GLP-1s - Why informed consent is key. A conversation with Aoife McMahon

Before I share the show notes below, a quick disclaimer: this episode is for information and education purposes only and does not focus on medical risk/ replace advice from a medical professional. If you are taking any weight loss drug or are considering taking one, please consult with a professional/ your healthcare provider. 

Now - what a treat to have the lovely Aoife McMahon on the pod today!

Aoife is a specialist eating disorder, disordered eating and body image dietitian. She supports individuals in one-to-one sessions to rebuild a peaceful relationship with food and their body. In addition to that, she works alongside colleague Rhian Houghton to raise awareness and provide training to professionals regarding eating disorders in the context of GLP-1 medications. One of the greatest gifts Aoife has found through her work — and through healing her own relationship with food and her body — is being able to raise her family in a home where a peaceful relationship with food is simply the norm.

Aoife gave a fantastic overview of what GLP-1 medications are and what evidence for their long-term effectiveness we have (or rather, we don't have..). We discussed our mutual concern on how there is a lack of support for patients on these drugs, how healing people's relationship with food is often not part of the consultation process, and that informed consent is absolute key in ensuring that anyone who is considering them does so with all the necessary information available. 

Aoife and her colleague Rhian have developed a fantastic resource for dietitians and other healthcare professionals - a webinar that addresses all of the above. 

Let us know your thoughts on this topic!

If you'd like to find out more about Aoife's work or contact her, here are the details:

Website

Instagram @thatirishdietitian

Email: aoife@centreforliberatingnutrition.com

Please reach out if you would like some support with your relationship to food OR movement. Ela currently has limited spaces for Intuitive Eating coaching and if you'd like to reconnect with movement, contact Christine.

Transcript

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Ela Law: Hello, my lovelies. Thank you for tuning in to the Find Your Strong podcast this week. I'm flying solo today because, sadly, Christine wasn't very well for the recording, but I had the pleasure of speaking to the fabulous Aoife McMahon.

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Ela Law: I've known her for a little while because I do peer supervision with her, and I asked her to come on the podcast because she is an expert in GLP-1s, in particular with relation to, eating disorders and disordered eating.

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Ela Law: She is a fabulous person. I'm going to read out her bio, because I don't want to miss anything.

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Ela Law: So Aoife is a specialist eating disorder, disordered eating, and body image dietitian, so she comes at it from a weight-inclusive, perspective. She supports individuals in one-to-one sessions to rebuild a peaceful relationship with food and their body.

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Ela Law: In addition to that, she works alongside colleague Rhian Houghton, I think I pronounced that, correctly, to raise awareness and provide training for professionals regarding eating disorders in the context of GLP-1 medications.

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Ela Law: One of the greatest gifts Aoife has found through her work, and through healing her own relationship with food and her body, is being able to raise her family in a home where a peaceful relationship with food is simply the norm. And I love that so much, and I think it's so important to have the conversations around, weight and weight loss drugs.

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Ela Law: But with a very open, compassionate, non-judgmental lens. And, Aoife and I spoke about that today, and how informed consent is really, really important in making the decision to go on a weight loss drug or not. And,

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Ela Law: how little evidence there is, in terms of long-term effectiveness, and also, you know, about…

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Ela Law: how… how do we support anybody who might be considering taking, a weight loss drug? So, hopefully, this conversation is helpful to you. Maybe you are someone who, is taking GLP-1s, already. We wanted to make sure that

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Ela Law: working with someone who is an intuitive eating counselor, a body image counselor, someone who works in the weight-neutral space doesn't mean that you cannot work with them if you are taking a weight loss drug. In fact.

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Ela Law: seeking support from some professionals who are clued up on the weight loss drug, but also come at it with compassion and non-judgment, could be really, really important. So, yeah, listen to the conversation. Any comments, any questions, anything that you would like to share with us, we would love to hear from you. And without any further ado, here is our episode.

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Ela Law: Hi, everybody! Welcome back. I am really excited because I'm talking to the lovely Aoife today. I know Aoife through a peer supervision group, which I started. When did I start that? Like, a year or two ago?

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Aoife McMahon: Yeah, one or two years, yeah.

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Ela Law: Yeah, I can't even remember, I should have checked the details. But yeah, so, I've known Aoife since then, and, I was very, very keen to have her on the pod, because she is an expert in GLP-1s.

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Ela Law: And in particular, with regard to disordered eating and eating disorders, so I was really keen to have her on to tell us a little bit about

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Ela Law: the weight loss drugs, and concerns, and things to be aware of. But before we start with that, I'd love you to introduce yourself, if you don't mind. Just tell us a little bit about yourself.

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Aoife McMahon: Yeah, lovely. So, hello, I'm Aoife, and I am a weight-inclusive dietitian. I work with body image, eating disorders, and disordered eating, and my main passion is just helping people to heal their relationship with food, eat normally, basically.

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Ela Law: Yeah, that's easier said than done, isn't it?

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Aoife McMahon: Yes, it's a process, unfortunately.

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Ela Law: Yeah, absolutely, absolutely. And I love that you're also coming at it from a weight-inclusive point of view, because very often that isn't the case for dietitians in particular. Sadly, as we know through our peer supervision group, there's still a lot of weight stigma in the healthcare system, and…

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Ela Law: In dietitians as well, especially those that are working with eating disorders, it's quite rife there, isn't it?

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Aoife McMahon: Yeah, yeah, unfortunately, healthcare is a big perpetuator of weight stigma, and I mean, when I initially started in dietetics, I was working in weight loss surgery, weight loss medications, weight loss, clinics as well.

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Aoife McMahon: And I think it's similar to everyone else, it was just…

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Aoife McMahon: Trying to find that key to… to help people to lose weight.

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Aoife McMahon: But, yeah, there were several reasons why I shifted into relationship with food work as well.

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Ela Law: Okay, can you tell us a little bit more about that? What sort of made you shift gears?

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Aoife McMahon: Yeah, yeah, so I suppose, I'm… I knew I wanted to be a dietitian from a young age. I just sensed around me and felt the pressures for people to lose weight, and could see the impact of that

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Aoife McMahon: to people close around me, and I thought the solution was weight loss, and then… so then I decided I wanted to be a dietitian, and then I did my dietetics degree, and I came out the other side of it, and I didn't know

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Aoife McMahon: how to support people to lose weight, and so then I went into the NHS, and as I said, worked in weight loss surgery, worked in weight loss clinics. I also prescribed weight loss drugs. This was before GLP-1s, but it's a unique position. Not many dietitians are in that prescribing position.

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Aoife McMahon: And when it comes to the weight loss medications, the weight loss clinics, I saw there was poor results. It wasn't people's fault. People were trying very, very hard.

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Aoife McMahon: So there was very few people losing any significant amount of weight,

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Aoife McMahon: And also, I started to notice the power that the scales had. There was a slight shift in the scales upward, and people would… it would…

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Aoife McMahon: dictate their mood. They would feel horrible, and…

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Aoife McMahon: If there was a slight decrease in the scales, that would lead to elation as well, and…

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Aoife McMahon: I just started to become incredibly uncomfortable that I was part of the force that was…

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Aoife McMahon: propping up that number of the scales in terms of importance in the people's lives, because when I was listening to them, and…

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Aoife McMahon: The lives that they led,

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Aoife McMahon: Having this disproportionate focus, negative focus on the number.

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Aoife McMahon: from where I was sitting was only causing additional stress.

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Aoife McMahon: And so I actually was thinking of retraining, because I felt so uncomfortable with it. Oh, wow. And…

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Aoife McMahon: it was at that time that I found intuitive eating, intuitive approach, and I have just only gone deeper and deeper into this world, and.

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Aoife McMahon: Whereas before, you know, the odd person would lose weight, whereas most people, it was just distress and food obsession. Now, and I'm sure you're the same, Ella, it's like…

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Aoife McMahon: Transformative work, and you're helping people to reclaim their lives, and it's…

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Aoife McMahon: Amazing, and I would never look back. It's great.

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Ela Law: Yeah.

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Ela Law: Yeah, once you've seen that side of things, and how powerful it is, and what a difference it makes to people's lives, it's really… you can't really go back, can you? It's such a shift and such a transformation for people.

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Ela Law: Which is hard to explain, because as you said, there's still so much weight stigma around, and so many people are hell-bent on losing weight, and that's the only option we have, but…

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Ela Law: And I think that probably resonates with quite a lot of people listening to this. It's absolutely miserable for a lot of people, and the scales dictate how you feel, absolutely. I'm working with someone who had that experience, and it made them spiral. It's awful when you step on the scales and you see a number, and it's not what you expected or wanted, and it dictates everything. It's really scary how

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Ela Law: Or how much power it has over you, right?

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Aoife McMahon: Yeah, yeah, and it can be…

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Aoife McMahon: 5, 10 years of people's lives, decades of people's lives, that are ruled by this.

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Aoife McMahon: And then in contrast, when we're working

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Aoife McMahon: Towards relationship with food, relationship with body. Like, I've recently had a client finish up last week.

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Aoife McMahon: And I did a happy dance after our session, because… do you know when it's got a feeling? She's… we'd done a solid piece of work together, 10 months, she came to me, she was, binging, felt out of control around food, despised her body, couldn't…

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Aoife McMahon: face it, in Pilates, you know when you're in different positions in the class without scrutinizing it, and then to finish up last week, where she has confidence, she described her mind as being calm.

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Aoife McMahon: She doesn't agonize over food, it's just… and she said that it was, like, it changed her life. And when you see stuff like that, you know, as you said, we're in it, so we get to see the process and how beneficial it is, but it can be really challenging to…

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Aoife McMahon: To communicate that when people haven't had a taste of it before?

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Ela Law: Yeah, absolutely. And it seems, like, so… so abstract for a lot of people, doesn't it? It's like, how… that will never happen to me. Why… I would never be in a good relationship with food. Therefore, I might as well just focus on weight loss, because that is just so…

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Ela Law: You know, unthinkable for a lot of people, definitely.

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Aoife McMahon: 100%.

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Ela Law: Yeah. I love that little happy dance. I sometimes do that when we have a bit of a breakthrough, or someone just really sort of absorbs the weight-inclusive message, and the made peace with food and their bodies. That's just so beautiful to witness. There are, however, lots of people who are not

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Ela Law: inclined to go down that route just yet, and are considering…

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Ela Law: possibly are even trying GLP-1s. We've been throwing that around, that word, or that acronym, but it would be really, really helpful for you to give us a little overview of what is a GLP-1, drug.

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Ela Law: you know, what are the differences to, say, diabetes medication? Because I think…

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Ela Law: We… we sort of all have a basic understanding of, oh, it's a lot… it's a drug that we inject, and we lose weight.

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Ela Law: But there is so much misinformation and disinformation around it out there as well, and a lot of people might not actually have enough information to make an informed decision about them. And I think that is absolutely vital for people to understand, well, this is… this is what it does.

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Ela Law: This is what can happen, and this is what, you know, the side effects are, and anything that you can share about it would be really, really helpful.

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Aoife McMahon: Yeah, lovely, and I think just the term you said there, informed consent, that's the most important thing when it comes to these medications, and there's so much information out there about them, and to be able to have a discussion,

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Aoife McMahon: especially from a place where it's not funded directly from the weight loss companies themselves, it's so important. But yeah, so GLP-1 medications, it stands for glucagon, like, peptide 1, and they are injected, as you say. They're… these drugs themselves have

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Aoife McMahon: Been around, like you mentioned, in terms of diabetes.

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Aoife McMahon: And so they support people with diabetes to manage their insulin, right?

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Aoife McMahon: And some of the drug companies, when they have been doing trials, for these diabetes medications, noticed that some people on the medications lost

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Aoife McMahon: marginal amounts of weight. And so they decided to shift these drugs and test these drugs out in the weight loss arena.

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Aoife McMahon: One of the important points about this shift

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Aoife McMahon: Is that many of the drugs, when they move into this weight loss arena, the dose is whacked up.

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Aoife McMahon: So, when people, you know, it's hard to get our heads around the fact that, well, if these drugs are already being used for diabetes, why is it so different when they're used in the context of weight loss? And that's one of the reasons.

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Aoife McMahon: I've not come across a medication before where, like in this case, we're focusing on the side effect of a diabetes drug. And normally with drugs.

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Aoife McMahon: The idea is to get the optimum effect of the drug with minimal side effects as possible.

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Aoife McMahon: Whereas in the case of these diabetes drugs, when we're shifting them into weight loss, we're actually trying to maximize what was a symptom of a drug to support your body to manage.

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Aoife McMahon: blood sugars. So that's one of the things.

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Aoife McMahon: And… I'm losing myself now.

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Ela Law: I found that very interesting to look at it from that point of view. Like, weight loss is a side effect of the drug, and usually, as you said, we're trying to minimize side effects, because we see them as something negative. Here, we see it as a positive that we want to amplify, which is…

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Ela Law: is… Wild, isn't it?

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Aoife McMahon: Yeah, I've not seen it before. I'm not a pharmacist, but it just… it shocks me that…

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Aoife McMahon: it's the side effects, and so what… what about the other side effects that come with that, with that drug? Exactly.

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Aoife McMahon: And so, in terms of the method of action, how it works, I like to focus a lot on, you know, the symptoms that someone might experience, especially working with relationship food. So these do primarily have an effect on

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Aoife McMahon: appetite and appetite suppression, so we can think of them as, like, a superficial or artificial appetite suppressor. But they also have effect on pleasure.

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Aoife McMahon: So we've noticed that people can, have a dampened pleasure response from food. And there are also reports of an impact of pleasure outside of food.

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Aoife McMahon: So… so, for example, any activities that you enjoy, we have noticed that there can be an impact on what kind of pledge that you'll gain from that. And one of the reasons that's important is because…

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Aoife McMahon: When we're looking at side effects, as you mentioned earlier, one of the side effects of this drug is that it can have an impact to suicidal ideation, which is… that's a heavy topic, but it gives an indication of the extent to which a drug like this

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Aoife McMahon: May have an impact to… to someone's mental health, and…

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Aoife McMahon: Pleasure from food, and appetite, you know, suppression of hunger.

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Aoife McMahon: When we're thinking about it in the context of food and weight.

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Aoife McMahon: There are many people, and even some people listening, understandably, who will tolerate that or see that as a route to weight loss.

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Aoife McMahon: And it's important to just… broaden our understanding. This is not just food that this can impact, and it…

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Aoife McMahon: Pleasure from food is actually really important for our mental health, but there are other things that this… this drug can impact as well.

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Ela Law: Wow, yeah, that's a… that's a scary thought. I mean, in general, we… we would never, ever judge anybody for making the decision to take a weight loss drug. I just want to put that out there, and Aoife, you're totally on that… on that… in that corner as well. Yeah, of course. As far as I know, but I think…

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Ela Law: it's so important to know about these side effects, so the sort of, you know, a lot of people might have heard that it suppresses appetite, but a lot of people probably won't have heard that it also suppresses any pleasure in food, but also broadens out to other aspects of life. I mean, that's…

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Ela Law: We know that dieting can be really miserable, because

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Ela Law: We're not getting pleasure from food, we're not eating enough, we're not sort of, you know, enjoying life, because it's just a load of directives. Like, you can't have that, you can't have that, you must do this.

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Ela Law: And having… having the weight loss drug isn't, like, a magic solution, because it can actually impact that even further, by the sounds of it. And it kind of…

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Ela Law: kind of makes sense. If you… if you rack up the dose and… and I don't know, is it 4 times the dose of diabetes?

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Aoife McMahon: It's different depending on which diabetes drug, yeah.

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Ela Law: Right, right. It kind of makes sense that all of that would be amplified as well, so the weight loss is amplified, but all of the other things that may not be so… so bad when you take it as a diabetes medication will also be amplified. So would you say that that's part of this kind of loss in pleasure, in general?

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Aoife McMahon: Yes, I don't do it.

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Ela Law: I'm just thinking, is that dose-dependent as well? Because that… that may not be so, so…

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Aoife McMahon: Yes, yes, I think I saw that.

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Ela Law: acceptable.

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Aoife McMahon: Yeah.

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Ela Law: when you.

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Aoife McMahon: Yeah.

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Ela Law: diabetes dose.

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Aoife McMahon: Exactly, and that's why it is important to have this dose conversation, and the effect of pleasure may be minimal when the drug is being used for diabetes.

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Aoife McMahon: That being said, people with diabetes have higher instances of depression compared with the general public, and.

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Aoife McMahon: as I've been exploring these medications, it's not like it can be put down to these medications solely or anything like that, but, if, you know, that has… can have an impact to pleasure, then is that having an effect at all? And that's why it is important to look into these things, but the other thing that you mentioned there about

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Aoife McMahon: not having… having any judgment towards anyone who takes these drugs. It is so understandable.

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Aoife McMahon: White people would have…

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Aoife McMahon: a draw towards these drugs. It's so understandable, and especially if someone has been trying to lose weight for however long it's been, and it's just not working, or they're trying to control how much they're eating, they feel like it's out of control, they feel like they, once they start, you know, eating, they just can't stop.

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Aoife McMahon: And then these GLP-1 medications come along.

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Aoife McMahon: In terms of weight loss, and they promise, hunger regulation, long-term weight loss,

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Aoife McMahon: Of course people are going to be interested in that. Of course, it makes sense. And when we do talk about the GLP-1 medications, I suppose from this point, it'll be in reference to the GLP-1 medications

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Aoife McMahon: For weight loss as opposed to diabetes, because these are actually really important medications alongside the other medications that are available.

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Aoife McMahon: For diabetes management.

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Aoife McMahon: But when we're talking about them, it's in the context of weight loss.

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Ela Law: Yeah, yeah, sure. You just said, long-term. Can we elaborate on that? Because I am…

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Ela Law: concerned about long-term, because I feel like we haven't really got any evidence that, A, these drugs are safe long-term, and B, that they actually work long-term. Is there anything that you can, sort of, speak to when it comes to long-term effects?

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Aoife McMahon: Yeah, yeah. So, the weight loss medications themselves, as you said, one of the things that they are promising is long-term weight loss. When you look on the websites and everything, it's long-term weight loss is the big message, the big promise that they're, talking about.

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Aoife McMahon: when it comes to weight loss research, you know, as someone, I interact with weight loss research all the time, and then also people who experience and who desire weight loss, what we know from research is that

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Aoife McMahon: people can lose weight short-term, you know. And we can see that around us as well, and we've experienced it, you know, a lot of people will have experienced that themselves. People can lose weight, they can lose weight short-term. It's the long term that these drugs are promising.

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Aoife McMahon: But when it comes to weight loss research, what constitutes long-term is when a research paper is 2 to 5 years plus.

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Aoife McMahon: The weight loss companies, or the drug companies, have released research

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Aoife McMahon: The first piece of research was just over a year.

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Aoife McMahon: and they put the drugs onto the market with this… with this evidence. They have since…

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Aoife McMahon: Increased it to 2 years.

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Aoife McMahon: And what we see is there is a downward slope, so the weight trends down.

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Aoife McMahon: And again, from drug to drug, it depends, but, a lot of the time it's 15%, which means 50%… or an average of 15% weight loss.

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Aoife McMahon: Yes, yeah. Which… which is the selling point of these drugs. This… that's what these drugs have hinged their marketing on, because there have been injectable weight loss drugs on the market before, but they haven't produced

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Aoife McMahon: that percentage before. But when we're looking at the percentage, so the average 15%, that means that 50% of people will have lost more, 50% will have lost less.

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Aoife McMahon: But they stop at 2 years.

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Aoife McMahon: And when looking at weight loss research, there's a phenomenon called the Nike tick of weight loss research.

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Aoife McMahon: And that's where…

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Aoife McMahon: Most weight loss interventions, whether it's dietary advice, whether it's a particular diet or a medication, can produce that downward slope.

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Aoife McMahon: You know, if you think of the front end of the Nike tick. But what happens is that over time, the weight loss.

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Ela Law: The weight regains again.

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Aoife McMahon: And so, I think we owe it to ourselves, you know, as a society who has been, offered so many weight loss interventions, I think we owe it to ourselves to demand more of the research, and that they do show that kind of two to five years plus of… of results.

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Aoife McMahon: So that we can see it actually works long-term, because no one wants to be in a position where they're taking a medication, the weight is coming down, they're getting comments from people around them, they start to, you know, really invest in the weight that they lost.

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Aoife McMahon: Only for that to… to gain again. That's not what people are investing in in their time and energy when they're looking at these drugs.

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Aoife McMahon: And so they haven't, in the weight loss arms of these medications, they haven't actually gone beyond 2 to 5 years. So…

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Aoife McMahon: When they're promising long-term weight loss, they actually don't have the research to support that.

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Aoife McMahon: There is one piece of research

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Aoife McMahon: From Nova Nordisk, which is the company that produces, Ozempic.

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Aoife McMahon: for diabetes, and then it's under the brand name Wegovy for… for weight loss.

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Ela Law: They produced a four-year.

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Aoife McMahon: piece of research. And… so that seems exciting, because it's like, right, okay, we're getting long-term weight loss.

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Aoife McMahon: What's interesting about this piece of research is that they didn't take it from the weight loss arm of their investigations of their research.

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Aoife McMahon: This four-year, this longer-term piece of research is from a different subset, so it's from the research in terms of GLP-1 medications and, heart health.

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Ela Law: Okay.

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Aoife McMahon: So I have question marks around that. That's kind of curious that they would use that

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Aoife McMahon: Piece of, the population in terms of

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Aoife McMahon: what they actually found from the weight loss arm. But even with that population, there is, again, there's a lovely slope downwards when we see… looking at the weight, so the weight comes down, and it does, stay relatively stable for the four years.

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Aoife McMahon: When we look at the, dropout rate of this research paper, it's astronomically high.

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Aoife McMahon: So the dropout rate is 89%, 89%.

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Ela Law: Awesome.

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Aoife McMahon: Yeah.

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Ela Law: Wow.

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Aoife McMahon: It's… it's a high…

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Aoife McMahon: dropout rate, and we do see dropout rates that can be higher than your average research paper when it comes to weight loss, but it's still around 40%, typically. We do not see dropout rates of 89%. And again, when we're thinking about the standards for this drug.

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Aoife McMahon: I… for myself, for my own safety, or for knowing that a drug works, I would like to know

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Aoife McMahon: That they were…

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Aoife McMahon: using messaging or developing their messaging based on research that showed results for more than 11% of the population, right? Where people could actually tolerate it for the four years. For any other medication, I would like to know that they had.

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Aoife McMahon: a greater… a richer research then. Here's a four-year study.

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Aoife McMahon: Look at the downward slope, but actually…

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Aoife McMahon: There's just over 10% of people left at the end of that study, which is not typical.

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Aoife McMahon: Of research.

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Ela Law: Yeah, that's a… that's a scary statistic. I mean, 89% of people dropped out for…

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Ela Law: whatever reasons they would have had, but clearly it was to do with the fact that they didn't get on with the drug in one way or another, and I would imagine no one reports on that. They just fall out of the study.

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Aoife McMahon: Yes, we do not know what happens to those, like, 89, but as you said, the people who tend to show up tend to be the people who are getting positive results, and we just don't know what has been going on with that 89% of people, and it may be that they, at minimum, it didn't work.

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Aoife McMahon: But also, they could have had negative experiences with the drug, and we just don't have that data.

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Ela Law: Yeah, yeah, it's a hugely biased sample, but then that's something that

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Ela Law: as a general popula… member of the general population, you don't necessarily know or look into. You just hear what the drug company tells you, and you think, oh, that's great, you know, all those people, you know, they showed prolonged weight loss, and what I find interesting, and that's why I sort of double-checked with you, the 15% average weight loss.

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Ela Law: That's an interesting one for me, because I think that if someone who is in a very large body loses 15% on average of body weight, that will still mean that they are a person in a very large body at the end. So…

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Ela Law: Is there a bit of a misconception as to what these drugs are capable of, in terms of weight loss?

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Aoife McMahon: Yeah, yeah, and… Expectation management is so important for

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Aoife McMahon: for the drug companies to manage, to prioritize. I've seen this before in weight loss surgery. There's a lot to learn from weight loss surgery when it comes to weight loss medications as well, but weight loss surgery, just like the GLP-1 medications, is promoted as this

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Aoife McMahon: cure all, and that you will lose, an astronomical amount of weight, and that your life will significantly improve, that kind of thing. But…

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Aoife McMahon: The weight loss results vary.

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Aoife McMahon: There are people that really don't get significant weight loss from that, and there are people that do. And just like we said with the 15%, in someone who has a smaller body, that's a more significant amount of their body weight. In someone who's a larger body, they may not

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Aoife McMahon: feel that they have gotten a significant amount of weight loss from these, these medications. And…

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Aoife McMahon: The other thing is that that's 15% when someone is in a trial, and that they have a big support team, and we often see higher levels of weight loss than when someone doesn't have as much support, and they're not in that trial, and they don't have

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Aoife McMahon: people checking on, how they're getting on as regularly, and the level that they would in that, that, that research. So…

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Aoife McMahon: Yes, being… Really real and connecting with the actual numbers that are there.

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Aoife McMahon: And seeing what that will realistically look like, and the 15% is… it's one number, as I said before, 50% will lose more, 50% will lose less. And then outside of a trial, it could be different as well.

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Ela Law: Yeah.

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Ela Law: So, yeah, that's…

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Ela Law: That's really interesting, and something probably people aren't really considering, that it could, you know, it could average that, like, that for you, it could be more or less.

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Ela Law: So, we can't really… we can't really tell people what to do, and we're not here in this capacity anyway, to give people advice. But where can people go if they are…

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Ela Law: on the fence, what… because we talked earlier about informed consent and how important it is. I've heard stories of people just getting the drugs on the black market, no one really monitors it.

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Ela Law: all sorts of things happening, and you just mentioned support and how important that is, but where can people get that? Where can people go and get a very unbiased, very, holistic view of

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Ela Law: what it would entail, taking the drug, and getting support if they are on it as well. What sort of things would you recommend?

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Aoife McMahon: Yeah, it's a really good question, and because of the scale of how fast these drugs have come on the scene.

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Aoife McMahon: with weight loss as the focus, the support tends to circulate around that.

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Aoife McMahon: unbiased support in an ideal world. If you have access to private dietetic input, that's something I offer, private support of people who are not funded by the drug companies.

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Aoife McMahon: The other thing is, I suppose… and…

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Aoife McMahon: if you are considering this, I think a great support to yourself is to be able to fully consider the drug. So I think some… some clinicians get nervous about encouraging people to really, really consider what it might be like taking this drug, because.

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Aoife McMahon: It might think the best way to approach this is to… to encourage people to steer clear about that kind of thing, but people are not…

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Aoife McMahon: considering these drugs lightly, you know? And…

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Aoife McMahon: I actually think it's important for people, if they are considering these drugs, to actually lean into that and to sit down and consider it.

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Aoife McMahon: And because of how challenging it can be to…

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Aoife McMahon: do this in a balanced way, because of how much we might be hoping for weight loss. Sometimes I encourage people to think about if it was someone that they really cared for that was considering one of these medications, and write it from the perspective of that, take down, notes of the pros and cons, what it'd be like.

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Aoife McMahon: if… if they didn't lose weight, what it would be like if they, statistically, what's most likely, regained the weight? And…

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Aoife McMahon: spending time with that, as I said, if it helps, thinking about it from the perspective of a loved one who's asking about these medications, what you would… what you would advise them. In an ideal world, there would be much more support when it comes to these things, and that's why I'm, you know, kind of advising

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Aoife McMahon: Something that you can do yourself is because the resources at the moment are so limited, or kind of private support.

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Ela Law: Yeah.

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Ela Law: Yeah, obviously, we do understand that that's not accessible for everybody, the private support, but if there is a way, that is definitely the ideal to kind of go and get someone who understands the pros and cons of it, and can sort of support you through it. I love what you said about, you know, think about it in terms of what would you say to a loved one about it, because we use that a lot with, generally, how do you speak to yourself?

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Ela Law: But I hadn't really considered it in terms of weight loss drugs, and to kind of really talk to yourself as if you were talking to a loved one, and going over the pros and cons in a compassionate way, rather than in a just focused on the weight loss, and not thinking about, you know, what effects

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Ela Law: other than the weight loss might this actually have on you? So I, I love, I love that, that's really beautiful. I…

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Ela Law: we were talking about, sort of, the weight stigma in healthcare settings and the lack of support that there is for people who are considering these drugs, and you and your colleague, Rianne, are doing something incredible, and I want you to share with us, because there may well be someone from a healthcare setting listening to this, or someone who knows someone who works,

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Ela Law: In whatever capacity in the healthcare service. You and Rhiann have developed a fantastic webinar.

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Ela Law: on this, in particular with regard to disordered eating and eating disorders, and the use of GLP-1s. I attended the webinar, it's super, super informative. I think anybody in this arena, in the nutrition-dietitian arena, would absolutely benefit from it, but also anybody who may work with people who are in larger bodies, who are considering weight loss.

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Ela Law: Can you tell us a little bit about the webinar, how it came about, and how people can maybe access it if they wanted to?

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Aoife McMahon: Yeah, wonderful, and thanks for the kind feedback. It's always.

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Ela Law: Honestly, it was brilliant. It's so, so helpful, because it did… it does start from, like, what is this, what it is all about, and the way that you, sort of, separated the, kind of, this is the weight loss drug, and then you went on to talk about the relation to eating disorders and the dangers that come with that. I thought… I thought it was just a really well-structured and very, very informative webinar that I would

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Ela Law: Just recommend anyone really watch it, but it's obviously geared towards people in healthcare settings, so…

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Aoife McMahon: Yes, yeah, lovely, thank you so much. Yeah, so myself and Rian had actually joined up originally to start to develop training, on, bariatric surgery, weight loss surgery, and eating disorders, and the importance of putting that on the map. As I said before, I used to work in weight loss surgery, and it is, there are so many people who would, benefit from

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Aoife McMahon: being picked up a little bit earlier, you know, in terms of eating disorders. So we were developing that training, as you said, geared towards healthcare professionals at that time, and then the two of us just noticed how prevalent these GLP-1 medications were becoming and starting to become. Both of us have experience in both weight-inclusive care.

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Aoife McMahon: and, weight loss surgery and weight loss medications. So we both come from that perspective. We haven't been funded by any drug companies.

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Aoife McMahon: to produce this training, which I think is really unique. Unfortunately, there's plenty of research, or there's plenty of training out there that people can access, and it'll focus on… it'll give you good information, potentially, on

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Aoife McMahon: what these drugs are, how they work, what the research says, but I have not yet seen training out there from an independent source who will then also put relationship with food on the map.

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Aoife McMahon: And when it comes to any drug that impacts the digestive system in any capacity, there is potential for an impacted relationship with food. And then the other thing is, any weight loss intervention

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Aoife McMahon: Can come with a risk of, worsening someone's relationship with food and their body, or making an eating disorder or disordered eating they already have.

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Aoife McMahon: more complex. So our training, we've developed… we've delivered it, we initially delivered it just to dietitians, but we both really see the value in any professional who is interacting with people

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Aoife McMahon: who are interested in GLP-1s, and if you are having conversations with them in any kind of way, the more people are savvy to the relationship with food.

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Aoife McMahon: piece, the better, because it's so significant, and it's really under-spoken about at the moment. So yeah, we have a webinar, and we also do bespoke training. If, you know, if people are interested, then they're more than welcome to… to get in contact.

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Aoife McMahon: With myself or Rhian.

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Aoife McMahon: Is it okay if I pop email details on the show notes of this.

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Ela Law: Oh, if that's okay with you, we would love to share that, yeah, definitely.

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Aoife McMahon: Yeah, and then other than that, I'm on Instagram at ThatIirishdietitian. I'm not, I'm managing my social media presence at the moment, so I'm not always present, but I do have more of a presence on there when we are starting to gear up towards another webinar, and when we're releasing another webinar, so you'll be able to hear more about it there.

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Ela Law: Perfect, wonderful. So, you're opening it up, basically, to… to anyone who's interested in it.

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Aoife McMahon: Yes, and the last, webinar that we ran, we had, nutritionists, we had, PT, we've had people, pediatricians involved, so it's, it's, it's not just dietitians that are watching this. Oh, and psychotherapists and psychologists.

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Aoife McMahon: Yeah, because we love having people in the mental health therapist, psychotherapist involved as well, because,

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Aoife McMahon: This is coming up in those spaces, too.

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Ela Law: Yeah, definitely. And part of what you do when people sort of sign up and book on the webinar is you send out lots of resources. And one of the resources I thought was something that everyone should have who works with people, full stop, is

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Ela Law: A very, sort of, basic assessment of relationship with food, and whether there is something that

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Ela Law: kind of puts a red flag up, in terms of, you know, is there something distressing around that relationship? And I think whether someone is interested in taking GLP-1s or not, I think that would be the gold standard for any kind of healthcare professional to kind of flag.

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Aoife McMahon: Symptoms of disordered eating and a potential eating disorder, because that needs to come first before we go anywhere near weight loss medication.

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Ela Law: Because it's just such a massive risk that people take when they are in an eating disorder, and then they're considering these drugs, right?

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Aoife McMahon: 100%, so yeah, one of the stats that I mentioned in the training is that up to a third of people who are interested in, treatment for their weight

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Aoife McMahon: may have a binging-type eating disorder. And so, as clinicians, when someone comes into our clinic, or if it's on the… on Zoom, you know, in our virtual room, we have to be very mindful that, that person may or may not have an eating disorder, and most eating disorders are undiagnosed. Most people won't have a formal diagnosis of them, so

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Aoife McMahon: It won't be a simple question of, oh, do you have a history? Do you have an eating disorder? And yes or no.

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Aoife McMahon: It requires really careful consideration. And then, as I mentioned before, these weight loss drugs themselves have significant potential to.

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Aoife McMahon: worsen someone's relationship with food, unfortunately. If someone has a poor relationship with food, and then this GLP-1 medication is layered on top of that.

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Aoife McMahon: I was saying this to you, Ella, before we hopped on the call, sometimes it can be difficult to actually discuss

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Aoife McMahon: Every which way.

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Ela Law: happens.

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Aoife McMahon: drug can negatively affect… impact someone's relationship with food, because they're

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Aoife McMahon: just so many different avenues that someone can go down.

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Aoife McMahon: But yeah, it's really careful when I'm thinking about, you know, have my clinician hat on. If anyone who is interacting with people who are

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Aoife McMahon: interested in these drugs, or if your profession involves speaking with people about food, or their well-being, or mental health, that

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Aoife McMahon: being able to have these conversations with more confidence, is so, so beneficial and so important. And some people think it's, like.

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Aoife McMahon: outside of their scope, or it's opening a can of worms, that kind of thing, but it's really not. People… whether or not we ask about them, people have eating disorders and have.

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Ela Law: Hmm.

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Aoife McMahon: and whether or not we ask about GLP-1s.

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Aoife McMahon: so many people right now are considering them, or may already be taking them, and we just don't know. So to be able to be that safe professional that holds those conversations and allows space for them, then we're able to

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Aoife McMahon: See our client, or the person we're working with, where they're really at, and help them There.

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Ela Law: Yeah.

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Aoife McMahon: point.

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Ela Law: Yeah, I love that so much, absolutely, and it makes it…

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Ela Law: A very, non-judgmental, compassionate way of supporting somebody, because, you know, at the end of the day, we have

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Ela Law: no say in what someone does, or decides to do. But we have the unique position to… to… to guide, to…

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Ela Law: To be… what's the…

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Ela Law: to kind of just be there and hold their space, basically, to kind of say, look, I have this information that I can share with you, there's no judgment, however, I feel like it's really important that you understand.

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Aoife McMahon: Thank goodness.

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Ela Law: With all of the information that you could possibly have.

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Aoife McMahon: Yeah, yeah, I think the people that I work with are probably tired of me saying this, but I often say, when I'm talking in session, that it's really important that you feel like you're in the driving seat of your care, and the minute you don't feel like that, if you can voice it as much as possible so we can get back to that place.

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Aoife McMahon: I, and I think you're the same, Ella, I value patient autonomy, so highly. I think it is the most important thing, or one of the most important things for us to… to respect, and being able to have that discussion of

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Aoife McMahon: I'm not… I'm not prescribing these medications, for the most part. Most people who are taking this training aren't, but you may be.

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Aoife McMahon: I'm not prescribing them, I'm not telling you to take them, I'm not injecting them into your body, or I'm not withholding them from you. I'm not going to go into your house and take them from wherever it is you're storing them, you know, that kind of thing. That's not my role. My role is to hear you out.

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Ela Law: You know.

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Aoife McMahon: 100% makes sense why you would desire these drugs.

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Ela Law: Yep.

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Aoife McMahon: Let's talk about what that might look like, and whether it serves you.

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Aoife McMahon: So we can have real conversations about it.

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Ela Law: Yeah, absolutely. I think that's…

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Ela Law: That's a really lovely note to end on, because I think it's the real conversation that really matter. It's not… we're not sugarcoating anything, but we're also not telling people what to do, basically. We, you know, we're here to… to guide, and to hold space, and to… to, as you said, hear people out, and… and have that discussion.

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Aoife McMahon: Yeah, 100%.

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Ela Law: Lovely. Ree, it's been so lovely, Aoife, to speak to you today. Thank you so much for sharing all of your knowledge and your expertise. I will pop everything, in the show notes of how people can get in touch with you. Is there anything else before we say goodbye that you wanted to say or ask or share?

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Aoife McMahon: No, it's been lovely having me on. Thanks a million, Nella. It's been a really good conversation, so thank you.

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Ela Law: Yeah, thank you so much, really appreciate it.