Clinic Event: Obesity & GLP-1 101 | Dr. Curnew MD

Timestamps:
00:00:00 Intro + audience question: % of Canadians overweight
00:00:25 Weight regain ~70% after stopping diets
00:00:44 DIRECT Trial: remission; 20–30 lb loss; ~13% still in remission at 5 years
00:01:27 Limits of diet/lifestyle alone
00:01:41 Personal weight journey, remission ups/downs; “going down fighting”
00:03:04 Toolbox mindset: blend lifestyle + meds; commit to making this a priority
00:03:47 Aging → muscle loss; lift heavy
00:06:03 Obesity Canada & WHO: obesity as chronic, biology-driven; stigma and bias
00:08:45 Redefining obesity: BMI limitations; staging by health impact; visceral fat focus
00:11:22 Measuring progress: waist circumference vs scale fluctuations
00:15:10 Insurance/recognition helps; shift from blame to biology
00:15:49 Heritability (~70%), brain-regulated appetite; environment collision
00:18:07 Treatment pillars: psychological therapy, pharmacotherapy, bariatric surgery; lifestyle as the roof
00:20:29 “Best weight” concept; ≥5% loss yields health benefits; think beyond the scale
00:21:11 Weight fluctuations; trend over day-to-day; 3,500-calorie heuristic
00:22:00 Weight management vs weight loss; Look AHEAD trial (-6% at 10 years)
00:23:07 DIRECT trial: early-diabetes window for remission; long-term relapse reality
00:24:38 Biological adaptation to weight loss; target ≤1% per week
00:26:03 GLP‑1 basics and mechanisms (satiety, appetite, gastric emptying, pancreatic effects)
00:29:13 Meds overview: semaglutide vs tirzepatide (dual agonist); emerging triple agonists
00:37:01 Safety and discontinuation: tirzepatide slightly better GI tolerance in head‑to‑head
00:38:08 Cost/coverage; discount cards; “counting clicks” and flexible titration strategy
00:49:33 Managing side effects with diet/habits; hydration, fiber, small meals; fasting cautions
01:04:58 Exercise for maintenance (not primary loss); walking dose & intensity; “comfortably hard”
01:06:17 Benefits without scale change: visceral fat reduction; intensity matters
01:10:37 Resistance training for aging muscle; failure reps; safe progression; home options
01:16:09 Preserving lean mass during weight loss; training halves muscle loss; focus on function
01:25:19 Psychology tools (CBT); SMART goals; habit stacking; community/accountability; resources; closing

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