Succeed in Medicine: Practical Knowledge for Busy Physicians · Bradley B. Block, MD, Doctor Podcast Network

GLP-1 Agonists: Separating Fact from Fiction with Sean Wharton, MD, PharmD, Part 2| Ep502

·24 min·2 clips

Dr. Sean Wharton explains how GLP-1 agonists can reprogram the brain to treat eating disorders like bulimia.

Dr. Bradley Block hosts Dr. Sean Wharton, an internal medicine physician, pharmacist, and lead author of the 2020 Canadian Obesity Guidelines, for a detailed discussion on GLP-1 agonists. This second part of a two-episode series focuses on clinical applications, differences between medications, and addressing common concerns. Dr. Wharton explains that GLP-1 agonists may help treat conditions like binge eating disorder by promoting "ordered eating" and calming food-related noise in the brain. He notes early evidence suggests these drugs might also aid in managing substance use disorders, including alcohol use, by quieting addictive drives. The conversation clarifies that only two primary GLP-1 agonist medications are currently widely available: semaglutide (marketed as Wegovy and Ozempic) and tirzepatide (marketed as Mounjaro and Zepbound). Dr. Wharton describes semaglutide as a "mono agonist" and tirzepatide as a "dual agonist" combining GLP-1 with GIP, which he analogizes to a football running back having a blocker. He expresses frustration that the same tirzepatide doses have different brand names in the U.S. and Canada, attributing this to insurance and bias against obesity, while many other countries use a single name. The discussion covers upcoming oral versions, including an oral semaglutide with a SNAC (Salmon Lawn Chemical Name) carrier for absorption and a small-molecule drug called orforglipron. Dr. Wharton, a lead author on these oral drug trials, notes they enrolled many patients with lower BMIs (27-30) who had been overlooked in previous studies. Common side effects are gastrointestinal, like nausea and constipation, which often improve over time with dose titration and are reversible upon stopping the medication. He addresses concerns about vision changes, suggesting rapid sugar drops in diabetics can affect retinal vessels, but pathological evidence for issues in non-diabetics is lacking. Dr. Wharton dismisses "Ozempic face" or "Ozempic butt" as general effects of weight loss, not unique to these drugs. He advises clinicians to avoid dogmatically telling patients they must take the medication forever, recommending a softer, collaborative approach instead. The tone is educational and conversational, blending clinical expertise with practical advice for practicing physicians. This episode is ideal for clinicians seeking a nuanced, evidence-based overview of GLP-1 agonists, including their potential off-label uses and management of patient expectations. Listeners looking for a basic introduction or those who strongly oppose pharmacological obesity treatments might find the depth less suitable.

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