Protein or Produce for Weight Loss

In this episode of the Pound of Cure Weight Loss podcast, Dr. Weiner and Zoe explore the key strategies and medical options available for weight loss, focusing on GLP-1 medications, a comparison between gastric bypass and sleeve gastrectomy, and effective obesity treatment plans. This episode provides valuable insights for individuals exploring weight loss surgery, those using GLP-1 medications, and anyone interested in long-term, sustainable weight management.

GLP-1 Medications and Their Role in Obesity Treatment

The episode starts with an in-depth discussion about GLP-1 medications, such as Wegovy (semaglutide) and Zepbound (tirzepatide). Dr. Weiner explains that these medications represent a significant development in the medical treatment of obesity. GLP-1 medications work by modifying hormonal pathways that regulate hunger, fullness, and metabolism, thereby influencing the body’s internal set point for weight. Rather than simply curbing appetite, these medications help adjust how the body manages energy and fat storage, making weight loss more achievable and sustainable over time.

Dr. Weiner emphasizes that while GLP-1 medications can be highly effective, they are most beneficial when combined with a structured nutrition program and, when appropriate, surgical intervention. He notes that addressing obesity often requires a multi-faceted approach that goes beyond medication alone. Zoe adds that integrating these medications into a comprehensive weight management strategy that includes lifestyle changes is key for long-term success.

Gastric Bypass vs. Sleeve Gastrectomy: What’s the Difference?

One of the central discussions of this episode is the comparison between Gastric Bypass vs. Sleeve Gastrectomy. Dr. Weiner explains the key differences, benefits, and considerations for each procedure, helping listeners understand which option might be best suited for their specific situation.

Gastric Bypass: This procedure involves rerouting the digestive system, creating a small stomach pouch that is connected directly to the small intestine. Dr. Weiner explains that gastric bypass tends to result in greater weight loss and has a strong track record for addressing severe GERD (Gastroesophageal Reflux Disease). For patients who experience significant acid reflux, gastric bypass is often the preferred option since it bypasses the portion of the stomach that makes digestive enzymes​​.

Sleeve Gastrectomy: Also known as VSG (Vertical Sleeve Gastrectomy), this surgery removes a large portion of the stomach, leaving a sleeve-like structure. Dr. Weiner notes that while the procedure is less invasive and has a shorter recovery time, it may not be ideal for patients with pre-existing acid reflux. Studies show that up to 5-10% of patients who undergo sleeve gastrectomy can experience worsening GERD symptoms, which may necessitate a revision to gastric bypass​​.

Dr. Weiner explains that the choice between these procedures often depends on factors such as the patient's starting BMI, the presence of GERD, and individual health goals. He encourages patients to work closely with their surgical team to determine which option is most effective for their needs. Additionally, online tools and assessments provided by the practice can help patients explore which procedure might suit them best based on their health history and weight loss goals​.

A Comprehensive Approach to Obesity Treatment: Combining Surgery, Medication, and Nutrition

Dr. Weiner emphasizes that obesity treatment is most effective when it includes a combination of surgical, medical, and nutritional strategies. For many patients, integrating GLP-1 medications with bariatric surgery can amplify weight loss results, as these interventions work synergistically rather than in isolation. Both approaches target hormonal pathways that influence hunger and fullness, creating a more comprehensive

Episode Transcript

Dr. Weiner (00:00):
The idea that you're going to eat one less piece of
pizza with your GLP-1 medicationand that's your weight loss
plan.
That's not a solid, lasting,long-term plan.
Nutrition alone isn't a greattreatment for someone who's 400
pounds, but neither is GLP-1medication alone and neither is
bariatric surgery alone.

Zoe (00:23):
All right, welcome back to the Pound of weight loss podcast
.
We are here, we.
I'm excited.

Dr. Weiner (00:30):
Look, look at what we got for you I know, pretty
cool huh yeah, your wife madethis my wife made this so
talented I know she really isand uh, we, you know, I don't
think when she made it it wasn'toriginally for a podcast
background.
I think, as we put thistogether, we're like why haven't
we been doing this all along?

Zoe (00:48):
It's what it always was meant for, yeah.

Dr. Weiner (00:51):
Well, this kind of leads into our title for today,
which is Protein or Produce forWeight Loss.
Certainly something we talkabout a lot, absolutely.

Zoe (01:02):
Unfortunately, it's not really a binary answer, is it
Just like so many things innutrition, there's so much gray
area and nuance, which is whyit's so great that we have this
podcast and this platform so wecan actually dive into these
topics and give the explanationthat they deserve, because it's
so dang hard to do it in a60-second clip for you on social
media.

Dr. Weiner (01:23):
Yeah, that's not really.
My forte is summing upsomething in 30 seconds.
So let's move into our questionand answer session.
So we'll hear from Sierra.
We've got our first questionout there and this is coming
from Phillip.
So, Sierra, what do we have?

Sierra (01:38):
First question is from Phillip from our YouTube video.
Should I have Weight LossSurgery?
I watched a number of videosbefore my gastric bypass last
year.
At a year post-op I can say heis almost 100% spot on.
The only thing I completelydisagree with is not eating more
red meat, chicken and fish.
A lot of us who get bariatricsurgery have that cracked out.

(02:01):
Look around eight months Meatand strength training,
especially in women, isimportant.
It helps build muscles and helpyour overall health.

Dr. Weiner (02:10):
So, zoe, what do you think about this?
Is meat and strength trainingimportant, and is there a
difference between women and men?

Zoe (02:18):
So, absolutely, strength training is important and we've
talked about that a lot right,and yes, protein is important
for muscle protein synthesis andbuilding muscle, but it does
not have to come from meat.
It can come from beans andGreek yogurt and, yes, in
moderation, meat and chicken andthose sorts of other animal

(02:40):
based protein sources, but wereally do lean on the side of
plant-based protein.

Dr. Weiner (02:46):
Yeah, I think anybody who challenges the idea
that you need meat in order tobuild muscle should just Google
vegan bodybuilders.

Zoe (02:55):
I know one.

Dr. Weiner (02:56):
Yeah, and so you can build a tremendous amount of
muscle.
Another thing I think that'simportant is think about the
largest animals out thereElephants, hippopotamuses,
rhinoceroses.
They are all plant-based.
They eat only plant-based.
Well, look at that.
Remember dinosaurs?
Well, we don't remember them,but remember learning about
dinosaurs.
The brontosaurus was like thegigantic one that was.

(03:19):
You know, 50, 60 feet long.
Right yeah, they wereplant-based.
It was the T-Rex.
They were the meat eaters.
They're a little bit smallerand more agile, so you can
absolutely build plenty ofmuscle with plants.
I think that they call it Idon't know why I like that term,
but I think it's verydescriptive this cracked out.

(03:42):
Look, we see some of that withrapid weight loss.
I think you can see it fromeither the GLP-1 meds or the
surgery.
What do you think about that?
What's causing that?
What can you do to prevent that?

Zoe (03:53):
Absolutely, and you know, like you said, even though we
don't love the phrasing of it,Right.

Dr. Weiner (03:58):
We all understand what it is.

Zoe (04:01):
So what we really need to focus on during that kind of
fast weight loss phase or thathoneymoon period whether it is
after surgery or after GLP-1, isthat protein, you know, and
really preserving muscle tissueto your muscles, to not only
just maintain them, but maybebuild a little muscle as well in

(04:26):
that weight loss phase, so thatthe weight that they're losing
comes primarily from fat and notfrom muscle.

Dr. Weiner (04:33):
Right, I think you know that.
Look that they're talking about.
To me, that's malnutrition.
I was going to say yep, that'sreally what we're seeing the
temples, the clavicle.
So in my mind there's three,three different types of
malnutrition.
Right, there's proteinmalnutrition not getting enough
protein in, and that's where,again, either a waste whey

(04:53):
protein or other supplement, ora plant-based protein like beans
and nuts, or animal proteinchicken, fish, beef that's how
you counteract that proteinmalnutrition.
Then there's the vitamin B12,the thymine, the folate, your
micronutrients.
Generally, taking your vitaminis going to cover that, I think,

(05:17):
in patients who are able to eatcomfortably and are taking a
bariatric vitamin and I thinkbariatric vitamins are a good
idea for GLP-1 patients,especially if they're losing
weight rapidly You're going tocover that with that.
But then there's this third kindof component that not as many
people talk about and that's thephytonutrients.
And the phytonutrients arethese kind of magical compounds

(05:39):
found in plants.
Only Phyto means plant, andthese are things like
resveratrol and the lecithinsand all these other compounds
that help aid in metabolism thatyou're going to get from plants
.
In my mind, again, not sosimple, especially in that rapid
weight loss phase.
Protein malnutrition is a realthreat in those first few months

(06:00):
when you're losing weightrapidly.
But after that you really haveto start bringing in the plants
if you're able to, and that canhelp you with that phytonutrient
malnutrition.
So yeah, unfortunately it's notjust this one thing.
It really is a verycomprehensive and thoughtful
approach where you're bringingin animal protein but you're
also bringing in the plants asmuch as possible.

Zoe (06:22):
Absolutely.

Dr. Weiner (06:23):
All right, so our next question.

Sierra (06:26):
Next question comes from Lucy from our website.
I'm struggling to decidebetween a sleeve and a gastric
bypass.
What factors are the mostimportant when making this
decision?

Dr. Weiner (06:37):
Okay.
So to me, this is a questionI've worked with, I don't know,
probably about 3,000 or 4,000,probably more, probably 5,000
patients.
I've kind of gone through thishow do I decide?
Should I have a sleeve or abypass?
And there really are a lot offactors.
It's a complicated decision.
We do have a quiz on ourwebsite.
You can plug all yourinformation in and it'll give

(06:58):
you actually an assessment ofwhich surgery may be a better
choice.
Of course, don't consider it aformal recommendation.
It's kind of an educationaljumping-off point.
But I think when we look at itthere's a bunch of different
factors.
I'll just kind of list throughthem.
The first is starting BMI right.
If you have a lot of weight tolose, then you should choose a

(07:21):
gastric bypass over sleep.
You just get more weight lossfrom it.
The GLP-1s have changed this alittle bit and I think access to
GLP-1 meds is another reallyimportant factor, and I think if
you're watching this podcast,you're starting to come to the
conclusion that we're not goingto be able to get these meds
affordably for a minimum of fivemore years Minimum, and so you

(07:45):
have to be committed to gettingthrough these next five years at
least.
It might be 10, honestly itcould be.
At least it's going to be eight, I think, until we can get them
affordably.
So if you can't get these meds,a sleeve where we're seeing 30%
, 40%, 50% of patients requiringGLP-1 meds for weight
maintenance or adequate weightloss might not be a good choice.

(08:08):
And so I kind of look at thestarting BMI and the access to
GLP-1 meds and now we're gettingmore people on these meds
before surgery and seeing whattheir response is and kind of
putting all those thingstogether to help determine hey,
if you're a great responder toGLP-1s, maybe we can do a sleeve
.
If you don't have a greatresponse to GLP-1s, we should
definitely be going with abypass Diabetes as well, and

(08:35):
this also impacts your access toGLP-1 meds because diabetics
have a lot more access to themeds than non-diabetics.
So I think if you're a diabetic,you're going to lose less
weight from either surgery.
A gastric bypass is a moreeffective diabetes treatment as
well.
Also, things likeweight-gaining meds.
If you're taking medicationsand we've talked about that a
lot and how it's important totry to get off them if you can,

(08:56):
but you can't always If you'regoing to be dependent on
weight-gaining meds again, don'tbring a knife to a gunfight.
Don't choose a sleeve when youneed all the weight loss help
you can get to be successful.
Your past surgical history ifyou've had a complicated
abdominal surgical history likelots of big hernias, multiple
bowel resections, things alongthose lines, then choosing a

(09:20):
sleeve is a much better optionbecause we're not going to have
to go in there and do that work.
That's going to be safe.
Also, heartburn A gastricbypass is essentially curative
for heartburn.
Where with a sleeve it canworsen heartburn.
That's another option.
I think the last two pieces arealcohol and smoking.
If you are a heavy alcoholconsumer you have to be very

(09:43):
careful choosing a gastricbypass.
We see alcoholism after agastric bypass surgery.

Zoe (09:51):
Which we discussed in one of our previous episodes how
gastric bypass can ruin yourlife?

Dr. Weiner (09:57):
Yes, and it can, and we have seen that, and so we do
try to.
If you're a heavy alcoholconsumer and you want to have a
gastric bypass, I think, acommitment to avoiding alcohol
altogether after surgery.
And then, finally, smoking.
Smoking is a hard no after agastric bypass, and so we put

(10:19):
all these things together and wehelp patients make a choice.
But the truth is is, I think,even though we have this great
calculator, it's a great jumpingoff point To me.
This is a way for you to sitdown with your provider, with
your surgeon, and make thisdecision, because it really is a
complicated decision.

Zoe (10:32):
Again so much nuance.

Dr. Weiner (10:33):
So much nuance?
Yeah, all right.
What's our next question here,sierra?

Sierra (10:38):
Next question comes from one of Zoe's one-on-ones.
I follow a lot of social mediaaccounts and influencers online
and there are so many differentsupplements they talk about that
it makes me confused about ifI'm taking the right things or
if I need to be taking more.
For example, I recently heardthis woman talking about
gut-healthy GLP-1 booster.

(10:58):
Is this something I need?

Zoe (11:01):
All right.
So this is actually something,not necessarily this specific
supplement, but just supplementsin general.
This is a multibillion dollarindustry.
I mean, yes, and we've talkedabout health halos, we've talked
about different productsjumping on the GLP-1 train as a
money grab.
So this specific product and wemight be able to pop it up on

(11:25):
the screen if you're watching onYouTube it's the Gut Healthy
GLP-1 Booster.
Great marketing, great, it'svery targeted, right?
She was like oh my gosh, do Ineed this?
It's fiber, it's basicallyMetamucil, but do you know what
else?
It's specifically resistantstarch.
Do you know where we getresistant starch?

(11:47):
Produce Yep Beans.
Yeah, so our whole philosophy ofeating whole, real, unprocessed
foods, primarily produce.
Guess what?
You don't need to spend yourmoney on a fancy.
What is this?
$26 for how many servings?

(12:07):
15 servings, so it's what?
$1.50a serving.
Basically, you can do so.
You can get so many morebenefits by eating the fiber
rich produce by itself.
You're also getting satiety.
You're getting all of thoseother benefits instead of just

(12:28):
spending your money on a product.
So my main recommendation whenwe're thinking about supplements
is, first, you can'tout-supplement a bad diet and
second, you have to have a verydiscerning eye, especially with
these products that are targetedspecifically to a pain point,

(12:49):
if you will, or a very nichedemographic now, specifically
the GLP ones, or you know wewere talking about those freezer
meals, right?
So, yeah, just be careful.
And no, you do not need to goand spend $30 on a fiber powder
when you could be eating thebeans and vegetables instead.

Dr. Weiner (13:11):
Yeah, I think it's important to understand, like
where did this thing come from?
Here's this product.
Right, let's walk through howthat made it onto Amazon.
So somebody said, hey, listen,I want to make some money.
Right, that's where it startedand there's no question it
started with I would like tomake money.
They said, well, let me thinkabout this.
What's big?
They did a little bit of marketresearch.

(13:32):
Honestly, you don't need to domuch market research to know
that these GLP-1 meds are bigright now.
Then they went out and said,well, let me think about this.
They did a little bit ofGoogling maybe two, three hours,
I would bet anything.
There wasn't even a dieticianor medical professional involved
in this.
They said we think fiber isgoing to be good.
Then they went out to thesefactories and said, hey, who

(13:55):
makes some fiber for us?
Anybody out there making fiber?
Oh, I make fiber.
I sell it as Metamucil, I sellit as Citrus Cell, I sell it as
this other stuff, and we'reselling that for seven, eight
bucks.
Well, I'm going to market this.
I'm going to hire a fancygraphic designer, I'm going to
put a new label as a GLP-1 gutbooster and I'm going to go to

(14:16):
the factory, the same one thatsells the exact same product.
I'm going to take the bag andI'm going to put it in a new box
.
So you're paying literallyseven bucks probably for the
product and I'm going to put itin a new box.
So you're paying literallyseven bucks probably for the
product and $19 for the box, andthat's how these products come
to be.

(14:37):
And so all you have to do islook at the active ingredient
and then shop, google thatactive ingredient and purchase
it from someplace.
It will be a third the price,most likely, and you can get the
same thing.
We're big believers in theplacebo effect.
We've talked about this, butwhat's the rule about the
placebo effect Is that it works.
Get it at a good price.
If you're going to get to use aplacebo effect, get it at a
good price.
And I think I don't know thatthere's any evidence that these

(14:59):
enhanced post-operative weightloss, post-glp-1 weight loss,
whether there is or there isn't,if you want to try it, just
find it as cheaply as possible.

Zoe (15:10):
So and actually we recently did a post on social media or I
was kind of responding to avery similar product.
This gentleman was reviewing itand it was putting this fiber
powder into the water bottle anddrinking it before he ate his
pizza because he won't digesthis pizza, and so just another

(15:33):
example of everything that's outthere to try to get your money.

Dr. Weiner (15:38):
Absolutely All right .
We have one more question,Sierra.
What's our last question forthe episode?

Sierra (15:44):
Our last question comes from our YouTube video on
episode 29.
We go V for the long run.
This is from Portal Creek.
I stalled at 2.4, so I wentback down to 0.5, and I'm
following Zoe's suggestions onthe podcast for nutrition and
kickstarting.
I came in at almost 400 poundsand stalled for months at 335.

(16:06):
Ironically for me, going downin dosage did the trick.
Is this a good strategy forbreaking a plateau All?

Dr. Weiner (16:13):
right.
So, zoe, you're talking to alot of people who are using
GLP-1 meds.
What kind of nutritional adviceare you giving?
We're seeing stalls.
We see stalls with GLP-1s, justlike we see stalls with
bariatric surgery.
What are you advising people todo to help get through a stall?

Zoe (16:31):
So there are a couple different avenues that we talk
through right.
One is stalls are going tohappen and we need to remain
consistent with those habitsthat you know you can control.
Those habits that you know youcan control when you're putting
all of your energy and focus onthat scale not going down and

(16:52):
why am I not losing weight?
You're on that scale every dayand that's all you can focus on.
Of course it's not going to godown.
Instead, we want to transferthat energy into controlling
what you can actually controland making sure you get your
hydration and making sure youget your produce and your making
sure you get your produce andyour protein and your walk all
of those habits right.
And oftentimes, when we takethat energy away from focusing

(17:13):
on the scale, it helps getthrough it a little bit easier.
So that's kind of my firstnugget.
But then you know, of course wewant to take a bird's eye view.
I always like to say zoom out,look objectively at what's going
on.
Have you let something slip?
Have you maybe had a little bitmore treats than normal and
that's maybe impacting yourprogress?

(17:33):
Can we make small butmeaningful tweaks to what you're
currently doing to help pushthrough that.
And then again, if it'severything's, you know, quote,
quote, perfect, which, there isno such thing, right, but that's
when we can maybe dig a littledeeper and amplify things and
and it might be time for a doseincrease right, right, I think

(17:56):
what happened with this person.

Dr. Weiner (17:57):
I think that some interesting things here.
First of all started 400 pounds.
They got down to 335.
So that's 65 pounds of weightloss.
So we go V at the max dose.
The average weight loss isabout 15, 16%.
So you take 15% of 400 poundsand that's what?
Is that 60 pounds?
So they're right at that 15%total body weight loss.

(18:21):
So the first thing I'm seeingis I think this person had the
expected amount of weight lossafter we govi and we know
there's variability, we knowsome people lose more, we know
some people lose less.
It looks to me like this personstalled right at that 15% or
16% point, which to me says themedication has done as much as

(18:42):
it can.
They then lowered the dose allthe way back down to 0.5.
So, first of all, I don't thinkthat that is a reasonable
strategy.
Once you get on the dose, youkind of work the dose, you stay
on that dose.
These are long-term medicationsTo some degree.
Playing around with your GLP-1dose is like playing around with
your blood pressure dose.

(19:03):
Right, you got to stay on thesame dose over the long run and
that controls your bloodpressure medicine, and so we
don't advocate going back downto 0.5 milligrams or restarting
it.
What I think happened is whenthey went down to 0.5, they also
paired it with improvednutrition, and that, to me,

(19:23):
shows the importance andnecessity of really good
nutrition with these meds, andthat's how you optimize weight
loss.
The idea that you're going toeat one less piece of pizza with
your GLP-1 medication andthat's your weight loss plan,
that's not a solid, lasting,long-term plan.
Nutrition alone isn't a greattreatment for someone who's 400

(19:46):
pounds, but neither is GLP-1medication alone and neither is
bariatric surgery alone.
You need all of these things.
You need the nutrition, youneed the exercise if it's safe,
you need the GLP-1, and youprobably need the surgery.
In this case, I think when Imeet with a 400-pound patient,
especially if their goal is, hey, I want to get down to 200

(20:06):
pounds, that's going to takeeverything we've got.
It's going to take nutrition,it's going to take surgery, it's
going to take the medication.
It's going to take all of thesethings together, and so I think
we can kind of play around withit and rearrange things.
But my sense is, in this personwe're seeing the amount of
weight that we're going to seefrom GLP-1s.
They got a little bit extrawith some nutrition, and it's

(20:28):
probably time to start thinkingabout bariatric surgery.
All right, so that wraps upthis episode.

Zoe (20:33):
Yeah, hey, we want to hear if you're watching on YouTube.
What do you think of our newbackground?

Dr. Weiner (20:38):
Absolutely.

Zoe (20:39):
We're excited about it.
We want to hear your thoughts.

Dr. Weiner (20:42):
Absolutely.
We're on social media, onTikTok, on Instagram, on YouTube
, and you can check out ourwebsite, poundicureweightlosscom
.
We're putting out a lot of newcontent on our website as well,
so so, um so, keep in touch andwe'll see you next time.

Zoe (20:56):
Bye.