Dr. Sarah Molasky
speaker
127 appearances
1 recordings
1 series
first heard Mar 2024
last heard Mar 2024
Dr. Sarah Molasky’s voice in public audio — every appearance, attributed to the second.
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And again, we also are dealing with a shortage of Moonjaro and please do not call my pharmacy to ask if I have it in stock because no.
Yeah, so I mean, in terms of the why this now for weight loss specifically, because they work. Right? They work with caveats. They work in certain patients with certain types of obesity and levels of obesity.
They also work really well for people with diabetes or prediabetes and for some people with insulin resistance, which is a kind of umbrella term for people whose bodies don't, the cells in their bodies aren't responding to the message the insulin is sending, which is, hey, here's sugar, store it, use it as fuel. And the muscle cells will go, okay, we'll take in more sugar and use it up.
Well, if someone's insulin resistant, the body, the pancreas is sending out all this insulin being like, hey, there's a lot of sugar in the blood. Let's bring it in. And their body isn't doing it. So for some people who are insulin resistant, drugs like this can potentially be somewhat helpful. Although I do have one medication I'll talk about that is much more helpful with that later.
That is sometimes used for weight loss. But it works and it works relatively quickly. And when it comes to weight loss... It's very difficult for people to see results from weight loss when it comes to doing lifestyle remedies like changing your diet, exercising more. Those are things that are important, but they take a really long time for you to notice something.
Whereas with these injectables, a lot of people are seeing results much more quickly, like say in a month or in two months, they're noticing, oh, I have way less of an appetite.
So for people who, I would argue that a prescriber who's doing their due diligence and really being picky about what patient they're giving this to, they're choosing patients whose BMI is very high because technically I have a BMI of 30 right now. So I qualify for Wigovi. I'm not going to do it, but I technically qualify.
But doctors and nurse practitioners and PAs who are being more diligent will do it for people who are a certain size. whose health would likely support it, who don't have pancreatic issues or thyroid issues that potentially might be concerning with these kinds of medications.
And also for patients who have diabetes or prediabetes, then the Ozempic side of things might be considered appropriate because, again, Ozempic is supposed to be for diabetics, right?
Unfortunately, what I'm actually seeing in practice is very different from that. I am seeing patients who do not have diabetes or prediabetes being prescribed, you know, Monjaro and Ozempic and When I get these prescriptions, I have to call the doctor and say, you know, this isn't really, that's not what this is prescribed for.
I have patients on my wait list to get this medication who are actually diabetics. So I'm going to reserve this for my patients. And that's kind of a tough discussion to have with prescribers because some prescribers don't like when pharmacists contradict them, but I'm going to prioritize my patients first.
So they're definitely, whenever there's an opportunity to make money, there will be a small number of people who will take advantage of that because they don't care about patients the way most prescribers do. And unfortunately, that small group is then prescribing to people who just want to lose a small amount of weight. Well, I shouldn't say small because everything's relative, right?
An amount of weight that isn't necessarily representative of what kind of weight loss these medications were
Yeah, so it really depends on the person, of course. But if the person comes up to me saying, you know, I've been doing all these things to lose weight and nothing's working, I really want to try one of these injectables. Obviously, the first thing I say is you need to talk to your doctor about it.
But another first line thing that I tell patients is, have you ever spoken to a registered dietitian? And that's really important because first of all, nutritionists and dietitians are two different things. You can be a registered dietitian and still be a nutritionist. But if I like literally anyone can call themselves a nutritionist. and get away with it.
Like I could call myself a nutritionist online, right? I have no credentials, but you don't need them to call yourself a nutritionist. To be a registered dietitian in America, you need a certain set of schooling. So I tell my patients, talk to your doctor, right?
Your clinic or whatever, and ask them if you can have an appointment with a registered dietitian to find out, okay, I'm eating less or I'm eating more carefully, but am I eating effectively? Because when it comes to dietary changes, that looks very different for each person. And I tell my patients, look, I can give you the quick and dirty, right? Cut out pop, cut out sugary drinks, cut out juice.
Just getting rid of really easy sources of quick sugar is a very... simple way to cut down on excess calories that also flood your body with sugar that gets stored as fat because your your blood sugar spikes and then your body is like, OK, let's pump out insulin and store that as fat. So those are the main things I tell people is talk to a registered dietitian first. Talk to your
you know, clinical team and find out what they recommend for you specifically. When people come up to me asking about diet pills that they can buy over the counter, I say, absolutely not. That's going to raise your blood pressure. Some of them can have been found to cause liver damage. Like it's not something that's worthwhile.
And if people say, you know, my, my doctor said they're going to prescribe me Ozempic because I have diabetes and I'm really worried. Like I've like, I don't know, I don't necessarily want to lose a lot of weight, valid because some patients don't want to lose too much weight, right?
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