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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Right. So I would, I don't feel as well versed at the age difference because most of my patients are on the younger end who are taking this. I have seen a lot of insurances not be willing to cover these for patients over a certain age because potentially there is higher risk. I would also argue that most of these meds weren't studied on that patient population. That's a big key issue.
We talk about studies, but studies and data don't, they're not made equal, right? There's the clinical trials where you have a very specific subset of patients, like only patients from this age range, no pregnant patients, no patients on this list of medications, no patients with this list of problems, but only patients with this list of problems.
Like it's very narrow and the drug companies are motivated to make sure it's the patient population that's most likely to show really great results, right? They're not trying to get some Joe Schmoe off the street who like may or may not care about their weight. Like they're really going for people where we're hopefully going to see really good weight loss off these people.
So then you have post-marketing data and that's once a drug hits the market and you have the general population taking it and you have prescribers prescribing it to not just the very specific study group subset, what are we seeing? And that's where we're seeing a lot more side effects. There's like gastroparesis is a really big one where your GI tract basically gets paralyzed, which is horrible.
There's potentially issues with the pancreas, potentially issues with the thyroid. That data is still very weak because, again, these injectables are quite new. So we don't have long-term data on, you know, Ozempic and Moonjara right now because they're they're pretty new to the market. So I would say the older you are, the more likely you are to have certain types of GI issues.
And also I would be worried if somebody is already on a lot more medications, which the older you are statistically, the more medications you'll be on. So there's confounding factors. There's various reasons why someone who's older may be at a higher risk of side effects with these medications. So just logicking my way through it, that's what I would say.
But I haven't seen the hard data stratifying different age groups.
Yeah, so that's a really big question. point of discussion when it comes to these meds. And I have a maybe slightly different view than some would. I think the concept that these are forever drugs is oversimplified. I think for a small number of people, these might have to be forever meds. And when I'm saying these, I'm talking strictly the weight loss ones.
Because there are diabetics who I have absolutely no qualms about certain diabetic patients being on Ozempic or Victoza or whatever for the long haul to control their blood sugar. I'm speaking strictly for people who do not have blood sugar issues but want weight loss.
I think these drugs for people where they're clinically appropriate to use and clinically safe to use can be an excellent stepping stone. towards long-term maintained weight loss without lifelong use. And my example would be one of my patients who was in a wheelchair for a really, really long time and was using, they had like diabetes as well.
So, you know, but they ended up losing a lot of weight. They were able to stop relying on the scooter basically when they were getting around and they were able to walk. more often. And this led to, you know, increased exercise, and they were able to continue losing weight.
And, you know, even though they're still on this medication, I feel like that's a really good example of if your mobility is so negatively impacted by your weight, and this weight loss medication helps you get down to a low enough weight that you can increase your exercise, then potentially between diet and exercise, you can maintain that weight loss
and not need to stay on the medication, you could safely taper off of it. And that's the other thing is tapering off. Unfortunately, many of our patients on these meds, either for diabetes or weight loss have not gotten to taper off of them, they just suddenly stop because they're not available anywhere. So I mean, we've gotten to see what people are experiencing when they don't get to taper.
And it's extreme hunger, right? Like that hunger comes back with a With a passion. So if someone were to say, I'm going to try using this medication to get down to a certain level of weight loss so I can be more mobile.
And while I'm doing that, and I have the suppressed appetite, I'm going to work with a dietician to make sure I'm getting enough food to maintain my muscle mass because I don't want to starve myself. but also not overeating so that I'm not going to, you know, meaninglessly take this medication, then I think it can be a really useful tool for a small subset of people.
I don't think it's clinically appropriate to have people stay on this medication for the rest of their life if it's strictly for weight loss, unless we get more data indicating that it would make sense and for who it makes sense to, right? Because we don't, We just don't have enough information right now.
But as things stand for now, I think for a small number of people, it could be very useful to get them to a point where healthy eating habits, which means something different for everybody, and healthy exercise habits, which look different for everybody, can be maintained, can become a habit for that person, and then slowly taper off that med while they still maintain those healthy habits.
Yeah, so the most common ones would be nausea, vomiting, stomach ache, just GI discomfort in general. Most of my patients... complain about these side effects when they start the medication. And I've had some patients go off of these medications because of the side effects, right? Where they're just like, I constantly felt nauseated.
I don't want to lose weight if it means I feel like I'm going to throw up all the time. So, and for some patients, you know, these side effects may peter off after a couple of weeks on a certain dose, but for others, they persisted and it was very uncomfortable. I believe one of the studies that
on Ozempic, like a third of the participants dropped out within a certain period of time because they just couldn't handle the side effects. So that's something worth talking about. That's a lot. That's a lot. And when it comes to nausea is one thing, but vomiting that causes damage to your esophagus over time.
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