Tag Archive for: health goals

Is It Worth It?

/in /by

At an obesity conference, the report on the clinical trials for a pre-diabetes and diabetes medication left the crowd on their feet and cheering. There are reports of well-known personalities who’ve used the drug with great results. But the ultimate question about a pharmaceutical approach to obesity has to be this: is it worth the money? Let’s start by looking at the pharmaceutical and then the return on investment.

How It Works

The body makes proteins called incretins which can stimulate the release of insulin. One incretin hormone, GLP-1 (glucagon-like peptide-1), is manufactured in the upper digestive system in response to carbohydrate intake. In subjects with type 2 diabetes, this hormone effect is diminished or no longer present.

The ability to stimulate the production of insulin and prevent the release of glucose by glucagon can be stimulated pharmacologically by semaglutide, a receptor agonist—that means it turns on the glucagon. In subjects with type 2 diabetes, semaglutide stimulates GLP-1 receptors significantly, thereby reducing blood glucose and improving glycemic control. In addition, it has multiple effects on various organ systems; most relevant are a reduction in appetite and food intake, leading to weight loss in the long term. Since GLP-1 secretion from the gut seems to be impaired in obese subjects, it was logical to test it in obese populations. Those were the study results I reported on Tuesday.

All in all, this sounds like it might be a potential solution to our obesity crisis, but there are some unanswered questions. What is the long-term safety of regular use of the drug? How does the microbiome impact the effectiveness of the drug? But more than that, everything comes with a price, which begs the question: is it worth it?

The Price

The price of using semaglutide for obesity is really two-fold. First is the actual cost of the weekly injections which is about $1,400 per month at retail. If your insurance will cover it, I’ve seen prices as low as $25 per month. We know that people lost an average of 18% of their starting weight at 68 weeks—the length of the longest study to date—but the rate of weight loss declined near the end of the study. How long will insurance cover it beyond that, and will a person continue to lose weight? We don’t know.

After using the drug for 20 weeks, the placebo group was switched to a placebo and immediately began to gain weight. By the end of 68 weeks, they had regained all but 5% and were still gaining. Would an investment of close to $17,000 to lose about 20% of your weight be worth it if you began to gain it back? There are many questions around whether people can take this drug for the rest of their lives; every pharmaceutical intervention must have an end strategy. The researchers did not address the issue.

The Bottom Line

The research into this pharmaceutical intervention was well done. However, unless the intervention includes an exit strategy, it could be a waste of money. Perhaps a lower carbohydrate diet may be a partial solution because this drug impacts carbohydrate metabolism. But we don’t know whether the weight loss would be enough to have the body take over and do the same thing on GP-1 by itself.

I think this shows a hopeful approach and it may turn out to be a boost to someone who is absolutely willing to change their lifestyle or someone who needs to lose weight for a specific purpose, such as joint replacement surgery or preparing for IVF. But for most of us, maybe it’s better to save the time and money and do what we know works: Eat less. Eat better. Move more.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2021;325(14):1414-1425. doi:10.1001/jama.2021.3224
2. JAMA. 2022;327(2):138-150. doi:10.1001/jama.2021.23619

Happy New Year!

/in /by

It’s good to be back talking to all of you again. The New Year is a time of optimism, everything seems possible, and there’s an enthusiasm for achieving health goals. One thing many people want to do is to lose some weight. It seems appropriate to cover a couple of drugs that were recently approved by the FDA to treat obesity. They’re a pharmaceutical approach to weight loss, and they’ve gotten so much press I have to cover them.

You’ve probably seen the commercials for a pre-diabetes and diabetes medication called Ozempic. It also has a sister drug called Wegovy that was approved for use in teens. In at least two clinical trials, subjects who had weekly injections of the drug lost at least 15% or more of their body weight in 68 weeks. Those who were switched to placebo injections started to gain back the weight they lost. All subjects were supported with monthly consultations with dieticians to induce a 500-calorie reduction in food intake and to increase exercise levels. Markers for type 2 diabetes improved such as HbA1c and blood glucose.

Is this the be-all and end-all to the obesity epidemic? And exactly how does this drug work? I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2021;325(14):1414-1425. doi:10.1001/jama.2021.3224
2. JAMA. 2022;327(2):138-150. doi:10.1001/jama.2021.23619

Is Consistency the Key to Health?

/in /by

As the new year progresses and you work toward your health goals, one thing that will help you just about more then anything else is being consistent in your effort. Seems obvious, doesn’t it? But we have a ranking system in our heads of how we perceive the importance of everything we’re doing, and sometimes health habits don’t rank very high.

For example, measuring food. When we get in a hurry, we may not take the time to weigh or measure our portions. We may eyeball it. I don’t see a problem with extra vegetables, but when it comes to high-fat or calorie-dense foods such as salad dressings or nuts or even pasta, it’s important, especially in the beginning. Accept that you’re not good at estimating yet and for a while, you must measure every time.

The same is true for stretching. If we get busy, we may not always take the few minutes to stretch our legs before walking, or our shoulders to improve posture. We know how good it feels when we do it but when we’re rushed, we may skip it. The older we get, the more important stretching becomes.

Do you ever go to bed without brushing your teeth? Do you skip your meds because you’re in a rush? I’ll bet 99% of us always brush and always take our meds. Spend some time thinking about why that is and how you can make your hit-or-miss health habits into never-miss habits.

We could apply this to any action connected to improving our health. There will be times when we have to make that decision and go with that ranking system in our head. Just get back to it later in the day or as soon as you can. Your health is the result of what you consistently do to get healthy. It all depends on: What are you prepared to do today?

        Dr. Chet

It’s Time to Take Inventory

/in /by

The New Year is here. For many businesses, it’s time to take inventory. Companies have to know what products and assets they have in order to plan for the upcoming year. If you’ve started or will begin a health improvement program, it’s a good time to take inventory on yourself. You have to know where you begin to track progress. Here are a few areas to consider, depending on your health improvement goals:

Body Mass

Weight is obvious. It’s also important to take some measurements such as waist, hips, chest, neck, arms, thighs, and calves. Tracking inches lost or gained allows you to know where you’re losing fat or gaining muscle. Not sure what you should weigh? Check out the body mass index chart on the Health Info page.

Fitness

There are at least three areas of fitness you can test for yourself or working with a trainer: cardiovascular fitness, strength, and flexibility. There are both simple and complicated tests for each that goes beyond the scope of this memo. The type of testing depends on the priority of each element in your health improvement program. I want to add some muscle mass, so I’m going to test for strength in my arms, shoulders, chest, and legs now and periodically throughout the year.

Medical Metrics

Resting heart rate and blood pressure are easy to test. If you’re working on pre-diabetes or cholesterol levels, you’ll have to get those tested by the pros. However, if you’ve made these a priority, you probably already know where you began at your last physical.

Finally, if you haven’t had a physical to check the medical metrics, get it scheduled. You can still begin your health improvement program without a specific goal in medical metrics, but do it ASAP. If you don’t know where you’re beginning, you have no idea where you’re supposed to go.

What are you prepared to do today?

        Dr. Chet

Before 2018 Goes…

/in /by

As
this year ends, keep these points in mind as you plan your health (or any)
goals for 2019.

  • Forget what you didn’t accomplish in 2018. You can’t go back to change
    anything, but you can learn from it. If you tracked things, that is; keep that
    in mind for 2019. But no guilt for what you didn’t do. Everything has a season,
    and 2018 apparently wasn’t it for you.
  • January 1st is an arbitrary date to begin to run, to start a diet, or
    whatever else you . . .

    We're sorry, but this content is available to Members and Insiders only.

    If you're already a DrChet.com Member or Insider, click on the Membership Login link on the top menu. Members may upgrade to Insider by going to the Store and clicking Membership; your membership fee will be prorated automatically.

Tips for a Healthier 2019

/in /by

Did
you notice there were no Memos this week? Maybe you were so busy with holiday
preparations, you didn’t notice. Rather than write long Memos during the week
before Christmas, I recorded an audio you could listen to at your convenience.

In
the audio, I give you three tips that can help you reach your health goals in
2019. Here is the link to listen:

https://fccdl.in/wxqhUWFlhw

You
can listen on your phone, your tablet, or your computer. If you have Bluetooth
in your car . . .

We're sorry, but this content is available to Members and Insiders only.

If you're already a DrChet.com Member or Insider, click on the Membership Login link on the top menu. Members may upgrade to Insider by going to the Store and clicking Membership; your membership fee will be prorated automatically.

Happy New Year!

/in /by

2,600,000

Think about how much that number represents. If you were to try to count to 2,600,000, at one number per second, 24 hours per day, it would take you over 30 days. If you were to limit yourself to 40 hours per week, it would take you 18 weeks. And you really would have nothing to show for it.

On the other hand, if you walked 10,000 steps per day five days per week, you would also reach 2,600,000. In that case, it would be 2,600,000 steps. If you began the year as a non-exerciser, you would have improved your fitness level. That’s quite an accomplishment.

Or pick a smaller number: 6,500. If you did 25 crunches a day five days a week, you’d have 6,500 crunches and a maybe less fat under your belt this time next year, and more than likely you’d have less lower back pain.

No matter what your health goal or goals are, just a little effort every day can bring you huge results. It really depends on one question that you ask yourself every day:

What am I prepared to do today?

Dr. Chet

 

2018 Health Goals: Part 2

/in /by

Now that you’ve written it down your health goal or goals for 2018, I have a question for you. Were your health goals really what you’d like to change about your health or was it limited by your thought process?

Here’s what I mean. Did you write down your goals or did you start to analyze your goal? You might think I’m talking about the what of the goal. I’m not; I’m talking about the how of your goal. It might go something like this:

“I really want to lose weight and finally get rid of the extra pounds I’ve gained. But to do that, I’ve got to be able to exercise and my knee is so bad, I can’t. Maybe I should see about getting my knee fixed first. But I don’t have any health coverage right now so I can’t afford it. I guess I’ll have to start by losing the weight, but how am I going to do that? There are so many diets, and I don’t know which to choose. Some of them are expensive, and I can’t afford that either. Maybe I’ll check out some programs online that don’t cost very much.”

You go from the goal—what you really want—to something that may be standing in your way that you have to do first. Instead of focusing on your goal, and you very well may have to address some of these issues, you pick something else you have to do first.

Let’s use the exercise obstacle to weight loss. My example picked the most complicated way of dealing with the issue, getting the knee repaired, instead of finding what you can do to exercise right now. You can do upper body exercise, swimming, or pool walking to relieve the pressure on your knee. Where there’s a goal, there’s a way, but you start with the what, not the how.

Now take another look at your health goals. If you allowed your thinking to get in your way, write down what you really want. You’ll figure out the how later, but it shouldn’t affect your goal setting.

Saturday I’ll focus on one goal that concerns many of us: keeping our brains as healthy and functional as we can for as long as we can.

What are you prepared to do today?

Dr. Chet

 

2018 Health Goals: Part 1

/in /by

It’s that time of year to set goals for 2018. There are many areas of your life for which to set goals, but let’s focus on your health goals. I want you take some time and write down your health goals for 2018. There are three areas that most people want to change: their body weight and shape, their fitness level, and their pain levels. Of course, there’s always smoking and if you smoke, that should be number 1.

Take some time when you read this and write down your health goals, whatever they are. I’ll be sending another Memo later today but don’t read it until you write down your health goals for 2018.

What are you prepared to do today? Prepare to write down your goals.

Dr. Chet

 

Schedule Your Physical

/in /by

Most of want to be healthier, fitter, and weigh less in 2017. In order to really know what your goals should be, you need to know how you measure up right now. That’s why you should schedule your physical today. You can track your weight on a scale, and you can track your miles and your heart rate easily, but there’s more to health than how much weight you can lift. The only way to know where you stand is by getting a physical.

If the Check Oil light comes on, do you ignore it? If the Low . . .

We're sorry, but this content is available to Members and Insiders only.

If you're already a DrChet.com Member or Insider, click on the Membership Login link on the top menu. Members may upgrade to Insider by going to the Store and clicking Membership; your membership fee will be prorated automatically.