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Unprecedented Weight Loss With Semaglutide

>> Sunday, August 19, 2018

Semaglutide is a medication that is used to treat type 2 diabetes (trade name Ozempic).  Not only does it improve blood sugars more than any other medication that it has been compared to (so far) in the diabetes world, but it is also very effective to help with weight loss.  Thus, semaglutide is currently under study as a medication to treat obesity in people without diabetes.

We have now completed the first study of semaglutide as an obesity treatment.  The study, published in The Lancet, in which I was an investigator and also an author of this paper, randomized 957 people to receive various doses of once daily semaglutide, with liraglutide 3mg and placebo as controls. (Liraglutide 3mg is also called Saxenda, which is a medication already in use for treatment of obesity.)

At 1 year, 93% of patients were retained in the trial, which is much better than most studies of weight loss medication, which tend to have much less follow up data. Overall, 81% of patients completed the full year of treatment. A higher percent of the placebo group (24%) stopped treatment than did those on semaglutide (18%).

The weight loss after one year on semaglutide was impressive, ranging from -6.0% weight loss on the lowest tested dose of semaglutide (0.05mg per day) to an impressive -13.8% weight loss on the highest dose tested (0.4mg per day), compared to -2.3% weight loss on placebo and -7.8% on liraglutide 3mg per day.

The weight loss had not plateaued by one year on the highest doses of semaglutide, suggesting that if the study had been longer than a year, even more weight loss may have been seen.

In terms of side effects, gastrointestinal were most common (e.g. nausea), in keeping with what we already know about this class of medication; these side effects increased with higher doses of semaglutide, and were a little higher on the highest semaglutide dose than on liraglutide 3mg.  There was also a higher risk of gallbladder side effects (e.g. gallstones), which was a little more common on the highest dose of semaglutide compared to placebo.

The weight loss seen in this study is more than has been seen with any other existing weight loss medication.  The next phase of studies of semaglutide for weight loss is underway.

Disclaimer: I was a principal investigator in this research trial and an author of the paper discussed. I am/have been involved in other trials of semaglutide and liraglutide as an obesity treatment.  I receive honoraria as a continuing medical education speaker and consultant from the makers of semaglutide and liraglutide (Novo Nordisk). 

Follow me on twitter! @drsuepedersen © 2018


The Ultimate Caesar Salad Recipe

>> Monday, August 13, 2018

Caesar salad gets a bad rap as a non healthy food choice - deservedly so in most cases, as they often contain a generous content of mayo, parmesan, croutons, and oil.  These versions can easily come in at a higher calorie count than a Big Mac!

Here is a fabulous, calorie savvy recipe that is sure to be a crowd pleaser.  Instead of adding croutons and cheese, throw a grilled chicken breast or salmon on top to make a fantastic, protein-rich dinner.
Note that this dressing is not low salt, due to the salt in the anchovies.

INGREDIENTS: (super easy to remember, as everything but the anchovies are in 2's):
  • 2 tbsp lemon juice
  • 2 tbsp olive oil
  • 2 tbsp red wine vinegar
  • 2 cloves of garlic, crushed
  • 2 tsp ground pepper
  • 1 can of anchovies (in olive oil) - 'Millionaires' brand tastes best
  • 2 large heads of romaine lettuce, chopped

DIRECTIONS:  (it couldn't be easier!)

Put the first six ingredients into a small blender (e.g. Magic Bullet).  Blend until smooth. 

Put the lettuce in a large bowl, pour the dressing on top, and toss.    Serve into bowls. 

Makes four dinner sized servings. Per serving:
  • calories: 133
  • fat: 11g
  • carbs: 4.5g
  • protein: 3g

Follow me on twitter! @drsuepedersen © 2018


Could Intermittent Fasting Benefit Our Metabolism?

>> Sunday, August 5, 2018

(this figure is from the study discussed below)

Intermittent fasting (IF) is a popular dietary strategy these days amongst people who are looking to shed pounds.  While IF has not been shown to be any better than daily calorie restriction for weight loss, many have speculated that IF may improve cardiometabolic health, with conflicting data as to whether this is actually the case.

A new study suggests that IF at the right time of day may actually improve metabolic health.

The study was small but elegant - 8 men with pre diabetes, who were assigned to intermittently fast using a new technique called 'time restricted feeding' by eating during only 6 hours per day (with dinner before 3pm), or to eat over a more typical 12 hour period each day.  They followed this eating pattern for 5 weeks, and later crossed over to the opposite eating assignment for another 5 weeks.
All meals were supervised, and were geared towards keeping body weight the same (i.e. this was not a weight loss study).

They found that eating only 6 hours per day resulted in improved insulin sensitivity, blood pressure, appetite, and markers of oxidative stress.

How does this work?  Well, there is a hypothesis that after 12 hours or more without food, our bodies flip a 'metabolic switch' of sorts, turning to fat as a fuel source once liver glycogen (sugar) stores have run out (there is an interesting review from the journal Obesity on this).

Interestingly, the time of day when food is eaten seems to be important - while this study showed a metabolic benefit to restricting food intake to 6 hours earlier in the day, other studies restricting food intake to the late afternoon or evening have shown either no benefit or worsening of metabolic parameters (these studies are referenced in the article).  This may be because eating earlier in the day fits better with our circadian rhythm of hormones, as our insulin sensitivity, and also the calories we burn while digesting food are higher in the morning.

We often recommend: "Eat breakfast like a king, lunch like a prince, and dinner like a pauper."  While this principle was founded on the idea of avoiding overeating in the evening due to not eating enough during the day, it seems that there may be a physiologic basis for eating earlier in the day to promote metabolic health.

Perhaps our new slogan should be: Eat breakfast like a king, lunch like a prince... and have your dinner early.

Stay tuned to for discussion of a brand new study on intermittent fasting in people with type 2 diabetes, coming soon!

Follow me on twitter! @drsuepedersen © 2018


Patients' Journeys Affect Everyone In Health Care

>> Monday, July 30, 2018

In my reading this week, I was particularly touched by a perspective article in the New England Journal of Medicine.  

In medicine, we see many happy stories, but also some very sad and difficult journeys that our patients endure.  It is well known and increasingly discussed how much impact these sad stories can have on the psyche and well being of doctors, nurses, and allied health care professionals, but as this article points out - what about those who have administrative and support roles in medicine?   I think it is wonderful that this article brings this important point to attention, and so I wanted to share it.

The article is written by a physician, recalling a day when her secretary became upset after transcribing a letter written by the doctor about a patient's impending death due to cancer.

“Rough morning?” (the doctor asks)

She takes off her headset. “This letter. I have been typ
ing letters about Kathy for a couple of years now. I’ve never met her, but she’s always so nice on the phone. I just wish I could just write a different ending to her story.”

Administrative, secretarial and support members of the clinical care paradigm are right up there with us on the front lines of patient care - even on the front lines for us in many cases, handling phone calls of patients dealing with serious health issues, being the first smiling face patients see as they arrive at our offices, and often getting to know our patients quite well if they are frequently visiting us, calling us, or seeing us over an extended period of time (in the practice of endocrinology, this can be years or even decades).   Our patients' journeys have an impact on everyone whose lives they touch.

I feel that it is so important to keep the lines of communication and friendship open amongst everyone participating in clinical care, so that everyone knows they have the support they need if they are struggling to handle the emotional burden of a patient case or situation.  I feel so grateful to have such a wonderful work family at our clinic, and I think I can speak for all of us to say that it enhances the quality of our work days and our satisfaction with our work lives, to know that we truly are a family, not only celebrating the successes but also sharing the burden of any sadness that we encounter in our patients' journeys.

Follow me on twitter! @drsuepedersen © 2018


Obesity Stigma and People First Language

>> Monday, July 23, 2018

In our efforts to help society and the medical profession understand that obesity is a medical condition and not simply a lifestyle issue,  a very important principle to remember is how we speak about obesity.  Obesity is a diagnosis, not a description of a person, and the way in which we should speak about obesity is called People First language.

This may seem minor to some, but actually, it is an extremely important point.  Consider the difference:

Jamie is an obese person.


Jamie is a person with obesity. (person first language)

Or even more simply, compare:

Jamie is obese. 


Jamie has obesity. 

Obesity is a medical condition that is unfortunately terribly stigmatized, and when a person is described by this medical condition (ie as being obese rather than having obesity), it comes with negative connotations and can sound outright shaming.   Let's consider someone with sleep apnea. Which would you choose?

Lou is a sleep apnea person.


Lou is a person with sleep apnea. (person first language)

Saying that Lou is a sleep apnea person doesn't even make sense. He has a diagnosis of sleep apnea.

Or consider this - which would you choose?

Mark has cancer.


Mark is cancer.

Well of course, we would all choose 'Mark has cancer'. We would never want cancer to define Mark  - so why would we want obesity to define Jamie?

So remember: obesity/overweight is a medical condition, not an adjective to describe a person or a population.  Try avoiding the word 'obese' in favour of 'obesity' and you'll automatically switch to Person First language in most cases. I would like to see the word 'obese' removed from our vocabulary entirely.

We would like to see all medical and general public literature to change to person first language.  We have a long way to go on this - most medical journals, for example, sadly still have not made this switch.

In the 2018 Diabetes Canada Clinical Practice Guidelines, we speak about obesity in patient first language, and we hope that this leads the way in Canada and globally towards uniformly adopting Patient First Language!

It's time to transfer the baton from the old way of thinking to the new - always put People First and Patients First.

Follow me on twitter! @drsuepedersen © 2018



I am excited that you have arrived at my site, and I hope you are too - consider this the first step towards a Healthier New You!! As a medical doctor, Endocrinologist, and obesity specialist, I am absolutely passionate about helping people with weight management. Though there is certainly no magic cure for obesity, there IS a successful treatment plan out there for you - it is all about understanding the elements that contribute to your personal weight struggle, and then finding the treatment plan that suits your needs and your lifestyle. The way to finding your personal solution is to learn as much as you can about obesity: how our toxic environment has shaped us into an overweight society; the diversity of contributors to obesity; and what the treatment options out there are really all about. Knowledge Is Power!!

Are you ready to change your life? Let's begin our journey together, towards a healthier, happier you!!

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