WEBVTT - How does Ozempic affect the brain in binge eating disorder? 0:00:00.009 --> 0:00:02.990 This podcast was made on the lands of the Wurundjeri people, 0:00:03.240 --> 0:00:06.159 the Woi Wurrung and the Bunurong. We'd like to pay 0:00:06.159 --> 0:00:09.238 respects to their elders, past and present, and emerging. 0:00:14.560 --> 0:00:17.879 From the Melbourne School of Psychological Sciences at the University 0:00:17.879 --> 0:00:20.360 of Melbourne, this is PsychTalks. 0:00:22.700 --> 0:00:25.169 Welcome back to a new season of PsychTalks. I'm Nick 0:00:25.170 --> 0:00:28.729 Haslam and I'm joined as always by my co-host, Cassie Hayward. 0:00:28.920 --> 0:00:31.860 Hi Nick, great to be back in 2025. 0:00:32.199 --> 0:00:34.979 And for anyone new, we're here to explore the latest 0:00:34.979 --> 0:00:38.668 research in psychology and neuroscience with our brilliant experts at 0:00:38.668 --> 0:00:42.388 the University of Melbourne School of Psychological Sciences. We break 0:00:42.388 --> 0:00:45.108 down the science behind how our mind works and what 0:00:45.109 --> 0:00:47.178 these insights might mean for you at home. 0:00:47.469 --> 0:00:49.429 That's right. And this season of psych talks is set 0:00:49.429 --> 0:00:51.708 to be a cracker. We'll be getting our teeth into 0:00:51.708 --> 0:00:54.269 some really fascinating research, like how 0:00:54.319 --> 0:00:58.110 self-compassion could ease the pathway through menopause. And why misinformation 0:00:58.110 --> 0:01:00.919 has spread so rapidly online, just to name a few. 0:01:01.150 --> 0:01:04.269 I can't wait. Now, today we're talking about Ozempic and 0:01:04.269 --> 0:01:08.669 other GLP-1 receptor agonists, drugs that have become hugely popular 0:01:08.669 --> 0:01:10.789 for weight loss. But there's a lot more to the 0:01:10.790 --> 0:01:13.430 story than just numbers on a scale, especially when it 0:01:13.430 --> 0:01:17.029 comes to their interactions with disorders like binge eating. Our 0:01:17.029 --> 0:01:20.419 colleague and guest, Dr Trevor Steward, is investigating what these 0:01:20.419 --> 0:01:23.309 medications do to the brain, not just our bodies. 0:01:28.639 --> 0:01:29.878 Welcome to PsychTalks, Trevor. 0:01:30.160 --> 0:01:31.029 Thanks for having me. 0:01:31.440 --> 0:01:34.080 It's a fascinating area, Trevor, but could you start by 0:01:34.080 --> 0:01:36.518 telling us a little bit about your background and your 0:01:36.519 --> 0:01:39.239 research interests and how you've ended up studying Ozempic? 0:01:39.519 --> 0:01:42.610 Yeah, sure, Cassie. So, my background is in psychology. I 0:01:42.610 --> 0:01:45.800 did my undergraduate degree in the United States and then 0:01:45.800 --> 0:01:45.949 now 0:01:45.995 --> 0:01:49.464 Afterwards moved to Spain to specialise in neuroscience and during 0:01:49.464 --> 0:01:52.324 my PhD I was embedded in an eating disorders unit 0:01:52.324 --> 0:01:54.345 in a public hospital and it was there that I 0:01:54.345 --> 0:01:58.495 really saw firsthand the burden of eating disorders and how 0:01:58.495 --> 0:02:02.025 much they can impact people's both physical and psychological well-being 0:02:02.025 --> 0:02:03.345 as well as their caregivers. 0:02:03.669 --> 0:02:07.536 And what really struck me was that there weren't any brain- 0:02:07.536 --> 0:02:12.169 based interventions available for these disorders. You know, anorexia nervosa 0:02:12.169 --> 0:02:15.250 is a perfect example. I recently went to a conference 0:02:15.250 --> 0:02:18.809 and there was a professor there who got into psychiatry 0:02:18.809 --> 0:02:21.850 and eating disorders, and he said in 1970, there wasn't 0:02:21.850 --> 0:02:25.609 a single approved medication for anorexia nervosa. 0:02:25.910 --> 0:02:28.919 And there still isn't a single approved medication for anorexia nervosa. 0:02:29.149 --> 0:02:31.789 So that just really makes it evident that we need 0:02:31.788 --> 0:02:34.830 to understand these disorders more in depth. Then I moved 0:02:34.830 --> 0:02:37.309 to the University of Melbourne in 2019 and that's where 0:02:37.309 --> 0:02:39.830 I sort of expanded my research program. But then just 0:02:39.830 --> 0:02:42.699 in the past two years, much like everyone in in society, 0:02:42.910 --> 0:02:45.830 we've really been awed by the emergence of these new 0:02:45.830 --> 0:02:48.269 medications called GLP-1 receptor agonists. 0:02:48.449 --> 0:02:52.288 Uh, for example, Ozempic, and these medications are absolute game 0:02:52.288 --> 0:02:55.399 changer in the in the realm of treating obesity. And 0:02:55.399 --> 0:02:58.478 then with more people using these, we started to get 0:02:58.479 --> 0:03:02.630 more anecdotal evidence around other psychological effects that they're having 0:03:02.880 --> 0:03:06.960 that are related to eating behaviours and eating disorders. And 0:03:06.960 --> 0:03:08.399 so that's where I want to step in and try 0:03:08.399 --> 0:03:10.829 to understand what's going on on a neurobiological level. 0:03:11.288 --> 0:03:13.529 So you talked about Ozempic - can you give us a 0:03:13.529 --> 0:03:16.570 quick definition of what kind of drug it is, what 0:03:16.570 --> 0:03:19.130 other drugs are in that class, and what they've mostly 0:03:19.130 --> 0:03:22.580 been used for before they became revolutionary in this area 0:03:22.580 --> 0:03:23.169 of weight? 0:03:23.410 --> 0:03:26.250 Yeah, for sure. So when we talk about drugs like Ozempic, 0:03:26.288 --> 0:03:29.050 we're actually talking about a broader class of medication known 0:03:29.050 --> 0:03:30.609 as GLP-1 0:03:31.190 --> 0:03:36.070 receptor agonists. Now, GLP-1 stands for glucagon-like peptide-1. Don't worry, 0:03:36.080 --> 0:03:38.380 you don't have to remember that. Which is a naturally 0:03:38.380 --> 0:03:41.589 occurring hormone in the body involved in the regulation of 0:03:41.589 --> 0:03:45.190 blood sugars. Now, after we eat, GLP-1 helps us to 0:03:45.190 --> 0:03:48.740 stimulate the secretion of insulin, which lowers our blood glucose, 0:03:48.910 --> 0:03:51.910 while then also, um, you know, helping to regulate our appetite. 0:03:52.419 --> 0:03:55.020 Now, what we can do with these medications is basically 0:03:55.020 --> 0:03:59.220 mimic the effects of this naturally occurring hormone, which will 0:03:59.220 --> 0:04:03.279 then slow, for example, our gastric emptying, our digestion, that 0:04:03.279 --> 0:04:06.619 makes us feel fuller for longer. And it also um 0:04:06.619 --> 0:04:09.059 does other things in terms of metabolic health and uh 0:04:09.059 --> 0:04:13.500 regulating insulin levels. Now, Ozempic is the most famous of 0:04:13.500 --> 0:04:17.420 these types of medications, but its generic name is actually semaglutide. 0:04:17.799 --> 0:04:20.130 Um, there's some several other ones out on the market 0:04:20.130 --> 0:04:22.640 now that you might have heard of, for example, Mounjaro 0:04:22.640 --> 0:04:25.820 or Zepbound, and all of these compounds are quite similar 0:04:25.820 --> 0:04:31.140 in the sense that they mimic this GLP-1 hormone. Now, historically, 0:04:31.260 --> 0:04:35.779 these medications were used to treat type 2 diabetes and 0:04:35.779 --> 0:04:38.779 what they found was that these individuals who are using 0:04:38.779 --> 0:04:43.500 these GLP-1 medications to regulate their diabetes were also losing weight. 0:04:43.880 --> 0:04:46.609 And then someone came up with a genius idea of saying, oh, 0:04:46.649 --> 0:04:49.089 what would happen if we really upped the dose of 0:04:49.089 --> 0:04:53.290 these medications in people with obesity? Would they also lose weight? 0:04:53.619 --> 0:04:55.579 And that's when we started to see the emergence of 0:04:55.579 --> 0:04:58.500 these compounds. And there have been some very large clinical 0:04:58.500 --> 0:05:00.940 trials for people with obesity that have found that it 0:05:00.940 --> 0:05:04.219 can help people to lose weight, um, at levels that 0:05:04.220 --> 0:05:07.469 you can't really ever see with other types of interventions. Um, 0:05:07.540 --> 0:05:10.419 apart from that, it's also there's now emerging clinical trials 0:05:10.420 --> 0:05:13.260 that have found that it's effective for conditions like sleep 0:05:13.260 --> 0:05:17.290 apnoea or for fatty liver disease, and so we're only 0:05:17.290 --> 0:05:19.659 um at the tip of the iceberg in terms of 0:05:19.660 --> 0:05:21.459 what is indicated uses could be. 0:05:22.309 --> 0:05:24.829 As you say, there's been this huge buzz about what 0:05:24.829 --> 0:05:27.928 these drugs can do from a weight loss perspective. 0:05:28.380 --> 0:05:31.589 But that's not entirely your focus, is it? You're looking 0:05:31.589 --> 0:05:33.940 at what they might also be doing to the brain. 0:05:34.029 --> 0:05:35.709 Can you tell us a little bit about what you're 0:05:35.709 --> 0:05:36.219 doing there? 0:05:36.390 --> 0:05:39.469 Yeah, exactly. And so, um, our, uh, study is going 0:05:39.470 --> 0:05:43.070 to be examining the effects of tirzepatide, which is also 0:05:43.070 --> 0:05:47.578 known as Mounjaro or Zepbound, in adults with binge eating disorder. 0:05:47.829 --> 0:05:51.149 Binge eating disorder is a very serious eating disorder. It's 0:05:51.149 --> 0:05:53.790 the most prevalent eating disorder. Um, there's more people living 0:05:53.790 --> 0:05:57.350 with eating disorder than bulimia nervosa or anorexia nervosa combined. 0:05:57.700 --> 0:06:00.309 And binge eating disorder is characterised by the presence of 0:06:00.309 --> 0:06:04.630 binge eating episodes, which are characterised by people eating large 0:06:04.630 --> 0:06:07.109 amounts of food for a short amount of time, often 0:06:07.109 --> 0:06:10.549 accompanied by feelings of loss of control, guilt, shame, and 0:06:10.549 --> 0:06:12.190 they really get locked into this really 0:06:12.500 --> 0:06:17.029 Um, difficult, entrenched cycle that impacts your quality of life 0:06:17.029 --> 0:06:19.600 and impacts their health and makes it very difficult for 0:06:19.600 --> 0:06:24.320 them to maintain a positive wellbeing. Whereas bulimia nervosa does 0:06:24.320 --> 0:06:27.320 have bingeing episodes, but it's also characterised by the presence 0:06:27.320 --> 0:06:30.640 of compensatory behaviours. So that could be, for example, someone 0:06:30.640 --> 0:06:34.690 self-inducing vomiting or, you know, exercising to excess to try 0:06:34.690 --> 0:06:38.130 to compensate for the previous binge eating episode. 0:06:38.670 --> 0:06:40.929 And what we're interested in this study is to try 0:06:40.928 --> 0:06:42.928 to understand how tirzepatide 0:06:43.809 --> 0:06:47.208 impacts the brain processes linked to some of these core 0:06:47.209 --> 0:06:51.519 eating disorder symptoms such as compulsions to eat, impulsivity around food, 0:06:51.730 --> 0:06:54.320 or what you as often um heard of in social media, 0:06:54.609 --> 0:06:59.010 food noise, which is these intrusive thoughts around food where people, 0:06:59.089 --> 0:07:00.880 for example, can't get this idea out of their head 0:07:00.880 --> 0:07:02.529 of how they're planning to binge eat. 0:07:02.815 --> 0:07:04.255 Or a certain type of food that they would like 0:07:04.255 --> 0:07:07.654 to eat. Now, there's a lot of anecdotal evidence around 0:07:07.654 --> 0:07:11.614 drugs like Ozempic or tirzepatide, being able to lower the 0:07:11.614 --> 0:07:15.165 volume of these intrusive thoughts around food. However, on a 0:07:15.165 --> 0:07:18.333 neurobiological level, we just don't understand how this is occurring 0:07:18.334 --> 0:07:22.524 and why this is happening. There are GLP-1 receptor, um, 0:07:22.785 --> 0:07:25.375 GLP-1 receptors located throughout the brain. 0:07:25.829 --> 0:07:29.269 But it's not really clear why uh a drug that's 0:07:29.269 --> 0:07:31.609 targeting the gut would have such a huge impact on 0:07:31.609 --> 0:07:34.130 these brain processes. And so we're really interested in trying 0:07:34.130 --> 0:07:35.459 to interrogate that further. 0:07:36.290 --> 0:07:38.359 It is a bit surprising, as you said, I mean, 0:07:38.399 --> 0:07:43.089 if the drug is primarily slowing the gastric processing or whatever, Uh, emptying, 0:07:43.130 --> 0:07:45.690 is that what you, what you said? Uh, how does that, 0:07:45.809 --> 0:07:48.970 how does that, um, have any effect whatsoever on attention 0:07:48.970 --> 0:07:51.609 you pay to certain thoughts or any of the other 0:07:51.609 --> 0:07:53.570 processes involved in binge eating disorder? 0:07:53.690 --> 0:07:57.049 No, that's a great question, Nick. And so we're stipulating 0:07:57.049 --> 0:07:59.290 this is mainly based off of animal research because we 0:07:59.290 --> 0:08:01.410 really don't have that much evidence in humans yet around 0:08:01.410 --> 0:08:06.049 us that by um lowering or slowing down the gastric 0:08:06.049 --> 0:08:10.440 emptying process, you are impacting food reward pathways. And so 0:08:10.489 --> 0:08:14.040 For example, dopamine is probably the most well known neurotransmitter 0:08:14.040 --> 0:08:17.950 out there. It's very much linked to motivation to find rewards. 0:08:18.200 --> 0:08:20.440 And so if you are able to slow down the 0:08:20.440 --> 0:08:23.160 emptying of someone's stomach and say, OK, now you don't 0:08:23.160 --> 0:08:25.880 need to find that reward. That reward isn't as salient 0:08:25.880 --> 0:08:28.839 for you anymore. Or if, if you even did find 0:08:28.839 --> 0:08:30.959 that reward, you wouldn't get as much pleasure from it 0:08:30.959 --> 0:08:34.270 as you would have previously. That's going to lead to 0:08:34.409 --> 0:08:37.950 neurobiological changes that extend beyond the gut. It's going to 0:08:37.950 --> 0:08:38.729 mean that these cues 0:08:38.880 --> 0:08:41.510 around food are no longer as salient as they used 0:08:41.510 --> 0:08:44.869 to be, or even the predictions that you make within 0:08:44.869 --> 0:08:48.260 your mind about whether this, um, food will give you pleasure, 0:08:48.469 --> 0:08:51.289 will start to be diminished. And so that really offers 0:08:51.289 --> 0:08:53.909 a lot of hope for people with binge eating disorder 0:08:53.909 --> 0:08:57.390 because it's breaking that cycle of like, oh, if I 0:08:57.390 --> 0:09:00.468 want to find relief from the stressors of everyday life, 0:09:00.549 --> 0:09:03.229 or I find myself entrenched in this pattern where as 0:09:03.229 --> 0:09:04.789 soon as I come home, I start eating one thing, 0:09:04.830 --> 0:09:07.150 which then leads to me eating everything in the kitchen. 0:09:07.640 --> 0:09:10.510 That's essentially pumping the brakes on that because it's saying, oh, 0:09:10.880 --> 0:09:13.439 this medication is telling me that, maybe that's not gonna 0:09:13.440 --> 0:09:14.429 work for me this time. 0:09:14.960 --> 0:09:18.260 If it's changing pathways, or if it's in some way, 0:09:18.520 --> 0:09:20.409 you know, breaking patterns in the way you say. 0:09:20.919 --> 0:09:24.599 Does that imply that potentially after a course of treatment 0:09:24.599 --> 0:09:27.868 with the drug, the problem might be fixed as it were, 0:09:28.080 --> 0:09:30.319 or does it imply that instead you have to continue 0:09:30.320 --> 0:09:31.909 to use indefinitely? 0:09:32.109 --> 0:09:33.919 Yeah, and so there's a lot of unknowns around that, 0:09:33.950 --> 0:09:36.479 and that's something that we are particularly cautious around for 0:09:36.479 --> 0:09:38.359 this study because studies in 0:09:38.804 --> 0:09:43.354 individuals with obesity have found that when individuals stop taking 0:09:43.684 --> 0:09:47.715 these medications that most often it's accompanied by weight regain, 0:09:47.924 --> 0:09:50.755 not necessarily to the same level that they had before, 0:09:51.005 --> 0:09:54.275 they began using the drug, but they do go back 0:09:54.275 --> 0:09:56.085 to or the weight is gained again. 0:09:56.479 --> 0:10:00.239 And also anecdotal evidence has shown that individuals who stopped 0:10:00.239 --> 0:10:03.960 taking the drug also report the re-emergence of, you know, 0:10:04.039 --> 0:10:07.909 intrusive thoughts around food or compulsions to eat and cravings. 0:10:08.119 --> 0:10:10.840 And what I'm really concerned about in this population is 0:10:10.840 --> 0:10:13.640 we're talking about people here with this severe psychiatric disorder 0:10:13.640 --> 0:10:18.109 and often they will report that starting to take these medications, 0:10:18.159 --> 0:10:20.569 opens up a lot of mental space for them. They 0:10:20.570 --> 0:10:23.479 feel as if they're, you know, much freer than they 0:10:23.479 --> 0:10:24.590 had been before or 0:10:24.635 --> 0:10:27.465 ever in their lives around the relationship with food. But 0:10:27.465 --> 0:10:29.145 what would happen if they were to suddenly stop taking 0:10:29.145 --> 0:10:32.695 this medication? Would these intrusive thoughts come back with a vengeance? 0:10:32.984 --> 0:10:35.494 Would they, for example, feel as if they had failed? 0:10:35.655 --> 0:10:37.614 And so we have to have a lot of care 0:10:37.945 --> 0:10:41.145 when we're dealing with this population and this medication. So 0:10:41.145 --> 0:10:44.015 that's why for this study we're using a multidisciplinary team 0:10:44.015 --> 0:10:49.304 involving psychiatrists, endocrinologists, and importantly, clinical psychologists that will be 0:10:49.304 --> 0:10:52.704 delivering CBT in conjunction with the tirzepatide. 0:10:53.650 --> 0:10:56.049 So, obviously, it's early days and you haven't got all 0:10:56.049 --> 0:10:58.650 your findings yet, but is it your sense that you 0:10:58.650 --> 0:11:01.439 can't simply give someone a prescription and expect it to 0:11:01.440 --> 0:11:05.450 be beneficial overall for binge eating disorder, you'd need to 0:11:05.450 --> 0:11:06.919 have adjunct treatments as well? 0:11:07.169 --> 0:11:09.330 I would advocate for that position. I don't think the 0:11:09.330 --> 0:11:12.539 evidence is there to say that tirzepatide alone or any 0:11:12.539 --> 0:11:17.199 other GLP1 receptor agonist alone is enough to treat, uh, 0:11:17.369 --> 0:11:20.329 an eating disorder or binge eating disorder specifically. And it's 0:11:20.330 --> 0:11:23.349 also important to remember that psychiatric disorders 0:11:23.585 --> 0:11:28.025 rarely exist in isolation. They're often accompanied by comorbid, um, 0:11:28.065 --> 0:11:32.174 for example, anxiety disorders or depressive disorders. And so, yes, 0:11:32.344 --> 0:11:36.743 this medication may prove to be effective at treating some 0:11:36.744 --> 0:11:40.224 of the core symptoms of binge eating disorder or reducing 0:11:40.224 --> 0:11:43.664 the frequency of bingeing episodes, but that doesn't mean that 0:11:43.664 --> 0:11:47.614 it's gonna necessarily help the patient to deal with, for example, 0:11:47.705 --> 0:11:50.984 the underlying trauma that caused them to use binge eating 0:11:50.984 --> 0:11:53.205 episodes as a form of coping. 0:11:53.799 --> 0:11:57.079 Or for example, if it will then lead to, OK, 0:11:57.159 --> 0:12:00.469 less mental space is being dedicated to seeking out food 0:12:00.469 --> 0:12:02.559 or that type of reward, but then now they're gonna 0:12:02.559 --> 0:12:04.909 be spending more time thinking about, you know, for example, 0:12:05.030 --> 0:12:08.640 entrenched negative thought patterns or anxious thought patterns. And so 0:12:08.640 --> 0:12:11.039 that's why I think from a duty of care perspective, 0:12:11.049 --> 0:12:14.159 we need to accompany it with CBT, which we know 0:12:14.159 --> 0:12:16.630 is effective for some individuals with binge eating disorder. 0:12:17.000 --> 0:12:19.864 So by CBT, Trevor, you mean cognitive behaviour therapy. 0:12:20.085 --> 0:12:20.705 That's right. 0:12:20.994 --> 0:12:24.265 So just on that, you mentioned the food noise issue, 0:12:24.474 --> 0:12:26.794 and you see that a lot on social media, just anecdotally, 0:12:26.825 --> 0:12:30.184 people talking about these drugs, just dialling down that noise. 0:12:30.395 --> 0:12:33.625 And you mentioned that with obesity and binge eating disorder. 0:12:33.835 --> 0:12:36.265 Are you saying that there's not clinical evidence that that 0:12:36.275 --> 0:12:39.515 that's actually happening, or we just don't know the pathways 0:12:39.515 --> 0:12:42.784 by which that food noise dials up and down? 0:12:43.140 --> 0:12:46.130 Yeah, that's a great question. So the, the situation is 0:12:46.130 --> 0:12:49.320 that the evidence is lacking. Um, most of these randomised 0:12:49.320 --> 0:12:54.599 control trials weren't specifically looking at intrusive thoughts around food. 0:12:54.890 --> 0:12:59.309 Their main primary outcome measure was weight loss, changes in BMI, 0:12:59.530 --> 0:13:02.400 and some of them maybe they had a questionnaire around 0:13:02.400 --> 0:13:05.690 food cravings pre-post, 6 months later after taking it, but 0:13:05.690 --> 0:13:06.209 they're not really 0:13:06.690 --> 0:13:09.809 getting into the granular details of how food cravings are 0:13:09.809 --> 0:13:13.250 being modified, and when it's happening to these participants, or 0:13:13.250 --> 0:13:15.650 even their food choices. And so for our city, what 0:13:15.650 --> 0:13:19.669 we'll be using is something called ecological momentary assessment or EMA, 0:13:19.890 --> 0:13:24.530 which essentially uses prompts on participants' mobile phones to ask 0:13:24.530 --> 0:13:28.250 them throughout the day how they're feeling from a mood 0:13:28.250 --> 0:13:29.329 and affect point of view. 0:13:29.919 --> 0:13:33.200 Some of their core binge eating behaviours and also how 0:13:33.200 --> 0:13:35.919 they're feeling around food cravings because I'm really interested in 0:13:35.919 --> 0:13:39.500 trying to understand the dynamics, the temporal dynamics of what 0:13:39.500 --> 0:13:42.109 happens first is it the food cravings that happen and then 0:13:42.109 --> 0:13:44.039 that go down and then the bingeing episodes that disappear 0:13:44.039 --> 0:13:46.200 or is it the other way around, or are the 0:13:46.200 --> 0:13:48.840 folks that respond best, the ones that lose the cravings 0:13:48.840 --> 0:13:50.559 right away and we don't really have that richness in 0:13:50.559 --> 0:13:53.400 the data yet at all. But I'm also concerned around 0:13:53.400 --> 0:13:56.369 the way that food noise is being used in social 0:13:56.369 --> 0:13:57.359 media because 0:13:57.840 --> 0:14:01.000 there's a lot of evidence demonstrating that people that with 0:14:01.000 --> 0:14:01.880 an eating disorder 0:14:02.309 --> 0:14:05.520 Suffer from problems with interoception. When I say interoception, it 0:14:05.520 --> 0:14:09.950 means that someone's ability to perceive internal bodily states, and 0:14:09.950 --> 0:14:12.750 that could be, for example, feelings of fullness, uh, you know, 0:14:12.950 --> 0:14:16.739 feelings of hunger, or even simple things like, you know, um, 0:14:16.750 --> 0:14:19.210 being able to count one's heart, heart rate or, you know, 0:14:19.390 --> 0:14:23.750 sensitivity to touch. And we don't understand whether or not 0:14:23.750 --> 0:14:27.940 these medications are gonna impact those interoceptive pathways as well. 0:14:28.229 --> 0:14:28.710 We have evidence 0:14:28.994 --> 0:14:31.875 showing that there's a risk of people with obesity taking 0:14:31.875 --> 0:14:36.625 these medications, often skipping meals or eating very little because 0:14:36.914 --> 0:14:41.515 they don't feel hunger. And these GLP-1 medications are maybe 0:14:41.515 --> 0:14:44.465 working too well if weight loss is your primary objective, 0:14:44.715 --> 0:14:47.635 which we, I really want to reiterate, isn't the primary 0:14:47.635 --> 0:14:51.354 objective in this population. Our our interest is understanding how 0:14:51.354 --> 0:14:54.094 it impacts the brain and how it impacts binge eating behaviours, 0:14:54.195 --> 0:14:55.275 not necessarily weight. 0:14:55.549 --> 0:14:58.549 And when we're talking about a population that's so used 0:14:58.549 --> 0:15:01.840 to this, you know, restrictive and then binge eating cycle 0:15:01.840 --> 0:15:04.590 that's been probably defining a lot of their adult life, 0:15:04.859 --> 0:15:07.929 we have to be extremely cautious around whether or not 0:15:08.320 --> 0:15:12.880 this medication is hijacking those interoceptive pathways and not allowing 0:15:12.880 --> 0:15:14.440 them to eat in a healthy way. 0:15:15.070 --> 0:15:17.539 And the food noise, as you say, there's a lot 0:15:17.539 --> 0:15:20.590 of anecdotal stuff on, on TikTok, recognising that's not the 0:15:20.590 --> 0:15:23.340 most scientific kind of way of gathering data, but I 0:15:23.340 --> 0:15:25.859 was looking at some TikToks in preparation for this. And 0:15:25.859 --> 0:15:28.809 the way people talk about food noise being turned off 0:15:28.809 --> 0:15:32.210 with these medications is just fascinating and 0:15:32.460 --> 0:15:35.130 I was listening to one woman from Australia, and she 0:15:35.130 --> 0:15:38.049 said she started taking Ozempic, and she said, Is this 0:15:38.049 --> 0:15:40.609 how normal people live every day? She said, she had 0:15:40.609 --> 0:15:42.659 no idea how much of her brain power was being 0:15:42.659 --> 0:15:45.049 taken up with, you know, and it wasn't binge eating, 0:15:45.130 --> 0:15:47.460 it was, it was mild obesity, but she was saying, 0:15:47.650 --> 0:15:50.289 I was constantly thinking about, well, should I eat this? 0:15:50.309 --> 0:15:51.369 And if I eat this, what do I have to 0:15:51.369 --> 0:15:53.900 do and what exercise will I do to counteract it? 0:15:53.929 --> 0:15:56.719 And she said, once she started taking this, that just 0:15:56.719 --> 0:15:59.929 simply went away, which is fascinating from a kind of 0:15:59.929 --> 0:16:01.530 brain function point of view. 0:16:01.960 --> 0:16:07.619 But as you say, with your binge eating disorder, um, clients, uh, population, 0:16:08.059 --> 0:16:10.320 if that then goes away and 0:16:10.599 --> 0:16:13.270 The trauma that might be underlying the binge eating disorder 0:16:13.270 --> 0:16:16.539 then takes over. How do you balance that kind of, 0:16:16.950 --> 0:16:19.190 maybe the food noise goes away, but is it worse 0:16:19.190 --> 0:16:22.260 then to have the trauma take up more space? 0:16:22.460 --> 0:16:24.549 Yeah, that's a really good question. And what you described 0:16:24.549 --> 0:16:28.109 there from the TikTok evidence, uh, is actually very commonly 0:16:28.109 --> 0:16:30.739 reported in, in just based on, you know, my interactions 0:16:30.739 --> 0:16:34.750 with endocrinologists and GPs and what their uh patients are 0:16:34.750 --> 0:16:35.309 telling them. 0:16:35.700 --> 0:16:38.580 And I think when you imagine someone with binge eating disorder, 0:16:38.869 --> 0:16:41.669 imagine that dialled up to 11, you know, they're basically 0:16:41.669 --> 0:16:44.880 constantly thinking about, OK, well, when I finish this activity, 0:16:44.989 --> 0:16:46.750 I'm gonna go home and I want to binge or 0:16:46.750 --> 0:16:49.270 this is gonna be my way of managing the situation 0:16:49.270 --> 0:16:49.619 and 0:16:49.969 --> 0:16:52.969 they want relief from that. I remember just seeing firsthand 0:16:52.969 --> 0:16:55.200 when I was working in the disorders unit, how much, 0:16:55.409 --> 0:16:58.369 how debilitating these intrusive thoughts were. It wasn't just around 0:16:58.369 --> 0:17:00.590 the food itself, it was the actual act of binge 0:17:00.590 --> 0:17:03.520 eating and just being able to carry out those motions 0:17:03.520 --> 0:17:06.250 of eating to find that relief. And so if we 0:17:06.250 --> 0:17:08.489 can open up that mental space for them by giving 0:17:08.489 --> 0:17:11.290 them this this medication, our hope is that it will 0:17:11.290 --> 0:17:15.250 then allow them to engage in a more effective way 0:17:15.250 --> 0:17:16.300 with therapy. 0:17:16.708 --> 0:17:19.338 Because often a big part of CBT is, for example, 0:17:19.388 --> 0:17:24.588 identifying triggers, restructuring negative thought patterns, but if you've gone 0:17:24.588 --> 0:17:26.779 through multiple courses of CBT and you're finding like, oh, 0:17:26.788 --> 0:17:30.259 this still isn't helping me stop this compulsive behaviour. 0:17:30.859 --> 0:17:32.760 Maybe it's time to find something else that can sort of, 0:17:32.880 --> 0:17:35.000 you know, tip the scales a little bit and allow 0:17:35.000 --> 0:17:37.679 that intrusiveness to go down and then to be able 0:17:37.680 --> 0:17:39.920 to face the other issues going on around it. I 0:17:39.920 --> 0:17:41.560 think the same goes as well in terms of other 0:17:41.560 --> 0:17:45.040 things like meal planning, or for example, one thing that 0:17:45.040 --> 0:17:47.119 I'm particularly concerned about around is 0:17:47.219 --> 0:17:50.280 with this population is, most people with binge eating disorder 0:17:50.530 --> 0:17:52.849 do have obesity. They're going to be somewhere between 70 0:17:52.849 --> 0:17:57.969 and 80%. And so I'm concerned that these individuals, most 0:17:57.969 --> 0:18:00.489 likely based on the evidence we have, will begin to 0:18:00.489 --> 0:18:02.530 lose weight over the course of the study because it's 0:18:02.530 --> 0:18:05.409 going on for 24 weeks. And they're going to start 0:18:05.410 --> 0:18:09.050 to receive messages from society, from their peers, from colleagues 0:18:09.050 --> 0:18:11.290 around their body shape. And this is going to start 0:18:11.290 --> 0:18:12.689 to internalise, you know, 0:18:13.400 --> 0:18:15.958 fat biases, you know, internalise the stigma that they may 0:18:15.959 --> 0:18:18.510 have around their body, and how will they deal with 0:18:18.510 --> 0:18:21.479 that when on the one hand they're feeling fantastic because 0:18:21.479 --> 0:18:24.119 they have all this mental space that's been opened up 0:18:24.119 --> 0:18:26.359 with the food noise, you know, going away and being 0:18:26.359 --> 0:18:28.839 able to have a better and healthier relationship with food. 0:18:29.260 --> 0:18:32.800 But then also being reminded of, oh, people did used 0:18:32.800 --> 0:18:34.400 to perceive me in this way and now they're making 0:18:34.400 --> 0:18:36.959 these comments around my body. And so that's why going 0:18:36.959 --> 0:18:39.479 back to your previous question, I think it's so important 0:18:39.479 --> 0:18:42.800 to accompany this with CBT or with some sort of 0:18:42.800 --> 0:18:45.530 psychological counselling because they're going to be facing a whole 0:18:45.530 --> 0:18:48.810 slew of new problems as they begin taking this medication. 0:18:49.319 --> 0:18:52.599 And, as we talked about, may have to keep taking it. 0:18:53.069 --> 0:18:56.189 Yes, exactly, and that's something that we're, it's probably the 0:18:56.189 --> 0:18:59.459 thorniest ethical issue that we're dealing with in the study 0:18:59.790 --> 0:19:02.810 is we're gonna, you know, be in direct contact with 0:19:02.810 --> 0:19:05.910 all of our participants, GPs and explain to them, OK, 0:19:06.150 --> 0:19:09.349 they're participating in the study, receiving tirzepatide over the course 0:19:09.349 --> 0:19:12.310 of 6 months, and then as the study begins to 0:19:12.310 --> 0:19:12.989 wind down. 0:19:13.609 --> 0:19:15.448 Being in contact with their GPs and saying, OK, do 0:19:15.449 --> 0:19:18.130 you want to continue to take this? And if so, 0:19:18.170 --> 0:19:20.890 this is the dosing that they've been using. Um, is 0:19:20.890 --> 0:19:24.329 there a possibility of a maintenance dose? Where, what would 0:19:24.329 --> 0:19:27.209 be the best option for their patient? Um, and then 0:19:27.209 --> 0:19:29.649 that also opens up a whole can of worms around 0:19:29.650 --> 0:19:31.300 the economics of this 0:19:31.300 --> 0:19:33.413 Because it's not cheap, right? 0:19:33.413 --> 0:19:37.369 Exactly, um, and it hasn't Been, you know, um, I'm sorry, 0:19:37.410 --> 0:19:38.329 what you call it in Australia? 0:19:39.170 --> 0:19:41.030 It hasn't been exactly, it hasn't been approved yet by 0:19:41.030 --> 0:19:45.050 the PBS for obesity, um, let alone for binge eating disorder, 0:19:45.130 --> 0:19:49.010 and so there's a lot of, you know, issues around 0:19:49.010 --> 0:19:50.640 access that we need to be cognizant of. 0:19:50.770 --> 0:19:55.239 What do you hope will come of your own research? What, what, uh, 0:19:55.369 --> 0:19:57.170 will be the fruits of, uh, your labours? 0:19:57.660 --> 0:19:59.390 Yeah, I think one of the first things that I 0:19:59.390 --> 0:20:02.630 want to study, um, or understand from my study is 0:20:02.630 --> 0:20:06.839 what's occurring on a neurobiological level with these medications. Um, 0:20:06.920 --> 0:20:09.629 why is it having these effects on, you know, intrusive 0:20:09.630 --> 0:20:13.109