Three New Obesity Medicines With Dr. Marilyn Galindo

Today’s guest is a fellow board certified obesity medicine physician, Dr. Marilyn Galindo, founder of Leon Springs Obesity Medicine in San Antonio, Texas. Her practice is dedicated to provide compassionate and patient-centered care to individuals navigating the challenges of obesity. Dr. Galindo is also deeply committed to advocating for patients with obesity and helping them overcome the stigma and discrimination they often face. 

Follow Dr. Galindo on TikTok @marilyngalindomd

Weight loss medicine is moving so quickly that it can be hard to tell what’s real progress and what’s just hype. Today we sit down with board-certified obesity medicine physician Dr. Marilyn Galindo to sort through the most talked-about “next” options and what they could mean for real people trying to improve metabolic health, reduce insulin resistance, and treat obesity as the chronic disease it is.

We dig into high-dose semaglutide (Wegovy), including why higher dosing may unlock more total weight loss for some patients, what the studies show about variability in response, and which side effects may become more common as doses rise. We also talk about the practical art of prescribing GLP-1 receptor agonists: slowing down titration when needed, preventing constipation and dehydration, and why specialist-led care can improve long-term tolerability and adherence.

From there, we explore cagriSema, a combination therapy that pairs semaglutide with an amylin analog to potentially boost satiety and support meaningful weight loss. One of the most interesting questions is whether amylin-based therapy could help with weight loss maintenance by blunting the metabolic slowdown that often follows weight reduction. If maintenance is the real finish line, this is the part to watch.

We also cover orforglipron, a daily oral GLP-1 that may bring flexibility for people who dislike injections, travel often, or need simpler planning around surgery. Finally, we address what’s still in the pipeline, why buying unapproved drugs on the gray market is risky, and how we can keep pushing back on obesity stigma with evidence-based education.

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Transcript

Welcome And Medical Disclaimer

Dr. Lindsay Ogle, MD 0:00

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 treatment. 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. Welcome back to Modern Metabolic Health Podcast. Today's guest is a fellow board-certified obesity medicine physician, Dr. Marilyn Galindo. She is the founder of Leon Springs Obesity Medicine, located in San Antonio, Texas. Her practice is dedicated to providing compassionate and patient-centered care to individuals navigating the challenges of obesity. Dr. Galindo is also deeply committed to advocating for patients with obesity and helping them overcome the stigma and discrimination that they often face. And part of that advocacy work is with promoting evidence-based education on platforms like this, like podcasts, and then on social media, which is actually where we met because we have very similar messages to share. So thank you so much for taking the time to be here with me and my audience.

Why Dr. Galindo Chose Obesity Medicine

Dr. Marilyn Galindo 1:43

Thank you for having me. I'm very excited to be here and having this conversation where we can hopefully provide more education for our patients.

Dr. Lindsay Ogle, MD 1:50

Absolutely. Well, to get started, could you share a little bit about what brought you to the field of obesity medicine?

Dr. Marilyn Galindo 1:58

So I'm I'm internal medicine and I graduated about 10 years ago. And initially I was a hospitalist, actually during the pandemic. And it just made me realize like I wanted to do more than just treat very, very sick patients. So I found the field of obesity medicine and I started practicing. And I really enjoyed seeing how patients were just getting healthier and better and we were preventing disease versus, you know, treating end stage disease. So, yes, I have a very strong background in acute illnesses and hospital medicine, but I also really enjoy having my practice where I can actually help people be less sick instead of more sick. So, you know, it's it's just very rewarding and I love helping others. And so that's how I ended up in obesity medicine.

High-Dose Wegovy Benefits And Risks

Dr. Lindsay Ogle, MD 2:44

Yeah, I think that's amazing. And all of the experience and you know, education that you have for complex chronic disease and acute disease, I think can really strengthen your practice as an obesity medicine physician with that um preventative health focus. And that's also what brought me to the field as well. Um, so I I love that. And in prior um episodes, I've talked about um our current FDA-approved obesity medications. Um, and there are so many new medication options on the horizon. And so today we are gonna discuss three of those um that are coming out within the next year about. Um, so to start off that list, um, we're gonna talk about high-dose Wigovie. So I would just love to hear um what your um thoughts are about this new option um and what might be unique about the high dose Wigovi. Who might it be good for? So, what are your some of your thoughts?

Dr. Marilyn Galindo 3:54

Yeah, so as you and I both know in our practices, usually the higher the dosing of these medications, we tend to have a higher effect, right? So if you're on a higher dose of Wigovi, you're gonna have more weight loss. And currently the highest dose of Wigovi is about 2.4. I think there's studies now going up as high as 7.2. And so it's that's exciting because you know, before the only reason we're giving people 2.4 milligrams a week is because that's what we were told is the highest dose that is safe. So it's nice to have these studies that are saying, well, maybe we can push it a little further for those patients who need that extra weight loss, right? Because if you're right now, I think with 2.4, you get about 13 to 15 percent body percent weight loss from when you start, but some people need to lose closer to 20. So giving you that higher dose of semi-glutide might be good for those patients who have more weight to lose. Um, obviously, there are downsides to going up on the medicine because as we get more weight loss, sometimes we get more of the side effects. Um, those being things like nausea, more constipation, those are the most common ones. Um, but some people do tolerate it even on the higher doses. Like everybody's different. So for me, as long as we can give our patients more options to have them reach their goals, the better.

Dr. Lindsay Ogle, MD 5:13

Yeah, absolutely. And we were talking before we started recording how we both have patients who really do very well on WeGovi, um, even better than Z-Bound. Um, even though it seems like everyone is you know more excited about Z-Bound, it's on newer and um on average people lose more, but there are people, a subset of people who do better on semaglutide and we go V. And so those patients, um, this is a great option if they have not yet met their goals on their current max dose of the 2.4.

Dr. Marilyn Galindo 5:47

And I also think a lot of times, at least I know for me, because we do know these medications are a little bit more expensive than people can afford. So a lot of times I make the decision on what to start based on what patients can afford or what their insurance will cover. So it is nice that if those were not factors, there we do know that some people do respond better to semi-glutide versus terzepatide, right? So it's really like if we could do whatever we wanted in our practices with all those constraints in place, um, we could figure out really what worked for patients. And so I think there are patients that I have seen in my practice that do much better with semiglutide. They just have better weight loss, they like how it feels for them versus terzepatide. They're just a slightly different medication.

Dr. Lindsay Ogle, MD 6:28

So yeah, the more options we have, the better we will be able to treat our patients. Um one thing I wanted to mention, as you mentioned, as you mentioned, that the higher doses on average people are going to lose more weight. When I was looking through the study for this higher dose, um, I just wanted to touch on that there were like 30% of patients lost 25% of their body weight or more. And so while the average is like right under that, it's like 18 to 20%, I think it was on average. There are a pretty decent amount of patients that are able to lose 25% or more. And that just highlights that there's that very variable response from person to person. Exactly. Um, the other thing I noticed that was different about that, um, that high dose was that there was a like the pens and needles side effect, like that sensation of like a pens and needles um sensation is more common at this higher dose, which um I don't have a lot of patients mention to me uh the current doses. I don't know if if you've had any patients have that side effect, but it looks like that might be more common on this higher dose.

Dr. Marilyn Galindo 7:42

Yeah, I have had a few patients mention that to me as they get, especially to the higher doses of either medication where they start to feel like it it kind of would feel like you said, like pins and needles or like an odd sensation like in their skin. Um, but usually it goes away with time, I've noticed, or we'll just think about if it's really bothering them, then we'll sometimes have to go back down and then it usually resolves. So um that is something very interesting that, like I said, as you get higher in dosing, you are gonna start to see some of these more um rare side effects actually probably um come to light because of the higher doses.

Dr. Lindsay Ogle, MD 8:21

Yeah. Um that also makes me think about how we're learning more and more about GLP1s as a medication class and how they really interact with so many different, you know, parts of the body. Um and also then um that's why we're finding out that they're helping with so many different medical conditions as well.

Dr. Marilyn Galindo 8:42

And that also kind of reminds me of like, remember when we started uh prescribing these medications, we were all kind of doing that very monthly increase in dose, like it was recommended. But I what I have found now is that you really do have to adjust the dosing to the patient. Um, so I wonder, like in these trials, a lot of times they bring up the dosing, they have a schedule, right? So I wonder if like maybe you give people more time, then you don't see those side effects later on. Um, I know for a fact, like a lot of my patients don't have a lot of side effects, but we do tend to go pretty slowly because I feel like if it's working, there's no need to go up until it's not. And so um so that is interesting too to see kind of what happens. Like maybe somebody has been on semi-glutide 2.4 for a long time and then going up to 7.2 is not a big deal because their body's just kind of used to it by now.

Dr. Lindsay Ogle, MD 9:32

Yeah, I think that's such an important point. And um, I've heard that there are also studies that show that if somebody is being managed by an obesity medicine physician, a specialist, that they are much more likely to tolerate them the GLP1 or their medication and stay on it long term because we have more of that experience and that nuance and comfortability of um really individualizing the treatment rather than following that to just standard protocol.

Dr. Marilyn Galindo 10:03

Yeah. And as somebody who also practices hospital medicine, I will say a lot of times we do get patients in the hospital that have things like pancreatitis, dehydration, severe nausea and vomiting because of their GLPs. And most of the time it's because the person prescribing it, you know, didn't give them enough education about what to do. Or um did, like, for instance, I'll have patients that are like, oh, it's probably your medication that's causing your constipation. And they're like, nobody ever told us that. And I feel like if you're obesity medicine specialist, you're gonna spend the time to educate the patients on these are the side effects you need to watch out. This is what you need to do to prevent those things. So I agree with you, it does make a big difference who is prescribing your medication and who's managing your care.

unknown 10:46

Yeah.

Dr. Lindsay Ogle, MD 10:47

Um, and then just to touch on when we might be able to expect um this semaglutide 7.2 milligram dose to be available. Um, it looks like maybe sometime this spring. Um, we will see, but hopefully in the next couple of months, that'll be available to our patients.

CagriSema And The Maintenance Problem

Dr. Marilyn Galindo 11:04

Yes, any new medication is very exciting for us because it just means one more option for our patients.

Dr. Lindsay Ogle, MD 11:10

Absolutely. Well, speaking of another option, um, I wanted to now touch on the cargi semma, um, which is a combo medication. So can you tell us a little bit about this option?

Dr. Marilyn Galindo 11:24

Yeah, so this is a combination of semiglutide, which is where the sema part comes from, and then the cargoneltide, which is an amlin hormone, which is made in our pancreas. Um, that hormone also helps regulate things like satiety, that feeling of fullness that patients have. Um, it also helps regulate your blood sugar, very similar to some of these other hormones. So, what they did is they combined the two and they wanted to see if this combination of semiglutide with the canilitide um gave you more weight loss. And there's a lot of very promising studies that it's actually very similar to terzepatide and the amount of weight loss that you get. Um, I know there was an article recently that compared the two, and there was some disappointment because it was like 1% less than terzepatide. But honestly, like in my opinion, 20% weight loss is still very significant. Um, for a lot of patients, that's a life-changing kind of amount of weight loss. Um, so I'm still very excited about it because again, it's another option that we will have. And the the studies are very promising, especially in patients with obesity. Like you said, some patients do lose above the 20%. That's just the average. You're you do have other patients that are above 25%. Yeah, absolutely.

Dr. Lindsay Ogle, MD 12:42

Um, one thing in what one of the articles that I was looking at with this new amylin um analog option is that there may be um like prevention in the compensatory decrease in energy expenditure. So, like when we uh when anybody loses weight, then their metabolic rate, a resting metabolic rate goes down. Um, but there's thought that this may the amylin analog may prevent that. And um current studies are not long enough to really know if that's happening. So I'd be really interested to see as we are able to use this medication if that pans out to be true, because right now we've really gotten down with our tools, the weight loss portion, but it's weight maintenance that can be so tricky and difficult. And so if we can maintain um the metabolic rate at a higher at a higher rate, and that can really help with weight maintenance long term. So um I thought that that was really interesting.

Dr. Marilyn Galindo 13:45

That is really interesting because, like you said, maintenance is I always tell patients like we're gonna get you to lose weight, but maintenance is the hardest part of this journey because you it's like you get to the finish line, but it's not really the finish line. You still have to put in the work, you still have to like take your medicine a lot of times. Yes, there are a few people that can get off of medicine, but not most people who have struggled with obesity their whole life. It is a chronic disease. Um, so if you have a drug like this that you're not having to decrease your metabolic rate as the smaller you get, then that's a really powerful tool for people like us to be able to prescribe to patients who need to maintain their weight.

Dr. Lindsay Ogle, MD 14:25

Yeah, yeah, absolutely. Um and then just to clarify, this is also a weekly injection like our current sema glutide. Um, and it's looking like this may be available end of 2026, early 2027. Um, so that's kind of the time frame that we're looking at for that medication. Um, any other thoughts about Cargi Semma?

Dr. Marilyn Galindo 14:52

No, I I just think it's another great option that we can offer patients, and so I'm excited to see how that works. And you know, it's always tricky when we get new medicines, like we just had Oral Wick Obi come out earlier this year. And so I'm excited to see which patients I can recommend it to based on the studies and um all of the usually when new meds come out, we get a lot of information from the reps on how to dose it and things like that. So I'm excited to see what how we can start treating patients with it.

Dr. Lindsay Ogle, MD 15:23

Yeah. A thought I just had while you were um talking was I I wonder for patients who have been on semaglutide or regove and maybe are uh, you know, they've they plateaued um at the 2.4 milligram dose. I wonder if they switched to the cargesema, how they would respond. Like, would that provide additional effects? Um, I don't think that that has been looked at at the end.

Dr. Marilyn Galindo 15:51

I don't think so either. And actually, when I was reading some of the studies that we were looking over to prepare for this podcast, I was also wondering like they didn't really talk about the dosing that much. They said it was like a single dose or something like that. So I I had more questions about that. So that's why I'm like saying, like, I can't wait to see what the packaging is once it comes out because um, you know, currently we're so used to like dosing up, but you're right, there's people who are already on semi-glutide doing well. How is the conversion going to be from switching them from that medication to the other? And yeah, so we have a lot of questions, but it is exciting what we're seeing. And so I know that by the end of the year we'll have a little more experience with this medication.

Dr. Lindsay Ogle, MD 16:30

Yeah. And then I think that also highlights like the nuance in why working with a specialist can be helpful, um, especially if you've had struggles along the way. Um, yeah, having someone that focuses on this would be really beneficial.

Dr. Marilyn Galindo 16:45

Yeah, I will say like one of the things that's very exciting about doing this field is we're always learning new things, right? Like I'm constantly reading articles and the new literature because there's so many new things going on and new studies, uh, new indications for medication. So you're right, like you have to constantly be educating yourself on what how you can best treat your patients.

Orforglipron A Flexible Oral Option

Dr. Lindsay Ogle, MD 17:07

Yeah. All right. So the third one that we're talking about today um is harder to say, um, or for glipron. Um and tell me what this medication is and what we can expect from it.

Dr. Marilyn Galindo 17:24

Okay, so this is a medication, an oral medication from Eli Lilly. It's also an oral GLP1 medication. Um, it's daily. So I think this is a great option for patients who do not like um injectables. Um, we do have a population of patients who don't like needles um or who would prefer a daily medication. I also think that there are benefits from daily medications. Like, for instance, when you're doing a weekly medication, like an injectable, let's say you're getting surgery, right? And all of a sudden you have to really plan ahead and be like, I need to stop my injection. Well, if you're on an oral medication because they're daily and the effect is only like about 24 hours, you can probably pause it a day or two and it's not a big deal, right? You're not having to like stop and then restart. So there are definitely a lot of advantages to having an oral medication. Um, why I'm excited about this medication, it has less weight loss than some of the other ones. It is oral, but unlike oral wigovy, where you have to take like an hour before you eat anything, it doesn't seem to matter when you take orgobliferon. You can probably take it with food. And I think that adds flexibility to that medication, because I can only imagine if you're taking several medications and you really have to plan and be like, okay, I have to take the oral wigovi before these medications. This one, you don't have that level of planning to do. So I think that's a pro. I also look at this medication more as because it doesn't give you as much weight loss, like we're talking more like 10% kind of level. I see it more as a maintenance tool. Um, I see it as like, and they actually did a study where they looked at um this medication after people had been on trzepatide and semiglutide and they had achieved like basically their goal weights. And they put people on this medication for a year, and in a year, they hadn't regained any weight. So I think for me, that's what I'm looking forward to using this medication for. Yes, if I have people that need to lose only like 10% of their body weight, this might be a great option for them. But if I have somebody who has already lost their weight and they're at goal and now they want to maintain, this could be a great option if, especially if the oral option is cheaper than the injectable, right? So this could be a great option for somebody in maintenance. And so that's why I'm excited about this medication, because I think it just gives another option for patients who are trying to maintain.

Dr. Lindsay Ogle, MD 19:53

Yeah, that's a great summary. And I have a lot of similar thoughts, especially with the fact that you can take it with or without food and with seemingly with other medications. And um, because so far when I've talked to patients about oral, we go V, and then I talk about everything, all the instructions you have to follow for it to be absorbed appropriately. Um, I haven't had a patient uh start it yet because of those limitations. Many patients are taking other medications in the morning, it just doesn't work for their morning routine. So having that flexibility to, you know, take it with other things is is huge. Um also, you know, the surgery part that's a great point. But for people who are traveling often or um, you know, the environmental impacts as well, there's less packaging and just like a typical medication pill container versus the weekly injectable um medication. So anyone who's worried about those environmental impacts, this is a great option too. Um, and then that's really great. I didn't see the study for maintenance, um, but how we were talking earlier, like maintenance can be the more the trickiest part. And so to have this as a maintenance tool would be wonderful, especially with um the hope that the pills will continue to be less expensive than the injectable option. So um hopefully it can make it more affordable affordable for many people. Um the average is uh average weight loss is lower, um, but again, there is a spectrum of people who respond. So um there are people who still get that 20 plus percent um body weight loss with um this option. So um everyone responds a little bit different, but on average, yeah, less than um our injectable options.

Dr. Marilyn Galindo 21:44

Um also I think in a lot of the articles, they did make a difference between people who already have obesity and diabetes, right? Versus people who just have obesity. And this is why I think prevention is so important, right? We want to start treating you before you develop. Diabetes because these medications work better for people who just have obesity. I mean, obviously they're still very powerful diabetic medications. Like I see patients that start off with very high A1Cs, we start them on these medications and then their A1Cs are now normal and they've lost weight too. So um, but I I also want to make that distinction because it is like a spectrum, right? Like if you have um just obesity, you're probably gonna lose more weight than if you have diabetes. And one of the reasons is sometimes when you already have that diagnosis of diabetes, you're on other medications like insulin who that promotes weight gain. Um and so it's a little bit harder to um have you lose significant amounts of weight on these medications.

New Drugs Hype And Safety Warnings

Dr. Lindsay Ogle, MD 22:43

Yeah. I'm so glad you brought that up because that was something that was very clear in the studies. Yeah, people who have um more advanced insulin resistance and type 2 diabetes and metabolic dysfunction, they are not gonna get the same effects as somebody who is earlier on in that um spectrum of disease. So again, we want to catch and treat um conditions as early as possible when treatment is more effective. Um, so yes, thank you for highlighting that. Um, I did want, we're not gonna go into details about other medication options, but I do want to um, you know, at least say that there are even more medication options um in the pipeline. Um, Reduchu Chide has been talked about a lot. Um, the triple G is what people talk say um sometimes on social media. Um, people are very excited about this option. It seems to be very effective. Um, I just want to say if anyone is trying to you know prescribe you that or sell it to you, it is not on the market yet. It is not safe to take right now. That would be definitely like the gray and black market of getting that medication. So we are not ready for it. It's not been proven safe and effective yet, um, it although studies are promising. Um, and then there are other medications out there. Um, I don't know if you have any thoughts about what's down the pipeline or um, you know, any of those future treatments.

Dr. Marilyn Galindo 24:12

All I know is that whenever I've been to an obesity conference, I leave those conferences very excited because there are so much research going on right now. And that's kind of what I want to leave our listeners with is like if you are currently on the existing medications that we currently have, semi-glutide, terzepatite, or a wigovi, like there is more coming. So if those are not working for you, we could possibly try others. And Redaturchite is very exciting. We're not gonna go into depth about that one, but that one should be coming out hopefully by the end of the year. And the reason that's exciting, because that's the highest percentage of weight loss that we've seen any medication give us, close to bariatric surgery level weight loss. And so I think that's a very good option for people who suffer from severe obesity. Um, obviously, we need to wait until it comes out and it's actually approved by the FDA. And you're correct, like we should not be buying this medication if it's available because you don't really know what you're gonna get. Like it's not approved yet. So um I just want to leave the view like the VR listeners by saying, like, we are excited because we are in in a very exciting era of getting more medications for a disease that for so long we weren't treating or we were under treating. Yeah, absolutely.

Dr. Lindsay Ogle, MD 25:33

Well, I think that's a very positive note. Um, any other, you know, final thoughts um about just obesity treatment in general, um, or advocacy thoughts, or any last um comments that you have?

Dr. Marilyn Galindo 25:49

Um I'm I'm excited that we're we have more of these platforms where we can share our knowledge about obesity medicine because we are definitely at a time where things are changing and shifting. Like before, you know, you would go to the doctor and people would just say, Oh, you need to lose weight, diet and exercise. And that's pretty much all the guidance. But now we have more knowledge and we know obesity is a disease that also is associated with 200 other metabolic diseases. And um, and so treating your obesity actually does make you healthier overall. And so I love that we're changing our mindset in medicine about how we treat obesity. And I think it's so important that you have a platform like this where you can share your knowledge or on social media where you can talk about these things because the more people understand that this is not a willpower issue, that this is really a disease like hypertension or diabetes, then we can help more people because obesity is one of the largest problems in healthcare that we currently have. I mean, there's over a billion people that already suffer from this disease currently in the world. And then about 46% of people in the US suffer from obesity. So it's not something that should be ignored and we should continue to advocate for our patients who for so long were being under-treated or not treated at all, really.

Advocacy Where To Find Dr. Galindo

Dr. Lindsay Ogle, MD 27:07

Yeah, absolutely. It's an exciting time to be in the field, and I'm so thankful that I was introduced to it during my residency training. So pretty early on, um, and I'm glad that you um found your way to OBC medicine as well. Um, and again, I think it's so wonderful that you're kind of practicing both um sides of medicine in the hospital setting and then in the outpatient and preventative side. So that's wonderful that you get that full spectrum because it brings so much, you know, um, knowledge uh to your patients. Um and then also like we started off talking about how we met on social media and you're sharing your knowledge with a you know large platform as well and reaching more people. Um, so if anybody who is listening and they're wanting to follow you to learn more on social media or if they're interested to become your patient, um, where can they find you?

Dr. Marilyn Galindo 28:05

So um currently I'm on uh I'm on TikTok and Instagram under Marilyn Galindo MD. Um you can find me on those two platforms. Um and also if you are interested in joining my clinic, you could just go to my website, leonspringsobesitymed.com. Um, and you can either set up a meet and greet with me or text or call my clinic, and then we'll call you back and you know explain the process of joining. And um, and if I can help you, I will. Um, so definitely reach out if you would be interested. And I treat patients all over Texas. So anybody in Texas, you can reach out to me. That's wonderful. Well, thank you so much for being here. I really appreciate it. Thank you for having me. This was wonderful, and I hope our listeners get a lot out of this um podcast.

Dr. Lindsay Ogle, MD 28:53

Thank you for listening and seeing 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.