Curious About Ozempic? Meet Our Friend Paulina

Curious about weight loss and drugs like Ozempic? 

Interested in learning some facts about these drugs? 

As with all of the information we provide, this is not medical advice. It is a really great conversation between 3 friends, one of whom has in-depth knowledge of drugs like Ozempic because of her job as a biopharma public equity investor. We know you’re really going to enjoy this catch up with our dear friend, Paulina Niewiadomska. Note: this also is not investment advice.

Episode Highlights:

• How Ozempic and other GLP-1 agonists, originally approved for type 2 diabetes, are now being used to address obesity.
• Paulina shares her personal experience with Ozempic to lose and maintain her weight.
• The risks and benefits of these medications, including the risk of muscle loss.
• How drugs like Ozempic can address emotional eating.

The intent of this podcast is to provide you with evidence-based information that will support more efficient and effective communication with your medical providers. It is not intended as medical advice.

Thank you so much for listening to the show. Here is how you can connect with us at This Is Perimenopause.

Sign Up for our Newsletter
Instagram
Facebook
TikTok

Want more resources? We've got a ton! Visit our website

Chapters

• 0:00 Perimenopause and Ozempic
• 4:39 Weight Loss Medication and Hormone Mimics
• 16:39 Weight Loss Medication Side Effects
• 22:58 Weight Loss Medication Benefits and Considerations
• 35:43 Podcast Promotion and Disclaimer

Transcript

Paulina: 0:00

From that perspective it's like magic and again, this is a personal view. I'm not, you know it's probably not the same for everybody. But patient stories are things like I am now able to eat one jelly bean and be happy with that. You know you have a plate of something that you like and you don't finish it because you're not hungry and that whole response is gone. Not only is that what's helping you to lose the weight, but once you plateau like I haven't lost any more weight in the last three years I lost all the weight in the first year. There are certain things that are just no longer appealing that I would have eaten significant amounts of earlier. So it really works. It signals to your brain that you're not hungry and your brain listens.

Mikelle: 0:47

Welcome to. This is Perimenopause, the podcast where we delve into the transformative journey of perimenopause and beyond. I'm one of your hosts, Michele.

Michelle: 0:56

And I'm your other host, Michelle, and we know firsthand how confusing, overwhelming and downright lonely this phase of life can be.

Mikelle: 1:04

Join us as we share real life stories and expert advice to help you navigate this journey and advocate for your best health.

Michelle: 1:11

We used to think menopause signaled an end, but really it's just the beginning.

Mikelle: 1:18

Before I introduce today's guest, I need to make clear that, as always, this podcast is not medical advice. I also need to make clear that today always this podcast is not medical advice. I also need to make clear that today's podcast is not investment advice. On the show today we have one of my very good friends, paulina Nowodomska. Paulina is a portfolio manager and has been analyzing pharmaceutical companies and their products for the past 20 years and as part of her job, she's been following the story and developments in diabetes and obesity over the past decade. So we invited Paulina to come on the show and share some facts with you about drugs like ozempic. She's also graciously agreed to share her personal experience. Thank you for joining us, paulina. We're so excited to introduce you to our listeners.

Paulina: 2:01

Hi Paulina, hi Mikkel, hi Michelle.

Michelle: 2:06

Hello, hello, how's it going?

Mikelle: 2:15

It's going well. Thanks, very much Thanks for having me on your podcast. Mbas together and became very close and bonded you know, at 3 am doing group work in the basement of a university building and have been good friends ever since, and I wanted to have Paulina on because she's incredibly talented and smart and she's got some great perspectives on things that, or a great perspective on something that I know will be of great interest to our listeners. So we'll maybe start with that. Paulina, maybe you could tell us about what kind of work you do or what your career has been about and why you have an in-depth understanding of drugs like Ozempic, why?

Paulina: 3:05

you have an in-depth understanding of drugs like Ozempic, absolutely so.

Paulina: 3:13

As Mikhail mentioned, my background was partially an MBA, but before that I went to school for science.

Paulina: 3:15

So I was partially a scientist, partially a business person, and what that turned into was a career in equity research. I've spent the past 20 years analyzing pharmaceutical companies from a perspective of whether or not they make good investments for the funds that I've been working with, but, as a result, the work essentially encompasses analyzing the drugs that these companies are selling, that are currently on the market, as well as their research in the relevant pipelines, so that I have a good understanding of what's coming to the market. And so the work entails, you know, making financial projections, but also attending medical meetings, speaking with the company management, talking to their R&D personnel, attending their R&D events and you know, as a result, drugs like Ozempic, which have been on the market. So Incretins as a class of drugs, have been on the market since 2005. First approved for type 2 diabetes and now for obesity as well. We have been watching this opportunity for the past four or five years already, and since it exploded over the summer last year, you know, especially so.

Mikelle: 4:31

Amazing. Well, maybe we could start with what Ozempic is and what it's used for. Sure.

Paulina: 4:39

So Ozempic, as I just mentioned, is a drug that belongs to a class of drugs called incretins. So it's a mimetic of a naturally occurring hormone that gets released as we eat to signal your brain, essentially, that you're full. So the hormone is called GLP-1. You may have heard of this. It stands for glucagon-like peptide and Ozempic is a glucagon-like peptide receptor agonist, which means it mimics the action of this hormone. What does this hormone do for you without the drug?

Paulina: 5:20

Just generally, so it is a hormone released by your small intestine when you eat. It triggers insulin release from the pancreas. It blocks glucagon secretion. Glucagon is another hormone that triggers the release of glucose into the bloodstream, so it slows that process down and it slows stomach emptying, so it slows down your digestion, so you don't release too much sugar into your bloodstream all at the same time. And it increases the feeling of satiety, so signals to the brain that you've eaten enough, you're full. These drugs are mimicking this hormone, the action of this hormone in your body, and were first developed for type 2 diabetes. So for diabetes, what they were doing is regulating your blood sugar levels. What they're doing for you in obesity now that they're approved here, is essentially reduce your appetite and your food intake by the other actions which have to do with the slower stomach emptying and the feeling of satiety.

Michelle: 6:25

So is it sort of like and forgive me if I get this wrong but bariatric surgery.

Paulina: 6:29

So the end effect is the same. So in gastric bypass surgery you're actually cutting out or putting a ring around part of your stomach to make it smaller so that you physically feel fuller faster. Here you're trying to mimic the natural hormones that your body should be producing. In type 2 diabetes, it's dysregulated. In obesity it's also dysregulated. We can talk about why it's so hard to maintain weight loss after a diet Not Mikel and not you after a diet, and not Mikel and not you, michelle. But many of your listeners, I'm sure, have struggled with the yo-yo effect. I'm a prime example. You lose 30 pounds or 40 pounds over the course of six or eight months. You've worked so hard and a year later you're right back where you started, or worse. And that's not just the lack of willpower. It's actually documented now that that is your body actively working against you.

Michelle: 7:31

Because we need to wait, in case we ever come across a bear or a lion or a dinosaur wants to eat us, our bodies, like we need to hold on to fat, so that we can have energy in case of stressful situations. So, yeah, it makes sense that it's all coming back.

Paulina: 7:46

So it's not even just you might have to run from a bear. When we were gathering nuts and seeds in the forest, we were going through, as a species, periods when there was plenty, you know, spring and summer, and periods when we were full, like when food was scarce. And so the evolutionary response is if you trigger your body to think that you're starving, you know, because you're actually starving out in the woods or because you've put yourself on a 1400 calorie diet for the past eight months.

Michelle: 8:18

That's being generous, Paulina. Let's be honest. These ladies are eating lettuce and water, so not me.

Paulina: 8:25

I was eating 1400. I was still going to work. These drugs are helping you to counter these biological responses which are working against you after weight loss, to help you not just like lose the weight more easily, but also to maintain it once you've lost it.

Mikelle: 8:48

Is it, would it be a good time to jump into duration? So then, what does that mean? Does it mean then you need to take this drug, these drugs, forever? Tell us about that tell us about that.

Paulina: 9:10

well, that might be the case. So it is not yet clear how long you have to be at your newly reached weight before your body there is. There is a theory that you're, you're, you're, there's a reset level and your body at some point accepts the new weight that you've reached as the new normal and maybe it doesn't mount a response once you're off the drugs. So Wigo-V is 2.4 milligrams semaglutide, ozempic is 0.5, 1, up to 2 milligrams of semaglutide for type 2 diabetes. Two different brands, essentially the same product. So patients on Wigovi who lose weight, the weight loss is between 15 and 18% of starting body weight. This is for patients who are obese. So at least I think the trials were done in BMI of 27 plus, but most of the patients were way, way above that. So truly obese, not just overweight. If you take Wigovi for a year and then stop, you start to gradually regain the weight and I think other studies have shown that within a year more than 50% of the patients have gained back more than 50% of the weight. So the current thinking is that you need some form of maintenance therapy. It could be that it's a lower dose. It thinking is that you need some form of maintenance therapy. It could be that it's a lower dose. It could be that you take it less frequently.

Paulina: 10:34

Personally, as someone who got on this boat really really early on, because you know how many times can you yo-yo back and forth and I saw the trial results, you know, back in 2019 when they first came out I've been on actuallyzempic because I was pre-diabetic and the the the reality of it is that you lose weight. So I lost 18 of my body weight, which by no means brought me to you know um, how should we put this? By no means brought me into the, the my ideal weight range, but I know that I'm healthier now. I'm certainly much more active and personally I don't want to risk coming off, just in case you know, it just means that I gain everything back.

Michelle: 11:16

You're part of that 50%. That's going to gain it all back.

Paulina: 11:19

Well, it's impossible to tell a priori who's going to gain weight. It's the same as when you're on a diet right, there is 10 to 15 percent of people that are able to maintain their weight loss. You know, with the drugs you have no idea. And maybe four years is long enough and I could taper off. But because I don't have any side effects and because the drug continues to work, my personal choice was to stay on.

Michelle: 11:43

So what happens? And maybe you're not like this, maybe you won't be able to answer this question, but for me, I get stressed out or excited, or upset or angry and I want to eat. So is this the magic bullet that's going to be like, well, no, I'm not hungry, so or do you just still eat anyway?

Paulina: 12:00

That's precisely it, really. No, you lose your appetite. Yes, it's, it's. From that perspective, it's like magic. And again, this is a personal view. I'm not, you know, it's probably not the same for everybody, but you know, patient stories are things like I am now able to eat one jelly bean and be happy with that. Hallelujah, that's amazing. Oh my God, seriously. So you just don't. You know, you have a plate of something that you like and you don't finish it because you're not hungry, and that whole response is gone. Wow, not only is that what's helping you to lose the weight, but once you plateau, like I haven't lost any more weight in the last three years. I lost all the weight in the first year, but I still. You know, there are certain things that are just no longer appealing that I would have eaten, you know, significant amounts of earlier. So it really works. You know, it signals to your brain that you're not hungry and your brain listens.

Mikelle: 13:03

So, Paulina, you're on Ozempic. Thank you for sharing. That's going to be really powerful for our listeners. You're on Ozempic pre-diabetic. Is Ozempic currently approved for weight loss or is that still an off-label use of that particular brand?

Paulina: 13:29

weight loss. It is approved for type 2 diabetes. I was pre-diabetic and, as a result, I didn't have to wait for Wigovi to come onto the market, which is indicated for weight loss and is the same drug. These two brands are drugs made by Novo Nordisk. There is a second company that's got drugs on this market. It's Eli Lilly, another large pharma company. Their drug is actually even better than Ozempic and Wigovi. It came to the market a little bit later and it is a combination product, so it's a dual agonist, not just of GLP-1, but also the second hormone called GIP, but also the second hormone called GIP. Gip stands for wait for it glucose-dependent insulinotrophic polypeptide, that's a mouthful.

Paulina: 14:16

It is also a hormone that is released when you eat.

Paulina: 14:20

It's not entirely clear how it works in weight loss because on its own it doesn't do much, but it helps you to take a better, higher dose of the GLP-1 because it reduces the side effects. That's a theory. It's not 100% clear yet how it works, but it is clear from clinical trials that a combination of GLP-1 plus GIP so this Lilly drug called Terzepatide, which is approved under the brand name again, two brand names for the two indications Munjaro for type 2 diabetes and Zepbound for obesity works even better. So whereas with Ozempic or Wegovi the weight loss is 15 to 18 percent, with Munj or the Zepan, in this case it gets closer to 20, and 25 percent weight loss is kind of like the magic number, because that's the amount of loss that patients experience with gastric bypass surgery. We're approaching the level of weight loss with a therapeutic so essentially with a weekly injectable drug that you would otherwise need to undergo a surgery for which is unprecedented and very, very exciting for the market development point of view and for patients' point of view.

Mikelle: 15:48

Right. What I'm wondering about, what is prevalent seems to be prevalent on social media right now in terms of risks, are different people talking about but wait a minute, you're losing fat and muscle mass and that's a problem. Can you? Can you talk about that, paulina?

Paulina: 16:07

and muscle mass, and that's a problem. Can you talk about that, paulina? So when you go on a diet, we burn both fat and we metabolize our muscles when we're losing weight. I would say it is a real problem for patients who are diabetic, elderly and frail. So they are prescribed these drugs for their diabetes. They lose weight as a side effect and, as a result, they suddenly have trouble walking up the stairs or getting up from a chair. This is a very small minority of patients. What I would like to and this is maybe not the most popular view on Wall Street, but so we know that this market is going to be huge. Estimates are that it's going to be $100 billion or more at peak and so many other companies are trying to get in.

Paulina: 16:57

These two guys so far are in a duopoly. Historically, they were the main players in diabetes. They realized that the drugs also work for obesity. They did the trials. They brought these drugs to market. They can't keep up with demand. Others went a piece of the pie and so we have additional drugs being developed, and some of them are addressing this problem of muscle, of lean muscle loss while you lose weight.

Paulina: 17:30

I think that this is a problem or this is a solution in search of a problem. If you weigh 300 pounds, your legs need a lot of muscle just to carry all of your weight around. If you then go down and you now weigh 200 pounds, you don't need as much muscle anymore. You know to function, so I'm not sure that you know. Aside from this sub-segment of people who are elderly and frail and for whom muscle loss is a real problem, you know this is just a way to try to differentiate your product to get on the market. However, is it going to get used If we're able to show that adding a myostatin to a GLP-1, ideally in an oral form, so you don't have to inject yourself will help you to lose weight while preserving muscle mass? Of course you know that will find a market. Is it really really necessary? In my opinion, no, but you know I will find a market. Is it really really necessary? In my opinion, no, but you know I'm just one person. Could it also be?

Mikelle: 18:31

that it's actually arguably better to take the drugs that exist and actually work on building and preserving muscle, because of the immediate, obvious benefit and all the other health benefits.

Paulina: 18:45

So yes, absolutely. If you do a little bit of resistance, exercising and eat a high protein diet, you can get the same benefits. If you think about where obesity epidemic has come from, it's largely people in the lower demographic who can't really afford to eat a high protein, vegetable rich diet. They are eating fast food, high processed food, and they don't have time or the resources. They spend time at the gym and I know you can do squats in your living room and you can do all kinds of things, but if you're working two jobs, you may not have the energy or the stamina to do that.

Paulina: 19:26

So we're years. Just to be clear, we are years away from this coming to the market. We're in like phase one and phase two trials. We are still not sure if the drugs are going to be these new options are going to be safe and as efficacious like this is years away. For the moment, the two options are the GLP-1-GIP dual agonist. The next one is actually a triple agonist, also from Eli Lilly, and what people are working at with enthusiasm is oral options, because not all patients like to inject themselves, and so if you can have a small molecule version of these drugs that you can just take as a daily pill. There's at least some subsegment of the market, maybe 20% of patients, that would prefer it.

Michelle: 20:12

I think that's a big piece of the pie. Piece of the puzzle that a lot of women don't know is that with Ozempic and these drugs, you're actually injecting yourself with a needle once a week, or I think it's just once a week, I don't really know. That blew my mind. When I found that out, like that for me, I was like whoa wait, what? Like no, no, not like.

Paulina: 20:32

I could never so it's not like the needle that you imagine. You know when you, when the doctor pulls out and you get a vaccine. It's not like that. It's a pen. Okay, the needle is maybe a centimeter long. It is very, very thin long. It is very, very thin. You wind the pen up, you put it on your thigh or somewhere and then you squeeze on the top. You don't really see the needle going in, you don't really see the like it is not a big deal.

Michelle: 21:02

So it's like the glucose monitors that you like just kind of pop on and it like it's a teeny, tiny little filament kind of thing that goes in you.

Paulina: 21:07

So it's somewhere between the big, long needle for your vaccine and what you're describing. Okay, someone like you would be a perfect candidate for the oral options once they come to the market, because there are people who are squeamish. On the other hand, the orals are going to be daily. This is once a week. It's kind of eventually going to be a personal choice, but we're not there yet either, because the orals, for now, the efficacy seems to be there, but there might be some side effects on liver toxicity, so not all of them are clean. We're only phase one, two, so we need phase three studies, which take some time. So we're, let's say two or know at best, away from an oral option that's on the market.

Michelle: 21:51

Paulina, can we actually circle back? You just mentioned side effects and we haven't had a moment to talk about those. What are the side effects of Ozempic?

Paulina: 21:59

So Ozempic and all of the incretin drugs that we've been discussing have largely, as a class, gi-related side effects. So people feel nauseated, people have vomiting, people may have diarrhea. All patients are different, but these side effects occur in 30-plus percent of patients and they are severe in a subset of these patients. When you look at clinical trial data, often early on the side effects are much higher and then the companies figure out how to titrate the product better, slower, and then for a majority of patients the side effects become tolerable. So there is a subset of patients that for whom the side effects are too much much and they don't stay on therapy. The vast majority of patients, given. You know that these are on target side effects, right? You're supposed to feel nauseated. This is how the drugs work.

Michelle: 23:00

To make you not want to eat.

Paulina: 23:01

To make you partially not want to eat, exactly. So if we can all think back I don't know about you, amy, but we can all think back about being pregnant right, nobody was hungry. We weren't really gaining weight if we were, you know, not feeling well. So it's a little bit like that, but it varies by patient. So for some you feel almost nothing, you do fine, You're just not hungry. Others, I had a slight bit of nausea.

Paulina: 23:25

It happens when you titrate up your dose. So you start always at a low dose, you stay on it for weeks to months, then you titrate up and then at the beginning, with each new higher dose the side effects are stronger and then they dissipate. Your body gets used to the medication. Then you titrate up again to the dose that is still efficacious and you're able to tolerate, and that's it. And for most patients, knowing that this is going to happen and seeing the quick results on their weight loss, which you know happen without having to restrict your diet, kind of without having to think about restricting your diet because in the end you are eating fewer calories, but not because you're withdrawing you know whatever eating just lettuce and water but because you're just not hungry for the food that's on your plate and you see the results quickly. For most people that's a risk benefit kind of ratio that they're willing to take. It's super motivating. It is very motivating, exactly, yeah, and in terms of long term, that kind of risks.

Paulina: 24:34

These drugs have been on the market since 2005 for diabetes, so we have a long history on the market with thousands, millions of patients at this point who have been on chronic therapy with these drugs. So if something unexpected that you can't find in clinical trials because of you know, even really large clinical trials have, let's say, 15 or 17 or 20,000 patients and they're run for a year or two and after that you know the drug comes to market. If something was going to surface it would have by now because of the long history of these products on the market. So I'm not concerned about that. And the side effects the tolerability aspect of it, again, for the majority of patients is tolerable or is manageable, paulina?

Mikelle: 25:27

I know because I've dined at your house more than one occasion and you have a husband who is an exceptional cook chef and I know you eat really, really well as a result, and I'm just wondering if what your thoughts are on the importance of because you're eating less, which is a good thing is there more importance on what it is that you're eating when you're taking these drugs, or is that just irrelevant, because you know your health depends on what you eat and doesn't matter whether you're on these drugs or not. Does that make sense? What I'm asking?

Paulina: 26:02

Yes, and I think the answer lies in how big a foodie you are deep down.

Paulina: 26:10

So what I think most people do on these drugs that like to eat and want to still enjoy the experience of eating good food is they take their injections on Sunday morning Because that means that by the end of the week the effect of the drug has waned a bit. Week the effect of the drug has waned a bit and that means that on Friday night and, let's say, saturday dinner, they can still enjoy their food a special, let's say, meal, and have a glass of wine and feel fine with that, and next morning it kind of starts again. But I think the way you think about it is that first year you are on a diet, in the end you know this is, this is for your health and this is so you should be thinking less about. Am I enjoying my meals as much as I used to, despite the fact that my husband is an awesome cook, and think, ok, I've just lost, in my case, almost 20 kilograms. That's amazing. You know, I'm becoming healthier. I'm going to enjoy my food later. Right, that was my attitude towards it, right?

Mikelle: 27:21

Paulina, you've talked about the risks of taking drugs like Ozempic. Are there benefits that we haven't addressed?

Paulina: 27:30

Absolutely. So you know, besides just kind of the feel good aesthetic aspect of having lost weight and being able to wear clothes that are, you know, a few small few, is that there are significant long-term benefits to patients who are obese and lose weight on these drugs. You know, unless they've been living under a rock. It was the select cardiovascular outcomes trial that was conducted by Novo Nordisk for Wigovi. So this was a trial that was run in 17,500 patients who were obese were non-diabetic, and what it showed was the patients who lost weight on Wigovi had a 20% reduction in the risk of MACE. Mace stands for major adverse cardiovascular events, so MACE basically means stroke, heart attack or heart failure. So your risk of death or an event of having a stroke goes down by 20% if you lose weight on Wigoovian.

Paulina: 28:55

You started out as obese. That is unprecedented, because for many, many years obesity was considered a social kind of problem and now it's being recognized as a chronic disease. You know there's a reason again that patients have a hard time losing weight and certainly have a hard time maintaining their weight loss. And you know it's because obesity is actually a very complicated kind of metabolic chronic disease that needs to be treated medically. And so trials like SELECT, which was for cardiovascular risk.

Paulina: 29:31

Since then we've had other outcomes trials in kidney disease, for example. So, again from the Venordisk, the FLOW trial showed that treatment with semaglutide, so Wigovi, reduced the risk of kidney disease progression and cardiovascular death in patients with kidney disease. We've had outcomes trials in osteoarthritis, showing that you have better or less pain in your osteoarthritic knee. We've had outcome trials in sleep apnea. This one from Eli Lilly was the first one that had positive results that shows that the severity of your sleep apnea also goes down as you lose weight on these drugs. So the body of evidence about the clinical benefits of weight loss and given what we know about the risk and comorbidities of untreated obesity, which leads to things like diabetes and cardiovascular disease and kidney disease and potentially death and sleep apnea and all of these other things, I think that is very important in changing the way that these drugs and obesity in general is being perceived and will be treated in the future.

Mikelle: 30:53

Thank you. That's important information and it's prompting for me. Are there people taking these drugs who aren't obese and are there any implications or discussions or studies about that?

Paulina: 31:08

So, absolutely, there are people that aren't obese that are taking these drugs.

Paulina: 31:11

In the US, the market, the consumer is king, so people are taking the drugs because they the US, the market, the consumer is king.

Paulina: 31:15

So people are taking the drugs because they want to go down two sizes and close, you know, but from size eight to size six, they're going to a wedding, they're movie stars. This is what kind of drove the hysteria over the last summer. What are the implications? The implications, first, are that patients who actually need the drugs are having a hard time filling their prescriptions because of shortages In terms of risk. It's hard to argue that those patients shouldn't, or those people shouldn't, be on these drugs, because their side effects are going to be the same as everybody else's and whether you're trying to lose the last 10 pounds or the first 50 on your journey, the drug is going to work the same. So I think it's more of an ethical than actually medical issue and I think, over time, as capacity grows and manufacturing stops being an issue in terms of supply, there are always going to be those kinds of people who find this as an easy solution, you know, to their perceived imperfections.

Michelle: 32:22

Is this being used in Canada off-label as much as it is in the States? Like, how are, how I can? I know that the healthcare system in the States is a bit different, so I can kind of grasp how they're getting a prescription. But are people in Canada just able to walk into the doctor and say can I have this, or do they have to go get a fasting glucose? Are they chugging 12 Cokes before they go so they can get the drugs?

Paulina: 32:44

Like, how are they getting prescribed these drugs if there's a shortage, so I think that in Canada it's only just starting. So what we're describing here is more of a US phenomenon where you can see, you know, an online telemedicine physician to get a prescription and you fill it and you you know if you don't meet the standards of your insurance for what's reimbursed, you just pay out of pocket. The cost here is not small it's about $1,000 per month but there are plenty of people that are able to afford that if their insurance doesn't cover it globally.

Michelle: 33:21

So, paulina, thank you, that's so much great information. What is the one thing that you want every woman in perimenopause to know about weight loss? So I would say like this.

Paulina: 33:31

We know that as we age and as we enter perimenopause, our metabolism changes and it becomes that much more difficult, you know, just to maintain weight, let alone lose it.

Paulina: 33:46

We have gone over how difficult it is to, if you're obese, to lose weight and then maintain that weight loss because your body is doing everything it can to make you gain the weight back. We've discussed the important downstream healthcare implications or health implications of losing weight in terms of reducing your risk for cardiovascular disease, for stroke, for kidney disease, for type 2 diabetes and all of that. So what I would say to your listeners if you are obese or pre-diabetic, read up about Ozempic, about Monjaro, about Wigovi, about Zetbound, and go and see your physician and discuss it with them. Discuss your risks, discuss the risk-benefit of being on one of these drugs, think about your insurance, think about what you can get done, but advocate for your long-term health. It's not needed if you're thin, if you've never struggled with your weight, but if you are like me, struggled with your weight all your life, dieted your way through various hills and troughs and then learned about this solution and the ability to not only lose but then maintain the weight loss.

Paulina: 35:21

It was revolutionary for me and I think I know that it's going to have very positive implications for the rest of my life, and I think everyone should advocate for their long-term health in this way, and this is one of the ways that you can do it.

Michelle: 35:41

Thanks so much for listening to the show. If you like what you hear, please take a moment to rate and subscribe to our podcast. When you do this, it helps to raise our podcast profile so more women can find us and get a little better understanding of what to expect in perimenopause.

Mikelle: 35:56

We also read all the reviews the good, the bad and the ugly to help us continuously improve our show. We would love to hear from you. You can connect with us through the podcast, on social media or through our website. Our information, as well as links and details from our conversation today, can be found in the show notes. This podcast is for general information only. It's designed to educate, inspire and support you on your personal journey through perimenopause. The information and opinions on this podcast are not intended to be a substitution for primary care diagnosis or treatment. The information on this podcast does not replace professional health care advice. The use of the information discussed is at the sole discretion of the listener. If you are suffering from symptoms or have questions, please consult a qualified health care practitioner.