--:-- Noel King: Welcome to Today Explained. I'm Noel King.
--:-- [Theme music fades out]
--:-- Noel King: Avoiding your unfinished home projects because you're not sure where to start? Thumbtack knows homes, so you don't have to. Don't know the difference between matte paint finish and satin? Or what that clunking sound from your dryer is? With Thumbtack, you don't have to be a home pro. You just have to hire one. You can hire top-rated pros, see price estimates, and read reviews all on the app. Download today.
--:-- [Music continues for a few seconds before fading out]
--:-- Noel King: Nobody knows your customers better than your team, So give them the power to make standout content with Adobe Express. Brand kits make following design rules a breeze, and Adobe quality templates make it easy to create pro-looking flyers, social posts, presentations, and more. You don't have to be a designer to edit campaigns, resize ads, and translate content. Anyone can in a click. And collaboration tools put feedback right where you need it. See how you can turn your team into a content machine with Adobe Express, the quick and easy app to create on-brand content. Learn more at adobe.com slash express slash business.
--:-- Noel King: Today's episode of Today Explained is a rerun, but we have updated it with some news. Perhaps you saw President Trump recently announced a deal with two drug companies that's going to result in much cheaper weight loss drugs. Perhaps you saw that he then revealed who in his administration is taking them. And we have Steve, we're Steve Seguir, head of public relations for the White House. He's taking it. Classic. Perhaps you saw someone then fainted in the Oval Office during that announcement. Classic.
--:-- [Music continues for a few seconds before fading out]
--:-- Noel King: Here's the thing. These drugs appear to be working. Obesity rates in the U.S. are declining, but there are still unknowns. The relationship between diet, weight, and health seems like it should be clear by this point, but it's really not. Coming up on Today Explained, why the gospel on weight loss is always being rewritten, and how medications have added a brand new chapter.
--:-- Noel King: And Sumita Mukhopadai is a writer and editor who was very anxious when she was hired as the executive editor of Teen Vogue back in 2018. Like everyone else, Sumita had seen The Devil Wears Prada, and she knew that the fashion industry was unforgiving. But not long after she started there, she realized that things were changing.
--:-- Sumita Mukhopadai: You know, I entered the fashion industry at a really unique moment where there was an increased interest in plus fashion. And so when I got the job at Teen Vogue, I started having all these fashion brands reaching out to me to be like, wow, we're so excited. We're launching a plus collection. We'd love to talk to you about it. We'd love to send it to you.
--:-- Noel King: How does it feel to be a fat fashion editor?
--:-- Sumita Mukhopadai: And at the time I had kind of newly gained the weight and so I wasn't totally embracing it. I didn't feel empowering. It almost felt like something that was happening to me where I was like, oh wait, I'm fat? I had to kind of get over that first step before being like, I'm fabulous. I love being fat.
--:-- Noel King: Okay, so you're in a period where Teen Vogue has become more accepting. It is okay to be a person in a larger body. And in fact, there's even some sort of advocacy or activism around the fact that there is more than one body type. And then you get some news that again changes how you see and experience all of this. What happened?
--:-- Sumita Mukhopadai: While I was at Teen Vogue and kind of as I was leaving Teen Vogue, I had had a series of stressful family-related things happen. My father passed away of diabetes-related complications. My mother was diagnosed with breast cancer. I had this really hectic job and I was managing all of it. And my stress response was eating. And it was, and not just eating, it was like really not taking care of myself ultimately, right? It was taking Ubers, it was getting takeout, it was kind of not really having a lot of time for myself.
--:-- Noel King: And that did lead to some unwanted weight gain on your part. And I was having some mobility issues. I was having trouble kind of, I just thought it was because I was exhausted because I had never had these experiences, but I was having trouble getting up and down the stairs on the subway. And I would just chalk it up to like, oh, I'm just so busy, you know, like I have to take Ubers because I'm like busy and I'm exhausted.
--:-- Sumita Mukhopadai: And I was having trouble keeping up on walks and I was having trouble sleeping. I wasn't feeling well. And, you know, on top of that, my clothes weren't fitting. And so I went to the doctor and, you know, this is after I had left Teen Vogue and like kind of after the pandemic, I decided to start the process of, you know, figuring out if I was okay. And also, you know, what I could do because I knew and I understood that diets don't work, right? Like I knew I could restrict what I was eating, but eventually I'd gain the weight back.
--:-- Noel King: And I really wanted something. I really wanted a strategy that would be more effective. And so I went in and got my blood work done and, you know, pretty much every indicator was elevated. So I was, had become pre-diabetic. My cholesterol was elevated. And so those scared me, right? Like I had just lost my father to exactly the things that I'm now looking at in my blood report.
--:-- Sumita Mukhopadai: And so I was like, you know, I think it's finally time for me to really take this seriously and figure out, you know, a strategy to move forward. And she suggested Manjaro. It is a injectable that you take weekly. It slows your digestion, basically, is how it works. And in doing so, it reduces the rate at which you can eat and how hungry you get.
--:-- Noel King: What did that mean for you? Like once you start taking it, what happens? Do you mean emotionally or physically? Both.
--:-- Sumita Mukhopadai: Both. Entirely, I mean both.
--:-- Noel King: Yeah, yeah, for sure. I mean, emotionally, it was really hard to make the decision to go on it. I saw it as two things. I saw it as a betrayal to the kind of body positivity and feminism that I had ascribed to of loving yourself at any size and not trusting pharmaceutical interventions.
--:-- Sumita Mukhopadai: And also there was another voice inside me that was like, this is how bad it's gotten, girl. Like you couldn't control this and now you have to take a drug. That's how not well you are.
--:-- Noel King: And so a lot of self-judgment, a lot of shame came out with the decision to go on the medication.
--:-- Sumita Mukhopadai: Physically, it is a bumpy road. It was for me. For me, I struggled with very intense nausea. So you you know one of the ways that it works is since it slows your digestion if you overeat you feel very sick And then a lot of digestive issues It is very hard to go to the bathroom when you're on it. You have to take all kinds of laxatives. They now have additional prescriptions they put people on that are taking it to help support with regular bowel movements.
--:-- Noel King: And so it was not the best physical experience. And then, you know, at a certain point I got used to it, but I think it was more that I just got used to managing the side effects. They never really went away for me.
--:-- Sumita Mukhopadai: You have made, interestingly enough, being on Munjaro sound absolutely horrible. But I appreciate you being honest about the side effects because I don't hear talk about the side effects very often.
--:-- Noel King: What was the good in this? What kept you on it?
--:-- Sumita Mukhopadai: It does something. And I think it's physiological and a doctor can speak more eloquently to this, but it does trigger something in your brain, a hormone that suggests that you're satiated, right? And so it started to help me feel satisfied with less.
--:-- Noel King: One of my behaviors is I tend to compulsively eat in the evening, whether it's stress or just fun or boredom or binge watching TV, whatever it might be. I will sit down with like an array of snacks and kind of eat mindlessly, not always keeping track of how much I'm eating, not necessarily food that had good nutritional value.
--:-- Sumita Mukhopadai: So when I was on Manjaro, I would finish dinner and I pretty much would not physically be hungry in the evening and I just wouldn't have space to eat anything else. And if I got the munchies, I started to reach for healthier snacks because I noticed that I digested them easier.
--:-- Noel King: And so if I just like ate an apple or some grapes, you know, like I ate so many freaking grapes or, you know, a handful of carrots or whatever that might be. And all the things we tell ourselves, we're like, this is the healthy choice. Let's make the healthy choice. The healthy choice all of a sudden became easier.
--:-- Sumita Mukhopadai: And so that was part of why I stayed on it, that it really gave me this release from this yearning that I always had where it wasn't a challenging decision. I didn't feel a lot of strain around it, whereas historically, when I would beat myself up for eating at night, I never felt like I could stop.
--:-- Noel King: Okay, so there are pros, there are cons. How is it going?
--:-- Sumita Mukhopadai: I guess when Manjaro hit the market, they had given a manufacturer's coupon to early people, to people that had first started taking the drug. And, you know, I don't read the fine print, Noelle. Like, I don't know. No one does, girl. I thought that was my insurance covering it. Like, I didn't understand that, like, the reason it cost that much was a coupon and not my insurance.
--:-- Noel King: And so the coupon is rescinded and overnight the drug becomes $600 to $800 a month. I think it was like, I think it was $800. And they were like, we can do this other coupon that will get you to like $600. Like I'm kind of like, these aren't the exact numbers, but all I'm saying is like, it was an insane amount of money that I was like, what? Like, I live in New York City. You can't just take on another payment like that. That's crazy.
--:-- Sumita Mukhopadai: Yeah, exactly. Exactly. I think the combination of the cost and the side effects, and I had lost a lot of weight. Like I think I lost 50 pounds about. Oh, wow. And I was feeling great. And I was like, you know, let me just try without it. Let me phase out of it. And so I came off the drug at the end of 2023. And, you know, I will say like maintained the loss for quite a bit of time. I probably gained like 10 to 15 pounds within like two or three months.
--:-- Noel King: And that was definitely not a great mental experience. Like I definitely came back to that feeling of control of like, oh my God, I'm losing control. I'm losing control. And, you know, but I was excited because I had made some lifestyle changes that I was maintaining and that felt like a really positive intervention.
--:-- Sumita Mukhopadai: Now, this is like the first interview I'm doing about this in like six months. And so I will say the last six months have been really stressful for me. I launched a book. I got married. Thank you. Nothing like gaining weight for your wedding. But I started, you know, some of the things that I had been committing to, like cooking and getting enough, you know, my steps every day and all of that, like, fell to the wayside a little bit. And so the weight started to creep on and creep on and creep on. And now I've probably gained back like 60 or 70 percent of what I lost, which has been really hard.
--:-- Noel King: You know, it's hard and it's also feels like it's forcing me to really face my relationship with my health and my own body. And to like, it's like I understand the options that are out there, but the options are limited. I wouldn't even say that I would necessarily go back on it because when I think about it, I just get sick to my stomach again. I'm just like, oh, I just don't know if I can go through that again.
--:-- [Music starts playing]
--:-- Noel King: Support for Today Explained comes from Indeed. Indeed says if you're looking to hire, you can give your job posting the best chance to be seen with Indeed Sponsored Jobs. With Sponsored Jobs, Indeed boosts your post so that it is more visible. Their data shows it's effective. According to Indeed, Sponsored Jobs posted directly on Indeed are 90% more likely to report higher than those non-sponsored jobs because you reach a bigger pool of people.
--:-- Noel King: 1.6 million companies sponsor jobs with Indeed. You can spend more time interviewing candidates, less stress, less time, More results now with Indeed Sponsored Jobs. Listeners of this show get a $75 sponsored job credit. To help your job get the premium status it deserves at Indeed.com slash Today Explained. Indeed.com slash Today Explained. Support our show by saying you've heard about Indeed on this podcast, Today Explained. Indeed.com slash Today Explained. Terms and conditions do apply, guys. Hiring, do it the right way with Indeed.
--:-- Noel King: Support for Today Explained comes from Bombas. Putting on a new pair of socks can instantly feel refreshing, according to Bombas, especially according to Bombas if they Bombas socks Bombas make socks for just about any activity Your warm merino wools your comfortable compressions your cushioned running socks and so much more High quality slippers t mudans Nisha Chital tried Bombas here's what she thinks.
--:-- Noel King: Bombas has great kid socks. I have a three-year-old. She runs around a lot indoors in her socks and she's often slipping on the hardwood floors. But Bombas Kids' socks have grips on the bottom, and they're really great to prevent that slipping around on hardwood or tile floors. So we love those for her. They're definitely our preferred socks for our daughter.
--:-- Noel King: Bombas says that for every pair of Bombas you buy, they donate one to someone facing homelessness. Anytime you get something cozy, someone else can too. According to Bombas, you can go to bombas.com slash explain and use code explain for 20% off. Your first purchase, that's B-O-M-B-A-S dot com slash explain. Code explain to check out.
--:-- Noel King: Support for Today Explained comes from Chime. What's Chime? Chime is different. Chime is a financial technology company that wants you to embrace each and every dollar. When you set up direct deposit with Chime, you can get access to fee-free features like overdraft protection, or they say you can get paid up to two days early and even more.
--:-- Noel King: Speaking of no fees, Chime says that when you open a checking account with them, there are no monthly fees and no maintenance fees. And with qualifying direct deposits, you can be eligible for free overdraft up to $200 on debit card purchases and cash withdrawals. Not to mention, although I will, 47,000 fee-free ATMs. You can work on your financial goals through Chime today. You can open an account in two minutes at chime.com. That's chime.com.
--:-- Noel King: Chime feels like progress. Chime is a financial technology company, not a bank. Banking services and debit card provided by the Bank or Bank N.A. or Stride Bank N.A. Members FDIC. Spot me eligibility requirements and overdraft limits apply. Timing depends on submission of payment file. Fees apply at out-of-network ATMs. Bank ranking and number of ATMs according to U.S. News and World Report 2023. Chime checking account required.
--:-- Noel King: You're listening to Today Explained. I'm Dan Bessison. I'm an MD by training. I'm an endocrinologist. I'm here at the University of Colorado in Denver, and I do clinical work taking care of patients at our county hospital, Denver Health. and I do research here at the medical school. I'm also the director of this building called the Anschutz Health and Wellness Center.
--:-- Dan Bessison: Dan, you have 47 jobs, man. All right, let's talk about the beginnings of this sort of cultural and medical interest in obesity. When did doctors start thinking of obesity as something that needed to be fixed, something that needed medical attention?
--:-- Dan Bessison: I think there's always been people with really high weights that doctors thought, well, that's probably a health problem. But I don't think it entered the general public consciousness until sort of the late 80s to the mid 90s.
--:-- Dan Bessison: The disease is obesity, but obesity is just a symptom of the real problem we as a nation face. Frances, you've been overweight since you can remember? since a child, about early teens.
--:-- Frances: Americans overeat. We are obsessed with food, and it's an obsession that's killing us. And when Greta was one year old, she weighed 100 pounds. Almost 100, yeah. Almost 100. That's a lot.
--:-- Dan Bessison: I think people looked around and thought, what's going on here? There seems to be more and more people at higher weights. And NIH had an expert panel that defined obesity using BMI, BMI is sort of controversial, but that was the point at which we had this accepted standard.
--:-- Dan Bessison: And shortly after that, the CDC looked at data they had and said, what's been happening with obesity? And I think they were sort of shocked to find there was just a dramatic increase in the number of people with obesity. And so in 1999, they published these maps, these CDC obesity maps. Maybe some people have seen those.
--:-- Dan Bessison: And they really brought a lot of attention to what really looked like an epidemic. If you had looked at those numbers and it was HIV or cancer, people would be quite worried. And people said, gosh, something is happening here. We should do something about this.
--:-- Dan Bessison: And what was the something that doctors decided they should do? Yeah, I think that the NIH panel had thought about levels of weight and that treatment or what intervention somebody did should be based on how serious the problem was. So people with a modest increase in their weight might change their diet and increase their physical activity.
--:-- Dan Bessison: People with a more severe weight problem might take a medication. And those at the highest weight might benefit from surgery. For most Americans, lifestyle is what was suggested. And I think at that point, we were still early in understanding the biologic basis of weight regulation.
--:-- Dan Bessison: And we all eat, we all move, and it seems like we choose those things. And so the obvious first step was to say, maybe people just don't know what to eat. And if they just thought about it some more and ate less and moved more, that this problem might go away.
--:-- Dan Bessison: So that was the first thought. And the Surgeon General had a call to action. Obesity, a major problem that has increased dramatically since 1990. Based on these numbers rising of obesity saying, you know, people ought to move more and eat a healthier diet.
--:-- Dan Bessison: When it comes to physical inactivity, obesity, diabetes, the fact of the matter is we're moving in the wrong direction in terms of these areas. The advice seems obvious. Change what you eat and move more.
--:-- Dan Bessison: Do diet and exercise prove to work? I think there's a couple ways to look at that. One is around this same time, there was a study published, the Diabetes Prevention Program. And what they found was that a modest weight loss, a 5% weight loss, could reduce the risk of developing type 2 diabetes by half.
--:-- Dan Bessison: It was a really dramatic study. And so it was really based on that that people said, gosh, this is achievable and it has clear health benefits of 5% weight loss. I'm just doing the math in my head. If you weigh 200 pounds, that's take 10 pounds off. Yeah. 300 pounds, take 15 pounds off. That feels like nothing.
--:-- Dan Bessison: It seems like a small change in weight and yet it had dramatic benefits. I got to tell you, I mean, I see people in clinic and so I've spent whatever 20 years trying to sell the benefits of a 5% weight loss. Most people don't buy it. Most people want more weight loss than that.
--:-- Dan Bessison: It not a weight loss that most people see in the mirror or that their friends are going to notice but it has clear health benefits and has become a benchmark of what a clinically significant weight loss is A little bit of weight loss helps.
--:-- Dan Bessison: So what happened after the study was over with these folks who lost 5% of their weight and then saw their health improve? Did they keep the weight off? Most lifestyle studies show that most people regain much of the weight.
--:-- Dan Bessison: It's not like everybody regains all of the weight. But much of the weight is regained. What has happened over the last 25 years is a real explosion in our understanding of the biology that underlies weight regulation.
--:-- Dan Bessison: I think now we think of weight much like we think about blood pressure or glucose, that there's complex biology that the body's got its own idea about what it wants to weigh. And what it seems like the body wants to do, it doesn't regulate around a set point. It regulates around a trajectory of gradual weight gain across the life.
--:-- Dan Bessison: So the biology of weight really pushes back against efforts to change our diet. And so that's why people regain the weight is when they lose weight, the body goes, this is not good. And the people become more hungry. Their energy expenditure goes down. And these things tend to push the weight back up to where it was before.
--:-- Dan Bessison: Were there, you mentioned two other ways that doctors saw of treating obesity, medications and surgeries. How common was it for a doctor to say, you sir or madam, you're going to need medication, you're going to need surgery?
--:-- Dan Bessison: I don't remember so much of that like 20 years ago. Only maybe one or two percent of people ever had that conversation, ever got that medication. And there are a number of reasons for that. One is the older medicines had some side effects. There were some bad stories about health problems with fen-fen and other medicines.
--:-- Dan Bessison: Oh, fen-fen. If you took the diet-drug combination known as fen-fen or the diet drugs pondamin or redux, you may have heart valve problems and not know it. Before Chicago area women are taking the makers of FinFen to court, it's been one week since the prescription diet drug was pulled off the market.
--:-- Dan Bessison: And I think to doctors and patients, doctors especially have this idea that, well, Mrs. Jones, you ought to be able to handle this on your own. This idea that weight is regulated, it's taken a long time to get any traction there. Doctors would say things like, you know, if you show me you can stick to a diet, well, then I'll maybe talk to you about a medicine.
--:-- Dan Bessison: We don't do that with diabetes or high blood pressure. We're very quick to go to a medication in those conditions. So I think there's a lot of maybe bias and stigma directed at people living with obesity that we tend to blame them for their health problem.
--:-- Dan Bessison: So medicines that weren't super effective and an environment that really thought that people could do this on their own. How long have you been in this line of work, Dr. Dan?
--:-- Dan Bessison: I'm an old person with kind of gray hair. I prescribe Fen-Phen. So I've been doing this for, gosh, whatever, almost 30 years.
--:-- Dan Bessison: Sometime in the last 24 months, I became aware of Ozempic. A lot of people became aware of Ozempic. I'm just wondering what the conversation was like in the medical community among doctors who do your type of work about the fact that there are these GLP-1 drugs that seem to work magically, work for a lot of people. And are now widely available.
--:-- Dan Bessison: Yeah, I would use the term game changer. There's never been anything like this. We've done studies with older medications. And, you know, the medications worked okay, but people weren't happy with them. These medicines just, not only the ones we have now, which are semaglutide and trisepatide, but the ones that are coming after that, that are in clinical trials.
--:-- Dan Bessison: we're in a time now that medications are likely to provide the kind of weight loss that we used to only see with bariatric surgery. I understand that there's more than 100 medications in this anti-obesity medication pipeline. We've been doing studies with some of the next generation and they're even more effective than the semaglutide and trisepetide are. Oh, damn.
--:-- Dan Bessison: Yeah. And, you know, when we have somebody go to bariatric surgery, we prepare them for that. They see a psychologist. They see a nutritionist. They talk to other people who've had surgery and say, how was that for you? They think about it. And then it's kind of a go, no go. You know, either you have surgery, you don't, and you get what you get.
--:-- Dan Bessison: Medications are going to give that kind of weight loss. But we're not preparing people for that. We're not.
--:-- Dan Bessison: What does your life look like when you're not interested in food? I had a woman tell me, you know, my husband took me out to this fancy restaurant here in Denver for my birthday. He was so excited. I looked at the food and I thought, gee, this is not going to work for me.
--:-- Dan Bessison: So it makes changes in people's relationships with other folks. When people see someone losing weight, they wonder, what are you doing? Do you have cancer? Who do you tell that you're out of medicine? What do you tell them about why and what your goals are? What are your goals? How much weight do you want to lose? And how will you know when you're done?
--:-- Dan Bessison: These are questions that we've never had to ask before. And we don't have good data. And people are willing to pay. So there's all these market forces with people just want a medicine. They don't want a doctor. They don't want advice. They just want the medicine. But they don't really know what they're getting into.
--:-- Dan Bessison: So it's a bit of a chaotic environment. I think the key message I'd ask people to understand is this idea that weight is biologically regulated and that it has some health problems for some people, maybe even many people. And that ideally they find somebody that they can talk to, a doctor or a health care provider, that they can get useful information from over time, because it's a journey.
--:-- Dan Bessison: Dr. Dan Bessison, he's an endocrinologist.
--:-- Noel King: Miles Bryan produced today's show. It was a rerun. Jolie Myers edited. Laura Bullard fact-checked. Andrea Kristen's daughter and Patrick Boyd are our engineers. I'm Noelle King. It's Today Explained.
--:-- Noel King: Support for this show comes from Delta. When you unlock your full potential, you get to meet a version of yourself you might have never met otherwise. And as the official airline of the National Women's Soccer League, Delta Airlines is there to help connect you to your full potential. To help you grow and recognize the power you have to change yourself, your team, and the world around you. Delta is dedicated to helping you get to where you need to be. From season kickoff to the championships.
