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Weight and Waistline Worries

Doc Gumshoe on BMI, Obesity and the latest wave of "weight loss" drugs

I began looking closely at the value of the body-mass index (BMI) as an indicator of a person’s health status after this incident, which took place more than twenty years ago in a large medical practice. The reason I was at that large practice is that my regular primary care physician had retired and merged his individual practice into that large practice as a way to give his patients a continuing care option.

So I went for my annual physical to this new location, had the usual examinations, got a very brief report (much shorter than was usual with my former PCP and no discussion) and told to report to the front desk. At the front desk I was handed a one-page summary of the results. I looked over the results – as the MD had said, nothing of particular note.

Except for one shocking little statement: according to this summary page, I was obese.

I politely explained to the nurse who was checking me out that there was a mistake on that form. I am not obese. Why was I labeled obese on that form?

The nurse explained to me that my BMI was just over the dividing line between overweight and obese.

“How can that be?” I asked. “I am not obese.”

The nurse then patiently explained to me that the BMI is calculated based on the relationship between a person’s weight and height. I knew that already, of course, not being a nincompoop. I then demanded to see what figures for my weight and height had been used in the calculation. This was a bit of a problem, because the nurse who had obtained those figures was off somewhere attending to other patients. I stated fairly bluntly that I was not leaving until I saw those figures.

So that nurse was found and the figures were produced. I saw the problem immediately. The nurse had my height as 5’ 11”, whereas in reality I am 6’ 2” tall. That accounted for the difference between slightly overweight and obese. Simple. And the obvious reason for that mistake is that the nurse who was weighing me was too short to see where the mark was on the device at the top of the scale that measured my height.

“Fix it,” I said. The response was “We can’t. It’s in the system.”

At this point I raised my voice. Every eye in the front office was on me. I said, “I am not leaving until you do whatever you have to do to fix it. I am not permitting that blunder to be in my medical records.”

There was a certain amount of fussing on their part. A senior person emerged and told me that I was causing a disturbance. I responded that I was willing to cause a much bigger disturbance, and that their other patients in the facility would learn of their blunder if they didn’t fix it. Eventually, an IT guy emerged, was told what the problem was, and responded that it was no trouble at all to fix it. So I was weighed and measured again and the correct BMI was placed in the records.

Serious doubts about using the BMI as a predictor of health

This experience got me thinking about the BMI and whether it was a useful way of assessing a person’s health. I knew how it was calculated, of course – your weight in kilograms divided by your height in meters squared. (The computer does the conversion from pounds into kilograms and meters into feet and inches.) I also knew that insurance companies might charge you a higher premium if you were classified as obese based on your BMI. And I had always thought that it was mostly a way for insurance companies to rationalize charging a few more bucks for coverage. But as an indicator of health status? I had serious doubts.

For a start, when you think about it, why does the formula square the subject’s height? Our bodies are three-dimensional; if you’re trying to figure out our body’s density, it might make more sense to cube the subject’s height, or to try to measure the length, breadth, and width of our body The latter would be awkward, of course, and exceedingly difficult to carry out in the course of a simple medical exam. But the formula itself struck me as simple-minded. Squaring the height does not produce the volume of the body, which is what you need to calculate the weight per unit of volume, otherwise known as the specific gravity.

As I did some investigating of the history of the body-mass index, those doubts became much stronger. The index was put forward by Adolph Quetelet, a Belgian astronomer and mathematician, in the mid-19th century. The Quetelet index, as it was called, was not meant to be used as a means of medical assessment. Quetelet was using this as part of a statistical study of l’homme moyen – the average man.

The modern term “body mass index” (BMI) for the ratio of body weight to height was coined in a paper published in 1972 in the Journal of Chronic Diseases by Ancel Keys and others. Keys explicitly judged BMI as appropriate for population studies, but inappropriate for individual evaluation.

There is a huge flaw in using the BMI as a means of assessing health status. It’s evident that a person with significant excess weight would have a body mass index in the overweight or obese category. But the reverse is not necessarily true. A person can be categorized as overweight or obese according to BMI formula without being overweight or obese.

Our bodies have many different components. We can put them in five major categories: bones, muscles, organs, fats, and fluids. Each of these has their own characteristics when it comes to assessing whether a person’s weight is in a healthy range. Bones, for example, have a significantly greater specific gravity than the body’s other components, meaning that a given volume of bone weighs a good deal more than a given volume of anything else in our body. For instance, bone is twice as heavy as fat.

Muscle also has a greater specific gravity than fat. Muscular individuals and people with heavy bones would therefore tend to have higher numerical scores on the BMI than usual, with no adverse implications for health. Persons of African ethnicity generally have larger and denser bones; therefore they often have higher BMI scores than a person with an equivalent amount of fat. The opposite is often the case with persons of Asian ethnicity, who tend to have smaller, lighter bones and therefore have lower BMI scores than a person with an equivalent amount of bodily fat.

The rationale for using BMI as an indicator of health status is that is it a quick means of assessing how much fat a person is carrying. That assumes that fat is, of course, always bad for us. There is plenty of evidence that extreme obesity (regardless of how we define extreme obesity) lowers life expectancy. But when we track life expectancy and attempt to correlate it with BMI, the results are a bit contrary to what one might expect. At either end of the scale, no surprises – severely overweight as well as severely underweight individuals have significantly shorter life spans. But when we work our way back towards the middle of the scale, the longest life expectancies are right around a BMI of 25, which is the dividing line between normal and overweight. A BMI of about 27.5, which is in the middle of the overweight category, is associated with the same life expectancy as a BMI of 22,5, which is close to the middle of the normal category. What is more surprising is that as BMI values go lower, while still in the normal range, life expectancy drops. And for underweight persons with a BMI of 18 or lower, life expectancy drops significantly.

Many health authorities prefer metabolic syndrome as a predictor of adverse medical events that affect life expectancy. Metabolic syndrome is characterized by elevated blood pressure, serum cholesterol, and insulin resistance, with elevated levels of blood sugar. An additional characteristic that often predicts metabolic syndrome is greater waist than hip circumference, pointing to significant amounts of excess fat around the middle. As a shorthand method of assessing a person’s overall likelihood of heart disease, waist-to-hip ratio may be a bit more accurate than BMI scores.

A study published in 2020 examined the prevalence of metabolic syndrome in persons with elevated BMI compared with those with BMIs in the normal range. The results were surprising. Although, as one would expect, individuals with BMIs in the obese range had elevated levels of insulin resistance, about one third of the subjects with BMI values in the normal range also had metabolic syndrome, and nearly half of the cohort with BMIs classifying them as overweight had blood pressure, cholesterol, and blood sugar in the normal range. A quarter of the obese group was metabolically normal. (Prev Chronic Dis 2020;17:200020)

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Shifting the emphasis from “feeling good” to “looking good.”

Determining how much fat is excess fat from a health standpoint is not often simple, except in extreme cases, in which case you can tell at a glance whether that individual needs to lose weight. But the notion of excess weight has also been strongly influenced by factors that have absolutely nothing to do with health.

The ideal figure, especially for women, but also for men, is slim-waisted. This ideal dates back centuries if not millennia. There are exceptions, of course – the famous statuette, Venus of Willendorf, has colossal breasts and a gigantic belly, probably a symbol of fertility. And Peter Paul Rubens painted women who were, to say the least, not skinny. But as we see images of women through history – marble sculptures, paintings, photographs – the ideal figure is reiterated: waist a good deal slimmer than the hips, and frequently, ample breasts. Fashions in clothing followed that ideal. Our grandmothers (some of them anyway) wore corsets to cinch in their bellies. And sometimes those figure-shaping contraptions came up considerably higher than the midsection to create what were sometimes called “muffin tops.”

That particular ideal has altered to some degree. Twiggy and her fashion-model ilk were not known for large boobs, but their waists were – and still are – decidedly slim. The Kardashians and their followers aren’t shy about displaying their curves, but those curves are above and below the waist. They and their followers still keep their waistlines slim.

Fat-shaming has been a factor in pushing weight-loss to the center of the concerns of many people. Stigmatizing the overweight has been condemned, of course, and as long ago as the 1960s there was a “fat-in” in Central Park in New York City to make the point that the overweight should not be viewed as though their excess avoirdupois was a fundamental character flaw.

Nonetheless, many people, especially young girls, were obsessive about losing weight, and anorexia was almost a sought-after condition. The remedies multiplied. These included potions that were completely ineffective unless accompanied by extreme dietary restrictions. Some individuals resorted to bizarre tactics, such as self-induced vomiting and taking laxatives after every meal.

The purpose of these weight-loss regimens was not to achieve good health, but to become “good-looking.” But a fundamental problem with these weight-loss regimens is that they were very often immediately followed by weight-gain. People deprived themselves of food. Naturally, they lost weight. But their underlying appetites did not diminish. Unless the weight-loss regimen was maintained, they would follow the commands of their hunger hormone, ghrelin, and resume the diet that led to weight-gain in the first place.

The sensations of hunger, on the one hand, and satiation, on the other, are conveyed via hormones. As mentioned above, ghrelin is the hormone that tells us that we’re hungry. Leptin is the hormone that tells us that we are not hungry – that our hunger has been satisfied. There is, however, a glitch in the system. Fat in the diet tends to inhibit the function of leptin. It would seem likely that of all the foods that we eat, fats would be the food that most induces satiation, but the contrary appears to be the case. A diet high in fats inhibits the function of the hormone that tells us that we don’t need to eat any more.

How can this be remedied? Fortunately, there is another hormone in the picture. It’s called glucagon-like peptide, abbreviated as GLP-1. GLP-1 functions as an agonist of leptin (agonist being the opposite of antagonist), boosting its function in signaling satiation. Leptin communicates to the sensory areas of the brain the sensation that we have had quite enough to eat, thank you. GLP-1 also stimulates the production of insulin and brings down the levels of HbA1c, which is an indicator of how much glucose is bound to the hemoglobin in our bloodstream.

Semaglutide, a peptide that almost duplicates GLP-1, has been developed and brought to market by Novo-Nordisk (NVO). It was first marketed as Ozempic for the treatment of Type 2 diabetes, and has been FDA-approved for treatment of T2DM since 2017. It is taken by injection once a week, starting with a dose of 0.25 mg for the first four weeks and then increased as the patient gets accustomed to the drug, which is not without disagreeable but not highly consequential side effects such as diarrhea, constipation, nausea, and dizziness.

In 2021, Novo Nordisk won FDA approval for semaglutide as an anti-obesity medication, and began marketing it under the name Wegovy. The recommended dosages for Wegovy are significantly higher than for Ozempic as a T2DM drug, and the drug packaging come with a different package insert and prescribing information.

Wegovy has had a very big market impact. Novo Nordisk has cited worldwide market growth of 50% for Wegovy, with about 40,000 new prescriptions being written weekly.

More recently, another potential weight-loss agent has entered the field. About a year ago, Eli Lilly’s (LLY) Mounjaro was approved for the treatment of T2DM. Now, Lilly has put together a 72-week head-to-head clinical trial, comparing Mounjaro with Wegovy. Mounjaro (tirzepatide) has a somewhat different mechanism of action than Wegovy – it is a dual agonist of GLP-1 and also of GIP (gastric inhibitory polypeptide), whose main role is to stimulate insulin secretion.

In the trial, dubbed SURMOUNT-5, investigators will compare the percentage weight loss from baseline between the two drugs after 72 weeks, and also the percentage of patients who have achieved a certain magnitude of weight loss.

In an earlier Mounjaro trial, patients taking the drug achieved a 21% weight loss, which compares with a 12% weight loss in patients in a similar trial with Wegovy. That suggested that treatment with Mounjaro, with its dual mechanism of action, would result in greater weight loss than treatment with Wegovy.

And just as I am writing this (April 27th), some results of the Phase 3 SURMOUNT-5 trial have been published. In that trial, subjects taking the 15 mg maintenance dose of Mounjaro experienced weight reduction averaging 15.7%, and those taking a reduced 10 mg dose experienced 13.4% weight reduction. This compared with 3.7% weight reduction in the placebo group. A total of 86.4% of subjects taking the 15 mg dose lost at least 5% of their weight, as did 81.6% of those taking the 10 mg dose, compared with 30.5% of the placebo group.

Financial analysts have made estimates of the market potential of these drugs that are likely to catch the attention of Gumshoe nation. In the fall of 2022, UBS projected that Mounjaro could reach $25 billion in peak sales for uses in diabetes and obesity. Morgan Stanley put the global obesity drug market at $50 billion.

Are there significant risks associated with weight-loss drugs?

The side effects, as mentioned earlier, are disagreeable, but pose no significant threats to life and health. However, there is one decidedly significant risk, namely malnutrition. The New York Times a few days ago described the case of a woman in her mid-thirties who was prescribed Ozempic as treatment for polycystic ovarian syndrome, which is frequently associated with insulin resistance. The woman essentially lost any trace of her appetite, which had formerly been substantial (she weighed more than 200 pounds). She was constantly exhausted, vomited frequently, and was only able to get down any nourishment by an extreme act of will. After four months on Ozempic, she had reached a state of severe and dangerous malnourishment. Her physician had to suspend the prescription.

The risks of malnutrition would seem to be most elevated in young girls and women who are literally willing to go through extreme privation to achieve what they see as an ideal figure. It may be that the ideal figure is moderating slightly. Doc Gumshoe pays very little attention to changing fashions, and they do change quickly, but I haven’t seen any pictures of fashion models with any excess fat around their midriffs.

Obesity drugs vs. weight-loss drugs: does it make any difference?

It does indeed. Obesity is considered a medical condition – an illness or a disease. Drug treatment for a medical condition is regulated by the FDA, and the drugs themselves are mostly available by prescription. Wegovy and (eventually) Mounjaro are prescription drugs, and physicians are not going to prescribe them for individuals who fall within the so-called “normal” range. Wegovy is approved for persons with a BMI of 30 and over, which is the recognized BMI for obesity, and also for persons with a BMI 27 and over with at least one recognized weight-related condition such as hypertension or T2DM. When Mounjaro gets the FDA blessing, which it almost certainly will, it’s highly likely that those same terms will apply.

(I note that, even though the deficiencies of the BMI as an instrument to determine whether we are overweight or obese are recognized, and not just by me, the BMI is deeply rooted in the procedures of the medical establishment. They need a number to arrive at a conclusion, not just a judgment, no matter how careful.)

What about persons with “normal” BMIs, or those with “overweight” BMIs who do not have those medical conditions that would qualify them to get an MD to prescribe these drugs, but who would like to lose some weight just the same – not for health reasons, but because they want to look svelte?

Well, semaglutide is out there in a number of different forms. And other compounds that have similar effects exist. Until fairly recently, knowledge of the underlying mechanisms of obesity was minimal. The common assumption, even among well-trained physicians, was that the cause of obesity was nothing more than a lack of willpower – essential laziness, a tendency to let the desires and appetites of the moment defeat efforts at moderation. Now that there is at least some basic understanding of what bodily agents communicate to our brains whether our bellies are empty or stuffed, research into weight-control drugs will continue and expand.

Novo Nordisk and Eli Lilly have about a dozen more drugs in development that are intended to have benefits in treating obesity and managing our sense of hunger. They, and other pharmaceutical companies, are lobbying to pass an act of Congress entitled the “Treat and Reduce Obesity Act,” which has been hanging around the legislative ballpark since 2012. The act would require Medicare to cover weight-management drugs. I assume that there would be requirements as to what individuals would be entitled to weight-management treatment. I do not want my Medicare taxes to cover a weight-loss program for normal-weight people who want to be super-thin. The young women who want to look like Twiggy are on their own, as far as I’m concerned.

Persons who are deemed of normal weight, but nonetheless want to slim down, do have resources. Of course, there will always be accommodating physicians who will prescribe a weight-loss drug to individuals who, according to the guidelines, do not need to lose weight, in the same way that there are accommodating physicians who will prescribe opiates to persons who are not in pain. However, contrary to the perception that indiscriminately prescribing opiates is a bad thing, prescribing weight-loss drugs does not have a negative onus. In our society, losing weight is widely regarded as a good thing.

Other sources of weight-loss drugs without a doctor’s prescription are the compounding pharmacies. There are a great many of these throughout the US – more than seven thousand. You usually can’t tell if a pharmacy is a compounding pharmacy. There’s no sign on the outside identifying it as a compounding pharmacy. It’s not a CVS or a Walgreen’s. Physicians will direct a patient to a compounding pharmacy in several circumstances, such as when there is a shortage of a manufactured drug. There have been shortages of Ozempic/Wegovy – not because of shortages of the basic ingredients, but because the drugs have been in such high demand that Novo Nordisk ran short of the injecting devices. In such cases, the compounding pharmacy may be able to source the ingredients and put together an acceptable substitute. Compounding pharmacies are bound by FDA rules, and they have to source the ingredients from FDA-approved suppliers, but the FDA does not check compounded drugs.

It’s not clear how compounding pharmacies obtain the essential ingredient in a weight-loss drug, that ingredient so far being semaglutide. Novo Nordisk owns the patent on semaglutide, and does not provide semaglutide to compounding pharmacies. However, there are compounds very closely related to semaglutide, for example, semaglutide chloride, in which a simple chloride ion is linked to the essential molecule. Semaglutide chloride has not been studied in clinical trials, so it is only an assumption that a weight-loss medication that uses semaglutide chloride would have the same effect as Wegovy. But it’s a likely assumption.

Now that the underlying mechanism of weight-loss drugs has been spelled out – i.e., it’s a molecule that acts as a potentiator of leptin, the hormone that tells us that our hunger is satisfied – similar molecules will be developed. Whether these get incorporated into FDA-approved drugs or not, the basic chemicals that have the ability to dial down our appetites will be out there and increasingly available. Will the overweight contingent become a historical relic? I am guessing that no matter how commonplace weight-loss drugs become, there will always be some folks that tip the scale with a bit more oomph.

*****

Doc Gumshoe’s chief concern in cobbling this piece together has been that some of my highly-valued readers would be offended. I deeply hope that it’s not so, and, if despite my best intentions I have strayed over the line between the acceptable and the unacceptable, I profoundly apologize. And, if I was offensive, please let me know! Thanks for all comments, regardless of their flavor! Best to all, Michael Jorrin (aka Doc Gumshoe)

[ed note: Michael Jorrin, who I dubbed “Doc Gumshoe” many years ago, is a longtime medical writer (not a doctor) and shares his commentary with Gumshoe readers once or twice a month. He does not generally write about the investment prospects of topics he covers, but has agreed to our trading restrictions.  Past Doc Gumshoe columns are available here.]

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modernrock
Irregular
May 3, 2023 11:34 am

$VKTX VK2735 is the other gip/glp-1 dual is starting an oral phase 1a after a successful phase 1a subc. At a $2.1b valuation $VKTX is ripe for a BO in late 23 or early 24

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arbrnrngr
Irregular
May 3, 2023 1:05 pm
Reply to  modernrock

Yup moderrock, Viking looks very interesting. I’ve been following LLY and NVO for over a year and have done quite nicely – especially with LLYs positive Alzheimer’s result last night. More good to come from all the players in this space I hope. Not only financially but for the benefit of all those who will see an improvement in their health.

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doc5653
Irregular
doc5653
May 3, 2023 12:37 pm

Body morphology is important. When I started working out with a professional trainer I was disappointed that I hadn’t lost weight. I redistributed weight from fat to muscle.

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James
James
May 3, 2023 2:21 pm

Doc
As I say to friends, if you want to offend me, you gotta try a lot harder than this. Peace

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lalgulab12
May 3, 2023 3:00 pm

Stop eating sugar, seed oil, refined flour, any food with additives and preservatives, eat very small portions with no snacks in between and regular fasting. This guarantees weight loss 100%

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doc5653
Irregular
doc5653
May 4, 2023 2:00 am
Reply to  lalgulab12

It’s difficult to do on American society. I haven’t done the fact-checking y et since I only saw it today but apparently Heinz ketchup in the US contains HFCS whereas in Canada it doesn’t. Our own food suppliers seem to be trying to kill us.

I spend a fair amount of time in Italy and like everyone else I marvel at how they stay thin. People speculate about portions, walking instead of driving, etc. Italians eat one of the most unhealthy breakfasts I know of. It’s basically coffee and something sweet, such as a cornetto or biscotti.

I think their emphasis on fresh food plays a major role. They won’t serve anything processed if at all possible. Cuisine largely depends on the region and season. At the coast you eat seafood. In the interior you can’t get seafood because it’s not fresh. Their potatoes aren’t sprayed with chemicals to prevent sprouting during transport. Their pasta is made fresh. Grated parmesan cheese doesn’t require addition of cellulose to keep it from clumping like our nasty pre-grated stuff in green cans.

Yet in the US despite exercise 5 times per week and counting calories people can’t lose weight.

Once you go off into the metabolic weeds with dozens of pounds of fat you’re in a different world. Fat is not like an inert jar of lard. It’s metabolically active and not in a healthy way. Then you’re caught in a vicious cycle of obesity and insulin resistance.

I grow my own vegetables and I’m thinking about some fruit trees. The HOA won’t let me keep chickens or cattle so I go to the farmer’s market on Saturday. I have a stocked pond on my ranch 2 hrs away where I grow catfish. Just avoiding store bought food with minimal exercise I’ve lost 15 pounds and kept it off for 3 years without dieting or destroying my knees on a treadmill. I dine out for a few meals per week, including a triple death cheeseburger at Sonic so you don’t have to be a zealot like a vegan for this to work. I also noticed that I’m less hungry. I don’t have to try to do intermittent fasting. One day I noticed I went from 3 meals/day to 2-3 without even being aware of it. That was during lockdown. Without a schedule to follow I just ate when I was hungry.

IMHO we’re poisoning ourselves with our food and then we clamor for antidotes from the pharmaceutical industry. Ironically people are afraid of GMO food in favor of stuff grown in pesticides. Organic produce isn’t what most people think it is. The “organic” label includes environmental practices that address ecological concerns, not necessarily what’s in the food.

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Wayne A Young
Irregular
Wayne A Young
May 3, 2023 4:30 pm

Personally, it is great that a medication that is relatively safe for weight loss has been found. It has become a problem for me because I have had problems getting my prescribed dose of Trulicity. The shortage of these drugs is a hardship as I have to get my medication @ half the dose I Should be taking. Thusly, I have to take two injections instead of one and the medication is twice as expensive.

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Valerie
Valerie
May 9, 2023 2:11 pm
Reply to  Wayne A Young

You’d almost think that was the plan wouldn’t you?

William M. Blackshear, M.D.
Guest
William M. Blackshear, M.D.
May 3, 2023 4:46 pm

Doc Gumshoe, you’ve done a very good job of summarizing the options and issues regarding the recent additions to treatment options in the field of obesity management. As a practicing physician operating a weight management franchise program for almost 20 years, I’d like to add some clarification on the BMI issue you discussed and raise a couple of cautionary notes notes for someone seeking these treatments for obesity.

For decades BMI was the only easily utilized tool available to aid in the diagnosis of obesity. You are right, however, that BMI is a poor tool for accurate identification and classification of patients with true obesity. The reason is that BMI is based on body weight without consideration of the portion of a patient’s weight composed of fat and of other tissues. The classic example is a very muscular NFL linebacker and, as you point out, a dense bone structure but with very little fat on his body However his BMI often puts him in Class 2 or 3 obesity with an attendant increase in the incidence of health problems.

Body composition analysis (BCA) based on bioimpedance, which has been widely available for the past 20-25 years, resolves this issue. BCA is using this principle is a rapid & inexpensive way to determine with a high degree of accuracy the percentage of a patient’s body composed of (1) fat, (2) water and (3) other tissue (muscle, organs, bone, etc.). It can and is being used in physician’s offices to rapidly & reliably identify obese patients who may be candidates for intervention. With a BCA you would never have been misclassified in your physician’s office, assuming they measured your height accuratelyly!

Patients are allocated to one of 6-7 categories of weight: Athletic, Normal, Overweight (little or no increased health risk) and /or one of four categories of obesity, with Cat. 4 being “Morbid Obesity” with the highest risk of obesity-related morbidity and mortality. Men and women differ in their basline percentage of fat which is considered to be normal. For example, for women Category 1 obesity begins at 30% body fat, whereas men are classified in Category 1 obesity with a BF% between 25 and 30. Both increase their Obesity Classification Category in 5% BF% increments.

Other important issues which may inhibit enthusiasm for these newer injectable weight management drugs are the issues of adverse effects and duration of efficacy. Most side effects are tolerated and diminish with duration of treatment; however, recently an increased incidence in birth defects has been reported in newborns of women who have taken these medications during their pregnancy, often unwittedly in early pregnancy. Since >75% of patients in most weight management clinics are female and many of child-bearing age, this issue requires thorough investigation via larger clinical trials. Additionally, significant weight regain after cessation of medication injections has been as high as 80% in some reports. With the high patient cost of each of the weekly injections, a cost/benefit analysic should be considered with every patient.

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vascguru
Member
vascguru
May 17, 2023 2:51 pm

In the Weight Management portion of our practice we do a BCA on every weekly visit. It takes about 30 seconds max. The complete yfoot scale system costs in the $2,500.00 range MOL. But you are right. It isn’t commonly performed on routine well (or obese!) patient visit – but it certainly should be!!

Gene_S
May 3, 2023 5:04 pm

“Follow the Money”

How Warren Buffett and Bill Gates Make a Killing Off the Childhood Obesity Epidemic

https://childrenshealthdefense.org/defender/bill_gates_warren_buffett_obesity_corn_syrup/

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Kipley S. Klein
Kipley S. Klein
May 3, 2023 11:38 pm

I’ve heard that this type of weight loss comes with major bone and muscle loss.

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Davepa100
Davepa100
May 4, 2023 5:05 am

Hi, I see that Dylan Jovine is teasing for his Breakthrough Wealth advice product. He is describing an AI software company (sub $10) to transform weapons systems warfare capability I suspect it has links to Lockheed Martins AEGIS weapons systems which is using. Any chance you could have a probe for an idea of what stocks might fit.

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clark30
clark30
May 4, 2023 11:31 pm

The mention of Ancel Keys set off memories of when I was in an undergraduate summer job in 1947 working for him at the Laboratory for Physiological Hygiene at the University of Minnesota. He was well-known for his famous studies on starvation, done at his lab, using conscientious 0bjectors. I did not know of his BMI work but in retrospect it was a way to quantify the starvation studies’ results.

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Dave
Dave
May 5, 2023 5:42 pm

Amen, BMI for me has always meant Bullshi_ Measurement Index or similar. For those of us that are tall and have lifted weights, and many other kinds of exercises our whole lives it always ticked me off when my report would come back near obese. I had very little fat on my body but rules are rules would be the attitude of the medical establishment. It’s a ridiculus measurement that should have been done away with many years ago. Thank you Travis.

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Valerie
Valerie
May 9, 2023 2:04 pm

This science was incredibly well translated into layman’s terms. It was very easy to follow the progression through relevant topics and to understand something I was completely unaware of. Thank you for the clear and concise information.

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quidpro
Irregular
quidpro
November 17, 2023 9:55 am

Hello Doc.,
I have not gained weight, only redistributed it. I always knew that I would reach an age where my metabolism would change and my fat to muscle ratio with it.
I have noticed a jump in advertising for over the counter drugs that offer relief specifically from belly fat. I can not however find any information about these drugs that is not part of the advertising! I can’t help but feel that the information is biased to say the least. Can you comment?

Sto41
Member
Sto41
November 18, 2023 8:00 pm

SHOT for DOC gumshoe. that is a ticker for wellness beverage company that is making a claim the beverage reduces blood alcohol by alot compared to control within 30 minutes. I get calls from time to time from these stock pitchers pushing stocks this one they pitched me is SHOT. Doc maybe you could vet any of the science or real medicinal claims that back up any of this? it is up a 100% in a couple weeks and i might have bought a couple hundred shares?

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Sto41
Member
Sto41
November 18, 2023 8:03 pm

alcohol is SHOT the answer?

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