Could Zepbound, the latest GLP-1 medication, eclipse the success of weight loss giant Wegovy? Tune in as we dissect the burgeoning revolution in obesity treatment, where medications such as Ozempic and Mounjaro are redefining the approach to this stubborn metabolic disease. We unpack the stunning efficacy of Zepbound, debate its potential to rival bariatric surgery outcomes, and confront the crucial issue of medication accessibility. Drawing on expert insights, we offer predictions on how Zepbound might reshape the availability and affordability of weight loss treatments in the upcoming year, navigating the complexities of supply chain disturbances and pharmaceutical management.
The conversation takes a futuristic turn with the introduction of AI into the weight management arena. Imagine a world where meal planning and health resources are fine-tuned by intelligent algorithms, shaping the way consumers and healthcare providers tackle obesity. We scrutinize Novo Nordisk’s supply dilemmas but offer kudos to Eli Lilly for their adept handling of Mounjaro distribution. The narrative then shifts to the adventurous—patients sourcing GLP-1 drugs from overseas to bypass insurance hurdles and the growing trend of non-diabetics using continuous glucose monitoring. We peel back the layers of these trends to reveal their implications for the future of weight loss and health management.
Lastly, we ponder the changing landscape of bariatric surgery amid the rise of GLP-1 medications, discussing the decline in surgery rates and the exciting potential for combination therapies. We also stir the pot on lifestyle shifts, spotlighting the conscious reduction in caffeine and alcohol intake for improved sleep and overall wellness. Our commitment to bringing you the latest insights in health and fitness remains unwavering. With our finger on the pulse, we promise another year of thought-provoking discussions and invaluable content that will keep you informed and motivated on your health journey.
Transcript
Zoe:
Well, I think that this episode would be kind of fun for us to do our predictions in weight loss trends for 2024. 2023 was a wild year, don’t you think?
Dr. Weiner:
I mean, it was a crazy year in the world of weight loss. It was a crazy year in our practice. This was the year that Ozempic came out.
Zoe:
It was the year of Ozempic.
Dr. Weiner:
It was the year of Ozempic and I think up until this time we’ve known this because we’ve been doing bariatric surgery for a while, but I’ve been talking literally for about 15 years now about how obesity is a metabolic disease and if you’re going to be successful in your treatment, you’ve got to treat it like a metabolic disease. I think Ozempic is what is going to really get the world to start to believe that.
Zoe:
Kind of tilted the scales a little bit it seems.
Dr. Weiner:
Yeah, for sure. We’ve seen so many people find success with these GLP-1 meds with this, initially Ozempic and ultimately Mounjaro and now Zepbound and they’re finding success when they have it for decades of trying and it really just shows you that this is a metabolic disease and unless you address it like that, you’re just not going to be able to lose weight. Well, most people aren’t going to be able to lose weight.
Zoe:
Yeah, and you mentioned Zepbound. So we have actually 10 topics, 10 kinds of trends that we’re going to cover today in today’s episode, and starting off with Zepbound, do you want to jump right in, Dr. Weiner?
Dr. Weiner:
All right, Zepbound. So my first prediction is that Zepbound is IN and Ozempic is OUT. So the naming of these medications is now even more confusing with Zepbound. We’ve talked in the past about our thoughts on the name Zepbound. It seems like there’s like eight different medications, but the truth is there’s two. There’s Semaglutide, also known as Ozempic, also known as Wegovy. is a generic name and that’s how, when it’s sold as a compounded molecule, it’s sold usually under the name Semaglutide. Ozempic is for Diabetes. Wegovy is for weight l oss. With the other molecule, Tirzepatide, that’s the generic name and what it’s sold as in terms of what it’s sold as a compounding agent, is also known as Mounjaro. That’s the diabetes version. And now Zepbound, that’s the weight loss version. Same medication. There’s just two of these. So Zepbound just came out for weight loss. Up until this was released, it’s really been only Wegovy as the only GLP-1 that is approved for weight loss. People have been prescribing Ozempic and Mounjaro. We’ve done that literally hundreds and hundreds of times in our practice. But we’ve had to prescribe it off-label using a diabetes med for the treatment of weight loss, knowing that it’s the same molecule. So it’s really just an insurance difference here. But Zepbounds out and now that it’s out for weight loss, I believe we’re going to see it almost completely supplant the use of Wegovy. It’s a better medication. There are fewer side effects that we’re seeing in our practice and better tolerance, and there’s better weight loss, substantially better weight loss. There’s a study out that shows 26% total weight loss in people who lost, I think, up to 7% through nutrition alone. 26% weight loss is crazy yeah.
Zoe:
What’s the percentage, mostly with like sleeve maybe.
Dr. Weiner:
So with the sleeve we’re probably looking at around 20% weight loss. It depends. It’s not quite a percentage. We often measure it in terms of excess weight loss, which accounts for the fact that if you’re a higher BMI patient you’re going to lose more. But around 20%, maybe 25% in better responders. So we’re seeing with Zepbound, Mounjaro, tirzepa tide, (wherever you want to call it) we’re seeing in that level of sleeve gastrectomy weight loss. Maybe gastric bypass is more 25% to 30% weight loss. So still not quite where we see with the gastric bypass, but it’s in that same neighborhood. So we see better weight loss. With Ozempic we’re looking at like 15%. There’s some studies out there that show in the real world that maybe as low as 10%. We see less weight loss with Wegovy. And I think we see the same, if not more, side effects and more intolerance. So I think, as we start to really get a good handle on what these medications are, what they can do, as the supply chain opens up and we’re able to get the medications that we have coverage for, we’re going to see most people moving over to Zepbound and it won’t be for another three years or so and we see Retatrutide and a couple of other agents come out that we have anything that’s even as good as Zepbound.
Zoe:
So we’re talking about a little bit like you’re mentioning that your supply chain. So Zepbound I actually saw commercial for Zepbound not too long ago. It’s not available in pharmacies quite yet, right?
Dr. Weiner:
Well, right now, at the time we’re recording this, which is early December, it is not. When this comes out in January, my prediction is I think Eli Lilly knows what it’s doing and my prediction is that we’re going to see this really hitting the shelves and being available as soon as January. But we’ll have more information that we’ll talk about in future episodes about the availability of this and the affordability of this. It’s going to be popular and I think we’re going to still see the supply chain issues in the first half of the year.
Zoe:
Well, it’d be great if they get their act together and we can hit the ground running in the new year, get this medication out to our patients.
Dr. Weiner:
Absolutely, absolutely. All right, Zoe, what’s your first prediction?
Zoe:
So we’ve got a prediction about fad diets. I’m predicting keto is out and plant-based is in. Listen, I am very excited for keto to be done having its moment. I am not a fan of keto, are you? No! Oh my gosh. So I mean, we’ve talked about keto and fad diets before. Why they perhaps don’t work, what medical implications it can actually have on blood work and that kind of thing as well. So the fact that plant-based (mostly plant-based), whole food diets having more of the spotlight, that’s what we preach, that’s what our main philosophy of our nutrition program and our practice as a whole is, and so really focusing on high volume, high fiber whole foods. I mean that’s really where we’re going to see not only better health outcomes but, of course, better weight loss outcomes as well.
Dr. Weiner:
Yeah, I think that’s a great point. Obviously, The Pound of Cure program on the front cover has this big grocery bag of vegetables. We got the vegetable head right here. So, yeah, obviously I’m a big fan of vegetables and a plant-based diet, not plant only diet, but just where most of what you eat is vegetables and when you eat meat you eat less of it. But first of all, I agree, it’s time for any diet that endorses eating a pound of bacon as being compliant with the diet. It’s time for that to go away.
Zoe:
Or pouring butter into your coffee.
Dr. Weiner:
Pouring butter into your coffee, right, anything where that’s kind of the mainstay of the nutritional approach. It’s time for us to move out of that, because I think it doesn’t take a nutrition expert, a dietitian, bariatric surgeon, to know that’s just not healthy.
Zoe:
Right, and I also think that the more people who’ve tried it, maybe they’ve lost some weight, but guess what? They can’t keep eating like that forever, and so as soon as they stop, the weight comes back. And so I think, you know, perhaps I’m hoping that as a society we are moving towards this, this idea that we’re really big on, which is the sustainability. Right? Sustainable weight loss. And so I think the more people who have tried keto realize it’s not sustainable, realize they’re not getting, you know, better health outcomes because of it, we’re kind of ready to move on, and I’m here for it.
Dr. Weiner:
Perfect, perfect. Yeah, I think, you know, with a keto diet, you smell bread and you gain weight, right? Yeah? Also, I think, as we start looking at the GLP-1’s and recognizing what they do, the keto diet doesn’t work great when you’re on GLP-1’s at all.
Zoe:
No more nausea.
Dr. Weiner:
Yeah. For sure. And so I think if we’re looking at a nutritional program that’s going to work well with these meds, a plant-based diet is going to be much more comfortable, absolutely. All right. So the next prediction is not good news, unfortunately. I think it is going to become much harder to get GLP-1 weight loss medications through your insurance. We have seen a lot of loopholes that we’ve used in our practice. We write 20- 30 new GLP-1 prescriptions per week in our practice. I mean we really are. We’re the biggest prescriber in Tucson, I think, without question. And so we’ve figured out pretty much every prescribing loophole we can use to get patients approved for their medication. So their insurance covers it, and I won’t go into the details, but there’s some gaps in insurance coverage and some things that have been done in the past. They’re very slow moving. They’re like a cruise ship changing their medical policy. They can’t just change it on a Tuesday in the middle of June, right, they need to go through it, they need to get it approved. It has to change with the calendar year typically, and so we’re going to see all these companies have been spending a lot of money on these meds. They know exactly what they’re doing and they’re going to close these loopholes. They understand where these are. We’re already seeing it, we’re seeing announcements about it and our fear is that we have a lot of patients out there on these medications and they’re going to show up and pick up their prescription in January and it’s not going to be covered by insurance.
Zoe:
Yeah, I’m curious about this because I think we’ve probably mentioned this before, but I’ve viewed it as Pandora’s box. Right?! We’ve opened this or the insurance companies. It’s been opened, so it’s like trying to close that again. I feel like it’s just going to be disastrous. They have to figure it out. I think you’ve said before going to get worse, but then it’s going to get better, so maybe our predictions for 2025 is that it’s going to be easier. We’ll see.
Dr. Weiner:
Yeah, let’s see, but I do think, I think we’re going to see a lot of people losing access to these medications and that’s going to be a big problem, because if you’ve lost 30, 40, 50 pounds, we know we’re going to figure this whole thing out what happens when you stop GOP-1’s? We’re going to figure this out this year. In general, we believe that the majority of people are going to regain a substantial amount of weight. Now, will it take six months, a year? Will it take six weeks? We don’t know. I think it’s going to take longer than six weeks, but we’re going to see less access to this, which is definitely it’s not a good thing, but it may be, like you pointed out, something we’re going to have to go through, to come up with some sensible prices for these medications, sensible insurance policies, and this is just something that we’re all going to have to work out. I think, on a side note, related to that is that we will see the supply chain open up. I think, especially as insurance coverage lessons, we’ll see less people able to use these medications or people getting more creative spacing out their dosing for two weeks instead of a week Again, not recommended. We always recommend it possible to take the medication exactly as it’s prescribed in, as exactly as you and your physician work out. But we understand the real world. We know that people are going to do what they need to do, that they think is best for their health, and it’s hard to argue that no, you shouldn’t be on a medication at all, versus being is better than taking it every two weeks. So we’re going to see a lot of creativity and dosing and, as people kind of adjust to the new pricing and lack of access, we’ll also see, I think, the supply chain will get fixed. Novo Nordisk, I don’t know who is running their supply chain they’re the makers of Ozempic and Wegovy, but somebody screwed up there because this medication they had the whole world, everybody had coverage. They had the only, they’re the monopoly, is the only one and they just. We were told at the beginning of 2023 that the supply chain issues were going to lessen, and here we are at the end of 2023. It’s gotten worse. Nothing. Oh, in general, when I’m writing prescriptions for this, I’ll say I’m going to write you this prescription, but just so you know you’re not going to get it, it’s not available. And so I do think that Eli Lilly has done a much, much better job with Mounjaro. It’s been much more available and, I think, equally, if not more, heavily prescribed lately. So we’ll see shortages, no question. But I think Eli Lilly’s been doing a better job managing the supply chain. Novo Nordisk not as well. I think they will get it fixed and we’ll have to see what happens, especially as Wegovy becomes kind of a second tier drug. We may see a decrease in price, we may see some self-paid specials, some things that improve access, and Wegovy still works. It’s a good drug, don’t get me wrong. I’m not saying it’s not useful. It is really good. It’s just not as good as Mounjaro. So it’s going to be an interesting year there, for sure.
Zoe:
Yeah, can’t wait to see how it unfolds. Yeah, yeah, all right. Next prediction has to do with AI. I think we’re seeing the rise of AI being used across so many fields, so many uses, right, it’s so prevalent and if we do not work with it, it’s just going to take over, right? So it’s like how can we utilize AI to our advantage, to be more efficient and not necessarily try to just ignore it, because then it’s going to I don’t want to say replace us, because it’s not going to replace us, but there are many uses that I believe that you as the consumer, that we as providers, can use AI to actually help with weight loss. So, for example, I saw an example of meal planning using AI. So coming up with here are the foods that I do not like, here are the foods I’m wanting to eat. Can you create me a meal plan, a five day meal plan X, y and Z and give me a grocery list? And it does it in 10 seconds? So instead of spending hours doing that, you could do that. Also, workout programming. I actually used AI recently to come up with a resource for our patients. So with The Pound of Cure program, we work towards eating a pound of vegetables. And so I had a patient ask me oh, at this point, it was a couple months ago she goes well, a cup of spinach weighs differently than a cup of carrots. So she goes. So if I’m trying to measure it via measuring cups versus a food scale, because she didn’t have a food scale, you know she asked me do you have a resource, or can you make me a resource, of how much these different vegetables weigh? I said, I don’t have one already made. But let me get back to you I’ll work on it. I spent about an hour starting it, right. Made an Excel spreadsheet. I was doing all the research. I was like this is just ridiculous. This is not worth my time is spending so much time. So I opened up chat GPT, put it in there and in 10 seconds I had this perfect table of how much a cup cooked and how much a cup raw of all of the non-starchy vegetables you could possibly think of. And now it’s this really great resource that we can use for our patients. So that is a great example of how we can work with AI to help with weight loss goals, and I think that’s just going to continue to flourish as the year progresses.
Dr. Weiner:
I think, you know, AI is here to stay, and there’s all this discussion about the ethics of AI, and it’s all very, very important that we discuss it, but the truth is it’s, you know, these are companies, businesses that are releasing the AI, and they answered, and they pray to the God of money and capitalism, and so we’re going to see AI come. It’s coming. How much we can regulate it and everything, I think is something we’ll have to figure out, but the piece that’s missing is, you know, when you meet with a patient. So you meet with a patient and you say, okay, I’m going to come up with a meal plan for you. We’re going to work on this together. That’s usually how you do it right. You work on it with them and you help them create it, rather than here, this is what you should eat. And then what happens is then you meet with them again and then there’s that kind of iterative process where you learn, they learn, and how we’re going to implement that with AI, how we’re going to get AI to learn. Hey, you gave me this meal, but it didn’t work for me because, you know, the carrots ended up mushy. How are we going to get that feedback loop? That’s not there yet with AI, and so that’ll be interesting to see how that works out.
Zoe:
Yeah, well, and I think that really reinforces what AI cannot do, which is the human connection piece. We can use AI for maybe being more efficient in data collection and whatever those kind of tasks, but meeting with the patients, working through more of that interpersonal connection and handling specific situations that only humans can do, that’s going to make us it. You’re replaceable as humans like.
Dr. Weiner:
Obviously maybe, hopefully, maybe, we’ll see. I hope you’re right, zoe, but I don’t know if you are. I’ve heard, I’ve read some articles about people having very meaningful conversations with the chat GPT.
Zoe:
Oh geez well, me too so yeah.
Dr. Weiner:
So we’ll have to see, but there’s no question that AI for meal planning, AI for exercise and routine planning, that’s going to work. I mean, that’s going to be very efficient and I think we’ll see apps using that. We’ll also see people just reaching out like you did and kind of creating it for themselves. So next topic, where this is kind of related to my last prediction, because it’s going to be harder to get the meds through insurance I think we’re going to see a tremendous increase in people using overseas pharmacies for their medications and getting a little bit creative with it. I’m not going to go into the details of it other than to say that these medications, when they’re sold and right now they are available in Canada and this is big and of course there’s shortages and getting them can be difficult but we are having patients getting Mounjaro self-pay right now. It’s about $150, $160 bucks for one dose. But keep in mind the way these things are sold the low dose and the high dose are the same. Now there’s a lot too kind of using this in a responsible way, because it’s sold as a single use vial and it’s tricky and you can make mistakes here and they can be dangerous. But there is something there. We’re going to see that as the major direction where a lot of people who don’t have insurance coverage may find that they’re able to get it, and the consequence of this, though, is that, where normally we’re just ramping the dose up, ramping the dose up, we may find that the higher the dose, the higher the expense, and so we may see people really trying to get by with low dose Mounjaro, low dose Ozempic. We’ve done this in our practice and it does work. The low dose of these medications, especially when you really dial in the nutrition, get enrolled in our nutrition program, focus on The Metabolic Reset diet and really getting as much healthy food as we talked about plant-based food, we see great weight loss, and it may be that just that low dose almost acts as a diet enhancer. You change your diet, where normally you kind of plateau install this kind of keeps you moving along at that low dose, and so I think we’re going to see more low dose use of GLP-1’s, more use of Overseas pharmacies and people getting creative with some ways to get access to these meds, because they are just too good to keep on the shelf.
Zoe:
Like something is better than nothing, even if it’s just a low dose.
Dr. Weiner:
But I think we’re going to see results from that. I think it’s going to work well for a lot of people.
Zoe:
And when people remember that this is a tool coupled with the nutrition and lifestyle changes. That’s where we really optimize the results and so, especially utilizing the low dose, that’s where really honing in on the nutrition changes is going to be important.
Dr. Weiner:
Yeah, and we’ll see less side effects with that approach too.
Zoe:
Yeah true, true, okay. So our next prediction has to do with non-diabetics utilizing continuous glucose monitoring. I’ve seen this really popularized by fitness influencers and kind of like.
Dr. Weiner:
This is the thing you put on your shoulder and it tells you, like on your phone, what your glucose is on like a minute by minute basis.
Zoe:
Right, exactly, you can pull it up on the app see what your glucose is. Like I said, fitness influencers, kind of Silicon Valley tech driven kind of data people. So here’s the thing it’s kind of as though we’re taking this we’re using one piece of data to make decisions about nutrition. That is much more complicated than just the one piece of data, right? So trying to create a data set and predict, sort of like, how social they’re trying to use data to predict social media clicks and whether somebody will purchase a specific product, using that same structure or that same algorithm, almost to make predictions about what your body needs nutritionally, but based on one very simple piece of data. You would need so much other data in order to create this really educational and physiologically data driven decision Accurate model. Yeah, exactly. So I really don’t think that it’s worthwhile. I mean, these come, yeah, listen, if you see a fitness influencer telling you to buy this continuous glucose monitor utilizing their code, they’re just trying to make money. Absolutely, and I think it’s important to remember that most people you don’t need it, and so we might see it trending more and you might not, but I think that if you see it as a trend, let’s just skip on over it and really focus on utilizing your nutrition to manage your blood sugar levels.
Dr. Weiner:
Yeah, I think they’re trying to use the same science about if I make a video of measuring my blood glucose while I eat a cheeseburger or I eat carrots or I eat something. They’re using the same science that’s going to get them all the clicks and the likes and the shares from that video to try to make assumptions about their nutrition. And, like you said, you need way more parameters and to collect all those parameters you’d be walking around like a bag over your head measuring your inhaled oxygen and exhaled carbon dioxide, and your sweat, and your sodium and potassium, and kidney function, and heart rate and blood pressure, and you can’t walk around measuring this stuff all day long. So the problem is that we’re seeing Silicon Valley apply Silicon Valley techniques to the human body. And the human body, no matter how complicated their algorithms are, the human body it’s 10 times more complicated and we know one tenth about it, but we do, with the technology, way less predictable and individualized too. So, yeah, I agree with you. I think it’s. You know. I hope that that’s on its way out, but I do. I think you’re right. I think we’re going to see more people trying to hack their body. Biohacking. Biohacking, yeah. Yeah, that’s what they call it. All right, big prediction here Compounded medications are on their way out. There are a lot of people out there purchasing using compounded semaglutide, compounded Tirzepatide. We’ve talked about this on a previous episode about where this stuff comes from generally manufactured in China, shipped over to the US mixed with some compound like thymine or B6 or B12 of vitamin typically, and sold as a novel compound. Now Novo Nordisk, which makes Ozempic Wegovy, and Eli Lilly, which makes Wegovy and Zepbound, have both made announcements and both filed. I know Eli Lilly has. I don’t know if Novo Nordisk has. I think they just announced that they’re going to, but Eli Lilly has actually filed lawsuits against compounding pharmacies, against physician practices. Don’t come, we never sold them. We never sold them. I promise I swear we never, not a single time. Not once, did we do it. Please don’t come after us, because you know, if Eli Lilly, you know, I don’t know how many billions of dollars that company’s worth but if they make a decision that they want somebody to not violate their patent, they’re not going to get what they want and the law is on their side on this. They have the patent on this, and we can talk a long time about drug patents. That’s definitely something we’ll cover in the future. I’ve got a lot of opinions about how they’re probably not serving their purpose. That’s the law right now, and these companies are shutting this down. And so you put this together with the reduced healthcare coverage and still some of supply chain issues lingering, and again, we’re going to see people having a much harder time getting access to these medications. I don’t necessarily think it’s a bad thing for these compounded drugs to be on their way out, because I think they are unpredictable and it’s definitely something that somebody can that can be unsafe, and so I think I have my complaints against the pharma industry for sure, but we’re going to see these meds on the way out. I don’t think they’re going to last, I think by the end of 2024, we’re going to say remember how people would go to that wellness spa and get like semaglutide or Tirzepatide. Yeah, you can’t do that anymore.
Zoe:
Right, Okay. Next prediction has to do with exercising. So I think that HIIT kind of group fitness class, very high intensity, cardio-based fitness classes. Crossfit. Orange Theory. Yeah, exactly, I think that’s more on its way out. And strength training they are very purposeful, intentional, hypertrophy-driven strength training to increase your metabolism, build strength right, decrease your set point All of those benefits. I think people as a whole, and specifically women, are seeing the benefit of more intentional, strength-based training. I know I definitely recommend our patients do this after they’ve kind of increased their exercise tolerance via walking and kind of the more low impact. But the amount of injury and the elevated, the chronically elevated cortisol levels that a lot of people experience doing a couple hit classes a week, it’s not giving them the results that they think, it’s not helping them change their body composition or increase their strength in the way that they desire. And so shifting more towards a progressive, overlapped, lowed, hypertrophy-based strength training program I think is on the way in.
Dr. Weiner:
Yeah, I think we have to come to terms with the fact that we’re not all professional athletes. I did CrossFit it was about 10 years ago. I got into it for – I did not last a year, I can tell you that much. And I remember I had to cancel cases because I couldn’t straighten my arms out. I couldn’t operate. And at that point I was like this doesn’t make any sense for me. And I think the thing is, if you’re going to be a professional athlete, HIIT training is probably really good for you.
Zoe:
Yeah.
Dr. Weiner:
You know what happens to professional athletes. They get injured. Injury is like a massive cause of the end of a professional sports career, and we’re not just talking football and these contact sports, we’re talking track and swimming and all those things. So when you exercise at that level, you really put yourself at risk for injury, and injury is probably one of the worst outcomes that you can see from exercise. Because what happens when you get injured? You gain weight and you potentially limit your mobility, you limit your flexibility, limit your ability. You know the way you can exist in this world. So injury prevention is so key to any exercise program. And when it comes to strength training versus HIIT, I mean strength training is pretty safe, right.
Zoe:
And I think it’s worthwhile also to. If you’re new to strength training, most gyms you get a free personal training session when you sign up. So if you’re completely new to the gym, you don’t know how to use the equipment, utilize that that free personal training session, get oriented to the gym and make sure you have good form. But, like you said, I mean you can go at a nice location so you can keep yourself safe and I think that thinking about exercise as a way to increase your longevity and to increase your quality of life, not decrease it by getting injured, that’s the way to go.
Dr. Weiner:
You’re training to be a person, not a professional athlete, and so keep that in mind when you choose your exercise. All right, so here’s my last prediction. This is number nine. Combination therapy will be the single most important component of bariatric surgery. So we’ve been, we’re all the way at number nine. We haven’t even talked about bariatric surgery. Keep in mind I’m a bariatric surgeon. There’s no question. Bariatric surgery volume is down 30% across the country. We are seeing more and more people embrace the GLP-1 medications or experiment with the GLP-1 medications, and but we’re still seeing bariatric surgery. I’m still doing, you know, five to eight cases a week here. So so we’re still seeing patients opting for bariatric surgery. But what we’re seeing in our practice and what we’re seeing unbelievable results with, is when we combine the medications with the surgery, and so what that does is it takes that gastric bypass where we talked about maybe 25% or 30% weight loss, and it allows you to extend that to 40 or 50%, which basically means that every single patient that walks into my office has the ability to get to something that we would kind of consider a normal weight. We won’t go into what a normal weight really is, but if there is such a thing. But we’re going to see bariatric surgery plus the medications together representing really the optimal treatment for obesity. And we’ll see patients, like with a sleeve gastrectomy, where in the past there’s been lots of weight regain. We’re going to see those patients being able to maintain their weight long term. We’ll see patients who say you know what the meds are? Not for me. They may opt for a gastric bypass, but they also get to know that, hey, down the road, at 10 or 12 years, you start to gain a little bit of weight back. There’s a treatment available for you, and so that takes some of the criticisms that have been rightfully given to bariatric surgery, which is that there is weight regain and all of a sudden we’ve got a treatment for it. So, yeah, it happens, but there’s a treatment. So we’re going to see more and more bariatric programs, more and more bariatric patients recognizing the power of combining nutrition, GLP1 medications and the surgery for optimal weight loss results. And we’re going to start to see more and more of these patients who are struggling at 350, 400, even higher weights, getting down to really unrecognizable weights that we haven’t seen before in the history of treatment of obesity.
Zoe:
It’s pretty powerful and so exciting too that there’s now this option that people can see a weight that they haven’t seen in decades. Yeah, all right, I think we’ve made it to our final, our 10th and final trend, and this one has to do with caffeine intake. So I think that there’s going to be a trend towards being more conscientious about caffeine intake and working towards decreasing total caffeine intake. Now there’s a lot of research that can show a moderate amount of caffeine being fine for you, but I think caffeine, especially in today’s society, has been abused. People are drinking a couple cups of coffee a day, maybe an energy drink, lots of caffeine on the upwards of 500 milligrams a day, I would say, for some people and so there’s a lot of caffeine. But there are a lot of other lower caffeine or non decaffeinated beverage options I’ve noticed coming out on the market in order to replace that caffeine more so, like cacao drinks and mushroom mud water, like kind of the mushroom based coffee, that kind of thing, and just being more aware of caffeine intake and working towards decreasing that, and hopefully we see an impact on sleep quality as well.
Dr. Weiner:
Yeah, I think you’re probably right. I don’t think you’re right about it for me, but I think you are probably right that we’re going to start to see people. But it is time for us to come back from these energy drinks that have like three cups worth of coffee and caffeine in them and you see people jittering all over the place. So I think, as a side note on that, I would also say that we’ll see people being more conscientious about alcohol intake. I think that’s probably a better thing from a health perspective. Is seeing less alcohol consumption, more and more people kind of taking on a teetotaling approach to things, recognizing you want to talk about how it impacts sleep, forget about it. I mean, you’re young, but me I have like a glass of wine and I’m up, you know.
Zoe:
No, it’s the same thing. I have a terrible night’s sleep, yeah terrible.
Dr. Weiner:
So I think we’ll see more attention to sleep and the value of sleep, and less caffeine and probably alcohol. Yeah. Well, that wraps up our 10 predictions. I also would like to throw out that I think we’re going to continue our podcast throughout the entire year of 2024.
Zoe:
Bonus prediction.
Dr. Weiner:
Yeah, bonus prediction, we’re going to do more and more episodes of this, so again, we’re putting it out there. It’s going to be out there in January and you can see this and you can check on YouTube and on our podcast channels and see did we honor our prediction and did we continue to put the podcast out for the year. Hopefully you’ll find it useful and you can listen to us anywhere on your favorite podcast. Well, yes, if you’re listening to this, you already are listening to it.
Zoe:
But don’t forget to subscribe so you can get that notification, like and follow or subscribe.
Dr. Weiner:
Yes, you have to do all those things. Right, also on Instagram and TikTok. So well, Zoe. I’m looking forward to a good year with you.
Zoe:
Me too.
Dr. Weiner:
All right, see you next time.
