Are Weight Loss Jabs Actually Safe? Drs Give Their Honest Opinion

Hinzugefügt: 2026-06-03

[00:00:00]10 years from now, will the obesity epidemic be solved by this drug, or are we going to regret this whole era of GLP-1s?

[00:00:07]>> Hi, welcome to our Doctors of Record podcast. This is one of many podcasts that we hope to do.

[00:00:14]So, my name is Dr. Shiraz Din, and my special interest is in diabetes and weight management.

[00:00:18]>> My name is Dr. Manso, I've been a doctor for about 8 years now, and my interest is longevity and digital health.

[00:00:26]>> Right, you're going to be talking about interesting topic today.

[00:00:28]>> I think it's a great one to start off the first episode of this podcast.

[00:00:32]>> So, we're actually talking about um well, which one do you use? Ozempic, Wegovy, Mounjaro. So, these are the three that a lot of people have been talking about lately for weight management. So, that's what you're going to be exploring today.

[00:00:46]>> Yeah, so interesting topic. I think it's quite a hot topic. The last few years have seen this market explode completely, and obviously pharmaceutical companies have been hot on trying to release new medications, better medications, um and we've actually seen an evolution essentially from the traditional Ozempic. I think that was the first one that came out.

[00:01:06]>> I get lots of patients coming to me and saying, "You know what? I've tried diet, I've tried exercise. Doctor, help me.

[00:01:13]Tell me what I could do to lose weight."

[00:01:16]So, it's no point telling them again and go saying, "You know, go to the gym, try uh Weight Watchers." It's patronizing.

[00:01:24]Now, we've got an option. We've got an option to give them which is solid, which is evidence-based, which works.

[00:01:30]And that's where this medication is coming. So, there are three players in the market. There's this Ozempic, which came first in the market came in 2017, then came Wegovy 2021, and Mounjaro 2022.

[00:01:42]And personally, I found I've been using these medications for the last 7-8 years in terms for my patient, and this is why I've been one of the most exciting times for me as a doctor to be able to help my patients with that that problem of weight management.

[00:02:00]Shall I ask you a question then? So, should GLP-1s be available to everyone?

[00:02:05]And or are they just medicalizing a normal problem? What do you think? And I'll give you my answers.

[00:02:13]>> Yeah, sure. I think I know what your answer is going to be, but my take on this one has been although this has been truly a miracle drug for a lot of patients, and I've seen people transform their lives with this medication, and it's actually benefited not only how they feel, their mental health and how they look, but also actual physical symptoms in terms of their blood markers, their blood test results. So, there's actual real evidence these medications work. The only thing is that I feel there is a level of abuse going on with these medications amongst certain patient groups.

[00:02:44]>> These are strong medications. So, we all know that, you know, these are initially designed for diabetes. These are designed for patients who have exhausted oral medications, and now we're reaching a point where we need to consider insulin. So, that's the space it occupies, right? So, you've tried all your oral medications before you reach insulin. That just by that definition, it is not for everyone.

[00:03:08]>> It's pretty powerful, right?

[00:03:10]>> It is a very Exactly. I think that's where lots of people miss the point.

[00:03:15]It's not a recreational drug that you It's not in the sense of drugs, you know, in the sense of medication.

[00:03:23]>> in the category of cocaine, right?

[00:03:25]>> It's not in that class of medications.

[00:03:27]But, I mean, it was It's not something that you go and, like, for instance, buy herbal tea for weight loss. It's not like that.

[00:03:33]>> prescribe the whole range. You know what's the latest medication coming out as well. From your experience, what do you think is currently the best of all three of them at the minute which are available in the market?

[00:03:45]>> So, the When you try to look at the comparison between all of the three major players, Ozempics, Wegovys, and the Monjaros, When you look at the data, they work on different receptors, right? Ozempic and Wegovy works on a GLP-1 receptor, and Monjaro works on two receptors, a GLP-1 and GIP. The other >> Just explain to the audience. Just explain to them what is a GLP-1 receptor? What's a GIP receptor?

[00:04:08]>> Yeah, so essentially that to mimic how you would feel when you've eaten a big meal. So, when you eat a big meal, your stomach stretches and produces GLP-1 hormones, right? To tell you tell the brain that you're full. First of all, what the Monjaro does is with the GIP, it stops the breakdown of the GLP-1, so it remains in the system for longer.

[00:04:27]>> Got it. Makes sense.

[00:04:29]>> Now, yeah. Um idea of all this is you're going to be taking this to lose weight.

[00:04:33]So, Ozempic loses 6.1% of your weight in clinical trials over a 52-week period.

[00:04:38]And again, Wegovy uh loses about 14%.

[00:04:42]And Monjaro 22.5. Monjaro works four times as well as Ozempic in weight loss, and twice as it's closer to twice compared to Wegovy. So, >> So, Monjaro is the best at the minute.

[00:04:54]>> So, at the moment, the best in the class is Monjaro for weight management because it's much more potent. But, there's something else coming up called retatrutide.

[00:05:03]The the results just came up uh for the phase three trial just about uh a week 10 days ago, which which suggested 34-35% weight loss with uh with the retatrutide, which is a game-changer. So, we are very excited.

[00:05:18]Hopefully, it's coming up in the next 6 to 8 months.

[00:05:22]When it hits the market, yes, it's going to be transforming how we manage weight compared to what you're doing.

[00:05:29]>> That's really impressive, those kind of those kind of numbers. But, is there any sort of data coming out in terms of uh what exactly is it targeting in terms of lean muscle mass? Is it fat?

[00:05:40]>> The the targeting is slightly different as well. So, it works on a triple receptor, GLP-1, GIP, and a glucagon. Okay. So, it's going to be quite interesting to see the real-world evidence. So, these are all from clinical trials. And that is more of a controlled uh environment, right? But, to see the real world. So, just talk about the real world. So, what have I seen in prescribing this medication to my patients?

[00:06:06]So, initially we uh I've given Ozempic in the past to um so, it's only 2 years ago to individuals who are diabetic. And then we found that they were losing weight, right? And then it came up to a point where everyone wanted Ozempic to lose weight.

[00:06:21]Now, then it can be go Wegovy was much more effective. So, people go on Ozempic or like, you know what? I want to try Wegovy. So, we moved them to Wegovy. And then the Mounjaro came. They're like, you know, it's not as working as well.

[00:06:33]So, I want Mounjaro.

[00:06:34]So, the the key with these medications are that, you know, as health can do health care professionals, we have to be quite careful on these medications because they come with a huge amount of side effects. So, we have to warn warn them.

[00:06:48]>> Just going back to that point you mentioned. I thought that was quite interesting. So, you mentioned that it acts the GLP-1 um it basically mimics a hormone that's released by the stomach when you are full uh to signal to the brain that, you know, you don't need to eat anymore.

[00:07:05]Can you not achieve the same thing just by fasting or just withholding calories like calorie restriction? But, is obesity actually a willpower problem or have we been completely wrong about this the whole time?

[00:07:18]>> Interesting question. So, I don't think it is a willpower problem. Obesity is an illness as we understand it. Now, we can't all we can't put it down to, say, you're fat because you're lazy. No, that's not what you're trying to say. It is because there are so many other factors at play.

[00:07:35]>> I've had patients I've seen who've, you know, come to me um they're overweight.

[00:07:40]They have a degree of metabolic dysfunction. They told me that, you know, they're doing 10,000, 12,000 steps every day. They restricted themselves to 1,000 calories a day, yet they're still not losing weight. Um so, and you know, sometimes it's hard to believe, but when you look at the numbers, the weight just plateaus. I mean, is that essentially where this is at play?

[00:08:00]>> This is a story for a lot of patients, and this is where this medication is making a huge impact. I got I had a patient who came to see me. This is about uh 3 months ago.

[00:08:11]Uh who was 180 kilos. He's tried everything. What he said was, "My family has problem with obesity, and I've always been like this. Now, doctor, it's getting to a point where I can't walk because my knees are giving way. Doctor, please do something to help me because if I go in this direction, I'm going to be in a wheelchair. Last time I went on holiday, I went in a wheelchair. So, that is quite powerful, actually. I felt really, really bad.

[00:08:36]And I explored all his blood. Everything was normal. Then I thank you talking to him about these options, and he thought, "Okay, you know what? Let me just give Mounjaro a go."

[00:08:45]>> What does this medication actually do to your hunger hormones that willpower never could do?

[00:08:51]>> So, essentially, this medication has two actions in terms of GLP-1 and GIP, right? So, it's a once-a-week injection you take. And what it does is it works centrally at the brain level. So, it suppresses your appetite. So, when it suppresses your appetite, it switches off um you know, your cravings. This is a thing that everyone struggles. I, as a patient, struggled with this. So, when I come home from work, you think about, "Okay, I need to stack on these things."

[00:09:21]But, the problem is the good thing about these medications is that it switches that off, and you don't really think about snacking. All that goes out the all goes all that goes out. So, in that sense, it becomes so much easier, even if you were to fast, or if you even if you wanted to like, you know, you asked me a question earlier about, like you know, why not fast?

[00:09:40]Yeah. It's easy for us to say it, but from a patient perspective, it is incredibly hard. And this gives patients a a tool in order to manage those a bit better in terms of it. And it switches off the hunger. It's the food noise stops. So, that's centrally. And then it works at a gut level, where it slows the gastric emptying.

[00:10:03]It can make you feel a bit bloated. And that again mimics the fact that, you know, like you know, it feels like you've eaten because of food remaining in your system for longer. Then it just reduces your hunger as well. So, it breaks down the fat that causes and causes lipolysis. Now, what's incredible is you're asking about, you know, you know, this is where the metabolic health comes in in terms of, you know, you have patients who have had fatty liver disease. They carry a lot of visceral fat around their tummy. Found it in my patient group who thought that it reverses fatty liver. It's amazing.

[00:10:38]You've because at the start of the medications, we I do the blood test.

[00:10:43]The ALT and the AST will be elevated and gamma GT will be elevated.

[00:10:50]>> Those are the the liver enzymes that basically give us an indication of the health of the liver.

[00:10:57]>> Yeah. Yes. And then you track them through the progress at week the month two, month three, you'll see that it gradually reduces. And which is amazing.

[00:11:06]We are >> Yeah. With these patients who have this degree of metabolic dysfunction, it works really well. It was as you mentioned, it was started as a medication to treat type 2 diabetes. But would you say that in someone who doesn't have metabolic dysfunction, does it work the same way? Or so, for example, in their 30s or 20s even, they're definitely overweight, but it's not got to a point where if their blood pressure's elevated or they have fatty liver disease, that core cohort of patients, do you think that these medications are suitable for them or should be reserved for people who have more of the metabolic syndrome type picture?

[00:11:46]>> My opinion, this is a personal opinion that's coined from experience uh of using for myself firstly and then for my patients.

[00:11:56]I find that that is the cohort of patients that we need to be targeting more. At the moment, all these guidelines are targeting much more older population with multiple comorbidities, but this is where we need to really work on.

[00:12:09]Um then we can potentially um reduce the risk of cardiovascular events, heart disease.

[00:12:16]>> My argument in that space would be Don't you think that that cohort of patients are the ones that who actually, if they did try to restrict their calories and exercise and fix their diet and lifestyle, they would actually see significant changes um and much uh faster improvements compared to the ones who have metabolic dysfunction?

[00:12:38]>> I'll give you an example of a patient who came to see me today. So, I had a patient today who uh was exactly the same cohort that you're saying. He was 109 kilos. He was in his 20s 74 kilos.

[00:12:53]He does a very busy job. He can't find the time to exercise and when he comes home, he's snacking on stuff. And now he has a family history of diabetes. He's worried that he's going to be diabetic if he goes down this pathway.

[00:13:06]>> And >> it is that cohort of patients that You know what? We He had already come to see me with all his blood results. His blood results are perfect, but he qualified for it because his BMI was 35 and we ended up going down the route of thinking about Mounjaro for him.

[00:13:23]>> Could these GLP medications eventually replace the need for bariatric surgery completely.

[00:13:29]>> So, some of my patients in the BMI range of about 50, right? And they would ideally in the past be considered for bariatric surgery.

[00:13:40]>> Okay.

[00:13:40]>> Now, bariatric surgery is a big process.

[00:13:43]It's a big process in the sense it either whichever you choose, whether it's you choose a balloon, the gastric banding, gastric bypass, so they involve surgery. That's cutting and chopping organs.

[00:13:57]And that means that you have to be on lifelong vitamins, right? So, it comes with it its own side effect profile.

[00:14:06]Um the uh having to be reliant on medications lifelong.

[00:14:12]Now, to that cohort of patients, not a lot of people will opt for it. Some people do, some people are too scared of it, right? And this um this medication fits in quite nicely.

[00:14:23]So, I've had a patient um in that category.

[00:14:28]He's lost 10 kilos a month on this medication on Manjaro.

[00:14:33]Yeah, so in that sort of a sense it's quite comparable.

[00:14:36]>> Um Okay. Let's talk about side effects, right? That's a big big thing about uh these medications. There are a lot of people that I've personally spoken to that asked me, "Doc, I want to try this medication, but uh I'm worried about the side effects." Um and I I guess obviously, you know, as doctors, the vast majority of patients that we treat have little or no side effects to any medications. But, when they do, things do go wrong, they can go very wrong, isn't it?

[00:15:04]>> Yep, absolutely. And this is something that you always have to mention to patients, right? You know, because um this medication was a diabetic medication.

[00:15:14]So, it does kick your pancreas to produce more insulin. Pancreas is the organ that produces insulin, right?

[00:15:20]>> Yeah.

[00:15:20]>> So, if it doesn't work so well, that's when you get diabetes because this kicks the pancreas for this more and more insulin. Sometimes it can make it get a bit swollen. And that is called pancreatitis.

[00:15:31]So, pancreatitis, you can't miss it.

[00:15:33]It's excruciating pains in your tummy going to your back with nausea and vomiting. So, it's a rare side effect.

[00:15:39]Nonetheless, it's something to bear in mind.

[00:15:41]>> Apart from pancreatitis, any other sort of side effects that you think?

[00:15:43]>> Yeah. Yeah. So, essentially the the more serious ones are pancreatitis, then it can go potentially have gallstones.

[00:15:50]Gallstones are you can develop stones in your gallbladder and that can cause pain on the right side of your tummy.

[00:15:56]>> Yeah.

[00:15:56]>> Um the other side effects usually are gastrointestinal, which sort of nausea, sulfuric acid burps because it slows your gastric emptying, can feel a bit bloated, potentially can have a bit of diarrhea, constipation, more of the gastrointestinal side effects, which to be fair, um most people tolerate it quite well. At the high doses, the side effects are much more common.

[00:16:20]>> Dr. Amir, so in your opinion, who should not be taking GLP-1s in your opinion?

[00:16:27]>> I mean I mean you've got the ones where there's a contraindication, right? For example, there's a reason they can't take it. Um and that's a medical reason.

[00:16:35]But then in my opinion, this is my opinion again, I've had quite a few patients approach me who are very young um and who want to lose weight. It's typically not a lot of weight. Usually it's maybe a maximum of 20 kg, not more than that.

[00:16:52]Um and they have a terrible lifestyle, but because they're young, perhaps they get away with it. And they just don't want to change their lifestyle. Um and I think for me personally, that becomes a bit of a gray area is because I know by giving them that medication, yes, they will lose the weight. Uh but will it actually benefit them in the long run? We We for example, it strips people of 30 to 40%.

[00:17:18]That was Danny's study that came out in 2024. It showed about 20 to 30 to 40% loss of lean muscle mass. We know that muscle mass is directly linked to longevity and independence as you get older.

[00:17:31]And if you lose that, then that can be a problem because you'll struggle to put it back on. And so, but I guess in those in that younger cohort where you're giving it and perhaps they don't they don't understand the value of actually having it. It feels almost unethical because I know in the long run, it's going to do harm to them.

[00:17:47]Interesting point.

[00:17:49]>> So, when you do stop the medications, if you haven't really adjusted your diet and lifestyle and build that into your routine, you're going to gain the weight back. There's no two things about it.

[00:17:59]>> On that point actually, now I mention it, what percentage of patients that you've seen that you've treated with this medication have you seen put the weight back on after they stopped?

[00:18:10]>> So, let me give you my example, right?

[00:18:13]My personal example. So, I went on this medication about 2 and 1/2 years ago. I went to see my GP.

[00:18:20]I had a conversation because my blood pressure was through the roof and the my weight with the best will in the world it was only going one way and that is up.

[00:18:29]So, I had to do something. So, I was how old was I? Late 30s and yeah.

[00:18:35]Now, I went on it. I lost about 22 kilos over about 4 and 1/2 5 months. All right. So, since then I stopped my blood pressure pills.

[00:18:47]Um I'm able to Yeah, I don't get my the back pains and knee pains that I used to get because body doesn't pick and choose whether it loses fat or muscle, right?

[00:18:56]So, this is where education becomes very important. I always tell my patients to do some strengthening exercises to maintain muscle mass. We have a lot of patients that we give it to for PMOS or PCOS.

[00:19:09]They're finding it difficult to get pregnant.

[00:19:11]When the weight comes down, the hormones were better and we coined the term wonder babies. We don't want wonder babies because it's not licensed. You have to be assured to once clear of it before you start um, thinking about pregnancy.

[00:19:24]>> And is that because uh, there's no known side effects or just because you don't know what happens?

[00:19:29]>> Yeah, we one, we don't know what happens because these are only very new medications. One other important thing that you touched on uh, Dr. Mayor is um, about what do you do when you stop this medication to gain weight, right?

[00:19:43]Now, we use a few techniques for that.

[00:19:46]So, um, we use something called microdosing. For myself, it's not a um, it's not a science that's well known, but practically, I do something called microdosing. My first specific sense, when I go on holiday, I gain a few kilos, like three to five kilos if I was to go to Sri Lanka, that's where I'm from. If I went to Sri Lanka for three to five uh, say about months to month, I'll come back with a couple of kilos above.

[00:20:13]And that's not good, right?

[00:20:15]>> [laughter] >> But food's amazing. So, and also the thing is when you when you have your routines, they're all well and good. You exercise, you follow a structure when you're when when you're in your routine, but when you're out of your routine, then enjoy life as well, right?

[00:20:29]So, microdosing is when let's say when your weight goes up and when you come back from holiday, you take a smaller dose for a couple of weeks until you reach your steady state. It is not evidence-based. It is just off um, it's more craft skills. So, microdosing pretty much is using part of the pen to get to a dose. So, what normal people do is use half the pen, so that's 30 clicks to get to a dose and so that is half the dose. So, it's not evidence-based. There's a lot lots of theories around it, lots of criticism of using it, but practically, it works. So, no matter what we advise patients, patients have their own reason for doing things.

[00:21:12]>> Yes, I guess perhaps I'm a bit old school. I believe in good old fashioned regular exercise, weight training, play sport, eat clean food. But I guess for a lot of people this has worked and this has worked quite well. I guess maybe it's a personality thing and I think a lot of people probably might feel the same, but I'm always wary of kind of injecting things into my body or putting anything any foreign substance in my body. I think it's just a normal sort of human reaction to have.

[00:21:39]To even though I'm a doctor and I know I understand the mechanism how it works.

[00:21:43]I understand the the risks in terms of the the data that's come out as well. It still just seems like you know what, natural's always better.

[00:21:51]But I guess at the end of the day a lot of it comes down to patient preference.

[00:21:55]>> I see those patients who have tried everything out there from weight loss pills to weight loss teas to exercises. So I I do empathize with them and so that is in a way it's quite powerful to having gone through this personally.

[00:22:12]>> Because you can understand that you've almost become like an advocate for Monjaro or for GLP-1s because you've you've actually experienced the the miracle drug first hand.

[00:22:24]>> It's a good point actually, you know, perhaps I'm I may be biased because I've tried it before.

[00:22:29]>> I've had a encounter once where a patient got quite aggressive with me because I wouldn't increase their dose of Monjaro. Basically, they wanted quite aggressively increase the doses. So when I didn't, it was quite a a visceral reaction and I just I thought to myself it almost seems like they are addicted to something. For example, you've got a drug addict and you take away their heroin or something and they get quite aggressive. I almost felt the same from that.

[00:22:57]>> The same vibes.

[00:23:00]Yeah, the same vibes. What you have to be quite careful about this is that we don't want to get people addicted to this. It's quite easy, actually, because for my personal use, right? When you know that this is an easy fix for a problem, you know, you kind of let go as well as a as a patient. I'm I'm thinking, you know, what? I When you go on holiday, you can be a bit extra um on the food and all that because you know when you go back, you can fix it.

[00:23:30]That's the wrong mentality.

[00:23:31]>> Right. You just take the medication.

[00:23:32]It's easy now, isn't it? Just uh >> Yeah, so that that that's probably the wrong mentality of the of thinking. But this is to be fair, this is the this is how patients think.

[00:23:42]Now, whether it's right or wrong, I will leave it to the judges, but in my opinion, I think that's not the right way of doing things. The right way of doing thing is is you've done all the hard work to attain the weight.

[00:23:56]Medications, one, it's not cheap.

[00:23:59]Very expensive. And the other thing is comes with a whole host of side effects, but unnecessarily.

[00:24:04]>> That's crazy. We really do live like in this culture now where everything's just instant, you know? I just I need a quick fix for losing weight, so take a drug for it. They just want the quickest, the path of least resistance, essentially, without having to compromise. But at the same time, you've got people who who do exercise regularly. So for example, they'll go to the gym regularly, they'll play sport, and they will never really experience this problem, and perhaps they will never really understand from the point of view of someone who does have metabolic health issues or is seriously overweight. Um perhaps they'll be just like, you know, why can't you just go to the gym? Why can't you just exercise? Why can't you just stop eating?

[00:24:44]>> But unless of course you've been there, you've experienced that, it's very difficult to empathize. So, knowing what you know about these medications, if someone in their 30s came to you with a BMI of 31 and they wanted to lose a few kilos for their wedding. What did you do?

[00:25:04]>> That's a tricky one. So, I've already had quite a few patients come and ask me for that very reason. There was one person they and basically they wanted it for their sister's wedding.

[00:25:15]And they said we just need it for a short time and after that I don't really care what happens. And so, yeah I declined it. I said I think you probably speak to private provider somewhere someone prescribe it to you but not me.

[00:25:25]I'm against that.

[00:25:27]>> go on to an online pharmacy and fill a questionnaire and find it and find it a questionnaire and get it themselves.

[00:25:33]>> Absolutely. I know I know that's probably what they did anyways.

[00:25:36]And I mean look at the end of the day I cannot control how the industry works. I can only really control what I do. And I think that's kind of the reason why I've I've gone in the direction I've gone you know creating this digital platform for you know health coaching and you know people to optimize their lifestyle factors and improve from that.

[00:25:58]And I think that it resonates well with me because I feel like I'll actually be doing a lot of people who perhaps don't know what to do. Right? So, for example I get a lot of patients come to me. They say well we've exhausted exercise. And I look at them and they're doing less than 5,000 steps today.

[00:26:12]They're going to the gym maybe once every two weeks.

[00:26:15]In the gym they're not really sure what to do. I guess perhaps there's a knowledge gap there. You know, they're not really sure in terms of you know what they need to be doing to lose the weight. And not all exercises will help you the same way in losing weight. For example, if someone has metabolic dysfunction. For example, the classic ones with you know, the ones that we treat with Monjaro and and GLP-1s. You know, often I get them they're trying extreme hit workouts or hit training.

[00:26:39]Often hit training can actually temporarily worsen metabolic function because of the release of stress hormones and cortisol.

[00:26:47]>> I didn't know >> So, it causes Yeah, so that's why so So, what I advise them is you actually what to be doing is you need to go into onto brisk walks.

[00:26:56]Um and that's all of zone two cardio.

[00:26:58]And also uh we talk about uh strength training and and what are the proper strength training routines they need to be doing. And I guess that's that's all incorporated into what I've built. And you know, I understand that there will still be some people who will need the GLP-1s as a push to help them get to their goal.

[00:27:18]And I think the way I look at GLP-1s now is exhaust nutrition, fixing your lifestyle, and exercising properly, right? Exhaust that first, okay? When your journey your health journey has plateaued, you're trying everything, and you hit a ceiling, that's when you bring in the GLP-1s because 100% they do work. They are very powerful drugs as we have established, but that's where you use them as an adjunct, not as a primary driver of of weight loss. And I think what's happening at that point is they're already in a routine to exercise regularly. They're already doing the right exercises, so they're maintaining that muscle mass and building on it. So, when you now give them GLP-1s, as long as they continue on that routine, they will actually preserve their muscle mass, and they will have the best outcomes long term. And that's the way I look at it.

[00:28:13]>> Fair enough.

[00:28:14]Yeah, so that's um what's interesting as well is So, that is you're looking at it purely from a healthy individual trying to lose weight, right?

[00:28:28]In comparison to someone who is, let's say, morbidly obese with multiple comorbidities >> Like arthritis, heart problems, things like that.

[00:28:39]>> Yeah. Yeah. So, that is a very different uh kettle of fish.

[00:28:43]>> 100%. Completely completely agree with you. And I guess initially the NA, I mean even now, the majority of patients on the NHS who take this medication is that category of those category of patients.

[00:28:55]>> That's right, absolutely. So, on the NHS, again, what needs to be said is these medications are very difficult to get hold of because the criteria set on the NHS is very strict. So, um what we what we are finding is like, you know, actually one patient day on my phone call list would be I want Manjaro on the NHS and I a BMI of more than 30, but that is not NHS criteria. NHS criteria is BMI of more than 40 with more than four weight-related comorbidities.

[00:29:35]Now >> So, in addition, you can have four four like health serious health problems that are weight-related in addition to having a BMI of 40. That's quite a hard criteria to me, isn't it?

[00:29:43]>> Yeah, that is a very hard criteria to meet and not a lot of people do qualify on that basis.

[00:29:49]>> My final sort of closing question to you, 10 years from now, will the obesity epidemic be solved by this drug or are we going to regret this whole era of GLP-1s? What do you think?

[00:30:00]>> Interesting question.

[00:30:02]No.

[00:30:03]I will reflect back onto a patient conversation that I had. So, he he was one of those patients that we spoke about in terms of he had bariatric surgery about 3 years ago.

[00:30:15]And then he came up to 150 kg of weight and then he came to see me because he wanted to lose further than 100.

[00:30:24]Now, he came to see me about a month ago.

[00:30:27]Uh weight was 96 kilos and I asked him the same question.

[00:30:33]Would you have the Would you would you have had the bariatric surgery knowing the correct diagnosis of these medications? are surprised by his answer.

[00:30:45]He said he would have still had the bariatric surgery. You know why?

[00:30:47]>> Why is that?

[00:30:48]>> So, what he said was with these medications, when you stop, the hunger comes back. I can't well, probably going to gain the weight back.

[00:30:57]But now having had the bariatric surgery, my stomach has shrunk. I can only eat a given amount. So, it is more of a permanent fix.

[00:31:06]Whereas Mounjaro, all these medications is a temporary thing, right? When it stops, everything goes back to normal.

[00:31:12]>> Well, see how this space evolves.

[00:31:14]Obviously, we'll have more episodes go in depth with different areas about this topic. Hopefully, the viewers enjoyed that episode. If you have any ideas for new episodes or information that you'd like to know, just drop it on the comments below or send us a message and we'll try and accommodate for everything. But any sort of final words, Dr. Dean?

[00:31:32]>> GLP-1s definitely works.

[00:31:36]But it's not for everyone. We have to be able to challenge patients with the restart good safe. This is now time to stop.