Modern Metabolic Health with Dr. Lindsay Ogle, MD

Medication Adjustments During Weight Loss

• Lindsay Ogle, MD

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We walk through how weight loss changes care plans for thyroid disease, type 2 diabetes, blood pressure, reflux, and sleep apnea. The goal is simple: treat the weight, then tailor the meds so you stay safe, feel better, and reduce long-term risk.

• reasons to monitor conditions during weight loss
• how thyroid doses shift with body weight
• adjusting insulin and sulfonylureas to prevent lows
• using CGMs to guide safe diabetes changes
• spotting low blood pressure symptoms and tapering meds
• reassessing reflux therapy and step-down plans
• rechecking CPAP or BiPAP needs and pressure settings
• the value of regular labs, home data, and follow-up

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Dr. Lindsay Ogle, MD:

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you. The goal of obesity medicine treatment is to help patients achieve and maintain a healthy weight so they may help treat and prevent weight-related conditions. And I'm gonna talk about several of those conditions that need to be monitored while someone is on a weight management journey and especially when they are starting to achieve those weight changes. What are these health conditions that we need to monitor and how should we adjust those treatments? My name is Dr. Lindsay Olgal, and I'm a board-certified obesity medicine physician, and I see patients all throughout the state of Missouri at Missouri Metabolic Health. And I utilize YouTube and podcasts and TikTok, Instagram to help share my medical knowledge with as many people as possible because not everybody has access to specialty care, but this is really important information to be aware of because about one in eight to one in nine people are on a GLP1 medication at this time, and many people are not getting the guidance that they need. And so my goal is to help people make sure that they are utilizing these medications in a safe and effective way. But always talk to your doctor about what is best for you, especially for an episode like this. I'm going to talk about specific medical conditions and some medication adjustments to be aware of, but none of this is direct medical advice. This is general medical knowledge to take to your doctor to apply to your specific circumstance. I thought about this topic because I recently saw a patient who has been doing very well on her GLP1 medication and has lost a little bit over 10% of her total body weight, and she has a few weight-related conditions that we now need to start monitoring to make sure that her treatments are adjusted appropriately in the setting of this weight loss. I also had somebody reach out to me on TikTok about a similar question. So I'm gonna go through some of these health conditions. The first is thyroid disease. And weight and thyroid, it can be intimately connected, and that goes outside the scope of this talk on how they are connected and would be a great topic for a future video or podcast. So subscribe to follow. But as your weight changes, whether that is increasing weight or decreasing weight, that will affect your dose of thyroid replacement or any thyroid disease medications that you are on. So if you are on thyroid replacement and you are on a weight loss journey, talk to your doctor and you probably need more frequent testing of your thyroid levels and may need an adjustment of your thyroid replacement. So thyroid disease, especially hypothyroidism, low thyroid, some of the common medications for that are levothyroxine or centhroid. If you're on those medicines, make sure that your doctor knows that you're having this weight loss and be tested more frequently for your thyroid levels to make sure you are on an appropriate dose. Another common weight-related condition is type 2 diabetes. And as many people know, GLP1 medication started out specifically for type 2 diabetes, or that was their only FDA indication for many years. Now they're FDA approved for obesity and prevention of cardiovascular disease, obstructive sleep apnea, and metabolic associated dysfunction, steatotic liver disease, or mastle. And I recently did a whole video on that condition, which I will link here. Um, but if you have type 2 diabetes and you're on a GLP1 or any obesity treatment, you should work closely with your doctor to adjust your other type 2 diabetes medications. This will likely mean reducing your other medications slowly over time, especially if you are on insulin or sulfoniurias. Those two medications or two groups of medications in particular can increase your risk of low blood sugar when on a GLP1. And so your blood sugars need to be monitored more closely. So work with your doctor if you have type 2 diabetes and are on treatment for your obesity. This can be a great time to utilize a continuous glucose monitor or a CGM. So ask your doctor if that may be appropriate for you. These can be excellent tools so you don't have to constantly be poking your finger. You just wear a continuous glucose monitor. Most of them are set up to be worn for two weeks at a time. The next condition is high blood pressure. So anybody who is on blood pressure medication and is losing weight, and especially if you are changing the way that you're eating or the amount of alcohol that you're drinking or how physically active you are, all of those things are gonna impact your blood pressure and help lower it over time. So if you're on a blood pressure lowering medication and are on obesity treatment, you need to closely monitor what your blood pressure is or the symptoms that you're having. So if you're feeling lightheaded or dizzy or tired, that is a time to check your blood pressure. And if it's starting to be on the low end for you, talk with your doctor and your blood pressure medicine should probably be lowered in their dose or maybe able to be discontinued altogether. Acid reflux is another condition that is related to excess weight, and that will likely get better on treatment for obesity. Medications to treat acid reflux, um, there's several, but many of the common ones are omeprazole, pantoprazole, fomodidine. If you are on these medications, there could be other reasons that you're on it, and you should always check with your doctor, but it could be time to trial a lower dose or maybe going off of it. These may be again ones that need to be titrated off. So talk to your doctor. Um, and they're ones that can be forgotten about, and sometimes people get started on it and do not get off of it at any time. So if you know you were started on it for heartburn and you've been losing weight and you're not experiencing heartburn right now, talk to your doctor and then work on getting um potentially getting off of that medicine. Sleep apnea is another diagnosis that um tends to be weight-related, not always. Um, and as I mentioned earlier, Zeppound is now FDA approved for the treatment of sleep apnea. So if you are on Zip Bound specifically, you're also treating your sleep apnea. But what I really wanted to highlight here is if you are utilizing CPAP or BIPAP to treat your sleep apnea and you are on treatment for your disease of obesity, if the obesity is improving and you're losing weight, you likely may be able to reduce your BAP or CPAP strength or potentially go off of your machine altogether. This is something that you definitely need to work with your doctor about and may need to have a repeat sleep study to ensure, but is worth looking into, especially if you're struggling with your you know BIPAP or CPAP at all. This is something to take a look at. So those are the main weight-related conditions that treatments should be titrated to um along with the treatment of obesity. Again, this is general medical knowledge and talk with your doctor, but I wanted to highlight these conditions and just bring them to your attention so you can be aware and monitor for any of your symptoms that may be changing, and or talk to your doctor about adjusting the treatment along the way. I hope you found this helpful and I'm so happy that you are on this journey. And again, the whole goal of obesity treatment is to treat and prevent weight-related conditions. This is the goal, and it is a joy and so fun to work with patients on this journey and being able to reduce or take them off of other medications, and that is ultimately my goal with my patients is to keep them happy and healthy for as long as possible. And I hope the same for you. Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.