: Well, it's a very interesting concept, that isn't it Because
Speaker 5: unquestionably one of the problems that women face with menopause
Speaker 5: is weight gain, some women more than others. But it
Speaker 5: is something that happens and is observed and then carries
Speaker 5: with it those health consequences as well, And if you
Speaker 5: could predictably prevent that, then you could make the argument that, yes,
Speaker 5: that would be a good thing to do. There may
Speaker 5: have been, but I'm not aware of a study which
Speaker 5: has specifically asked that question. Because I think that's what
Speaker 5: you'd want to do, is to actually take a group
Speaker 5: of women at the sort of perimenopausal stage and randomize
Speaker 5: them to receiving one of these drugs or not, and
Speaker 5: then actually demonstrating those benefits before you could make a
Speaker 5: public statement about it.
Speaker 2: But there's a thing, you see, you'd be so gutted
Speaker 2: you'd know how quickly would you see a difference in
Speaker 2: your way if you started taking it. How quickly would
Speaker 2: you know, oh, I'm on the Blasibo, Well I got
Speaker 2: the drugs.
Speaker 5: Yeah, you begin to see within two to three weeks,
Speaker 5: and because predictably the side of the nausea does happen
Speaker 5: upfront and often will settle down after a few weeks,
Speaker 5: but predictably people do get some nausea at the start.
Speaker 5: And so when we were lucky enough to be a
Speaker 5: site in Wellington for some of the early controlled trials
Speaker 5: for these drugs and diabetes, and it was although we
Speaker 5: were blinded to who was on what, it was very
Speaker 5: obvious very quickly as to who was on the active agent.
Speaker 3: So no good placebo effect with that one.
Speaker 2: Then, sadly not, I think probably the one reason why
Speaker 2: I wouldn't consider a drug like this, and this is
Speaker 2: just my personal opinion. Is I really enjoy food. I
Speaker 2: enjoy eating, I want to savor a beautiful meal, or
Speaker 2: appreciate the fact that my children cooked me a meal,
Speaker 2: or I like I don't. And what I hear from
Speaker 2: people who are on it, they're like, oh, you have
Speaker 2: three or four bites of food and you're kind of
Speaker 2: done all of a sudden. Food isn't It feels like
Speaker 2: food isn't really part of your life anymore. Is that
Speaker 2: a good description of it?
Speaker 5: That's a beautiful description of it. It is very variable.
Speaker 5: So I've had people say exactly the same sort of
Speaker 5: phrasing that you've expressed there and converse here. I've had
Speaker 5: others who have said, look, it's made absolutely no difference
Speaker 5: to my appetite.
Speaker 1: Wow, and they still lose weight.
Speaker 5: But some of those people do still lose weight, they
Speaker 5: are subconsciously not eating as much. But then you have
Speaker 5: those people like you've just described, where they're very aware
Speaker 5: of the effect that's had on their appetite.
Speaker 1: I think it will penned on the cost benefit though, Francesca.
Speaker 1: If you're only looking for five keyloads a weight loss,
Speaker 1: you go while I still I don't want to not
Speaker 1: enjoy my meals five. If you're looking at you know,
Speaker 1: a kilos, it's it's probably a little bit different. I
Speaker 1: have heard that that has wiped off some of the
Speaker 1: profits that restaurants and things are making because people in
Speaker 1: La for example, are eating less.
Speaker 5: They're probably drinking best too, which is where most of
Speaker 5: their profits.
Speaker 4: Yeah, and that's the thing.
Speaker 2: You know that brands like Ozenpek have made a name
Speaker 2: for themselves due to such high profile celebrity use.
Speaker 4: Is that profile and awareness a good thing or a
Speaker 4: bad thing? Do you think.
Speaker 5: Again. I think that's an interesting philosophical question, and it's
Speaker 5: a double edge to it. I think that anything that
Speaker 5: increases the awareness of the health consequences of being overweight
Speaker 5: and the potential pathways to reduce that is a good thing.
Speaker 5: But where it's used potentially, where that profile potentially means
Speaker 5: that people are reaching for it for a few kido's
Speaker 5: weight loss. Here as I say, to get into the
Speaker 5: address with the daughter's wedding or those types of scenarios,
Speaker 5: then you have to say, well, that's actually not socially
Speaker 5: a good a good thing that we're seeing.
Speaker 2: Jrummy, do you know I have any black market supply of
Speaker 2: white drugs? And New Zealand, said exerts.
Speaker 5: Quite possibly. No, I'm not aware. But if you've got
Speaker 5: any context, I shouldn't say that that was ri I
Speaker 5: withdraw that comment fair enough.
Speaker 1: It probably wasn't a fair question either, I guess, but
Speaker 1: we were curious. I mean, it's black markets plus for everything, surely. Look,
Speaker 1: it's just it's I think you're right. I think this
Speaker 1: is a philosophical question. Almost everything you know about this
Speaker 1: is kind of deeparly philosophical. But I guess my angel
Speaker 1: and devil on each shoulder is and you know, I
Speaker 1: really do get concerned about those who would like to
Speaker 1: access or who need to access and at the moment
Speaker 1: in New Zealand anyway, and we do seem to be
Speaker 1: how many other first of all, countries are there that
Speaker 1: aren't funding this because I feel like they are in Australia.
Speaker 3: I could be wrong.
Speaker 5: I so certainly they're funding this class of medications for
Speaker 5: diabetes and we would have to be one of the
Speaker 5: last countries to do that. I'm not aware whether they're
Speaker 5: funding it for obesity are.
Speaker 1: Yeah, that might be the key point. And that's something
Speaker 1: you've clarified beautifully for us today.
Speaker 4: Yeah.
Speaker 2: I was reading in the UK, I think it was
Speaker 2: the House Secretary has just announced that he thinks that
Speaker 2: ozimpac could be a brilliant way to get people back
Speaker 2: to work and he would like to use it on unemployed.
Speaker 4: How do you feel about that.
Speaker 5: That this morning?
Speaker 1: Yeah?
Speaker 5: I mean I think it's really fascinating, isn't it. And
Speaker 5: if you could be specific and quantify the extent to
Speaker 5: which obesity was preventing people getting back to work, then
Speaker 5: you could, you know, you could drill down to that
Speaker 5: discussion and argument a bit better. I think it's it's
Speaker 5: slightly political speak that statement, but not beyond the realms
Speaker 5: of what might be a good public health measure. Potentially.
Speaker 5: I'm not saying we should, but I'm saying potentially. I
Speaker 5: think you need to drill down to it a bit more.
Speaker 1: First, Yeah, no, I won't get on my high horse
Speaker 1: about the food food chain, supplies and availability of healthy
Speaker 1: food to people, you know, from every socioeconomic group. I
Speaker 1: just to get on my high horse. But I hire
Speaker 1: the ambulance at the bottom of the cliff, you know.
Speaker 5: Yeah, yeah, yeah, Look, I join you on that horse
Speaker 5: by the way too.
Speaker 4: You howd to put your foot in the stirrup and
Speaker 4: thought about leafing front?
Speaker 5: You know?
Speaker 2: I hear also ozenpeck gets rid of fifteen percent of
Speaker 2: body weight. There are two more drugs which are about
Speaker 2: to come out. I think one is branded Mingaro. They're
Speaker 2: claiming they're going to get rid of twenty percent. Then
Speaker 2: there's Triple G which is apparently going to be out
Speaker 2: next year, which is claiming to get rid of twenty
Speaker 2: four Are we heading into dangerous territory here?
Speaker 5: Yeah? Even better question. So those new drugs ones called
Speaker 5: ta zeppatide, and I can't quite remember the name of
Speaker 5: the other one, but they are slightly different to the
Speaker 5: ones we've been talking about today. So the ones we've
Speaker 5: been speaking about act purely on the GLP one glucur
Speaker 5: and like peptid one receptor. As I mentioned earlier, there
Speaker 5: are other gut hormones that are involved in food regulation.
Speaker 5: And what these newer classes of agents are doing are
Speaker 5: combining agents that are working on different hormone receptors, and
Speaker 5: we're going to see more of these coming out. And
Speaker 5: by doing that, you are increasing the potency or the
Speaker 5: effectiveness of the change on body weight. And you're absolutely right.
Speaker 5: So the newer classes are now up to that twenty
Speaker 5: five plus percent weight life loss on average in the
Speaker 5: clinical trials. And it's not everybody, of course, but you
Speaker 5: know you're getting you're getting a quantum again greater weight
Speaker 5: loss that takes you into the territory of what you
Speaker 5: see with a gastric bypass operation barretric surgery, and so
Speaker 5: you were really then getting equivalent weight loss with a
Speaker 5: medication that we've never had before. Again, who knows what
Speaker 5: the implications of that is. After five years, ten years,
Speaker 5: fifteen years, we simply don't know it's crystal ball gazing,
Speaker 5: but it does open up another whole avenue of research
Speaker 5: and questions.
Speaker 3: You know.
Speaker 1: Yeah, it's fascinating, and I guess you know, we've just
Speaker 1: looked to Hollywood to see what happens in five, ten,
Speaker 1: twenty years.
Speaker 5: Maybe that's our study, that's our I think.
Speaker 2: I think it probably is where you would get your
Speaker 2: cohort from. But you see that that in itself I
Speaker 2: find really depressing. We have been fighting for so long
Speaker 2: to encourage people, and I'm not talking about people with
Speaker 2: health issues and obesity, but the general population. It's absolutely
Speaker 2: fine that we all look different and we all have
Speaker 2: different bodies.
Speaker 4: We've worked so.
Speaker 2: Hard to get to that place where you're just comfortable with,
Speaker 2: you know, being a healthy weight, and I feel like
Speaker 2: we're throwing this sort of Yeah, as I said before,
Speaker 2: I feel really positive about what it can do for
Speaker 2: the house system, but then I feel like we're just
Speaker 2: throwing this bomb into the middle of the population.
Speaker 4: Just who knows what in Peper's going to have.
Speaker 2: Absolutely, yeah, Jeremy, I know that we had to drag
Speaker 2: you onto this podcast, so I am hugely grateful that
Speaker 2: you that you have come on board because that information
Speaker 2: is excellent. We now have a really good understanding of
Speaker 2: what's available in New Zealand and how it works and
Speaker 2: things and lots to think about around this.
Speaker 4: Thank you so much.
Speaker 5: You're very welcome, and I very much enjoyed the conversation
Speaker 5: having been dragged to these.
Speaker 3: We really did. Thank you so much.
Speaker 2: How great was it having Professor Krebs with us today.
Speaker 2: What a nice guy, really nice and just such a
Speaker 2: good communicator of the information. And it's just kind of
Speaker 2: explained where we're at because we're hearing so much about this,
Speaker 2: but it's a lot of it is coming from global
Speaker 2: media and news and celebrities, so it's nice to kind
Speaker 2: of get a bit of an idea about what is
Speaker 2: actually happening here in New Zealand, what was available.
Speaker 1: I was super grateful for explaining the setting in New
Speaker 1: Zealand because it actually wasn't what I expected. I assumed
Speaker 1: that we had some funding for obese.
Speaker 4: People if they need.
Speaker 2: We're not struck totally, and we should write. I believe
Speaker 2: we should, and I think that there should be standards
Speaker 2: in place for when people's lives are unable to live
Speaker 2: a healthy, productive life, and it is impacting on their heart,
Speaker 2: their limbs and fertility, all the things that Jeremy had mentioned,
Speaker 2: that we should be able to provide them with an option.
Speaker 4: And I say it's an option.
Speaker 2: It's totally up to an individuals to whether they want
Speaker 2: to actually go down that path and take it.
Speaker 1: Oh absolutely, I mean there is I know that you
Speaker 1: do have to for some people, they have to lose
Speaker 1: a certain amunt of wakeful. They can even have gastric
Speaker 1: sleeve or beriatric syndery. And I'm kind of late, well,
Speaker 1: where does it leave those people when there is something
Speaker 1: available that works.
Speaker 2: Big farmer anyway, Big Farmer. And it was interesting too,
Speaker 2: that whole the supply and demand. I've heard a lot
Speaker 2: about this that and this is the thing. You know,
Speaker 2: those who can afford it are accessing it and raving
Speaker 2: about it, while the majority of us it's just.
Speaker 4: Gone for another run and there's nothing wrong with it.
Speaker 3: Oh no, God no.
Speaker 1: And I mean I think that is one of my
Speaker 1: concerns is health and wellness. You know, for a lot
Speaker 1: of us should start with going for that walk or
Speaker 1: lifting those weights or whatever it is, or reducing our
Speaker 1: intake of fatty foods or alcohol, whatever you know, I don't.
Speaker 3: That's my other concern about this, is it.
Speaker 1: So yeah, it is a deeply philosophical issue as we
Speaker 1: discuss more and hopefully when we can talk about again sometime.
Speaker 4: I hope.
Speaker 5: So.
Speaker 2: Hey, so we're at the end of season three. What
Speaker 2: have been some of your sort of highlights. I see
Speaker 2: the wings that you've turned up for the last episode
Speaker 2: of the season with the very fancy haircut.
Speaker 4: Which is the haircut of the year, is it?
Speaker 1: And I mean the one haircut of the I asked
Speaker 1: a last quite lovely woman at Blaze, Eliza. Thanks you
Speaker 1: big big unsponsored shout out to Eliza from Blaze for
Speaker 1: my gorgeous haircut. But no, I actually had one in May.
Speaker 1: My hair does grow really really fast. But yeah, no,
Speaker 1: I probably should do more than two a year. Yeah,
Speaker 1: in fact, I absolutely should do more than two and year.
Speaker 1: Sure it was your advice, Francisca. You said in the
Speaker 1: hair episode, my mother or grandmother always said, if you're
Speaker 1: going to have long hair, catual car Well.
Speaker 3: I cut it off because I don't look after.
Speaker 2: You're not supposed to be listening to me. You're supposed
Speaker 2: to be listening to the experts.
Speaker 4: That's the whole that's the whole point.
Speaker 3: Anyway, I'm much happier.
Speaker 2: I'm very pleased to say that I have one of
Speaker 2: my outtakes from the season was after talking about heart health,
Speaker 2: I realized I wouldn't know how to do CPR, and
Speaker 2: so I'm going to do a first aid course and
Speaker 2: I am in the process of booking that. The problem is,
Speaker 2: I'm taking my eighteen year old son because he doesn't
Speaker 2: know how to do first aid or cpror anything like that,
Speaker 2: and I feel as he's about to head off into
Speaker 2: the world next year, leaving home to go to university.
Speaker 2: It's a gift that I want to give him, and
Speaker 2: as you can imagine, always, it's not a gift that
Speaker 2: he's readily open arm with, accepting with open arms. So
Speaker 2: we're just trying to lock in a day to go
Speaker 2: and spend a day together learning first aid. I said
Speaker 2: to my fifteen year old daughter, do you want to
Speaker 2: come as well? And she goes, I can do CPR,
Speaker 2: I can remember it, and then she launched into some
Speaker 2: song while pumping with the hands, and then she started
Speaker 2: to tell me something else about what you do, and
Speaker 2: I said, oh, did you learn that in first day?
Speaker 2: And she said, no, Gray's anatomy, So I'm slightly concerned
Speaker 2: about actually how well prepared she is.
Speaker 1: But if there is anyone listening that's responsible for curriculums
Speaker 1: in high schools, first aid.
Speaker 2: Well, that's where she did it. She did it a
Speaker 2: year ten or something. She has done it at school.
Speaker 2: Oh okay, they other kids must Hey, anything else? Any
Speaker 2: other episodes really kind of resonate with you.
Speaker 4: I mean, I know they all did, but with.
Speaker 1: Well Eron's one, As I sent a photo to you,
Speaker 1: I've I've rearranged my dancety sort of area in my
Speaker 1: house to make it easier for me to have space
Speaker 1: less obstacles for me to go down there and do
Speaker 1: some breathing meditation. And I'm, in fact I have done
Speaker 1: that a couple of times since then. Stacy obviously just
Speaker 1: reminds me of Oh.
Speaker 4: Stacey's great.
Speaker 2: I don't even think about food anymore now. I've just
Speaker 2: you know what you're eating, She's given you the guidelines.
Speaker 2: It's all there at works. Yeah, yeah, yeah, very much
Speaker 2: to say. Do you know I think it's this season.
Speaker 2: I think it's some of the less sexy topics we've
Speaker 2: talked about, which I've taken a lot from and I
Speaker 2: know that a few people have said to me that
Speaker 2: was the podcast I didn't know I needed. And I'm
Speaker 2: talking about when we spoke to Esther Periam about how
Speaker 2: to look after people and older age. Oh yeah, I
Speaker 2: just think huge, really great practical advice there about a
Speaker 2: really difficult phase that so many of us are in,
Speaker 2: the Sandwich generation. Also the I Love Joe crib when
Speaker 2: we were talking about the value of women in middle
Speaker 2: age in the workplace and the and she sort of
Speaker 2: validated the unpaid work that women do. I thought she
Speaker 2: was just really positive about what women can offer. The
Speaker 2: same with heart health when we spoke to doctor Kara Wozziwitch.
Speaker 2: I just thought, really great practical information that we all
Speaker 2: know a way to look after ourselves. Yeah.
Speaker 4: So I think those podcasts are some that really kind
Speaker 4: of hit a nerve with me.
Speaker 1: I'll leave you with one thought that my husband sent
Speaker 1: me a photo and a little text yesterday and it
Speaker 1: was probably a bid for connection.
Speaker 3: And I wrote back and said, why did you send
Speaker 3: me this?
Speaker 2: I was just going to say, I was just going
Speaker 2: to ask how you're managing your forty close to dear friends.
Speaker 1: I got more and more since I did this podcast,
Speaker 1: they keep coming out of the woodwork.
Speaker 4: It's hilarious. I love that, like such a loser.
Speaker 2: In the friendship episode, she said, look, how many really
Speaker 2: good close friends do you have?
Speaker 4: And I'm like, oh, maybe six sixty teen and you
Speaker 4: go forty and I'm like, oh man.
Speaker 1: I'm obviously I'm talking about wider and wider circles.
Speaker 3: But anyway, it's all been good.
Speaker 1: I loved it as always a pleasure, Louise Oh definitely Friendshisca.
Speaker 1: Thanks for joining us on our New Zealand Herald podcast
Speaker 1: series The Little Things.
Speaker 2: This is the final episode of season three. Thank you
Speaker 2: so much for listening and following us. We've loved your
Speaker 2: feedback and hope to be back for season four.
Speaker 4: Hey, if you.
Speaker 2: Joined the party late, please feel free to listen to
Speaker 2: our previous episodes. There's some fabulous and timeless episodes there
Speaker 2: for you to enjoy.
Speaker 1: You can follow this podcast on iHeartRadio or wherever you
Speaker 1: get your podcasts, and for more on this and other topics,
Speaker 1: head to end zed Herald dot co dot NZ
Speaker 2: And we'll catch you next time on the Little Things.