Michael Mindrum, MD

Internal Medicine & obesity specialist. Born in 🇺🇸, 🇨🇦 is home.

[Michael Mindrum, MD @MichaelMindrum]

@StevenMBelknap @_eleanorina define major in absolute risk compared to the benfit.

[Michael Mindrum, MD @MichaelMindrum]

In general,
Don’t stop taking a GLP1.
Thanks.

[The Lancet @TheLancet]

Stopping GLP-1 treatment linked to twice the risk of heart attack, stroke or death compared with continuing, in people with type 2 diabetes and no cardiovascular disease, according to a new study.

Find out more in @LancetRH_Europe: https://t.co/iNJmDhOPAU

[Michael Mindrum, MD @MichaelMindrum]

@WaleedMastery Love it!

[Michael Mindrum, MD @MichaelMindrum]

I spend my day helping people divorce the concepts of “healthy behaviour” and the “number on the scale.”

Diet culture marries these two ideas. Diet culture has created multi-billion dollar weight loss programs that has taken advantage of our misunderstanding and led to misplaced blame and shame. Diet culture needs to die.

The end goal of behaviour change is to see healthy behaviours in our life…. and *body weight* is not a behaviour.

[Tamar Haspel @TamarHaspel]

This is demonstrably false.

In 40 years, there has not been a single lifestyle intervention that, in trials, worked for long-term weight loss.

GLP-1 users lose weight *and* improve their diet.

You guys had nearly a half-century to come up with something, and you didn't.

[Michael Mindrum, MD @MichaelMindrum]

Yes! It’s beautiful to see knowledge 😍

[Waleed @WaleedMastery]

@MichaelMindrum Sleeping better, walking more and eating real food are wins even in a week the scale doesn't move. Tying them only to the number is how people quit habits that were working.

[Michael Mindrum, MD @MichaelMindrum]

@BevTchangMD I would love a risk calculator for things like this to help quantify risk reduction (be it cancer, metabolic disease, etc)

[Beverly G. Tchang, MD @BevTchangMD]

The data exploring #GLP1 and #cancer continues to expand: https://t.co/xUcj1aHj3S

This retrospective observational study of electronic health records looked at electronic health records for about 360,000 adults with type 2 #diabetes at UT Southwestern (2010–2025) who had no prior obesity-related cancer. They compared people starting a GLP-1 drug vs. those who started metformin, insulin, an SGLT2 inhibitor, a DPP-4 inhibitor, or a sulfonylurea — five separate head-to-head comparisons, matched with propensity weighting. Then they split everyone by how severe their diabetes was at baseline.

Their findings:

- At 3 years, GLP-1 starters had lower obesity-related cancer risk than insulin starters (1.25 percentage points lower; HR 0.62) and sulfonylurea starters (1.14 points lower; HR 0.67).

- No meaningful difference versus metformin, SGLT2 inhibitors, or DPP-4 inhibitors.

- At 5 years, the gap vs insulin held (−1.67 points; HR 0.61) and vs sulfonylureas (HR 0.75).

- The advantage was clearest in people with milder diabetes. In the most severe group, the 3-year comparison actually favored SGLT2 inhibitors over GLP-1s.

In oncology, no one is surprised that GLP1s were better than insulin starters since insulin is an anabolic hormone--ie, it stimulates growth.

A nice plain language summary here: https://t.co/CDMwGfYuEc

HT: Jaime Almandoz, MD, MBA, FTOS!

[Michael Mindrum, MD @MichaelMindrum]

A number of patients I know who would have benefited from timely access to bariatric surgery in Nova Scotia have died because our health system ignored them. In my view, this is discrimination and a human rights issue. It is a tragedy that very physicians or healthcare leaders recognize or acknowledge.

[Michael Mindrum, MD @MichaelMindrum]

People still don't like it that we have effective treatment for obesity - can hear the bias from a mile away.

[Michael Mindrum, MD @MichaelMindrum]

@GuillaumeHeller same goal. Its a tool for patients to consider using. Success is health - less disease, more health, less suffering.

[Michael Mindrum, MD @MichaelMindrum]

@manacalaczar wrong answer!

[Daniel J Drucker @DanielJDrucker]

Rare GLP1R variants (about 1:500) attenuate weight loss with semaglutide but not tirzepatide, whereas rare LOF GIPR variants have little effect on drug responses
https://t.co/eaIYNd6vDo

[Michael Mindrum, MD @MichaelMindrum]

lets wait until 2066 to treat obesity - a leading cause of morbidity and preventable death? the disease that has surpassed smoking in causing ASCVD. there are millions of life-yrs observed in clinical trials w/ over a decade of surveillance. CVOT trials with 10s of thousands of patients. Outcome trials now showing level 1 evidence for ASCVD, MASLD, OA, OSA w/ emerging evidence of benefit for others. Not sure what you are looking for.

[Michael Mindrum, MD @MichaelMindrum]

re: prices you pay - It's not so much pharma as it is the beurocratic layer where prices are jacked up. But yes, pharma is very powerful none the less. Its a societal decision - how much should pharma profit? should there be a cap? How to recognize that their success leads to the R & D needed to motivate and make breakthroughs. It can be a love / hate.

[Michael Mindrum, MD @MichaelMindrum]

yes, individualizing therapy is reasonable. Careful doese reduction while making advances in nutrition and exercise fits in a concept of "treat to target".

Stopping the drug, especially when it is treating a metabolic disease like t2D, ASCVD, MASLD, etc. shoud be considered a very high risk time. It also often ignores weight independent effects of the therapy. These are more than weight loss drugs.

This approach is much different than your initial comment:

"Take it lifelong? With all potential long-term risks? Take it to loose weight AND to change lifestyle which then can reduce the risks of stopping the drug."

[Michael Mindrum, MD @MichaelMindrum]

thanks, I hadn't reviewed that paper yet. I think this is first line of evidence that there may be any strength compromise in those on GLp1/GIP and it is very reassuring that strength training not only mitigates this but improves. Adequate protein and resistance training should be part of the treatmen tplan. It doesn't support your position of needing to stop the drug though, right?

[Michael Mindrum, MD @MichaelMindrum]

@OliverFaude there are other lines of evidence to support my position.

[Michael Mindrum, MD @MichaelMindrum]

@OliverFaude show me data that you lose considerable amt. of strength

[Michael Mindrum, MD @MichaelMindrum]

@OliverFaude STEP 4 JAMA 2021; PMID 33755728
STEP 1 extension ; Diabetes Obes Metab 2022, PMID 35441470
SURMOUNT-4, JAMA 2024, PMID 38078870
SURMOUNT-1 3-year, N Engl J Med 2025; PMID 39536238
ATTAIN-MAINTAIN, Nat Med 2026, PMID 42120723
West et al. meta-analysis, BMJ 2026, PMID 41500720

[Michael Mindrum, MD @MichaelMindrum]

Nice review by Dr. Matthias Blüher on the pathophysiology of obesity and its pharmacotherapy.

[Science Magazine @ScienceMagazine]

A new #ScienceReview highlights progress in the development of obesity management medications (OMMs), including GLP-1 receptor agonists, as well as key limitations associated with these medications, such as gastrointestinal side effects, variable treatment responses, loss of muscle mass, and weight regain after stopping treatment.

Learn more: https://t.co/rGS40zwT1h

[Michael Mindrum, MD @MichaelMindrum]

@OliverFaude this not a good plan, in general.