The end of dieting

Summary

Today, Explained – "The End of Dieting" (Nov 11, 2025)

Main Theme and Purpose

This episode of Today, Explained explores how the conversation around weight loss and obesity has transformed in the United States, especially with the rise of new, highly effective weight loss drugs like Mounjaro and Ozempic. Host Noel King, joined by writer and editor Sumita Mukapadai and endocrinologist Dr. Dan Bessason, unpacks the personal, cultural, and medical implications of moving from traditional dieting and exercise to pharmaceutical interventions. The episode questions whether we have reached ‘the end of dieting’ as we knew it, and what that means for individuals and society.

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Key Discussion Points and Insights

President Trump’s Weight Loss Drug Announcement

• Timestamps: 01:06–01:40
  • Recent political news: President Trump announced a deal to make weight loss drugs more affordable, revealing members of his administration—including his head of PR—are taking these drugs.
  • The drugs appear effective, and US obesity rates are declining, but there are still many unknowns regarding long-term health.

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Sumita Mukapadai’s Personal Journey with Weight, Dieting, and Medication

• Timestamps: 02:10–12:31

• Entering the Fashion Industry (02:33)

  • Sumita describes joining Teen Vogue during a shift toward acceptance and advocacy for diverse body types.
  • Quote: "There was an increased interest in plus fashion...How does it feel to be a fat fashion editor?" (Sumita, 02:33)

• Personal Health Turning Point

  • A series of family tragedies (father’s death from diabetes, mother's cancer diagnosis, stressful job) led to stress eating, weight gain, and notable health/mobility issues.
  • Initial medical assessment showed prediabetes and high cholesterol.

• Decision to Try Mounjaro (05:48)

  • Emotional struggle: Conflict between body positivity beliefs and the need to address serious health issues.
  • Quote: "I saw it as a betrayal to the kind of body positivity and feminism that I had ascribed to...And also there was another voice inside me that was like, this is how bad it's gotten, girl." (Sumita, 06:15)

• Physical and Emotional Effects

  • Difficult side effects: intense nausea and severe constipation requiring additional medications. Sumita notes these never entirely faded.
  • Quote: "Physically, it is a bumpy road. It was for me...It is very hard to go to the bathroom when you're on it." (Sumita, 06:15)
  • The drug successfully reduced compulsive evening eating and made ‘healthy choices’ far easier.

• The Cost Barrier and Aftermath

  • Mounjaro was affordable due to a manufacturer's coupon, but after it ended, monthly costs skyrocketed to $600–800, prompting Sumita to stop.
  • Quote: "Overnight the drug becomes six to eight hundred dollars a month...That's crazy." (Sumita, 09:44)
  • She lost about 50 pounds, maintained it for several months after quitting, but regaining weight has been emotionally difficult.
  • Quote: "It’s been a roller coaster...the high of like, oh, like the weight came off and then to like, be feel like I’m back to square one. Even though I know in my mind and my heart and my spirit, I am not." (Sumita, 12:28)

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The Medical and Historical Context of Dieting and Obesity

• Dr. Dan Bessason, Endocrinologist (16:08–27:01)

• Obesity as a Medical Problem (16:48)

  • Serious medical concern emerged in national consciousness in the late '80s–mid '90s, with focus ramping up after NIH and CDC began tracking obesity via BMI.

• Early Medical Strategies (18:29)

  • Initial interventions centered on:
    • Diet and exercise for mild cases
    • Medication for moderate cases
    • Surgery for severe cases
  • At the time, little was known about the biology of weight regulation; the advice was to "eat less and move more."

• Effectiveness of Diet and Exercise (19:51–21:22)

  • Clinical studies show a modest (5%) weight loss can significantly reduce diabetes risk—but most people regain much of the lost weight over time.
  • Quote: "[Most] lifestyle studies show that most people regain much of the weight...The biology of weight really pushes back against efforts to change our diet." (Dr. Dan, 21:22)

• Medications and Stigma

  • Early weight loss drugs (like fen phen) were rarely prescribed due to safety concerns and societal attitudes—doctors believed patients should lose weight on their own.
  • Quote: "Doctors would say things like, you know, if you show me you can stick to a diet, well, then I'll maybe talk to you about a medicine. We don't do that with diabetes or high blood pressure." (Dr. Dan, 23:12)
  • Only about 1–2% of patients had weight loss medications prescribed 20 years ago.

• The Advent of Modern GLP-1 Drugs (Ozempic, Mounjaro, etc.) (24:30)

  • Dr. Bessason calls these drugs a "game changer," producing weight loss akin to bariatric surgery.
  • Over 100 new anti-obesity medications are in development, some even more effective than current offerings.
  • These drugs have transformed not just medical potential, but what it means to live with and treat obesity.

• Unexpected Impacts of Medication

  • Profound changes in physiological hunger—and thus, relationship to food and social dynamics—aren’t always anticipated by patients.
  • Quote: "What does your life look like when you're not interested in food?...It makes changes in people's relationships with other folks." (Dr. Dan, 25:18)
  • The landscape is chaotic, with demand high, patients sometimes ill-prepared, and little social infrastructure for these changes.
  • Key message: weight is biologically regulated, and obesity treatment is a journey that ideally involves collaboration with a healthcare professional.

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Notable Quotes and Memorable Moments

• "I really wanted a strategy that would be more effective. And so I went in and got my blood work done...I was prediabetic. My cholesterol was elevated. And so those scared me."
  —Sumita Mukapadai (04:24)

• "It really gave me this release from this yearning that I always had...with the kind of pharmaceutical intervention, I was able to stop."
  —Sumita Mukapadai (08:34)

• "We tend to blame [patients] for their health problem. So medicines that weren't super effective and an environment that really thought that people could do this on their own."
  —Dr. Dan Bessason (23:53)

• "There’s never been anything like [these new drugs]...medications are likely to provide the kind of weight loss that we used to only see with bariatric surgery."
  —Dr. Dan Bessason (24:30)

• "It's a bit of a chaotic environment. I think the key message I'd ask people to understand is this idea that weight is biologically regulated...it's a journey."
  —Dr. Dan Bessason (26:30)

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Important Timestamps

• 01:06–01:40: Context of President Trump’s weight loss drug announcement
• 02:33–06:06: Sumita Mukapadai’s entry into fashion, personal health challenges, and decision to try weight-loss medication
• 06:06–09:26: Experience taking Mounjaro—struggles with shame, stigma, and side effects
• 09:26–12:31: The high cost of medication, transitioning off Mounjaro, emotional toll of weight regain
• 16:08–19:51: Dr. Dan Bessason on how obesity became a medical crisis and early approaches
• 19:51–21:22: Effectiveness and limitations of diet and exercise
• 22:20–24:30: Medications and shifting perspectives in medical treatment
• 24:30–27:01: The impact of new drugs like Ozempic on patients, the medical system, and society

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Conclusion

This episode draws a nuanced picture of a society at a crossroads: as groundbreaking drugs make lasting weight loss possible for millions, the biological, personal, and social complexities of obesity and health remain. The guests highlight the hope these treatments bring, while honestly detailing their costs—financial, physical, and emotional—and the continuing need for supportive, well-informed care.

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For listeners, the takeaway:
The end of traditional dieting isn't just about new drugs—it's about rethinking blame, biology, and what real support looks like in the journey to health.

Transcript

[Sumita Mukapadai]

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[Noel King]

Today's episode of Today Explained is a rerun, but we have updated it with some news. Perhaps you saw President Trump recently announced a deal with two drug companies that's going to result in much cheaper weight loss drugs. Perhaps you saw that he then revealed who in his administration is taking them.

[Sumita Mukapadai]

And we have Steve.

[Dr. Dan Bessason]

Where's Steve?

[Noel King]

Se here, head of public relations for the White House.

[Sumita Mukapadai]

He's taking it.

[Noel King]

Classic. Perhaps you saw someone then fainted in the Oval Office during that announcement. Classic. Here's the thing, these drugs appear to be working. Obesity rates in the US Are declining, but there are still unknowns. The relationship between diet, weight and health seems like it should be clear by this point, but it's really not. Coming up on Today explained why the gospel on weight loss is always being rewritten and how medications have added a brand new chapter.

[Sumita Mukapadai]

You're listening to Today Explained.

[Noel King]

Sumita Mukapadai is a writer and editor who was very anxious when she was hired as the executive editor of Teen Vogue back in 2018. Like everyone else, Sumita had seen the Devil Wears Prada and she knew that the fashion industry was unforgiving. But not long after she started there, she realized that things were changing.

[Sumita Mukapadai]

You know, I entered the fashion industry at a really unique moment where there was an increased interest in plus fashion. You know, and so when I got the job at Teen Vogue, I started having all these fashion brands reaching out to me to be like, wow, we're so excited. We're launching A plus collection. We'd love to like talk to you about it. We'd love to send it to you. How does it feel to be a fat fashion editor? And at the time, I had kind of newly gained the weight, and so I wasn't totally embracing it. I was, I wasn't. I didn't. It didn't feel empowering. It was almost felt like something that was happening to me where I was like, oh, wait, I'm fat. Like, you know, I had to kind of get over that first step before being like, I'm fabulous. I love being fat.

[Noel King]

Okay, so you're in a period where Teen Vogue has become more accepting. It is okay to be a person in a larger body. And in fact, there's even some sort of advocacy or activism around the fact that there is more than one body type. And then you get some news that again, changes how you see and experience all of this.

[Sumita Mukapadai]

What happened while I was at Teen Vogue? And kind of as I was leaving Teen Vogue, I had had a series of stressful family related things happen. My father passed away of diabetes related complications. My mother was diagnosed with breast cancer. I had this really hectic job and I was managing all of it. And my stress response was eating. And it was. And not just eating. It was like really not taking care of myself ultimately. Right. It was taking Ubers. It was getting takeout. It was kind of not really having a lot of time for myself. And that did lead to some unwanted weight gain on my part. And I was having some mobility issues. I was having trouble kind of. I just thought it was cause I was exhausted because I had never had these experiences. But I was having trouble getting up and down the stairs on the subway. And I would just chalk it up to like, oh, I'm just so busy, you know, like, I have to take Ubers. Cause I'm like, busy and I'm exhausted and I was having trouble keeping up on walks and I was having trouble sleeping. I wasn't feeling well. And you know, on top of that, my clothes weren't fitting. And so I went to the doctor and, you know, this is after I had left Teen Vogue and like, kind of after the pandemic, I decided to start the process of, you know, figuring out if I was okay and also, you know, what I could do. Because I knew and I understood that diets don't work. Right? Like, I knew I could restrict what I was eating. But eventually I'd gained the weight back and I really wanted something. I really wanted a strategy that would be more effective. And so I went in and got my blood Work done. And, you know, pretty much every indicator was elevated. So I was. Had become pre diabetic. My cholesterol was elevated. And so those scared me, right? Like I had just lost my father to exactly the things that I'm now looking at in my blood report. And so I was like, you know, I think it's finally time for me to really take this seriously and figure out, you know, a strategy to move forward. And she suggested Mounjaro. It is a injectable that you take weekly. It slows your digestion, basically is how it works. And in doing so, it reduces the rate at which you can eat and how hungry you get. And so, you know, I decided to go on it.

[Noel King]

What did that mean for you? Like, once you start taking it, what happens?

[Sumita Mukapadai]

Do you mean emotionally or physically?

[Noel King]

Both. Both entirely. I mean both. Thank you for asking.

[Sumita Mukapadai]

Yeah, yeah, for sure. I mean, emotionally, it was really hard to make the decision to go on it. I saw it as two things. I saw it as a betrayal to the kind of body positivity and feminism that I had ascribed to. Of loving yourself at any size and not trusting pharmaceutical interventions. And also there was another voice inside me that was like, this is how bad it's gotten, girl. Like, you couldn't control this, and now you have to take a drug. That's how. That's how not well you are. And so a lot of self judgment, a lot of shame came out with the decision to go on the medication. Physically, it is a bumpy road. It was for me. For me, I struggled with very intense nausea. So one of the ways that it works is since it slows your digestion, if you overeat, you feel very sick, and then a lot of digestive issues. It is very hard to go to the bathroom when you're on it. You have to take all kinds of laxatives. They now have additional prescriptions they put people on that are taking it to help support with, you know, regular bowel movements. And so it was not the best physical experience. And then, you know, at a certain point, I got used to it, but I think it was more that I just got used to managing the side effects. They never really went away for me.

[Noel King]

You have made, interestingly enough, being on Mounjaro sound absolutely horrible. But I appreciate you. I appreciate you being honest about the side effects, because I don't hear talk about the side effects very often. What was the good in this? What kept you on it?

[Sumita Mukapadai]

It does something, and I think it's. It's physiological. And a doctor can speak more eloquently to this, but it does trigger something in your brain, a hormone that suggests that you're satiated. Right. And so it started to help me feel satisfied with less. One of my behaviors is I tend to compulsively eat in the evening, Whether it's stress or just fun or boredom or binge watching tv, whatever it might be. I will sit down with, like, an array of snacks and kind of eat mindlessly, not always keeping track of how much I'm eating. Not necessarily food that had good nutritional value. When I was on Mounjaro, I would finish dinner, and I pretty much would not physically be hungry in the evening, and I just wouldn't have space to eat anything else. And if I got the munchies, I started to reach for healthier snacks because I noticed that I digested them easier. And so if I just, like, ate an apple or some grapes, you know, like, I eat so many freaking grapes or, you know, a handful of carrots or whatever that might be. And all the things we tell ourselves, we were like, this is the healthy choice. Let's make the healthy choice. The healthy choice, all of a sudden became easier. And that was part of why I stayed on it, that it really gave me this release from this yearning that I always had where. And it wasn't a challenging decision. I didn't feel a lot of strain around it. Whereas historically, when I would beat myself up for eating at night, I never felt like I could stop. And with the kind of pharmaceutical intervention, I was able to stop.

[Noel King]

Okay, so there are pros, there are cons. How is it going?

[Sumita Mukapadai]

I guess when Manjaro hit the market, they had given a manufacturer's coupon to early people that. To people that had first started taking the drug. And, you know, I don't read the fine print, Noel. Like, I don't know.

[Noel King]

Like, no one does, girl.

[Sumita Mukapadai]

I thought that was my insurance covering it. Like, I didn't understand that. Like, the reason it cost that much was a coupon and not my insurance. And so the coupon is rescinded, and overnight the drug becomes six to eight hundred dollars a month. I think it was like. I think it was 800. And they were like, we can do this other coupon that will get you to, like, 600. Like, I'm kind of like, these aren't the exact numbers. But all I'm saying is, like, it was an insane amount of money that I was like, what? Like, I live in New York City. You can't just take on another payment. Like, that. That's crazy. Yeah, exactly, exactly. I think the combination of the cost and the side effects and I had lost a lot of weight. Like, I think I lost 50 pounds about.

[Noel King]

Wow.

[Sumita Mukapadai]

And I was feeling great and I was like, you know, let me just try without it. Let me phase out of it. And so I came off the drug at the end of 2023, and, you know, I will say, like, maintained the loss for quite a bit of time. I probably gained like 10 to 15 pounds within, like two or three months. And that was definitely not a great mental experience. Like, I definitely came back to that feeling of control, of like, oh, my God, I'm losing control, I'm losing control. And, you know, but I was excited because I had made some lifestyle changes that I was maintaining and that felt like a really positive intervention. Now this is like the first interview I'm doing about this in like, six months. And so I will say the last six months have been really stressful for me. I launched a book, I got married. Nothing like, thank you. Nothing like gaining weight for your wedding. But I started, you know, some of the things that I had been committing to, like cooking and getting enough, you know, my steps every day and all of that, like, fell to the wayside a little bit. And so the weight started to creep on and creep on and creep on. And now I've probably gauge back like 60 or 70% of what I lost, which has been really hard. You know, it's hard and it's also feels like it's forcing me to really face my relationship, relationship with my health and my own body and to like. It's like, I understand the options that are out there, but the options are limited. I wouldn't even say that I would necessarily go back on it because when I think about it, I just get sick to my stomach. I'm just like, ugh. I just don't know if I can go through that again. But the, you know, it's been a roller coaster, emotional roller coaster, having the kind of high of like, oh, like the weight came off and then to like, be feel like I'm back to square one. Even though I know in my mind and my heart and my spirit, I am not.

[Noel King]

Sumita Mukapadai writer and editor Coming up is the age of diet and exercise over. Support for Today Explained comes from Indeed. Indeed says if you're looking to hire, you can give your job posting the best chance to be seen with Indeed sponsors. Sponsored jobs. With Sponsored Jobs Indeed. Boost your post so that it is more visible. Their data shows it's effective. According to Indeed, Sponsored Jobs posted directly on indeed are 90% more likely to report a higher than those non sponsored jobs because you reach a bigger pool of people. 1.6 million companies sponsor jobs with Indeed. You can spend more time interviewing candidates. Less stress, less time, more results. Now with Indeed Sponsored Jobs, listeners of this show get a 75 sponsored job credit to help your job get the premium status it deserves@ Indeed.com todayexplained Indeed.com todayexplained support our show by saying you heard about Indeed on this podcast. Today explained Indeed.com todayexplained terms and conditions do apply. Guys hiring do it the right way with Indeed. Support for Today Explained comes from Bombas Putting on a new pair of socks can instantly feel refreshing according to Bombas. Especially according to Bombas. If they're Bombas socks. Bombas make socks for just about any activity. Your warm merino wools, your comfortable compressions, your cushioned running socks and so much more. High quality slippers. T shirts, Mudans Nisha Chital tried Bombas. Here's what she thinks. Bombas has great kids socks. I have a three year old, she runs around a lot indoors in her socks and she's often slipping on the hardwood floors. But Bombas kid socks have grips on the bottom and they're really great to prevent that slipping around on hardwood or tile floors. So we love those for her. They're definitely our preferred socks for our daughter. Bombas says that for every pair of Bombas you buy, they donate one to someone facing homelessness. Anytime you get something cozy, someone else can too. According to Bombas. You can go to bombas.com explain and use code explain for 20% off your first purchase. That's B O M B-A-S.com explain explained code explained at checkout. Support for Today Explained comes from Chime. What's Chime? Chime is different. Chime is a financial technology company that wants you to embrace each and every dollar. When you set up direct deposit with Chime, you can get access to fee free features like overdraft protection. Or they say you can get paid up to two days early and even more. Speaking of no fees, Chime says that when you open a checking account with them, there are no monthly fees and no maintenance fees. And with qualifying direct deposits, you can be eligible for free overdraft up to $200 on debit card purchases and cash withdrawals. Not to mention, although I will 47,000 fee free ATMs you can work on your financial goals through Chime Today. You can open an account in two [e-mail] explain. That's chime.com explain. Chime feels like progress. Chime is a financial technology company, not a bank. Banking services and debit card provided by the bank or bank NA or Stride bank NA members, FDIC spot and eligibility requirements and overdraft limits apply. Timing depends on submission of payment file. Fees apply at out of network ATMs, bank ranking and number of ATMs, according to U.S. news and World Report. 20 time checking account required. You're listening to TODAY Explained.

[Dr. Dan Bessason]

I'm Dan Bestason. I'm an MD by training. I'm an endocrinologist. I'm here at the University of Colorado in Denver, and I do clinical work taking care of patients at our county hospital, Denver Health, and I do research here at the medical school. I'm also the director of this building called the Anschutz Health and Wellness center.

[Noel King]

Dan, you have 47 jobs, man. All right, let's, let's talk about the beginnings of this sort of cultural and medical interest in obesity. When did doctors start thinking of obesity as something that needed to be fixed, something that needed medical attention?

[Dr. Dan Bessason]

I think there's always been people with really high weights that doctors thought, well, that's probably a health problem. But I don't think it entered the general public consciousness until sort of the late 80s to the mid-90s.

[Sumita Mukapadai]

The disease is obesity, but obesity is.

[Noel King]

Just a symptom of the real problem.

[Dr. Dan Bessason]

We as a nation face.

[Sumita Mukapadai]

Frances, you've been overweight since you can remember, since a child about early teens. Americans overeat.

[Noel King]

We are American obsessed with food, and.

[Sumita Mukapadai]

It'S an obsession that's killing us. And When Greta was one year old, she weighed 100 pounds.

[Dr. Dan Bessason]

Almost 100, almost 100.

[Sumita Mukapadai]

That's a lot.

[Dr. Dan Bessason]

I think people looked around and thought, what's going on here? There seems to be more and more people at higher weights. And NIH had an expert panel that defined obesity using bmi. BMI is sort of controversial, but that was the point at which we had this accepted standard. And shortly after that, the CDC looked at data they had and said, what's been happening with obesity? And I think they were sort of shocked to find there was just a dramatic increase in the number of people with obesity. And so in 1999, they published these maps, these CDC obesity maps. Maybe some people have seen those. And they really brought a lot of attention to what really looked like an epidemic. If you had looked at those numbers and it was HIV or cancer, people would be quite worried. And people said, gosh, something is happening here. We should do something about this.

[Noel King]

And what was the something that doctors decided they should do?

[Dr. Dan Bessason]

Yeah, I think that the NIH panel had thought about levels of weight, and that treatment or what intervention somebody did should be based on how serious the problem was. So people would. People with a modest increase in their weight might change their diet and increase their physical activity. People with a more severe weight problem might take a medication, and those at the highest weight might benefit from surgery. For most Americans, lifestyle is what was suggested. And I think at that point, we were still early in understanding the biologic basis of weight regulation. And we all eat, we all move, and it seems like we choose those things. And so the obvious first step was to say, maybe people just don't know what to eat, and if they just thought about it some more and ate less and moved more, that this problem might go away. So that was the first thought, and the Surgeon General had a call to action. Obesity, a major problem that has increased dramatically since 1990. Based on these numbers rising of obesity, saying, you know, people ought to move more and eat a healthier diet. When it comes to obesity, physical inactivity.

[Sumita Mukapadai]

Obesity, diabetes, fact of the matter is.

[Dr. Dan Bessason]

We'Re moving in the wrong direction in terms of these areas.

[Noel King]

The advice seems obvious. Change what you eat and move more. Do diet and exercise prove to work?

[Dr. Dan Bessason]

I think there's a couple ways to look at that. One is around the same time, there was a study published, the Diabetes Prevention Program. And what they found was that a modest weight loss, a 5% weight loss, could reduce the risk of developing type 2 diabetes by half. It was a really dramatic study. And so it was really based on that, that people said, gosh, this is achievable, and it has clear health benefits of 5% weight loss.

[Noel King]

I'm just doing the math in my head. If you weigh 200 pounds, that's take 10 pounds off.

[Dr. Dan Bessason]

Yeah.

[Noel King]

300 pounds, take 15 pounds off. That feels like nothing.

[Dr. Dan Bessason]

It seems like a small change in weight, and yet it had dramatic benefits. I gotta tell you. I mean, I see people in clinic, and so I've spent whatever, 20 years trying to sell the benefits of a 5% weight loss. Most people don't buy it. Most people want more weight loss than that. It's not a weight loss that most people see in the mirror or that their friends are going to notice, but it has clear health benefits and has become a benchmark of what a clinically significant weight loss is. A Little bit of weight loss helps.

[Noel King]

So what happened after the study was over with these folks who lost 5% of their weight and then saw their health improve? Did they keep the weight off?

[Dr. Dan Bessason]

Most lifestyle studies show that most people regain much of the weight. It's not like everybody regains all of the weight, but much of the weight is regained. What has happened over the last 25 years is a real explosion in our understanding of the biology that underlies weight regulation. I think now we think of weight much like we think about blood pressure or glucose, that there's complex biology, that the body's got its own idea about what it wants to weigh and what it seems like the body wants to do. It doesn't regulate around a set point. It regulates around a trajectory of gradual weight gain across the life. So the biology of weight really pushes back against efforts to change our diet. And so that's why people regain the weight, is when they lose weight, the body goes, this is not good. And the people become more hungry, their energy expenditure goes down, and these things tend to push the weight back up to where it was before.

[Noel King]

Were there. You mentioned two other ways that doctors saw of treating obesity medications and surgeries. How common was it for a doctor to say, you, sir or madam, you're gonna need medication. You're gonn. I don't remember so much of that.

[Dr. Dan Bessason]

Like, 20 years ago, only maybe 1 or 2% of people ever had that conversation ever got that medication. And there are a number of reasons for that. One is the older medicines had some side effects. There were some bad stories about health problems with fen phen and other medicines.

[Noel King]

Oh, fen phen.

[Dr. Dan Bessason]

If you took the diet drug combination known as fen phen or the diet drugs pondamin or redux, you may have.

[Noel King]

Heart valve problems and not know it before.

[Sumita Mukapadai]

Chicago area women are taking the makers.

[Dr. Dan Bessason]

Of fin phen to court.

[Sumita Mukapadai]

It's been one week since a prescription diet drug was pulled off the market.

[Dr. Dan Bessason]

And I think too, doctors and patients, doctors especially have this IDEA that, well, Mrs. Jones, you ought to be able to handle this on your own. This idea that weight is regulated, it's taken a long time to get any traction there. Doctors would say things like, you know, if you show me you can stick to a diet, well, then I'll maybe talk to you about a medicine. We don't do that with diabetes or high blood pressure. We're very quick to go to a medication in those conditions. So I think there's a lot of maybe bias and stigma directed at people living with obesity that we tend to blame them for their health problem. So medicines that weren't super effective and an environment that really thought that people could do this on their own.

[Noel King]

How long have you been in this line of work, Dr. Dan?

[Dr. Dan Bessason]

I'm an old person with kind of gray hair. I prescribed fen phen. So I've been doing this for, gosh, whatever, almost 30 years.

[Noel King]

You've been doing this for 30 years? Sometime in the last 24 months, I became aware of Ozempic. A lot of people became aware of Ozempic. I'm just wondering what the conversation was like in the medical community among doctors who do your type of work, about the fact that There are these GLP1 drugs that seem to work magically work for a lot of people and are now widely available.

[Dr. Dan Bessason]

Yeah, I would use the term game changer. There's never been anything like this. We've done studies with older medications and, you know, the medications worked okay, but people weren't happy with them. These medicines just not only the ones we have now, which are semaglutide and tirzepatide, but the ones that are coming after that that are in clinical trials. We're in a time now that medications are likely to provide the kind of weight loss that we used to only see with bariatric surgery. I understand that there's more than a hundred medications in this anti obesity medication pipeline. We've been doing studies with some of the next generation and they're even more effective than the semaglutide and tirzepatide are.

[Noel King]

Oh, damn.

[Dr. Dan Bessason]

Yeah. And you know, when we have somebody go to bariatric surgery, we prepare them for that. They see a psychologist, they see a nutritionist, they talk to other people who've had surgery and say, how was that for you? They think about it and then it's kind of a go, no go. You know, either you have surgery or you don't. You get what you get. Medications are going to give that kind of weight loss, but we're not preparing people for that. We're not. What does your life look like when you're not interested in food? I had a woman tell me, you know, my husband took me out to this fancy restaurant here in Denver for my birthday. He was so excited. I looked at the food and I thought, gee, this is not going to work for me. So it makes changes in people's relationships with other folks. When people see someone losing weight, they wonder, what are you doing? Do you have cancer? Who do you tell that you're out of medicine? What do you tell them about why and what your goals are. What are your goals? How much weight do you want to lose and how will you know when you're done? These are questions that we've never had to ask before and we don't have good data and people are willing to pay. So there's all these market forces with people just want a medicine, they don't want a doctor, they don't want advice, they just want the medicine. But they don't really know what they're getting into. So it's a bit of a chaotic environment. I think the key message I'd ask people to understand is this idea that weight is biologically regulated and that it has some health problems for some people, maybe even many people, and that ideally they find somebody that they can talk to, a doctor or healthcare provider that they can get useful information from over time, because It's a journey.

[Noel King]

Dr. Dan Bessason, he's an endocrinologist. Miles Bryan produced today's show. It was a rerun. Jolie Meyers edited. Laura Bullard, fact checked. Andrea Christensdotter and Patrick Boyd are our engineers. I'm Noel King. It's today. Expl.

[Sumita Mukapadai]

Sam.