Link Between Obesity and Inflammation with Dr. Isabelle Amigues, MD

Isabelle Amigues, MD, CEO and Founder of UnabridgedMD in Rheumatology  Isabelle Amigues, MD, is a rheumatologist based in Denver, Colorado. She honed her expertise by studying in Paris, as well as at Columbia University, in New York City. At age 40 she was diagnosed with stage IV metastatic breast cancer. A timely meeting with a non-traditionally trained practitioner taught her a different approach to disease where she experienced the power of meditation, visualization, energy healing, and love. Her journey through cancer inspired her to learn more about these alternative techniques and she now blends western medicine and eastern techniques into her practice at UnabridgedMD.

Website: UnabridgedMD.com
Youtube: @Rheumatology101
Instagram: @unabridgedmd
Facebook: @UnabridgedMD
X: @UnabridgedMD

Fat tissue isn’t just “extra weight.” It can function like an immune-active organ, packed with inflammatory cells that quietly raise the baseline inflammation in your body. That one shift in understanding changes how we think about obesity, insulin resistance, and chronic disease and it may explain why conditions like rheumatoid arthritis and psoriatic arthritis can be harder to control when excess adipose tissue is in the mix.

We’re joined by Dr. Isabelle Amig, a board-certified rheumatologist in Denver and the host of Unabridged MD, to unpack what the research and real-world clinic patterns are showing. We talk about what doctors literally see in fat biopsies, why ongoing inflammation becomes “fuel on the fire” for autoimmune disease, and how obesity can raise risk and severity in inflammatory arthritis. Then we connect the dots to cardiometabolic health, including why systemic inflammation also matters for cardiovascular disease and kidney outcomes.

We also go deep on GLP-1 receptor agonists and why their impact may extend beyond appetite and weight loss. Dr. Amig shares why some patients report feeling better fast, sometimes before significant weight changes, and how emerging science suggests a direct anti-inflammatory effect at the cellular level. Finally, we address the stigma head-on: insulin resistance is common, menopause and biology play a role, and using evidence-based obesity medicine isn’t a moral failure.

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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 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.

Fat Tissue As An Inflammatory Organ

Dr. Lindsay Ogle, MD 0:44

I am so excited for today's guest. I know I'm gonna learn a lot today, and I'm sure you will as well. Today I have Dr. Isabel Amig. She is a board-certified rheumatologist based in Denver, Colorado. And not only does she see and take great care of her patients, but she shares her knowledge with all of us on her podcast, Unabridged MD. And I love her mission. Her mission is hope, this to bring hope driven by science, which I think is so powerful. And today we're going to talk about the link between obesity and inflammation and how the role and how GLP1s can help manage both of those chronic conditions. So, Dr. Amiek, thank you for being here.

Speaker 1:30

And thank you so much for having me. Thank you.

Dr. Lindsay Ogle, MD 1:33

Yeah, so let's just get started. Um we used to assume that adipose tissue or fat cells really were inert and they just held on to our extra energy to use in the future, but we now know that is not the case and they're highly active cells. Could you just share a little bit more about how these cells are active in our body and how they contribute to inflammation?

Speaker 2:00

Yeah, absolutely. So I've, you know, um, so we could go into a lot of very nitty, like greedy uh details uh that you know would probably not be super clear for everyone. But basically, uh when you do biopsies uh and you can actually do uh fat biopsies, so you can uh you can take it in uh the abdomen, you can take the fat tissue biopsy, and if you're looking at it under a microscope with the proper staining and so on, you actually can see macrophage, which are inflammatory cells. And uh what we have found in psoriatic arthritis, so uh it's a very inflammatory arthritis, but we've also seen it in rheumatoid arthritis, and we probably are seeing it in other autoimmune disorder, but that that's pretty clear in those two, uh, is that the more adipose tissue you have, the more risk of inflammatory arthritis you have. And you not only have a chance to develop more, uh, like you know, develop rheumatoid arthritis or psoriatic arthritis, you actually also develop more uh activity, so more severe disease if you have uh more adipose tissue. And so while we thought that adipose tissue was inert, we are actually now clearly showing that it is inflammatory. And so the more, I mean, it's probably like everything in our body, you have to have a balance. If you have not enough, that's not great. But if you have too much, that is also not great. And so if you have too much adipose tissue or that they are hypertrophics or too big, there are more inflammatory activity. Thank you for explaining that. And like you said, trying to make it simple.

Dr. Lindsay Ogle, MD 3:43

Yes, we could go into the weeds and talk about specific inflammatory markers, but I don't think that that's as important for you know day-to-day application as just the general understanding. So thank you for that. Um, and you kind of answered my next question, just how does it um how does excess adipose tissue um cause inflammatory conditions, or how might it make it more severe? Because you're saying it says if you have excess adipose tissue, then you have more inflammatory markers, and that could lead to chronic inflammatory conditions like rheumatoid arthritis or psoriatic arthritis, and um it could lead to more severe disease. Um and I'm curious what your thoughts are about um using GLP1 medications to help manage these conditions. How do they play a role?

Speaker 4:34

Yeah, and we can talk about GLP1, but there is something I wanted to just touch uh, uh just to go a little bit more in uh in more details about this inflammation related to uh fat tissue.

How Excess Fat Fuels Arthritis

Speaker 4:46

Um, I truly believe that the way that our body heals is to create inflammation, right? So uh, if you think about it, when we have the flu, our body creates inflammation. And because there is this inflammation, we can heal, right? The issue is if the inflammation is ongoing. And when you have an inflammatory arthritis like chromatoid arthritis or psychotic arthritis, the issue is that your body never gets back to normal. And when you are having too much adipose tissue, the issue is that you're creating a fuel on the fire. So you already have an inflammatory condition, and then you're adding those markers that are, you know, proteins such as NF kappa B and so on. And I'm not gonna go into this, but we have like those little proteins that are causing inflammation. And so on top of having already a predisposition for rheumatoid arthritis or psoriatic arthritis, you're adding that. And so people who may develop rheumatoid arthritis way down the line are developing it earlier, or maybe people who would not have developed it are gonna develop it, right? Because there is this ongoing inflammation that's tipping the patient down to having an inflammatory process. Um that's something that I wanted to share. And it's gonna link into the GLP1 agonist.

GLP-1s And Rapid Symptom Relief

Speaker 6:11

So I'm a huge fan, a huge fan. Um, I've I was the first uh rheumatologist to uh I actually referred my first patient to a necrinology because she had psychoatic arthritis, we couldn't get her into remission, and she had diabetes. And I was like, I think you need to be on GLP1 agonist. I really think so. She comes back and she has lost, I think she had lost 15 pounds and full remission. And why the 15 pounds, you know, yes, she had lost some weight, but she was still obese, right? Uh, I couldn't really completely explain explain why she was in full remission with just that one added benefit. But now it makes sense in psychatic arthritis in a way, right? We know that adipose tissue is pro-inflammatory, especially in psoriatic arthritis. And then what are we going to decrease with like what we're finding is that if we're decreasing the inflammation with GLP1 agonists, we are decreasing uh NF kappa B as well. And so we're decreasing inflammation. So um we've I think it was about a year ago, we had already, like there was already uh an article in Nature in one of the big journals of medicine that showed that like we're already raising that point of probably GLP1 antagonists are anti-inflammatory more so than just by their decreasing the um fat tissue, right? It's not just decreasing the weight, there's clearly an anti-inflammatory uh component. And uh there are studies and they are ongoing and we're seeing that. And it's like in my practice, where you know, not all my patients are needing GLP1 agonists, we're seeing that, where a patient is almost in full remission, but not just there yet. Like, and you keep trying different stuff, but they are not there yet, you and but they are, you know, they are overweight or obese. You put a GLP1 agonist, bam, they're going into full remission. That's our goal, right? Food remission. And uh some people are a little bit um, you know, they are a little bit afraid about those drugs, and I get it. But the truth is that I think it's a balance of realizing how much chronic inflammation can cost your body, which is not great, versus those GLP1 agonists who have been on the market for over 10 years now because we have uh clearly demonstrated that people who have renal disease or heart disease uh don't need emodialysis and don't have heart failure as much as they used to be. And it first was started in uh diabetes, but we're seeing it now like everywhere. Those drugs have the potential of changing the face of medicine. Uh, and so to me, that's extremely exciting.

Dr. Lindsay Ogle, MD 9:07

Yeah, I agree. I think it's the we're gonna find just continue to find so many benefits. And like you said, these medications, the first one, um, I believe it was Baieta on the first GLP one that was FDA approved back in all the way back in 2005. Um, and I don't know how often it was used back then, but um they've been on the market for a few decades now, and we've just continued to see positive benefits. And when they're prescribed, you know, appropriately with good guidance from a physician, um, plus or minus a dietitian, then people are having great results and um tolerating them very well overall. Um, at least that's what I see in my practice, and hopefully that's what you're seeing as well.

Speaker 9:49

So Zulu. Oh, absolutely. Yeah.

Dr. Lindsay Ogle, MD 9:52

And I um I have two follow-questions about using GLP1s in chronic um inflammatory conditions. Um, but I also want to thank you for bringing up the fact that this truly is a spectrum of disease. That's so many, really probably all of our chronic medical conditions really are a spectrum. And so the earlier we can identify where somebody is on that spectrum and interven intervening there to prevent, you know, more significant disease or even prevent the development when someone's at a high risk, they're gonna have better outcomes and you know live longer and fuller lives. So thank you for bringing that up. Um, the two follow-up questions I have one was about just the anti-inflammatory effects of the GLP1s, because I've seen in my practice and I've seen people talk about it on social media how right away when they started, they felt better, they have less joint pain or more energy or other systemic benefits prior to even losing any weight. And so I'm assuming that's those anti-um-inflammatory properties of the GLP one. But I was curious if you have anything to add on.

Speaker 10:58

That's exactly it. It's basically uh that we think, and it's this is still ongoing and it's gonna take a little bit of time to actually prove, but uh clearly there is an anti-inflammatory effect. Um, so I mentioned the NF kappa B, but really what we have to realize is that uh like the uh the mechanism of action is you know, we're still learning about how it works. Uh and yeah, most of the time we know that it decreases uh weight by decreasing the calorie intake, but what we are failing to recognize yet, and we're starting to learn about it, is that it has an anti-inflammatory effect directly intracellular, like at the cell level. And that is what causes our patients to have less symptoms of inflammatory arthritis. Yeah. We're still learning. I think we have to be very uh open-minded about that and very excited uh about researchers that are doing this work because it is there, we're doing it, and we're looking into this.

Dr. Lindsay Ogle, MD 12:00

Yeah, absolutely. Yeah, we always have to have that you know open mindset and growth mindset and learning more. And um, this is a little bit of a tangent, but just uh like some underlying causes that are systemic, like insulin resistance or chronic inflammation. I think we're just continuing to learn more and more how those are truly the underlying causes of many of our chronic diseases, especially cardiovascular disease. And you mentioned kidney disease and even you know liver function. I think we're gonna start being able to tie that all together. And these medicines really have been, I guess, one tool that has shown to link all of those things together, which is really exciting.

Speaker 12:46

It is, it is absolutely yeah. I think that all diseases are probably inflammatory. Uh, we know that cancer is uh due to uh ongoing inflammation. We know that there is more risk of recurrence of breast cancer if you are overweight. Uh so there's definitely a link between inflammation and overweight and obesity. And uh in cardiovascular disease, there's a there's a link of cardiovascular disease with uh rheumatoid arthritis or you know, psychiatric arthritis, like inflammatory arthritis cause uh chronic uh condition of heart failure, uh, coronary artery disease. We know that. And then suddenly you're putting GLP1 agonies that are decreasing the inflammation, it's gonna help not just the heart, but also the joint. So I I fully agree with you. I'm looking at it from a very systemic uh perspective because that is what I do as a rheumatologist. I look at the patient in his whole, it's not just the joint, right? Um, but yeah, it's fascinating and it's very, very exciting.

Adjunct Therapy Now Replacement Later

Dr. Lindsay Ogle, MD 13:51

Yeah. And my second question about using GLP1 medications in chronic inflammatory conditions and in your your practice is do you see this as an adjunct to I guess typical treatments, or do you could you see a role where this could replace other treatments? Yeah.

Speaker 14:10

What a good question. What a very, very uh very good question. Okay, I would say right now, with the evidence that we have, it's just an adjunct, right? Uh that said, I think that a patient that is uh you know clearly obese uh and that has inflammatory arthritis, you could potentially think, okay, can I get them to full remission with just a GLP1 agonist? My take on managing rheumatologic conditions is that you don't want a fire for too long. And so I um my goal is to put off the fire as fast as possible. To do this, you may need both, right? You need a rheumatologic, anti-rheumatologic uh drug, and you may need a GLP1 agonist. And then you can see how you do. I think most patients would rather not be on a GLP1 agonist long term. So we get them off, and then we decrease the amount of immunosuppression to the least amount that they need. That's the goal, right? But if you're in a healthy body weight, you have much less uh adipose tissue, it's less inflammatory, and so on. I mean, you probably are feeling better anyway, and you probably don't feel as much rheumatoid arthritis or epsilonic arthritis symptoms. So uh it would be interesting to see. I think this we will only know this answer, get this answer in the next five, 10 years. I don't think we're gonna know that just yet. So very exciting time to be.

Dr. Lindsay Ogle, MD 15:43

Yeah, absolutely. It's such an exciting time to be in medicine, especially in these fields. Um, well, this was all super helpful. Do you have any other thoughts um that you would like to share on this topic, whether it's general knowledge or your thoughts about the future?

Stigma Insulin Resistance And Getting Support

Speaker 15:58

Yeah, I do. I think because I'm French, so I really, I really want to actually. Um I find that a lot of patients that we offer the GIP1 agonist have a lot of judgment about it. And they feel like they haven't done it's their fault, uh, you know, that they did something to themselves. No, it's not. And I think insulin resistance uh is you know a big issue in uh in America. Uh I think that people are more and more willing to understand that you know what we put on our plate is what creates our bodies, so they are they are more cognizant of that. Uh, and uh so it's really, really hard to be healthy in a world that keeps advertising fast food. Uh, you know, that's that's the number one. So no guilt about that. And the second is that um it's not our fault. Like, for example, menopause can cause incident resistance, right? Like and and and uh and withholding a medication to help us does not actually help us. And I think um, you know, for me, the way I see it is put the GLP1 and a healthy lifestyle so that we can go off of the GLP1 agonist, you know, down the line with keeping the healthy lifestyle. But at first, you may need some help, and it doesn't mean that you've done something wrong. Uh, and you know, for me, it's like, yeah, you wouldn't say no to chemo uh if you had uh stage four cancer. So then why would you say no to advances in medicine if you know that it's gonna help? Yeah.

Dr. Lindsay Ogle, MD 17:47

Yeah, I love that message. Yeah, it's not your fault, and we have these safe and effective tools that we can use, and uh, they are have been proven to be very beneficial. And so um I I see that too. Like people are very nervous to try the medication. Um, but I think it's something to at least consider and talk with you know your doctor and see if it could be beneficial to you.

Speaker 18:14

Yeah. And if anyone is in the do you see, you see patients, do you see patients all throughout Colorado or just yeah, I see patients all throughout Colorado via telehealth, but I have two offices, one actually free, but uh so two in Denver and one in Boulder. We just are starting to see our first patients uh this week in Boulder. So I'm super excited about that. Uh it's not super far away. Uh and yeah, and then we have uh YouTube videos where I do uh weekly lives uh to explain a little bit more rheumatology because I love it. And then, you know, everything is under unabridged MD, and the lives are rheumatology 101 by Dr. Isabelle

Where To Learn More And Closing

Speaker 18:55

Amig, A-M-I-G-U-E-S. But rheumatogy 101 should get you there. Now ready.

Dr. Lindsay Ogle, MD 19:01

That's awesome. Well, thank you so much for taking the time here today to talk with me and then all the time you take to share your knowledge with the broader population. I think we're all better with some accurate, reliable health information. So thank you again. 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 and they may also improve their metabolic health. I look forward to our conversation next week.