TVJ’s Interview with Dr. Karen Phillips on Weight Loss Medications
This interview highlights the complexities of weight loss medications, management and the importance of a holistic approach combining diet, exercise, and behavioural changes, even when considering weight loss medications.
Host 3: In recent news, Making the Rounds, TV mogul, Oprah, has said she now uses weight loss drugs. To discuss the role weight loss medication may play in maintaining a healthy weight is Dr. Karen Phillips. She’s an endocrinologist, obesity and weight management specialist, and consultant physician. It’s a mouthful but a very important job.
Host 2: And so much more, actually. Good morning and welcome.
Dr. Karen Phillips: Thank you. Thank you for having me.
Host 3: How would you decide whether you’re overweight? Because I’m 6 foot? Is there a weight for me as a man?
Dr. Karen Phillips: Well, I want to tell you that’s an area of controversy because the best fit we have right now is a body mass index, which looks at your weight compared to your height in meter squared. For that, so that is the most standardized way because really and truly, it’s not the best method because as you said, if you’re 6 foot and you’re muscular, your BMI can come out high and you’re not. It doesn’t represent excess fat, which is what we’re trying to define. BMI or Body Mass Index, that’s the best way we can really define it. For overweight, anything from 27 to 29 kilogram per meter squared and over 30, definitely is obese. So overweight is below 30, say from 27 to 29, and obese is greater than 30 kilogram.
Host 2: Just before Dailiah, but the average Joe would know if he works out all the time or would they?
Dr. Karen Phillips: There are a lot of calculators online. There are a lot. You have charts. It can just fit in your height and your weight, and it just spits it out. It’s very simple. But as I said, it’s not the best fit. We still have not found a good fit for telling about excess fat or adiposity. But we work with BMI because it’s the best so far.
Host 3: Okay. Let’s talk a little bit about the weight loss drugs, doc. I think a lot of this conversation has been inspired even more by what happened with Ozempic.
Dr. Karen Phillips: And Oprah looking so fabulous.
Host 3: Yeah, and a lot of people trying to get the medication for that purpose, but the weight loss people are having all of it. Who should doctors say, yes, you’re a candidate for weight loss drugs?
Dr. Karen Phillips: Right. I would like the focus to be a little bit off weight loss drugs, even though I want to say it’s a very exciting time in obesity because for the first time, you have drugs that are performing almost to the extent of bariatric surgery, which is affording you 30% of your body weight in terms of weight loss. But I want to stick to the foundations of it because really it goes back to a very holistic lifestyle approach to it. Even for the decision as it relates to who to give weight loss drugs, we really expect that you should have at least tried diet and exercise and really have not lost 5% of your body weight in 3-6 months. So persons who have failed that, and certainly for persons who have certain comorbidities, so overweight persons who may have diabetes, high cholesterol, hypertension, and obese persons with comorbidities or not, severely obese persons, we would want to trial them with weight loss drugs. We have a number of weight loss drugs on the market now, and some of them are working really, really, really well. As I said, previously, we’d have weight loss drugs, maybe 5 to 10% of your weight loss in terms of your body mass, in terms of your weight.
Dr. Karen Phillips: But now we have some performing like 15%, you’re losing 15%, 20%. With recently, FDA-approved Monjara, you’re losing up to 20% of your body weight.
Host 3: I’m sorry. Why I said who’s a candidate is because, yes, it’s a weight loss drug, but it’s a drug.
Dr. Karen Phillips: It’s a drug.
Host 3: People should be aware of.
Dr. Karen Phillips: That is the other thing. I’m really glad that Oprah did suggest in her speech that it’s not a magic wand. It’s not. You have to do the work, and she’s doing other work. She’s doing her lifestyle stuff. Persons have to understand that. Not everybody’s a candidate for these weight loss drugs. Correct. Because there’s some serious contraindications. Persons who may have had gall bladder problems, kidney problems, previous pancreatitis, those are some absolute contraindications for the newer, we call them GLP-1 agonist drugs, which are the ones that are performing really well.
Host 2: How does the medication work, though?
Dr. Karen Phillips: It has a number of ways to do that. One, it increases insulin production, it decreases glucose manufacturing in the body, it causes increased satiety, and it has a central effect on appetite. That is the glucose-like peptide 1 agonist drugs. That’s the one that everybody’s talking about, Wegovy or Ozempic. Monjara is a combination of GLP-1 and GIP inhibitor agonist as well.
Host 2: I want to go back to the overweight. If I know my weight, so I’m supposed to be 160. When am I overweight? 161 or 170 or 180? When are you considered to be fat?
Dr. Karen Phillips: That’s why I’m saying the body mass index is the way that we try to determine that. Say, weight in kilogram of a computer height in meters squared.
Host 2: I understand that, but my question is, does it have to get to X amount over what you think it should be before you’re overweight?
Dr. Karen Phillips: No, because it depends on your height. It’s always in relation to your height for the body mass index.
Host 3: Then it calculates like a 23 or a The body mass index has a point.
Dr. Karen Phillips: Well, there’s a range. Normally, it’s less than 25. Really, 26 to 29 would be overweight. Then over 30 would be obese, and then over 35 would be severely obese, and then over 40 would be morbidly obese.
Host 2: Many months ago, we were doing this Ministry of Health program. It was saying, I can’t remember the ratio now, but I said one in every two people in other countries are overweight or obese. Anything like that?
Dr. Karen Phillips: No, listen to me. I mean, about a third of Jamaican women are obese. A third? Yes, I’m telling you. Obese? Obese, yeah. There are figures for it, yes. A lot of it is really in our society, a lot of it is cultural because If you’re a mugger, you’re seen as…
Host 3: You’re sick and dying.
Dr. Karen Phillips: Yeah. And even back from slavery days, you have on weight, you feel like you look good. There’s this cultural reinforcement for overweight and obesity in all populations. So we see there’s a lot of obesity in Jamaica.
Host 2: In other words, we almost want to be like that.
Dr. Karen Phillips: We want to be like that, and that’s the problem. It’s a cultural thing, and so you have to get into that. And then the problem now, though, is there’s a whole tsunami of childhood obesity in Jamaica and in the world as well. But in Jamaica as well, there are so many contributing factors. It’s something that is really, really important and we really have to look at it because we’re going to become more sick as we get older because there are complications of obesity.
Host 3: That’s why I like the term management. That’s a part of what you do. Because at the end of the day, we’ve had interviews with surgeons who’ve done liposuction, for example, and they’ll tell you, “We remove the fat, but we can’t stop it from coming back.”
Dr. Karen Phillips: Yes, the behavioral modification.
Host 3: Even the weight loss tablets. We’ve seen Oprah herself yo-yo with all the things that she’s done. What is the key to management? Because you can take the tablet and then you lose it very quickly, but you don’t develop a habit of maintaining what you’ve lost.
Dr. Karen Phillips: That’s why it goes right back to diet, exercise, behavioral modification. That’s very key. It’s modifying that behavior with counseling, with support groups, with whatever you need. But making it a habit, you have to get back to that because you lose the weight. As you said, because your body does this, it eats itself back to its set point. You lose weight, and then there’s this pesky hormone called Ghrelin. It just makes you want to eat and eat and eat back to where you’re supposed to be, genetically. You really have to conquer that through behavioral modification. That’s key. Just forming habits, making If you eat something like brushing your teeth, your diet and exercise. I want to tell you, the diet is very important. If anybody who eats, even people who think they’re resistant to weight loss, if you eat less than a thousand calories a day, you’re going to lose weight. Burning energy as well is also very important, but it’s not the whole problem with that is that you may lose 5 to 10% of your body weight, but you’re going to gain it back if you don’t stick to it.
Host 3: One of the things that always gets me is if you ask people in their 40s, 50s, and 60s if they want to go back to where they were before, or in their teens or 20s, is that even possible?Dr. Karen Phillips: That’s the problem. The problem is that when you gain weight, your body does this thing where you make more fat cells. That’s the problem. So you lose weight, but you still have those fat cells, even though they get smaller. You have more of them. When you regain, that’s why people who regain their weight gain more because they’ve made more fat cells, so when they get back, they tend to put on more.
