WEBVTT
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Hi, I'm Dr.
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Nick Dunn, and I had a lot of experience in Scotland as a general practitioner in a practice, as well as being a lead in some of the clinical services for out-of-hours and postgraduate GP training.
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And during that time, one of my big passions was trying to help people understand better how their bodies worked and some of the medical issues that arise with them, particularly people who are not part of the medical world.
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So, this podcast, Doctors Decoded, the whole aim of this is to try and simplify some of the issues that are current and help people understand a bit more about the issues that are affecting their bodies.
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In addition to that, it's a great opportunity to meet some people who are specialists in their field and get to understand what they do, but also how they tick as doctors and get behind the scenes and understand what motivates them as doctors and maybe what they do out with work, which keeps them going.
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So in this episode, we're going to talk about overweight and obesity and some of the issues around that.
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So we know that in Guernsey, around about 57% of people in Guernsey are overweight or obese.
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And in the UK, the numbers are even higher, around about two-thirds.
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We've known for many years that overweight and obesity are issues which actually impact quite significantly in our health.
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And they contribute to issues such as diabetes or osteoarthritis or ischemic heart disease and even depression.
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And we've grappled as a medical community for decades to try and find ways to address this.
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And there have been many, many projects to try and encourage people to eat less, exercise more.
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But over the years we've discovered that it's actually much more complex than that.
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And as we delve into the science behind obesity, we know that there are hormonal factors, there are genetic factors, there are factors which even we don't even be aware of as children that might be affecting us as we grow up.
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So what we're going to look at today is these new drugs that are available, the injectable weight loss drugs.
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And more recently, we now know that there's a weight loss drug that's available to be taken as an oral pill.
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And although that's not been approved by the NHS, it is available privately and it might be a game changer.
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So what we're going to do today is speak to Sally, who is a specialist GP who runs a weight loss clinic in Guernsey, and find out a bit more about her experiences over the past few years.
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So welcome Sally.
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Nice to see you.
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And you've been working as a GP in Guernsey for about what three or four years now?
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Oh, longer than that, I goodness.
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Had two kids during that time, so it probably is more like three and a half or four years.
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And um tell me a bit about what was it that made you decide to study medicine?
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So it's quite boring, actually.
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Both of my parents are doctors.
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Um my dad is a surgeon and my mum's a GP.
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So I could quite clearly see how it was being a doctor growing up.
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Um my dad did a lot more shift work, um, and my mum was kind of there for school pickups and things.
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Um, but I absolutely loved science and I love talking to people, I love finding out what makes people tick.
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Um, and so medicine just actually unfortunately was quite an easy career choice.
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There's no there's no excitement there.
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That's interesting, but there was no pressure for you to do that.
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It was my husband actually asked me the other day, did you consider anything else?
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And I just was like, no, and I realize how crazy that is now.
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Um, but I think that's probably the way with some people who have doctors as parents, um, and for people who don't, some people probably just want to be doctors, and yeah, but I love it, it's great.
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No, it is a great job.
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I've something I've really enjoyed with medicine is the the variety it brings, um, and I think it's quite a forgiving career.
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I mean, I started off in anaesthetics and intensive care, I did that for five years, um, and the switch from doing that to GP training was actually quite seamless, to be honest with you.
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Um, so I don't know if there's many other careers where you can make that kind of switch so dramatically.
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Yeah, there's something for everyone.
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Yeah, yeah.
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I did five years in AE, I really enjoyed that, but the training was about 13 years that I would be stuck in kind of one place or rotating around, and it just it was going to be too difficult.
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I wanted to have a family.
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Yeah.
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Um and what was it?
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What was it you enjoyed about AE?
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What was it?
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I think it's just that you could you I am a problem solver.
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I love to kind of yes or no sort it, whatever.
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Um, so it was just kind of like you sort the problem and it's done.
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Um, I guess GP is actually the opposite, really, because um, especially in Guernsey, we are kind of, you know, we're in almost in a patient's extended family here.
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We take responsibility for our patients, um, they wait sometimes to see us.
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Um, I really love the trust that's here, the relationships that we build together, um, and the way that kind of in Guernsey, seeing the same people, often five generations of a family, you can understand more of the whole picture.
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So you can often kind of practice holistically much easier than elsewhere.
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I was working in London and it was kind of 10-minute NHS appointments, bam, bam, bam.
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I never saw the same patient twice.
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And it was quite tricky, you know.
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I've got a sore elbow.
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Okay, let's why is the sore the the elbow sore?
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Let's mend that.
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Whereas here it's like, okay, you've got a sore elbow.
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Okay, well, why has that happened?
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How is that affecting your life?
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Um, what else is going on?
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Are you not able to rest because of the sore elbow?
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Is that spilling over into any other areas of the life?
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How how is your daughter dealing with your sore elbow?
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I know you guys do this together.
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You know, it's just it's a completely different ball game here in Guernsey.
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And I'm I'm not saying that that is the case for all of the UK.
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Um, but it was just the kind of intercity, you know, um urban area I was working in before.
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And it's interesting because I sometimes think when I've spoken to trainees who are in hospital doing the more acute jobs like A and E or anaesthetics and ICU.
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Um, for them, I think the thought of that continuity is quite daunting.
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I think they think, gosh, that must be quite hard because how do you deal with people keep coming back to you?
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Um, but like you say, that's what makes it really satisfying, I find.
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And especially after me, I've been a GP now for about over 20 years, and it's actually one of the things that keeps me interested in the job, actually, is that continuity.
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Yeah.
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And um you did a bit more than just um AE though, didn't you?
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You've done some other interesting things.
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Yes.
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Yes, I have.
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Um, so um my husband is a lawyer and he's an offshore lawyer.
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We ended up moving to the British Virgin Islands for a while for a couple of years, and I was um a registrar in the hospital um for AE, and then I also covered some of the private islands in my spare time.
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Um, so a few of the private islands around the British Virgin Islands, I'm sure you can tell what I'm talking about.
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But um, needless to say, I had a fabulous time, and everyone was really, really good fun, very kind.
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Um, and yeah, it was uh an amazing life out there.
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Uh-huh.
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And you're not going to tell us who your your patient was, the famous patient?
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Um no, I won't.
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You can you can guess.
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He's a sir.
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There's there's something in the neighborhood islands, I think, that might be a good idea.
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Possibly, indeed, yeah.
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So um you came to Guernsey and you've obviously been enjoying German practice, and it sounds like you really enjoy all aspects of the job, actually.
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But recently you've had this opportunity to work with the with the weight loss drugs.
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Yeah.
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Um tell me a bit about how that all evolved.
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So I think um, as you know, this is a huge area now, but it kind of came into play a couple of years ago, two, three years ago, and we kind of flagged it quite early as something that would be really useful um for Guernsey as a whole.
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As you say, 57% of um of adults here are overweight or obese, and that's quite startling numbers.
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Um, the WHO have just recognised obesity as a disease, so that means it's on a par now with asthma, you know, type 2 diabetes.
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Um and so I think So, and just to clarify that WHO is the World Health Organization.
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That's it, exactly.
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So now doctors are are kind of recognizing that it's a massive area that we need to understand more about.
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Um, it's not just one area, it underpins our lives as a whole, really.
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Um so I had quite quite a lot of patients um who had put on excess weight that they they didn't want, they didn't feel comfortable in their skin anymore, even though some of them look fantastic.
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Um sometimes if you're overweight and you're carrying excess weight that you don't want, you just know it.
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Um, and I guess the particular categories that kind of um I was able to relate to would be the young mothers or people, um, even kind of um more mature mothers who are kind of juggling so much, you know, childcare, pickups, clubs, you know, at work at work, maybe in some cases, and just don't have time to kind of eat healthily, don't have time to exercise.
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Often they don't have time for self-care at all.
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They're so busy looking after everyone else.
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And it's interesting that whole idea of describing obesity as a disease, because I think for a long time we have thought of it as a bit of a cosmetic issue, really, hasn't it?
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And how people look.
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Whereas thinking about it as a disease process is it's quite important, isn't it?
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Just to reclassify that.
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So I think that, well, the word fat in my office is banned.
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That's done.
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I think that whole ethos of judgment on someone's weight is and should be over.
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Um, I think we need to understand that people who are carrying more weight than they like, it's not due to um, you know, them eating the wrong things or um eating too much in a lot of cases.
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Somebody can actually have a perfect, what we would call perfect diet, perfect kind of um uh energetic kind of um active lifestyle and still be heavier than they would like.
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We know, as you said in your introduction, it's hormones, it's genetics, it's environmental factors, it's psychology.
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I mean, to go back to the group that I mentioned, there are a lot of triggers there for young mums and indeed anybody to hear food noise.
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That's something that's now entered our ethos of this food noise um quote unquote.
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What is that?
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I mean, I've obviously it's something I'm familiar with, that term, um, but because I'm not dealing with this particular issue quite as much as you are, what what do you what do people mean by food noise?
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So food noise would just be kind of like as you're going about your day, thoughts of eating, thoughts of cravings, thoughts of I guess shame with food.
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Um, everything that kind of underpins us, you know, we'll be walking along the street.
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Oh, there's that cafe.
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Like, oh my gosh, do I have time to get a croissant on this?
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You know, that would be a food noise, or um, I'm so tired today.
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I just need to have X to make it through.
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So the food noise might be heard by some people if they're tired, they might hear food noise if they're stressed, they might hear food noise if they're bored.
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Like a typical example is you're sitting off an evening watching telly and you're going backwards and forwards, backwards and forwards to the to the fridge or to the cupboard.
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Um, you might hear something out of habit.
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Whenever you go to get petrol, you pick up a Twix.
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Um, and the food noise, we all do need food noise.
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Our body does and our brain does need to tell us when we're hungry.
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And of course, we need to be looking for the right things.
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Do we need carbohydrates for energy?
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Do we need protein for our muscles?
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What is it that we need?
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Um, so food noise can be very good, but often it's being used to kind of describe um when it's becoming overwhelming for people, they're hearing it all day.
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Um, it's been very satisfying and really interesting in the weight management clinic that I run to hear that a lot of people's mental health is completely changed because actually they have been hearing food noise all day and it's exhausting for them.
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It's almost like someone on the back going like this, just tapping you exhaust constantly, and that's been taken away.
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And some people have come in and burst into tears and just been like, the food noise is gone.
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Thank God.
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Um, so that's really lovely.
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Yeah, it's interesting you talk about that food noise because it it makes me think about is there an addiction element to this?
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You know, is is there such a thing as food addiction in the same way that we get alcohol addiction or drug addiction or gambling addiction?
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Is that is there anything in that at all?
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Absolutely.
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So I mean, we know that there can be so when you eat something, so your body releases it gerolin, which makes you feel hungry, and that's all very good.
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And then there are two mechanisms by which they it should stop.
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So the first is the GLP1 mechanism, the glucagon-like um, glucagon-like peptide one, um, and that is released from the gut in response to food, and that triggers us to feel like we've taken enough in, we're not hungry anymore.
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Um, the second is the leptin pathway, and that leptin pathway is triggered by fat cells.
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So, usually if we get some um, we get a healthy amount of fat cells, they secrete leptin and it tells us stop eating.
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We've got enough in reserve, we don't need any more.
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Um, but what can happen is where the fat cells are that much bigger for that much longer, so somebody who may be battling with their health, with sorry, with their weight for years and years, um, that leptin pathway gets broken.
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And so the body is not being triggered by the leptin.
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Um, the leptin goes to the brain and it doesn't cross over the blood blood-brain barrier, and so then the body thinks it's starving, and then you start trying to eat more and more and more.
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So there is definitely an addiction in that if you have bigger fat cells, um, so you're more overweight, you want to eat more and more and more.
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Um, and then obviously there's kind of the sugary carbs addiction pathway.
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You eat some sugar, your your um liver basically makes you want to eat more, you kind of dump sugar and then you're locked in it.
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So, yeah, there are addiction pathways and then it is almost a vicious cycle that people get into.
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Massively.
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Right, I see.
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Massively.
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And it's interesting.
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I was reading recently that they were describing fat as an organ.
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Um, you know, we think of fat as being individual cells and not really very intelligent and not doing very much, but actually they reckon that there's something about fat that communicates between fat cells communicating with each other, and that there's a bit of a memory there.
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So some people struggle if they've been overweight when they've been younger, then you lose weight, but there's still this drive to gain weight again that's intrinsic in the body.
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And I think it's incredible how complex the whole system is, isn't it?
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Yeah, it's really interesting.
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And I think the thing to remember is well, something that's been interesting is that when we remove that kind of food noise and the psychology of needing to eat and being locked in the cycle.
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So, say, for example, somebody was on a weight loss injectable and that's gone, it's really important to put the work in to kind of identify what was it that my body or my brain was wanting me to do before that led me to be bigger than I would like.
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And how can I stop that?
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Like, you know, you go to you go to get the petrol from the from the um from the petrol station and you see the twigs, what are you gonna do?
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Are you gonna say, Oh, I'm I'm on a weight loss injectable, I'm not gonna eat that?
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I don't think that's the answer.
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The right thing to do is to be like, um, I'm going to grab some, I've got some water in the car, or I'm going to grab an apple instead and just retrain so that when if you did want to come off the weight loss injectable in the future, um, then those kind of areas are there to catch you.
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Um so we've talked a bit about sort of how these drugs work.
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Um, and um from a practical point of view, you know, how do you assess people?
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For example, you know, I I might see someone who's talked to me about their weight, or I might even discuss it with them.
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And in fact, that that's an area that can be quite sensitive as well, is actually how do you bring it up in a consultation?
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Because um obviously I try and be very sensitive about it and use open questions, and the person might be in a bit something to do with their blood pressure, and then it's maybe asking, you know, how's your weight?
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And some people are very open about it, they will say, actually, I feel overweight, but I want to do something about it, I'm trying to exercise more, or I'm trying to eat less, or I want to think about maybe some medication for that.
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But there are some people who often, if I'm honest woman, who have really struggled to get their weight off, become very emotional about it, no matter how hard I try to be sensitive about it.
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Um, but it's difficult because on the other hand, I feel I would be remiss not to mention it because, like you say, it's a disease.
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So, how do we get around that?
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What would you say?
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What would your advice be, I suppose, to other GPs in that regard?
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Well, I think times have massively changed because we I feel that it is okay to bring up now because we can.
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I'm not just going to be saying to somebody, um, you know, you're overweight or you're obese.
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I mean, I would never say that to anyone.
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Um, but um, and then that's it, do something about it.
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Here's weight watches.
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I mean it I don't know whether this is a good thing or a bad thing, but there is now obviously weight loss injectables or the tablet that you mentioned.
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And so people are not kind of left being like, oh my gosh, um, I'm overweight or I'm obese, and it's affecting all of these areas of my health, and there's nothing I can do, I can't manage to do anything about this, and often that would make it worse.
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So I think it has become much easier to talk about in that there is actually something that we can suggest and that can help the patient automatically.
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Um, but yeah, so I think the way so because I'm doing a weight management clinic, um, it they're kind of scattered into my normal day, and so it's very natural for me to bring it up and then I say, I'm so sorry to mention it.
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It's just that I'm I'm doing a weight management clinic and don't think no more of it.
00:17:57.920 --> 00:18:06.960
There are some people who I can see have have got offended, and that might be once a month, but absolutely sometimes it's worth saying, and I would never mention it out of nowhere.
00:18:07.039 --> 00:18:11.359
So it might be someone saying, I'm taking four tablets now of my blood pressure.
00:18:11.519 --> 00:18:13.519
Like, is this really my life now?
00:18:13.759 --> 00:18:19.440
Or like my knee is so sore, and I I've had some steroid injections, and I just I don't know what to do.
00:18:19.519 --> 00:18:31.440
I don't want a replacement, and so I would probably pick up on triggers and try to find a way to kind of introduce it based on what the patient had said, rather than just bringing it up out of nowhere.
00:18:31.680 --> 00:18:41.440
Um, but I would say that people are more receptive to it now, you know, it's all over newspapers, it's all over social media.
00:18:41.599 --> 00:18:59.039
Um, it's kind of underpinning our generation, I guess, in terms of uh one of the techniques that I have found, I suppose I've found quite useful, um, is using some motivational interviewing techniques, you know, sort of recognizing that you don't necessarily come up with a solution in that consultation.
00:18:59.119 --> 00:19:03.839
Um, and it's about the idea that you might be planting a seed or like rolling with resistance.
00:19:03.920 --> 00:19:08.559
So if someone actually doesn't want to talk about it, it's just to accept that and not not to probe any further.
00:19:09.039 --> 00:19:14.640
Um and then you know, maybe when they come back, and it's that it's about that sort of longitudinal relationship you have with patients, isn't it?
00:19:14.799 --> 00:19:19.279
You can give it time, you can plant a seed, and they might come back later and say, actually, I've thought about that.
00:19:19.519 --> 00:19:21.039
Is there something that you can do to help me?
00:19:21.119 --> 00:19:23.599
And that's where you get into a really useful conversation about it.
00:19:23.920 --> 00:19:45.359
Yeah, it's very interesting because um a lot of my diabetic patients um who very clearly would benefit um from um a weight loss injectable, so not a weight loss injectable, but one of the medications for it, for example, Manjaro or Azempic, um do not want to take it and they will not hear anything that I say about the subject.
00:19:45.599 --> 00:19:49.599
And you know, they're they're damaging their bodies with really high sugars.
00:19:49.759 --> 00:19:55.359
They're on four other classes of medication, there's nowhere else to go, and they still will not have it.
00:19:55.680 --> 00:19:58.240
And the funding situation with patients with diabetes is a very important thing.
00:19:59.119 --> 00:20:01.279
It will be free for them, so they still don't want it.
00:20:01.599 --> 00:20:09.279
So that's one of the one of the advantages at the moment, isn't it, that we have got that funding from the states for diabetic patients with the same thing.
00:20:09.599 --> 00:20:10.559
Game changing, yeah.
00:20:11.039 --> 00:20:18.079
And um initially I seem to recall the weight loss injectables were not first line for diabetics, but I understand they are now.
00:20:18.400 --> 00:20:25.599
Yeah, so um you would usually use metformin first, and then after that, it would completely depend on each patient.
00:20:25.680 --> 00:20:28.000
But yeah, it can be second line for some people, yeah.
00:20:28.160 --> 00:20:28.400
Absolutely.
00:20:28.880 --> 00:20:34.880
And um you've found that even despite the fact they're not paying for it, yeah, they're not interested.
00:20:35.279 --> 00:20:36.799
Yeah, it's very interesting.
00:20:36.960 --> 00:20:45.680
Um, I think there is and has been a lot a bit of shame actually about um these medications, these injectable medications.
00:20:45.920 --> 00:20:56.640
Um, some patients will come to me and say, I've tried everything, I've been on this diet, I've done Atkins, I've done Weight Watches, I've done a marathon, and I've gone up and down, up and down.
00:20:56.720 --> 00:20:58.480
I can't shift this weight.
00:20:58.720 --> 00:21:01.119
And I'm just so ashamed to be here.
00:21:01.279 --> 00:21:03.920
I feel like this is um, you know, a quick fix.
00:21:04.079 --> 00:21:05.119
Um, I'm cheating.
00:21:05.759 --> 00:21:09.519
And I say to them, this is gonna take work.
00:21:09.599 --> 00:21:12.079
This is not a quick fix, it's not a cheat.
00:21:12.240 --> 00:21:14.480
Um, it's gonna be amazing.
00:21:14.880 --> 00:21:17.119
Um, if we do this, there's no shame.
00:21:17.279 --> 00:21:20.079
It's up to you whether you share it with people, whether you don't.
00:21:20.160 --> 00:21:21.519
You can say whatever you want.
00:21:21.680 --> 00:21:22.799
This is your business.
00:21:23.119 --> 00:21:30.000
And when people come back to see me at the six-month mark, I don't feel like mostly any of them have shame anymore.
00:21:30.160 --> 00:21:33.759
Um they have had to work at it, it's a complete lifestyle change.
00:21:34.000 --> 00:21:37.599
Um, you know, they've got boosted energy, so they want to exercise.
00:21:37.759 --> 00:21:44.480
Um, they're feeling lighter, they're feeling happier, they're feeling um just much, much better.
00:21:44.559 --> 00:21:46.640
And they always say, I don't feel ashamed now.
00:21:46.799 --> 00:21:48.559
I can see that my body needed this.
00:21:48.720 --> 00:21:51.920
I feel that I suit this, this is my natural weight now.
00:21:52.000 --> 00:21:53.359
I'm starting to get there.
00:21:53.519 --> 00:21:56.079
Um, you know, thank, thank goodness for this.
00:21:56.480 --> 00:22:08.319
And I suppose the big thing that often people want to find out about at the end of Day because like I said earlier on, there's a lot of information out there about these weight loss injectables and um chat on social media and on media.
00:22:08.480 --> 00:22:11.279
Um the big question they will ask is is it safe?
00:22:11.440 --> 00:22:14.559
So presumably you have that conversation at the outset.
00:22:14.799 --> 00:22:19.359
So so what what do you see as you know the the downsides of these drugs?
00:22:19.680 --> 00:22:23.039
So I think the downsides are that it can make people feel a bit grotty.
00:22:23.440 --> 00:22:27.359
So the day you inject in a few days afterwards you can feel quite nauseated.
00:22:27.599 --> 00:22:37.680
I have had some patients who've vomited um diarrhea, constipation, acid reflux, those can happen, probably one in ten, maybe.
00:22:37.839 --> 00:22:44.720
Um, and then uncommonly the big risk is the risk of pancreatitis, which is um one in one to two thousand.
00:22:45.119 --> 00:22:48.880
Um, and one in twenty times you get pancreatitis, you can die.
00:22:49.200 --> 00:22:50.880
So that is quite concerning.
00:22:50.960 --> 00:22:54.240
And I have had some patients turn around at that stage and just be like, Do you know what?
00:22:54.480 --> 00:22:54.799
No.
00:22:55.039 --> 00:22:59.599
Um, but it, you know, it I think have you had any occasions where you've had complications with that?
00:22:59.920 --> 00:23:06.480
I haven't actually, but we have had four cases of pancreatitis in Guernsey because of weight loss injectable medications.
00:23:06.559 --> 00:23:08.240
So it's definitely happening.
00:23:08.480 --> 00:23:10.720
Um, no, I've been quite lucky.
00:23:10.880 --> 00:23:14.799
Um, we have had a uh have had a uh case of gallstones.
00:23:14.880 --> 00:23:25.920
So if you lose a huge amount of weight quite quickly, regardless of whether you're taking a weight loss injectable or you're lost in a forest, um, you can get gallstones, you can lose hair, you can lose muscle.
00:23:26.240 --> 00:23:27.759
Um that's a big thing, isn't it?
00:23:28.000 --> 00:23:28.480
It is a big thing.
00:23:29.920 --> 00:23:44.799
Something I'm quite interested in because obviously I'm getting interested in sports medicine and musculoscular medicine and the importance of physical activity and maintaining muscle mass, particularly for people who are in their 50s and beyond, as they're getting older, you tend to lose muscle mass anyway.
00:23:44.880 --> 00:23:58.720
Yeah, and trying to encourage people to take part in resistance training routinely because we all know that, for example, cardiovascular exercise is really good for us, but there's less emphasis on resistance training, and there's been quite a lot of research coming through about that.
00:23:58.880 --> 00:24:04.319
But for people who are on weight loss injectables, I think that is a risk that they might not be so aware of.
00:24:04.400 --> 00:24:05.839
Is that a fair comment?
00:24:06.160 --> 00:24:06.799
Yeah, definitely.
00:24:06.880 --> 00:24:11.519
I have had a couple of patients who I didn't start on it come to me having lost muscle.
00:24:11.680 --> 00:24:18.559
Yeah, and I suppose this was kind of two, three years ago when there wasn't the bigger knowledge base around it that there is now.
00:24:18.720 --> 00:24:21.359
But yeah, some people have been quite disappointed by that.
00:24:21.759 --> 00:24:29.519
But um, muscle's greedy, it wants um energy, and if there's a calorie deficit, the muscle can be lost.
00:24:29.680 --> 00:24:31.279
Um, and it's it's tough.
00:24:31.440 --> 00:24:37.599
But people do need to be really strict um with trying to conserve muscle if they go on a weight loss injectable.
00:24:37.920 --> 00:24:38.720
And how would they do that?
00:24:38.799 --> 00:24:39.440
What would you recommend?
00:24:39.680 --> 00:24:50.640
So absolutely, so resistance training, so Pilates yoga, even just lifting the shopping and walking with something on their back, and making sure that they exercise their legs and their arms.
00:24:50.720 --> 00:25:02.319
So if you're walking with something on your back, obviously you've got the weight going through your legs, but you need to keep your arms so even baked beans at dinner, whatever it takes, um, some gentle weights or yeah, whole body weight.
00:25:02.400 --> 00:25:05.119
So Pilates yoga, press-ups, those sorts of things.
00:25:05.519 --> 00:25:06.720
And what about hair loss?
00:25:06.799 --> 00:25:08.880
Is that something that's been increasingly recognised?
00:25:09.440 --> 00:25:09.839
For sure.
00:25:10.000 --> 00:25:13.279
Um, so again, it's just nutrient deficient, really.
00:25:13.519 --> 00:25:20.000
So we always recommend if you were to start any diet, really, you should um take a multivitamin.
00:25:20.319 --> 00:25:25.519
So that will conserve your folate, um, your vitamins that you need for hair growth.
00:25:25.680 --> 00:25:27.599
Um, iron is another big thing.
00:25:27.920 --> 00:25:33.519
Um, so people just need to make sure that they're taking in enough iron and uh fill it.
00:25:34.000 --> 00:25:40.640
And so if someone came along to you to start on treatment, what what's the kind of clinic appointment basis like?
00:25:40.720 --> 00:25:43.839
What just talk me through you know how that all works from a system point of view?
00:25:44.160 --> 00:25:50.640
So they will kind of tell me a bit about what's led them to be heavier than they would like, um, then we'll weigh them.
00:25:50.960 --> 00:25:52.960
Sometimes they don't want to look and that's fine.
00:25:53.200 --> 00:25:56.400
I can then check if they're gonna be eligible or not.
00:25:56.640 --> 00:25:59.839
Um, then we talk a little bit about um their options.
00:26:00.079 --> 00:26:10.960
There were uh if they're only doing it, so if if they have diabetes, um, we would use the gold standard, which is Manjaro, um, unless they didn't want to do that, and then a Zempic would be okay.
00:26:11.200 --> 00:26:17.680
If they don't have diabetes and they were doing it for um weight management purely, then it would be Manjaro versus Wegovy.
00:26:17.759 --> 00:26:20.480
There is a Wegovy pill now that you've mentioned as well.
00:26:20.559 --> 00:26:30.720
Um, so then we would talk about the different options, we'd talk about the side effect profile, uh, we would talk about the psychology of eating, so food noise, um, and then what to eat.
00:26:30.799 --> 00:26:34.240
So a kind of like protein cannot be stored as fat.
00:26:34.319 --> 00:26:40.720
So eat as much protein as you like, it's amazing, it fills you up, it helps your muscles, hair, skin, and nails, it's great.
00:26:40.799 --> 00:26:44.079
Um and just remind us what what protein-based foods are out there.
00:26:44.400 --> 00:26:47.519
So the best protein-based foods will be the ones that have low fat in.
00:26:47.599 --> 00:26:54.960
So that would be lean proteins like chicken, fish, lentils, peas, um, quinoa, uh, those sorts of things.
00:26:55.119 --> 00:27:05.519
Um, and then obviously you can get protein that's marbled with fat, so that would be your red meat, so mince, uh, sausage, um steak, lamb.
00:27:06.079 --> 00:27:11.599
And um, what about in terms of the long-term treatments?
00:27:11.680 --> 00:27:16.880
With you know, we've talked about some of the side effects, obviously, and you're mentioning that you get that follow-up with the nurse as well.
00:27:16.960 --> 00:27:23.200
And I my understanding is that they'll obviously try and emphasize some of these psychological elements as they go.
00:27:23.279 --> 00:27:28.400
It's not just about checking blood pressures and weights, it's actually about that psychological support as well.
00:27:28.559 --> 00:27:28.799
Yeah.
00:27:29.119 --> 00:27:33.039
How long do you tend to see people staying on these drugs for?
00:27:33.119 --> 00:27:35.039
And could they stay on it forever?
00:27:35.359 --> 00:27:41.599
Yeah, so there was a licensing, um, certainly of one of the injectables for two years, that's now dropped away.
00:27:41.759 --> 00:27:45.440
So there are some thoughts that people may be on these lifelong.
00:27:45.599 --> 00:27:53.359
I think the statistics are something like one in five Americans are on them or have been on them in the last five years, which is staggering.
00:27:53.680 --> 00:27:59.920
Um, and I do think that as time goes on, more and more people will probably start to be on them.
00:28:00.160 --> 00:28:04.079
Um, people may switch from the injectable to the tablet.
00:28:04.160 --> 00:28:05.759
We'll have to see how it goes.
00:28:05.920 --> 00:28:11.119
Um, this is obviously a very new area of medicine, so we're quite flexible at the moment.
00:28:11.279 --> 00:28:20.079
Um, if you meet the criteria to go on a weight loss injectable, um you can, in theory, have it for as long as you need.
00:28:20.240 --> 00:28:32.400
Um, there will be some other bits and bobs that you know we need to make sure that are not happening, but um, unless your BMI drops worryingly, you could have it for decades, is the thought at the moment.
00:28:32.559 --> 00:28:35.279
But as I say, this is new and things may change.
00:28:35.440 --> 00:28:40.319
So there are some people who don't want to go on a weight loss injectable because they're worried about coming off it.
00:28:40.720 --> 00:28:51.440
Um, some people do want to come off it, and I have seen I have had one patient who went on it for one month and then completely retrained his brain, lost four stones.
00:28:51.680 --> 00:28:52.480
Yeah, that's amazing.
00:28:53.200 --> 00:28:54.160
It's interesting, isn't it?
00:28:54.240 --> 00:28:58.480
It's almost like they've made that psychological leap to take action and they've really embraced it.
00:28:58.559 --> 00:29:03.599
I've had one or two people at that as well, where they've started the injection and then think, actually, I don't want to be doing this.
00:29:03.680 --> 00:29:03.920
Yeah.
00:29:04.160 --> 00:29:08.960
And if it's so serious that I need to be injecting myself, then I should really be taking some action.
00:29:09.039 --> 00:29:20.079
And it's great if people can do that, but like you say, I think it's important that we don't um necessarily use these people as a prime example because they're they're the exception to the rule, yeah.
00:29:20.240 --> 00:29:25.680
And we don't want to be, I suppose, judgmental about people's behaviours either, because that's a really important part of it all.
00:29:25.839 --> 00:29:26.160
Yeah.
00:29:26.559 --> 00:29:31.839
So um which part of the weight management clinic do you enjoy most?
00:29:32.000 --> 00:29:33.599
What is it you enjoy most about this?
00:29:33.920 --> 00:29:48.000
Um I think it's when people come in and they're like, I've battled my whole life, my mum's overweight, um, I've gone through the menopause, I can't lose weight, I'm leading a perfect life.
00:29:48.160 --> 00:29:48.960
Please help.
00:29:49.039 --> 00:29:51.759
And I can help, and that is amazing.
00:29:51.920 --> 00:29:59.039
Um, and then the kind of feedback, you know, six months, 12 months, 18 months, two years later, this is me.
00:29:59.119 --> 00:30:02.880
Uh, you know, I'm so pleased, I'm feel so much better.
00:30:03.119 --> 00:30:11.039
Of course, there are some people who are really tired when they're on it, and there are some people who get side effects and they don't want to stay on it, and that's that's fine.
00:30:11.279 --> 00:30:21.759
Um, but I think it's just being able to do something um that helps a patient so quickly, um, and then selfishly getting the success stories, like it's really nice.
00:30:22.160 --> 00:30:40.000
Um, sometimes as a GP, you you could go a morning where um you haven't quite resolved anything really, and um you're trying and you're trying to um help your patients as best you can, um, but the patients may feel like they're not yet thriving, they're still surviving.
00:30:40.319 --> 00:30:46.000
And to see these patients, they're starting to thrive, and it's lovely.
00:30:46.160 --> 00:30:52.000
I think it is one of the drugs that we are confident for the majority of the time it seems to work, isn't it?
00:30:52.480 --> 00:30:53.519
Absolutely, it does.
00:30:54.160 --> 00:30:58.240
And which part of living in Guernsey do you enjoy most?
00:30:58.559 --> 00:31:08.720
Um, well, I've got sandy toes today, so I think it's just you know, popping out from the office, going for a swim, um, uh taking my kids to the beach.
00:31:08.880 --> 00:31:12.079
Um, it's just life feels a bit lighter here.
00:31:12.240 --> 00:31:13.359
Yeah, it's easier.
00:31:13.440 --> 00:31:20.720
Um, and it's obviously smaller and it's not for everybody, but I certainly find it, you know, I I love it here.
00:31:21.279 --> 00:31:21.519
Okay.
00:31:21.680 --> 00:31:22.559
Thanks very much, Sally.
00:31:22.720 --> 00:31:23.920
That was really interesting to talk to you.
00:31:24.160 --> 00:31:24.480
Thank you.
00:31:24.799 --> 00:31:30.319
So um we'll be talking a bit more about other topics in the next few um episodes.
00:31:30.480 --> 00:31:35.759
Um, we've got another episode coming up to talk about childhood allergy, particularly food allergies.
00:31:35.920 --> 00:31:48.480
Um, but that was a really interesting topic to talk about the whole issue around obesity, weight management, some of the complex psychological issues that Sally touched upon there and changing attitudes to how we approach these things.
00:31:48.640 --> 00:31:58.480
I would say that since I graduated, um, the approach to these things has been much more gentle and much more collaborative with patients rather than the doctor telling patients what they should do.
00:31:58.640 --> 00:32:02.000
It's actually about us trying to work with the patients and find a solution.
00:32:02.160 --> 00:32:08.079
Um, and we also know that although these drugs have got some side effects, they are very effective.
00:32:08.240 --> 00:32:14.480
And it's opened up that area so that we can approach people um or people can approach us to ask about solutions.
00:32:14.880 --> 00:32:15.920
So thanks again.
00:32:16.000 --> 00:32:19.200
Um, and uh we'll catch up with you again some other time.
00:00:00.239 --> 00:00:01.040
Hi, I'm Dr.
00:00:01.120 --> 00:00:13.679
Nick Dunn, and I had a lot of experience in Scotland as a general practitioner in a practice, as well as being a lead in some of the clinical services for out-of-hours and postgraduate GP training.
00:00:13.839 --> 00:00:27.039
And during that time, one of my big passions was trying to help people understand better how their bodies worked and some of the medical issues that arise with them, particularly people who are not part of the medical world.
00:00:27.280 --> 00:00:37.920
So, this podcast, Doctors Decoded, the whole aim of this is to try and simplify some of the issues that are current and help people understand a bit more about the issues that are affecting their bodies.
00:00:38.240 --> 00:00:55.039
In addition to that, it's a great opportunity to meet some people who are specialists in their field and get to understand what they do, but also how they tick as doctors and get behind the scenes and understand what motivates them as doctors and maybe what they do out with work, which keeps them going.
00:00:56.079 --> 00:01:02.880
So in this episode, we're going to talk about overweight and obesity and some of the issues around that.
00:01:03.119 --> 00:01:09.439
So we know that in Guernsey, around about 57% of people in Guernsey are overweight or obese.
00:01:09.599 --> 00:01:12.799
And in the UK, the numbers are even higher, around about two-thirds.
00:01:13.519 --> 00:01:20.480
We've known for many years that overweight and obesity are issues which actually impact quite significantly in our health.
00:01:20.719 --> 00:01:28.560
And they contribute to issues such as diabetes or osteoarthritis or ischemic heart disease and even depression.
00:01:28.879 --> 00:01:34.319
And we've grappled as a medical community for decades to try and find ways to address this.
00:01:34.480 --> 00:01:40.159
And there have been many, many projects to try and encourage people to eat less, exercise more.
00:01:40.319 --> 00:01:44.079
But over the years we've discovered that it's actually much more complex than that.
00:01:44.239 --> 00:01:56.879
And as we delve into the science behind obesity, we know that there are hormonal factors, there are genetic factors, there are factors which even we don't even be aware of as children that might be affecting us as we grow up.
00:01:57.120 --> 00:02:03.120
So what we're going to look at today is these new drugs that are available, the injectable weight loss drugs.
00:02:03.359 --> 00:02:09.039
And more recently, we now know that there's a weight loss drug that's available to be taken as an oral pill.
00:02:09.280 --> 00:02:15.919
And although that's not been approved by the NHS, it is available privately and it might be a game changer.
00:02:16.400 --> 00:02:29.439
So what we're going to do today is speak to Sally, who is a specialist GP who runs a weight loss clinic in Guernsey, and find out a bit more about her experiences over the past few years.
00:02:30.080 --> 00:02:31.280
So welcome Sally.
00:02:31.599 --> 00:02:32.159
Nice to see you.
00:02:33.520 --> 00:02:37.759
And you've been working as a GP in Guernsey for about what three or four years now?
00:02:38.719 --> 00:02:39.599
Oh, longer than that, I goodness.
00:02:40.560 --> 00:02:44.800
Had two kids during that time, so it probably is more like three and a half or four years.
00:02:46.159 --> 00:02:51.280
And um tell me a bit about what was it that made you decide to study medicine?
00:02:51.599 --> 00:02:53.199
So it's quite boring, actually.
00:02:53.360 --> 00:02:54.960
Both of my parents are doctors.
00:02:55.039 --> 00:02:57.759
Um my dad is a surgeon and my mum's a GP.
00:02:57.919 --> 00:03:01.680
So I could quite clearly see how it was being a doctor growing up.
00:03:02.000 --> 00:03:08.240
Um my dad did a lot more shift work, um, and my mum was kind of there for school pickups and things.
00:03:08.400 --> 00:03:16.319
Um, but I absolutely loved science and I love talking to people, I love finding out what makes people tick.
00:03:16.479 --> 00:03:21.840
Um, and so medicine just actually unfortunately was quite an easy career choice.
00:03:21.919 --> 00:03:23.759
There's no there's no excitement there.
00:03:24.080 --> 00:03:26.240
That's interesting, but there was no pressure for you to do that.
00:03:26.400 --> 00:03:29.919
It was my husband actually asked me the other day, did you consider anything else?
00:03:30.080 --> 00:03:34.240
And I just was like, no, and I realize how crazy that is now.
00:03:34.319 --> 00:03:45.039
Um, but I think that's probably the way with some people who have doctors as parents, um, and for people who don't, some people probably just want to be doctors, and yeah, but I love it, it's great.
00:03:45.360 --> 00:03:46.080
No, it is a great job.
00:03:46.159 --> 00:03:52.240
I've something I've really enjoyed with medicine is the the variety it brings, um, and I think it's quite a forgiving career.
00:03:52.319 --> 00:04:01.919
I mean, I started off in anaesthetics and intensive care, I did that for five years, um, and the switch from doing that to GP training was actually quite seamless, to be honest with you.
00:04:02.080 --> 00:04:06.479
Um, so I don't know if there's many other careers where you can make that kind of switch so dramatically.
00:04:06.719 --> 00:04:07.919
Yeah, there's something for everyone.
00:04:08.000 --> 00:04:08.319
Yeah, yeah.
00:04:08.560 --> 00:04:19.519
I did five years in AE, I really enjoyed that, but the training was about 13 years that I would be stuck in kind of one place or rotating around, and it just it was going to be too difficult.
00:04:19.680 --> 00:04:20.879
I wanted to have a family.
00:04:20.959 --> 00:04:21.120
Yeah.
00:04:21.279 --> 00:04:22.959
Um and what was it?
00:04:23.120 --> 00:04:24.720
What was it you enjoyed about AE?
00:04:24.800 --> 00:04:25.040
What was it?
00:04:25.360 --> 00:04:28.240
I think it's just that you could you I am a problem solver.
00:04:28.319 --> 00:04:31.759
I love to kind of yes or no sort it, whatever.
00:04:31.920 --> 00:04:36.079
Um, so it was just kind of like you sort the problem and it's done.
00:04:36.240 --> 00:04:47.360
Um, I guess GP is actually the opposite, really, because um, especially in Guernsey, we are kind of, you know, we're in almost in a patient's extended family here.
00:04:47.439 --> 00:04:52.000
We take responsibility for our patients, um, they wait sometimes to see us.
00:04:52.240 --> 00:05:05.360
Um, I really love the trust that's here, the relationships that we build together, um, and the way that kind of in Guernsey, seeing the same people, often five generations of a family, you can understand more of the whole picture.
00:05:05.600 --> 00:05:10.800
So you can often kind of practice holistically much easier than elsewhere.
00:05:10.959 --> 00:05:15.759
I was working in London and it was kind of 10-minute NHS appointments, bam, bam, bam.
00:05:15.839 --> 00:05:17.680
I never saw the same patient twice.
00:05:17.920 --> 00:05:19.920
And it was quite tricky, you know.
00:05:20.079 --> 00:05:21.600
I've got a sore elbow.
00:05:21.759 --> 00:05:24.720
Okay, let's why is the sore the the elbow sore?
00:05:24.800 --> 00:05:25.600
Let's mend that.
00:05:25.759 --> 00:05:28.399
Whereas here it's like, okay, you've got a sore elbow.
00:05:28.560 --> 00:05:30.480
Okay, well, why has that happened?
00:05:30.639 --> 00:05:32.480
How is that affecting your life?
00:05:32.639 --> 00:05:34.560
Um, what else is going on?
00:05:34.720 --> 00:05:36.720
Are you not able to rest because of the sore elbow?
00:05:36.800 --> 00:05:39.759
Is that spilling over into any other areas of the life?
00:05:39.920 --> 00:05:42.160
How how is your daughter dealing with your sore elbow?
00:05:42.240 --> 00:05:43.680
I know you guys do this together.
00:05:43.759 --> 00:05:48.000
You know, it's just it's a completely different ball game here in Guernsey.
00:05:48.079 --> 00:05:52.160
And I'm I'm not saying that that is the case for all of the UK.
00:05:52.319 --> 00:05:57.839
Um, but it was just the kind of intercity, you know, um urban area I was working in before.
00:05:58.319 --> 00:06:07.439
And it's interesting because I sometimes think when I've spoken to trainees who are in hospital doing the more acute jobs like A and E or anaesthetics and ICU.
00:06:07.759 --> 00:06:11.040
Um, for them, I think the thought of that continuity is quite daunting.
00:06:11.199 --> 00:06:16.000
I think they think, gosh, that must be quite hard because how do you deal with people keep coming back to you?
00:06:16.160 --> 00:06:19.600
Um, but like you say, that's what makes it really satisfying, I find.
00:06:19.759 --> 00:06:27.199
And especially after me, I've been a GP now for about over 20 years, and it's actually one of the things that keeps me interested in the job, actually, is that continuity.
00:06:27.519 --> 00:06:27.839
Yeah.
00:06:28.160 --> 00:06:31.680
And um you did a bit more than just um AE though, didn't you?
00:06:31.759 --> 00:06:32.800
You've done some other interesting things.
00:06:33.439 --> 00:06:33.680
Yes.
00:06:33.920 --> 00:06:34.800
Yes, I have.
00:06:34.959 --> 00:06:38.800
Um, so um my husband is a lawyer and he's an offshore lawyer.
00:06:38.879 --> 00:06:51.519
We ended up moving to the British Virgin Islands for a while for a couple of years, and I was um a registrar in the hospital um for AE, and then I also covered some of the private islands in my spare time.
00:06:51.680 --> 00:06:58.560
Um, so a few of the private islands around the British Virgin Islands, I'm sure you can tell what I'm talking about.
00:06:58.800 --> 00:07:04.959
But um, needless to say, I had a fabulous time, and everyone was really, really good fun, very kind.
00:07:05.360 --> 00:07:08.959
Um, and yeah, it was uh an amazing life out there.
00:07:09.199 --> 00:07:09.600
Uh-huh.
00:07:09.839 --> 00:07:14.000
And you're not going to tell us who your your patient was, the famous patient?
00:07:14.399 --> 00:07:15.680
Um no, I won't.
00:07:15.920 --> 00:07:17.040
You can you can guess.
00:07:17.120 --> 00:07:17.839
He's a sir.
00:07:18.160 --> 00:07:20.319
There's there's something in the neighborhood islands, I think, that might be a good idea.
00:07:20.639 --> 00:07:22.000
Possibly, indeed, yeah.
00:07:22.319 --> 00:07:29.519
So um you came to Guernsey and you've obviously been enjoying German practice, and it sounds like you really enjoy all aspects of the job, actually.
00:07:30.000 --> 00:07:33.759
But recently you've had this opportunity to work with the with the weight loss drugs.
00:07:34.000 --> 00:07:34.160
Yeah.
00:07:34.399 --> 00:07:37.120
Um tell me a bit about how that all evolved.
00:07:37.600 --> 00:07:51.040
So I think um, as you know, this is a huge area now, but it kind of came into play a couple of years ago, two, three years ago, and we kind of flagged it quite early as something that would be really useful um for Guernsey as a whole.
00:07:51.199 --> 00:07:58.399
As you say, 57% of um of adults here are overweight or obese, and that's quite startling numbers.
00:07:58.560 --> 00:08:07.040
Um, the WHO have just recognised obesity as a disease, so that means it's on a par now with asthma, you know, type 2 diabetes.
00:08:07.199 --> 00:08:12.000
Um and so I think So, and just to clarify that WHO is the World Health Organization.
00:08:12.240 --> 00:08:13.199
That's it, exactly.
00:08:13.439 --> 00:08:19.680
So now doctors are are kind of recognizing that it's a massive area that we need to understand more about.
00:08:19.759 --> 00:08:24.160
Um, it's not just one area, it underpins our lives as a whole, really.
00:08:24.399 --> 00:08:36.559
Um so I had quite quite a lot of patients um who had put on excess weight that they they didn't want, they didn't feel comfortable in their skin anymore, even though some of them look fantastic.
00:08:36.720 --> 00:08:41.279
Um sometimes if you're overweight and you're carrying excess weight that you don't want, you just know it.
00:08:41.679 --> 00:09:06.960
Um, and I guess the particular categories that kind of um I was able to relate to would be the young mothers or people, um, even kind of um more mature mothers who are kind of juggling so much, you know, childcare, pickups, clubs, you know, at work at work, maybe in some cases, and just don't have time to kind of eat healthily, don't have time to exercise.
00:09:07.600 --> 00:09:09.679
Often they don't have time for self-care at all.
00:09:09.840 --> 00:09:11.440
They're so busy looking after everyone else.
00:09:11.679 --> 00:09:20.799
And it's interesting that whole idea of describing obesity as a disease, because I think for a long time we have thought of it as a bit of a cosmetic issue, really, hasn't it?
00:09:20.960 --> 00:09:21.600
And how people look.
00:09:22.159 --> 00:09:26.480
Whereas thinking about it as a disease process is it's quite important, isn't it?
00:09:26.720 --> 00:09:27.679
Just to reclassify that.
00:09:28.399 --> 00:09:32.240
So I think that, well, the word fat in my office is banned.
00:09:32.320 --> 00:09:33.039
That's done.
00:09:33.120 --> 00:09:38.240
I think that whole ethos of judgment on someone's weight is and should be over.
00:09:38.559 --> 00:09:51.360
Um, I think we need to understand that people who are carrying more weight than they like, it's not due to um, you know, them eating the wrong things or um eating too much in a lot of cases.
00:09:51.519 --> 00:10:02.879
Somebody can actually have a perfect, what we would call perfect diet, perfect kind of um uh energetic kind of um active lifestyle and still be heavier than they would like.
00:10:03.039 --> 00:10:10.639
We know, as you said in your introduction, it's hormones, it's genetics, it's environmental factors, it's psychology.
00:10:11.039 --> 00:10:20.559
I mean, to go back to the group that I mentioned, there are a lot of triggers there for young mums and indeed anybody to hear food noise.
00:10:20.639 --> 00:10:25.360
That's something that's now entered our ethos of this food noise um quote unquote.
00:10:25.679 --> 00:10:26.000
What is that?
00:10:26.080 --> 00:10:34.720
I mean, I've obviously it's something I'm familiar with, that term, um, but because I'm not dealing with this particular issue quite as much as you are, what what do you what do people mean by food noise?
00:10:35.200 --> 00:10:44.080
So food noise would just be kind of like as you're going about your day, thoughts of eating, thoughts of cravings, thoughts of I guess shame with food.
00:10:44.480 --> 00:10:48.399
Um, everything that kind of underpins us, you know, we'll be walking along the street.
00:10:48.480 --> 00:10:49.600
Oh, there's that cafe.
00:10:49.679 --> 00:10:52.399
Like, oh my gosh, do I have time to get a croissant on this?
00:10:52.480 --> 00:10:56.159
You know, that would be a food noise, or um, I'm so tired today.
00:10:56.240 --> 00:10:58.960
I just need to have X to make it through.
00:10:59.200 --> 00:11:07.120
So the food noise might be heard by some people if they're tired, they might hear food noise if they're stressed, they might hear food noise if they're bored.
00:11:07.200 --> 00:11:14.240
Like a typical example is you're sitting off an evening watching telly and you're going backwards and forwards, backwards and forwards to the to the fridge or to the cupboard.
00:11:14.639 --> 00:11:16.720
Um, you might hear something out of habit.
00:11:16.879 --> 00:11:19.440
Whenever you go to get petrol, you pick up a Twix.
00:11:19.840 --> 00:11:23.679
Um, and the food noise, we all do need food noise.
00:11:24.080 --> 00:11:27.759
Our body does and our brain does need to tell us when we're hungry.
00:11:27.919 --> 00:11:30.559
And of course, we need to be looking for the right things.
00:11:30.720 --> 00:11:33.120
Do we need carbohydrates for energy?
00:11:33.360 --> 00:11:35.519
Do we need protein for our muscles?
00:11:35.679 --> 00:11:37.039
What is it that we need?
00:11:37.200 --> 00:11:46.399
Um, so food noise can be very good, but often it's being used to kind of describe um when it's becoming overwhelming for people, they're hearing it all day.
00:11:46.960 --> 00:12:02.399
Um, it's been very satisfying and really interesting in the weight management clinic that I run to hear that a lot of people's mental health is completely changed because actually they have been hearing food noise all day and it's exhausting for them.
00:12:02.559 --> 00:12:08.639
It's almost like someone on the back going like this, just tapping you exhaust constantly, and that's been taken away.
00:12:08.720 --> 00:12:12.879
And some people have come in and burst into tears and just been like, the food noise is gone.
00:12:13.120 --> 00:12:13.840
Thank God.
00:12:13.919 --> 00:12:16.080
Um, so that's really lovely.
00:12:16.320 --> 00:12:22.159
Yeah, it's interesting you talk about that food noise because it it makes me think about is there an addiction element to this?
00:12:22.320 --> 00:12:28.080
You know, is is there such a thing as food addiction in the same way that we get alcohol addiction or drug addiction or gambling addiction?
00:12:28.159 --> 00:12:29.360
Is that is there anything in that at all?
00:12:29.840 --> 00:12:30.240
Absolutely.
00:12:30.320 --> 00:12:40.320
So I mean, we know that there can be so when you eat something, so your body releases it gerolin, which makes you feel hungry, and that's all very good.
00:12:40.480 --> 00:12:43.679
And then there are two mechanisms by which they it should stop.
00:12:43.840 --> 00:12:58.799
So the first is the GLP1 mechanism, the glucagon-like um, glucagon-like peptide one, um, and that is released from the gut in response to food, and that triggers us to feel like we've taken enough in, we're not hungry anymore.
00:12:58.960 --> 00:13:03.919
Um, the second is the leptin pathway, and that leptin pathway is triggered by fat cells.
00:13:04.320 --> 00:13:11.039
So, usually if we get some um, we get a healthy amount of fat cells, they secrete leptin and it tells us stop eating.
00:13:11.200 --> 00:13:14.000
We've got enough in reserve, we don't need any more.
00:13:14.159 --> 00:13:28.080
Um, but what can happen is where the fat cells are that much bigger for that much longer, so somebody who may be battling with their health, with sorry, with their weight for years and years, um, that leptin pathway gets broken.
00:13:28.240 --> 00:13:31.360
And so the body is not being triggered by the leptin.
00:13:31.440 --> 00:13:40.960
Um, the leptin goes to the brain and it doesn't cross over the blood blood-brain barrier, and so then the body thinks it's starving, and then you start trying to eat more and more and more.
00:13:41.279 --> 00:13:50.639
So there is definitely an addiction in that if you have bigger fat cells, um, so you're more overweight, you want to eat more and more and more.
00:13:51.279 --> 00:13:56.159
Um, and then obviously there's kind of the sugary carbs addiction pathway.
00:13:56.399 --> 00:14:04.080
You eat some sugar, your your um liver basically makes you want to eat more, you kind of dump sugar and then you're locked in it.
00:14:04.159 --> 00:14:08.879
So, yeah, there are addiction pathways and then it is almost a vicious cycle that people get into.
00:14:09.440 --> 00:14:09.840
Massively.
00:14:10.080 --> 00:14:10.399
Right, I see.
00:14:10.559 --> 00:14:10.799
Massively.
00:14:11.120 --> 00:14:11.519
And it's interesting.
00:14:11.600 --> 00:14:15.279
I was reading recently that they were describing fat as an organ.
00:14:15.600 --> 00:14:28.799
Um, you know, we think of fat as being individual cells and not really very intelligent and not doing very much, but actually they reckon that there's something about fat that communicates between fat cells communicating with each other, and that there's a bit of a memory there.
00:14:28.960 --> 00:14:37.759
So some people struggle if they've been overweight when they've been younger, then you lose weight, but there's still this drive to gain weight again that's intrinsic in the body.
00:14:37.840 --> 00:14:40.960
And I think it's incredible how complex the whole system is, isn't it?
00:14:41.279 --> 00:14:42.320
Yeah, it's really interesting.
00:14:42.480 --> 00:14:52.639
And I think the thing to remember is well, something that's been interesting is that when we remove that kind of food noise and the psychology of needing to eat and being locked in the cycle.
00:14:52.720 --> 00:15:09.039
So, say, for example, somebody was on a weight loss injectable and that's gone, it's really important to put the work in to kind of identify what was it that my body or my brain was wanting me to do before that led me to be bigger than I would like.
00:15:09.200 --> 00:15:10.559
And how can I stop that?
00:15:10.960 --> 00:15:18.879
Like, you know, you go to you go to get the petrol from the from the um from the petrol station and you see the twigs, what are you gonna do?
00:15:19.039 --> 00:15:22.720
Are you gonna say, Oh, I'm I'm on a weight loss injectable, I'm not gonna eat that?
00:15:22.960 --> 00:15:24.399
I don't think that's the answer.
00:15:24.559 --> 00:15:40.480
The right thing to do is to be like, um, I'm going to grab some, I've got some water in the car, or I'm going to grab an apple instead and just retrain so that when if you did want to come off the weight loss injectable in the future, um, then those kind of areas are there to catch you.
00:15:40.960 --> 00:15:45.440
Um so we've talked a bit about sort of how these drugs work.
00:15:45.919 --> 00:15:51.440
Um, and um from a practical point of view, you know, how do you assess people?
00:15:51.600 --> 00:15:57.759
For example, you know, I I might see someone who's talked to me about their weight, or I might even discuss it with them.
00:15:57.840 --> 00:16:03.120
And in fact, that that's an area that can be quite sensitive as well, is actually how do you bring it up in a consultation?
00:16:03.279 --> 00:16:14.480
Because um obviously I try and be very sensitive about it and use open questions, and the person might be in a bit something to do with their blood pressure, and then it's maybe asking, you know, how's your weight?
00:16:14.720 --> 00:16:25.840
And some people are very open about it, they will say, actually, I feel overweight, but I want to do something about it, I'm trying to exercise more, or I'm trying to eat less, or I want to think about maybe some medication for that.
00:16:26.080 --> 00:16:36.000
But there are some people who often, if I'm honest woman, who have really struggled to get their weight off, become very emotional about it, no matter how hard I try to be sensitive about it.
00:16:36.080 --> 00:16:43.600
Um, but it's difficult because on the other hand, I feel I would be remiss not to mention it because, like you say, it's a disease.
00:16:43.759 --> 00:16:45.600
So, how do we get around that?
00:16:45.679 --> 00:16:46.720
What would you say?
00:16:47.039 --> 00:16:49.600
What would your advice be, I suppose, to other GPs in that regard?
00:16:49.919 --> 00:16:57.519
Well, I think times have massively changed because we I feel that it is okay to bring up now because we can.
00:16:57.679 --> 00:17:03.200
I'm not just going to be saying to somebody, um, you know, you're overweight or you're obese.
00:17:03.279 --> 00:17:05.279
I mean, I would never say that to anyone.
00:17:05.440 --> 00:17:08.480
Um, but um, and then that's it, do something about it.
00:17:08.559 --> 00:17:09.680
Here's weight watches.
00:17:10.400 --> 00:17:17.839
I mean it I don't know whether this is a good thing or a bad thing, but there is now obviously weight loss injectables or the tablet that you mentioned.
00:17:18.000 --> 00:17:31.920
And so people are not kind of left being like, oh my gosh, um, I'm overweight or I'm obese, and it's affecting all of these areas of my health, and there's nothing I can do, I can't manage to do anything about this, and often that would make it worse.
00:17:32.079 --> 00:17:40.960
So I think it has become much easier to talk about in that there is actually something that we can suggest and that can help the patient automatically.
00:17:41.119 --> 00:17:53.680
Um, but yeah, so I think the way so because I'm doing a weight management clinic, um, it they're kind of scattered into my normal day, and so it's very natural for me to bring it up and then I say, I'm so sorry to mention it.
00:17:53.759 --> 00:17:57.680
It's just that I'm I'm doing a weight management clinic and don't think no more of it.
00:17:57.920 --> 00:18:06.960
There are some people who I can see have have got offended, and that might be once a month, but absolutely sometimes it's worth saying, and I would never mention it out of nowhere.
00:18:07.039 --> 00:18:11.359
So it might be someone saying, I'm taking four tablets now of my blood pressure.
00:18:11.519 --> 00:18:13.519
Like, is this really my life now?
00:18:13.759 --> 00:18:19.440
Or like my knee is so sore, and I I've had some steroid injections, and I just I don't know what to do.
00:18:19.519 --> 00:18:31.440
I don't want a replacement, and so I would probably pick up on triggers and try to find a way to kind of introduce it based on what the patient had said, rather than just bringing it up out of nowhere.
00:18:31.680 --> 00:18:41.440
Um, but I would say that people are more receptive to it now, you know, it's all over newspapers, it's all over social media.
00:18:41.599 --> 00:18:59.039
Um, it's kind of underpinning our generation, I guess, in terms of uh one of the techniques that I have found, I suppose I've found quite useful, um, is using some motivational interviewing techniques, you know, sort of recognizing that you don't necessarily come up with a solution in that consultation.
00:18:59.119 --> 00:19:03.839
Um, and it's about the idea that you might be planting a seed or like rolling with resistance.
00:19:03.920 --> 00:19:08.559
So if someone actually doesn't want to talk about it, it's just to accept that and not not to probe any further.
00:19:09.039 --> 00:19:14.640
Um and then you know, maybe when they come back, and it's that it's about that sort of longitudinal relationship you have with patients, isn't it?
00:19:14.799 --> 00:19:19.279
You can give it time, you can plant a seed, and they might come back later and say, actually, I've thought about that.
00:19:19.519 --> 00:19:21.039
Is there something that you can do to help me?
00:19:21.119 --> 00:19:23.599
And that's where you get into a really useful conversation about it.
00:19:23.920 --> 00:19:45.359
Yeah, it's very interesting because um a lot of my diabetic patients um who very clearly would benefit um from um a weight loss injectable, so not a weight loss injectable, but one of the medications for it, for example, Manjaro or Azempic, um do not want to take it and they will not hear anything that I say about the subject.
00:19:45.599 --> 00:19:49.599
And you know, they're they're damaging their bodies with really high sugars.
00:19:49.759 --> 00:19:55.359
They're on four other classes of medication, there's nowhere else to go, and they still will not have it.
00:19:55.680 --> 00:19:58.240
And the funding situation with patients with diabetes is a very important thing.
00:19:59.119 --> 00:20:01.279
It will be free for them, so they still don't want it.
00:20:01.599 --> 00:20:09.279
So that's one of the one of the advantages at the moment, isn't it, that we have got that funding from the states for diabetic patients with the same thing.
00:20:09.599 --> 00:20:10.559
Game changing, yeah.
00:20:11.039 --> 00:20:18.079
And um initially I seem to recall the weight loss injectables were not first line for diabetics, but I understand they are now.
00:20:18.400 --> 00:20:25.599
Yeah, so um you would usually use metformin first, and then after that, it would completely depend on each patient.
00:20:25.680 --> 00:20:28.000
But yeah, it can be second line for some people, yeah.
00:20:28.160 --> 00:20:28.400
Absolutely.
00:20:28.880 --> 00:20:34.880
And um you've found that even despite the fact they're not paying for it, yeah, they're not interested.
00:20:35.279 --> 00:20:36.799
Yeah, it's very interesting.
00:20:36.960 --> 00:20:45.680
Um, I think there is and has been a lot a bit of shame actually about um these medications, these injectable medications.
00:20:45.920 --> 00:20:56.640
Um, some patients will come to me and say, I've tried everything, I've been on this diet, I've done Atkins, I've done Weight Watches, I've done a marathon, and I've gone up and down, up and down.
00:20:56.720 --> 00:20:58.480
I can't shift this weight.
00:20:58.720 --> 00:21:01.119
And I'm just so ashamed to be here.
00:21:01.279 --> 00:21:03.920
I feel like this is um, you know, a quick fix.
00:21:04.079 --> 00:21:05.119
Um, I'm cheating.
00:21:05.759 --> 00:21:09.519
And I say to them, this is gonna take work.
00:21:09.599 --> 00:21:12.079
This is not a quick fix, it's not a cheat.
00:21:12.240 --> 00:21:14.480
Um, it's gonna be amazing.
00:21:14.880 --> 00:21:17.119
Um, if we do this, there's no shame.
00:21:17.279 --> 00:21:20.079
It's up to you whether you share it with people, whether you don't.
00:21:20.160 --> 00:21:21.519
You can say whatever you want.
00:21:21.680 --> 00:21:22.799
This is your business.
00:21:23.119 --> 00:21:30.000
And when people come back to see me at the six-month mark, I don't feel like mostly any of them have shame anymore.
00:21:30.160 --> 00:21:33.759
Um they have had to work at it, it's a complete lifestyle change.
00:21:34.000 --> 00:21:37.599
Um, you know, they've got boosted energy, so they want to exercise.
00:21:37.759 --> 00:21:44.480
Um, they're feeling lighter, they're feeling happier, they're feeling um just much, much better.
00:21:44.559 --> 00:21:46.640
And they always say, I don't feel ashamed now.
00:21:46.799 --> 00:21:48.559
I can see that my body needed this.
00:21:48.720 --> 00:21:51.920
I feel that I suit this, this is my natural weight now.
00:21:52.000 --> 00:21:53.359
I'm starting to get there.
00:21:53.519 --> 00:21:56.079
Um, you know, thank, thank goodness for this.
00:21:56.480 --> 00:22:08.319
And I suppose the big thing that often people want to find out about at the end of Day because like I said earlier on, there's a lot of information out there about these weight loss injectables and um chat on social media and on media.
00:22:08.480 --> 00:22:11.279
Um the big question they will ask is is it safe?
00:22:11.440 --> 00:22:14.559
So presumably you have that conversation at the outset.
00:22:14.799 --> 00:22:19.359
So so what what do you see as you know the the downsides of these drugs?
00:22:19.680 --> 00:22:23.039
So I think the downsides are that it can make people feel a bit grotty.
00:22:23.440 --> 00:22:27.359
So the day you inject in a few days afterwards you can feel quite nauseated.
00:22:27.599 --> 00:22:37.680
I have had some patients who've vomited um diarrhea, constipation, acid reflux, those can happen, probably one in ten, maybe.
00:22:37.839 --> 00:22:44.720
Um, and then uncommonly the big risk is the risk of pancreatitis, which is um one in one to two thousand.
00:22:45.119 --> 00:22:48.880
Um, and one in twenty times you get pancreatitis, you can die.
00:22:49.200 --> 00:22:50.880
So that is quite concerning.
00:22:50.960 --> 00:22:54.240
And I have had some patients turn around at that stage and just be like, Do you know what?
00:22:54.480 --> 00:22:54.799
No.
00:22:55.039 --> 00:22:59.599
Um, but it, you know, it I think have you had any occasions where you've had complications with that?
00:22:59.920 --> 00:23:06.480
I haven't actually, but we have had four cases of pancreatitis in Guernsey because of weight loss injectable medications.
00:23:06.559 --> 00:23:08.240
So it's definitely happening.
00:23:08.480 --> 00:23:10.720
Um, no, I've been quite lucky.
00:23:10.880 --> 00:23:14.799
Um, we have had a uh have had a uh case of gallstones.
00:23:14.880 --> 00:23:25.920
So if you lose a huge amount of weight quite quickly, regardless of whether you're taking a weight loss injectable or you're lost in a forest, um, you can get gallstones, you can lose hair, you can lose muscle.
00:23:26.240 --> 00:23:27.759
Um that's a big thing, isn't it?
00:23:28.000 --> 00:23:28.480
It is a big thing.
00:23:29.920 --> 00:23:44.799
Something I'm quite interested in because obviously I'm getting interested in sports medicine and musculoscular medicine and the importance of physical activity and maintaining muscle mass, particularly for people who are in their 50s and beyond, as they're getting older, you tend to lose muscle mass anyway.
00:23:44.880 --> 00:23:58.720
Yeah, and trying to encourage people to take part in resistance training routinely because we all know that, for example, cardiovascular exercise is really good for us, but there's less emphasis on resistance training, and there's been quite a lot of research coming through about that.
00:23:58.880 --> 00:24:04.319
But for people who are on weight loss injectables, I think that is a risk that they might not be so aware of.
00:24:04.400 --> 00:24:05.839
Is that a fair comment?
00:24:06.160 --> 00:24:06.799
Yeah, definitely.
00:24:06.880 --> 00:24:11.519
I have had a couple of patients who I didn't start on it come to me having lost muscle.
00:24:11.680 --> 00:24:18.559
Yeah, and I suppose this was kind of two, three years ago when there wasn't the bigger knowledge base around it that there is now.
00:24:18.720 --> 00:24:21.359
But yeah, some people have been quite disappointed by that.
00:24:21.759 --> 00:24:29.519
But um, muscle's greedy, it wants um energy, and if there's a calorie deficit, the muscle can be lost.
00:24:29.680 --> 00:24:31.279
Um, and it's it's tough.
00:24:31.440 --> 00:24:37.599
But people do need to be really strict um with trying to conserve muscle if they go on a weight loss injectable.
00:24:37.920 --> 00:24:38.720
And how would they do that?
00:24:38.799 --> 00:24:39.440
What would you recommend?
00:24:39.680 --> 00:24:50.640
So absolutely, so resistance training, so Pilates yoga, even just lifting the shopping and walking with something on their back, and making sure that they exercise their legs and their arms.
00:24:50.720 --> 00:25:02.319
So if you're walking with something on your back, obviously you've got the weight going through your legs, but you need to keep your arms so even baked beans at dinner, whatever it takes, um, some gentle weights or yeah, whole body weight.
00:25:02.400 --> 00:25:05.119
So Pilates yoga, press-ups, those sorts of things.
00:25:05.519 --> 00:25:06.720
And what about hair loss?
00:25:06.799 --> 00:25:08.880
Is that something that's been increasingly recognised?
00:25:09.440 --> 00:25:09.839
For sure.
00:25:10.000 --> 00:25:13.279
Um, so again, it's just nutrient deficient, really.
00:25:13.519 --> 00:25:20.000
So we always recommend if you were to start any diet, really, you should um take a multivitamin.
00:25:20.319 --> 00:25:25.519
So that will conserve your folate, um, your vitamins that you need for hair growth.
00:25:25.680 --> 00:25:27.599
Um, iron is another big thing.
00:25:27.920 --> 00:25:33.519
Um, so people just need to make sure that they're taking in enough iron and uh fill it.
00:25:34.000 --> 00:25:40.640
And so if someone came along to you to start on treatment, what what's the kind of clinic appointment basis like?
00:25:40.720 --> 00:25:43.839
What just talk me through you know how that all works from a system point of view?
00:25:44.160 --> 00:25:50.640
So they will kind of tell me a bit about what's led them to be heavier than they would like, um, then we'll weigh them.
00:25:50.960 --> 00:25:52.960
Sometimes they don't want to look and that's fine.
00:25:53.200 --> 00:25:56.400
I can then check if they're gonna be eligible or not.
00:25:56.640 --> 00:25:59.839
Um, then we talk a little bit about um their options.
00:26:00.079 --> 00:26:10.960
There were uh if they're only doing it, so if if they have diabetes, um, we would use the gold standard, which is Manjaro, um, unless they didn't want to do that, and then a Zempic would be okay.
00:26:11.200 --> 00:26:17.680
If they don't have diabetes and they were doing it for um weight management purely, then it would be Manjaro versus Wegovy.
00:26:17.759 --> 00:26:20.480
There is a Wegovy pill now that you've mentioned as well.
00:26:20.559 --> 00:26:30.720
Um, so then we would talk about the different options, we'd talk about the side effect profile, uh, we would talk about the psychology of eating, so food noise, um, and then what to eat.
00:26:30.799 --> 00:26:34.240
So a kind of like protein cannot be stored as fat.
00:26:34.319 --> 00:26:40.720
So eat as much protein as you like, it's amazing, it fills you up, it helps your muscles, hair, skin, and nails, it's great.
00:26:40.799 --> 00:26:44.079
Um and just remind us what what protein-based foods are out there.
00:26:44.400 --> 00:26:47.519
So the best protein-based foods will be the ones that have low fat in.
00:26:47.599 --> 00:26:54.960
So that would be lean proteins like chicken, fish, lentils, peas, um, quinoa, uh, those sorts of things.
00:26:55.119 --> 00:27:05.519
Um, and then obviously you can get protein that's marbled with fat, so that would be your red meat, so mince, uh, sausage, um steak, lamb.
00:27:06.079 --> 00:27:11.599
And um, what about in terms of the long-term treatments?
00:27:11.680 --> 00:27:16.880
With you know, we've talked about some of the side effects, obviously, and you're mentioning that you get that follow-up with the nurse as well.
00:27:16.960 --> 00:27:23.200
And I my understanding is that they'll obviously try and emphasize some of these psychological elements as they go.
00:27:23.279 --> 00:27:28.400
It's not just about checking blood pressures and weights, it's actually about that psychological support as well.
00:27:28.559 --> 00:27:28.799
Yeah.
00:27:29.119 --> 00:27:33.039
How long do you tend to see people staying on these drugs for?
00:27:33.119 --> 00:27:35.039
And could they stay on it forever?
00:27:35.359 --> 00:27:41.599
Yeah, so there was a licensing, um, certainly of one of the injectables for two years, that's now dropped away.
00:27:41.759 --> 00:27:45.440
So there are some thoughts that people may be on these lifelong.
00:27:45.599 --> 00:27:53.359
I think the statistics are something like one in five Americans are on them or have been on them in the last five years, which is staggering.
00:27:53.680 --> 00:27:59.920
Um, and I do think that as time goes on, more and more people will probably start to be on them.
00:28:00.160 --> 00:28:04.079
Um, people may switch from the injectable to the tablet.
00:28:04.160 --> 00:28:05.759
We'll have to see how it goes.
00:28:05.920 --> 00:28:11.119
Um, this is obviously a very new area of medicine, so we're quite flexible at the moment.
00:28:11.279 --> 00:28:20.079
Um, if you meet the criteria to go on a weight loss injectable, um you can, in theory, have it for as long as you need.
00:28:20.240 --> 00:28:32.400
Um, there will be some other bits and bobs that you know we need to make sure that are not happening, but um, unless your BMI drops worryingly, you could have it for decades, is the thought at the moment.
00:28:32.559 --> 00:28:35.279
But as I say, this is new and things may change.
00:28:35.440 --> 00:28:40.319
So there are some people who don't want to go on a weight loss injectable because they're worried about coming off it.
00:28:40.720 --> 00:28:51.440
Um, some people do want to come off it, and I have seen I have had one patient who went on it for one month and then completely retrained his brain, lost four stones.
00:28:51.680 --> 00:28:52.480
Yeah, that's amazing.
00:28:53.200 --> 00:28:54.160
It's interesting, isn't it?
00:28:54.240 --> 00:28:58.480
It's almost like they've made that psychological leap to take action and they've really embraced it.
00:28:58.559 --> 00:29:03.599
I've had one or two people at that as well, where they've started the injection and then think, actually, I don't want to be doing this.
00:29:03.680 --> 00:29:03.920
Yeah.
00:29:04.160 --> 00:29:08.960
And if it's so serious that I need to be injecting myself, then I should really be taking some action.
00:29:09.039 --> 00:29:20.079
And it's great if people can do that, but like you say, I think it's important that we don't um necessarily use these people as a prime example because they're they're the exception to the rule, yeah.
00:29:20.240 --> 00:29:25.680
And we don't want to be, I suppose, judgmental about people's behaviours either, because that's a really important part of it all.
00:29:25.839 --> 00:29:26.160
Yeah.
00:29:26.559 --> 00:29:31.839
So um which part of the weight management clinic do you enjoy most?
00:29:32.000 --> 00:29:33.599
What is it you enjoy most about this?
00:29:33.920 --> 00:29:48.000
Um I think it's when people come in and they're like, I've battled my whole life, my mum's overweight, um, I've gone through the menopause, I can't lose weight, I'm leading a perfect life.
00:29:48.160 --> 00:29:48.960
Please help.
00:29:49.039 --> 00:29:51.759
And I can help, and that is amazing.
00:29:51.920 --> 00:29:59.039
Um, and then the kind of feedback, you know, six months, 12 months, 18 months, two years later, this is me.
00:29:59.119 --> 00:30:02.880
Uh, you know, I'm so pleased, I'm feel so much better.
00:30:03.119 --> 00:30:11.039
Of course, there are some people who are really tired when they're on it, and there are some people who get side effects and they don't want to stay on it, and that's that's fine.
00:30:11.279 --> 00:30:21.759
Um, but I think it's just being able to do something um that helps a patient so quickly, um, and then selfishly getting the success stories, like it's really nice.
00:30:22.160 --> 00:30:40.000
Um, sometimes as a GP, you you could go a morning where um you haven't quite resolved anything really, and um you're trying and you're trying to um help your patients as best you can, um, but the patients may feel like they're not yet thriving, they're still surviving.
00:30:40.319 --> 00:30:46.000
And to see these patients, they're starting to thrive, and it's lovely.
00:30:46.160 --> 00:30:52.000
I think it is one of the drugs that we are confident for the majority of the time it seems to work, isn't it?
00:30:52.480 --> 00:30:53.519
Absolutely, it does.
00:30:54.160 --> 00:30:58.240
And which part of living in Guernsey do you enjoy most?
00:30:58.559 --> 00:31:08.720
Um, well, I've got sandy toes today, so I think it's just you know, popping out from the office, going for a swim, um, uh taking my kids to the beach.
00:31:08.880 --> 00:31:12.079
Um, it's just life feels a bit lighter here.
00:31:12.240 --> 00:31:13.359
Yeah, it's easier.
00:31:13.440 --> 00:31:20.720
Um, and it's obviously smaller and it's not for everybody, but I certainly find it, you know, I I love it here.
00:31:21.279 --> 00:31:21.519
Okay.
00:31:21.680 --> 00:31:22.559
Thanks very much, Sally.
00:31:22.720 --> 00:31:23.920
That was really interesting to talk to you.
00:31:24.160 --> 00:31:24.480
Thank you.
00:31:24.799 --> 00:31:30.319
So um we'll be talking a bit more about other topics in the next few um episodes.
00:31:30.480 --> 00:31:35.759
Um, we've got another episode coming up to talk about childhood allergy, particularly food allergies.
00:31:35.920 --> 00:31:48.480
Um, but that was a really interesting topic to talk about the whole issue around obesity, weight management, some of the complex psychological issues that Sally touched upon there and changing attitudes to how we approach these things.
00:31:48.640 --> 00:31:58.480
I would say that since I graduated, um, the approach to these things has been much more gentle and much more collaborative with patients rather than the doctor telling patients what they should do.
00:31:58.640 --> 00:32:02.000
It's actually about us trying to work with the patients and find a solution.
00:32:02.160 --> 00:32:08.079
Um, and we also know that although these drugs have got some side effects, they are very effective.
00:32:08.240 --> 00:32:14.480
And it's opened up that area so that we can approach people um or people can approach us to ask about solutions.
00:32:14.880 --> 00:32:15.920
So thanks again.
00:32:16.000 --> 00:32:19.200
Um, and uh we'll catch up with you again some other time.
