Vital Signs: How weight loss drugs are changing the obesity conversation

[MUSIC PLAYING] NINA MOINI: It's time for our segment "Vital Signs." Each month, we'll be talking about topics that are important to your health and take a deep dive into medical news or what's top of mind at the doctor's office. MPR News host Cathy Wurzer sat down with Dr. Jon Hallberg, a family medicine physician at Mill City Clinic and a professor at the University of Minnesota Medical School.

CATHY WURZER: Good to see you again.

JON HALLBERG: Thank you, Cathy. It's great to see you as well.

CATHY WURZER: I have got to ask you about this. There was news recently that Nestle is going to launch a food line specifically for folks who use the weight loss drugs such as Ozempic and Wegovy. Now, these are wildly popular drugs, and I'm assuming you've got patients asking for them.

JON HALLBERG: Oh, my gosh. I've been practicing for almost 30 years since residency, and I really haven't seen this kind of, what's the right word, enthusiasm, clamoring for than this sort of family of medications. It's really unprecedented.

CATHY WURZER: How do you decide if the drug is a right fit for one of your patients?

JON HALLBERG: We Americans love drugs. We love to do something that's easy to take. Like, I want to take a pill for something. So it's pretty rare that someone comes in asking for one of these and they haven't tried anything else. But of course, we need to pause for a second-- what have we tried?

Are people active? Are they trying to pay attention to what they eat? And that combination-- of course, that's the classic, classic, the energy you put in and the energy you expend. But we know that there are deep, deep genetic reasons why people sometimes are truly, obese or even, as we say, morbidly obese with BMIs, Body Mass Indexes, over 35, let's say.

So when they come in, they're asking for this, a lot of times they'll say, I want Ozempic. And it's like, you have to pause. And that's actually technically for diabetes. You don't have diabetes. That drug's not covered if you have prediabetes.

So then we talk about its companion, exact same drug, but just rebranded as Wegovy. And that's about $1,200 to $1,300 a month, many times out of pocket. People don't realize that, that it's not covered by all insurance plans. And there are other medications.

But I guess the long story short is that we want to pause, talk about it. It's not an "oh, by the way" thing. I really encourage people to come in for a visit specifically to talk about this, because it's a big deal.

CATHY WURZER: Say, what do you make of a study that shows that, gosh, almost 95% of pharmacies in the country found that these drugs are soaring among young people, like 12 years old to 25?

JON HALLBERG: Yeah.

CATHY WURZER: What the heck is going on with that?

JON HALLBERG: Well, same thing. And I think it's important to say that. This category of medications, these GLP1 receptor agonists, they're changing the conversation about obesity.

What is obesity? In fact, this last year's caldecott winner, Big, was about a young girl with obesity, and saying hey, this is OK. This is who I am. And it's interesting because we're kind of having conversations about, is that OK, especially if there's a medication you can take once a week that can reduce that?

And yeah, it's really complicated, because we don't want body-shaming. We want to encourage people to be who they are. But these drugs are changing that conversation. And now, it's not just an adult conversation, it's a child and adolescent conversation. So this is just, again, unprecedented that we're having these kinds of discussions in the clinical setting.

CATHY WURZER: By the way, does it really help with weight loss?

JON HALLBERG: It does.

CATHY WURZER: Is it permanent?

JON HALLBERG: Well, no, this is not a permanent fix. I think it's important to remind people, too, that what it's really doing is that when you eat a meal, glucose levels rise-- you're breaking down food, glucose levels rise-- insulin level increases. So that's really what's happening. That's why it's so good for diabetes.

And we can't forget that this is really, initially, a diabetic medication. But what it also does, we think, is that it slows down gastric motility. So it slows down how fast your stomach is emptying and your intestines are moving. So you can imagine, then, if that's how it works and your stomach feels fuller longer, that all the major side effects are GI-- really uncomfortable abdominal pain for some people, gallbladder issues.

It's not a perfect drug. For many people, it's great. For some people, it's intolerable. So it doesn't work for everybody.

CATHY WURZER: Interesting. So you mentioned that you've seen attention around certain drugs in your career. Would you call this not hysteria-- that seems like that's too harsh of a word here-- but is there a form of hysteria around this drug?

JON HALLBERG: I think there kind of is. So recently, I remember when the COVID vaccine came out-- I remember being more stressed out then than I've been in almost any other time in my career because people were clamoring for it. And they were like, my friend is at Health Partners, and they got theirs. Why don't you have it yet?

And it was this whole jockeying. And we got it the next week, you know? But it was just so stressful because people were clamoring for it. This is kind of similar because of, is it covered by insurance? Is it not?

If it isn't, how do we go about this? This pharmacy is out of it. We spend so much time trying to get it to people and get it covered by insurance. Luckily, we have a pharmacist that we work with, a MTM, medication therapy management, pharmacist, and, oh, my gosh, I don't know what I would do if I didn't have access to her to work with, who's just amazing.

Many clinics, by the way, do have access to these kinds of pharmacists. But that's really the person who helps us navigate these really, really choppy waters.

CATHY WURZER: So let me ask you about something else. I found this to be very, very interesting. Evidently, another study now, daily marijuana use now outpaces drinking in the United States-- an estimated, what is it, almost 18 million people reported using marijuana daily, compared to about 14 million daily or near-daily drinkers. Wow.

JON HALLBERG: Yeah, it's something. It's tipped, right? And I think it's important to remind ourselves that it's not that there are more people using marijuana than alcohol. Alcohol is still more commonly used, but this is daily consumption.

And then, of course, for people who study abuse and addiction, daily use of something like that is concerning. If people drink every single day, that, by almost every measure now, is considered excessive drinking. So we really need to be careful about that.

And we're trying to figure out what to do with marijuana. I've always taken the approach that I just can't believe, if it's smoked, for example, that if you're breathing some hot substance deep into your lungs, I don't care if it's cigarette smoke or marijuana smoke, that doesn't seem like a great idea.

And people are saying, oh, but it doesn't cause lung cancer the way that cigarettes do. But it's like, yeah, but if millions and millions of people are now doing it, it gives me concern. And I know my pulmonology colleagues and others who work with people on their lungs-- it's really interesting.

Now, granted, of course, there are many other ways to absorb THC and CBD, whether it's gummies, or elixirs, or whatever it might be. But yeah, again, really interesting-- and I don't know quite what this means yet.

CATHY WURZER: Because it is legal in Minnesota, will you be asking patients about their usage?

JON HALLBERG: Oh, sure. We kind of already do. It's like when you do questionnaires-- what substances do you use? And we kind get at that. And it's probably not a big focus of what we do, but it's part of the patient questionnaires in many, many cases now. And we certainly do talk about it.

CATHY WURZER: I'm assuming, because it is legal, people are now more willing to say, yeah, I do use.

JON HALLBERG: Yeah. I had a situation the other day that was quite interesting. It was like a couple, they put their child to bed, and then they take a hit and kind of a way to wind the day down. But yet one part of the couple was absolutely opposed to cigarette smoking, but was totally fine with this. So I think this is becoming kind of a new reality in how it's becoming very, very acceptable.

CATHY WURZER: I wonder about the effects on older people-- I don't know, 65-plus, I suppose-- I've been hearing that some of those individuals are ending up in ERs.

JON HALLBERG: Well, I have a personal story with one of my patients who, in-- I'll use the pronoun "they"-- they were on vacation and in their mid-80s, and took a gummy before going to bed just to sort of help with sleep-- woke up in the middle of the night, thick speech, felt very strange, a little out of body, woke up spouse, worried that this person was having a stroke, went to the hospital, got worked up, had an MRI, everything clear.

It wasn't until after the visit that this person realized that it was the gummy that was probably causing it. So it led to thousands and thousands of dollars of a workup all because of using a gummy-- and someone who is in their mid 80s. So it's buyer beware. I think that we need to be really careful with this stuff.

And I also remind people, too, that if you're getting things like that, you really don't know exactly what you're getting. I know that people say oh, no, no. This is well-documented. We know where the source is. We know exactly--

CATHY WURZER: A lot of people say it's safe.

JON HALLBERG: Yeah. I will say that the Minnesota Department of Health has had in place a medical cannabis program for years. And I'm a person who certifies some of my patients to go through that. And I do have some patients who, even though they can get things now at a dispensary, wherever they want to go, they still like using that because there, you actually do know what you're getting.

You actually know how much CBD, how much THC. They can compound it in certain ways. You can get it in different forms-- typically used for people with everything from PTSD, to sleep apnea, to intractable pain can be used in a lot of different ways.

And so in the expression we often use is, hey, it's just another tool in the toolbox to help you manage your symptoms. But that's one way you know what you're getting. Every other way, you honestly really don't know exactly what you're getting.

CATHY WURZER: As a physician, how do you think you might be dealing with this situation where, now that it's legal in Minnesota, you may be seeing more patients and maybe seeing more health concerns, possibly?

JON HALLBERG: Yeah. I think we just weave it into the conversation. Over the course of a career, we see things ebb and flow, new things hit the market, whether it's a prescription drug or it's a trend with supplements. We've certainly seen that over the years that at one time, everyone wanted to be in vitamin d.

That seems pretty innocuous, but that's kind of ebbed and flowed. The pendulums always swing one way and the other. And right now, the pendulum is definitely swinging in the way of using gummies, and CBD, THC, marijuana. And we'll have to adapt. We'll have to weave it into our practices and the questions that we ask.

CATHY WURZER: All right. Always good talking to you. Thank you.

JON HALLBERG: Thank you, Cathy.

NINA MOINI: That was MPR News host Cathy Wurzer with Dr. Jon Hallberg, a family medicine physician at Mill City Clinic and a professor at the University of Minnesota Medical School.