now to separate fact from fiction. doctor fatima coady stanford, harvard medical school professor and obesity specialist at massachusetts general hospital. doctor stanford, thank you for your time. >> thank you so much for having me. it's a delight to be here. >> i'm so glad you're here because this is the topic. i mean, it seems like everybody is either on ozempic or wegovy to lose weight if they can get their hands on it. but is it safe? >> absolutely. this is actually one of the safest class of medications that we've seen in a long time. actually, we've seen that these medications have actually been able to reduce the risk of heart attack, stroke and all cause mortality. when we've looked at 20 years of data from the use of these types of medications, what we call glp one agonists, what does that mean? glucagon like peptide one receptor agonist, which is the class of medications that these fall into. the thing is, is that

we have to use these medications in a safe fashion. and we aren't seeing that always when these are not being prescribed by patients or prescribed by prescribers that know how to use these medications correctly. for patients that need them, like you said. >> right. there's a lot of data because it's not a new class of drugs. it's just new to weight loss for using it. but now that it's going to gone that way and everybody's getting it prescribed, can i just ask you like, who are they going to online doctors who will just say yes to anybody without knowing how they need to be used? can you talk a little bit about how to find someone responsible and really how to do it right? >> absolutely. so the key thing is knowing that these medications are approved for the treatment of both diabetes and for patients with obesity, and they've actually been on the market for the treatment of obesity since 2015 and 2016. the key thing is, is that there's different types of medications. and when do we use these? we use these in patients that have

obesity. that's for patients with a bmi of 30 plus or patients that have a bmi of 27 plus. obesity related comorbid conditions. what do i mean by that? patients that have hypertension, patients that have issues with obstructive sleep apnea, or patients that carry metabolic risk factors. and so that's really important for us to recognize. now what i've been seeing is also inappropriate prescribing, escalating the dose of these drugs too rapidly, all for seeking weight loss in a rapid fashion. we have to follow the prescription, making sure that we escalate these doses in a really prescribed fashion. that means looking at the package insert. so if we're using something like semaglutide, semaglutide is the medication that is ozempic for diabetes or wegovy for the treatment of obesity. we do want to follow the package insert. and let's look at what govie. and there are five different treatment doses 0.25mg, 0.5mg, one milligram, 1.7mg, and then

2.4mg. now you're supposed to stay on those doses for a minimum of one month before going to the next dose. however, some people skip these doses and they are just ready to go all the way to the 2.4mg without ever starting at the lowest dose. it's like starting to jump into the middle of the pacific ocean without ever learning to wade in the kiddy pool. is that really the appropriate way to do that? absolutely not. and that's when we get into major issues like these issues like we've heard of stomach paralysis as these drugs do, slow movement through the gi tract. but if we gradually do it, we see the body get adjusted to this. and so it's important for us to do this in a safe way so that we don't run into these issues that we're hearing about in the news, these bad issues. it's about doing things so that your body gets acclimated to the side effects and so that your body can handle these chronic drugs for the chronic treatment of issues like type two diabetes and obesity. >> got it. okay. so i know gi

issues are one of the most commonly reported ones. what are some of the other side effects. and you know, also talk about whether there are any long term concerns because questions have been asked about our cardiovascular impact, renal or pancreatic cancer. are those somewhat fact based or not at all? >> so let's go through all of the things you just asked. let's kind of take it step by step. so the most common side effects are as follows. number one is nausea. up to 45% of patients can experience nausea. and this is usually as we're titrating the dose of these medications. we talked about that gradual dose titration. and we want to stay on the dose long enough so that we can become acclimated to these medications. nausea is the most common side effect. and then of course with nausea can come vomiting. but not everyone will experience it. notice we said up to about 45, which means it's not 100, but that's a sizable portion of individuals. after that is constipation. this gets into that gi side effect. these movements slow movement

through the gi tract. if things move slower, it improves satiety, a sense of fullness. and so constipation is something that we often are working with patients to deal with. there are some other issues that can happen. some people can feel some sense of fatigue, a sense of tiredness. this is something that maybe you start noticing. people can say, you know, i'm not noticing why am i feeling tired? that may be something that people aren't talking a lot about, but let's get into some of the other issues you're talking about. you actually have seen a significant reduction in cardiovascular events. actually, some of the key studies have shown that there's a 20% reduction in mace. what is mace major adverse coronary events. actually, five year study results have just come out showing that there's a reduction in major adverse coronary events . so what group of people are really excited about this? are cardiologists. very rarely do we see our cardiologists get excited about medications, particularly of this kind. and the reason why they're getting excited is because they've seen

a reduction in major adverse coronary events. the excitement is so, so much that we're now seeing medicare starting to approve these agents to cover these drugs for the reduction in major adverse coronary events, and that older patient population. so those that are of medicare age. so that's really, really exciting. >> but what about cosmetic stuff like ozempic face and but first of all, don't don't laugh folks. what is that and what causes that. >> so let's talk about some of these cosmetic issues that we've heard about ozempic face. what have we heard about? we've talked about losing lean muscle. so a reduction in fatty tissue. so adipose is what we call fat. actually adipose is an organ housed in our body fat tissue. adipose can be housed in our cheek muscles. it can be housed in our butt. right. we carry fat within our buttocks or gluteus medius minimus etc. in those areas. and so when we start to lose weight, we also start to

lose fat and muscle. and so people will refer to these as quote unquote ozempic face ozempic. but i don't, i don't refer to them as that. but i will use your terminology. there's no such thing technically as ozempic face and ozempic. but because when we lose weight, whether it be through diet and lifestyle mechanisms or through medications or through something like metabolic and bariatric surgery, we can lose lean muscle and fat. and so we can have that kind of shrunken look that's associated with it. but it's not necessarily the medicine itself. the one thing about glp one, for those that lose prominently, is that they can get that kind of more shrunken look, it's not necessarily the medicine, it's just that they have an aggressive response to these medicines, those people that are high responders. and so they're losing adipose fat and muscle. and so that's what's causing those more esthetic looks that are changes that may not make them look as full as they looked before. >> all right. so let me just ask you, you know, do you recommend it overall. and if you do, do

you know, if people stop then what right. do they kind of go back to what they were. and as such, do you still recommend it? >> okay. so these are really important questions. i'm so glad you asked these. so number one absolutely. do i use these medications to treat patients with either type two diabetes or obesity. these medications have shown tremendous impact in terms of both of those entities. they've shown to reduce blood glucose. we've already said that they reduce the risk of heart attack, stroke, all cause mortality. and so when we see these types of outcomes, not only with regards to weight reduction, but improvement in life quality and reduction in death, obviously, these are agents that i would turn to. but you raised a very important point. and what happens if you don't use these long term? we're treating two chronic diseases. the two chronic diseases are type two diabetes and obesity. as soon as we stop using these

medications, we are no longer treating those two chronic diseases, which are type two diabetes and obesity. so when i pull back the use of these medications, either that blood glucose or blood sugar or hemoglobin a-1c is going to start to go back up, and that weight is going to start to go back up, because these medications are acting on the two pathways of the brain that regulate weight, that is that palm c pathway, that pathway that tells us to eat less and store less. it's upregulating that pathway, it's making it more potent. and it's down regulating this pathway called the agrp or the orexigenic pathway. and as soon as we're no longer acting on that pathway, you can imagine that weight regain will occur. so if this is a useful tool for you and notice i use the word if, this will not be the magic cure or magic bullet for everyone. and i want to really overemphasize this. not everyone will be a responder to a glp one agonist. i can't overemphasize that. for those

that are responders, however, we do need to use these medications as long term. all right, so that if it's not being utilized, this will no longer be working within the body. >> well, we're going to leave it on that main point that you emphasized, doctor fatima cody stanford, thank you so much for joining us. really appreciate all this great information. >> thanks for having me. it's been a great delight to be here. >> up next, a leading republican vice presidential candidate shoots and kills her puppy, calling it untrain double. as public outrage grows over south dakota governor kristi noem's actions, how should you deal with a difficult dog? we'll talk with an expert next. >> it's time to stop worrying about mattress shopping because of the living spaces sleep center, we treat you to an easy no stress experience. our team of non commissioned experts are here to guide you. whether you're looking for top brands like tempur-pedic, sealy and purple. an organic option like avocado or the latest in mattress technology which you'll get with our revive adaptive

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running mates for donald trump is south dakota governor kristi noem. but she stirred up debate and outrage this past week after writing in her new book that she shot and killed her unruly dog, and followed up with interviews suggesting that president biden's dog should be killed as well. >> and i had put months and months of training into this dog. this dog had gone to other trainers as well. all of that shows that when you put someone in a position where they have to make a decision and they want to protect their family and protect children and other people from getting attacked. so how many people is enough people to be attacked and dangerously hurt? before you make a decision on a dog? >> so she continues to defend her actions. but there's a lot of talk about it. joining us live now is ann glasscock behavior and training client services manager at marin humane society. and thanks for joining us. thank you. can i just get your take? what is your reaction to this whole story, i think that, it's pretty it sounds very

short lived. like she did not, really do all the right things would be in my opinion. there's a whole lot of reasons that dogs, can appear aggressive, typically, you know, training anxiety, fear based aggression and prey, you know, aggression towards prey, which, let's face it, dogs were originally designed for that. so dogs eating give our viewers a little bit more background on this particular case. >> and dogs. so governor noem says she killed her 14 month old wirehaired pointer. now, i don't know dog breeds, but you tell us named cricket after the dog showed aggressive behavior. she says she was training the dog for pheasant hunting and that it had attacked and killed chickens and bit the governor, and she wanted to protect her kids, but just what she described there is that really abnormal behavior for that dog, the breed and the age. >> i mean, i think any, any dog that is designed to, to be a bird dog can definitely go a little bit past the limit that

it should going should go and, and go to the, the attacking and killing stage. and so, the first thing you got to do is figure out what it is and then the second thing is we obviously don't want dogs biting people or killing chickens. we don't want dogs putting kids. we don't want to put kids at risk. but let's face it, the first thing you do is you is you go to management and you figure out how can we manage this dog, to figure out how to keep everybody safe until we can get the training done. and it sounds like she was looking for some, some fast, quick solutions right before we talk about perhaps, you know, better solutions, i just want to show people the fallout from this, democrats and republicans have really jumped on it. >> michigan's democratic governor, gretchen whitmer tweeted, you know, this picture of her with her dogs, post a picture with your dog that doesn't involve shooting them and throwing them in a gravel pit. and then also the anti-trump republican group, the lincoln project, they were also pretty critical of her actions, and they put out a video saying

that this was tragic and justice for cricket. that's her dog's name. but basically, you know, saying that it didn't have to be that way, so this is where i get to asking you for your expertise, because i know you guys have, dogs that are quote unquote difficult, right? what what could she have done and what, you know, would cause you to say a dog is untrainable, first of all. i mean, does she show the dog enough effort, you know, just walk us through what should be done. >> so they're pretty. they're they can be complicated cases. and we really first have to start with, assessing the, the underlying cause of it and then, and then sort of doing the management component next, and then the last part is to figure out as you start training, is the prognosis, what's the prognosis. and not that some dogs might end up in a position where you decide it's just very challenging. and you need to either consider rehoming or sometimes behavioral euthanasia. but that's a pretty extreme case. and it sounds like she's

sort of flippantly, just, tried to send the dog to a trainer and tried to try to do some work, and it didn't work. so she took the fast way out. in my opinion. what does rehoming mean? so she could have found it sounds like this dog might have been rehomed to her and she was told the dog was aggressive, so that's a little bit silly too, because you don't want to bring a dog that's aggressive into your home. sometimes there are people who people who want and can take a dog that has these tendencies, and they want to have a dog that they can work with and take the time and make sure that it's safe in their home and in their, their community, so sometimes you can find it. we have lots of success rehoming dogs that way. so but it takes some work and it takes some time and, and professional, you know, behavioral behavior professionals will be able to help get to the right solution. i'm just not quite convinced that maybe that was done in this case. >> i mean, as a last resort, could she call up you guys, the humane society in her area? and would you have taken care of it

or taken away, or you know, what would have been the outcome? yeah yeah. >> i mean, any, any, any, you know, dogs like that, we don't want them out there. but we would do some evaluation, make sure there's nothing medically going on that's causing this. do some behavioral evaluation and figure out the prognosis before making any decisions. it sounds like that was not done okay. could be wrong. >> if it does get to a point where the dog continues to attack, by the way, i mean, she talked about, you know, commander president biden's dog because it had shown aggressive tendencies and bitten some people and then was taken out of the white house and then, you know, and it was brought back and i guess who decides? and i guess if you reach that point where you decide this dog really can't, you know, it's a liability, it's going to hurt people. is there a difference? i know this sounds like a dumb question, but from your standpoint, the difference between just taking out and shooting the dog and doing euthanasia in a setting such as yours, i mean, i certainly wouldn't want to do that. i know that if we do end up having to

euthanize any dog, you know, typically it's severe health or severe behavior issues, it's a compassionate thing. that dog is still a being, and it's deserves compassion. so we're very careful to make sure that that we are, giving that dog the best possible experience, even though it's the last experience. >> yeah. no doubt. look, and i really appreciate all this information you came on to give us. i mean, this has just been a crazy story. so hard to believe, but yet here we are before i let you go, because you're a great partner and you guys do so much great work. is there anything going on right now on a happy note that you want people to know about? >> well, we have our our woofstock coming up in a couple of weeks. that's very exciting. and, certainly our website will give you all of our events, but we always love to have more supporters and, come and visit. we're doing some great things. >> all right. ann glasscock with the marin humane society, thank you so much. >> thank you. >> the perilous state of california's piers, there are

growing concerns about the conditions of some of the iconic sea structures. a project manager with the california state coasl nservancy tells us why they are at risk and what can be done next. >> for over 25 years, lovesac has been rewriting the rules of comfort. it's okay to change your style, get messy, get immersed with lovesac. you make the rules. >> create lasting memories at cirque du soleil kooza in san jose.

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you're in luck, i did. if you weren't thinking that, i bet you are now. my popcorn chicken combos are only $6.99. get 'em sauced & loaded for just a buck more. welcome to jack in the box! an increasing risk of destruction. we're talking about california's iconic piers, some of which have dotted the pacific coast since the gold rush. but they may not survive today's storms and climate change. joining us live now to discuss the problem and possible solutions. timothy duff, project manager with the california state coastal conservancy. hi timothy, thanks for joining us. >> happy to be with you. thank you. so there's a lot of history, love and folklore when it comes to our piers, right? >> pier 39 san francisco pacifica pier, capitola pier in santa cruz. but we don't think about them that much, or at least their condition. what is the state of our piers in california? >> all right. thank you. yeah.

our california piers are our treasured icons, structures that are valued uh- by people from all over the state. and beyond. the kind of like lighthouses in that there's so much passion in uh- for uh- protecting our piers and being able to access the ocean, through our piers. and they've just been getting battered as a lot of people have seen on the news the past few winters with these, atmospheric rivers just slamming, big waves and tidal surges into piers like the capitola pier, and so doing what we can here at the state coastal conservancy to help our local communities, like in the city of capitola and elsewhere, to renovate those piers, to make them more resilient to climate change, consequences like warming oceans that just create these big waves, and stronger storms. >> yeah. i mean, they've been

rebuilt time and time again, right? capitola one, as you mentioned, dates back to 1857. so it's gone through phases. but talk about what today's storms and today's conditions demand in terms of when you rebuild them. >> sure. so we're working, with the city of capitola just to take one of the piers that we're assisting local communities to restore. and that's a multi-year effort to assist the city of capitola. to, rebuild the infrastructure of that pier. you have those pilings. those are the critical infrastructure, the decking, the design there is to raise those, the height of the deck there to make it more resilient to, sea level rise. and also those, increasing storm events. so capitola is a good example where we're working, to assist local communities, in a multimillion dollar renovation effort so that we can reopen that pier and other piers, to the public again.

>> so i guess who pays for this, right. because is it each city is the state right >> so local governments are are responsible for maintaining and operating, their piers, the state coastal conservancy and other state funders assist these local communities to by, you know, by providing grant funds, so that they can do those structural repairs when they get damaged, but ultimately, yes, it's up to these small coastal communities, who are strapped to , invest the kinds of dollars that are required to keep these piers open in the face of climate change. are you concerned that some of our beloved piers may fade away with time? well, sure. you know, these a lot of these, piers, as you mentioned, are 100 years old or more. good example is the pacifica pier, that that pier

has been closed now for months and, city engineers estimate that it's going to cost in the range of $10 million to do the repairs necessary to open up that pier again. and that's just not the kind of money that a little coastal town of pacifica has. so it's going to be a real challenge for communities like pacifica and others to find the funds, whether it be local funds or state funds, needed to keep these piers open into the future. >> i know, i mean, they are so, there's such a draw, you know, you see, roller coasters and ferris wheels around, piers. you see people just hanging out, you know, it would be a shame. so another reason for us to all try to do our part to limit climate change and, you know, stall this, you know, coming storms and all that. but i appreciate you coming on, tim, to talk about all this tim duff with the california state coastal conservancy. thank you. >> thank you. >> remember abc seven news is streaming 24 seven. so just get our app and you can join us

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tonight, breaking news. the new warning just as we come on the air tonight. what the national weather service is now warning is a particularly dangerous situation. their highest threat level for tornadoes and severe storms. several states. ginger zee is live in the storm zone. the threat of multiple intense long tractor natos on the ground for much longer. tornadoes would be ef-3s in strength. and potentially hitting in the overnight hours. we're also tracking major