317: I Was Wrong About Wegovy, Ozempic, and Mounjaro with Dr. Taylor Brueseke

Introduction 

You're listening to Biceps After Babies Radio Episode 317.

Hello and welcome to Biceps After Babies Radio. A podcast for ladies who know that fitness is about so much more than pounds lost or PR's. It's about feeling confident in your skin and empowered in your life. I'm your host Amber Brueseke, a registered nurse, personal trainer, wife and mom of four. Each week my guests and I will excite and motivate you to take action in your own personal fitness as we talk about nutrition, exercise, mindset, personal development and executing life with conscious intention. If your goal is to look, feel and be strong and experience transformation from the inside out, you my friend are in the right place. Thank you for tuning in. Now, let's jump into today's episode.

Hey, hey, hey! Welcome back to another episode of Biceps After Babies Radio. I'm Amber Brueseke, and I am very excited to welcome to the podcast, my amazing, handsome, rugged,  

Dr. Taylor Brueseke 00:59 

Oh, rugged. That's so manly. 

Amber B 01:02 

intelligent, just amazing, all around everything to me. Husband. Doctor Taylor Brueseke.  

Dr. Taylor Brueseke 01:09 

Hi, folks! 

Amber B 01:10 

Welcome to the podcast. 

Dr. Taylor Brueseke 01:11 

Oh, I should do this more often. 

Amber B 01:12 

Yeah, I would say more nice things about you. I'm very excited to have my husband on the podcast. He's been on the podcast a couple of times and this is going to be a really fun topic to talk about with you. 

Dr. Taylor Brueseke 01:22 

Yeah, I'm excited. This is gonna be great. Let's do it. 

Amber B 01:24 

So this topic has been a long time coming. It started. I don't. This is probably a year ago, I swear it was probably a year ago that we were driving up to Northern California. I remember because I was driving. We were going to Grapevine, and somehow the topic of Ozempic came up and we had a conversation for like 45 minutes to an hour about Ozempic. And I learned a lot of things that I didn't know. I changed my opinion on several things. And at the end I was like, Dang it if I was a better podcaster, I would have just carried a mic to me, and we would have just recorded that, that conversation that we had and we would have put it on the podcast, but I did not have a mic with me and so that. 

Dr. Taylor Brueseke 02:06 

Well, I'm actually kind of glad that you don't have a mic on you all the time. Secretly recording our conversations. 

Amber B 02:12 

That is fair. All right, so let's do, you want to start with disclaimers? 

Dr. Taylor Brueseke 02:17 

Yes, I am a gynecologist. I do not prescribe ozempic. I am a bladder doctor. The bladder has no need for ozempic. Although obesity does impact bladder function, but that's a different story. And so, you know, we're not out here trying to convince people that they should take ozempic or that ozempic is right for them or any of those other types of things. If you have that question, you should talk to your doctor, you know and seek your own medical advice from your own healthcare professional. 

Amber B 02:47 

Yeah, we're really just kind of given some opinions here, some somewhat educated opinions. Especially, I would say on your side trying to. But at the end of the day, like we aren't your medical provider and the best person to have this conversation with, if you are thinking about ozempic is to have it with your trusted medical provider, also I will say that we also are both thin people and so we're going to be talking about body positivity and how this impacts fat phobia and things like that towards the end of the podcast. And I just want to kind of approach that conversation, realizing that like both of us walk around the world in very like, average. Well, I wouldn't even say average sized bodies. I would say like a thinner sized body that people look at us and we don't have to deal with fat phobia on a day-to-day basis. And so that's you know it's an important bias that we bring to the conversation as well. 

Dr. Taylor Brueseke 03:35 

Yeah, it's really important. Thanks for bringing that up. 

Amber B 03:38 

Yeah. So OK, let's dive in. Maybe do you wanna start with like background or just general information about ozempic? Yeah, we'll start with that. 

Dr. Taylor Brueseke 03:45 

So here's the thing about ozempic they have the there are two different manufacturers that make medicines that are like ozempic, and those things come in two different flavors. So it gets a little confusing, sometimes ozempic is actually made by a company called Novo Nordisk, and it was first approved by the FDA back way back in 2017, which I think is one of the things that was surprising to Amber was that this medicine has actually been on the market for I guess whatever that is 7 years now, it's 6 1/2 years. Whatever, whatever time of that year it got released and it was originally approved for the treatment of diabetes and they just happened to realize that a lot of the people that were taking it for diabetes were also losing weight. And Novo Nordisk being one of the, you know, pharmaceutical companies that recognizes the we'll say you know need for additional treatment options realize that maybe they could market this for weight loss as well. 

Amber B 04:42 

And just just to be clear too, like if a drug is approved in 2017, it means there was trials predating that as well. Yeah. So I think one of the things that when I came to that conversation, it felt like Ozempic was brand new on the market like it had just come out because it kind of blew up in the media. And so you know, some of my biases were like, man, this thing is brand new. I don't know if people should be hopping on this bandwagon, being the first trying out this like brand new drug and you were like no, it's actually been around for quite a long you know, a reasonable amount of time. It's not like brand new. And then they had testing data even before 2017 to be able to get it approved. 

Dr. Taylor Brueseke 05:22 

Yeah, somebody once upon a time told me, like you never want to be the first person to try something new, but you also don't want to be the last. 

Amber B 05:30 

Yeah. That's good. That's good advice. 

Dr. Taylor Brueseke 05:32 

So ozempic, you know the drug that makes up ozempic is called semaglutide, and the semaglutide is also marketed by the same company under the name Lagovi. It's the exact same medicine, it's just marketed for weight loss and overweight and obesity are actually the FDA indications for that. 

Amber B 05:51 

So it's like they took the same thing and just like slap two different yeah, stickers on to them. 

Dr. Taylor Brueseke 05:56 

And this is when it really started to kind of pick up steam in the news, in the media, because now we had a treatment that was for obesity, diabetes just doesn't, you know, some important disease, but it just doesn't catch the for all the reasons we're going to talk about our podcast, it doesn't catch people's attention the same way that talking about something for obesity does so in addition to the. The fact that Novo Nordisk makes this drug called semaglutide, which is marketed as ozempic and magobei, there's another company that recently has brought a similar drug to market, and that company is called Eli Lilly and they make a drug that's called terza apatite, and that gets marketed also in two different ways. Same drug, two different brand names. One is Manjaro and the other is called Zepp Bound and Manjaro was approved in 2022 for the treatment of diabetes. Kind of like Ozempic and Zepp bound was approved in 2023 for the treatment of overweight and obesity. Kind of like logobi and those. So semaglutide and tirzepatide are similar. They're both the same type of molecule, but then tirzepatide also has a second drug in it, if you will. And I can, I can tell you a bit more about that if you want to know how the medicines actually work? 

Amber B 07:23 

Yeah. But we don’t know what's the mechanism of action. 

Dr. Taylor Brueseke 07:06 

So ozempic is what's called a GLP one agonist? Let me tell you a little bit about what GLP does. So whenever we eat food, our body has a natural hormone response to eating, eating things and some, you know, you've noticed too, right? Like some foods you eat and you eat just a little bit of it, be relatively full and other foods you can probably eat all day and you don't get very full. That's because of the different hormones that our body creates as a result of eating different foods affect the way our brain processes the food signals, and so the the, the stomach, the GI tract when we eat releases this class of hormones that are called incretins or incretins. I guess it depends where you're from and those molecules have a number of different you know effects and one of the things they tell the brain is like, hey, we're, we're full, we don't need to eat more and that if we're going to, if we've just eaten and we're full, that means we need to digest this food, so it's going to slow down your stomach and slow down your intestines and allow that food time to kind of process inside of it and it's going to make your pancreas get ready to secrete, you know, hormones that will digest the food and your gallbladder and your stuff, you know, it kind of gets the whole system going, saying like, hey, it's time to digest things. And so one of the results there is when those hormones are released, those incretins are released, then you're you, we tend to feel full and that's this. That's the mechanism. That same natural mechanism is what ozempic and these other drugs do is they stimulate the receptor that those incretins work on. And so in particular it's called GLP, which is stands for Glucagon-like peptide and then most people probably don't you know, get lost in the the abbreviations. I do too sometimes, but nonetheless the drug works by activating that pathway that tells the body that you're full. And so Ozempic works in with one molecule, tirzepatide works with two, but they basically have the same impact, although the fact that there's a second molecule in the tirzepatiide suggests that it might turn out to be even more effective than ozempic. 

Amber B 09:13 

Yeah. And so. It basically mimics the same things that the GOP does, which makes you it increases feelings of fullness, and so what people do is they don't. They don't feel hungry like they have in the past and for a lot of people who live in larger bodies and have been trying to make them smaller for a lot of their life, a lot of their life has surrounded by a lot of this food chatter of like I'm hungry, but I shouldn't eat. But I'm starving. And when's my next meal and how much am I going to eat and how do I not overeat? And and all of this like food chatter in their brain. And So what patients have reported is one they don't feel hungry as much as they used to. And so they can eat less and feel satiated and not deal with like endless hunger all day. And it really decreases that food chatter in their brain. So they're not always thinking about food. And that can be really helpful in, you know, producing the side effect of the weight loss. 

Dr. Taylor Brueseke 10:07 

Yeah. And so speaking of side effects, these generally tend to be pretty well tolerated, but it is an injection, right. It's not a pill that you take, it's a, it's an injection that you have to administer to yourself or your partner or friend has to administer to you. They're usually done once a week and they can have some side effects. The most common side effects reported are nausea and vomiting, just like GI upset or or or of stomach problems. And remember, I was saying that like these hormones tell your body that it's full and it slows the stomach down so that it has time to digest the food and that's why it has the side effect profile that it does because if it happens to slow your body down a little too much, then you might hold on to that food longer than you want to. And you might then, you know, start to get kind of nauseated. Because it's it's so full, so to speak. That happens in about 5% of patients is what's reported in the literature. So it's not a small number, you know it it's it's a, it's a significant number, but at the same time, 95% of people don't seem to have that issue. So that's important to know about that side effect.  

Amber B 11:14 

Yeah.  

Dr. Taylor Brueseke 11:15 

And there are some rare side effects too, if you want to hear about that. You know the less than 1% are that this stomach like slowdown happens to the point that it's it's significant enough that you have significant trouble eating. We call that gastroparesis, where the stomach almost slows down to the point that it doesn't empty. Similarly, like the pancreas can get inflamed or irritated by, you know, too much signaling the gallbladder can have issues. So folks that have had a history of pancreatitis or gallbladder disease might not be good candidates for these studies or for these drugs. And certainly, you know, if you have any problem with stomach emptying or gastroparesis, that in the past that would not be a good person to put on this medicine. And even rare, like with all drugs that are out there, there's a, you know, very small chance of anaphylaxis or, you know, life threatening conditions. Anytime we take any particular drug. Yeah, very rare. 

Amber B 12:05 

That's good. So you know a lot of my information that I was bringing or my perspective that I was bringing to this this initial conversation that we had was just that this drug is really new. We don't know a lot about it. We don't know a lot of risk factors. I was. I was reverting back to like Fen Fen. Like you know, we thought there was this miraculous drug back in the 90s and turns out it caused a lot of problems and, you know, ended up being pulled from the market. And so, you know, my perspective was, man, it's it's so new. We don't have longitudinal studies. We don't know how this is going to to impact people and, you know, do you really want to be the first people signing up to Guinea pig for this drug and understanding a little bit more about the mechanism, understanding a little bit more about the history, how long it has been on the market, although we still need more, you know, longitudinal studies and we don't. 

Dr. Taylor Brueseke 12:53 

We won't. We won't know what it's like to take the drug for 20 years, until 20 years comes again. 

Amber B 12:57 

Right. Because that's the other thing, right is that when people go off of the medicine, they tend to gain the weight back. Yeah. And so the thought is now that, you know, if you're gonna be on the medicine, it's going to be for a long time, yeah, it's it's not a. It's not a take it lose the weight and then get off of it. It's it's having to, like, maintain that that medicine. 

Dr. Taylor Brueseke 13:17 

Yeah, and this is just me hypothesizing, but my suspicion is that we don't know that you're going to gain the weight back. We just know that most people that stop taking it gain the weight back. So you know if over the course of a long period of time your habits adjust and your body, you know, reset, so to speak, and you become an exerciser that you weren't before and you start to learn how to cook differently or whatever. Those different factors are that might be contributing. I don't think it's unreasonable to think you might be able to keep the weight off again. I don't prescribe this and I probably, you know, maybe would be very guarded in how many patients I told that to. But as I kind of think about it, that makes a little bit of sense to me. And so I think there are a chance. 

Amber B 13:59 

We can figure it out. 

Dr. Taylor Brueseke 13:59 

That we can figure it out over the long haul like, I guess what I'm trying to say is I don't think it's a, it's a lifelong commitment. Certainly we have seen that the vast majority of people that stop the medicine do regain the weight, but I don't think it's everybody I guess is the point I'm trying to say and we don't know what options will be available five, ten, fifteen, twenty years from now. We just haven't even considered yet. This is a very active area of research. So I guess I'm putting that out there because some people I know won't start it because. 

Amber B 14:27 

Afraid to stay on it forever.  

Dr. Taylor Brueseke 14:28 

They're gonna have to stay on it forever and.  

Amber B 14:30 

Although wasn't that the idea with the diabetes medication in the first, I mean it's a diabetic medication in the first place. 

Dr. Taylor Brueseke 14:36 

Yeah, it kind of depends on how you think about the situation, right? Like most people would consider diabetes to be a disease and it's a disease that is manageable. But most of the time you don't. 

Amber B 14:45 

Cure it.  

Dr. Taylor Brueseke 14:45 

Cure it. That's right. And so you know, this gets to the root of a lot of what we want to talk about today is, is obesity a disease that needs to be managed? Or is it something that can be affected or cured or what? I mean what or is even exactly? Or is it even a problem that's right? 

Amber B 14:59 

Or isn't even a problem, but we like that we say that it. Yeah, we're going to talk about that a little bit. The other thing is I think the other thing I think that is really important because I have a lot of people who are like, especially coaches who are worried that with the advent of ozempic, they're going to not have a job anymore. And here's what I have to say about that. First, there's been a lot of coming out that yes, weight loss occurs. But as my listeners are so well versed and weight loss was not necessarily equate fat loss. And so yes, do people lose fat on ozempic?  Yes, but they also tend to lose muscle mass and so just like any caloric restriction, if you are in enough protein, if you aren't lifting weights or having some sort of resistance training and you're in a caloric deficit, your body is likely going to also eat some of the muscle. And we don't know the long term repercussions of that, you know, making like maintaining muscle mass during this process seems to be a very important focus. And so even for someone who is taking ozempic, counting macros can still be very helpful, especially when we're focusing on that protein intake and of course, including some sort of resistance training in what you're doing, is also going to be really helpful in you know, maximizing the fat loss you're losing from ozempic and minimizing the amount of muscle loss that you're having at the same time. 

Dr. Taylor Brueseke 16:20 

Yeah, because these drugs, ozempic, wegovy, whichever other one you're talking about. They have a very profound weight loss of impact, right? Like Fen Fen. Got approved of the FDA because I think that the, the, the expected weight loss on that drug was like 5% or something like that.  

Amber B 16:34 

That was like enough to clear 

Dr. Taylor Brueseke 16:34 

That was enough to kind of tip it over the edge or something. These things result in lot body weight loss of up to 20 to 30% which is approaching what we see with bariatric surgery. So that's a that's a significant drop in weight. It looks like it takes people about a year to plateau on the medicine, so you know you'll lose the weight, but it won't be immediately because again, it's a dietary change more than anything else but yeah, if you lose that much weight, you're gonna lose muscle and exercise is really important to and protein intakes really important to minimize that muscle loss. 

Amber B 17:07 

And resistance training. Yeah, not even just like exercise. Cause people here exercise and they think cardio. So we gotta, like, spell it out. Like lifting weights. Progressive overload. 

Dr. Taylor Brueseke 17:14 

Got it. It’s my favorite. 

Amber B 17:18 

It's really important to even, even if you're just doing ozempic. And the thing that I hear from people again is that that food chatter is decreased. So you still need to make food choices. You still need to eat food. It's just that you may have an easier time sticking to your plan. You don't have that, that food chatter that makes it really hard for you to because you're always hungry. That makes it hard for you to stay in a caloric deficit or to, you know, eat a certain amount of macros. So it's not that macros go out the door or that we don't need them anymore, it is that it's still really important and it just can help you to be able to stick to it a little bit better because it's easier because you feel full and it's a lot easier to maintain a caloric deficit if you're not always hungry. 

Dr. Taylor Brueseke 18:03 

Yeah. Do you want to get into some of the social sides of this question and whether this is a problem or any of those kind of things? 

Amber B 18:11 

Yeah, I do think that's important. So I mean, I think the advent of a medicine. I think already starts to bring into the question of, well, I think the broader question is, is obesity a problem and if we are making a medication, we're almost stating that yes, it is a problem. 

Dr. Taylor Brueseke 18:30 

Yeah, I think one of the, you know, interesting things about this whole situation is that when the FDA approved this drug for weight loss, now we are, you know, going counter culture a little bit to the body positivity movement that had really been gaining steam. I mean, you know, you probably can tell them better than I can, but like over the years prior to 2022, when this got approved for weight loss, the excuse me, 2021, there was this kind of like growing fire of like acceptance like this, this idea that you know we should love our body for what it is and stop spending so much energy trying to tell people that they're overweight and just, you know, love ourselves for who we are and move on. And you know, it's just in my kind of perspective that that seemed to be a it was taking hold, you know, after a number of years. 

Amber B 19:20 

It's taking hold. Yeah, it took a lot. I feel felt like it took a lot of convincing for a long time because it, you know, fitness as an ideal has been so ingrained into so many of our psyches. 

Dr. Taylor Brueseke 19:32 

Yeah, we were like finally starting to see models and target that were plus sizes and we were seeing, you know, different, I don't know ads and things like that. 

Amber B 19:38 

Right. Different body. Yeah, it was. It was also a little bit of an acceptance of like, I feel like people were starting to come to terms with like the fact that genetics play such a large role in this and that not everybody can be a size 6, it's it's not a lack of motivation. It's not a lack of willpower, but it literally is a lack of like biology and genetics, and that there's a wide range of human sizes and it doesn't make some bodies more, better than other bodies. I do think it is important to distinguish between body positivity and fat activism. Because while body positivity, I feel like was taking a role, a hold on society more and more is becoming more mainstream. Body positivity is focused all around how you view yourself, how you view your own body. So this idea of body positivity was was, you know, self love and falling in love with your own body and not judging your body and and viewing your body as. OK. Whereas the broader fat activism movement, which has been around since about the 60s, is really focused on the acceptance of other people accepting your body where it's like, we want people to not be discriminated for their size. We want people to be appreciated and loved for who they are and not their body. And so there's there is a slight difference there in the body positivity movement and that seemed to take a. That's that was an easier sell to the population of like a love yourself. It's a little bit harder sell to be like don't be discriminatory towards fat people don't be fat phobic. Don't you know, think bad things when you see a fat person and think ohh they're they're lazy and you know they don't have any willpower. And these thoughts that a lot of people carry because yeah, because the society has kind of ingrained that into us from a very young age. 

Dr. Taylor Brueseke 21:27 

Yeah. And so then when you approve a drug for this, can this condition of overweight like now you are almost pathologizing it right you're you're you're taking? That, I mean, that's what doctors do, right? Is they prescribe you things for things that are wrong. We don't prescribe you drugs for things that are right. Oh, good job. You're studied hard in school today. Let me give you medicine or something that you know this is just how these things work. And so the prescription the the development of a prescription drug to treat this I think. It it almost labels it as something that's wrong with you. 

Amber B 22:02 

Yeah. So we had these women who were getting to the point of, like, accepting their bodies, accepting, you know, themselves for who they were and their bodies and their genetics and things like that. And then a drug comes on the market, and now it's like, drop that because now I have another option. 

Dr. Taylor Brueseke 22:15 

Throws water on that whole fire. 

Amber B 22:18 

And I can get myself out of it. And hey, I don't blame anybody for that. I'm not saying that that's a bad reason to do it. I think we as a society have a long way to go when it comes to accepting people who are outside of the “ideal” body size, color, race or, you know, ethnicity like, yeah, whatever we want to deem as like the ideal, we have a long way to go when it comes to breaking down that ideal and seeing diversity as ideal. But you know, again, it's now it's. It's there's an out. There's a way to get out of this and it it it kind of cuts the legs out from the body positivity movement in in some ways because of that. 

Dr. Taylor Brueseke 22:57 

Yeah. And so you know, again, we're not here to tell people whether they should or shouldn't take one of these drugs. But I do think that's a good thing to just reflect on for a second is like we wouldn't. I would hope that the idea of body positivity doesn't change based on whether you lose weight or don't lose weight. Right.  

Amber B 23:18 

Yeah. Well. This is where I think we can talk about the complex relationship between weight and health. 

Dr. Taylor Brueseke 23:24 

Sure. Yeah. 

Amber B 23:25 

And you know, I I did a podcast about how your weight is not your health, and I think it it is a tricky conversation because humans are terrible at nuance. 

Dr. Taylor Brueseke 23:36 

That's true. We like black. We like white. We like up. We like down, fat, thin, healthy, unhealthy. 

Amber B 23:39 

Fat, thin, right? We like these binaries and there is not. Sometimes we take health and weight and we make them the exact same thing. And that is not the case, right? You can be healthy and not and “you can be healthy” and overweight and you can be not healthy and normal weight, so it's not a one to one relationship, but it also is not the exact opposite and right. You can talk about this from like the perspective of medicine and and your experience as a surgeon, but they're not the exact opposite like there isn't no relationship between the two which would make it simpler, but there isn't 100% relationship between the two, which makes it tricky to talk about that. Yeah, that fine line. 

Dr. Taylor Brueseke 24:21 

And we know that people that carry more weight have an increased risk for heart disease and stroke and cardiovascular disease in general. And actually that's one of the things that's come out in some of these newer drug trials with wegovy and tirzepatide, is that not only are these drugs reducing peoples' weight on the scale, they're also reducing their risk for heart attacks and strokes, so you know. 

Amber B 24:48 

Well, we don't. Do we know that if it's reducing their risk of heart attacks and stroke? Because of the reduction of weight. Or because of some other mechanism right? This is where it gets cloudy. 

Dr. Taylor Brueseke 24:58 

I mean, we don't know for sure, but it these are in studies where people are taking the drug compared to people who are not taking the drug. So I mean any trial could have its confounders, but it seems like these drugs do more than just lower the scale. They look like they probably also improve your cardiovascular. 

Amber B 25:15 

Yeah, I guess my question is, is that the mechanism of the drug or is that a byproduct of the weight loss? 

Dr. Taylor Brueseke 25:21 

Yeah, I don't know. Yeah, I would assume it's the weight loss. Yeah. Yeah. And my presumption is that the drug causes the weight loss, which improves, you know, cause there's all kinds of hormonal effects from adipose cells, from fat tissue. And when that fat tissue accumulates, there's a number of downstream cascading effects. So I, I mean, I don't have any reason to think that the drug has a direct impact on the heart, but it and we know it reduces the number of adipocytes you have and how much work they're doing. So I would assume that that's the mechanism, but it's. 

Amber B 25:51 

Yeah, so that's important. Because you know, it's one thing to see a reduction in weight, but we could have, you know, we can have a conversation about, well, do we really need to, like, reduce weight? But when we see that reduction in health factors, right, in lowering mortality and morbidity then now it now it becomes like a health conversation, which is tricky. 

Dr. Taylor Brueseke 26:13 

Right, which is very tricky. Yeah, I mean, and there's no doubt that, I mean, there aren't, there are a number of medical comorbidities that are present in that are people are at a higher risk for, I should say when they carry more weight. I mean as a surgeon I I struggle with this on a regular basis. I was doing a case earlier this year, excuse me, earlier this week when you know this is. It was very challenging, particularly because the patient was overweight and that just puts her at all kinds of risk during the surgery, right when the challenge, when the difficulty level goes up, the likelihood of an injury increases and. You know, not to mention the wound complications and and difficulties that. 

Amber B 26:51 

Healing, lack of. Like the mobility? 

Dr. Taylor Brueseke 26:53 

Yeah, healing issues that people have, like mobility because they're not getting up and moving, cause they tend to be if they're, if they're overweight, they tend to be less active. Certainly not all, but many. So you know weight does impact health. I think you're exactly right, and it's so important to say that weight does not equal health. But it certainly does impact it, or at least they're correlated, strongly. 

Amber B 27:15 

I never. I didn't understand until like I married you. And you know, you started operating how much more difficult a surgery is on someone who's carrying? Yeah, who has a higher BMI? Yeah. I didn't realize that. 

Dr. Taylor Brueseke 27:30 

Abdominal surgeries? Yeah, definitely. 

Amber B 27:32 

Especially abdominals, which I mean maybe like the leg surgeon. The leg surgeons don't notice it as much. 

Dr. Taylor Brueseke 27:36 

Yeah, cataracts probably the same, you know. 

Amber B 27:38 

But the abdominal surgery is much more technically challenging, for the surgeon with more weight. 

Dr. Taylor Brueseke 27:44 

Yeah. And I mean, that's just my job and that's that's fine, but it it does increase the risk to the patient and to be honest, it's it increases in the risk. That we probably don't talk about very much as surgeons, you know it's it's a hard conversation to have to talk to a person and say, OK, we're going to do this surgery, but I just have to let you know, you know, your your, your weight, you know directly increases the, you know, the the risk of you having a complication because then they're like, well, do you think I shouldn't have it? And I'm like, well, I think I can get it done, but you're just going to be at a higher risk compared to the average person. And then when you start talking about relative risk versus absolute risk,  

Amber B 28:21 

People's eyes glaze over. 

Dr. Taylor Brueseke 28:22 

Kind of people get really confused and let's say, well, what do you think and anyway, so it gets to be a really challenging conversation, not just for the statistics, but you know the the social aspect of it, you know. You you don't want your patients to think that you're, you know, prejudice against them. 

Amber B 28:38 

Right. Well, and I mean, that is a very real experience for people in larger bodies. Is there is they are walking through a world that does constantly prejudice them. And that is something that's really important to talk about it, you know, in the medical field that is well documented. 

Dr. Taylor Brueseke 28:53 

For sure. 

Amber B 28:54 

And it's, you know, it's it's something that needs to be shifted. It needs to be changed. We also didn't talk about how expensive it is.  

Dr. Taylor Brueseke 29:01 

Oh, the medication, yeah.  

Amber B 29:02 

Yeah, this not a cheap drug.  

Dr. Taylor Brueseke 29:03 

Yeah, I haven't looked it up recently, but I think it's like $1000 a month, something like that. 

Amber B 29:06 

Yeah, it's like $900 to $1000 a month and because it's newer, a lot of insurances don't cover it. And and so now you're paying out of pocket, you know, $12,000 a year. 

Dr. Taylor Brueseke 29:16 

Yeah, the insurance cut. It'll be interesting to see how the insurance companies shift with this over time, because if it does in fact reduce heart attacks and strokes, it will probably provide,. 

Amber B 29:24 

Save that money. 

Dr. Taylor Brueseke 29:25 

Yeah, in the long run. A large cost savings, which will incentivize the insurance companies to cover these drugs. But the number of people that will then be eligible for these drugs in the United States is very, very high. And so coming up with the out of pocket cost for that you know to prevent a heart attack five years from now, it's going to have a huge impact on the finances of this of this environment. 

Amber B 29:48 

Yeah, and and then there's just people who just it's not accessible to you know whether it's the the cost of it, whether it's the side effects that it causes or whether they just choose not for whatever reason not to take it. And you know, I I fear that we will get into a place fat, fat people are already judged. They're already judged on a daily basis. And I fear that if we have this, like, so-called miracle drug and a lot of people take it and we have less fat people, that the people who can't take it won't take it, aren't able to take it. It's not accessible to them. Will now be judged even harsher as like. Well, you could fix this. If you wanted to and you're not, and now it's your fault. 

Dr. Taylor Brueseke 30:29 

Right. It's like that, that idea of personal responsibility, just like went up a notch.  

Amber B 30:35 

Yes, right. Because now there's now there's there's one solution. So now it's even more your fault. That you're in a larger body, right. And there's so many problems with that  

Dr. Taylor Brueseke 30:44 

With that line of thought. 

Amber B 30:44 

With that line of thought. Yeah. And and almost like the two class system that it creates, like people who can't afford it, who can take it. And then the very again. Like 5 you said 5% of of patients will experience. Like distressing, nausea and vomiting. Not just like ohh. I feel a little queasy. It's like to the point that they can't keep. Yeah, they can't tolerate it, right. It's the side effects are too bad. And and they can't tolerate it. So. So then you know. 

Dr. Taylor Brueseke 31:13 

Yeah, yeah, that's a good question. 

Amber B 31:16 

Something that I hear I've heard from some of my followers and clients is that people also view it as like the “easy way out”. 

Dr. Taylor Brueseke 31:25 

Taking the drug is the easy way out. 

Amber B 31:27 

Right. You know, and in some ways like, of course it is less effort to take an injection than it is to change your habits and behaviors. But I don't like. I don't love that idea of, like, categorizing it as the “easy way out”. Also, the easier way out of what, like like again it's this idea of pathologizing body variation and and pathologizing something that is  “different” than the ideal and making that and making that a problem. I just think it it shows a lot about. How it shows a lot about exposes a lot about how we feel about fat people in a way that we're not comfortable saying out loud. 

Dr. Taylor Brueseke 32:10 

Yeah, I think if you take that idea that there is some “easy way out”, you kind of neglect the complexity of the situation, right? 

Amber B 32:17 

Yes, that's a much better way to say it. 

Dr. Taylor Brueseke 32:19 

Yeah, the the fact that the food chain that we live in, you know, provides us with calorie is that are far in excess of what we need. You know, from a day-to-day basis like you can't go out to dinner and get a Steak or whatever it is you like to eat and have less than 2000 calories on your plate, and that's what most people need in a day, you know, probably more than that. And and somehow, you know, this is our fault because we're we are eating too much and you know this. 

Amber B 32:45 

Well, we're also like moving way less, right? We don't we don't have to. You don't have to wash our clothes by hand anymore. You know? There's just, like, so many things that are just our just culture and society and aid. We live in a world where. 

Dr. Taylor Brueseke 32:56 

We live in a world where you're where we're mostly sedentary, right? 

Amber B 32:59 

Where it's very easy to eat a lot of calories. Yeah, it's very accessible. 

Dr. Taylor Brueseke 33:02 

And and we're so busy that we don't move as much as we could, you know? And you know, I mean exercise is exercise. 

Amber B 33:06 

Yeah, yeah. 

Dr. Taylor Brueseke 33:09 

But I mean, I think I'm doing pretty good and I exercise for like 45 to. 60 minutes, like four or five days a week. And what about all those other hours of the day that I'm sitting? 

Amber B 33:20 

Literally sitting at the console doing surgery. 

Dr. Taylor Brueseke 33:21 

Right. Yeah, I I tell patients I'm like I can, I can eat my calories that I burned in my exercise with like an apple. And a glass of milk. Is that right macro master pretty close. 

Amber B 33:32 

I mean, yeah, pretty close was it, wasn't it you that said that you wanted to do you wanted to pick an area of surgery where you could sit down and do surgery? 

Dr. Taylor Brueseke 33:42 

That's true. 

Amber B 33:42 

Yeah, I read an article recently that was talking about how how the like the desire we have to not exercise and not move is is very innate and born into us, right. The body is meant to conserve calories and so. It is hard to encourage ourselves to get up and move and go actually, and that is biological. 

Dr. Taylor Brueseke 34:05 

Yeah. If you go back to the evolutionary standpoint, like back when we were like hunter gatherers or whatever like,  

Amber B 34:10 

It made sense. 

Dr. Taylor Brueseke 34:11 

You know you would find a tree with apples on it and you'd be so excited, but they weren't like the big apples that we have in the store today that like. I don't know what they do. Those apples are so big. 

Amber B 34:17 

Oh my gosh, we went. We were in Costa Rica. So we have this is the last week's episode about my Costa Rica trip. But we were in Costa Rica and we went and bought Apple. We like looked at we we bought some. Yeah, we bought 1. 

Dr. Taylor Brueseke 34:26 

Yeah, we bought one. 

Amber B 34:28 

The apples were like tiny, they were. So I mean, they were.  

Dr. Taylor Brueseke 34:32 

Like the size of a plum or like a little bigger. 

Amber B 34:34 

They were. I'm sure that they are like normal sized normal. Just grow apples that just grow and haven't had any hybrids made of them and things like that. Yeah, but it was just shocking to see how small and “normal” apples are and how big and gigantic are apples are here.  

Dr. Taylor Brueseke 34:47 

So it's like. That's, I mean, that's the whole idea around our body evolved when we didn't have ginormous apples. Our body evolved when we had little tiny apples and we didn't. Yeah. Yeah. I mean, no, all the above. But I think apples are the great example because like, that's the healthy thing, right? Like, you know, and and that's what. 

Amber B 34:55 

We'd have Doritos. We'd have Doritos. I mean, like, I think that's probably. Apples are probably not a problem. 

Dr. Taylor Brueseke 35:07 

Anyway, so lots of complexity there that goes into the biology story you were discussing earlier in the social aspects of it and and everything else. So I don't know what an easy way out is in a situation that's complex like that.  

Amber B 35:19 

Yeah. I just think when. Whenever we get into starting to blame people, I think we're just automatically wrong. Like like like pointing fingers and blaming people. And this is what I feel like I I mean, I think this is the experience of. A lot of fat people is like they get. Fingers pointing at them that it's like you're discriminated against, but really at the end of the day it's your fault because if you just would lose weight and you just would get your act together, then you could save yourself all this worry and it it just lacks understanding of the complexity of weight. It lacks understanding of the complexity of people's biology. It lacks understanding of the complexity and diversity of humans that we have on this planet and it it just it's wrong. 

Dr. Taylor Brueseke 36:01 

Yeah, it's not. It's it's not a helpful or skillful way of looking at it for sure. 

Amber B 36:04 

Is definitely not a skillful way of looking at it. OK, so we've covered a lot of ground. So to kind of wrap up the conversation, is there anything you want to like leave people with? 

Dr. Taylor Brueseke 36:15 

Yeah. I mean, I think from a medical perspective the the take home from the the story is that these are very effective drugs for weight loss. And you know whether weight loss is something that you need or want or. You know, we're considering like these have the potential to be a helpful thing. You need to talk to your doctor and see if that's right for you and something that is helpful in your overall journey. And they're a tool like any other tool in the toolbox. I guess maybe going back to the easy out story a second ago like you still will need to modify behaviors and you know exercise patterns, resistance training patterns. You know, if you're going to use this tool. It's not. It's not that simple, but it is a very powerful one I think I said it earlier, but if I didn't, you know you can lose up to 20 to 30% of your body weight with this, which is quite a bit a very, very powerful option. 

Amber B 37:14 

Yeah, yeah. And and perhaps, you know, we see. I mean I think there is this connection to it that the larger your body is, the harder it is to move it. I mean, and so I I wonder if we have people who are in larger bodies who don't exercise. And I'm not saying everybody in larger bodies doesn't exercise, but for those people who don't because. They don't want to get looked at at the gym because they don't can't find clothes that fit because they don't have quite the access, because whatever the reasons are that perhaps. They will it with weight loss will come a newfound confidence, or a newfound ability to be able to exercise more and to move their body to have an easier time moving their body. Their joints don't hurt, their knees don't hurt, their back doesn’t hurt. 

Dr. Taylor Brueseke 37:58 

Yeah. There’s the chicken and the egg problem here, right? It's like the bigger you get, the harder it is to to do some of the activities that are helpful to lose the weight and so. You know, this might be an avenue for people in that situation to, you know start restart the system right to help the weight loss. Turn around so that then you can do these things. I mean, I have lots of patients that come to me that say I would exercise, but every time I, you know, jump or run or whatever, I leak urine. So I, you know, and then I'm talking to them about because the condition comes up in weight loss because if you do carry a lot of weight around your belly, that does push more urine out when you're, you know, exercising. 

Amber B 38:30 

Push pressure on your bladder. 

Dr. Taylor Brueseke 38:33 

And then they say, well, I can't exercise because you know, I'd lose urine. And so then it's like, well, like, OK,  

Amber B 38:39 

It's like which came first. 

Dr. Taylor Brueseke 38:40 

Yeah, you lose weight, you're stop leaking. But if you don't exercise, you'll have a hard time doing that. And so, anyway, so this might be a way to short circuit that negative spiral. 

Amber B 38:48 

Yeah. I mean, I think at the end of the day, I think that the take away that I want to have for, for anybody who's listening, who's who's maybe thought about or consider, you know, taking any of these medications is to go have a really good conversation with your provider and your physician. I really hope that we can get out of the moralizing of medication 

Dr. Taylor Brueseke 39:07 

Yeah, that's so important. 

Amber B 39:08 

The moralizing of weight, the moralizing of medication, I've talked to people who have considered it, but they worry about what people think will think about again, them taking the easy way out or them like you don't need it, or being judged for it or like thinking that it doesn't count because you didn't do it through diet and exercise in a way that you're supposed, you know, “supposed to”. And I just. Like all of that. Moralizing I think we just need to get rid of. And again, this is a conversation between healthcare provider and their patient and get out of people's businesses. It drives me nuts on social media. When I see people like questioning, are they ozempic or are they are? It's like none of your business. Yeah, like why do we care? Why are we? I don't know. It it just reeks to me of like. The popular girls in high school getting mad that like other girls are getting popular. Like that's what it breaks up to me is like this idea that like. 

Dr. Taylor Brueseke 40:06 

Yeah, actually, I mean it's a total aside and we can cut it out if you want to, but it's like when people, I get that feeling when people look at guys that are muscular and. Like, oh, you must be on steroids, yes. And I'm like, OK, well, if he is on steroids, that just means that he probably worked out twice as hard while he was on steroids, because steroids don't just make you get bigger like they they do make you grow a little. But like, you have to put in the work. 

Amber B 40:26 

You still didn't put in the work. 

Dr. Taylor Brueseke 40:29 

To do it, and I mean if you want to put in the work and take the health risks that come with taking steroids, I don't care what you do with your time. Like you know that but that. But I think what happens is guys, you know, they see that person and then they instantly compare themselves to that person and like, oh, that guy's only muscular because he did something he wasn't supposed to do. Yeah. 

Amber B 40:48 

It's like a discounting, it's like a weighted discount,  

Dr. Taylor Brueseke 40:49 

And that it brings them down so that I don't feel so low. Yeah, that's right. 

Amber B 40:51 

Yes. So you feel better about yourself, right? Like, like, cuts their legs out from under them anyway, let's not do that. Let's just, like, let people make the decisions that is best for their health and their life and what they need to do and stop judging what people are deciding to do. That's my take away that I want people to have  

Dr. Taylor Brueseke 41:11 

Agreed.  

Amber B 41:12 

Awesome. All right, well, this has been fun.  

Dr. Taylor Brueseke 41:15 

Thanks. Thanks for having me. That was fun. We should do it again. 

Amber B 41:17 

Thanks for coming on the podcast.  

Dr. Taylor Brueseke 41:19 

Hear all those nice things about me again. 

Amber B 41:20 

I hope that this has been a helpful podcast. An interesting podcast giving you something to think about and, you know good luck. We're we're. I I feel like this will be a conversation, a topic of conversation in society for the next yeah, the next, like decade to come. I think we're going to see a lot of shifts with medication this. This opens up a whole new world when it comes to things.  

Dr. Taylor Brueseke 41:43 

Disruptor for sure. 

Amber B 41:44 

Yeah, it's for sure medication disruptor. So it'll be interesting to see how this all shakes out. 

Dr. Taylor Brueseke 41:48 

Okay.

Amber B 41:50 

That wraps up this episode of Biceps After Babies Radio. I'm Amber , now go out and be strong because remember, my friend, you can do anything.  

Outro

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