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Rheumer Has It: Weight, GLP-1 and Arthritis

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Episode Summary 

How does weight affect arthritis pain and inflammation, and what actually helps? In this episode* of Rheumer Has It, Cheryl Crow and Eileen Davidson talk with rheumatologist and obesity medicine specialist Dr. Derin Karacabeyli about the science of weight, adipose tissue, and arthritis. They explain how excess body fat can increase inflammation and joint stress, why BMI (Body Mass Index) isn’t a perfect measure, and how stigma and mental health impact weight management for people living with rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, and osteoarthritis.

They also discuss safe, realistic strategies that support joint health, including tailored exercise and strength training, plus the emerging evidence on GLP-1 medications (like semaglutide/Ozempic/Wegovy) for people with obesity and arthritis. The key message: obesity is a treatable chronic condition, and care should be compassionate, individualized, and evidence-based.

*Content note/ trigger warning: This episode includes discussion of body weight, obesity, BMI, and weight-loss medications (including GLP-1 drugs).  We approach this topic from a stigma-free, evidence-based perspective, as well as lived experience, but we know conversations about weight can be sensitive or activating, especially for those with a history of weight stigma, eating disorders, or body image challenges. Listener discretion encouraged.

Episode at a glance:

  • Weight and arthritis: inflammation + joint load (OA and inflammatory arthritis)
  • Why adipose tissue can worsen pain and disease activity
  • BMI limits: muscle loss, fat distribution, and rheumatoid cachexia
  • Exercise myth-busting: movement helps when it’s tailored and gradual
  • Strength training for knee support and better joint mechanics
  • GLP-1 medications (semaglutide, tirzepatide): what research shows so far
  • Stigma-free framing: obesity is chronic, not a personal failure
  • Practical next steps and trusted resources (Arthritis Research Canada webinar)

Medical disclaimer: 

All content found onArthritis Life public channels (including Rheumer Has It) was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Episode Sponsors

Rheum to THRIVE, an online course and support program Cheryl created to help people with rheumatic disease go from overwhelmed, confused and alone to confident, supported and connected. See all the details and join the program or waitlist now! 

Speaker Bios:

Dr Derin Karacabeyli

Dr. Derin Karacabeyli is a Vancouver-based rheumatologist who is also board-certified in obesity medicine. Dr. Karacabeyli is completing a PhD in Experimental Medicine at the University of British Columbia. He is studying the effects of treating conditions like obesity and type 2 diabetes on people with inflammatory arthritis. His goal is to establish a clinic for patients with obesity and arthritis to help them manage their weight and optimize their overall health.

Eileen Davidson Bio

Eileen Davidson, also known as Chronic Eileen, is a disability and chronic illness advocate from Vancouver BC Canada. Living with a diagnosis of rheumatoid arthritis, she spends a large focus on volunteering and creating awareness around arthritis. With The International Foundation for Autoimmune and Autoinflammatory Arthritis (AiArthritis) Eileen is the Educational Media Assistant. Along with AiArthritis, Eileen is a member of the Arthritis Research Canada patient advisory board, and author with over 100 published articles.

Cheryl Crow

Cheryl is an occupational therapist who has lived with rheumatoid arthritis for over twenty years. Her life passion is helping others with rheumatoid arthritis figure out how to live a full life despite arthritis, by developing tools to navigate physical, emotional and social challenges. She formed the educational company Arthritis Life in 2019 after seeing a huge need for more engaging, accessible, and (dare I say) FUN patient education and self-management resources.

Episode links:

Full Episode Transcript:

Eileen Davidson: [00:00:00] Welcome to Rheumer Has It, the podcast that busts myths, highlights evidence, and inspires hope for living better with rheumatic disease

Cheryl Crow: Through plain language interviews with experts, we offer actual knowledge so you can thrive today.

Eileen Davidson: My name is Eileen,

Cheryl Crow: And my name is Cheryl.

Eileen Davidson: Join us as we bust myths and spotlight evidence.

Disclaimer to this episode today, it is not an episode to shame anyone about their body weight, and we know this can be a very sensitive topic. Our goal with this episode is to educate people on how and why weight management can improve rheumatic diseases and our quality of life.

Weight is different for everyone. I personally have struggled with my weight for a number of my years but when I did lose 60 pounds, I felt my best. Because it improved my pain, my sleep, mental health.

Now, unfortunately with medications it’s been a bit [00:01:00] bumpy and kind of difficult to manage keeping a healthy weight when living with a rheumatic disease for a variety of reasons, which we’ll go on about.

But today we have a very special guest who I have personally the honor to work with a number of times with Arthritis Research Canada, and I’ve also seen him win some nice awards during some of the rheumatology research conferences, which is very exciting. So congratulations for all that you have accomplished.

I’m happy to introduce Dr. Derin Karacabeyli here to take talk about weight and arthritis. Now, can you let us know a little bit about your training and how you came to specialize in this topic?

Dr. Derin Karacabeyli: Of course. Thanks Eileen, and thanks for having me on the podcast. So I am a rheumatologist and I’m also certified in obesity medicine.

I started off my undergrad studies in kinesiology at UBC and then did all my medical training at UBC and then through the American Board of Obesity Medicine. There’s a certification pathway where you can do some additional training, take some additional [00:02:00] courses to become more knowledgeable about how to manage obesity.

And so I did that because I thought it would complement my ability to help patients with arthritis and extra body weight manage the other piece, the obesity piece.

I also do research in kinda the intersection of metabolic diseases like diabetes and obesity with inflammatory arthritis. So a lot of my work is in looking at GLP-1 receptor agonists. I’m currently doing a PhD on that topic.

Cheryl Crow: That’s incredible. And I didn’t know until recently that there were doctors that could become, did you call it a certification in obesity?

Dr. Derin Karacabeyli: Yeah, that’s right. Yeah.

Cheryl Crow: Okay. Yeah, that’s really, that’s great for people to know. ‘Cause I’m, I was been just personally like on a kind of a smaller frame and I haven’t had, my actual only struggle with weight was muscle loss. Like one of my first symptoms when I didn’t know I had rheumatoid arthritis yet was unintended weight loss and muscle loss from rheumatoid [00:03:00] cachexia. And sarcopenia.

But I know other people struggle more on the other side or maybe they have a bit of both weight gain and some areas and then muscle loss. So long way of saying, can you explain a little bit just an overview, bird’s eye view, how arthritis affects weight, what’s the spectrum here?

Dr. Derin Karacabeyli: You bring up an excellent point, Cheryl. So I think it really depends on the person. Some people lose weight, some people no effect on their weight, and a lot of people do gain weight.

So, quickly touching on the point that you mentioned having an inflammatory type of arthritis, like rheumatoid arthritis, that systemic inflammation itself can lead to muscle loss and weight loss.

So especially in the early phases before you get on effective therapies, that can totally happen. On the other end of the spectrum is weight gain.

And so Eileen alluded to this, you know, at the very beginning when she said that some of the medications that are used to to manage inflammation in arthritis, things like prednisone, those can promote weight gain.

And then on top of that, when you get diagnosed [00:04:00] with arthritis. It can be life changing. It can affect your ability to sustain certain behaviors that were perhaps helping you maintain your weight. And so if you’re no longer able to continue with certain amounts of physical activity, or if now there are barriers, functional and pain barriers to grocery shopping or meal prepping, and if there are effects on your mental health or your sleep, all of these things could impact behaviors and hormones that affect body weight regulation.

And so it can be complicated, but it’s, it’s common and totally understandable why some people gain weight, why others lose weight. And for some the weight stays the same. Is that, I know it’s a bit of a wishy-washy answer.

Cheryl Crow: No, I think you painted to, to me at least a really great picture of, a really clear picture of the spectrum.

And honestly, I actually didn’t even know that my weight loss related to my rheumatoid arthritis until six years after my diagnosis. And I just think one of our goals, Eileen and [00:05:00] I’s goals in doing this is just helping people know earlier along in their journey. They tend to be educated on like the joint stuff, but not the extra articular manifestations.

So this is really helpful. So I’ll let Eileen ask the next question.

Eileen Davidson: Yes. And you know, you brought up a lot of great points there and I will add that weight can fluctuate for so many different reasons throughout our journey, especially depending on what age we’re diagnosed as well.

So I actually did experience some in the muscle loss and the weight loss at the beginning of my diagnosis when it was really bad and they didn’t really, I didn’t have effective treatment. And it has shifted throughout my patient journey depending on medications.

I have two forms of rheumatic disease now. Rheumatoid arthritis and non-radiographic axial spondyloarthritis. So, those gaps in finding effective treatment can also be a place where physical activity is not as easy.

So you, you brought up a lot of key points that are [00:06:00] very unique to somebody living with a rheumatic disease and why we struggle with the typical exercise plan and meal plan that maybe somebody who isn’t experiencing what we are experiencing symptom wise and all it takes to manage living with a rheumatic disease, because it takes time as well. It can interrupt our sleep a lot. So all these things really do impact how we can manage our weight.

But now that we have talked about what can impact us, we gotta talk about why we need to talk about this subject. So why does excess body weight consisting of adiposity tissue, AKA fat, have a negative impact on people living with all forms of arthritis? Not just inflammatory, but let’s say osteoarthritis as well.

Dr. Derin Karacabeyli: So, it’s interesting ’cause our understanding of of adipose tissue or fat tissue has, has evolved quite a bit over the years. And, you know, in [00:07:00] the past we used to think that fat tissue is, was just benign. It was just extra weight. And the extra weight itself would increase the mechanical load on joints, like the knees on, on weight bearing joints.

That that’s what you used to think. Your arthritis was perhaps worse if you had obesity because there was more load on joints like the knees or the hips. But over time, what we’ve learned is that excess adipose tissue or excess fat tissue, especially in certain areas of the body, can actually generate inflammation itself. So it can be inflammatory, we call it metabolically active tissue.

And so when you already have a disease that’s affecting your joints and there is inflammation in those joints and, and even osteoarthritis, which, you know, traditionally it was thought of as a non-inflammatory type of arthritis. We now recognize that there is some low grade inflammation, osteoarthritis as well.

And so the extra inflammation that comes from having extra body fat can make all forms of arthritis worse. And so what we know from [00:08:00] osteoarthritis is, it’s a combination of those mechanical factors, the increased load, but also the inflammation from the obesity itself that can make the arthritis worse, the pain worse.

And then inflammatory arthritis like rheumatoid arthritis. You mentioned axial spondyloarthritis and the other one is psoriatic arthritis. We know in all three of these types of arthritis, people who have obesity often have more active disease and also their disease is harder to to manage with existing therapies. They don’t respond as well to some of our commonly used therapies like TNF inhibitors.

So those are some of the reasons why, I think trying to facilitate the management of extra body weight or extra body fat, I should say, is, is so important for people with rheumatic diseases because we’ve seen from some research that people who are able to, to lose a healthy amount of weight, whether that be through diet or or surgery or some of the newer studies are showing through medications, people tend to feel better, their pain tends to get better, their function tends to improve. Not for everybody, but for a lot of [00:09:00] people.

Cheryl Crow: Thank, thank you for that. And I wanted to add a little additional disclaimer, that I think it’s important, at least for me, as like a patient and a practitioner, to separate the idea of like fatness as a social construct, the word “fat” or people being “overweight” as like a label that gets put on people versus the real, the physical reality of adipose tissue being a physical thing that’s in people’s bodies.

I believe everyone should be accepted and loved, you know, in whatever body size they have. And we have to hold that perspective alongside that perspective that our bodies are physical, things made up of physical tissue.

The other thing I remember learning as an occupational therapist is like every 10 pounds you are overweight increases the force on the knee joint by 30 to 60 pounds per step. Just from like that mechanical standpoint. So sometimes the reason people feel better when they lose weight is they’re literally just loading the joint a less.

Dr. Derin Karacabeyli: Yeah, I’ve [00:10:00] heard similar, I’ve heard similar statistics Yeah. About the the mechanical load as you said.

Cheryl Crow: But yeah. I’ll, I’ll let Eileen do the next, the next question.

Eileen Davidson: Yes, I have also heard similar statistics to that as well. And from my own personal experience, when I was regularly in the gym at my healthiest weight, I was more active, I didn’t have as much pain. I was able to get more steps in the day without pain coming, you know, sooner in the day.

So you notice little things like that and, less knee pain as well, and you sleep better through the night. So there’s so many reasons why being a healthy weight is important.

But also so many reasons it’s challenging when we live with arthritis. So we’re gonna move on to one of the myths around weight, and that is that the body mass index, BMI, as it’s also known, is the best way to measure what a person’s healthy weight is.[00:11:00]

Dr. Derin Karacabeyli: Okay. Yeah, I think I’m glad we’re starting with this one because I think this this comes up a lot. So I think it’s important just to start with what is the body mass index? So, so Body Mass Index is, is simply a ratio of your weight over your height squared. So the only two things that go into calculating a person’s body mass index is their weight and their height.

And so all it can really tell us is how much you weigh for how tall you are, so to speak. And, and then based on, essentially based on references that were developed from healthy white European men, we have these cutoffs that we use to determine whether somebody is underweight normal weight overweight or, or have obesity.

And on a population scale, the BMI is is actually a helpful tool because it’s quick, it can be easily calculated. It can give us a quick snapshot of, you know, how somebody’s weight compares to their height.

But there are a number of [00:12:00] limitations to it, especially for a person or a patient standing right in front of you. One is that it doesn’t give you an idea of what that weight’s coming from. So it doesn’t tell you how much of that is adipose tissue or fat tissue, how much of that is muscle tissue.

It also doesn’t tell you where that adipose tissue might be. So depending on where a person carries their extra fat tissue, some areas are less harmful than others. Some areas are healthier than others less metabolically active.

And then, like I said earlier, the, the cutoffs that were initially developed for BM I were based on a single population that’s not representative of our diverse world. And so applying BMI cutoffs are not always applicable to people of different backgrounds.

And so actually different BMI cutoffs are sometimes used now for different populations as well. And also I should mention that for people with like, for example, rheumatoid arthritis, as Cheryl was mentioning, when you have that sarcopenia or, or rheumatoid cachexia because there is that preferential loss of muscle, you know, there’s an [00:13:00] argument to be made for maybe using different BMI cutoffs, perhaps lower BMI cutoffs because people have less muscle as well.

But all this to say, it’s still a helpful quick screen, but it’s not a great tool for the person in front of you always.

Cheryl Crow: Thank you. That’s, that’s really helpful. The next stigma we wanted to go over is that people with arthritis are lazy and that’s why they’re overweight or that it’s totally your fault if you’re overweight, it’s not like a disease or anything.

And we wanna recognize that there really is a mental health impact of these sort of societal stigmas around this. What would you say maybe, how do you help your patients work through that?

Dr. Derin Karacabeyli: A hundred percent. I’m I’m so glad you brought this up. I think unfortunately there still is a lot of stigma, not only in general public, but even in healthcare, there’s still a lot of stigma.

There’s a lot of shaming people and, and kind of blaming extra weight as if it’s like a willpower [00:14:00] deficiency or as if it’s a, a choice that you’re making which I just think is, number one, I just don’t think it’s helpful. And number two, I don’t think it’s fair.

We know that based on genetic studies, the, the proportion of one’s weight that’s inherited, the numbers fluctuate, but anywhere from 20 to 70% of, of body weight is said to be inherited or genetic. So a big chunk of where, where your weight ends up settling is determined by your genes, which you don’t have control over.

And then the other component is the environment within what, like within which you live also has a huge impact on the choices that you’re able to make. Like if you’re living in a place that doesn’t have healthy access to foods or isn’t walkable or isn’t safe, like that’s gonna steer you to certain behaviors that might not be as conducive to maintaining a healthy weight. But that’s also not your fault, a product of, of where you live in your circumstances.

So again, blaming people is just not helpful. Trying to help people navigate these challenging situations I think is helpful. And [00:15:00] so I try to tell people that it is not your fault, and if people have told you it’s your fault, I, I’m sorry, on behalf of, of them.

I think what’s more helpful is understanding where a person’s at, how we can help them where they’re at. But again, kind of thinking upstream and recognizing that these aren’t, this is not all a matter of, of choice.

I guess in terms of arthritis, “people who have arthritis are lazy,” again, I, I don’t think it’s fair. ‘Cause again, a lot of, like arthritis often just develops outta the blue. Like for a lot of people, especially if it’s, you know, inflammatory arthritis or even osteoarthritis.

Again, like, there are a number of risk factors, but there’s a lot of things that are outside of a person’s control. And then once you develop this disease, it becomes a lot harder to address the underlying factors. So it, it becomes this cycle that’s really hard to, to get out of.

And the last thing I’ll mention is that now many [00:16:00] international bodies recognize obesity as a chronic disease similar to diabetes or, or high blood pressure. And so. When we look at diabetes and, and high blood pressure, we know that there are lifestyle factors that certainly help, you know, like a healthy diet, physical activity can help manage your blood sugars or they can help with your blood pressure.

But like when somebody has diabetes and they’ve done their best at being physically active and eating a healthy diet, if their sugars are still high, we don’t say walk, like, walk more or like cut your sugar more. If your blood pressure’s high, like cut your salt even more.

There’s a stage where we say, okay, you’ve, you’ve done your best with kind of these foundational principles. Now let’s look to add on therapies that might help you achieve your goals. So we, we see obesity, at least I see obesity a similar way, and that’s, that’s how a lot of my colleagues in obesity medicine see obesity as well.

Cheryl Crow: That’s really helpful. Thank you.

Eileen Davidson: Yes. Many valid points there. Thank you. And also thank you for recognizing that it’s so much more than just [00:17:00] being overweight.

Alright, so we are going to move on to another myth, and this one is about movement. “If your joints hurt, you shouldn’t exercise because that’ll just cause more wear and tear or inflammation on your joints, or it’s just gonna make your fatigue worse and your cognitive dysfunction worse. It’s just gonna make you feel worse.” Is there any truth behind this?

Dr. Derin Karacabeyli: So yeah, this is, this is nuanced for sure. So what we know is that generally speaking, if people are able to introduce, I should say gradually introduce physical activity in perhaps a supervised way or in a guided way, generally speaking, physical activity helps people feel better. They have less pain and energy levels sleep. All these other factors, mental health, cardiovascular health, like part health, all of these things tend to improve with physical activity.

The notion of [00:18:00] exercise causing more wear and tear, we’ve tried to move away from labeling things like osteoarthritis as a wear and tear disease because again, we know that physical activity generally actually slows progression, makes people feel better.

There is some truth to the statement in that if you exercise too much or if you do too much too soon, or if you do very high intensity exercise and your body’s not ready for it, that can lead to injury. And injury can accelerate, for example, osteoarthritis. Like if you have like an ACL tear that can accelerate osteoarthritis and things of that nature.

Generally, for most people, if exercise can be done safely in small amounts approved by, you know, a certified professional, I encourage that. I think that is, that the benefits far outweigh the risks. I just think the, the key to it is tailored for the person.

Eileen Davidson: I would just like to add that that is so true. I have had the same physiotherapist for a number of years now, and [00:19:00] I keep him because throughout my patient journey, my disease changes and I will need to say, “Hey, I have a new, a new autoimmune disease. It’s in my back. So let’s go over my exercise routine and tell me which exercises are not good for me to do now.”

That I have, you know, some more answers to what’s going on in my body. So I am, I, I wanna emphasize how important having that tailor exercise program for your unique needs, where your arthritis is, what types of arthritis you have, what types of comorbidities you have. Is so important. And then also how they can help you with adjusting behaviors throughout the day that you can, you know, get more little exercise snacks and things throughout.

So, just wanted to make a comment on that. I’m gonna pass it on to Cheryl though.

Cheryl Crow: No, that’s perfect.. But another thing that, that is a huge hot topic. I think Eileen, wasn’t this, like, you wrote a blog about this and it was like your most looked at one or one of your most looked at the GLP-1s.

Eileen Davidson: Yeah, actually, and I interviewed Darren in it, or actually that was on obesity [00:20:00] for a campaign.

But I disseminated the most recent a ACR 2025 abstracts on GLP-1s. And it was definitely my most red blog, most social media engagement.

So, and it is also a topic that I am consistently daily seeing in a lot of the groups, and either Facebook Instagram, and, you know, I hear people all over.

And then I also, like when I’m in the fitness groups too, I see a lot of shame against the medications. So it’s very, very interesting. So, I’m gonna move this over to Cheryl because she’s about to ask a very, very important question.

Cheryl Crow: Yeah, like, a misconception is that “the GLP-1 kinds of weight loss medications are just for people with diabetes and not really for arthritis.” Or maybe there’s a little stigma that” they are for people who wanna take the easy route.” Can you help us understand what is the [00:21:00] role potentially of this class of medications in arthritis care?

Dr. Derin Karacabeyli: Sure. I guess, I guess I’ll start by saying that. The way that I see the GLP-1 receptor agonist class, I’ll just call them GLP-1 medicines because it’s easier. But the way I see GLP-1 medicines I see them like a, like a tool in a, a doctor’s toolkit or, or in a patient’s toolkit. And they can be a very effective tool.

So we know that they manage diabetes really well. You alluded to their use in diabetes. So they were originally developed as diabetes drugs, and they’re still used for diabetes. They are also approved for use in obesity. And they’ve also been shown in people who have obesity with certain other conditions.

So for example, if you have obesity with high risk of cardiovascular disease or, high risk of having heart attacks and strokes and things of that nature. These medications have been shown in that population to reduce the risk of having those serious events, heart attack strokes, death from cardiovascular [00:22:00] causes.

And then more recently it’s been shown that in people who have obesity and osteoarthritis, adding a GLP-1 receptor agonist, the one that they studied in that study was semaglutide, which is also known as ozempic or wegovy. When people who receive, when people received semaglutide versus placebo or sham treatment, those who got the GLP-1, they experienced a lot more weight loss, but they also experienced a lot more improvements to, to pain and function. And these were all people with moderate, at least moderate knee osteoarthritis.

So that was a very exciting finding and a lot of people, you know, there haven’t been a lot of effective medical therapies for osteoarthritis.

And again, it’s important to stress that this was in a group of patients who had obesity and actually the average BMI in that trial was around 40. So these are people who had more severe forms of obesity. Nonetheless, these people benefited a lot from having that treatment.

So I suspect that moving forward there will be a lot more interest [00:23:00] in adoption of, of using GLP-1s for people with both obesity and osteoarthritis.

There was also a study that, it’s finished, but the full study hasn’t come out yet. It looked at coupling Tirzepatide, which is also known as Manjaro or Zep, it’s a GLP-1 plus GIP co-agonist. It looked at coupling that medication with with a biologic for psoriatic arthritis. And again, they found that when you got the, the couple people lost more weight and had more improvement in their, in their joints versus if you just got the biological alone, you didn’t lose as much weight and your, your joints didn’t improve quite as much.

We haven’t seen the full results of the study, but again, the top line results are pretty encouraging. Coming back to, I guess, the original question around their role. I would say right now we know they have a role in people who have diabetes, and we know they have a role in people who have obesity or who have extra body fat who have, I would call it excess cardiovascular risk or extra risk factors for heart health. It seems like [00:24:00] it improves outcomes for those people.

For people who don’t meet those conditions, there still needs to be more research into their role. But generally speaking, again, I think coming back to my original point about like obesity being a chronic disease, like I don’t think it’s kind to people to, to make them feel shame about using these medications or, or taking “the easy way out, so to speak.” Because often the people who are exploring these medications, who are trying to manage their weight, have worked super hard, haven’t taken the easy way out.

They’ve tried often multiple types of diets. They’ve often tried several different physical activity programs and cycle through different things, and often they just haven’t quite achieved the results they do with those interventions alone.

And sometimes a GLP-1 can be something that you add on to the existing nutrition practices or physics activity practices that you’re doing and in combo that gets you to your goals.

The final point I’ll say, and then I’ll pass it back, in these trials that studied obesity in people, again on like semaglutide or [00:25:00] Tirzepatide, in these studies, they’re always paired with, usually at the beginning of the studies, it’s like monthly check-ins with a dietician or a registered exercise professional to talk about nutrition, to talk about physical activity.

And so people are doing both. Like I find that there’s often this narrative of it’s GLP-1 or, or exercise diet, but like I, what I try and tell people is it’s, it’s GLP-1 and exercise and diet. You know it, I think that exercise, nutrition that forms the, the pillar, the foundation, and then on top of it, we could add things if needed.

That’s kinda how I see it and explain it to people.

Eileen Davidson: Absolutely. And you’d actually just alluded to our, our next topic, which was, other than exercise, what are some lifestyle and therapeutic changes, including other medications than GLP-1s that can improve weight management for people living with arthritis?[00:26:00]

Dr. Derin Karacabeyli: Sure. So the way I kind of see obesity management and, and this is kind of what I learned through some of my extra training is, i, I kind of see it as a pyramid. So at the, at the base of the pyramid are your behavioral interventions, things like physical activity, nutrition, optimizing sleep, optimizing stress levels, making sure you have healthy social connections.

So that’s, that’s the foundation and again, it, it can be really helpful to get support with those things. So we talked about. Occupational therapy, physiotherapy, registered dietician, social worker, therapist, like all of these people can be really helpful for that kind of base layer. And then when people can’t achieve their goals with, with those interventions alone, we can look to adding medications onto that.

So we talked about the GLP-1 medicines already. There are other drug classes that can help people with weight loss. Again, it. It depends a little bit on one’s underlying conditions and what medication is the best fit for them. So I would say talk to your doctor about that.

Another common one [00:27:00] that it, it’s not used as commonly anymore. I, I find that right now it seems like GLP-1 medicines have kind of become the, the most used therapies for obesity. But other ones, like another one that’s commonly used is Naltrexone, bupropion. It’s a combination of two medications that one can also be used that typically leads to weight loss in the realm of around five-ish percent.

Whereas with the newer GLP-1s, kind of, we see weight loss 10, 10, 15%. So, the responses with these newer GLP-1 medicines is, is larger than we’ve seen with previous obesity therapies. And I think that’s why one of the reasons why they’ve gained popularity, the other is that they’ve shown these benefits for heart health and now for kidney health and people with diabetes. So that’s also exciting.

But again, having a discussion with your doctor is important. ’cause these medic medicines aren’t for everyone. There are side effects, there can be contraindications. So, I do think it’s still, again, in individualized decision.

And at the top, at the very top of the pyramid for certain people is things like bariatric surgery.

Eileen Davidson: No, [00:28:00] I actually have a follow up question for you because there has been a little bit of talk about something you’ve just brought up. The naltrexone and buproprion. The combo of that, which is also, I think, I believe goes under contrary, is the name.

Dr. Derin Karacabeyli: Yep. Yep.

Eileen Davidson: Okay. So there’s been a lot of I’ve seen some studies on it as well as people talking about how it’s actually helped them with fatigue.

Can you make any comments on that or have you heard anything on that?

I know I’ve seen some studies in fibromyalgia, but I’ve also heard from other autoimmune patients that they have found that it has actually helped them with their fatigue levels, which might then, if they’re, you know, less fatigue, they’re able to be more active.

Dr. Derin Karacabeyli: Yeah, no, totally. So Bupropion is an antidepressant. It’s also known as the, the, like the Brad name is Wellbutrin. And so that’s the Bupropion piece. So again, if somebody has depression or even like low, low levels of mood, then perhaps the, that piece of the combo drug might help [00:29:00] address one’s mood symptoms and that could potentially impact energy levels, improving energy levels.

And then Naltrexone itself is it’s kind of another treatment that’s often used in things like alcohol use disorder or opioid use disorder. And I think at low doses there are some, again, I’m not an expert in this, so, so take this with a grain of salt, but I think there was some, some literature looking at low dose naltrexone for, for chronic pain I believe, I could be wrong.

But again, I think I, I wouldn’t be surprised if there were people who are feeling better taking this combination of therapies, ’cause they do have secondary benefits on, on working in the brain to improve stuff like mood and maybe energy. But again, I have to, I have to admit I’m not an expert in that.

Eileen Davidson: Well, when our mood improves, so does our energy levels.

Cheryl Crow: Yeah, that, that makes sense. And the other thing I really liked the, when you said earlier about it really is like an individualized decision. Like you as a doctor are individualizing your advice to the person in the room with you.

[00:30:00] But when I mentioned that knee, you know, being every 10 pounds of being overweight causes a lot of load on the knee. What’s complicated is it’s like the devil’s in the details because if you have a lot of extra fat on, let’s say your leg versus a lot of muscle that’s causing that is the weight, the mass of your leg, it’s going to act differently to support the joint.

We are always talking about on this podcast strength training and like I feel like someone’s, like “you’re being paid by big strength training to promote strength training.” But I’ve had a huge positive effect and I’ve seen, I’m familiar with the literature that strength training is important, but you might think, well, wait a minute, strength training is actually technically, you’re gonna gain some muscle. So you might actually gain a little weight from that because all weight isn’t created equal.

When you have more musculature, you’re reducing the load on the joint. So how do you have help your patients think through this? I don’t know. Probably some more coherently than I’m saying.

Dr. Derin Karacabeyli: No, I think that’s a great point. Usually what I tell people is that, when you build more muscle in [00:31:00] certain areas, like for example, when you build more muscle in the quads and the hamstrings, like around the legs, if you have knee osteoarthritis, it can help better distribute the load in the joint itself.

Or it can, I almost say this is overly simplified, but I almost say it can help take off some of the load from the, the joint itself because the muscles are helping move the joint in a healthier way and, and taking off, taking on some of that load in a sense when they’re contracting in a healthy way.

So I kind of tell them that the, the strengthening of the legs can essentially offload and help the knee joint itself function better.

Cheryl Crow: That’s, that’s beautifully said. Unfortunately, we do have to pay attention enough science and physics in high school to remember some of, some of these basic physics lessons.

And yeah, I think just we’re getting to the conclusion part, believe it or not. Although I think both Eileen and I would love to talk to you for hours ’cause you have such knowledge in this area.

You alluded to a few studies already that are currently maybe [00:32:00] underway. Are there any other exciting or groundbreaking research projects underway at the Arthritis Research Canada that you’d like to highlight?

Dr. Derin Karacabeyli: There’s there’s so much amazing work that’s being done at arthritis Research Canada, and so, to, to pick amongst all of my colleagues amazing work would be really challenging.

So instead, maybe what I’ll do is, I don’t think this is the most groundbreaking work, but I’ll just tell you briefly about what I’m doing and that way I don’t have to pick amongst all the other stuff. So, I’m currently doing my PhD and, and essentially what I’m looking at is I’m looking at the, the safety and effectiveness of semaglutide, or again, for people who don’t recognize the generic name of Ozempic or Wegovy in people who have inflammatory arthritis.

So I’m studying people who have rheumatoid arthritis, axial spondyloarthritis or psoriatic arthritis, and we’re looking to see based on existing administrative health data, whether people who get semaglutide for their diabetes, whether or not it helps their inflammatory arthritis.

And what I mean by helps is whether they’re less [00:33:00] likely to have flares of their disease that require increases in therapy. So we know that when people have worsening disease, say, say rheumatoid arthritis. They often have to have increases in things like either you get prednisone added on short term, or your disease modifying agents get upped or you get switched to a different drug. Maybe they add a biologic, maybe they add methotrexate.

And so we’re trying to see whether those additions are less likely if you’re on semaglutide. Does this drug help keep your disease under control? That’s part A. And then part B is we wanna see if it’s safe in people with inflammatory arthritis. So we’re looking at things like, are people more or less likely to go to the hospital for gallbladder attacks or for pancreatitis or is, are they more or less likely to go to the hospital with suicidal ideation or severe depression?

Because, you know, there have been some concerns around mood with these drugs. There have been concerns around gallbladder attacks and pancreatitis with these drugs.

So we wanted to look at some of those areas that have been brought [00:34:00] up and see how they affect people specifically with inflammatory arthritis who often have been understudied in these GLP-1 trials to date.

Again, this is just my work. No, there’s so much amazing work. I just thought it’d be easier to talk about my own.

Cheryl Crow: Well, that’s definitely the number one question on people’s minds when this comes up, that in my audience online and in the support groups that I lead. So people really wanna know, yeah, what is the effect? Is there any reason people with inflammatory arthritis shouldn’t take, you know, shouldn’t take these meds specific to our population? So I think it’s wonderful that you’re doing that.

And yeah, where where do you recommend people go to learn more? I know that we mentioned the Arthritis Research Canada site.

Do you have any links you want us to direct people to, like your own, you know, LinkedIn or do you have social media, or how should people. Find you,

Dr. Derin Karacabeyli: Fair. I, I would say I, I don’t really have much of a social media presence, if I’m being honest. But Eileen and I worked on a webinar [00:35:00] together, it, this also lives on the Arthritis Research Canada website.

But in September we did a webinar on arthritis and weight. And so I gave about a 20 ish minute presentation and then Eileen and I did a moderated q and a where people were able to submit their questions. And then we also collated a bunch of resources, a bunch of websites, studies references to other helpful resources like Obesity Canada’s website the physical activity guidelines for Canada things of that nature.

And it’s all on the, all, all on one page. So I would say that would be a great starting point that that link to that webinar and all the resources with it.

Cheryl Crow: Thank you.

Eileen Davidson: Absolutely. And even though talking about weight is such a difficult topic and I didn’t exactly want to do it, but I just felt like it was such an important topic.

So I was really excited to be the patient partner in the video, but also not excited for, you know, what’s going on. But. It, it’s so much information there and I’ve been using a lot of it to, in my, my life lately and going at my [00:36:00] own pace. So, I really, really highly also recommend that informational page.

”Cause it’s not just the webinar, there’s so much more. But in wrapping up this episode, ’cause I know that there is so much more information and we can go on a lot more, but in one sentence. What is the most important takeaway you’d like someone to take away from this episode?

Dr. Derin Karacabeyli: Okay, I will, I will I’ll is a three, three part sentence.

It’ll be one sentence though with a few comments. Okay. I would say obesity is a chronic disease, but it’s not a person’s fault and is treatable. So I, I’d say that’s three, three parts. Chronic disease, not a person’s fault, treatable.

Eileen Davidson: That’s a very good sentence, actually. Three, three key points to a very impactful sentence.

So again, thank you so much for being here and giving us all your wisdom. It’s been an absolute pleasure once again, [00:37:00] getting to work with you and highlighting the important work that you are doing.

Cheryl Crow: Yes. And this concludes our episode of Rheumer Has It, and make sure to thank you all again so much for listening.

And be sure to check out the full show notes on the Arthritis Life website, my arthritis life.net, where you can see also a full transcript plus a video of this conversation, if that’s your learning style.

Eileen Davidson: And we would also love to hear what you think about this episode. Shoot us an email or comment on our social media pages and let us know.

And if you have any topics you want us to cover, we definitely wanna know about it.

Cheryl Crow: Absolutely. All right. Thanks again, Dr. CarVal. We’ll see you later. Bye-bye for now.

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