S4 Ep 1 Beyond the Scale: GLP-1s, Weight Loss and the Fire Fighter

[00:00:01] Scott Dau: The scary thing to me was like, it’s working. But, you know, and then even now, people joke around, they’re like, is this going to be one of Those things in 10 years there’s going to be a commercial? Did you take GLP-1s? You know, in 2020, you know, you’re entitled to, you know, a class action lawsuit.

But and then like I said, I thought, you know, what if I don’t do anything, it’s not, I’m just going to get, not worse, but not being healthy. It’s trying to just get back to a point where I’m healthy and just realizing you can stay there and, and what it takes to get there.

[00:00:29] Jen Pennington: Welcome back. Seattle fire fighters. This is Listen Up L27. I’m your host Jen Pennington. And we’re talking today about a topic that’s gotten a lot of attention lately. We are going to be talking about GLP-1 medications and weight loss. There’s a lot more to the conversation than the number on the scale. We’re going to talk about how the medications work, what they can and can’t do, the role nutrition and behavior change still play, and what fire fighters should consider when strength and performance are part of.

And joining us today are Dr. Hamrick from Station 2 Clinic and Seattle fire fighter Scott Dau, who brings his own firsthand experience with GLP-1. So let’s get into it. Welcome.

Thanks.

[00:01:12] Dr. Marcie Hamrick: Hi, Jen. Thanks for having us.

[00:01:14] Jen Pennington: Of course, of course.

Dr. Hamrick, let’s start with you. Why are we talking about these medications with fire fighters in particular who might actually benefit from them?

[00:01:25] Dr. Marcie Hamrick: Yeah, I think this is a particularly relevant topic for fire fighters because weight isn’t really the issue that ultimately we’re trying to treat.

It’s what comes along with excess weight.

And those are the things that I see a lot in fire fighters like high blood pressure, sleep apnea, high cholesterol, insulin resistance, like prediabetes, joint problems and early cardiovascular disease.

These things matter for anybody. But they matter even more when your job requires to going from zero sitting at the station in the recliner to being, you know, 1,000% climbing stairs in a fire event.

So these medications, you know, aren’t for somebody who just wants to lose a few pounds, but I think for someone with obesity or someone who’s overweight who has one of the weight related conditions like high blood pressure, high cholesterol or sleep apnea, this is something to consider.

[00:02:26] Jen Pennington: Some fire fighters are pretty, you know, maybe they’re medication reluctant. What concerns do you hear most often about GLP-1 medications? And then, Scott, I’LL turn it to you afterwards and ask you, you know, what concerns you had. But let’s start with Marcie.

[00:02:43] Dr. Marcie Hamrick: Yeah, I actually understand the reluctance. I totally do. fire fighters tend to be pretty health, healthy, self reliant a bunch. And I hear things like, I don’t want to be dependent on a medication. I should be able to do this myself. And I totally get it. And I admire that part of fire fighters. And there’s reasonable medical questions that people have too, like, what are the long term effects? Do we know what they are? Am I going to end up taking a medication forever?

Am I going to lose muscle mass? Nobody wants to lose performance on the job by losing muscle. Am I going to feel nauseated or full all the time?

I think these are all really important questions to consider, and it’s all about analyzing the pros and the cons for each individual.

[00:03:29] Jen Pennington: And Scott, what were some of your concerns before you started?

[00:03:33] Scott Dau: My concerns were, you know, I was getting towards the end of my career and I’ve always been, you know, everybody, I think everybody in the Seattle Fire Department, if you look at the BMI chart, we’re all obese or overweight according to that thing.

But, you know, I just started looking at my weight and I hadn’t really gained a whole lot of weight. You know, the last, I would say 15 to 20 years. But, you know, I’d come in for my annual visit and you know, Chris would put the tape measure around you and, and Marcie would say, you could lose some pounds here. And my lab numbers were always, you know, they weren’t bad, but they were always borderline. She’d be like, ah, you’re on the, you know, getting towards this little range on here. When I came in, I think it was 20, 24. I came in, you know, it was the same things over and over. And I can’t remember the other doctor who I talked to. I said, you know, you know, I tried to lose weight. I’ve changed my diet, I’ve done this, done that.

And she said, maybe it’s a gut thing. So she said, maybe you should try like a supplement like the AG1 or something like that. And I thought, well, I got nothing to lose by trying that. So I tried that. And I don’t know if either of you have ever tried AG1, but it is not the greatest stuff. It’s like mushrooms in a cup with water. And I did that for a year. And as I was doing that, I would still eat healthy. And I was doing that. And my weight wasn’t really changing. And I thought, well, my weight’s not changing, but when I go back in there, like, my numbers are going to be better and they’ll be happy. And I went back in and my weight was the same. And I was like, yeah, well, let’s do the blood tests. And then those came back and nothing had changed. It was like the whole year of AG1 and everything I was doing just felt like a waste.

And that’s when she said, you know, have you ever tried or ever considered trying, you know, the GLP medications? And I said, well, do you think that would work? And she said, you know, for some people, that seems to be the kick that they need. And so I was like, all right, I’ll think about it. And this was before we had coverage for it that was totally out of pocket. And so I always used to start to think, you know, Tim O’Mahoney, who’s on the HealthCare Trust, I worked with him for 25 years and he would always go to those conferences and he would come back and say, the best thing we can do for retirement healthcare is not to need it, you know, it’s to stay healthy. And so, you know, I’m getting towards the end of my career and I was thinking, well, I don’t want to be getting into those levels where you need medication, not only after I’m not here and I don’t have coverage for it or don’t have the best coverage for it, but then just needing it. So I looked into it and like I said, it wasn’t covered. So I went online and I went with one of the places that, you know, they provide the prescription, they have the doctor and the check in. And I think most of those things now they send. Everybody sends you a scale and you gotta weigh in on the scale. And I thought, all right, I’m gonna do this. And then I started doing it. And as far as like what I was reluctant about, you know, I had read like the side effects and stuff like that and I had thought, well, you know, you, you gotta try it. You just gotta try it, man. The side effects on most of the ones that they said they do go away. And I didn’t really have any. When I started it, I didn’t really have any side effects and I was prepared for em, like I didn’t start my medication. Like, I was like, there’s no way I’m starting this either at work or on a two day. I’m like, I’m giving myself a four days of starting this because that’s when people said the side effects came the most when they first started them.

[00:06:37] Jen Pennington: So people often describe these medications as doing more than just making them eat less.

What did they actually do and what did you notice?

[00:06:47] Scott Dau: I noticed, like, when I first started taking them. I mean, it does exactly what they say, you know, it slows down your digestion. It makes you feel full. But, you know, I wasn’t eating as much. And there would be, like, days when I first started, There would be days where I wasn’t used to making myself eat, because that’s something you have to do with this because you don’t feel hungry, but you still realize you gotta eat. And I would go like, a whole day, and I’d be like, man, I haven’t had lunch. It’s dinner time. I don’t feel hungry. But, like, you know, your body still needs the nutrients, so I would have to work on that. And it basically teaches you. And that’s what I learned, is that not only does it teach you what you’re gonna eat, you have to make it count. So you gotta make, you know. Cause you’re gonna get full. You’re gonna eat it, and you’re gonna get full. So you can eat.

Not. I’m going to use this example. You can either eat junk and get full on junk, or you can. You got to make what you can eat to count. So that’s what I would end up having to do, you know, is make those portions. And then what that started doing, I realized after about like a month or two, is it kind of just trained your brain. Because I like food, it just kind of trained your brain. I was like, wait a minute. You don’t need that much food. Like, you know, I’d look at it like, what I prepare, and I’d be like, that’s not going to be enough. And then I would eat it.

And then, because, you know, you’re not digesting as fast, so your body is like, oh, that was enough. Like, you don’t need a second or a third. And that’s part of the problem at fire stations is people are good cooks. And somebody cooks something, and you’re like, man, that’s good. All right, I’m just gonna have one more portion, and then you have another one. You’re like, there’s still some left.

That was good. I’m gonna go back like, I. I don’t do that anymore.

[00:08:13] Jen Pennington: Is that what you’re hearing too, Dr. Hamrick?

[00:08:16] Dr. Marcie Hamrick: Absolutely. I mean, I think that.

I think some people think that the medication just makes you feel badly and therefore, you don’t eat. But it’s actually makes a natural hormone that we have in our body that affects both our gut and our brain. So reduce appetite. It helps us feel fuller sooner and longer, and it reduces our drive to eat as much.

And one thing they talk about a lot is food noise. And, Scott, you can probably speak to this better than I can, but when you use the medication, you realize that you’re not constantly thinking about your next meal or thinking about your second serving while you’re eating your first serving, and just how much you’re thinking about hunger or food all the time. And then when people use these medications, they notice that that gets really quiet, either a little bit or maybe not at all. And that that drive to eat just goes down, which is part of the reason it works so well.

[00:09:15] Scott Dau: Yeah, I mean, it was like before the medication, like, if I came into a station or somebody brought donuts in and be like, yeah, I’m gonna have that Boston cream.

It was Halloween time. There’s candy sitting around the table. People bring. I’ll be like, yeah, I’m gonna have a Snickers, and I’m gonna try one of those Reese’s Pieces. And it’s. I mean, I love chocolate. It’s still that way, but, you know, like, I just look at that stuff now. It’s like, I don’t even. Like, I don’t want anything to do with the donut. I’ll, you know, occasionally I’ll have ice cream, and if somebody brings in like a chocolate. A Hershey’s bar sample. Yeah, I’m probably gonna have one, and I might go back for another one, but it’s like it just doesn’t. I just don’t look at you. You just don’t feel the same, you know?

[00:09:51] Dr. Marcie Hamrick: Do you feel like the joy of food is gone?

[00:09:53] Scott Dau: No, I still like eating, but it’s just like you get used to eating differently, and that kind of becomes your new norm. You know, I just find different ways to eat the same healthier kind of stuff. You know, you’re not eating as much, you don’t want to eat, and you’re not looking at snacks or whatever and be like, it’s there, it’s convenient. I’m just going to eat. It just goes away. And like I said, for me, it was like a mind reprogramming. Like I said, just looking at food and being like, ah, that’s all I’m going to have, and that’s all I need, you know, and then you. That’s it. You Eat it. And then you’re like, well, I’m full. I don’t feel like I gotta eat, but I’m gonna eat anyways. Cause I have to. You know, you still gotta get the nutrients and stuff.

[00:10:28] Jen Pennington: So I am kind of fascinated with the rewiring of the brain that you’re noticing that. I just don’t have to do that. I have a girlfriend who, when she goes out to lunch, she’s like, you know, I just wind up taking half of it home, you know, And I don’t. I realized I don’t have to eat the entire plate because a lot of us are, you know, we’re brought up. You finish everything on your plate, right? And now you’re kind of in this other mode. So I am kind of interested in how it rewires the brain. And you talk about food noise, like how that calms that.

So I’m interested more in that.

[00:11:04] Dr. Marcie Hamrick: I think it’s a really interesting area of research, you know, And I remind myself that these medications act at the level of the gut, which is why it slows digestion and helps you feel fuller for longer. It’s also why, you know, the most common side effects are nausea, diarrhea, constipation, sometimes acid reflux.

So it acts on that level, but it also acts on the brain around our satiety centers or the places in our brain that tell us when we’re full.

And what I think is super exciting, too, is that we started using this medication for diabetes, and we noticed that people were losing 10 to 20% of their body weight. So then people, of course, the pharmaceutical companies were like, aha. We think we have another use here. It can treat overweight and obesity.

So now more people are using it. Then we’re also noting more things that people are experiencing who are taking the medicine, like their sleep apnea is better, or their arthritis in their knees and hips is better, or they’re not craving alcohol.

[00:12:08] Jen Pennington: I was going to say that’s one of the big things that comes up a lot.

[00:12:11] Dr. Marcie Hamrick: It’s really interesting. It’s not an indication to start GLP-1 medication because we don’t yet have enough research.

But we certainly have a lot of observational information about people on GLP-1s no longer engaging in rewarding behaviors, which could be smoking, drinking, alcohol, gambling, porn, all sorts of things that people just say, I used to be addicted, and now I just don’t have that drive anymore. So it could be, in the future, a useful tool for some people with addictive behaviors.

[00:12:45] Jen Pennington: All the things that I’ve read about it. That is so fascinating to me. You know, when you think about all the different uses one drug can have, when you talk about the different benefits, it’s crazy. Scott, are you using any other program as you take the GLP-1 medications? There are different programs out there?

[00:13:03] Scott Dau: No.

Well, when I started with like, and the place that I went to was Form Health, like, they, you have to check in with the nutritionist, you have to check in with a doctor, and they would basically give you the guidelines of like. These are the, like, protein and fiber and, you know, the nutrition goals you want to aim for. And it wasn’t like, go do this, go buy that, or do that. It was just kind of like whatever you eat, just make sure, you know, it’s. It’s. You’re going to reach these goals every day. And that’s, that’s what I did. I work out like a lot of people.

I don’t work out on shift like that. That isn’t my thing. I don’t work on shift, but, you know, still doing that, you know, when I can. So, you know, I haven’t, I haven’t really experienced any muscle loss. I would go in when I first started on it. I would go into the clinic once a month and go use the, the InBody scale to track it, you know, for myself. And then I would, you know, basically scan those in, send those to my doctor, and she’d be like, you’re doing great. Your muscle mass is actually up.

And my muscle mass went up. My body fat was going. It was like, one chart’s doing this, the other chart’s going down.

My whole thing when I said I was just watching, you know, the numbers, my visceral fat, eventually it went from 11 to 4, which is where I’m at now. I hadn’t been in. I started at like after my last AFFME visit. So it almost been almost a year.

And I come back in and Marcie is like, what happened to you?

I did it to you. And then we did the lab numbers. That was the first time I had actually done the blood work since I had started on it. And everything came back, everything was down. I didn’t have problems with before. There were some things, you know, that was borderline or my happy cholesterol wasn’t the greatest or whatever it was, but everything was, you know, where it should be.

[00:14:35] Jen Pennington: Do you mind sharing how much weight you’ve lost?

[00:14:37] Scott Dau: Probably between 45 and 50 pounds.

[00:14:40] Jen Pennington: That’s considerable.

[00:14:41] Scott Dau: Like I said, I didn’t feel like I was an obese person. But like I said, the BMI chart, we’re all obese. You know, everybody’s. I mean, the BMI chart says I’m supposed to weigh 150 pounds to be at the top end of.

I haven’t weighed 150 pounds.

[00:14:53] Jen Pennington: It’s like a small teenage boy. Right?

[00:14:57] Scott Dau: But.

And it was weird because I would weigh in. You know, they give you the scale, and you had to weigh in. You have to weigh in twice a week. And, like, I’d get on the scale, it would go down, but it was just, like. It just kept going down and down. I get on the scale, like, you know, every week I’m like, man, there’s another three pounds. And then, you know, one. You know, and then I’m under 200, and then I’m like, wow, I haven’t been under 200. Like, I was under 200 for, like, a week, 10 years ago or something. And then I’m under 200, and I’m like, I’m having to punch new notches in my belt because, like, you know, I’d sit there one day and I’d go to tighten my belt, because if I didn’t tighten my belt anymore, my pants would just fall off, even if they were.

[00:15:30] Dr. Marcie Hamrick: But.

[00:15:31] Scott Dau: And I would tighten it up, and I had to punch a hole. And I’d be like, this stuff’s working. And people would be like, what’s wrong with you? Like, are you sick or something? I’m like, nope, just doing drugs, telling the truth.

And people would be like, okay, whatever, Scott. But it. But it was. It was like I went on vacation the first time I actually came back from vacation weighing less than I started on vacation.

[00:15:53] Dr. Marcie Hamrick: Wow.

[00:15:53] Scott Dau: But, you know, most people, it’s like, that doesn’t happen. Yeah, that’s. That’s the thing. I came back. I think I was like, six pounds less than when I left, you know, and then you get on the scale, and you just watch the numbers. And then one day, I’m down under 190, and it’s like, this stuff is definitely working. And then, you know, a couple of months later, you’re down to 180. You’re like, this is great. You know, and it’s weird because I think, like I said, I wasn’t really a. I didn’t feel like I was a big person. I knew I was like, you know, in the way the Sears catalog days. I used to call it husky or whatever.

But it’s weird now to think, like, you know, I put my gear on and it’s definitely bigger than it was.

But it’s weird to think that before I put my gear on, when I put it all on, now I weigh as much. Like, if I got my SCBA on, I weigh as much now as I did before. Like, putting all that stuff on. I weigh the same weight I did before I even put that stuff on. So I’ve lost the equivalent, you know, almost of all my gear when I’m not wearing it. So, you know, now it’s like, I feel like now when I have my gear on, it’s a little easier to do things because now I don’t have that 50 pounds that I’m carrying around.

But I was so used to carrying that 50 pounds around, that now when I put the gear on, that puts that 50 pounds back on. It’s like, well, I’m back to normal before. But like Marcie said, you don’t want to be in this job.

You don’t want to be pushing your limits at the extremes of your job. So being ready before the job and being ready during the job, to me is like, that’s the difference. You can quantify, I guess.

[00:17:14] Jen Pennington: Did it ever feel a little scary at first that all of a sudden you’re dropping weight and you’re like, I know this is what’s supposed to happen, but this is.

Oh, wow. This is a. This is a lot.

[00:17:26] Scott Dau: For me, the scariest thing was, like, I’ve never really had any side effects from it. That was my thing. And, you know, people were like. They’d say nauseous, you know, diarrhea, where I’m like, I don’t want that at work. You know, nobody wants that.

So. And that was the thing. That’s why I waited to start. I’m like, you know, every day I’m like, at work, I’m like, is this the day? The side effect. And I prepared for it, you know, I was like. You know, I had like. Like, you know, stool softener, and I was. I think at the beginning, I was even over hydrating. You know, I’m gonna go to the bathroom every, like, 30 minutes because I’m like, I don’t want to get, you know, constipated, which is one of the other side effects, but I never really had the side effects from it. The scary thing to me was, like, it’s working. But, you know, even now, people joke around. They’re like, is this gonna be one of those things in 10 years? Is it gonna be a commercial? Did you take GLP-1s? You know, in 2020, you know, you’re entitled to, you know, a class action lawsuit.

But. And then, like I said, I thought, you know, what if I don’t do anything, it’s not. I’m just gonna get. Not worse, but like, not being healthy. It’s trying to just get back to a point where I’m healthy and just realizing, you can stay there and what it takes to get there. And if it took, like I said, you know, to people, a lot of people came up to me, like, what’s going on? Like, how do you do? So, and I tell them and like, they’d be like, oh, that’s cool. And then later, people have come up and a lot of people come up to me, they’re like, all right, tell me the real story. Like, how does this work? Or whatever. And I was just telling them. I was like, you know what? I just didn’t want to be. Be unhealthy. Like, you know, like I said when, you know, Tim always harped on, like, be healthy when you’re retired and you don’t need retirement healthcare. I mean, you. You have it, but you don’t need it. Like, don’t be on daily pills and stuff like that every day. And that was my motivation, was like, it’s a now or never. You know, I’m not getting any younger. You know, and they say, like, getting older, you’re not going to be able to lose weight as easy when you get older.

[00:19:01] Jen Pennington: So that is true.

[00:19:03] Scott Dau: Yeah.

[00:19:03] Dr. Marcie Hamrick: I mean, I can.

[00:19:04] Scott Dau: But as far as, like, this, I

[00:19:05] Jen Pennington: can adjust to that.

[00:19:06] Scott Dau: I will. Third, that, like I said, it wasn’t really. There wasn’t anything scary. It was just. It was weird. Like, I, like, I tried so many things and I always thought, this is just me. Like, I’m just a big dude. Like, I’m just gonna be one of these guys that always, you know, is gonna be the husky section of the catalog when I’ve got down past the point of weight. When I got into the fire department when I started back in 1991, it was like, man, that’s weird. Like, I haven’t been this weight in 36 years.

[00:19:31] Jen Pennington: Well, something I wanna ask you brought it up, but something I wanna ask you, Dr. Hamrick, is if you’re starting a GLP-1, is there something nutritionally that you want to pay attention to when you start the drugs? I mean, there’s always the good nutrition things that we should pay attention to. But is there something especially important to pay attention to nutritionally as you start and you begin to take more of these drugs.

[00:19:58] Dr. Marcie Hamrick: Yeah. I think what. What Scott was alluding to earlier about, like, because you’re not eating as much, you want to make what you eat nutritionally count. You know, if you’re going to eat 800 calories in a day, which is not very much, probably a lot less than, you know, you want that to be whole grains with fiber and fruits and vegetables and protein. Protein is the big thing that I emphasize in people on these medications, because we know that anyone who loses weight, regardless of how they do it, they will not lose just fat, they will also lose muscle. Studies have shown about 25% of weight loss is muscle and 75% is fat. And you can minimize that muscle loss by focusing on how much protein you get in your diet.

So, you know, sometimes 100, 150 grams of protein daily is really a goal. And when you’re not eating that many calories, it’s hard. It’s hard.

[00:20:57] Scott Dau: I’m starting with 200 grams of protein.

[00:21:00] Dr. Marcie Hamrick: That’s right.

[00:21:00] Scott Dau: You know, you eat like, half a pound of chicken, and you’re like, well, that was like a hundred. Like, not really hungry to eat another half pound of it, but.

[00:21:07] Dr. Marcie Hamrick: Right, right. And I know people use protein powders,

[00:21:10] Scott Dau: and everything’s got protein now. You look at everything now. Everything’s got a protein label.

[00:21:14] Jen Pennington: Yes. Yeah.

[00:21:15] Scott Dau: They’re probably going to put on Pop-Tarts or something.

[00:21:18] Jen Pennington: They did. They did.

There’s, like, some weird thing that Pop-Tarts just came out. I don’t know if it’s protein, but they, you know, it’s advertising.

[00:21:27] Dr. Marcie Hamrick: Yes. Yeah.

So I just wanted to comment that Scott really set himself up for success in what he’s describing in terms of having some support and being aware that nutrition is still really important, hydration is really important, and knowing what the side effects can be and what you’re going to do to help mitigate those side effects. I think that’s.

[00:21:51] Scott Dau: I think that’s why, like, I have a couple people talk to me, like, about the program I was in and, like, even the. The My Path program. I think that’s why they harp on, like, that contact with them is to make sure, you know, it’s like, hey, like this. You got to do this. And that’s what they’ll, you know, every time, like, I check in now, they’re like, you know, what are you doing for your protein? What are you doing for, like, you know, how are you hydrating? Do you have any side effects or anything like that? Because, like I said, I mean, the first couple weeks on It. It was like I could literally go a whole day and not eat and not feel hungry and not realize that I hadn’t eaten. You’re like, all right, this is how this thing works. Like, I gotta. And they would tell you, like, you can’t not eat. You gotta get your protein. Like, if you don’t get your protein, you know, one of the side effects is the muscle loss. And, like. Like I said, I would eat the protein. I still work out. That’s why I was going in the clinic. You know, I want to make sure that that number, the. The SMM number was. Wasn’t diving. And it basically, you know, it was going up slowly as my weight was going down. So.

[00:22:43] Dr. Marcie Hamrick: That’s awesome. That’s quite an achievement.

[00:22:46] Jen Pennington: It is. It is. I’ve been reading about, like, there’s high doses and low doses, and there’s also the pill forms. Can you talk a little bit about that, Dr. Hamrick, when are you looking for, like, a high dose versus a half dose or.

Yeah, I shouldn’t say half, but a low dose.

[00:23:02] Dr. Marcie Hamrick: I will say people respond very differently to different doses of this medicine. So in my mind, starting at a. At a very low dose and only increasing dose if you are not losing weight.

[00:23:16] Jen Pennington: Oh, interesting. Okay.

[00:23:17] Dr. Marcie Hamrick: Like, they used when these drugs first came out, the pharmaceutical company had a very strict guideline of a starting dose, and four weeks later you go up, and four weeks later you go up again. Every four weeks, you increase the dose until you’re at the maximum. But people were losing weight sometimes too quickly and losing their muscle mass by doing that more so. And getting loose skin because they lost weight so quickly.

So now I think that prescribers are more commonly checking in with people regularly and saying, hey, what side effects are you having, if any? How is the food noise?

You know, how are your markers of health, not just the scale. Right. How are you feeling? Let’s check how your health is doing and kind of thinking of it as the long game instead of, let’s get you to this ideal weight as quickly, quickly as possible. It’s not healthy to lose weight that quickly.

[00:24:14] Jen Pennington: No.

[00:24:15] Dr. Marcie Hamrick: So I think the dose can be titrated very individually based on patient preference, side effects.

It’s normal to plateau. And sometimes people don’t lose any weight for several weeks or even a month, and then all of a sudden they lose weight again. So being patient with those periods of time and not necessarily increasing the dose will also help reduce those side effects.

[00:24:46] Jen Pennington: That answers a big question for me in terms of things that I’ve been reading and whatnot. So that’s really important to understand.

And I think as we look at this, Scott, for any fire fighter that’s listening, who’s maybe struggled with their weight for years, who thinks I should just have more discipline, I should be able to do this on my own, right? What would you want them to know?

[00:25:09] Scott Dau: You know, for, like, three or four years before I tried this, that was the thing. I would try this. And I always felt like that I thought it was me. You know, I’m like, I’m not. I’m not doing enough. There’s so many things have come and gone over the years. You know, Atkins diet and fasting and all these different things. And I would try some of those, or I would. You know, I would. There was times where I would just do it, and it’s. It was so frustrating to just not see results.

And, like. And it’s just like, you do it. You do. You’re like, well, like I said, I’m like, I. Forever. I thought, well, it’s just me. If you’re stuck, it doesn’t hurt to give it a try. I mean, like I said, there’s been so many people that have come up to me, you know, that. That’ll say, you know, it’ll become like, I’ll, you know, show up for training or something. People will be like, I haven’t seen you forever. What happened to you? In fact, I’m not going to mention names, but somebody saw me off shift and thought I was my own brother.

They’re like, you have a brother that works in the fire department? Like, dude, it’s me. They’re like, what? I’m like, yeah, that’s me. And they’re like, oh, my God, what happened to you? You know, and it was like, there’s no. I mean, to me, like, it’s my biggest worry was the side effects. And, like, I didn’t have any. So, I mean, I can’t say, like, hey, try it. Like, it doesn’t. I didn’t have any side effects. I don’t want to be like, the guy that’s like, you know, somebody else tries it. Because I said, no side effects. And they’re like, man, I couldn’t go to work for two weeks because I had diarrhea or something. Thanks a lot for not telling me. Like, I feel like I was, like, the perfect, like, the classic patient. And the thing. Because, literally, like, I had no side effects. My lost. You know what they say? You can lose up to 23% of your weight. I lost 23% of my weight. And I was like, all right, I’m the people that they put in this group that they want to use for the sales. And like, the people who have the side effects are the ones they don’t give you the big, oh, by the way, getting. You also might have this. But if you, if you feel like you’re that. I mean, like I said, my numbers were getting borderline, you know, in the areas you don’t want to be in. And I was like, I got to make a change.

So I thought, you know, I got nothing to lose by trying this. And like I said, that was before we even had coverage for it. I was like, you know what?

I don’t care what, you know, I’d rather pay this amount out of my pocket than be unhealthy and then get diabetes. And then you’re paying for the medication or statins or anything like that.

That’s to me was like, the goal is to avoid that stuff.

[00:27:13] Jen Pennington: Absolutely, absolutely. Dr. Hamrick, what haven’t we covered in terms of this conversation?

[00:27:20] Dr. Marcie Hamrick: Yeah. For fire fighters in particular, some of the side effects could potentially impact safety on the job.

So I feel like this is a special area of education that I want to emphasize as people are learning about these medications and are interested in them.

[00:27:35] Jen Pennington: It.

[00:27:35] Dr. Marcie Hamrick: It is a diuretic. It causes you to lose fluids more and you’re not eating as much. Where we get fluids from what we eat as well. So dehydration is a possible side effect which can cause people to. Their blood pressure can, can go really low. They can get lightheaded or dizzy. And I think about people who often say that they don’t drink fluids much when they’re on shift and then they go to a fire event and they’re sweating.

I just worry about people getting lightheaded or dizzy during a fire event.

But I think you can certainly mitigate that potential side effect by making sure that you’re drinking a lot of fluids. Of course, then you’re peeing all the time, and that’s not fun on the fire shift.

[00:28:16] Scott Dau: That’s what I think the big thing they harp on is like, you gotta stay hydrated. So I was, you know, carrying my 40 ounce water bottle around me and drinking that all the time. And like I said at the beginning, I thought, man, am I over hydrating? Am I doing too much? I would drink it and be like, it was, you know, as soon as it would come in, like five minutes later, back in the bathroom, and I’m like, I can’t be on A call like this, I can’t be in a call, like, like asking a patient, can I use your bathroom? I gotta go to the bathroom. And that’s the way it always works, you know, it always comes when you’re like, you know, you’re like, all right, I gotta go to the bathroom. Hold on, I gotta go. You know, check this or whatever. And then as soon as you leave to do that, then you get a call and you’re like, huh, I should have gone to the bathroom when I had a chance because now you’re out for two hours or whatever.

[00:28:50] Jen Pennington: Yeah, but there’s something that you said earlier and you were joking about it, but maybe it’s something to think about. Like, if you’re going to start the medication, don’t start it. It when you’re, you know, right on shift.

[00:29:03] Scott Dau: No, that was, you know, that was like, I got.

[00:29:05] Jen Pennington: I figured that out on your.

[00:29:07] Scott Dau: I had my medications for, like, I think for like three weeks before I even started. Because it was back, you know, was working overtime. I had trades, I was traveling. Definitely not going to start it. When I’m traveling. I was like, I got to get a good four day and maybe even trade a day with somebody just to be safe. And that’s pretty much what it is. That’s what it came down to. I was like, all right. And when I would weigh in, you know, I’m weighing in and my weight’s staying the same, and they can see my weight online, I would check in the doctor, like, have you started the medication yet? I’m like, no, I’m like, I’m waiting a good time, like, in case I got the side effects, she’s all right, okay, you know, it’s your choice or whatever. And then it came and I started the medication and then weighing in the charts doing this. And the next time I had my teleconference with her, you know, the first thing she says, she says, I know you started the medication.

I tell you exactly what day you started. And I’m like, yep, I sure did. Because like I said, it was like, it was a line that was doing this. And then when I started, it was just a line that just went down.

[00:29:57] Jen Pennington: Interesting, interesting, interesting.

[00:29:59] Dr. Marcie Hamrick: The other thing, like staying hydrated is also getting enough calories. Like, Scott said he would sometimes go a whole day without eating. But if you think about being in an intense, like, high intensity fire environment with no calories on board, like, that could potentially be a dangerous situation too. So.

[00:30:16] Scott Dau: And it is hard. Like I said, they. When they tell you oh, yeah, you gotta, you know, like, oh, try to get 200 grams of protein. You’re like, ah, that seems easy. Like, I wasn’t, I wasn’t eating. I don’t feel like I was eating excess of protein before and I wasn’t losing muscle mass. But now it’s like, like, okay, now you got this additional threat of losing muscle mass, and now you have to eat 200 grams of protein and you don’t want to eat because you feel full. It’s like, it’s a challenge sometimes.

[00:30:38] Jen Pennington: Let’s talk a little bit about the kinds of protein that maybe are better. I was just doing an episode with Ben Bergstrom and Kawika Jarman, and we were talking about different proteins that you’re cooking in the, in the fire station and whatnot. And so you have the heavier proteins and you have your meats and everything else, and then you have your beans and lentils and things. I mean, can you talk a little bit about, like, better proteins to really help you along in this journey?

[00:31:04] Dr. Marcie Hamrick: Yeah, I mean, I think of proteins in the form of plants. Like, we, we often think of protein as meat.

[00:31:11] Jen Pennington: Right.

[00:31:11] Dr. Marcie Hamrick: But plants also have a lot of protein and they have the fiber and the nutrients that will help you be healthy while you’re on this. Well, in life in general, but especially while on this medication and can help mitigate some of the side effects of constipation or diarrhea as well.

So beans, lentils, vegetables have protein. Whole grains like quinoa, they all have protein. So edamame or soy, tofu, all of these things are really quite high in protein. You can get to your protein goals without eating all meat all the time.

[00:31:48] Jen Pennington: Well, this has been a great conversation. Do you feel like you’re at your optimal weight, size, you know, health right now?

[00:31:55] Scott Dau: I’m where, you know, when I first started and the doctor online was like, where do you think you would be? What do you think a good weight was for you? And I was like, well, I said, I feel like if I got down, if I could get down, like it was going to be some unobtainable goal because to me, that it had been, you know, I tried for years. I was like, well, I’m like, if. I feel like if I could get down to like 170, 175, that would be good. And that’s, you know, that’s where I am now. You know, I’m like 168 right now.

I’m also at the point where, like, like, I haven’t changed my dosage but the weight loss has stopped. You know, it’s just kind of staying. And that’s when, you know, my doctor’s like, well, you don’t want to go up in dosage because then you’re just going to lose more weight. And. And she’s like, if you feel comfortable, feel comfortable, you feel good about where you are, is like, this is where, you know, you start that tapering off program.

[00:32:37] Jen Pennington: And. And let’s talk a little bit about the tapering off program. What does that look like?

[00:32:42] Scott Dau: I haven’t really officially started yet because I still have all my dosages because it’s. They give you three months at a time. They basically said like, some of your options are you can either go down in dosage, you can take your dosage every other week. You can go to like a switch to a pill format, which is like a different dosage. I mean, for me, like, the injection thing is great because it’s like once a week. You don’t have to worry about, you know, having a pill with you or if you get pills or if you get, you know, held over. You work another shift or something. You’re like, ah, I don’t have my medication. But you don’t miss a thing. And literally it’s just like you’re done and that’s it.

But I mean, they haven’t really, you know, started. I haven’t started that thing yet, but I’ll probably just do like the, every. Try the, every other week and then like this is still monitoring, you know, see if your weight’s still staying. How do you feel, you know, is your weight staying off? Is your food cravings coming back and stuff like that. They don’t just cut you cold turkey off.

[00:33:27] Jen Pennington: Yeah.

[00:33:27] Scott Dau: All right, good job. Thanks. You know, have a good day. So,

[00:33:32] Jen Pennington: yeah, yeah.

[00:33:33] Dr. Marcie Hamrick: Most people are able to reduce their dose to maintain their weight, particularly if they’ve put the work in to make the lifestyle changes. If they are doing the weight resistance exercise to maintain their muscles, they’re doing the diet, they’re doing all that stuff.

[00:33:47] Scott Dau: I don’t really call it a diet anymore. I mean, for me, like I said, it was literally like I’ve been like a reprogramming. Like, I just, I don’t want to eat as much or I look at something and I’m like, I know I don’t have to have three servings of that to get full because like I said before, I was one of those classic, like, eat it. And I don’t realize I should have stopped 10 minutes ago. And then you’re like, oh, God, like everybody at the fire station. I shouldn’t have had that much. I hope we don’t get a fire because then I’m going to fill my mask up with puke, you know, and that’s. And it’s like, like. And now I realize, you know, I can look at food. And I’m like, I know that’s gonna work for me. Like, and sometimes I’ll even look, I’m like, eh, is that gonna be enough? Or you eat it? And you’re like, that was it. The biggest worry I have is more like, is the food noise gonna come back?

[00:34:27] Jen Pennington: That’s what I’m interested in. Because you’ve taken something that’s rewired your brain a little bit to think about food differently. And then once you’re off, does that switch start to come back on?

[00:34:39] Dr. Marcie Hamrick: So studies have shown that 80% of people gain at least some of their weight back a year or two after they’ve stopped.

But I also wonder how many of those did the work on the lifestyle change. They haven’t looked at that in particular, but many people are able to find a lower dose or taking it less often, less than once a week as their maintenance to continue at their ideal weight.

[00:35:08] Scott Dau: Some people are like, oh, I can eat whatever I want now that I’m on this. And it’s like, if that’s your plan right now, you’re either going to be on it forever or when you get off of it, you’re going to go back. Right back to where you were.

[00:35:18] Dr. Marcie Hamrick: That’s right.

[00:35:19] Jen Pennington: Yeah.

[00:35:19] Scott Dau: You know, it’s not. To me, it’s like, people always like, oh, can you eat whatever you want? I’m like, yeah, you can still eat whatever you want. You may not like what you’re eating. You may not like the side effects. Because if you fill yourself up on ice cream when you should have had protein and now your stomach’s full and you’re like, I can’t eat anything. If I eat anything more, I feel like I’m going to barf. That’s the reprogramming that goes on in your head, like, without even thinking about it. It’s like, you just know that you’re only gonna be able to eat so much and you just gotta make it count. And then the other thing for me, like, it wasn’t that big a deal was like, especially when you’re paying out of pocket for it. Like, I’m not gonna waste my money doing all this and then just let it go to Waste. Why pay all that money to. To get on this program, get the results from it, and then just as soon as it’s done, we’ll be like, ah, let’s go back to what it was. That was fun. Exactly. I had a great summer bod. But now,

[00:36:09] Dr. Marcie Hamrick: now I love that reframe of not thinking of it as a diet, because I. I think that’s. That’s great. It is.

[00:36:14] Scott Dau: And for me, like I said, for me, I love food. I mean, people, like, I love food. Like, I. Tim cooked great food. I mean, there was Tim’s pad Thai. Have you ever had it? If you’ve ever had Tim’s pad Thai, you know, like, you just. You look at, you’re like, I want more of that. And even though you’re like, I shouldn’t have more of that, you look at it, you’re like, that was good. I want more of that. And that’s just like, now it’s just gone.

So you just look at, you’re like, yeah, that was good. I know. I like that. But I don’t need as much. And like I said, you know, somebody leaves a Hershey’s bar on the table, a little snack size one, I’m probably going to eat it. Thank you very much for leaving that out, but that’s just my chocolate addiction.

[00:36:47] Jen Pennington: Well, I want to thank you both for being here and congratulations on, you know, not just. Not just the weight loss, but changing your lifestyle, your nutrition intake and everything else.

[00:36:57] Scott Dau: To be able to sit like a

[00:36:58] Jen Pennington: travel dude, you’re not the husky guy from.

[00:37:01] Scott Dau: And not have the seat belt, like, pinch you the seat belt. You’re gonna have to, like, loosen the seat belt like 4 inches so you could sit.

I don’t have to do that anymore. You know, like I said, I had to buy a bunch of new clothes. You know, I was punching notches in the belt. And then he had to buy a new belt because eventually you end up with like 10 inches on the other side of the buckle. You got to do something with.

So it was just like, it’s been

[00:37:23] Jen Pennington: like, turn them into bracelets.

[00:37:24] Scott Dau: And, you know, like I said, like, the best thing, like, you know, I feel like somehow I became the spokesman for it because everybody was coming to me. Everybody. Like, what are you doing something? You’re doing something. I know you’re doing something. I’m like, I’m not going to lie about it. Yeah, I’m doing the GLP-1s. Are you doing Ozempic and be like, nope. Doing Zepbound.

And they’d be like, oh really? Like, how’s that work? And I’d tell them and be like, I gotta talk to my doctor about that. And people have done it because I’ve had people that have been on it now for a couple months now that have come back to you, like, dude, I’m so glad I talked to you. I have not been able to lose weight for 10 years. And like now that I’m on this, it’s like I’m having buy new pants myself. And it’s like, I’m glad you talked. I’m glad. Like I said, I’m glad we’re covering it now. I think that was part of the thing before it was like, it’s expensive, you’d have to do it out of pocket. I mean, there are the manufacturers incentive programs that make it a little more reasonable.

But now that it’s covered, it’s like people are like, hey, you know. And I think that was one of the things that Tim told me. He was like, we looked at this drug and we’re like, look, we can either have a bunch of people that are overweight and on drugs and medications and, and having problems that are costing the HealthCare Trust more than what it would cost to just cover this medication.

And so they said we’re gonna start covering it and see where it goes from there. So I’m glad we did.

[00:38:39] Jen Pennington: Yeah. Great.

Anything else?

[00:38:42] Dr. Marcie Hamrick: I wanna emphasize that it is a tool in the toolbox of many things that people can do to achieve better health.

And it’s one that I want people to be educated about. Both the advantages and also some of the side effects and involved like both are always true.

But the question in my mind is, would meaningful weight loss improve a person’s quality of life, function and long term risk? And if the answer is yes, then I think they should consider this tool to help them get there.

[00:39:17] Jen Pennington: And that’s a great place to end this podcast. So thank you so much both of you for being here. Really appreciate it and I’m sure there’s a lot of people out there who really appreciate hearing firsthand.

[00:39:27] Scott Dau: Come talk to me.

[00:39:28] Jen Pennington: Your experience.

[00:39:28] Scott Dau: Don’t tell anybody. You talk to me.

Your secret is my secret.

[00:39:32] Jen Pennington: That sounds great. Thank you all so much.

[00:39:34] Dr. Marcie Hamrick: Thank you, Jen.

[00:39:35] Jen Pennington: Bye bye.

Thanks for joining us. Listen up. L27 is a Seattle fire fighter HealthCare Trust production. Our music is Hagadate Line by Blue Dot Sessions. This podcast is produced by the Rhizome Collaborative. I’m your host Jen Pennington. And until next time, stay safe and stay healthy.