The Disease of Obesity: Why Diets Alone Are Not Enough With Dr. Sandra Cortina Ep. 184

Discover why the future of weight management lies beyond the realm of traditional diet and exercise as we welcome Dr. Cortina, a leading internal medicine specialist focused on obesity management. Challenge your assumptions about Ozempic and other weight loss medications as we unravel their dual purpose beyond diabetes treatment. Dr. Cortina enlightens us on the critical role of GLP-1, a gut hormone mimicked by these medications, which offers a scientific approach to managing appetite and obesity-related health conditions like prediabetes. We dig into the complexities of assessing who qualifies for these treatments, stressing the importance of evaluating obesity-related risks. Dr. Cortina also takes on the problematic nature of the diet industry, likening it to "weight loss cartels" that often exploit vulnerable individuals. We conclude with a hopeful vision for a future where informed medical guidance prevails over diet culture, and we invite you to explore more of Dr. Cortina's insights on Instagram.

About Dr. Cortina
Dr. Sandra Cortina is an internal medicine specialist and diplomate of the American Board of Obesity Medicine who practices obesity medicine in British Columbia, Canada. She has a special interest in ADHD and Binge Eating Disorder as well as managing the multifactorial causes of obesity that help ensure long-term treatment success. Her previous training includes a bachelors in Kinesiology, a masters in Public Health and a bachelors in Nursing with prior nursing practice experience in mental health, harm reduction and addiction medicine. She currently holds active memberships with the Canadian ADHD Resource Alliance and Eating Disorders Association of Canada. She is passionate about helping patients unlearn diet culture myths, and to replace them with evidence-based approaches to clinically important weight loss. As an advocate for scientific communication, she actively shares accurate weight loss information on social media and works to debunk misleading trends.

Takeaways

• Weight loss medications should be reframed as anti-obesity medications, as their goal is to reduce the burden of excess fat tissue that leads to other health issues.
• Weight loss medications work by mimicking gut hormones that control appetite and help individuals feel full.
• Weight loss medications should be used in conjunction with lifestyle changes, such as reducing processed foods and engaging in physical activity.

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Chapters

• 0:25 Weight Loss Medication Misconceptions and Benefits
• 11:01 Weight Loss Medication Side Effects Explained
• 25:31 Obesity and Weight Loss Medication Insights

Transcript

Speaker 1: 0:25

Okay, welcome back to the Elegoo podcast. My name is Lisa, I am your host, and today's guest is Dr Cortina. Dr Cortina, thank you for coming to the show. Oh, thanks for having me. So why don't you tell us a little bit about what you do?

Speaker 2: 0:42

For sure, yeah, so I am an internal medicine specialist, which basically means I do adult medicine, but my specialty training is in obesity management. So I am American board certified in obesity medicine and I do community obesity medicine essentially here in New Westminster Canada.

Speaker 1: 1:03

Okay. So I found you on Instagram and I was like oh, wow, okay, she's dropping bombs and gems. Because I saw the comments and I'm like woo Okay. And obviously there is this whole talk about weight loss medications with Ozempic. There is this whole talk about weight loss medications with Ozempic and I'm going to be real honest with you, I don't know a lot about those medications, which I'm probably going to guess a lot of people don't know a lot about these medications. When I look at your comments, I'm seeing that. So let's start with what's the biggest misconception with weight loss medications.

Speaker 2: 1:46

Yeah, the biggest misconception has to be that they're weight loss. No, they're called weight loss medications. I think if we were to just reframe the narrative and call them anti-obesity medications, it might be a bit different. But because we always call them weight loss medications and so we always think that this is about a number on a scale, when the whole purpose and the goal of using these medications is to reduce the burden of excess fat tissue that is leading to other health issues. I think that's the biggest thing.

Speaker 1: 2:20

Okay, yeah, yeah, for sure, okay. So what are the most commonly prescribed weight loss medications? Like, I even mentioned the Ozempic, and then there's another one out there and how do they work in the body? Because, honestly, when I think about the weight loss medications, as they call them, I mean back in the day there were a lot of ones that were already out there. I don't even think people realize that there are a lot out there, but now, because of I don't know if it's because of social media or just the way we are in the world everybody knows the names of these medications. So what are the ones that are most commonly prescribed?

Speaker 2: 3:07

Hands down, it has to be Ozempic and of course it's prescribed off-label because it's intended for diabetes. But as physicians we can prescribe things off-label. And what really made Ozempic popular among everyone is that it's the most cost-effective medication, or it's the most cost effective medication, or it's the most affordable one on the market. And so when you look at, when you look at just the anti obesity medications, the ones that are approved for obesity, let's say like will go be the same medication, but it's they charge more for it same medication. And so what? What, as doctors have been doing is we don't want patients to take on that burden of the extra costs when we know it's the same medication. So we prescribe the Ozempic off label because it ends up being the, you know, most cost effective one, at least.

Speaker 1: 3:55

So was it around like cause it's for cause that's the thing I heard that it's for diabetes. So has this been around for a while.

Speaker 2: 4:03

It's been around for some time. Yes, it's been around since about 2018. Ozempic I was certainly prescribing it back then off label and I was probably begging people to just even consider it at that time. It's a different landscape now, but it has been around. So Ozempic's been around for some time. When you look at just the class of the medications because we call them GLP-1s, which stands for glucagon-like peptide 1, it's a long name. It's the name of the hormone in it or the copy of the hormone in it these classes, this class of medications, have been around since 2007. So we're talking 17 years. They've been around.

Speaker 1: 4:46

Okay, so let's talk about what exactly do they do Like? How are these people losing weight? What's going on?

Speaker 2: 4:55

Yeah. So what's really interesting or at least how I explain it to my patients is this is a copy of a gut peptide and they've copied the peptide really well. Ozepic mimics our natural GLP-1 by 96%. It's a very close copy with it and basically what I explain to patients is that this is an appetite hormone. It helps us feel full when we eat food. Normally, okay, food travels down the gut right and it'll hit the gut wall and when it hits the gut wall, our gut will secrete. There's actually a slew of different hormones, but one of them is GLP-1, and it has a lot of jobs. But for our purposes, it controls our appetite when we eat. So it goes to the brain and it says, hey, food is here, feel full? Okay. So that's that's the predominant way I would say. It works and people will say, yes, there's reduced gastric emptying, yada, yada. Yes, but remember, obesity is a disease of the brain and that's where this thing is working, okay.

Speaker 2: 5:58

Well, why is that even important? Because we know that when people start to carry extra weight, the extra weight leads to prediabetes, diabetes. This is the same same guys. This is the same disorder. The question is, where are you on this spectrum? Because we already know across the spectrum whether it's excess weight to diabetes. The functioning of GLP-1, it's not as robust when we compare it to people without extra weight or without type 2 diabetes, et cetera. So that's a whole idea about why we give this hormone back.

Speaker 1: 6:31

Wow Okay.

Speaker 2: 6:32

I didn't know that.

Speaker 1: 6:33

So I didn't realize that it is something that's natural, that we already have. So let me ask you this, because I'm sure people are listening and they're thinking the same thing Okay, we already have it. Why, what? Why are we giving more of it? I don't get it.

Speaker 2: 6:51

Cause it doesn't. It doesn't work as well, it's not as robust, and so we have. We have studies. At least it correlates with BMI. The higher the BMI, the less robust or the lower levels of this hormone people with higher BMIs will have. I think probably the next most natural question that always comes up is well, can't we test it Right? Why don't? Can we test the levels to know for sure? We can't. Because our natural GLP-1, it gets released after a meal. It's gone after about eight minutes. Glp-1. It gets released after a meal. It's gone after about eight minutes. Wow, the half-life of this medication is a week, so it makes it last a long time. So you're feeling full, fuller, faster, longer after you eat consistently.

Speaker 1: 7:36

Okay, all right, so you mentioned two of them, so of course I only know Ozempic. And then there's a what is it? Wagozi, or?

Speaker 2: 7:44

Wagovi yeah.

Speaker 1: 7:46

Wagovi. Okay, what's the difference?

Speaker 2: 7:48

They're the same. It's the same. It's the same. It has to do with marketing, basically. So the drug company who makes it is Novo Nordisk, and when they speak to the medication for a certain audience for the diabetes audience they want to use a specific brand, and that's Ozempic. But when they want to speak to the different audience, for weight management, that's where they package the same medication just in a different color pen than they go and write Wagovi on it. But it's the same medication. So they're the same, essentially Ozempic the. They're the same, essentially Osempic diabetes. Wagovi is for weight management.

Speaker 1: 8:30

Okay.

Speaker 2: 8:31

But there's a newer medication on the market that maybe you've heard of is Manjaro. Yes, yes.

Speaker 2: 8:39

There's Manjaro and then there is the weight management version cousin. Again, this is going to be the same medication, right, which is called Zepbound, and that medication is called weight management version. Cousin. Again, this is going to be the same medication, right, which is called Zepbound, and that medication is called Terzepatide. So when they brand it for diabetes, sponjaro, when they brand it for weight management, zepbound, that is a very interesting medication.

Speaker 2: 9:00

So, if you remember, with Ozempic it has a copy of glucagon-like peptide 1. With manjaro it has two hormone copies, so it has that glp1, but it has a second hormone, has even longer name. We call it gip for short. Okay, but it's glucose dependent insulin tropic peptide c really long, so it's gip for short. What gip does is it blocks the side effect profile of glp1 that you would otherwise experience with just Ozempic alone. So everyone hears about those side effects, right, and so what you get with this newer one is you actually get more weight loss because there's two hormones, but you get a much lower side effect profile, like 50% lower the rate of side effects.

Speaker 1: 9:45

Okay, all right, yeah, okay. Yeah, that's the other one I'm hearing about. All right. So, yes, the side effects is what we're hearing about a lot, and especially you know you said. You said I don't want to say this the wrong way, but you said delayed gastric emptying. So can you just say a little bit about what that exactly means?

Speaker 2: 10:14

So delayed gastric emptying basically means when your gastrointestinal system is processing food and it's going down at a rate like a regular rate, so food has to travel down our gastrointestinal tract, gets digested, moves along, the nutrients get absorbed, all that stuff. With delayed gastric emptying that is slowed down and if it's slowed down there's more food in our gut. And remember, when there's food in our gut it's stimulating those fullness hormones, right? Because when it's stimulating the gut, those fullness hormones, right? Because when it's signaling in the gut, those fullness hormones are constantly getting secreted and so that helps with that fullness feeling. So that's what I meant by the, or that's what's meant by the gastric emptying piece.

Speaker 1: 11:01

Okay, so a lot of the words or the terms that I hear a lot is also gastroparesis as part of the side effects. So what is that? Gastroparesis as part of the side effects? So what is that?

Speaker 2: 11:15

And okay, let me start with that. What is that? Yeah, no, that's great, yeah, and probably you were hearing a stomach paralysis too, I'd throw in there, right, so, so, yeah, so we know that, um, we know, like we already know, that the medication causes delayed gastric emptying, and the Latin medical term for that is gastroparesis. Okay, paresis means slowing down, and gastro well, you know, it's gastro, right, so it kind of makes sense Gastroparesis, same same, okay. What's happened, though, is, in media, they've really they've started to confuse, in my opinion, paresis with paralysis. That's not the same thing. Paralysis is like halting, right, this is slowing, and so when they use the terms the paralysis, people of course can get a bit freaked out, but what's happening is it's paresis, it's the slowing down of gastric emptying out, but what's happening is it's paresis, it's the slowing down of gastric emptying.

Speaker 1: 12:14

Okay, so, with the side effects, which you know, with every drug there's side effects, right, and it's kind of like a toss up whether you're going to be the one that's going to have that. I mean, isn't it really like that's how it is, like you might have more of?

Speaker 2: 12:38

those side effects than somebody else. Is there any reason for that? I mean, what? What is your take on that? The side effects are. So the side effects, all the side effects, are a result of the gastroparesis. They're a result of the gastric emptying. Okay, so everyone gets a bit spooked with the word gastroparesis. Stomach paralysis and it's not stomach paralysis. Right, it's slowing, but when there is slowing, what happens is people get acid reflux. That's a more relatable side effect, right, okay, that makes sense. Constipation right, slowing down, that makes sense. More relatable side effect Nausea it's also because of the slowing down. So, all of the known side effects, the underlying physiological reason for all the side effects that have been listed for this medication is due to gastroparesis. The word gastroparesis is new to the public, not new to me. I knew about that already. I know it causes gastroparesis and that's why the list of side effects looks like this. I don't know if that helps.

Speaker 1: 13:41

No, that helps, but I guess it's not new to people who've been around, the people who have it. But yeah, I guess you're right, not a lot of people are aware of that terminology. Okay, so let's get into. How do you determine if a patient is a good candidate for weight loss medication?

Speaker 2: 14:03

Yes, so the drug companies do have a, you know, a list of what we call indications. Indications meaning this is who you can prescribe it to and this is who you don't. And the biggest, you know, what we're looking for is does this person have obesity and will they benefit from weight loss? And you know they, they sort it out and they base it on BMI. But it does get a bit more complex than that. Really. You're looking to see if they have excess fat tissue really around their abdomen and if that's going to help reduce other things like do they have high cholesterol? Yeah, reducing their weight is going to help Diabetes. Yeah, do they have pain at their joints, at their knees? Yeah, that's who you want to prescribe it to. When they have excess weight around their abdomen, that's leading to other medical issues. Okay, really, really, how you determine.

Speaker 1: 15:00

Okay, let me take a step back. So most people are thinking, okay, you know, if you're overweight, then why don't you just do it the natural way? And then there are people who are extremely like obese and I'm thinking, yeah, they need help. Like the, the, the um, them like, right now, we need to save them. Like there's you know what I'm saying? Because, like, there's the, the cholesterol, the potential of a heart attack. I mean, we're talking life threatening things that could potentially happen to this individual. And then, um, you know, a lot of people are like, well then, I, you know, I can understand them taking these weight loss medications. But then you see people like the Kardashians, supposedly, you know, we think, okay, they might, they might, are they on it? They're not on it, we don't know. I mean we suspect. And then there's tons of celebrities. I mean we suspect. And then there's tons of celebrities who are not obese that are taking this medication. So, like, what is? What are your thoughts?

Speaker 2: 15:59

on that? Yeah, it's, yeah, there's. It's a loaded question, isn't it there is sometimes it's hard to know if they, if they should or should not be on it, like, sometimes, like you, you don't know what their lab tests are doing. So it's it's, it is hard. But then there's some cases you're like, oh, I don't know about this one person, like they weren't you know, I don't know.

Speaker 2: 16:21

I think I came across something about ice spice on on it, yes, yes, okay, uh, so that I can't. I can't fault them. I actually have to fault the person who's prescribing them. Like, who is this person prescribing it to? This person who probably doesn't have the indication? Because every time we prescribe something as a physician, you always have to weigh. Okay, the patient has to have more benefits than downsides, more benefits than risks.

Speaker 2: 16:55

If you're going to prescribe this thing, or else you're not practicing first, do no harm. And if you do prescribe it to somebody with just a little bit of extra weight, you run the risk of more side effects or disadvantages. People lose muscle loss and that's significant. When you're in a lower BMI category, I would argue. But people don't also appreciate this is they'll lose their hair, they'll grow back, but when you don't have that much extra weight to lose and you throw on something like that that causes you to lose weight when you really didn't have that much. You will lose hair. It grows back, but that can be distressful, which I don't think people appreciate.

Speaker 1: 17:36

That makes a lot of sense. That makes a lot of sense. So the other thing that I've heard people say well, you know, these medications are expensive and they're taking it away from the people who really need it, Like those aren't diabetic.

Speaker 2: 17:51

Sorry, I'm throwing this at you.

Speaker 1: 17:54

What are your thoughts on that?

Speaker 2: 17:56

Yeah, during the whole shortage and everything, yeah, yeah. So it's like, who deserves to be on this medication at the end of the day, right? So what if I put it this way? What if I had two medication? Or I had a medication, it treated both, uh, let's say, multiple sclerosis and rheumatoid arthritis, right, okay, and it went to shortage. We wouldn't be having a conversation. Who deserves to have the medication more?

Speaker 2: 18:26

So that comes down to weight bias. For one, okay, here's the other weight bias. Okay, so I've got somebody with diabetes. We can use Ozempic, I can use it off label for somebody for weight management, okay, and it goes into shortage. Who deserves it? Okay, how many treatments do I have in obesity? One, two, three. How many medications do people with diabetes have? They got like 20 medications. So why are we saying that they get first priority? You know they've got 20 other medications, and so you're. Are we saying that, um, it's okay to leave one population just completely untreated, right? And so that's another example of the weight bias that happens. At the end of the day, semaglutide is semaglutide, zampic, wogovie. I don't care what rules the drug companies have made. They're a business.

Speaker 1: 19:24

I know what the medication is, it's the same right, okay, all right, let's talk about the amount of weight loss, like what's realistic, and you know, then, taking these medications, I mean I really don't know, like if when I see somebody obviously these celebrities I don't see them every day, so it's not like I'm like, oh my God, they lost all that in one week, like I can't say that because it's not like we see them every day. But then it's like you know, you see them maybe six months ago, and then you're like what Holy crap? But realistically, speaking.

Speaker 2: 20:00

What should they be expecting? So it depends on the medication. If I was to talk about Wagovi, let's say what I quote. Everybody is expect to lose about 15% of your body weight, maybe up to 17,. But expect that over the course of a year, a year and a half. So it happens slowly, and so how you calculate that percent is well, whatever your current weight is 15%, that's how much weight you would lose.

Speaker 1: 20:32

Okay, Should they be doing other things besides that? I mean, like, what are your recommendations? I mean, should they also be working out eating?

Speaker 2: 20:45

healthy like, or are they just, you know, getting this medication? Yeah, that's, yeah, what a wonderful question. Yeah, of course. So what I tell everyone is reduce your intake of processed foods and do 150 minutes of, like, moderate intensity physical activity if you can. Some people have limitations, right, um, but those recommendations are no different than the recommendations for the general public people People with obesity don't get special recommendations that are different from the general public.

Speaker 1: 21:19

Wow, really no, okay, yeah, I know.

Speaker 2: 21:22

It's very shattering.

Speaker 1: 21:24

This kind of goes into the question I was going to ask you and the question was how do these medications compare with diet and exercise alone in terms of effectiveness? Because, like I said, a lot of people are going to say, well, why can't they do it the natural way and working out and eating healthy, versus taking the medications? What is your answer to that?

Speaker 2: 21:47

Sure.

Speaker 2: 21:48

So to answer that, we're going to have to go over what happens in obesity, I guess. How does obesity even happen? So when we think about obesity, you have to remember that this is a disease of the brain, our brain, that controls weight, and it's subconscious. Okay, so it's subconscious, but it likes to pick the best weight it goes. I like this weight. We call it the set point, but really it's like a range of, I don't know, plus or minus 10 or 20 pounds. So as long as you're in this weight range, your brain thinks you're happy, safe, whatnot? Okay.

Speaker 2: 22:26

When we gain weight, though, and for whatever reason is, this range will go, shifts up, shifts up, and this process naturally does not go in this direction on its own, because if it does, what are we worried about? We're about cancer or something right? Why is this person just losing weight, not doing anything? So, from an evolutionary basis, this thing is going up, because we would have survived longer as a species going this way, and what happens in the disease of obesity is this thing gets stuck at an inappropriately high weight set point or set range. Okay, it's stuck here. Your brain thinks this is the best weight for you to be here, while the rest of your body's looking up, going right. It's like the one thing. The brain gets wrong. And so when we're talking about how do we get the weight down and why not use diet and exercise over medications, because they work completely differently. Let's say I diet, okay, and I remember I said just got to reduce processed foods. Okay, let's say we do that. What happens is your weight will probably drop 5% in the longterm. It goes from here to here, but I know that's sustainable and that's what matters. And people are like I could lose more. I can lose more than 5%, for sure I can. I've done it before because they probably have. They've done something really restrictive and that's true. So I could start using my conscious brain and I could force my weight out of here. Right, I force it here. But dieting doesn't change where this doesn't. It doesn't change where this lives. This is still here.

Speaker 2: 23:57

And because you left the safety zone, your subconscious brain thinks you're in trouble, like you're in the famine. Has no idea. You got a fridge full of food. Thinks you're in the famine and you're in trouble Like you're in the famine. Has no idea. You got a fridge full of food. Thinks you're in the famine and you're down here, and what it does to counteract this is it makes you tired, lowers your metabolic rate, makes you hungry. All of a sudden, all you want is McDonald's and ice cream. Can't stop thinking about it, and it's not sustainable.

Speaker 2: 24:21

So what happens as soon as you let go back here? Okay, this is what obesity is. Okay, it's stuck here. Okay, well, what about medications then? So medications change this, they alter this, so it's a treatment. Medications will take this range, move it down Okay, depending like how much you know it, depending on the medication, how much down, but it holds it here, holds it here and your new weight range is here, and it stays here for as long as you're on the medication. Because if you stop it, compare that to bariatric surgery. Bariatric surgery is a hormonal surgery. I know this is a hormonal surgery. Okay, I know this is a little bit off topic, but we should compare it. Bariatric surgery permanently moves this all the way down here, and then you can let go right, because it's a solution. Right, it's a treatment. Yeah, so those are the main three treatment options, and that's why Diets are not going to treat obesity, the disease.

Speaker 1: 25:31

I'm speechless because that is probably the best way to explain that, and I'm like like mind blown. I mean, do I know this? Yes, but the way you explained it just makes so much sense and it is with your brain. Of course it's with the brain. You could do all the fancy stuff, but if you're not doing this, it's 100% you let go. You're going to go back to that safe place. The way you explain that is just right on point. My God, okay. Safe place. The way you explain that is just right on point. My God, okay. Now you just answered my question because I was going to ask you what happens when the patient stops taking the medication. Is there a risk of regaining the weight?

Speaker 2: 26:20

Yeah. So I tell everyone yes, yes, yes, yes. We think that there is okay. When you look at the data, we think that there's about probably 5% of the population that can keep the weight off after stopping the medication, which is diet and exercise alone. But we also think those are the same people who would have lost the weight anyways without the medication. And if that's the case, they don't have obesity and they're able to sustain it.

Speaker 2: 26:55

Because there are some people who they've gained the weight, ok, but their weight range isn't. So it's not so narrow as what I said, right, it's probably a weight range, but it's like going up, but it's like a big weight range and they so it's not so narrow as what I said, right, it's probably like a weight range, but it's like going up, but it's like a big weight range and they'd make these diet changes and it's still here to here, but because their diet was so poor in the beginning, they can keep it off because this thing was so big, right, and this is genetically determined or whatnot. So so what I guess what I'm trying to say is there is the people who can do this get significant weight down, keep it off lifelong without medication. They don't have obesity. Okay, obesity is when this is stuck. This is when you're stuck.

Speaker 1: 27:43

You can't get this down. I think that's one of the. That's the biggest misconception, because I don't. They don't get that that. This is first of all. I'm going to be honest with you. When people used to say it was a disease, I was like, how is that?

Speaker 2: 27:56

But when how is it?

Speaker 1: 27:58

a disease. But you're right, you're so right about the minds, the brain. You're so right about the brain putting you in that spot and when people think about, well, just do their organic way. Oh my God, why is the diet culture, the diet industry is booming? Because you go back. Hello, because you go back. It's a good business model, I'm telling you, you go back to. How many times do people do that? They lose the way, they eventually go back and that's why it's a big moneymaker. I got to say you pretty much opened up my eyes today. I didn't know if I could be opened up any further, but it is. And you explaining it the way you did really makes a lot of sense. And let me ask you this one question what do you see as a change as far as all these medications coming up, as far as the diet culture, the diet industry? What do you foresee happening in the future with all this?

Speaker 2: 29:06

Oh, what I foresee, I I hope I will. What I foresee and what I hope I guess is different. I think, slowly, though I think diet culture will start to whittle, you know, whither away a bit. If you follow me on Instagram, I will talk about like the diet culture and diet culture companies as weight loss cartels, and that's how. That's exactly what they are. They prey on people who are vulnerable, desperate, right, and they're charging people with, you know, stuff that is not going to treat your obesity. I'm talking about like diets or whatever. It's not going to treat obesity. I just said obesity, is this okay? And they're nothing more than weight loss cartels.

Speaker 2: 29:57

At the end of the day, people need to see it. They need to see somebody who can like a health professional. At the end of the day, I think it will start to wither away. I think it'll take some time for people to appreciate the double standards, but I think, over time, we'll start to see it. And and the double standard meaning, if you know, we don't see this with other diseases. So, um, let's say, somebody has heart disease. I don't see Weight Watchers doing a uh, uh, comes to our cardiology clinic, right, it's all. It's like comical, really, right, and that comes down to that bias piece. That weight bias thing is we still don't believe obesity is a disease because we would never do that to other diseases, we just wouldn't.

Speaker 1: 30:48

Yeah, yeah, right, I again. I just thank you so much for providing all this information. I'm going to urge everyone to check her out on her Instagram. I'm sure she's like batting everybody as she's looking at the comments, but I mean, you're providing education and I'm sure people are getting triggered by that because it's completely opposite of what they're thinking. But I want to thank you so much for literally giving us the basics of these medications and talking about this disease, because it is a disease and you know again I go back to you know the risk, the risk of those other risks of heart disease and stroke, and I mean we just sit here and talk about all the other risks from being obese. You know that is the reason why these medications are being given, because we want to save these people. So, um, again, dr Cortina, thank you for being a part of this.

Speaker 2: 31:54

Oh, you're very welcome, very, very welcome.

Speaker 1: 31:57

Spread the word always, so where can we find you?

Speaker 2: 32:02

Yeah, so you can find me on on Instagram. So my handle is yeah, so you can find me on Instagram. So my handle is Cortina Weight Medicine and yeah, that's where I post all my content on social media.

Speaker 1: 32:16

I just post it on my Instagram.

Speaker 2: 32:17

there she hasn't gone to the TikTok land. I did have TikTok, but it was too many impersonators. I had a TikTok until maybe like two weeks ago, when I had these impersonator accounts and TikTok wouldn't take them down. Oh my God. So I deleted my TikTok. Oh my God, it's really bizarre, tiktok. Be better. What is wrong with you? Be better.

Speaker 1: 32:40

What is wrong with you? Okay, all right, I didn't know. I think I saw a post you talking about that, so I think I did. I'm like she's talking impersonators. Anyways, follow her on Instagram, get educated, listen to what she's saying. But, yes, I'll put all the links to get ahold of her on the show notes. And again, dr Cortina, thank you for being a part of this. I really appreciate it. All right, awesome, very welcome. Okay, and until next time, bye you.