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#weightmanagement #obesitymedicine Family practitioner Catherine Varney, DO is the Obesity Medicine Director for UVA Health. Katie George, DNP, AG-ACNP, is a board-certified Adult-Gerontology Acute Care Nurse Practitioner within the UVA Department of Family Medicine. They speak with us about caring for patients who live with obesity. Learn more at: https://blog.uvahealth.com/2025/01/07/weight-loss-medication/ Transcript Catherine Varney, DO: Patients coming to UVA Health and our Obesity Medicine clinic can expect a very individualized plan. Some people just need lifestyle changes and don't need medications, but if those medications are indicated and the patient would like to explore that, we see which one is best for them and we try to pick the right medication based on their overall health and other medications that they're taking. Katie George, DNP, AG-ACNP: Obesity medication is indicated for patients that have a BMI of 27 or greater with a comorbidity. And the typical comorbidities that are included in that are high blood pressure or hypertension, hyperlipidemia or high cholesterol or type two diabetes, or a BMI greater than 30. Catherine Varney: So anti-obesity medications have been used since the 1960s, and there's lots of options out there. And some of the ones that we were using in the '60s we still use today. But there are new medications, a newer generation of anti-obesity medications that seems to be kind of the hot topic right now. And they're very safe, they're very effective. And we previously used them for treatment of type two diabetes, and so we have almost 20 years of data showing their safety. So we pick those medications based on what's right for the patient, and also we have to consider what's covered and affordable for patients. Katie George: As far as what risks are involved with medication treatment, I think you have to first step back and ask what are the risks associated with not treating the disease process? So I tell patients, we basically have two buckets when we're looking at medical therapy. We have oral therapy or pills. We also have the GLP-1 receptor agonist injections that get so much attention in the media.The GLP-1 receptor agonist injections, some people have no side effects whatsoever. Most people have mild-to-moderate nausea, but it can be mitigated and managed with dietary modifications. Other side effects can include other GI side effects, including constipation or diarrhea. Some people will tell me, "I know I'm not going to feel great for a day or so." But then they look back six months or a year later, and I have had people say to me, "Oh my gosh, I thought those side effects were so bad. I am so glad I stuck with this."In the care of the patient that has obesity, we have a really broad team base that supports the work we do. The entire team is really passionate about taking care of patients that are struggling with weight.1 Thing No One Tells You About Losing Weight

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Is LDL cholesterol the best way to measure and predict heart disease? New research suggests no! Dave Feldman is an engineer turned citizen scientist who has devoted his life to understanding a phenomenon that some individuals around the world are experiencing: a robust increase in LDL cholesterol while on a ketogenic diet. Dave’s past research has identified a unique phenotype dubbed Lean Mass Hyper-Responders (LMHRs). LMHRs respond to ketogenic therapy with a metabolic profile that includes elevated LDL-C and ApoB levels with otherwise healthy metabolic markers, including low triglycerides, high HDL, low blood pressure, low insulin resistance, and low BMI. In Dave’s most recent publication, what most doctors would consider dangerously high LDL levels in LMHRs did not correlate with an increased risk of heart disease. In this video, Dr. Bret Scher sits down with Dave Feldman to discuss this groundbreaking study and its implications for ketogenic therapy and cardiology. *Key Takeaways:* - LMHRs on a long-term ketogenic diet who show elevated LDL can show robust metabolic health - LDL-C and ApoB were not linked to plaque progression in LMHRs - Existing plaque did predict future plaque accumulation in LMHRs - Individualized approaches to cardiovascular risk assessment are crucial to serve this group better. 🎬 These exciting new findings are featured in Dave Feldman and Jen Isenhart’s  upcoming documentary, *The Cholesterol Code,* the story of how one engineer’s health experiment sparks a global investigation, exposing myths about cholesterol and reshaping our understanding of heart health. Real stories of healing from disease with ketogenic diets provide a blueprint for using food as powerful medicine. Visit [cholesterolcodemovie.com](https://cholesterolcodemovie.com/) to learn more about the film and to be the first to hear about private screenings and the general release in the fall. *Expert Featured:* Dave Feldman CEO, Citizen Science Foundation https://x.com/realDaveFeldman Cholesterol Code website: https://cholesterolcode.com/ *Resources Mentioned:* Coronary Artery Plaque Progression in Asymptomatic Lean Mass Hyper-Responders: A Case Series - https://www.jacc.org/doi/10.1016/j.jacadv.2025.101686 *CMEs Mentioned:* _Managing Major Mental Illness with Dietary Change: The New Science of Hope_ - https://www.mycme.com/courses/managing-major-mental-illness-with-dietary-change-9616 _Brain Energy: The Metabolic Theory of Mental Illness_ - https://www.mycme.com/courses/brain-energy-the-metabolic-theory-of-mental-illness-9615 Follow our channel for more information and education from Bret Scher, MD, FACC, including interviews with leading experts in Metabolic Psychiatry. Learn more about metabolic psychiatry and find helpful resources at https://metabolicmind.org/ *About us:* Metabolic Mind is a non-profit initiative of Baszucki Group working to transform the study and treatment of mental disorders by exploring the connection between metabolism and brain health. We leverage the science of metabolic psychiatry and personal stories to offer education, community, and hope to people struggling with mental health challenges and those who care for them. Our channel is for informational purposes only. We are not providing individual or group medical or healthcare advice nor establishing a provider-patient relationship. Many of the interventions we discuss can have dramatic or potentially dangerous effects if done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications. *Timestamps:* 0:00 - Introduction to Lean Mass Hyper Responders and researcher Dave Feldman. 3:10 - What is the background and setup of Dave’s new Lean Mass Hyper Responder (LMHR) trial? What did the participants’ baseline data look like? 8:00 - What did the 1 year follow up scans show for the participants? Did their elevated LDL & ApoB lead to an increase in plaque buildup? What is the difference between LDL & ApoB? 21:42 - Did the group see an increase in plaque volume and was it rapid? Did anyone see a decrease? What does predict a future increase in plaque if not LDL or ApoB? 26:48 - What causes arterial plaque and what doesn’t cause it? 29:45 - Will Dave Feldman’s study help clinicians and patients accept or continue ketogenic therapy when LDL may be high? 33:09 - What are the limitations to the study and the interpretations to the study? 39:10 - What does Dave Feldman hope a cardiovascular researcher would take away from this study? How does Dave feel about potential pushback from the medical community? 43:45 - Where can people hear more from Dave Feldman and follow his work?