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Inside the clinic: GLP-1s with Dr. Rekha B. Kumar

20 min episode · 2 min read
·
Rekha B. Kumar

Episode

20 min

Read time

2 min

Topics

Productivity, Health & Wellness, Personal Finance

AI-Generated Summary

Key Takeaways

  • Drug Efficacy Evolution: First FDA-approved GLP-1 Saxenda showed 60% response rate for 5%+ body weight loss. Newest dual agonist ZepBound achieves 90% response rate, treating significantly more patients effectively. Second-generation tirzepatide demonstrates less muscle loss compared to semaglutide, with future compounds like bimagrimab targeting preferential fat loss while increasing muscle mass.
  • Weight Regain Data: When patients with high BMI and weight-related comorbidities stop GLP-1 medications, two-thirds of lost weight returns within the first year. Lower BMI patients without significant metabolic disease may successfully cycle on and off medications, using them intermittently when weight regain occurs rather than continuous lifelong treatment.
  • Optimal Usage Protocol: Patients should use appetite suppression from GLP-1s to make deliberate food choices rather than simply eating less. Focus on high protein intake and weight training to preserve muscle mass during weight loss. The goal targets metabolic health markers and functional improvement, not lowest possible weight, as plateaus occur at different points for different individuals.
  • Telehealth Access Model: Obesity care traditionally concentrated in academic centers with year-plus wait lists. Telehealth democratizes access nationwide, particularly effective for endocrinology, obesity medicine, and psychiatry which saw volume increases during COVID while surgical specialties declined. Comprehensive platforms integrate physician prescribing, coaching support, and lifestyle modification guidance.
  • Health Equity Concern: GLP-1 medications demonstrate 20% reduction in heart disease plus benefits for neurodegenerative disease and fatty liver. High medication costs create potential two-tier health system where wealthy populations access preventative benefits while lower-income populations face continued metabolic disease burden until patent expiration enables broader access.

What It Covers

Dr. Rekha B. Kumar, endocrinologist and Chief Medical Officer at Found, explains GLP-1 medications for weight management, covering efficacy rates (90% lose 5%+ body weight on newest drugs), side effects, patient selection criteria, telehealth delivery models, and long-term treatment expectations including weight regain patterns when medications stop.

Key Questions Answered

  • Drug Efficacy Evolution: First FDA-approved GLP-1 Saxenda showed 60% response rate for 5%+ body weight loss. Newest dual agonist ZepBound achieves 90% response rate, treating significantly more patients effectively. Second-generation tirzepatide demonstrates less muscle loss compared to semaglutide, with future compounds like bimagrimab targeting preferential fat loss while increasing muscle mass.
  • Weight Regain Data: When patients with high BMI and weight-related comorbidities stop GLP-1 medications, two-thirds of lost weight returns within the first year. Lower BMI patients without significant metabolic disease may successfully cycle on and off medications, using them intermittently when weight regain occurs rather than continuous lifelong treatment.
  • Optimal Usage Protocol: Patients should use appetite suppression from GLP-1s to make deliberate food choices rather than simply eating less. Focus on high protein intake and weight training to preserve muscle mass during weight loss. The goal targets metabolic health markers and functional improvement, not lowest possible weight, as plateaus occur at different points for different individuals.
  • Telehealth Access Model: Obesity care traditionally concentrated in academic centers with year-plus wait lists. Telehealth democratizes access nationwide, particularly effective for endocrinology, obesity medicine, and psychiatry which saw volume increases during COVID while surgical specialties declined. Comprehensive platforms integrate physician prescribing, coaching support, and lifestyle modification guidance.
  • Health Equity Concern: GLP-1 medications demonstrate 20% reduction in heart disease plus benefits for neurodegenerative disease and fatty liver. High medication costs create potential two-tier health system where wealthy populations access preventative benefits while lower-income populations face continued metabolic disease burden until patent expiration enables broader access.

Notable Moment

Kumar describes the reversal in patient behavior over ten years. Previously, patients arrived embarrassed after trying everything, viewing medication as last resort failure. Now patients specifically request GLP-1 medications after observing friends and family succeed, representing rare medical condition where patients actively seek pharmaceutical treatment rather than physicians recommending it.

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Episode Transcript

Welcome to the RTW podcast. I'm your guest host, Stephanie Sirota, partner and chief business officer leading the strategic partnerships team and RTW Investments. Today, I'm speaking with doctor Rekha b Kumar, endocrinologist, obesity medicine specialist, and chief medical officer at Found. Found's platform integrates the latest medical research and clinical practices, ensuring that users receive evidence based effective treatments. The first medical director of the American Board of Obesity Medicine, Rekha currently practices endocrinology in New York City. Rekha, thank you so much for joining us in the studio today. Thanks for having me here. Well, why don't we start actually with your fascinating background. Tell us why you went into medicine. You're an internist, endocrinologist focused primarily on female patients. I'd love to hear a little bit about your practice and what shaped your journey through school and then into clinical medicine. I would say my interest in medicine actually stemmed from my interest in endocrinology even as a teenager. I loved learning about exercise, muscle metabolism, and nutrition. I was a gymnast growing up. I was always intrigued by muscle mechanics, and that led me down a path of science, biology, medical school. And once in medical school, I really knew I wanted to focus on a specialty that included every organ and understanding how the entire body functioned together. And I also wanted a field of medicine where lifestyle and behavior affected the disease states. And that landed me an endocrinology. And I was finishing my training literally around the years that obesity was declared a disease, where the hormones that are involved in body weight regulation were just starting to be discovered, and it was a very exciting time to understand body weight regulation and metabolism. So it was sort of right timing where all my interests seem to match this new emerging field of medicine. People always say that obesity is so challenging because it's multifactorial. Did you think of it as a disease when you were really interrogating it and when you were studying it from so many different ways before it was officially marked a disease? To call it a disease always felt bold, and I think some people still don't feel great about that because should we be saying that forty percent of The US population has a disease? I know that's still controversial despite the official terminology. I was aware of the dysfunction in the body, but I did not know that it was called a disease. So being a clinician, what made you take this bold leap into entrepreneurship, and how did that happen? So like many doctors, COVID created some creativity in my career path. I think for many physicians who experienced burnout or saw people get very sick during COVID, many of us reassessed our careers. I was a traditional academic doctor, seeing patients, doing research, writing papers, writing textbook chapters, and then got pulled to work in the hospital during COVID as a COVID doctor. During …

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  • Second-generation tirzepatide demonstrates less muscle loss compared to semaglutide, with future compounds like bimagrimab targeting preferential fat loss while increasing muscle mass.
  • Second-generation tirzepatide demonstrates less muscle loss compared to semaglutide, with future compounds like bimagrimab targeting preferential fat loss while increasing muscle mass.
  • First FDA-approved GLP-1 Saxenda showed 60% response rate for 5%+ body weight loss.
  • Newest dual agonist ZepBound achieves 90% response rate, treating significantly more patients effectively.
  • future compounds like bimagrimab targeting preferential fat loss while increasing muscle mass

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  • Dr. Rekha B. Kumar, endocrinologist and Chief Medical Officer at Found, explains GLP-1 medications for weight management

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