David Macklin

Me: At conference eating a sandwich. Keto guru Doc: “You know that bread will kill you”. Me: “My grandfather lived to 104 years old”. Keto guru Doc: “By eating bread”? Me: “No, by minding his own business”.

The GLP-1 receptor agonist semaglutide (Ozempic®/Wegovy®) -soon to be available at 7.2 mg once weekly- has been shown to reduce the incidence of cardiovascular death, non-fatal heart attacks, and non-fatal strokes in people living with established heart disease and overweight or obesity. So… cardiologists will now be prescribing GLP-1 agonists to their patients more frequently. If you are someone prescribing a GLP-1 receptor agonist or personally starting one, you’ll find this podcast extremely relevant. I was recently invited by @Dr. Grace Chua and the @Canadian Cardiovascular Society to discuss exactly this on the Cardio Connector Podcast episode “Sustaining Success: Real-World Approaches to Obesity Management.” In the episode, I share three key principles every cardiologist should integrate when prescribing these medications: 1️⃣ Addressing internalized weight bias
2️⃣ Discussing appetite dysregulation
3️⃣ Setting realistic weight loss expectations Integrating these principles is: 
🔹 Straightforward
✅ Simple
⏱️ Not time-consuming
⚡ Yet critical I suggest that doing so will meaningfully improve: 
✅ Medication adherence
❤️ Clinical outcomes 🎧 Listen to the full episode here: ccs.simplecast.com/episodes/susta… What challenges or successes are you seeing when discussing GLP-1 therapies with your patients (or in your own experience)? I’d love to hear your thoughts in the comments 👇 #Cardiology #GLP1 #Semaglutide #Ozempic #Wegovy #ObesityMedicine #PatientAdherence #CanadianCardiovascularSociety #HeartHealth

@shaunmmaguire @anndrrson Agreed the people in Dubai don’t like the Flintstones, but the people in Abu Dhabi Do😂

@anndrrson Abu Dhabi is very dif than Dubai

The UAE is a rare country that combines vision with courage The world sees the skyscrapers they have built But most don't know about the work they have done to root out extremism This is an incredible country with remarkable leadership The UAE will thrive this century

@cremieuxrecueil More effective?

Some patients are too lazy to wait 30 minutes to take Novo's pill to lose weight. When Eli Lilly drops orforglipron–which is more effective, requires no wait, and is supposedly being launched at a lower price–they're just going to nab up the entire market.

@shaunmmaguire @PierrePoilievre Canadian here and agree 💯

@PierrePoilievre I wish you were the PM of Canada

Congratulations to President Trump on successfully arresting narco-terrorist and socialist dictator Nicolas Maduro, who should live out his days in prison. The legitimate winner of the most recent Venezuelan elections, Edmundo González, should take office along with the courageous hero and voice of the Venezuelan people, María Corina Machado. Down with socialism. Long live freedom.

@shaunmmaguire @sethbannon @msuster @grok Obesity medicine expert here. FYI fMRI is validated and provides our best in human mechanistic data showing how people with obesity have hyper responsivity to food stimuli (photos) in the “human motivation to food system”.

@sethbannon @msuster @grok are fMRI studies reliable?

This is PRECISELY the point. See: Paul Graham, Dave Chappelle, Mark Ruffalo, Tucker Carlson and all the others obsessed with 0.2% of the population while mostly ignoring 99.8%. Somehow we stoke that emotion & have for 2,000+ years.

@drmarkhyman Mark, can you explain the difference between absolute risk and relative risk?

What are your thoughts on this research? ebm.bmj.com/content/early/…

Alcohol can increase your risk of dementia. A brand new study out of Oxford followed 559,559 adults for up to 12 years and found shocking results on alcohol and dementia: - Heavy drinkers: 41% higher dementia risk - Alcohol use disorder: 51% higher risk - Genetic analysis: 15% dementia increase per standard deviation of weekly drinks - with NO protective effect

@drmarkhyman Insulin resistance does not cause obesity. Obesity causes insulin resistance . Over eating does not cause obesity. Obesity causes over eating.

Insulin resistance affects 88% of Americans but only 12% know they have it. It's the root cause of obesity, diabetes, heart disease, and Alzheimer's. Yet most doctors never test for it until you're already sick.

@sguyenet @cremieuxrecueil This will be informative. onlinelibrary.wiley.com/doi/epdf/10.10…

@cremieuxrecueil I don't think it's accurate to say people "keep it off". As you noted in your post, trials suggest that most weight is regained when the drugs are stopped. It is good news that apparently, not *all* of the weight is regained.

One of the major concerns about GLP-1RAs like Ozempic is that people will regain lots of weight. Late last year, reassuring data came out showing that people generally didn't regain the weight at one year. Now we have two years of data and most people keep the weight off!

@KevinH_PhD @AaronHengist Hey Kevin, why are you and now @AaronHengist testing the effects on sleeping energy expenditure of nicotinamide ribosome supplementation?

People often ask me if my studies are still running at NIH after I felt compelled to retire earlier this year. The answer is yes, and @AaronHengist is still recruiting for this one testing the effects on sleeping energy expenditure of nicotinamide riboside supplementation during a ketogenic diet.

Standing room only in Malaga Spain at #ECO2025 as Dr. Horn presents the landmark Surmount-5 trial data published today in NEJM. nejm.org/doi/full/10.10…

@MichaelAlbertMD @GLP1Insider Hey Michael, I am at ECO in Malaga Spain this week. I’m sure this will be a hot subject, I’ll be sure to mention your data.😀Congratulations, yours is a model obesity clinic👍

@GLP1Insider They care about money, not patient outcomes.

📊 NEW STUDY: Real-World Semaglutide: great promise, stubborn barriers - - - Key data (N = 1,072): 🔹 18.6% never started treatment (due to access/cost issues) 🔹 25% stopped within a year (side effects, other factors) 🔹 56.4% 1-year adherence overall 🔹 8.8% mean total weight-loss (%TWL) across all who were prescribed 🔹 10.9% mean %TWL among those who stayed on therapy a full year 🔹 13.6% vs 10.1 %: greater loss after Roux-en-Y gastric bypass (RYGB) than in surgery-naïve patients (P = 0.022) ↪️ Lower response when BMI > 40 💡 STEP Program reported ≈ 14-16% weight-loss at one year with semaglutide 2.4 mg + lifestyle support — nearly double today’s real-world figure. By comparison, @accomplishHLTH has presented three Real-World Cohorts, all of which achieved mean TBWL > 20% at one year (with observational limitations) with integrative, multi-disciplinary specialty obesity care. @accomplishHLTH is presenting its 4th cohort, which includes combined bariatric and medical therapy, at the @ASMBS Annual Meeting in June 2025. H/t @Nimeri_MD for the slides. - - - Study: journals.lww.com/annalsofsurger…

@sguyenet @HermanPontzer Hey @sguyenet and @HermanPontzer, happy new year. Quick switch to the other side of the energy equation. High levels of exercise leading to lower calorie intake as a consequence of ⬇️ incentive motivation and ⬆️ executive self regulation? Lots of evidence there…

@HermanPontzer Interesting thought. It would be pretty surprising if exercise caused weight loss but there was no relationship to dose though, right?

Meta-analysis of exercise RCTs making the rounds today shows what we’ve known: expect ~2kg wt loss from exercise, some get more, many get 0. Text from Burn, fig from paper. jamanetwork.com/journals/jaman…

@Tellit007 @MichaelMindrum Thinking this through… Why are obesity rates in Kuwait, Qatar, and Egypt equal to or higher than the U.S., despite significantly lower consumption of ultra-processed foods and less sedentary lifestyles?

@DavidMacklinMD @MichaelMindrum So these folks have always had obesity? History begs to differ. There is a big flaw in your logic.

What’s going on USA? 🇺🇸

@Tellit007 @MichaelMindrum The point is that genetics trumps food environment. Crazy but true.

@Tellit007 @MichaelMindrum Countries with obesity rates within 2–3% of the US often lack the same obesogenic ultra-processed food environment. What else might be driving the numbers?

@MichaelMindrum Oh and there is no way that obesity prevalence in Canada is only 26%. Certainly above 30%.

@MichaelMindrum People would be tempted to say the signal is the US food environment, but the answer is likely genetics… look at the comparators. For example, US rates are similar to Kuwait. US is a melting pot of obesity associated genes.

@MWeintraubMD Hey Michael, why do you say surpassed by smoking?

Obesity stands as one of the primary preventable causes of death, surpassed only by smoking. Confronting obesity has escalated into a public health crisis that can no longer be overlooked.