May 9, 2024 • 42 mins
Episode 24 of The Pound of Cure Weight Loss podcast is titled, Zepbound to happen: More Drug Shortages. The title comes from our Economics of Obesity segment where we discuss the Zepbound shortages and offer strategies that you can use to ride out the shortage.
In our In the news segment, we discuss an article from the New York Times titled, The Miracle Weight-Loss Drug Is Also a Major Budgetary Threat. In the United States, we pay more for medication than any other country in the world - often 3-4 times more. So, what can we do to bring those prices down? Tune in to find out!
In our Patient Story, we talk to Janet who started gaining weight after pregnancy. She lost well over 100 pounds on Mounjaro and is currently using a creative dosing strategy to save money during maintenance.
For the first few months after surgery and while taking a GLP-1 medications, you might not feel like eating but your body still needs fuel. So, in our Nutrition segment, Zoe offers advice about what to do when you just don’t feel like eating.
Finally, we answer 3 of our listeners' questions including, how to transition from weight loss to weight maintenance, why does a revision carry more risk, and how to keep your set point lower while on weight gaining medications.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Weiner (00:00):
Drugs cost way more money in this country than they
do in any other country.
By a lot, not by 5%, but by asubstantial amount.
Zoe (00:16):
Here we are, episode 24 of the Pound of Cure Weight Loss
Podcast.
Zep Bound to Happen.
More drug shortages, yes, yeah,more drug shortages.
For sure We'll talk about it.
Yep, it is Zep Bound to Happen.
Dr. Weiner (00:23):
Zep Bound to Happen.
More Drug Shortages, yes, yeah,more drug shortages, for sure,
we'll talk about it.
Yep, it is Zep Bound to Happen,zep Bound to Happen.
So, zoe, by the time thisepisode airs, you will be a
married woman.
Zoe (00:34):
I will, three days from today, of recording.
Dr. Weiner (00:37):
I know?
Yes, I'm heading up to Chandler.
Zoe (00:49):
I'm looking forward to it.
I got my dancing shoes.
I'm bringing them Good, good,good.
Dr. Weiner (00:51):
I have a pair of sandals to change into, in case
I need to, because I plan to bedancing most of the time.
Perfect, yeah, I'm lookingforward to it and I'm really
excited for you.
It's such an exciting time ofyour life, right.
I feel like you got a lot ofgood things going on right now.
Zoe (01:01):
Life is good.
I feel very grateful.
Dr. Weiner (01:09):
Yeah.
So you got to pause and justsoak it all in and just you know
, cause there's good things andthere's bad things.
Everybody has bad things happento them and I think that's
that's one of the things I'vekind of learned about marriage
over the years is like we allhave this vision of this.
Our marriage is going to beperfect and I love my wife and
you.
You know my wife, I have anamazing wife.
We have this vision of thisperfect marriage.
No, marriage is perfect.
There will be difficult timesand it's the understanding that
(01:30):
just because at one moment intime your relationship isn't
everything that you want it tobe doesn't mean that it's not a
good relationship and that thatis just part of the nature of
marriage.
It's not the easiest thingbeing married, but with the hard
work it it, it is awesome, it'slike you.
Zoe (01:48):
all right, we know it's not always going to be great, but I
want to do this with you.
Dr. Weiner (01:52):
Yes, exactly Right.
I want someone that I'm goingto spend the tough times with
and the good times with, yeah,and so I think you've got that
in in in your mat.
He's a good guy and I think youguys are both very lucky to
have each other, so we'relooking forward to celebrating
with you in a few days.
Zoe (02:06):
Thanks yeah.
Dr. Weiner (02:07):
All right.
Well, now let's move on to thepodcast.
First segment is in the news,and this is an article from the
New York Times called theMiracle Weight Loss Drug is Also
a Major Budgetary Threat.
Zoe (02:19):
No kidding.
Dr. Weiner (02:19):
Yeah, how about that ?
Have you heard?
They're expensive, hard to getsometimes, yeah.
So I think, first of all, we'vetalked about this quite a bit
and a lot of the things thatwe've been talking about over
the last 24 episodes, about thisfact that our healthcare system
has constantly struggled withthis tension between
(02:40):
incentivizing the pharmaindustry to develop new
medications but, at the sametime, keeping breakthroughs
affordable for patients.
Right, and it's a pendulum.
We talked about that last timewith the drug patents and so
what I think we all have toacknowledge is that right now,
that pendulum has shifted towardthe pharma industry.
(03:01):
The classic example of this isthat drugs cost way more money
in this country than they do inany other country by a lot, not
by 5%.
So Ozempic in the United Statescosts 10 times as much as it
does in Britain, australia orFrance 10 times, and in Denmark,
(03:23):
which is where Novo Nordisk isheadquartered the manufacturers
of Ozempic the drug is $3,500 ayear.
Wow, compared to about $15,000a year in the.
Zoe (03:34):
US, and I wonder what percentage of the population
needs it versus you know ours.
Dr. Weiner (03:39):
I think our need is pretty high in the US.
Yeah for sure.
Right now in the US we'repaying out $15,000 a year for
this medication.
Do you know what the averagehealthcare cost is per capita in
the US?
No, $13,500.
So just this drug alone morethan doubles a person's
(04:01):
healthcare expense.
So 40% of the US population isobese.
If we were to provide everybodywho needs this medication at
our current cost, it would beover $1 trillion per year.
Trillion, right, a thousandbillion.
A billion is a thousand million, so it's a million million
(04:23):
dollars, that's hard to fathom.
Yeah.
And then a lot of people saywell, what about all the
healthcare benefits?
What would the cost savings beif we got 40% of our population
who's obese on these medication?
How much money would we save innot paying for heart attacks,
strokes, cancer, all that stuff?
(04:43):
Any ideas Gosh well.
Zoe (04:45):
I all that stuff, any ideas Gosh?
Well, I would hope it's morethan a trillion dollars.
Dr. Weiner (04:47):
It's not, that's the problem, it's 200 billion.
Oh, wow so these medications arefive times more expensive than
the cost savings, and so that isreally the crux of the matter,
because, truthfully, if it waseven even, then we could
probably figure out a way tomake this work.
But what this article points outis that we have no chance
(05:10):
whatsoever of being able toadequately provide these
medications to the people thatneed them in this country at the
current price, and I think itdoesn't take a New York Times
author to realize that that'strue, and that is really the
fundamental issue behind theshortages, behind the excessive
(05:31):
costs and behind the problemthat our country is going to
have to face when it comes totreating patients who need these
medications.
So Medicare costs about atrillion dollars a year, and so
a big conversation is isMedicare going to cover this?
And this is something we see.
We have tons of Medicarepatients in our practice, and
last year we could get them onit because a lot of Medicare
(05:53):
policies didn't require priorauthorization, and come January
1st it was just likeannihilation, like everybody
lost their coverage, and so justthe cost of Medicare is $1
trillion per year.
If we put everybody on thesedrugs, we would probably
increase the cost of Medicare by50%.
We can't even afford Medicareat its current rate.
So there's absolutely noquestion that if we're going to
(06:15):
figure this out, there has to benew policies.
Zoe (06:19):
Something's got to give Something's got to give.
Dr. Weiner (06:21):
We talked about the Inflation Reduction Act in the
past, which is what allowsCongress to negotiate, or
Medicare to negotiate, with thepharma industries on certain
medications, and come 2025,we're going to see the first
round of medications come up.
None of them are GLP-1 meds.
So now that Wegovy is approvedby Medicare for cardiovascular
(06:44):
risk reduction, the question isis Wegovy going to become one of
these drugs where Medicare cannegotiate with the pharma
industry?
And the answer is no, not forseven years, because in the
Inflation Reduction Act, thedrug has to be on the market for
seven years before it'seligible to be negotiated, and
(07:05):
so there's absolutely noquestion that this problem won't
be solved without new policies.
We talked in the last episodeabout march-in rights, where the
government can basically sayNovo Nordisk, great, you've got
this patent, you've made enoughmoney.
Sorry, charlie, we're takingover.
We're going to license this to ageneric drug manufacturer
(07:26):
because you can't produce enoughof it and our people need it
and we need to bring the costdown, and the government does
have the potential to do that.
I think we all agree that's alittle heavy handed and maybe
not the best way to do it, butthese medications are really
bringing to a boil the conflictbetween the pharma industry and
Medicare and all of you outthere who need these medications
(07:50):
but can't afford them.
The pendulum has swung far moreto the side of encouraging
innovation and away fromimproving access, and the
pharma's quest for profits isinterfering with our ability to
deliver care to the people ofour country.
The bottom line here is thatpolicymakers need to intervene
(08:11):
if we're going to bring the costof these medications down to a
reasonable level.
So great article in the NewYork Times.
I encourage any of you who arepassionate about healthcare
economics, passionate aboutaccess to these medications, to
look through this, because I ofthese issues, if they are
important to you, and let's seeif we can get some people in to
(08:44):
the government who are willingto take a stand up against the
pharma industry and take actionso that these medications can
become more affordable.
Zoe (08:52):
Well, now we have Janet here, our patient story of the
day, super excited to welcomeJanet, all right, so now we've
got our patient guest Janet.
Welcome Janet.
Thanks so much for coming inand thank you for being patient,
because we're running behind.
Janet (09:05):
Not a problem, not a problem.
Thank you for having me.
Zoe (09:07):
Yeah, of course.
So we'd love to just have youshare a bit about your story and
maybe what brought you to ouroffice and what led you to the
decision that you made.
Janet (09:19):
Okay, Well, I had a normal childhood, pretty active,
and was a dancer in high school, so I was pretty slim.
Sierra (09:29):
Sure.
Janet (09:30):
Had my first child and I did okay with the weight loss
after that.
But the second one I had tohold on to a little bit of that
and that's when I started allthe different techniques, all
the different things that peopletry.
So it was shakes and you know,extra exercise, and I joined a
(09:50):
weight loss study and Meridia,which was a favorite of mine.
It worked well for me.
I was very upset when they tookit off the market.
Sierra (10:00):
Yeah.
Janet (10:01):
But you know, then I continued on with my life.
I didn't lose a lot.
It was kind of like it wouldcome and go and after gosh my
third child, I had gained 100pounds with that pregnancy.
Dr. Weiner (10:16):
So it was really pregnancy.
Janet (10:17):
I think so.
Dr. Weiner (10:18):
Now, do you have a family history of obesity?
I do.
Did it also start withpregnancy?
Janet (10:23):
I am not sure.
Dr. Weiner (10:24):
Family members I'm not sure I think, just like
there's, you know, geneticpredisposition to weight gain,
there's also some genetics aboutthings that cause weight gain
more than others it's probablyit's possible that that's where
it started.
Janet (10:37):
I'm thinking about my sister now and, yeah, it's very
likely.
Sierra (10:41):
Yeah.
Janet (10:43):
And even you know just, I remember growing up and seeing
my mom struggling with the samethings, and so you know that's
why I did a lot of things, thatshe did Some work.
Dr. Weiner (10:53):
Were you able to successfully lose weight?
Janet (10:55):
I was.
Dr. Weiner (10:55):
And how much could you lose.
Janet (10:57):
You know when you would diet 30 was probably the lowest
weight, and then 80 pounds on myown.
Dr. Weiner (11:07):
And how much did you weigh when you first came to
our office?
Janet (11:12):
264,.
Dr. Weiner (11:12):
I want to say Okay, yeah, and was that the heaviest
you'd ever weighed?
Janet (11:17):
No, the heaviest was 275.
Dr. Weiner (11:19):
It was 275.
So what made you kind of seekout treatment?
Because you were kind of one ofour earliest non-surgical
weight loss patients, oh, okay.
Janet (11:27):
I did not come to you trying to lose weight.
Believe it or not, that was agood side effect.
I had a lot of pain, I had someinjuries and things were just
not working well for me.
And I continued to gain weightduring the time that everybody
was forced to stay at home and Ijust kept putting on weight and
(11:51):
it happened so fast that it waslike before I could do anything
about it.
But that really wasn't my focus.
My focus was okay, I have thispain If I can get rid of this
pain.
But that really wasn't my focus.
My focus was okay, I have thispain.
If I can get rid of this pain,I can exercise.
Zoe (12:05):
You know, I can go back to what I usually do.
I can go back to my old methodsto lose weight Exactly.
Janet (12:07):
Okay, exactly, and that really came from my older sister
who was taking Manjaro at thetime, suggesting that you know,
for her it had worked to removesome arthritis pain that she had
.
And I thought, well, if I coulddo that, you know, if I can do
that, I don't care if I loseweight or not.
This is how bad I was feelingat the time.
I'll be happy, you know, I canmove myself again if I can just
(12:32):
get rid of the pain, startedlosing weight and got very
excited about that.
So then I was okay.
Dr. Weiner (12:40):
You're like oh, I like it, it was joint pain that
kind of drove you to see.
Janet (12:44):
It was a lot of joint pain and also I had lymphedema,
we discovered, and so I washolding a lot of water.
So it was just like I was justmiserable at the time.
Dr. Weiner (12:56):
And so your sister also was taking Monjaro.
Janet (12:57):
Yes.
Dr. Weiner (12:58):
Was she also successful?
Yes, just like there may besome genetic components that
cause weight gain, there's also,particularly when it comes to
medications but we see this withsurgery too is that there is a
genetic tendency towards successor failure to respond to
certain medications, and so wecall that.
There's a whole field, it'scalled pharmacogenetics.
Zoe (13:20):
So how long have you been on Manjaro now?
Janet (13:23):
Gosh, I think it's.
We're at 18 months now.
Zoe (13:26):
And how much have you lost total?
Janet (13:28):
About 120 pounds.
Wow, wow.
Dr. Weiner (13:31):
And how are your?
Zoe (13:31):
joints feeling, they're a lot happier.
Janet (13:34):
They're a lot happier.
Yeah, I can stand up and justbe there for a moment and not
have any throbbing.
You know, nothing starts toache, so that's good.
Dr. Weiner (13:44):
So you lost almost you know 40% of your total body
weight.
Janet (13:49):
Quite a bit Right.
Did I do the math right?
You're doing the math thing.
Sierra (13:52):
More than that 45%.
Dr. Weiner (13:54):
You lost about 45% of your total body weight when
we look at the success rate for.
And what dose of Monjar are youon?
Janet (14:02):
Seven and a half, now Seven and a half.
I made it up to 12 and a half.
Dr. Weiner (14:05):
You're not even you made it up to 12 and a half and
you've kind of backed off theseven and a half.
We'll talk about why you'vedone that in a moment.
First of all, we look atgreater than 25% total body
weight loss.
We see only about a third ofpeople do that and if we look at
the dose, those patients areeither 10 or 15 milligram dose
(14:26):
and so you were kind of in thatrange but you've been able to
maintain it at seven and a half,but that's 25%.
So we're looking at.
So I think the first thing forthose of you out there, these
are atypical results.
This is really exceptionalweight loss.
Zoe (14:42):
Super responder.
Super responder yes.
Dr. Weiner (14:44):
Yes.
Zoe (14:47):
So what did you do with your nutrition to combine with
the medication?
Did you make a lot of nutritionchanges?
Janet (14:53):
Changes were made for me.
Mount Jaro did that.
Dr. Weiner (14:56):
Yeah.
Janet (14:57):
I lost my appetite and so it was a fight to eat.
At times it was almost like Iwas repulsed by food and so I
(15:24):
had to overcome that and we'rejust trying, like oil heating or
you know, I'm partnered with achef, so anything that she's
cooking, you know, if it's thewrong thing, I'm like open
windows open doors, you knowbecause I can't stand the smell
of it.
So any butter or anything likethat.
Dr. Weiner (15:33):
Fast food restaurants probably repulse you
.
Janet (15:35):
French fries.
Dr. Weiner (15:36):
Yeah.
Janet (15:37):
Yeah, I used to love them , but yeah.
Dr. Weiner (15:39):
Not anymore.
Zoe (15:42):
Do you find that you're craving, like the vegetables and
the whole foods now?
Janet (15:45):
I'm craving fruit a lot of like cold fruity things, so
smoothies are one of my go-tosat this point so.
Dr. Weiner (15:51):
So let's talk a little bit about dosing.
You were on 12.5.
You're originally getting thiscovered by your insurance
company, correct?
Janet (15:57):
no, oh, you've always been self-paying, always been
self-pay.
You've spent a lot of money onthis.
I have.
I have, unfortunately, yeah.
Dr. Weiner (16:07):
So we're using some of our creative dosing
strategies.
How much are you paying permonth right now to keep you on
the medication?
What are you doing?
Because you're much more of aweight maintenance phase.
You're much more of a weightmaintenance phase correct, Right
.
Janet (16:27):
So I would be breaking it down because I'm spacing things
out a little bit at times.
I'm still paying the full costbecause I did have a bit of
stock.
Yeah, because there were timesbefore where it wasn't available
.
Right, I was able to hold on toprobably a couple of boxes and
so that's helped.
So I haven't had to pay outanything else yet, okay.
Dr. Weiner (16:46):
Are you taking it weekly?
No, how often are you taking?
Janet (16:49):
it Every 14 to 21 days.
Zoe (16:53):
Okay, 21 is the longest I've gone.
So talk us through that change,like when you start to notice
the medication decreasing inyour system and if you notice,
like your hunger coming back,that food chatter coming back.
Is there anything like that, um?
Janet (17:09):
one of the things that I noticed is that my appetite
definitely comes back.
Um, I don't have to fight ashard to.
I'm just ready to eat Um, and Ican finish my plate if I want
to um, so that's.
That's one of the main thingsthat I notice is, but other than
that, I still.
There are still things that Idon't want, so that sticks with
(17:30):
me, which is I'm happy aboutthat.
Um, the other thing that Inoticed recently is that I start
to retain water from yourroutine fluid and so once I take
Manjaro again, then I'm peeingit out.
That's fascinating, yeah.
Dr. Weiner (17:48):
So you're taking the drug every two to three weeks.
You're kind of shelling out alot of cash for it.
Still, yes, we're using somedosing strategies by moving you
down to 7.5.
We may be able to cut some, cutthe cost down a little bit that
way.
Um, and so your goal is to stayon this med long term.
Yes, you feel comfortablestaying on the med I'm
(18:09):
comfortable staying on the medlong term yeah you know,
interesting, I had someone youknow talk to me today and
they're like what do you think,dr, why you think these things
are really safe?
And and I think my answer is atthis point and again, keep in
mind.
I'm a bariatric surgeon, right?
This is what I trained to do.
My entire life is also beingthreatened by a medication and
(18:30):
and.
But you know, I, what I've alsobeen trained to do, is to treat
patients who are suffering withobesity, and so that's where
all the nutrition work thatwe've done comes in.
And so the medications to me,just they do, kind of they work
with what I like to do.
But my answer is yeah, I reallydo think that these medications
are going to be proven to besafe.
I think in 10, 15, 20 years,we'll still be using some form
(18:53):
of them, probably a slightlybetter version.
Zoe (18:56):
Hopefully a cheaper version .
Hopefully a cheaper version forsure, I think in 10, 15 years,
we will have a cheaper version.
Dr. Weiner (19:03):
It might take that long, though, zoe.
So, and the reason I think thatis because with every single
medication we take, with everysingle surgery that we perform,
there are risks and there arebenefits.
We know that.
That's just the nature ofmedication and science and
medicine is that nothing's forfree medicine?
Zoe (19:25):
is that nothing's for free?
Yeah, do you have like aspecific memory or a specific
non-scale life-changing momentthat you can kind of like taste
and want to share?
Janet (19:33):
Um, yes, I don't like football, but we went to a
Superbowl game and I we wentdown the stairs, sat in our seat
and I was like I have all thisspace I could cross my legs and
lean back.
You know, I had all this spaceand that's.
That's something that matteredto me, because, you know, when
you have extra here and you'vegot arms, you know armrests
(19:57):
there and everything's pressingup against there, you're
uncomfortable and you're notfocused on anything.
That's fun.
You're thinking about howuncomfortable you are, so that
was great.
Dr. Weiner (20:05):
It takes the joy out of the moment.
Janet (20:07):
Yeah.
Dr. Weiner (20:08):
And so you were able to really fully enjoy that
moment.
Zoe (20:10):
Be present.
Have you found yourself beingable to be more present in other
situations?
Janet (20:14):
Absolutely, and it's nice because this is not something
that's preoccupying my mind.
I'm not always thinking aboutwhat I have to do.
You know that's.
It just frees up so much spacein your head.
Dr. Weiner (20:24):
Yeah, have you noticed the medication not
working as well after a certainamount of time?
Janet (20:30):
I think when I got to maybe the 10th month in, I want
to say that's when my hungercame back.
It came back with a vengeanceand I was like what is this, you
know?
Did I get a faulty pen?
You know what's happening hereand um it, it kind of tapered
off.
So I guess, after it was heldback for so long, it was just,
(20:51):
like you know, rushing out toyeah, exactly that's what it
felt like yeah but, um, it's notnearly as as bad as as that,
that's.
That's the one thing that Ireally noticed.
So the medicine's still workingpretty well, the medicine is
still working and I think that'swhat we're going to find.
Dr. Weiner (21:08):
It's going to take tweaking and adjusting.
It's going to be like highblood pressure, like diabetes,
like anything where we're goingto need to make adjustments.
Right now we only have twodrugs to work with, but over
time we'll have more and moreoptions and different doses and
even second drugs that you canadd in if necessary, and so I
think we'll have more and moretools over time to support
people through this.
(21:28):
But you know it's so good tosee how well you've done.
You've really put a lot ofenergy and effort into this too.
You kind of made up your mindthat you were going to figure
out a way.
Janet (21:40):
One way or another it was going to happen.
But this is a wonderful tool.
I mean, it takes so much of theweight off of you so that you
literally and figuratively, youknow, can work on the other
things in your life that youneed to focus on.
Dr. Weiner (21:51):
Yeah, it's the fishing pole, right, yeah, you
know, you want to give a man afish feed him for a day.
Teach a man to fish feed themfor life.
But maybe if you give them afishing pole they might help
them out a little bit.
And I think that's what thismedication does for you is it
just gives you that extra sothat you can make the good food
choices, so that you can focuson the things that are important
(22:12):
.
And you know people thinkthere's no effort involved in
this.
That's not true, yeah.
Janet (22:20):
You know, there are times where I was like, do I really
want to continue with this?
Because I was nauseated or, um,I felt tired and it was just
like that.
That can be work too.
You know, figuring out how todeal with those little issues
that come up is also work.
So, um, but it's worth the work.
I think it's worth worth it.
I think you're worth it.
(22:40):
People are worth it, yeah.
Zoe (22:42):
You're worth the work You're worth the work,
absolutely.
Dr. Weiner (22:45):
Anything that's good comes with work.
Zoe (22:47):
Yeah.
Do you have anything else you'dlike to share?
Anything to share with ourlisteners, any nuggets of
helpful information that youthink would be helpful to?
Janet (22:57):
share.
One of the things that I thinkis important is to go ahead and
check with your doctor.
Don't feel ashamed about howyou feel about yourself.
It's your body.
So if you're uncomfortable inyour body, don't listen to
TikTok and whoever else Anysocial media that's telling you
that you should like yourselfthe way you are.
If you're struggling with that,then you go talk to someone who
(23:23):
can a professional who can helpyou, make a plan or do
something that's going to begood for you.
Zoe (23:27):
Thank you so much for making the trip and we really
appreciate you sharing Thank you.
Dr. Weiner (23:32):
Thank you for having me.
Absolutely Congrats on yoursuccess.
Thank you, I appreciate it.
Zoe (23:36):
All right.
So for our nutrition segmenttoday, I want to talk a little
bit about something that Janetwas mentioning but that I help
people with all the time, whichis what to eat when you just
don't feel like eating, whetheryou just had surgery, you know,
a couple of months ago, oryou're adjusting to a new dose
of a GLP-1 and you have maybethat food aversion or you're
(23:57):
just like ugh food aversion, oryou're just like ugh.
And we have to toe this lineand this is a conversation I
have with patients a lot betweenlistening to your body and
being mindful and like, yes, wewant to have that awareness and
presence in our body, but thenalso recognizing that those
hunger signals are beingsuppressed and your body still
needs fuel.
So it's okay, I want to listento my body, but I also know my
(24:20):
body needs nutrition, and sowhen we're experiencing that,
what I find is actually drinkinglike a smoothie and having
these little spaced outthroughout the day mini meals or
snacks, so that you aren'tsitting down to a big plate,
which will just make that desireto eat not to eat even greater.
(24:40):
But, like Janet was mentioning,she is craving, like fruit
smoothies and that kind of thing.
So of course we want to makesure you get a protein source in
that smoothie or that littlemini meal snack, whatever you're
having.
But just even if you make asmoothie and then maybe you
drink a third of it, put it inthe refrigerator, go back to it
later on and just kind of sip onit throughout the day.
It's a really great way todeliver a lot of nutrients, a
(25:03):
lot of protein, micronutrients,fiber, great stuff in there,
without necessarily forcefeeding yourself to eat a big
plate of food if you don't feellike eating it.
Dr. Weiner (25:16):
Yeah, no, I think that's great.
It's really a delicate balancebecause we talk so much about
mindful eating Right, but thereare moments when what we're
doing is maybe not the mostnatural thing.
Let's be honest Bariatricsurgery not the most natural
thing.
Glp-1 meds not the most naturalthing.
But our whole food chain hasgotten out of whack and there's
(25:36):
so many environmental factorsthat are causing obesity.
We're having to kind of pushthe envelope on some of these
medical things to try to bringthings a little bit back in
check.
Zoe (25:45):
Well, because most of the food on the market for us these
days are not the most naturalthing.
Dr. Weiner (25:49):
Absolutely, absolutely.
So we're doing in response tounnatural foods, we're using
some unnatural medication andsurgical therapies and there's
that balance response tounnatural foods, we're using
some unnatural medication andsurgical therapies and there's
that balance, that pendulum.
And there are moments when youkind of shift out of balance.
And we see that in the firstfew months after surgery.
We see that right afterstarting GLP-1 meds or
increasing the dose, and so atthat moment you have to realize,
(26:12):
hey, listen, maybe listening tomy body exactly is not going to
work at this time because we'vejust kind of shifted a little
bit out of balance.
But you want to keep the faiththat once you get through this
it will shift into a morenatural balance and you will be
able to really be more mindful.
Zoe (26:29):
It reminds me of this, something that someone was
talking about online a while agois you have to go through
periods of unbalance, orimbalance, like you were just
saying, in order to get tobalance?
Sierra (26:40):
whether it's you know.
Zoe (26:42):
I'm just going to eat whatever I want, screw it to the
extreme of being super strictand then finding your way back
to incorporating mostly healthy,whole, real foods with the
balance of some treats every nowand then.
But you have to kind of figureout that pendulum swing in order
to find that middle ground.
Dr. Weiner (27:00):
Yeah, I think that's .
To get to balance, you have tohave moments of imbalance.
Zoe (27:04):
Because then you don't appreciate what balance is.
Yeah.
Dr. Weiner (27:07):
So let's talk about the economics of obesity.
We're going to do an update onthe shortage.
You know, a couple of monthsago Eli Lilly came out.
They're the manufacturers ofZepbound or Monjaro and they
said we do not see any shortagescoming.
We've got this covered.
We have planned for this.
We don't see anything on thehorizon at all for shortages.
Let's now fast forward threemonths when all of the doses
(27:33):
except for one of both Monjaroand Zepbound are on shortage.
And so I think the first thingthat I've learned and I learned
this back with Novo Nordisk, soI don't want to point a finger
at Eli Lilly Novo Nordisk hasdone the same thing, and they
told us over a year ago that theshortage was going to disappear
, and the shortage is still inplace a year later.
So I think the first thing thatyou can tell about these drug
(27:54):
shortages is ignore whatever thepharma industry says.
They're not telling the truth.
Zoe (27:59):
They're saving face.
Dr. Weiner (28:00):
They're saving face, I think.
Also, the demand is justunprecedented.
I think, whatever theircalculations were going to be
for how many people were goingto prescribe this drug, they
were based on other drugs thathave come out in the past, and
the truth is there's no otherdrugs like Zepbound or Wegovi.
There's nothing like this, evenlike the SSRIs which kind of
took over our culture.
(28:20):
People weren't clamoring forthem, they weren't running from
pharmacy to pharmacy, thereweren't celebrities talking
about it Totally.
Totally Exactly so.
These medications areunprecedented and so, as much as
the pharma industry, theyhaven't necessarily been
truthful.
I think it did exceed eventheir best case scenario for
demand.
So both Zepbound and Monjaroare on shortage.
(28:44):
They do have new manufacturingplants that are coming online.
So does Novo Nordisk, but youcan't just build a manufacturing
plant in a few months.
I mean, this takes a long time.
So there are a lot of strategiesthat we use in the office to
help patients get through, andwe do have our Pound and Cure
Platinum Program, which is kindof our best version of what we
(29:06):
can offer for non-surgicalweight loss and also for
surgical weight loss, if you'relooking for revisions, and so if
that's something you'reinterested in, we do have a lot
of techniques that we use in theoffice to help patients
navigate through these shortages.
So we just heard from Janetabout some of the strategies
she's using about increasing thedosing interval.
There's other things as wellthat can help reduce the cost,
(29:28):
but I think getting through thiscan be tricky, and guidance by
someone who has a kind of anopen and creative mind can help
you.
You get through it.
Um, there are websitesavailable.
So if you go to supplylilycomslash Monjaro or slash ZepBound
uh, it will list all of thedrugs that are available.
And also you can look on theFDA site.
(29:49):
Uh, there's an FDA shortagelist, and so if you, if you
Google this, it's pretty easy tofind which doses are available.
Right now.
When it comes to Monjar andZepbound, the 2.5 milligram is
available, but all other dosesare listed as limited
availability.
It doesn't mean you can't getit, it just means it's going to
(30:09):
be hard.
We're using Lilly DirectPharmacy a lot.
Even we're seeing shortageswith them as well.
In fact, I've had people whowere able to get the drug at
their local CVS who weren't ableto get it through Lilly Direct,
and so just because they dohave that direct relationship
with the pharmacy doesn'tnecessarily mean that they have
a better supply than everybodyelse.
(30:30):
The drugs they're out there.
They're hard to find.
If you work through it, you canoften track them down, but it's
going to take some work.
I talk a lot with patientsabout timing and when you want
to be aggressive with yourweight loss and when it might be
time to circle your wagons, andso I think right now, if you're
really relying heavily on thesemedications, it's time to
(30:51):
circle your wagons.
Zoe (30:52):
Hunker down for a little bit of maintenance.
Dr. Weiner (31:01):
Exactly yeah.
So this is not the time to bepushing the envelope and going
up to that next dose and reallyworking to drive the weight off
through medications.
It's time to be working withsomeone like Zoe and focusing on
nutrition and getting theweight down and maximizing your
nutrition.
Zoe (31:14):
And that's what we're actually doing in the new group
that I started Navigating.
Glp-1 shortages is about likehow to bridge the gap.
Maybe if you're just chuggingalong on a lower dose than
normal or you have kind of likea hiatus waiting until you can
find another dose, what can wedo nutritionally and lifestyle
ways to really get you throughuntil you get your medication
(31:34):
again?
Dr. Weiner (31:34):
Yeah, there's a lot of people frustrated about these
shortages.
I get it, but the truth is,this is, above all, of our pay
grades Like we are not able tochange this shortage, and things
happen in your life that areunfortunate.
Every single personbillionaires, you know, movie
stars, actresses, Instagram,famous people they all have bad
(31:55):
things happen in their life too,and so when these bad things
happen, it's very.
Actresses, Instagram, famouspeople they all have bad things
happen in their life too, and sowhen these bad things happen,
it's very.
You know.
A lot of times we're like, ohmy gosh, this is so terrible,
how could this ever happen?
But sometimes these bad thingsthat happen are a gift and you
know, perhaps right now, ifyou're having trouble getting
that medication, it's a signthat you should be focusing as
much energy as possible onimproving your nutrition.
(32:17):
I think if there's one mistakewe see over and over and over
again out there, it's peopleover-relying on the medications
and under-relying on nutritionto drive weight loss and to help
them with weight maintenance,and so if you're struggling with
a shortage out there, maybethis is the universe telling you
hey, time to focus on nutritiona little bit more than you have
been in the past.
(32:38):
All right With that.
Let's move on to our questionsfrom social media.
We've got Sierra here to readthe questions.
I think the first question isfor Zoe, so why don't you let us
know what?
We've got Sierra.
Sierra (32:52):
First question is from our YouTube video, durable
Weight Loss.
Please could you do a video orpodcast on how to transition
from the weight loss phasetowards maintenance?
I'm still losing weight rapidlyafter my bypass October of 2023
, and wish to slow it up andmaintain now so I don't get too
(33:12):
thin.
Love your books, videos andpods.
Zoe (33:15):
Well, I think this question goes beautifully with Janet's
story because she's in herweight maintenance phase and
she's really great at attendingnutrition sessions and she's
really involved in the nutritionprogram.
So I really I wanted to applaudher when she was here but I
forgot to.
So that's the little shout out.
But anyway, let's talk aboutwhat the priority is.
(33:36):
While you are losing weight,post-op, you are prioritizing
protein because we want tominimize muscle loss, right,
maximize fat loss.
So you're prioritizing proteinbecause of that volume
restriction and then filling inthe gaps with your produce, your
vegetables and your fruit.
Then, once your hormones shiftto weight maintenance, we want
(33:57):
to flip those priorities.
We want to eat primarilyvegetables and fruit and plants,
filling in the majority of yourvolume, and then, yes, still
getting high quality whole foodprotein.
But it's not going to be yourmain priority.
This is also where we kind ofdabble a little bit into those
(34:18):
planned indulgences and how wecan find that pendulum swing
right.
We were just talking aboutbeing in a period of imbalance
to then find your balance.
Perhaps maintenance is youfinding that balance of mostly
real, whole, unprocessed foods,but then we want the majority of
your life to be in maintenanceanyway and real life says you're
(34:43):
probably going to have somebirthday cake on your birthday.
You might have a piece of pizzaat your kid's birthday.
Dr. Weiner (34:50):
A piece of wedding cake on your wedding A piece of
wedding cake, for heaven's sake.
Zoe (34:54):
And that's part of life.
And we want you to have thisnew relationship with food that
allows you to have those thingswithout letting that pendulum
swing in the opposite directionand say, well, screw it Right.
So that's what I would sayShift towards eating more volume
through plants, stillprioritizing whole foods, and
(35:14):
maybe we want to work a littlebit into some of those planned
seldom treats.
Dr. Weiner (35:19):
Yeah, so I think another thing is that people get
so hung up on the 60, 80 somepractices say a hundred grams of
protein.
What's your thought on that?
Is that a lifelong goal?
Do people need to track proteinforever?
Zoe (35:32):
I will say it depends on their activity level.
So if somebody is just, youknow, maybe like getting the
most of their movement throughwalking, maybe they're not super
active and they're just kind ofmaintaining mostly through
their nutrition, then being onthe lower end of protein is fine
.
If someone has really, you know, found themselves in love with
(35:56):
fitness and they're exercising alot and they're lifting weights
and those sorts of things, thenin and their goal might be to
build muscle, which means weneed more protein.
So I would say it depends onthe person, but as a blanket
recommendation, we don't need toworry so much about tracking
that protein long-term.
Dr. Weiner (36:14):
Yeah, track the pound of vegetables.
Yeah yeah, if you want ofvegetables, yeah yeah.
Zoe (36:17):
If you want to track anything, track that.
Dr. Weiner (36:19):
Yeah, and maintenance phase for sure.
All right, what's our nextquestion, sierra?
Sierra (36:23):
Okay, this one is from our YouTube short on bariatric
revisions and it's from Fanny.
She says why does a revisioncarry more risk?
Dr. Weiner (36:33):
When I go in for a primary surgery, everything's
right where it should be, justlike in the textbooks.
When I go in for a revisionsurgery, somebody else has been
there before and so there'sgoing to be a lot of scar tissue
.
I want to get to the stomach.
I may have to cut down scartissue for 20, 30 minutes to get
there, and cutting down scartissue has risk.
It's everything stuck togetherand I have to separate the
(36:56):
intestine or the colon or thestomach or the liver from
another structure.
And when you're doing that it'sdifficult.
You have to be very, verycareful.
I do lots of revision surgery asI've kind of worked out a lot
of the kinks, but it takes extratime.
There's risk involved in that.
So the scar tissue is reallythe major issue, and then
scarring also causes the stomachor the intestines to be thick
(37:20):
and inflamed, so it's not goingto hold suture as well as that
kind of native tissue that weoperate on the first time, and
so you know your suturing has tobe.
You just have to be a littlebit more careful.
Things don't line up just asnicely as they do in primary
surgery and so it just is moredifficult.
So when normally a gastricbypass might take me an hour and
(37:41):
15 minutes or so.
If I'm doing a complicatedrevision surgery, that surgery
can take two or three hours, andso when you're dealing with
previous surgical anatomy, younever know what you're going to
get.
There's always going to be alot more scar tissue.
The tissue is not going to beas soft and pliable as it has
been, and it just requires a lotmore time and care and
therefore has more risk.
Sierra (38:00):
Okay, last question.
Here is from our Instagram reelon durable weight loss how can
we keep a set point lower whenon medication that causes weight
gain?
Ozempic has been a godsend, butnow my benefits won't cover it.
I'm very active and already hada bypass five years ago.
Zoe (38:22):
Well, the first thing that comes to my mind, because we've
talked about this before, is howto lower your set point.
Well, one of those ways is tobuild muscle.
It sounds like you're veryactive, and if you are not
already incorporating strengthtraining into that activity, I
would recommend it.
Dr. Weiner (38:34):
Yeah.
So I think yeah.
Four ways to lower your setpoint right Nutritional change
not eating less, but eatingdifferently.
And that's where our metabolicreset diet comes in.
And so the first way I wouldhave you do is get on the
metabolic reset diet.
You can go to our website anddownload the handout for free.
Zoe (38:53):
Yeah, actually, if you haven't done that yet, anybody
listening, everyone's loving it,even the people already in our
nutrition program.
They've, like, I've downloadedthat handout, so definitely get
that.
It just pops up on the chatwidget in the bottom of the
screen.
Dr. Weiner (39:06):
Right, and then you can join Zoe when she gets back
from her honeymoon on themetabolic reset diet support
groups and kind of really takingthat handout and learning how
to put it into action and thenbuilding muscle, absolutely,
absolutely.
And then I think the otherthing to consider is you know,
the medications are a godsend,particularly in the situation
(39:29):
where you're taking a medicationthat causes weight gain, and so
, again, I like to fight firewith fire, and you didn't.
It's not covered by yourinsurance.
We do have some ways.
We only use real medication.
We don't use compoundingmedication.
Again, our Pound and CurePlatinum program.
We we are able sometimes to getpeople the medication at a more
(39:49):
reasonable price than you wouldexpect.
I'm not going to tell you it'ssimple, straightforward way, but
there's.
There's some tricks and somethings that can be done, and so
you may want to consider lookinginto that or working with us or
another creative provider.
Just see if you can come upwith something that would
potentially fit within yourbudget.
Zoe (40:07):
All right.
Well, I think that about wrapsus up.
Thanks so much for listeningand, of course, we'd like to
acknowledge and thank ourwonderful team.
We've got Sierra Miller andRhiannon Griffin, the podcast
producers, and the editing isdone by Autogrow.
And, of course, we need tothank our special patient guest
again, janet.
Dr. Weiner (40:26):
So please check us out on social media.
Our website we can download ourMetabolic Reset Diet handout.
Consider joining our onlinenutrition program or our Pound
to Cure Platinum program if youneed more assistance.
See you next time.
Drugs cost way more money in this country than they
do in any other country.
By a lot, not by 5%, but by asubstantial amount.
Zoe (00:16):
Here we are, episode 24 of the Pound of Cure Weight Loss
Podcast.
Zep Bound to Happen.
More drug shortages, yes, yeah,more drug shortages.
For sure We'll talk about it.
Yep, it is Zep Bound to Happen.
Dr. Weiner (00:23):
Zep Bound to Happen.
More Drug Shortages, yes, yeah,more drug shortages, for sure,
we'll talk about it.
Yep, it is Zep Bound to Happen,zep Bound to Happen.
So, zoe, by the time thisepisode airs, you will be a
married woman.
Zoe (00:34):
I will, three days from today, of recording.
Dr. Weiner (00:37):
I know?
Yes, I'm heading up to Chandler.
Zoe (00:49):
I'm looking forward to it.
I got my dancing shoes.
I'm bringing them Good, good,good.
Dr. Weiner (00:51):
I have a pair of sandals to change into, in case
I need to, because I plan to bedancing most of the time.
Perfect, yeah, I'm lookingforward to it and I'm really
excited for you.
It's such an exciting time ofyour life, right.
I feel like you got a lot ofgood things going on right now.
Zoe (01:01):
Life is good.
I feel very grateful.
Dr. Weiner (01:09):
Yeah.
So you got to pause and justsoak it all in and just you know
, cause there's good things andthere's bad things.
Everybody has bad things happento them and I think that's
that's one of the things I'vekind of learned about marriage
over the years is like we allhave this vision of this.
Our marriage is going to beperfect and I love my wife and
you.
You know my wife, I have anamazing wife.
We have this vision of thisperfect marriage.
No, marriage is perfect.
There will be difficult timesand it's the understanding that
(01:30):
just because at one moment intime your relationship isn't
everything that you want it tobe doesn't mean that it's not a
good relationship and that thatis just part of the nature of
marriage.
It's not the easiest thingbeing married, but with the hard
work it it, it is awesome, it'slike you.
Zoe (01:48):
all right, we know it's not always going to be great, but I
want to do this with you.
Dr. Weiner (01:52):
Yes, exactly Right.
I want someone that I'm goingto spend the tough times with
and the good times with, yeah,and so I think you've got that
in in in your mat.
He's a good guy and I think youguys are both very lucky to
have each other, so we'relooking forward to celebrating
with you in a few days.
Zoe (02:06):
Thanks yeah.
Dr. Weiner (02:07):
All right.
Well, now let's move on to thepodcast.
First segment is in the news,and this is an article from the
New York Times called theMiracle Weight Loss Drug is Also
a Major Budgetary Threat.
Zoe (02:19):
No kidding.
Dr. Weiner (02:19):
Yeah, how about that ?
Have you heard?
They're expensive, hard to getsometimes, yeah.
So I think, first of all, we'vetalked about this quite a bit
and a lot of the things thatwe've been talking about over
the last 24 episodes, about thisfact that our healthcare system
has constantly struggled withthis tension between
(02:40):
incentivizing the pharmaindustry to develop new
medications but, at the sametime, keeping breakthroughs
affordable for patients.
Right, and it's a pendulum.
We talked about that last timewith the drug patents and so
what I think we all have toacknowledge is that right now,
that pendulum has shifted towardthe pharma industry.
(03:01):
The classic example of this isthat drugs cost way more money
in this country than they do inany other country by a lot, not
by 5%.
So Ozempic in the United Statescosts 10 times as much as it
does in Britain, australia orFrance 10 times, and in Denmark,
(03:23):
which is where Novo Nordisk isheadquartered the manufacturers
of Ozempic the drug is $3,500 ayear.
Wow, compared to about $15,000a year in the.
Zoe (03:34):
US, and I wonder what percentage of the population
needs it versus you know ours.
Dr. Weiner (03:39):
I think our need is pretty high in the US.
Yeah for sure.
Right now in the US we'repaying out $15,000 a year for
this medication.
Do you know what the averagehealthcare cost is per capita in
the US?
No, $13,500.
So just this drug alone morethan doubles a person's
(04:01):
healthcare expense.
So 40% of the US population isobese.
If we were to provide everybodywho needs this medication at
our current cost, it would beover $1 trillion per year.
Trillion, right, a thousandbillion.
A billion is a thousand million, so it's a million million
(04:23):
dollars, that's hard to fathom.
Yeah.
And then a lot of people saywell, what about all the
healthcare benefits?
What would the cost savings beif we got 40% of our population
who's obese on these medication?
How much money would we save innot paying for heart attacks,
strokes, cancer, all that stuff?
(04:43):
Any ideas Gosh well.
Zoe (04:45):
I all that stuff, any ideas Gosh?
Well, I would hope it's morethan a trillion dollars.
Dr. Weiner (04:47):
It's not, that's the problem, it's 200 billion.
Oh, wow so these medications arefive times more expensive than
the cost savings, and so that isreally the crux of the matter,
because, truthfully, if it waseven even, then we could
probably figure out a way tomake this work.
But what this article points outis that we have no chance
(05:10):
whatsoever of being able toadequately provide these
medications to the people thatneed them in this country at the
current price, and I think itdoesn't take a New York Times
author to realize that that'strue, and that is really the
fundamental issue behind theshortages, behind the excessive
(05:31):
costs and behind the problemthat our country is going to
have to face when it comes totreating patients who need these
medications.
So Medicare costs about atrillion dollars a year, and so
a big conversation is isMedicare going to cover this?
And this is something we see.
We have tons of Medicarepatients in our practice, and
last year we could get them onit because a lot of Medicare
(05:53):
policies didn't require priorauthorization, and come January
1st it was just likeannihilation, like everybody
lost their coverage, and so justthe cost of Medicare is $1
trillion per year.
If we put everybody on thesedrugs, we would probably
increase the cost of Medicare by50%.
We can't even afford Medicareat its current rate.
So there's absolutely noquestion that if we're going to
(06:15):
figure this out, there has to benew policies.
Zoe (06:19):
Something's got to give Something's got to give.
Dr. Weiner (06:21):
We talked about the Inflation Reduction Act in the
past, which is what allowsCongress to negotiate, or
Medicare to negotiate, with thepharma industries on certain
medications, and come 2025,we're going to see the first
round of medications come up.
None of them are GLP-1 meds.
So now that Wegovy is approvedby Medicare for cardiovascular
(06:44):
risk reduction, the question isis Wegovy going to become one of
these drugs where Medicare cannegotiate with the pharma
industry?
And the answer is no, not forseven years, because in the
Inflation Reduction Act, thedrug has to be on the market for
seven years before it'seligible to be negotiated, and
(07:05):
so there's absolutely noquestion that this problem won't
be solved without new policies.
We talked in the last episodeabout march-in rights, where the
government can basically sayNovo Nordisk, great, you've got
this patent, you've made enoughmoney.
Sorry, charlie, we're takingover.
We're going to license this to ageneric drug manufacturer
(07:26):
because you can't produce enoughof it and our people need it
and we need to bring the costdown, and the government does
have the potential to do that.
I think we all agree that's alittle heavy handed and maybe
not the best way to do it, butthese medications are really
bringing to a boil the conflictbetween the pharma industry and
Medicare and all of you outthere who need these medications
(07:50):
but can't afford them.
The pendulum has swung far moreto the side of encouraging
innovation and away fromimproving access, and the
pharma's quest for profits isinterfering with our ability to
deliver care to the people ofour country.
The bottom line here is thatpolicymakers need to intervene
(08:11):
if we're going to bring the costof these medications down to a
reasonable level.
So great article in the NewYork Times.
I encourage any of you who arepassionate about healthcare
economics, passionate aboutaccess to these medications, to
look through this, because I ofthese issues, if they are
important to you, and let's seeif we can get some people in to
(08:44):
the government who are willingto take a stand up against the
pharma industry and take actionso that these medications can
become more affordable.
Zoe (08:52):
Well, now we have Janet here, our patient story of the
day, super excited to welcomeJanet, all right, so now we've
got our patient guest Janet.
Welcome Janet.
Thanks so much for coming inand thank you for being patient,
because we're running behind.
Janet (09:05):
Not a problem, not a problem.
Thank you for having me.
Zoe (09:07):
Yeah, of course.
So we'd love to just have youshare a bit about your story and
maybe what brought you to ouroffice and what led you to the
decision that you made.
Janet (09:19):
Okay, Well, I had a normal childhood, pretty active,
and was a dancer in high school, so I was pretty slim.
Sierra (09:29):
Sure.
Janet (09:30):
Had my first child and I did okay with the weight loss
after that.
But the second one I had tohold on to a little bit of that
and that's when I started allthe different techniques, all
the different things that peopletry.
So it was shakes and you know,extra exercise, and I joined a
(09:50):
weight loss study and Meridia,which was a favorite of mine.
It worked well for me.
I was very upset when they tookit off the market.
Sierra (10:00):
Yeah.
Janet (10:01):
But you know, then I continued on with my life.
I didn't lose a lot.
It was kind of like it wouldcome and go and after gosh my
third child, I had gained 100pounds with that pregnancy.
Dr. Weiner (10:16):
So it was really pregnancy.
Janet (10:17):
I think so.
Dr. Weiner (10:18):
Now, do you have a family history of obesity?
I do.
Did it also start withpregnancy?
Janet (10:23):
I am not sure.
Dr. Weiner (10:24):
Family members I'm not sure I think, just like
there's, you know, geneticpredisposition to weight gain,
there's also some genetics aboutthings that cause weight gain
more than others it's probablyit's possible that that's where
it started.
Janet (10:37):
I'm thinking about my sister now and, yeah, it's very
likely.
Sierra (10:41):
Yeah.
Janet (10:43):
And even you know just, I remember growing up and seeing
my mom struggling with the samethings, and so you know that's
why I did a lot of things, thatshe did Some work.
Dr. Weiner (10:53):
Were you able to successfully lose weight?
Janet (10:55):
I was.
Dr. Weiner (10:55):
And how much could you lose.
Janet (10:57):
You know when you would diet 30 was probably the lowest
weight, and then 80 pounds on myown.
Dr. Weiner (11:07):
And how much did you weigh when you first came to
our office?
Janet (11:12):
264,.
Dr. Weiner (11:12):
I want to say Okay, yeah, and was that the heaviest
you'd ever weighed?
Janet (11:17):
No, the heaviest was 275.
Dr. Weiner (11:19):
It was 275.
So what made you kind of seekout treatment?
Because you were kind of one ofour earliest non-surgical
weight loss patients, oh, okay.
Janet (11:27):
I did not come to you trying to lose weight.
Believe it or not, that was agood side effect.
I had a lot of pain, I had someinjuries and things were just
not working well for me.
And I continued to gain weightduring the time that everybody
was forced to stay at home and Ijust kept putting on weight and
(11:51):
it happened so fast that it waslike before I could do anything
about it.
But that really wasn't my focus.
My focus was okay, I have thispain If I can get rid of this
pain.
But that really wasn't my focus.
My focus was okay, I have thispain.
If I can get rid of this pain,I can exercise.
Zoe (12:05):
You know, I can go back to what I usually do.
I can go back to my old methodsto lose weight Exactly.
Janet (12:07):
Okay, exactly, and that really came from my older sister
who was taking Manjaro at thetime, suggesting that you know,
for her it had worked to removesome arthritis pain that she had
.
And I thought, well, if I coulddo that, you know, if I can do
that, I don't care if I loseweight or not.
This is how bad I was feelingat the time.
I'll be happy, you know, I canmove myself again if I can just
(12:32):
get rid of the pain, startedlosing weight and got very
excited about that.
So then I was okay.
Dr. Weiner (12:40):
You're like oh, I like it, it was joint pain that
kind of drove you to see.
Janet (12:44):
It was a lot of joint pain and also I had lymphedema,
we discovered, and so I washolding a lot of water.
So it was just like I was justmiserable at the time.
Dr. Weiner (12:56):
And so your sister also was taking Monjaro.
Janet (12:57):
Yes.
Dr. Weiner (12:58):
Was she also successful?
Yes, just like there may besome genetic components that
cause weight gain, there's also,particularly when it comes to
medications but we see this withsurgery too is that there is a
genetic tendency towards successor failure to respond to
certain medications, and so wecall that.
There's a whole field, it'scalled pharmacogenetics.
Zoe (13:20):
So how long have you been on Manjaro now?
Janet (13:23):
Gosh, I think it's.
We're at 18 months now.
Zoe (13:26):
And how much have you lost total?
Janet (13:28):
About 120 pounds.
Wow, wow.
Dr. Weiner (13:31):
And how are your?
Zoe (13:31):
joints feeling, they're a lot happier.
Janet (13:34):
They're a lot happier.
Yeah, I can stand up and justbe there for a moment and not
have any throbbing.
You know, nothing starts toache, so that's good.
Dr. Weiner (13:44):
So you lost almost you know 40% of your total body
weight.
Janet (13:49):
Quite a bit Right.
Did I do the math right?
You're doing the math thing.
Sierra (13:52):
More than that 45%.
Dr. Weiner (13:54):
You lost about 45% of your total body weight when
we look at the success rate for.
And what dose of Monjar are youon?
Janet (14:02):
Seven and a half, now Seven and a half.
I made it up to 12 and a half.
Dr. Weiner (14:05):
You're not even you made it up to 12 and a half and
you've kind of backed off theseven and a half.
We'll talk about why you'vedone that in a moment.
First of all, we look atgreater than 25% total body
weight loss.
We see only about a third ofpeople do that and if we look at
the dose, those patients areeither 10 or 15 milligram dose
(14:26):
and so you were kind of in thatrange but you've been able to
maintain it at seven and a half,but that's 25%.
So we're looking at.
So I think the first thing forthose of you out there, these
are atypical results.
This is really exceptionalweight loss.
Zoe (14:42):
Super responder.
Super responder yes.
Dr. Weiner (14:44):
Yes.
Zoe (14:47):
So what did you do with your nutrition to combine with
the medication?
Did you make a lot of nutritionchanges?
Janet (14:53):
Changes were made for me.
Mount Jaro did that.
Dr. Weiner (14:56):
Yeah.
Janet (14:57):
I lost my appetite and so it was a fight to eat.
At times it was almost like Iwas repulsed by food and so I
(15:24):
had to overcome that and we'rejust trying, like oil heating or
you know, I'm partnered with achef, so anything that she's
cooking, you know, if it's thewrong thing, I'm like open
windows open doors, you knowbecause I can't stand the smell
of it.
So any butter or anything likethat.
Dr. Weiner (15:33):
Fast food restaurants probably repulse you
.
Janet (15:35):
French fries.
Dr. Weiner (15:36):
Yeah.
Janet (15:37):
Yeah, I used to love them , but yeah.
Dr. Weiner (15:39):
Not anymore.
Zoe (15:42):
Do you find that you're craving, like the vegetables and
the whole foods now?
Janet (15:45):
I'm craving fruit a lot of like cold fruity things, so
smoothies are one of my go-tosat this point so.
Dr. Weiner (15:51):
So let's talk a little bit about dosing.
You were on 12.5.
You're originally getting thiscovered by your insurance
company, correct?
Janet (15:57):
no, oh, you've always been self-paying, always been
self-pay.
You've spent a lot of money onthis.
I have.
I have, unfortunately, yeah.
Dr. Weiner (16:07):
So we're using some of our creative dosing
strategies.
How much are you paying permonth right now to keep you on
the medication?
What are you doing?
Because you're much more of aweight maintenance phase.
You're much more of a weightmaintenance phase correct, Right
.
Janet (16:27):
So I would be breaking it down because I'm spacing things
out a little bit at times.
I'm still paying the full costbecause I did have a bit of
stock.
Yeah, because there were timesbefore where it wasn't available
.
Right, I was able to hold on toprobably a couple of boxes and
so that's helped.
So I haven't had to pay outanything else yet, okay.
Dr. Weiner (16:46):
Are you taking it weekly?
No, how often are you taking?
Janet (16:49):
it Every 14 to 21 days.
Zoe (16:53):
Okay, 21 is the longest I've gone.
So talk us through that change,like when you start to notice
the medication decreasing inyour system and if you notice,
like your hunger coming back,that food chatter coming back.
Is there anything like that, um?
Janet (17:09):
one of the things that I noticed is that my appetite
definitely comes back.
Um, I don't have to fight ashard to.
I'm just ready to eat Um, and Ican finish my plate if I want
to um, so that's.
That's one of the main thingsthat I notice is, but other than
that, I still.
There are still things that Idon't want, so that sticks with
(17:30):
me, which is I'm happy aboutthat.
Um, the other thing that Inoticed recently is that I start
to retain water from yourroutine fluid and so once I take
Manjaro again, then I'm peeingit out.
That's fascinating, yeah.
Dr. Weiner (17:48):
So you're taking the drug every two to three weeks.
You're kind of shelling out alot of cash for it.
Still, yes, we're using somedosing strategies by moving you
down to 7.5.
We may be able to cut some, cutthe cost down a little bit that
way.
Um, and so your goal is to stayon this med long term.
Yes, you feel comfortablestaying on the med I'm
(18:09):
comfortable staying on the medlong term yeah you know,
interesting, I had someone youknow talk to me today and
they're like what do you think,dr, why you think these things
are really safe?
And and I think my answer is atthis point and again, keep in
mind.
I'm a bariatric surgeon, right?
This is what I trained to do.
My entire life is also beingthreatened by a medication and
(18:30):
and.
But you know, I, what I've alsobeen trained to do, is to treat
patients who are suffering withobesity, and so that's where
all the nutrition work thatwe've done comes in.
And so the medications to me,just they do, kind of they work
with what I like to do.
But my answer is yeah, I reallydo think that these medications
are going to be proven to besafe.
I think in 10, 15, 20 years,we'll still be using some form
(18:53):
of them, probably a slightlybetter version.
Zoe (18:56):
Hopefully a cheaper version .
Hopefully a cheaper version forsure, I think in 10, 15 years,
we will have a cheaper version.
Dr. Weiner (19:03):
It might take that long, though, zoe.
So, and the reason I think thatis because with every single
medication we take, with everysingle surgery that we perform,
there are risks and there arebenefits.
We know that.
That's just the nature ofmedication and science and
medicine is that nothing's forfree medicine?
Zoe (19:25):
is that nothing's for free?
Yeah, do you have like aspecific memory or a specific
non-scale life-changing momentthat you can kind of like taste
and want to share?
Janet (19:33):
Um, yes, I don't like football, but we went to a
Superbowl game and I we wentdown the stairs, sat in our seat
and I was like I have all thisspace I could cross my legs and
lean back.
You know, I had all this spaceand that's.
That's something that matteredto me, because, you know, when
you have extra here and you'vegot arms, you know armrests
(19:57):
there and everything's pressingup against there, you're
uncomfortable and you're notfocused on anything.
That's fun.
You're thinking about howuncomfortable you are, so that
was great.
Dr. Weiner (20:05):
It takes the joy out of the moment.
Janet (20:07):
Yeah.
Dr. Weiner (20:08):
And so you were able to really fully enjoy that
moment.
Zoe (20:10):
Be present.
Have you found yourself beingable to be more present in other
situations?
Janet (20:14):
Absolutely, and it's nice because this is not something
that's preoccupying my mind.
I'm not always thinking aboutwhat I have to do.
You know that's.
It just frees up so much spacein your head.
Dr. Weiner (20:24):
Yeah, have you noticed the medication not
working as well after a certainamount of time?
Janet (20:30):
I think when I got to maybe the 10th month in, I want
to say that's when my hungercame back.
It came back with a vengeanceand I was like what is this, you
know?
Did I get a faulty pen?
You know what's happening hereand um it, it kind of tapered
off.
So I guess, after it was heldback for so long, it was just,
(20:51):
like you know, rushing out toyeah, exactly that's what it
felt like yeah but, um, it's notnearly as as bad as as that,
that's.
That's the one thing that Ireally noticed.
So the medicine's still workingpretty well, the medicine is
still working and I think that'swhat we're going to find.
Dr. Weiner (21:08):
It's going to take tweaking and adjusting.
It's going to be like highblood pressure, like diabetes,
like anything where we're goingto need to make adjustments.
Right now we only have twodrugs to work with, but over
time we'll have more and moreoptions and different doses and
even second drugs that you canadd in if necessary, and so I
think we'll have more and moretools over time to support
people through this.
(21:28):
But you know it's so good tosee how well you've done.
You've really put a lot ofenergy and effort into this too.
You kind of made up your mindthat you were going to figure
out a way.
Janet (21:40):
One way or another it was going to happen.
But this is a wonderful tool.
I mean, it takes so much of theweight off of you so that you
literally and figuratively, youknow, can work on the other
things in your life that youneed to focus on.
Dr. Weiner (21:51):
Yeah, it's the fishing pole, right, yeah, you
know, you want to give a man afish feed him for a day.
Teach a man to fish feed themfor life.
But maybe if you give them afishing pole they might help
them out a little bit.
And I think that's what thismedication does for you is it
just gives you that extra sothat you can make the good food
choices, so that you can focuson the things that are important
(22:12):
.
And you know people thinkthere's no effort involved in
this.
That's not true, yeah.
Janet (22:20):
You know, there are times where I was like, do I really
want to continue with this?
Because I was nauseated or, um,I felt tired and it was just
like that.
That can be work too.
You know, figuring out how todeal with those little issues
that come up is also work.
So, um, but it's worth the work.
I think it's worth worth it.
I think you're worth it.
(22:40):
People are worth it, yeah.
Zoe (22:42):
You're worth the work You're worth the work,
absolutely.
Dr. Weiner (22:45):
Anything that's good comes with work.
Zoe (22:47):
Yeah.
Do you have anything else you'dlike to share?
Anything to share with ourlisteners, any nuggets of
helpful information that youthink would be helpful to?
Janet (22:57):
share.
One of the things that I thinkis important is to go ahead and
check with your doctor.
Don't feel ashamed about howyou feel about yourself.
It's your body.
So if you're uncomfortable inyour body, don't listen to
TikTok and whoever else Anysocial media that's telling you
that you should like yourselfthe way you are.
If you're struggling with that,then you go talk to someone who
(23:23):
can a professional who can helpyou, make a plan or do
something that's going to begood for you.
Zoe (23:27):
Thank you so much for making the trip and we really
appreciate you sharing Thank you.
Dr. Weiner (23:32):
Thank you for having me.
Absolutely Congrats on yoursuccess.
Thank you, I appreciate it.
Zoe (23:36):
All right.
So for our nutrition segmenttoday, I want to talk a little
bit about something that Janetwas mentioning but that I help
people with all the time, whichis what to eat when you just
don't feel like eating, whetheryou just had surgery, you know,
a couple of months ago, oryou're adjusting to a new dose
of a GLP-1 and you have maybethat food aversion or you're
(23:57):
just like ugh food aversion, oryou're just like ugh.
And we have to toe this lineand this is a conversation I
have with patients a lot betweenlistening to your body and
being mindful and like, yes, wewant to have that awareness and
presence in our body, but thenalso recognizing that those
hunger signals are beingsuppressed and your body still
needs fuel.
So it's okay, I want to listento my body, but I also know my
(24:20):
body needs nutrition, and sowhen we're experiencing that,
what I find is actually drinkinglike a smoothie and having
these little spaced outthroughout the day mini meals or
snacks, so that you aren'tsitting down to a big plate,
which will just make that desireto eat not to eat even greater.
(24:40):
But, like Janet was mentioning,she is craving, like fruit
smoothies and that kind of thing.
So of course we want to makesure you get a protein source in
that smoothie or that littlemini meal snack, whatever you're
having.
But just even if you make asmoothie and then maybe you
drink a third of it, put it inthe refrigerator, go back to it
later on and just kind of sip onit throughout the day.
It's a really great way todeliver a lot of nutrients, a
(25:03):
lot of protein, micronutrients,fiber, great stuff in there,
without necessarily forcefeeding yourself to eat a big
plate of food if you don't feellike eating it.
Dr. Weiner (25:16):
Yeah, no, I think that's great.
It's really a delicate balancebecause we talk so much about
mindful eating Right, but thereare moments when what we're
doing is maybe not the mostnatural thing.
Let's be honest Bariatricsurgery not the most natural
thing.
Glp-1 meds not the most naturalthing.
But our whole food chain hasgotten out of whack and there's
(25:36):
so many environmental factorsthat are causing obesity.
We're having to kind of pushthe envelope on some of these
medical things to try to bringthings a little bit back in
check.
Zoe (25:45):
Well, because most of the food on the market for us these
days are not the most naturalthing.
Dr. Weiner (25:49):
Absolutely, absolutely.
So we're doing in response tounnatural foods, we're using
some unnatural medication andsurgical therapies and there's
that balance response tounnatural foods, we're using
some unnatural medication andsurgical therapies and there's
that balance, that pendulum.
And there are moments when youkind of shift out of balance.
And we see that in the firstfew months after surgery.
We see that right afterstarting GLP-1 meds or
increasing the dose, and so atthat moment you have to realize,
(26:12):
hey, listen, maybe listening tomy body exactly is not going to
work at this time because we'vejust kind of shifted a little
bit out of balance.
But you want to keep the faiththat once you get through this
it will shift into a morenatural balance and you will be
able to really be more mindful.
Zoe (26:29):
It reminds me of this, something that someone was
talking about online a while agois you have to go through
periods of unbalance, orimbalance, like you were just
saying, in order to get tobalance?
Sierra (26:40):
whether it's you know.
Zoe (26:42):
I'm just going to eat whatever I want, screw it to the
extreme of being super strictand then finding your way back
to incorporating mostly healthy,whole, real foods with the
balance of some treats every nowand then.
But you have to kind of figureout that pendulum swing in order
to find that middle ground.
Dr. Weiner (27:00):
Yeah, I think that's .
To get to balance, you have tohave moments of imbalance.
Zoe (27:04):
Because then you don't appreciate what balance is.
Yeah.
Dr. Weiner (27:07):
So let's talk about the economics of obesity.
We're going to do an update onthe shortage.
You know, a couple of monthsago Eli Lilly came out.
They're the manufacturers ofZepbound or Monjaro and they
said we do not see any shortagescoming.
We've got this covered.
We have planned for this.
We don't see anything on thehorizon at all for shortages.
Let's now fast forward threemonths when all of the doses
(27:33):
except for one of both Monjaroand Zepbound are on shortage.
And so I think the first thingthat I've learned and I learned
this back with Novo Nordisk, soI don't want to point a finger
at Eli Lilly Novo Nordisk hasdone the same thing, and they
told us over a year ago that theshortage was going to disappear
, and the shortage is still inplace a year later.
So I think the first thing thatyou can tell about these drug
(27:54):
shortages is ignore whatever thepharma industry says.
They're not telling the truth.
Zoe (27:59):
They're saving face.
Dr. Weiner (28:00):
They're saving face, I think.
Also, the demand is justunprecedented.
I think, whatever theircalculations were going to be
for how many people were goingto prescribe this drug, they
were based on other drugs thathave come out in the past, and
the truth is there's no otherdrugs like Zepbound or Wegovi.
There's nothing like this, evenlike the SSRIs which kind of
took over our culture.
(28:20):
People weren't clamoring forthem, they weren't running from
pharmacy to pharmacy, thereweren't celebrities talking
about it Totally.
Totally Exactly so.
These medications areunprecedented and so, as much as
the pharma industry, theyhaven't necessarily been
truthful.
I think it did exceed eventheir best case scenario for
demand.
So both Zepbound and Monjaroare on shortage.
(28:44):
They do have new manufacturingplants that are coming online.
So does Novo Nordisk, but youcan't just build a manufacturing
plant in a few months.
I mean, this takes a long time.
So there are a lot of strategiesthat we use in the office to
help patients get through, andwe do have our Pound and Cure
Platinum Program, which is kindof our best version of what we
(29:06):
can offer for non-surgicalweight loss and also for
surgical weight loss, if you'relooking for revisions, and so if
that's something you'reinterested in, we do have a lot
of techniques that we use in theoffice to help patients
navigate through these shortages.
So we just heard from Janetabout some of the strategies
she's using about increasing thedosing interval.
There's other things as wellthat can help reduce the cost,
(29:28):
but I think getting through thiscan be tricky, and guidance by
someone who has a kind of anopen and creative mind can help
you.
You get through it.
Um, there are websitesavailable.
So if you go to supplylilycomslash Monjaro or slash ZepBound
uh, it will list all of thedrugs that are available.
And also you can look on theFDA site.
(29:49):
Uh, there's an FDA shortagelist, and so if you, if you
Google this, it's pretty easy tofind which doses are available.
Right now.
When it comes to Monjar andZepbound, the 2.5 milligram is
available, but all other dosesare listed as limited
availability.
It doesn't mean you can't getit, it just means it's going to
(30:09):
be hard.
We're using Lilly DirectPharmacy a lot.
Even we're seeing shortageswith them as well.
In fact, I've had people whowere able to get the drug at
their local CVS who weren't ableto get it through Lilly Direct,
and so just because they dohave that direct relationship
with the pharmacy doesn'tnecessarily mean that they have
a better supply than everybodyelse.
(30:30):
The drugs they're out there.
They're hard to find.
If you work through it, you canoften track them down, but it's
going to take some work.
I talk a lot with patientsabout timing and when you want
to be aggressive with yourweight loss and when it might be
time to circle your wagons, andso I think right now, if you're
really relying heavily on thesemedications, it's time to
(30:51):
circle your wagons.
Zoe (30:52):
Hunker down for a little bit of maintenance.
Dr. Weiner (31:01):
Exactly yeah.
So this is not the time to bepushing the envelope and going
up to that next dose and reallyworking to drive the weight off
through medications.
It's time to be working withsomeone like Zoe and focusing on
nutrition and getting theweight down and maximizing your
nutrition.
Zoe (31:14):
And that's what we're actually doing in the new group
that I started Navigating.
Glp-1 shortages is about likehow to bridge the gap.
Maybe if you're just chuggingalong on a lower dose than
normal or you have kind of likea hiatus waiting until you can
find another dose, what can wedo nutritionally and lifestyle
ways to really get you throughuntil you get your medication
(31:34):
again?
Dr. Weiner (31:34):
Yeah, there's a lot of people frustrated about these
shortages.
I get it, but the truth is,this is, above all, of our pay
grades Like we are not able tochange this shortage, and things
happen in your life that areunfortunate.
Every single personbillionaires, you know, movie
stars, actresses, Instagram,famous people they all have bad
(31:55):
things happen in their life too,and so when these bad things
happen, it's very.
Actresses, Instagram, famouspeople they all have bad things
happen in their life too, and sowhen these bad things happen,
it's very.
You know.
A lot of times we're like, ohmy gosh, this is so terrible,
how could this ever happen?
But sometimes these bad thingsthat happen are a gift and you
know, perhaps right now, ifyou're having trouble getting
that medication, it's a signthat you should be focusing as
much energy as possible onimproving your nutrition.
(32:17):
I think if there's one mistakewe see over and over and over
again out there, it's peopleover-relying on the medications
and under-relying on nutritionto drive weight loss and to help
them with weight maintenance,and so if you're struggling with
a shortage out there, maybethis is the universe telling you
hey, time to focus on nutritiona little bit more than you have
been in the past.
(32:38):
All right With that.
Let's move on to our questionsfrom social media.
We've got Sierra here to readthe questions.
I think the first question isfor Zoe, so why don't you let us
know what?
We've got Sierra.
Sierra (32:52):
First question is from our YouTube video, durable
Weight Loss.
Please could you do a video orpodcast on how to transition
from the weight loss phasetowards maintenance?
I'm still losing weight rapidlyafter my bypass October of 2023
, and wish to slow it up andmaintain now so I don't get too
(33:12):
thin.
Love your books, videos andpods.
Zoe (33:15):
Well, I think this question goes beautifully with Janet's
story because she's in herweight maintenance phase and
she's really great at attendingnutrition sessions and she's
really involved in the nutritionprogram.
So I really I wanted to applaudher when she was here but I
forgot to.
So that's the little shout out.
But anyway, let's talk aboutwhat the priority is.
(33:36):
While you are losing weight,post-op, you are prioritizing
protein because we want tominimize muscle loss, right,
maximize fat loss.
So you're prioritizing proteinbecause of that volume
restriction and then filling inthe gaps with your produce, your
vegetables and your fruit.
Then, once your hormones shiftto weight maintenance, we want
(33:57):
to flip those priorities.
We want to eat primarilyvegetables and fruit and plants,
filling in the majority of yourvolume, and then, yes, still
getting high quality whole foodprotein.
But it's not going to be yourmain priority.
This is also where we kind ofdabble a little bit into those
(34:18):
planned indulgences and how wecan find that pendulum swing
right.
We were just talking aboutbeing in a period of imbalance
to then find your balance.
Perhaps maintenance is youfinding that balance of mostly
real, whole, unprocessed foods,but then we want the majority of
your life to be in maintenanceanyway and real life says you're
(34:43):
probably going to have somebirthday cake on your birthday.
You might have a piece of pizzaat your kid's birthday.
Dr. Weiner (34:50):
A piece of wedding cake on your wedding A piece of
wedding cake, for heaven's sake.
Zoe (34:54):
And that's part of life.
And we want you to have thisnew relationship with food that
allows you to have those thingswithout letting that pendulum
swing in the opposite directionand say, well, screw it Right.
So that's what I would sayShift towards eating more volume
through plants, stillprioritizing whole foods, and
(35:14):
maybe we want to work a littlebit into some of those planned
seldom treats.
Dr. Weiner (35:19):
Yeah, so I think another thing is that people get
so hung up on the 60, 80 somepractices say a hundred grams of
protein.
What's your thought on that?
Is that a lifelong goal?
Do people need to track proteinforever?
Zoe (35:32):
I will say it depends on their activity level.
So if somebody is just, youknow, maybe like getting the
most of their movement throughwalking, maybe they're not super
active and they're just kind ofmaintaining mostly through
their nutrition, then being onthe lower end of protein is fine
.
If someone has really, you know, found themselves in love with
(35:56):
fitness and they're exercising alot and they're lifting weights
and those sorts of things, thenin and their goal might be to
build muscle, which means weneed more protein.
So I would say it depends onthe person, but as a blanket
recommendation, we don't need toworry so much about tracking
that protein long-term.
Dr. Weiner (36:14):
Yeah, track the pound of vegetables.
Yeah yeah, if you want ofvegetables, yeah yeah.
Zoe (36:17):
If you want to track anything, track that.
Dr. Weiner (36:19):
Yeah, and maintenance phase for sure.
All right, what's our nextquestion, sierra?
Sierra (36:23):
Okay, this one is from our YouTube short on bariatric
revisions and it's from Fanny.
She says why does a revisioncarry more risk?
Dr. Weiner (36:33):
When I go in for a primary surgery, everything's
right where it should be, justlike in the textbooks.
When I go in for a revisionsurgery, somebody else has been
there before and so there'sgoing to be a lot of scar tissue
.
I want to get to the stomach.
I may have to cut down scartissue for 20, 30 minutes to get
there, and cutting down scartissue has risk.
It's everything stuck togetherand I have to separate the
(36:56):
intestine or the colon or thestomach or the liver from
another structure.
And when you're doing that it'sdifficult.
You have to be very, verycareful.
I do lots of revision surgery asI've kind of worked out a lot
of the kinks, but it takes extratime.
There's risk involved in that.
So the scar tissue is reallythe major issue, and then
scarring also causes the stomachor the intestines to be thick
(37:20):
and inflamed, so it's not goingto hold suture as well as that
kind of native tissue that weoperate on the first time, and
so you know your suturing has tobe.
You just have to be a littlebit more careful.
Things don't line up just asnicely as they do in primary
surgery and so it just is moredifficult.
So when normally a gastricbypass might take me an hour and
(37:41):
15 minutes or so.
If I'm doing a complicatedrevision surgery, that surgery
can take two or three hours, andso when you're dealing with
previous surgical anatomy, younever know what you're going to
get.
There's always going to be alot more scar tissue.
The tissue is not going to beas soft and pliable as it has
been, and it just requires a lotmore time and care and
therefore has more risk.
Sierra (38:00):
Okay, last question.
Here is from our Instagram reelon durable weight loss how can
we keep a set point lower whenon medication that causes weight
gain?
Ozempic has been a godsend, butnow my benefits won't cover it.
I'm very active and already hada bypass five years ago.
Zoe (38:22):
Well, the first thing that comes to my mind, because we've
talked about this before, is howto lower your set point.
Well, one of those ways is tobuild muscle.
It sounds like you're veryactive, and if you are not
already incorporating strengthtraining into that activity, I
would recommend it.
Dr. Weiner (38:34):
Yeah.
So I think yeah.
Four ways to lower your setpoint right Nutritional change
not eating less, but eatingdifferently.
And that's where our metabolicreset diet comes in.
And so the first way I wouldhave you do is get on the
metabolic reset diet.
You can go to our website anddownload the handout for free.
Zoe (38:53):
Yeah, actually, if you haven't done that yet, anybody
listening, everyone's loving it,even the people already in our
nutrition program.
They've, like, I've downloadedthat handout, so definitely get
that.
It just pops up on the chatwidget in the bottom of the
screen.
Dr. Weiner (39:06):
Right, and then you can join Zoe when she gets back
from her honeymoon on themetabolic reset diet support
groups and kind of really takingthat handout and learning how
to put it into action and thenbuilding muscle, absolutely,
absolutely.
And then I think the otherthing to consider is you know,
the medications are a godsend,particularly in the situation
(39:29):
where you're taking a medicationthat causes weight gain, and so
, again, I like to fight firewith fire, and you didn't.
It's not covered by yourinsurance.
We do have some ways.
We only use real medication.
We don't use compoundingmedication.
Again, our Pound and CurePlatinum program.
We we are able sometimes to getpeople the medication at a more
(39:49):
reasonable price than you wouldexpect.
I'm not going to tell you it'ssimple, straightforward way, but
there's.
There's some tricks and somethings that can be done, and so
you may want to consider lookinginto that or working with us or
another creative provider.
Just see if you can come upwith something that would
potentially fit within yourbudget.
Zoe (40:07):
All right.
Well, I think that about wrapsus up.
Thanks so much for listeningand, of course, we'd like to
acknowledge and thank ourwonderful team.
We've got Sierra Miller andRhiannon Griffin, the podcast
producers, and the editing isdone by Autogrow.
And, of course, we need tothank our special patient guest
again, janet.
Dr. Weiner (40:26):
So please check us out on social media.
Our website we can download ourMetabolic Reset Diet handout.
Consider joining our onlinenutrition program or our Pound
to Cure Platinum program if youneed more assistance.
See you next time.
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