NAVIGATING THE COMPLEXITIES OF WEIGHTLOSS
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Episode 212:
Show Notes
Welcome to the fourth episode of our Menopause series, where we delve into the multifaceted aspects of navigating health during this significant life stage. In this episode, our lovely host, Dr Lucy Burns with special guest Dr Angela Kwong, a dedicated General Practitioner with a profound interest in medically supervised weight loss, delve into the complexities of weight management and the pivotal role of GLP-1 medications in facilitating weight loss.
They tackle the stigma surrounding weight issues, advocating for a holistic approach to treatment. Dr Kwong provides valuable insights into the underlying causes of weight gain, the nuanced application of GLP-1 medications, and the importance of personalised patient care.
Complexity of Weight Management: Weight management involves addressing multiple factors beyond just diet and exercise, including genetics, medical conditions like insulin resistance and thyroid issues, and psychological factors.
Stigma and Judgment: Patients often face stigma and judgment when seeking help for weight management. It's crucial to approach weight loss with empathy and understanding of individual health goals.
GLP-1 Medications: GLP-1 medications have been effective in weight management by improving satiety and slowing gastric emptying. They were initially designed for diabetes management but are increasingly used off-label for weight loss. Before prescribing GLP-1 medications, healthcare providers should assess the patient comprehensively, considering medical history, lifestyle factors, and individual goals. It's essential to discuss potential side effects, interactions, and realistic expectations with patients.
Weaning Off Medication: Dr Angela Kwong advocates for using GLP-1 medications as part of a comprehensive plan, including a weaning-off phase once weight goals are achieved and underlying health conditions are managed. This approach aims for sustainable weight management rather than dependence on medications.
Holistic Approach: Both Dr Lucy Burns and Dr Angela Kwong emphasise the importance of a holistic approach to weight management, addressing both physical and psychological aspects. This approach includes lifestyle changes that are sustainable and maintainable in the long term.
Pros and Cons of GLP-1 medications: Pros of GLP-1 medications include effective weight loss and potential improvement in metabolic health. Cons involve potential side effects and the necessity for ongoing monitoring and management.
Protein Powders: Many protein powders marketed as health foods contain fillers, emulsifiers, sugars, and other additives. Not all protein powders are created equally, and consumers should be cautious about their nutritional content.
Meal Replacement Shakes: Dr Kwong advocates for nutrient-dense meal replacement shakes rather than traditional diet-focused shakes. These provide balanced nutrition, especially important for patients on weight loss medications like GLP-1s, who may struggle to meet nutritional goals.
Role in Obesity Management: Dr Kwong discusses her role as the NSW State lead for the RCGP Specific Interest Group for Obesity Management, aiming to destigmatize conversations about obesity and weight management, fostering open dialogue and education among healthcare practitioners.
Empowerment and Support: Both doctors emphasise the importance of personalised approaches to weight management, understanding that what works for one person may not work for another. The goal is to support people in achieving long, active, and healthy lives without judgment.
Australian Weight Loss Summit: Dr Kwong is organising a free online event, the Australian Weight Loss Summit, featuring expert panellists from various fields of weight management, promoting open discussions and education. It aims to empower individuals with diverse approaches to achieve health goals.
Event Details: The summit will run over three nights in July—July 25th, July 29th, and August 1st. It offers a platform for participants to ask questions and gain insights into effective weight management strategies tailored to individual needs.
Practical Information: Details about the summit, including registration and more information, can be found at www.awlsummit.com.au. Dr Kwong's Instagram handle, @DrAngelaKwong, is also shared for further engagement and updates.
Link to Menopause checklist: www.rlmedicine.com/checklist
Episode 212:
Transcript
Dr Mary Barson (0:04) Hello, my lovely friends. I am Dr Mary Barson Barson.
Dr Lucy Burns (0:09) And I'm Dr Lucy Burns Burns Burns. We are doctors and weight management and metabolic health experts.
Both (0:16) And this is the Real Health and Weight Loss podcast!
Dr Lucy Burns (0:23) Hello, lovelies. We are super excited to be bringing you this series in Menopause, where we're interviewing guests on their expert subjects regarding perimenopause, menopause, and beyond. As always, any information in this podcast is just considered general advice and we would urge you to seek medical attention if you have any concerns about your health. If you're interested in exploring the symptoms of menopause or perimenopause, we have a checklist that you can download at our website, www.rlmedicine.com/checklist or as always, you can click the link in the show notes. Thanks, lovelies, enjoy this series!
Dr Lucy Burns (00:57) Good morning lovely listeners. How are you this morning? Dr Lucy here and I have a fantastic expert with me today. I know we get zillions of questions about all things weight loss but in particular weight loss medications. So I thought well who better to come onto the podcast and help us go through some of these than our very good friend Dr Angela Kwong who is a GP a bit like Dr Mary and I but also has a very significant interest in weight, all things weight loss. Angela, welcome to the podcast.
Dr Angela Kwong (01:29) Thank you so much, Dr Lucy, for having me on the podcast.
Dr Lucy Burns (01:33) It's a pleasure. And you know, we love talking to other doctors and finding out how they're running their practices. And I think that you know, there's such a big demand for this that it's, and again, we can talk a bit more about this going through, but there's also some, what I might call, shysters setting up shop. So let's dive into it. I thought we'd start by, I mean, you and I both help people with weight management, but it's interesting because the phrase weight loss is a little kind of on the nose. And I wonder how you navigate that working in this space.
Dr Angela Kwong (01:21) It isn't easy, is it? Patients receive a lot of discrimination and a lot of stigma when they are trying to seek help for their weight or when they're trying to fill in a script for their weight loss medication. Sometimes patients will say to me, look, I receive a lot of judgment trying to get help with my weight. And I say I know exactly what you mean.
Dr Lucy Burns (02:38) Yeah. Yeah, absolutely. And I think it's interesting, isn't it? It's navigating that little space, and it is quite a little space, I reckon, between helping people really manage their health-related issues around weight versus diet culture and, you know, my big hobby horse that I like to jump on is, you know, Jim bros telling particularly menopausal women how to lose weight and which is all just about cut your calories and do more, you know, the whole calories and calories out and have very little understanding about the physiology of it. So on one hand, we've got that, you know, industry, the diet industry, you've got to be thin, all of that versus, you know, the very real health, both physical and psychological health issues that come when your body is storing excess fat.
Dr Angela Kwong (03:40) Definitely. And weight loss is really just the top of the pyramid, isn't it? Weight loss is just when someone is coming to you for that conversation because they're looking to improve their weight. But underneath it all, they might have so many motivations because they are trying to improve their cholesterol. They're trying to improve their blood pressure. They're trying to prevent chronic disease. They're trying to improve their physicality. People have so many reasons why they want to improve their weight rather than what people might think, which can be very superficial type values that their friends might think, I just want to be skinny to be able to fit into this dress, or I just want to be ready for this event. People often have a much bigger vision for themselves, and they just want to be a better version of themselves, and we should be trying to support them with that.
Dr Lucy Burns (04:31) Yeah, absolutely. And I think, you know, there are lots of people who will say, we should stop promoting weight loss or stop, you know, asking people to lose weight, which I find really hard because I know that there are plenty of people whose lives are vastly compromised by their physical size. And that is not as a judgment, it's just as a fact of life. Like, and you, I'm sure you like me, we have people who have trouble putting on their shoes. And that's just because their tummy gets in the way, or they have trouble getting in the car and you know, using the steering wheel. And whilst there are accommodations that could easily be made in our society and you know, you and I do this already with things like chairs without arms and bigger seats and all of those sorts of things. There are still just things that happen because our body is storing more fat than it was originally designed to do.
Dr Angela Kwong (05:33) Definitely. And even when it comes to the conversation of size, we often think about people who want to lose weight when they're at the larger end of the spectrum. And so a lot of services are accommodating for those patients. Say, for example, you have someone who's 160 kilos who's looking to lose 10%. But then there is also a lot of judgment towards people who are at the lower end of the spectrum who are trying to improve their health. Often I'll get women who are starting at 60 kilos and they're still trying to lose 10 % and they'll say, no one will help me because I'm only 60 kilos, but I am 10% heavier than I was before. And right now I'm pre-diabetic and I have a mum who has diabetes and I have a dad who has diabetes and I would dearly love to lose this extra 10% that I know is contributing, but no one will help me because I'm only 60 kilos and not 160 kilos. So do the numbers really matter or is it looking at someone's metabolic health and looking at their medical factors and looking at their overall risk as a person?
Dr Lucy Burns (06:39) Yeah, absolutely, absolutely. And one of our favourite sayings is that really weight gain, it’s a symptom of something else going on underneath. And if we need to manage the root cause. So in your experience, Dr Angela, what do you see mainly as the root causes in the people that you help?
Dr Angela Kwong (06:36) There are a lot of root causes actually. I created a free weight loss guide, which I can give to your listeners, which is called, What to Do When Nothing Else Has Worked. This is something that I like to use with my patients when we start the conversation when it comes to weight. Because for a lot of patients, they come to me and they say, look, I've tried eating less, I've tried moving more, I've tried calories in versus calories out. Why am I still stuck on my weight loss journey? And I say, look, when it comes to your weight, it's actually quite multifactorial. There are a lot of factors that can contribute to your weight. Say, for example, your genetics, say for example, could it be the medications that you're taking that are medications that cause weight gain? Could it be the medical conditions that you have? Some people have undiagnosed thyroid disease. Some people have untreated obstructive sleep apnea. Sometimes there are psychological factors at bay. So there are a lot of medical, genetic and other factors. Being a female doctor, I do attract a lot of women into my weight loss program and really common conditions that I see that contribute to weight are, you know, insulin resistance. So I see a lot of women who have polycystic ovarian syndrome who are struggling with their weight, or I see women who have insulin resistance related to past gestational diabetes or another group that I see are women who have never really struggled with their weight, up until the time when they go through perimenopause and then suddenly they have a lot of central weight gain. So there are a lot of factors that can contribute to a person's weight, which is not always necessarily just up to the individual and them eating less and moving more.
Dr Lucy Burns (08:43) Absolutely. And I think, one of the ways we like to try and divide it is into sort of your physical causes or physiological causes and then there's the psychological causes. And I think one of the trickiest things is looking particularly at people who have had bariatric surgery. And I'm sure you see this too, where people have had bariatric surgery and it's potentially, and it's worked maybe initially. And then over time, the weights come back on. So, yeah, we like to divide it sort of into the two categories. So, you know, you've got your physical causes, which are, you know, many of all the things you mentioned in insulin resistance, thyroid, etc. But we also see, and I'm sure you do too, people who have had bariatric surgery, but who never really had their psychological relationship with food addressed. And as we all know, you can still eat a lot of things, even if you've had the majority of your stomach removed, you can still melt chocolate, you can still, and even with sleeves, you know, the sleeve over time can stretch, like there's still a whole heap of stuff that I think for a lot of people then really need to have that psychological relationship delved into as well.
Dr Angela Kwong (10:07) Definitely. When it comes to people who have had bariatric surgery and who have experienced regain who reach out to me, about 20% of the patients who enter the program are patients who are ex-bariatric surgery patients. And some of the common factors that I can see that may have been identified pre-op are that they did have some medical conditions. So some of them were already pre-insulin resistant before they had their surgery. Some of them, like you said, did have psychological factors where it would have been good to have a look at their relationship with food or some past traumas that they'd had earlier in their life, which had affected their relationship with food and their food choices. So being able to identify these factors so that you can make a long-term plan and so that you can address them head-on is going to be important whether you do the surgery or not, because yes, the surgery is going to achieve some volume restriction. And yes, there might be some stretching afterwards and there will be some aftercare, but at the end of the day, you will always need to be able to address those factors. Otherwise, it's very difficult to have sustainable weight loss.
Dr Lucy Burns (11:20) Yeah, absolutely. And I think this is actually the crux of the whole thing. Like, you know, you can ask any old Joe Blow in the street and they'll tell you, I did this, you know, Lady Shakes or I did this plan and I lost 10 kilos and everybody thinks they know how to lose weight. But it's, if it was that easy, we would have all done it and it would all be off and nobody would have this problem. And It's a complex, it's such a complex problem. It requires a complex, not so much a complex solution, but often a multifactorial solution. And I think so many people are out there just as the one trick pony. And this is not to denigrate any particular profession, but it really needs, you know, multiple layers to it.
Dr Angela Kwong (12:14) I agree. And often when patients come to see me, then they say, it's actually quite refreshing to know that it was not all my fault that I had not tried hard enough and that there are multiple things that we need to consider in my plan for me to move forward. So it is a massive sigh of relief for them that they actually have some clarity and they know, okay, we've just got to address one, two, three, and four. Whereas if I had done this on my own, I was just going to do just shakes, or I was just going to do intermittent fasting. And yes, they might've been able to have lost a small amount in a significant amount of time, but would that have resulted in sustained weight loss? Maybe not.
Dr Lucy Burns (13:02) I totally agree. And I think the thing is, and here's the other interesting thing is you, and you alluded to this at the start of our conversation, which is stigma. There is so much stigma. There's a stigma around the size of your body. There's a stigma around how fast you lose weight. There's a stigma around you're not losing it fast enough. There's judgment around how you're losing it. There's judgment around how you're not losing it, what tools you're using, and what you're not using. And everybody has got this opinion on what they think everyone else should be doing. And it's just rubbish.
Dr Angela Kwong (13:35) It's hard to, you can't win either way, can you? Poor patients.
Dr Lucy Burns (13:41) It reminds me of when I was, you know, when I was pregnant, I had, you know, and people, everyone loves to comment on pregnancy. Oh my God, you're so big. You're so big for those dates. Have you got twins? No, no twins. yes. you're hardly showing. Are you sure you're pregnant? And it's like, just, you just can't win sometimes. So I just think at the end of the day, people need to be given all the options. All the options should be laid on the table. They need to be educated and empowered with the correct information. And then as you're describing, a management plan that is multi-layered with lots of options, lots of sort of plan A, plan B, and then we mosey along and tailor it as we need to. Yeah.
Dr Angela Kwong (14:37) I agree.
Dr Lucy Burns (14:39) So speaking of one-trick ponies, which I know you're not, but there are plenty of platforms at the moment offering Ozempic and various other medications or similar medications. What are your thoughts on the GLP-1s as they're known?
Dr Angela Kwong (14:59) Yeah, the GLP-1s have been a bit of a game changer when it comes to weight management. And I think the reason why is because for a lot of patients who have struggled with their weight, there has been some degree of insulin resistance. So the GLP-1 medications were always designed as a diabetes type medication to help address insulin resistance. And one of the side effects of those medications is that they improve satiety, They slow down gastric emptying, which means that food is moving slower through the digestive tract and also patients lose weight. And as a result, a lot of patients have been using that medication as a primary weight loss medication off-label. So that's how the GLP-1 medications have been used. As a result, a lot of pop-up practices have appeared where they seem to be using the medication in a prescription-only manner. Now, whether that is good or bad is for every person to decide. I think that when it comes to using these medications, they should still always be used with a comprehensive weight management plan in place where a conversation is had between the patient and their healthcare practitioner. And it's not solutions-focused. So it's not, I would like weight loss. Can I have a script for a GLP-1 medication? It's still that assessment that happens where the patient is seeing the healthcare practitioner, and they're looking to see what are the factors contributing to your weight. Can we address those? And would a GLP-1 be the most appropriate pharmacotherapy for you? And also, what are the lifestyle factors that we need to consider? Because are you planning to use a GLP-1 as a kickstarter or as a long-term medication? We know that GLP-1 medications do have risks, they do have side effects and so some patients might not actually want to have a GLP-1 medication in the long term. So there are a lot of factors to consider and the answer might not always be, let's just get a script for a GLP-1 medication and be so solutions-focused.
Dr Lucy Burns (17:12) Yeah, I love that. We often talk about that idea that particularly when your goal or your solution or your endpoint is purely looking at numbers on the scale, that's a double-edged sword for so many people. We see it even within the people who take the GLP-1s where for some people, for whatever reason, they don't work. And I think that just adds to the fact that, you know, obesity and I know obesity is a trigger word. So for anybody who's triggered, please don't think that we're triggering you. It's just, it's just that medical diagnosis, but we know that it is multifactorial. And I don't, I don't think we have all the answers yet. I think you're right. They have had a profound effect on a lot of people, but there are still a few pieces of the puzzle missing.
Dr Angela Kwong (18:04) Definitely, I agree.
Dr Lucy Burns (18:07) What are your thoughts on stopping GLP-1s?
Dr Angela Kwong (18:11) That's a really good question because I feel like I'm a little bit alone in that field in that the great majority of my patients do stop the medication. So I spoke at the Wonka Sydney World Conference last year and presented to GPs who were all over the world and presented some case studies, including one case study where I showed where I had used the GLP-1 medication in a kickstart fashion, which is the way that I use it for most of my patients. So the way that I would generally treat someone is like I said, assess them and see what are the factors contributing to their weight. Sometimes consider whether they need to use a weight loss medication to kickstart the process, help them to implement new lifestyle routines that they'll be able to continue that on and use the GLP-1 medication in a weaning up and in a weaning down phase. So when they're getting close to their target weight, I would generally help them to wean down that medication while we are still maintaining their lifestyle routine. So that's the way that I tend to use it. There are a lot of doctors who would disagree with me and they would say, I have been taught that obesity is a chronic disease, similar to high blood pressure and that just like high blood pressure, you've been diagnosed with it, it's a chronic disease, you take your high blood pressure medications for the rest of your life. But I would actually say that even with high blood pressure, sometimes there is a lifestyle element to it. I have had patients with high blood pressure who have been able to wean down, reduce or cease their blood pressure medications and have been able to maintain normal blood pressure just with lifestyle factors. And I think that it is possible for patients to be able to wean up and wean down their GLP-1 or their weight loss medication if you have been able to address the factors contributing to your weight. So say, for example, the reason why someone had been struggling with their weight was because they were taking a medication that was causing the weight gain and you've been able to identify that and switch them onto a weight-neutral medication during that time. Or if you've been able to identify that they are actually pre-diabetic or they're hypothyroid and you've been able to stabilise them. I think the beauty in that is being able to identify, treat and manage their medical condition. Use the GLP-1 in a weaning style. For me, the great majority of my patients have been able to wean off a GLP-1 and I find that very rewarding, I must say.
Dr Lucy Burns (20:50) Absolutely. And the same for me as a lifestyle medicine doctor. When I first started being a doctor, which is like a long time ago now, I was sort of excited to write a script. I was like, goody, I can help somebody. I write a script and wow, look at this. They got better until I realised that they weren't necessarily better. So now my greatest thrill is to be able to deprescribe and cross off things with Glee. With the caveat though, and I think this is the caveat that if you want to reverse your high blood pressure or you want to reverse your diabetes or your type two diabetes or your obesity, you have to, the thing that you do to reverse it is the same thing you do to maintain it. And this is the thing that I think dieting and diet culture have missed because, in diet land, you go on a diet for a while get to your weight, and then you move into this maintenance phase, which usually means more food. And in general, I find that it doesn't actually work like that. So what we want to do is have a process that is maintainable, rather than really, really restrictive that you'll hard knuckle, white knuckle your way through, get to it, because then you get to maintenance and then wow, look at that after my maintenance, I'm suddenly back to where I was.
Dr Angela Kwong (22:15) I agree having a new normal, which is a very healthy version that can be maintained and is not too different to what you would normally enjoy something that you can embrace and something that is quite acceptable to the rest of the family is something that is going to be very easy for you to continue on for the rest of your life.
Dr Lucy Burns (22:34) Yeah, totally. I love that. Totally. So interesting. Do you what are your thoughts? Do you think the people in general are given enough information about the GLP-1s before they start?
Dr Angela Kwong (22:49) Not usually. I find that that's usually given to the job to the pharmacist, isn't it? For most patients, they tell me that the first time that they find out about the side effects of the medications is when they open up that box and they find that humongous leaflet that is the size of a fridge.
Dr Lucy Burns (23:06) Yeah, absolutely. And it's interesting. And again, I don't know the reason why, whether it's the practitioner, whether there's so much information they haven't been able to hear at all, or whether it's because they're accessing this script on a telehealth service that provides minimal information. But I think part of the reason I know that people aren't always given the right information is because I like to do a little bit of Facebook stalking in various groups. And I see questions that I think, why hasn't that been answered by your doctor or your prescriber? Things like people writing, you know, they've been on the starting dose of 0.25 milligrams for two weeks and they haven't lost any weight yet. What's going on? And you think, wow, you really, you really didn't, you weren't given the full picture.
Dr Angela Kwong (23:56) Yeah, it's very important for patients to be informed about the dosing, the side effects, the interactions, and also the expectations as well in that, you know, when you are put on the starting dose, it is not a weight loss phase. It is a getting-to-know-you phase for the medication to get to know your body. Isn't it? It's so important.
Dr Lucy Burns (24:16) Yeah, yeah, absolutely. Yeah. Expectation management, I think is the biggest thing that people, you know, that sets people up for success when they know what to expect. And then they're not sort of disappointed then when it hasn't worked in the way that they thought. And realising that what they had thought was unrealistic or not, not, not reasonable. So yeah, I think that's a great, great point. Yeah.
Dr Angela Kwong (24:38) Having said that, that's part of the reason why I did my consultations backwards. So, you know, there is limited time in a consultation. And sometimes if say, for example, you were doing a traditional 15-minute consultation with a patient and they said to you, look, I'm thinking about starting a weight loss medication. You've done that assessment and is there really time to start going through it? These are the risks, these are the side effects, these are the contraindications. You're really going to run out of time, aren't you? So maybe you would have to book a follow-up appointment with the patient to go through all of this information. What I realised was that a lot of that information was the same information that I could give to each patient. And so I did it as a program where I could pre-record that information for patients. So these are all the medications, these are the costs, these are the side effects, these are their interactions. And I would like you to watch this video before you come in for this consultation, where we will make a decision about which medication might be your best preference. And I will have to think about which medication might be a good match and we'll come to that decision together. It's a slightly backwards way of doing it, but it allows the patient to have a think about that essential information.
Dr Lucy Burns (25:53) Yeah, absolutely. And it gives them, you know, basically you're educating them beforehand. And that helps them make an informed choice because gone are the days where it used to be, I don't know, doctor, what do you think? Like that's, you know, that's, that's just not how we work anymore. So yeah, that's a great idea. I love that. So pros and cons then of the, of the GLP-1s in a nutshell, what do you think they are?
Dr Angela Kwong (26:20) Pros are that for some of the GLP-1s they are weekly. They are quite effective. So they have good percentages of weight loss and some of them are actually starting to achieve effectiveness in reaching bariatric surgery. And cons would be that they generally need to be done by injection. So some patients who are scared of needles, it might not suit you. Cons are also that they generally are quite expensive, more so expensive than oral medications. And also they can be associated with reduced appetite. So it can be quite hard for you to achieve your nutritional goals. And some patients may also have reduced muscle mass as well. So there are a lot of things to consider for patients.
Dr Lucy Burns (27:10) Yeah, absolutely. And I think you're right. I mean, people, and again, just based on my research from stalking Facebook groups, people have very little idea about nutrition. And, you know, because of this decreased satiety, which is the whole point of the medications, like that's one of their most effective strategies. You really have to prioritise getting protein in, or if you fill up on a non-nutrient-dense food, you won't be able to fit your protein in.
Dr Angela Kwong (27:42) It used to be the mindset, wasn't it, that people think, hooray, I will take an appetite suppressant or I will take a weight loss medication and I will eat nothing and I'll be able to lose weight. Excellent. That is fantastic. But actually what is happening now is when people are taking weight loss medications, they suddenly realise, I am not hungry. I achieved satiety much earlier, like around 30 to 50%. And then it suddenly clicks and it suddenly dawns on them. How am I going to get in enough protein and how am I going to get in enough nutrition? I'm actually concerned that I'm going to be quite thin and I'm not actually going to be smaller and slimmer towards the end of my weight loss journey. I'm actually going to be quite thin instead. So I might not actually achieve the goal that I had intended when I get to my goal weight.
Dr Lucy Burns (28:38) Yeah, absolutely. And I think that muscle mass loss is something that happens anyway as we get older, naturally. And we need to take active steps to counter that. But the same with the GLP-1s. If you're taking a GLP-1, you need to be actively countering the muscle mass loss. What do you, how do you recommend people do that?
Dr Angela Kwong (29:02) Well, currently what I'm doing with my patients is that I try to just two things that I do. So the first thing that I do is I don't always do traditional dosing of the GLP-1 medications for my patients. I only titrate to give them as much medication as they need to have an effect that is desired and an effect that is achieving weight loss for them. So if a patient is telling me that they are having effective weight loss and they are at already achieving about 30 to 50 per cent satiety, I might only be giving them a very small dose increase and not necessarily putting them up to the full dose where they might be very nauseous, having vomiting, low energy and not necessarily be able to function or go into work. So that comes from a prescriber point of view where I'm really individualising the dose and not giving people more than they need. I'm looking at the individual and thinking about how can I give you the right dose so that It's just the right amount, not too much and not too little. On the other side, then we're having a look at how can we best supplement you so that you have all of the nutritional requirements that you need. Because if you're really only having 30 to 50% of your appetite, it's not going to be 100% of your nutrition. You're only going to be having 30 to 50% of your protein. You're only going to be having 30 to 50% of your calcium, magnesium, your B group vitamins. So sometimes we need to be thinking about how are we going to supplement that. What I've noticed is that when my patients are taking GLP-1 medications, because of the effect of the delayed gastric emptying, where the food is moving in slow motion down through the stomach, they do report that it's more uncomfortable for them to have protein in the solid form. So they say, look, I love how you're promoting me to have lots of meat and lots of eggs for me to get lots of protein in, but it does get a bit uncomfortable and I do get sulphur burps and I do tend to get a bit of reflux at nighttime because of that. So as a result, then we do encourage our patients to try and have other forms of protein. So we might encourage them to have plant-based protein, for example, in the form of nuts and seeds on top of their yogurt or we might encourage them to have meal replacement shakes, or we might encourage them to add some collagen protein or some protein powder. There are lots of different ways that you can have increased protein and increased nutrition that doesn't necessarily worsen your symptoms.
Dr Lucy Burns (31:37) Yep. Excellent. So do you have with, I mean, it's tricky. So protein powders and again, the protein powders are one of my, another hobby horse I like to jump up and down upon because they've been given like this health halo. I'm going to the gym and then I'm following it with a protein powder. And in fact, I look at, and I covered the other day cause I've got two adult daughters and there's this tin of protein powder. And when I look in it and it's just full of garbage, there are so many fillers and emulsifiers and sugar and a whole heap of crap in it. And I just said, and really they are like the wolf in sheep's clothing in many ways. They're just hyper-ultra-processed food dressed up as health food. So I think, you know, one of the things that I say to people is that you know, not all protein powders are created equally. What are your thoughts on that?
Dr Angela Kwong (32:33) Yeah, there are a lot of different types of proteins. So there's like plant-based protein, there's meat-based protein. I think when it comes to patients who are taking weight loss medications and they're really only getting about 30 to 50 % of their total daily intake, whilst protein is important if they're really only getting 30 to 50%, they don't just need protein, they also need a balanced source of nutrition, which is why I usually get them to think about having meal replacement shakes that also have the nutrition in there. Now I was trying to get my patients to have meal replacement shakes or soups to fill in the nutritional gap. But what I found was that quite a lot of those shakes had quite a medium source of protein and a high source of carbohydrates. And what I also found was that a lot of the sources of protein were not that easily digestible. So one of them even had gluten as its source of protein. And for a lot of patients who already have gastrointestinal-type side effects from the GLP-1 medications like bloating, reflux, nausea, or constipation, if there were artificial sugars in there, then it tended to exacerbate their symptoms. So one of the things that I've tried to do is just design an Australian-made meal replacement shake that has high protein, low carb and no artificial sugars. It's not really that secret of a formula. It just has three main features. And it's just so that patients have an option where if they can't necessarily hit their protein or their nutritional goals because they're taking a GLP-1 medication or they're taking medications that reduce their overall appetite, they can take something to try and hit that goal. It's the complete opposite to what we had before which is the old way of using meal replacement shakes which is that I'm going to use this shake to skip my dinner because I'm trying to diet. It's that used to be the mindset of meal replacement shakes. I think the new way of thinking about meal replacement shakes is now that we're taking these weight loss medications and people are not able to hit their goals, what is a good resource that we can use to be able to nourish the body so that we are still able to be able to hit our nutritional goals during our weight loss journey.
Dr Lucy Burns (34:57) Yeah, so really, they're nutrient supplement shakes rather than meal replacement. Yeah, amazing. Amazing. Now, lovely, I also know that you have a new role that you've been appointed to the New South Wales State lead for the RCGP Specific Interest Group for Obesity Management, which is quite a mouthful. But I do what you know, the summary of that means that you're now in a leadership role around advocating and educating particularly other doctors and GPs around obesity and its complications. What do you want to achieve with this role?
Dr Angela Kwong (35:36) Thank you. So I have two things that I want to achieve with this role. The first thing that I want to do is really open the conversation on obesity and on weight management and make it something that people are proud to talk about. You know how at the beginning of the conversation we said weight loss or who really wants to say the word weight loss? I want people to be proud to have a weight loss conversation. So I want people to be proud and to be present and have fearless conversations and feel welcomed essentially. So I want the practitioners to feel welcome. I want people to feel welcome. And in fact, I want everyone to feel invited. I'm actually running a free online event of which Dr Lucy is a panellist and it is called the Australian Weight Loss Summit. I've invited eight panellists who are all experts in their own fields. We've got GPs, we've got Dr Lucy, who is a lifestyle medicine expert. We've got a low-carb expert. We've got a weight loss surgeon. We've got a dietician and exercise physiologist. We've got a psychologist. So we've got people from all aspects of weight management where we're going to have really lovely, open conversations. I deliberately called it the Australian Weight Loss Summit because I want it to just be out there and shouted from the rooftops rather than in these quiet little secret conversations. I want everyone to feel welcome and to come and ask their questions and get their questions answered.
Dr Lucy Burns (37:19) I love that. I love that. Now, could you tell our listeners, when is it on?
Dr Angela Kwong (37:23) It's happening in July, so it's going to happen over three nights in July. The first night is going to be on the 25th of July, Thursday the 25th of July. Night two is Monday the 29th of July and night three is Thursday the 1st of August.
Dr Lucy Burns (38:09) Beautiful. So lovelies, you get to the opportunity to come along and listen to some panel, some expert panellists talk about their approach to weight management and again, everyone is different. And I think that that's okay because as we've discussed, every person is different things that work for some people don't work for others. Sometimes you need to hear the same message from a different person and the penny drops for you. And I think all of us just want people to be well. We just want people to feel good. We want people to have long active vital lives and not be weighed down by chronic disease. And there was a pun in there, but it's really important. And I mean, look, you lovelies all know, you know that Dr Mary and I and Dr Angela, none of us are here to judge anybody. We're all just here to unravel and unpack the complex picture that having obesity and being overweight can paint and optimise it to the best of our ability and to the best of yours.
Dr Angela Kwong (38:54) Wonderful. I hope everyone can join us. The URL is www.awlsummit.com.au.
Dr Lucy Burns (39:00) Good. So lovelies, we will have all this in the show notes for you. So it'll be all the W's, A W L so Australian weight loss summit .com .au and that'll be fantastic. I love that. Dr Angela, this has been a great conversation. I'm sure that we will have heaps of people joining the summit. We will also put the links to your Instagram in the show notes. What is your Instagram handle?
Dr Angela Kwong (39:27) It's /DrAngelaKwong
Dr Lucy Burns (39:28) Excellent. So we'll put that in the show notes as well and lovelies. I hope to see you at the summit. That'll be great.
Dr Angela Kwong (39:35) Thank you so much. See you soon.
Dr Lucy Burns (39:38) Bye everybody. Have a good week and I'll talk to you all next week. Bye, for now, lovelies.
Dr Lucy Burns (39:43) The information shared on the Real Health and Weight Loss Podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.
