Ever wonder how to silence that incessant chatter in your brain that’s always talking about food? This episode of the Pound of Cure Weight Loss podcast we delve into the role of GLP-1 medications like Ozempic, bariatric surgery, and proper nutrition in quieting ‘food noise.’ Our guest, Josh, shares his awe-inspiring weight loss journey, shedding 160 pounds through bariatric surgery and incremental fitness SMART goals. His story is a testament to the power of finding joy and community in exercise, from walking to hitting home runs with his softball team.
Picture a space where men can candidly discuss their triumphs and trials, especially when it comes to the sensitive subject of bariatric surgery recovery. As a male peer leader, I’ve seen firsthand the transformative power of such support groups. We shed light on the unique challenges men face post-surgery and the incredible benefits of having a tailored community. But that’s not all – we also navigate the complex terrain of nutrition and medication access, revealing how our program arms you with the skills for sustainable meal planning and tackling real-life obstacles to obesity treatment.
As we wrap up another enlightening conversation, remember to enrich your weight loss journey by connecting with our broader community. Follow us on social media for daily doses of inspiration, and don’t hesitate to share the podcast with anyone who could use a helping hand in their health quest. Josh’s success story could be just the motivation someone needs to take that first step towards a lifestyle transformation. Join us as we continue to break down barriers and build up spirits on the Pound of Cure Weight Loss podcast.
Transcript
Zoe: 0:33
All right, welcome back to the Pound of Cure Weight Loss podcast. Here we are in episode number 17: “How to Quiet the Food Noise.”
Dr. Weiner: 0:41
Yeah, people like that term, food noise. I think it’s pretty telling.
Zoe: 0:43
Yeah, absolutely, and I think it’s relatively new that it’s been really popularized and utilized.
Dr. Weiner: 0:51
Yeah, it’s kind of come out of the Ozempic zeitgeist that everybody’s starting to talk about how Ozempic quiets the food noise, but it really brings attention to this idea that some people have more of a drive to eat than other people, and for some people, it’s almost like a full-time job just to keep their nutrition on track. So, anyway, we’re going to talk about how you can quiet the food noise and give you some strategies for that. So, Zoe, you exercise a lot. What’s your latest exercise routine? What are you doing?
Zoe: 1:20
Well, you know I love doing things that get me outside, like hiking or running, but guess what? I don’t do it very often. I would love to. We were talking about how I was able to enjoy some time this weekend to go outside and hike, but my bread and butter is really in the gym. I love lifting weights, and I do incorporate cardio. I love doing the stair stepper put on my YouTube video, and it’s actually something that I talk about with clients and patients about temptation pairing. So I have an arrangement with myself that I will only watch YouTube if I’m doing cardio, and so we talk about that. Like, if there’s something that you want to form, pair it with something that you look forward to doing, or like a treat such as watching YouTube or listening to a podcast.
Dr. Weiner: 2:11
Your favorite podcast while you do it. That’s really kind of a double plus, right? Because you’re getting great nutritional medication and surgery advice at the same time you’re exercising. Speaking of gyms, our news segment is from CNN, and it’s Ozempic is coming for gyms. Here’s how they’re responding, and there’s kind of two parts to it. The first part is that a lot of gyms are coming up with customized workout plans for people using GLP-1 medications, like Ozempic. But then they’re also talking about a couple of gyms starting to hire nurse practitioners or mid-level healthcare providers to be able to prescribe the medications. I kind of have mixed feelings about this. Zoe, let’s talk first of all about gyms and programs for preventing muscle loss and Ozempic. You probably know more about this than almost anybody, so…
Zoe: 2:56
Well, yeah, I think it’s great, and I think it’s a need that needs to be addressed, and really having somebody like a personal trainer that you’re working with to make sure you’re doing the exercises correctly and safely in proper form, not only to help prevent muscle loss but to prevent an injury, So I think it’s great for gyms to stay in their lane of helping people with their exercise.
Dr. Weiner: 3:23
I think it also takes away some of the bias, like, “Hey, listen, you’re taking these meds. Okay, we have a program for you. No shame; we’ll be open about it. Let’s talk about battling the disease of obesity using these medications.” But I think your point about hiring nurse practitioners. To me, I say go for it, knock yourselves out of lifetime fitness, hire some nurse practitioners, and start having the same battles with the insurance companies that we have every day.
Zoe: 3:49
They’re going to quit real quick.
Dr. Weiner: 3:50
Yeah, I think they’re going to quickly learn that this is probably not the best business model. Working and taking care of patients through insurance-based reimbursement is very enjoyable, and I love working with my patients, and that’s fantastic. But I will tell you, from a business perspective, this just doesn’t make a lot of sense, and they could probably do a lot better selling some memberships, coming up with some personal training programs, and even selling their protein powders and all the other things. So my hunch is that that’s probably not going to go anywhere. I say let them do it; the more people out there that are accessing it in an unbiased way, we’ve talked about how Eli Lilly does have some relationships with providers that, in my opinion, is biased and really shouldn’t be allowed. I don’t see any bias. They’re not going to have an incentive to promote one medication over the other or change their treatment plan based on who they work for. So I think this is a really good thing. I think it takes the bias out of taking the medications, and it’s really very much needed.
Zoe: 4:47
Well, and the other piece of it that I was thinking about, how it kind of mirrors the community aspect that we have built for our patients and the nutrition program having maybe an exercise group class for people to build connections with other people on these GLP-1s, like you said, to decrease that but that bias and that stigma.
Dr. Weiner: 5:08
Yeah, I think we’re going to see more and more of this as more people get on the medication.
Zoe: 5:11
Well, I think so many people want their hands in this pot.
Dr. Weiner: 5:17
Yeah, so all right. Well, let’s move on to our patient story. I think you know our guest, Zoe, so why don’t you introduce Josh?
Zoe: 5:24
Yeah, so I’m really excited to have Josh here with us. I’ve known Josh for almost two years because he was one of our very first participants in the nutrition program when he was getting surgery, and he has done incredibly well. Of course, we’ll hear from him, and I’m excited to have him share his story. Now that he’s one of our peer leaders, he has a lot of good value to add.
Dr. Weiner: 5:46
Yeah, and I think he brings kind of the man’s side of the story. 80% of our patients are women, but that means 20% are men, and we need to make sure that they have that safe space and that place that they can go, and sometimes guys just want to talk to other guys.
Zoe: 6:00
Exactly.
Dr. Weiner: 6:01
So Josh is here for that, and I think that’s a great addition to the program. So welcome, Josh.
Zoe: 6:06
All right. So now we’d like to welcome Josh, one of our peer leaders. Josh has been in the nutrition program for like, almost two years.
Josh: 6:14
Almost yeah, July of ‘22.
Zoe: 6:16
Yeah, so why don’t you just tell us your story, tell us a little bit about you, and let us know what you’ve gone through in the past couple of years, but also what made you decide to get bariatric surgery in the first place?
Josh: 6:27
Yeah, you bet. So, like many, I was overweight my whole life and struggled with it, losing and gaining the normal thing—fat diets, whatever. I was thinking about it on the way here. It’s kind of interesting the way different people measure whether you’re overweight, you know, and I was kind of telling my mom about this experience and that I was going to do this, and they were going to ask me my story, and I was going to tell them I was overweight my whole life, and she goes, “No, you were skinny as a kid.” And I go, mom; that’s not what the playground said. The playground is the rule. They said I’m fat. Yeah, fat, that’s what it is. So that was just an interesting thing. I thought it’s like peer judgment is what it is, not what your mom thinks, not what you think. Unfortunately, that’s kind of what it is. So that was where I started. I remember, you know, getting bullied occasionally, whatever, I have built my personality now, that’s fine, but yeah, I was overweight my whole life and got thin a couple of times doing different exercise and diet stuff.
Josh: 7:25
I am not a stranger to the bariatric process. My wife had it in 2010, and she had it in Illinois. She had the gastric bypass, and she had a ton of complications, like the one and the 3% tiles, like, super rare stuff. So I was a bit gun shy, not going to lie. The real kicker was going to the doctor because I’ve been on high blood pressure medicine for a little while and I was more or less maintaining that, and they kept telling me for years and years that I was pre-diabetic, and then, of course, I got the diabetes diagnosis.
Josh: 7:58
So I got surgery. But I got in there and started the process, and gosh, what a change! I mean, I more or less knew what I was getting into. I had sleeve surgery, which I felt was a better choice for me. I like to say I don’t want to brag too much, but I have made a lot of good decisions in my life. This is by far, if not the best, right up there, one or two, I mean right there. So, yeah, I mean, that’s in a summary, I guess, of how I got where I am.
Zoe: 8:26
Yeah, well, and I know that you know you’ve worked so hard; you really capitalized on the tool, but you put in the work to make the changes to your lifestyle, especially in the exercise realm. So, talk to us about your current exercise routine. What has really kind of spearheaded that newfound love of exercise in your life?
Josh: 8:48
Yeah. So exercise—I mean, just the word is like; you know I don’t do that. And for me, I played sports when I was younger, and I was relatively active, you know, doing stuff. And then, as I got older and bigger, that sort of faded, and I tried to go on a hike or two with my friends, and it was like, man, I just can’t; I won’t hold them back. And so I was like, set some sort of soft goal for myself. I want to be able to do stuff; I want to be able to play softball; I want to be able to go on a hike; I want to be able to walk a few miles and not be sore forever the next day or even whatever. So it really was, and I followed different disciplines in my life that involved baby steps, and so I just turned it into a baby step project for myself.
Josh: 9:33
Yeah, exactly at my work, we do use smart goals, so I am very familiar with that too. So for me, it was right after surgery. It was like you had to walk to get that gas paid out, right? So that was the big one—do that. And so I was like, “This isn’t as hard as I thought; I’m going to walk,” and I just started going around the block. And then I started going—can I make it half again around the block? Can I go down that little cul-de-sac and get that? And I just step a little bit, little bit, little bit.
Josh: 10:03
And I’d take the dogs. And I got to be where I was dragging the dogs back with me. You know, I was like, man, this is, I’m getting pretty good at this. And so then it gotta be where, like okay, look, I’m going three ish miles. It’s taken me roughly an hour. I’m like, do I want to add more time? And this is taking a lot of time, you know. So I said, “Let me try to maximize what I’m getting in my 45-hour walk.”
Josh: 10:25
And I went and got the weight vest, and it’s got adjustable levels. It starts at, like I think, 14 pounds, and then, like I use seven pounds, 14 pounds, 25 pounds, 35, and then 45. So I started it at the middle level, like 25 pounds or something like 15 or 20, I can’t remember. I did that, and I started just doing my normal route. I would just go, but I didn’t care about how fast I did; I just wanted to complete it, and so that built some confidence, and you can really feel it. And especially after you get back, you take that thing off, and then you’re walking like, “Oh my god, this is incredible, right?”
Dr. Weiner: 10:58
How much weight did you lose?
Josh: 11:00
So I’m down now at 160 pounds, 160 pounds rough, so more than 10 weight vests, yeah.
Zoe: 11:06
You were predicted to lose what? Was it 80?
Josh: 11:08
Yeah, the doctor told me I should lose 80 pounds, and I was like, Okay, that’ll be cool. But I was like, I knew it wouldn’t be satisfied. Yeah, I knew I had more to go right, so I doubled him up, which I’m proud of.
Zoe: 11:14
The other thing that I think has been a cool development is finding forms of movement that you enjoy. Whether it’s pool, racquetball, or softball. So tell us a little bit more about all these different activities that you’ve now been able to do, and you plug your softball team in a little bit too.
Josh: 11:36
So, yeah, just exactly an exercise for me is if you just say exercise, it’s that necessary, evil, right? But if you can find little pockets of exercise, that is something you enjoy or have fun doing. That is really the key. And for me, I do enjoy going on walks. I can clear my mind, and aside from that, I love getting out, meeting people, and trying new activities. Pickleball has been a good one for me. I’ve met a few friends doing that.
Josh: 12:08
So one of my soft goals was, and then it became a true goal. It was like I wanted to play softball, right, because I played little league baseball and I was moderately successful at that, and I thought, well, let’s see what I can do now. So I got on a co-ed team with just a free agent randomly thrown together last season, to very little success, but I had fun. And so in that process, the coach that I had said, “Hey, listen, there’s an open practice this guy puts on every Sunday. Do you want to go to that?”
Josh: 12:36
I was looking for practice because I didn’t like how our team was disorganized, but it just looked like we were the bad news bears, right? So I said, “Alright, I got to go to this practice,” so I went blind. He told me about it, but he wasn’t going to be there. I didn’t know anyone, and I was just like, I’m going to try. So I went blind, and now these guys are my buddies. I help them run it sometimes, and that’s how I met all these guys that are now on the team that I made. So we are real “Sons of Pitches” here.
Josh: 13:03
So this is our team name and logo. And then the Pound of Cure team was super awesome to sponsor us there, so I threw that name on the back to make sure we got a good advertisement. Everybody who wants to take a chance and see what they can become of themselves, see what improvements they can make. So, yeah, that was. That was a big one for me.
Dr. Weiner: 13:24
Yeah, I think that’s what was fitting, because, you know, without your weight loss, you’re not playing softball.
Josh: 13:30
You’re absolutely correct, that’s, that’s a hundred percent, and I’ve got you know the program, my hard work to thank, and I wouldn’t have been there without it. I’ve done hard work, I’ve done diets, I’ve done whatever, but I know I wouldn’t have had this sustained level of success; I never would have gotten there. So yeah, I mean the surgery, the program—everything has been just incredible.
Zoe: 13:53
So you’re one of our peer leaders; you are our only male peer leader, and we’re super grateful to have you on our nutrition program, leading a weekly support group. So tell us a bit about your experience as a peer leader and how the community has impacted your six sustained successes.
Josh: 14:13
Yeah, it’s pretty interesting because I can see myself and a lot of the people that join the group. Most of the people that join are early in the process, and so it’s fun to be able to share little, simple things that I learned but that are eye-popping for them.
Josh: 14:30
So that’s kind of nice, you know; throw some low-hanging fruit down, and they’re still going. “Yeah, that’s great.” So that’s pretty good. But it’s helped me kind of re-evaluate the things I’ve done and see, oh yeah, where I made that mistake. You’re making it too. You can’t overcome it. Just try to. You know, do x, y, or z, whatever this specific case might be.
Josh: 15:39
But yeah, it’s been a pretty good experience to meet all these other people, hear their stories, hear what’s gotten them into the surgery live, the post-surgery live, how they’re managing that, and share any tips and tricks that I’ve discovered.
Dr. Weiner: 15:55
You are the leader of our guys group. About 80% of our patients are women, but that also means 20% are men. So how is it, how’s it been different for you, kind of as a man, in a primarily female support system, and what have you done to kind of create that space for men to feel more comfortable as they talk about their experience after surgery?
Josh: 16:20
Yeah, you’re totally right.
Josh: 16:21
I mean, it’s definitely female-dominated, the people that I interact with in the groups. But we do have the men’s group now every other Thursday, and I’m happy to host that, and there’s a key three or four guys that generally call in, and it’s nice to be able to, you know, have that kinship where you have just a, I don’t wanna say you’re exclusionary, but you’ve got just a just us kind of mentality. You know what I mean. So I enjoy that, and it is nice to be able to talk about things, about how we experience things as men, and for one, for me, it was super simple, and I didn’t get it because, like I said, I was always overweight and I didn’t understand. I didn’t know where to wear my pants.
Josh: 17:04
And after I lost weight, I was wearing my pants where I always used to, at my hip line, because that was the narrowest place I could get them to button before. So that’s where I was wearing them, and everybody was like, “Pull your pants up, pull your pants up.” I’m like, what are you talking about? And now I know you have to wear them up here. Oh, that’s where your waist is. So that was one of the things that I shared and talked about with the guys group there, and there was, “Oh, I know what you’re talking about,” and so there’s some just little things like that, and you can’t really share the fashion stuff with the women. It’s the same as you can, guys. It’s just a little bit different, and you know there’s a huge range of age groups too. You know we’ve got guys that are my age. I’ve got a few that are younger, one guy who’s, let me say, in the 70s. I can’t remember his name offhand, but he’s a great guy. And so we’ve got a nice group, and it’s one to three people, usually in the men’s, which is about what you’d expect for your clientele splits there. But yeah, I really enjoyed doing it. I’m hoping I’m sending out good vibes and good messages for the gang, and they seem to keep calling back.
Dr. Weiner: 18:04
And I think it’s so great to have you as part of our team. We had a patient who kind of reached out to me a few days after surgery, and he was like, “What have I done? Why did I do this?” I think probably every bariatric surgery patient has that moment where they’re like, “Oh my god, what did I do to myself? Why did I sign up for this? This was the dumbest thing I’ve ever done.” And so he had that moment. He was really depressed about it, and it was so good to know. I’m like Josh; I’ve got to get this guy to Josh. And he joined the group and happened to coincide with the group that night, and you guys kind of surrounded him and really helped him and let him know, “Hey, listen, we’ve all kind of felt that it’s not going to be like this forever.”
Zoe: 18:44
Having that safe, like that special space for the guy to talk, and knowing that it’s still within this community of support, just like a kind of dedicated time, I think it’s really cool.
Josh: 18:57
Everybody likes to feel like something is carved out just for them, right? So there’s a nice little red carpet there. Guys, can come on in. And you know, I’ve said it several times: I’m your typical guy, and I’m macho or whatever. And I thought support groups—no, come on, man.
Josh: 19:11
And then, once I went, I felt the love, I really did, and it was just like, you know, there’s something to this, and I decided this was a good move to stick with. My wife had told me to go; dude, you gotta do it. I know you think you’re too good for that; you’re too tough for that. Whatever she goes for, just do it. Man, it was huge for me, and she said I thought they should have made that mandatory for the program, and I thought, yeah, that’s not a bad idea, but who’s going to give the right effort if something’s made?
Dr. Weiner: 19:38
It is mandatory for our patients. I didn’t do your surgery, and you just kind of stumbled on our support group.
Josh: 19:44
Yeah, well, mostly because of her prodding, because she said I was how helpful it was for her back in Illinois.
Dr. Weiner: 19:50
But I appreciate the support and us making it mandatory, because we do get pushed back on that. Yeah, like, “What do I need to do? Just give me the handout,” you know? Yeah, but there’s something about that connection. There’s something about hearing it from someone who’s gone through the service. Zoe hasn’t had the surgery, and I haven’t had the surgery. We’re not going to be able to talk to our patients about the things that only someone who’s had the surgery can tell them. So we need to have that out there, and we really appreciate you doing that. If you’re a guy out there and you’re looking for some how-to tips in terms of getting through bariatric surgery or just want to talk about how the surgeries affected you and what’s working and what’s not, you should definitely check out Josh’s support group.
Josh: 20:29
Yep, every other Thursday. I think it’s a guys group this week. I don’t know. I have to check.
Zoe: 20:40
Well, Josh, thanks so much for being here. Is there anything else you’d like to share?
Josh: 20:45
Well, I’ll talk about that realization I had the other day.
Josh: 20:49
So I am experiencing this. My daughter is also in the program, looking to have bariatric surgery, and she has some naysayers in not our tight circle but our extended family circle. And it’s her, my wife’s sister, and the more I thought about it, you know she’s thin, has always been thin, and has paid attention to her diet, will moderately exercise here and there. She’s not, you know, a gym rat or like a fit person, but she’s thin, she’s not heavy at all, and to preface it a little bit, she’s a judgmental person, but that’s fine. So she wants to pooh-pooh the idea of surgery as the easy way out.
Josh: 21:32
You always hear that’s the easy way out. So it got me thinking, and I am just an only child, so I’m used to entertaining myself when I get alone; that’s what I do, I think. So I’m just thinking one day while driving in the car about why a person would be motivated to say that to somebody—it’s the easy way out, hold them down, or whatever. And I started thinking, “Is it just a baked-in survival mechanism for people back from, you know, the Stone Age or whatever?” Because I started thinking. Think of a pack of gazelles or whatever in Africa.
Josh: 22:02
You don’t have to outrun the lion; you just have to outrun the other gazelle, right? So it’s never in my experience, especially, I can say, because I know people that are very fit and active and are on their nutrition, and they’re like healthy people. I called them the elite class, right? So it’s never the people in that elite class that seem to want to pooh-pooh someone for trying to join that and better themselves. Always those people in the middle.
Josh: 22:25
And I started thinking it’s these people in the middle, and probably the people near the bubble at the bottom, that are like subconscious survival mechanisms. I’ve got competition in the pack now. No, you can’t get skinny. No, you might not run me now that I’m in danger of the lion. So I was just wondering, you know, is there any credence to that? Is that something that’s psychologically baked in way back in your DNA of survival? Oh, I have to hold this person back because they might challenge my position in the herd.
Dr. Weiner: 22:50
That might be the single best explanation for the cause of obesity bias that I’ve ever heard. I dialed in on that, Josh.
Dr. Weiner: 23:00
That’s freaking brilliant.
Josh: 23:02
Yeah, I was just thinking of it the other day. Why would a person try to block somebody? And it’s never those people at the top who are very fit, very active, and very healthy. They’re always like, “Yes, good for you; come on, let’s go.”
Dr. Weiner: 23:13
But you know, I think you could extend that, and I think in the most primal sense, it’s like survival from getting eaten by the lion, but then it’s also competition for a partner, competition for a job, and just social standing and everything. As people get thinner, it’s like they start to maybe climb the ladder a little bit. And everybody who’s been on our show and talked about how much weight they’ve lost, they were like, “People open doors for me, people look me in the eye, people do things for me that they never did when I was overweight,” and so maybe there’s some kind of social jealousy that abscess out there when you start to lose weight and maybe climb up the ladder a little bit.
Josh: 23:59
And to add to that, even my own self. I’ve got a cousin who’s overweight. We’ve always both been overweight, and I would compare myself to him. “At least I’m better than that. At least I can run faster than him; at least I can do whatever, better than him.” But now that I’m where I am, those comparisons are long gone. I’m looking at other peer levels now. Where can I be now? But I mean, if he were ever to do something like that, I would never have held him back. Thankfully, I don’t have that thought process, but I think that’s also another part of it, though. Someone who would try to shun someone out, are they measuring sticks? Now, are they going to get better? And now it challenges me that I have to do it. I can’t compare myself to that person anymore. I don’t know; that’s just something to think about.
Dr. Weiner: 24:35
Yeah, those are really good thoughts. I like that. For more wisdom like that. Join his support, for sure.
Josh: 24:41
Thursdays at 5.
Dr. Weiner: 24:46
Yeah, there’s room for you. All right, well, thank you, Josh. I really appreciate that. That was fantastic. It was great to hear from you.
Josh: 24:50
All right, well, thanks so much for having me, and it was a pleasure.
Zoe: 24:54
Awesome.
Dr. Weiner: 24:55
Well, that was great to hear from Josh. I really am so happy that he’s part of our program, and I think if you’re out there and you want to talk to Josh and you know, especially if you’re a guy kind of going through this process and want to join a group where you can talk to really just other men, join Josh’s support group. Our program is available on our website, and it’s pretty affordable as well. So let’s move on to our nutrition segment. Zoe, what have you got for us this week?
Zoe: 25:17
Well, you know, as we were discussing these gyms dabbling in GLP-1 medication prescribing, it made me think about how many gyms and trainers dole out these cookie-cutter meal plans. So I wanted to discuss why cookie-cutter meal plans don’t work. And here’s the thing: we offer meal plans and meal planning for our patients. We have a lot of really great resources. But this is what I like to say. There’s a big difference between saying, “Here’s your meal plan; follow it perfectly or you fail,” and “Here are some meal plans for you to use as inspiration; mix and match for your preferences.” Here’s why meal plans don’t set you up for long-term success because they don’t teach you the skills to be successful on your own. So in our program, we help with meal planning. Yeah, that’s a huge piece of success during the week, but there needs to be flexibility, there needs to be that ability to account for real life, and being able to help you develop the skills and the tools to be successful on your own is our whole mission.
Dr. Weiner: 26:30
Yeah, it’s kind of like, “Give a man a fish, feed him for a day, teach a man to fish, and feed him for life.”
Dr. Weiner: 26:37
I think there’s another piece of that little story too, and that’s “Give a man a fishing pole, and it might help him learn to fish a little bit better.” And I think there’s something along this whole approach of how you empower someone to make meal plans on a daily basis, and I think that’s something you do a really great job of in the nutrition program because you know you’re giving some kind of cookie cutter meal plans, but, like you said, their inspiration is the fishing pole right there, right? That’ll help you get through a rough day. But it’s also important to understand that there’s some skill involved in this and that you have to make the adjustments yourself to make it fit into your life. So, whatever is happening is going to have moments when we’re more focused and moments when we’re less focused, and you need to have some skills and some things that you lean on in order to get the meal planning done during those tough times.
Zoe: 27:28
Yeah, well, and specifically with the metabolic reset diet we just had this morning and our metabolic reset diet session. Yes, these are the core components, but seeing them just written out as bullet points, that’s hard to compute. So being able to see what that looks like in a real-life, you know, day-to-day situation, here’s where these meal plans can be beneficial.
Dr. Weiner: 27:52
Yeah, yeah, we actually just revamped our metabolic reset diet handout, and it’ll be available on our website fairly soon. But you know, the thing is, I’ve given that handout 1000 times, but I don’t know that it’s ever really solved the problem; it’s kind of gotten you to that first step. Without that, it’s a lot harder to follow. But then you need that regular check-in, the smart goal, accountability, and all of those things. And so you know the truth: changing your life is complicated, and the idea that you’re just going to, you know, take a pill, pick up a meal plan, take a supplement, and that’s going to solve your weight loss problems—that’s not how it works. We’re seeing this even with GLP-1 medications and with surgery, those alone don’t solve the problem either. And so it’s really all of these pieces together. And then you see someone like Josh who’s done that and who’s really put all of that together. He’s done the exercise, he’s done the meal planning, he’s not doing the meds, but the surgery is working really, really well for him.
Dr. Weiner: 28:50
I think putting all of that together is what’s necessary. It’s a complicated thing; it’s not simple. That’s what our podcast is about. It’s like, “Listen, there’s a lot of stuff; it is possible, but it’s hard, and it takes a lot of knowledge and a lot of insight to get it right.”
Dr. Weiner: 29:04
Okay, well, let’s change gears a little bit and move into our economics of obesity segment. We’ve actually discussed this in the past, but it’s such an important part of so many people’s access to these medications, and we’re starting to see some issues with it. So we’re going to talk about the Zepbound coupon. So if you go to www.zepbound.com, that’s Eli Lilly’s website for the drug, and you can get a copay savings card. And this coupon is actually a pretty complicated one, and we’re starting to see some pharmacies push back on using it. I think that the pharmacies don’t get paid very well when people use the card, and so we’re starting to see some pharmacies kind of make it, “Oh we can’t accept it; it’s too difficult.” They’re kind of putting some friction in the way of people using that card in order to reduce the number of prescriptions that they have to fill.
Dr. Weiner: 29:57
First of all, there was this huge ransomware attack from some Russian hackers. They got a hold of Change Healthcare’s database. Change Healthcare is owned by United Healthcare. And this is, I think, kind of how lucky United Healthcare is, just in this space, like, so you know what change healthcare is responsible for? Paying doctors, paying hospitals, and paying pharmacies. So, quite honestly, if there was something that was going to get taken over, it’s you having to pay other people. That would be the thing. “Please take away my checkbook so I can’t write any checks for a couple of weeks. Oh no, that’s so terrible.” But anyway, Change Healthcare was also part of the coupon processing chain, and so for a couple of days, nobody was able to get their zepbound because of this ransomware attack. But anyway, I just want to go over some of the criteria that the coupon has. So this is March 5th that we filmed this, and the first is that you must have commercial insurance. You cannot have Medicare, you cannot have Tri-Care, you can’t have Medicaid, or in Arizona, we call it Access.
Dr. Weiner: 31:13
There’s been some debate about whether federal health plans like federal Blue Cross, which is what government employees get for healthcare, will work, and we have, in general, seen that that works. Some people may, and again, pharmacies can kind of interpret this however they want, but some of them may interpret Blue Cross Federal as a federally funded health plan, but it really isn’t. You have to be 18 and over. The prescription has to be consistent with the FDA-approved product labeling. What that means is that most pharmacies will say you need a diagnosis of obesity on the prescription, and so I don’t know if the intent is to keep it at a BMI of 25 and above and kind of keep people who are looking for that 10-pound weight loss with a zepbound from using the coupon, and I don’t necessarily disagree with that. It gets tricky, though, because we may see a sleeve patient who’s regained 10 pounds and wants to stop his/her regain and is taking zepbound, but when you look at the BMI, it’s hard to say we can’t interpret that as a diagnosis of obesity. If someone gets, God forbid, diagnosed with breast cancer and then it’s in remission, we wouldn’t deny them treatment for their breast cancer to help maintain their remission. We look at that the same way. So we kind of keep that diagnosis of obesity on all of our bariatric surgery patient charts.
Dr. Weiner: 32:21
The maximum monthly savings is $150. The real benefit, though, is if it’s your self-pay, and so we’ll see patients typically get it for about $550 or $600 if they don’t have insurance coverage. Another big thing that we need to be aware of is that this coupon expires on December 31st, and so there’s a lot of people out there using this medication and relying on this current pricing. They could offer another coupon. They could not, and if there’s no coupon, the price is probably about $1,000 to $1,200 a month, which really is getting to the ridiculous point.
Dr. Weiner: 33:02
I think something that I really noticed over time is that this medication is really kind of a 1% medication. It’s really the wealthiest patients who are getting access to this medication, and I think that’s a really unfortunate statement about what’s happening with our access to these GLP-1 medications. When I see patients, if I want to make, if I want to predict whether or not they’re going to get GLP-1 meds, and like, if I see them in six months and they’re on the meds, the one question I would ask them is, How much money do you make? And I think if they’re making a lot of money, it’s much more likely that they’re going to be able to get access to the medication. But now, that doesn’t mean that it’s impossible, and we certainly have a lot of people with lower incomes who are receiving the medication. But there’s definitely a bias toward that, and I think if you go on TikTok and social media and everything, you’ll see that if you pay close attention, you’ll see that’s a lot of who’s using the medicine right now.
Dr. Weiner: 33:56
So one more thing about this, and I found this interesting, and this is actually something I didn’t really know much about, but patients who utilize alternate funding programs for specialty drugs, and there’s a number of companies that do this, like ImpaxRx and Payer Matrix. They are forbidden from using this coupon for the medication. I don’t really know much about these. I started to look into them, and I found that they were really universally hated by insurance companies and also by PBMs, Pharmacy Benefit Managers, and also by the pharma industry, and so immediately I got very interested because I thought these guys might be doing something right or interesting, and so I don’t know that this is really a meaningful method of reducing healthcare costs, but we might talk about them down the road. I have to do a little bit more research about what their plan is and how they work. But if you do use one of those funding programs, you will be excluded from using the coupon.
Dr. Weiner: 34:53
All right, well, let’s move on to our questions. We’ve got our office manager, Sierra, here to read the questions, and we’ve picked out three questions that came to us from social media. If you’re interested in asking us a question, you can just go on our TikTok, Instagram, or YouTube account and ask the question there. Also, on our website, there’s a podcast page, and you can submit the question through our website as well. But we love hearing from our users, and I find that there are so many good questions that come to us. It’s really hard to pick the ones that we have time to answer.
Sierra: 35:24
Okay, the first question we have is from Gail. She asks, “Would you please discuss food noise? I’m particularly interested to know if you consider it to be a component of the psychophysical social makeup of obesity, and if so, is it something that can be mitigated by nutrition, medication therapy, or bariatric surgery?
Zoe: 35:44
Yeah, well, I think that food noise phrase we were talking about earlier is something that seems to be more prevalent in some people and less prevalent in others.
Dr. Weiner: 35:56
And people who suffer from obesity.
Zoe: 35:58
Absolutely, and we have heard from countless patients once taking a GLP-1 medication or especially right after bariatric surgery, having that food noise quieted, that constant chatter.
Dr. Weiner: 36:13
Yeah, let’s first define what food noise is. I think everybody’s going to have their own definition. Like we talked about earlier in the show, it’s kind of a new term, but it’s this constant barrage of thoughts about food and this continuous desire to eat. That’s kind of like you’re sitting there watching television, talking to your partner, and you’re just in the back of your mind, thinking about that one food that’s somewhere tucked in your refrigerator. Should I eat that or not? That kind of preoccupation with food.
Dr. Weiner: 36:47
Some people can spend hours and hours and hours and not think much about eating at all. For other people, it’s really all they think about. When that’s all you think about, it’s really hard to keep the diet in check and minimize the processed calories. Let’s get to the heart of this question. Do you consider this to be a component of the psychophysical and social makeup of obesity? What do you think about that? Absolutely, the idea of food noise really speaks to the fact that some people have a greater desire to eat and a greater drive than other people. We see that with addicts of all types.
Dr. Weiner: 37:28
Some people just like alcohol. I remember back in college, I liked alcohol like everybody else did, but I didn’t wake up in the morning and think about it. During the week, I usually didn’t drink, unless it was really only social. I would never just have a drink, but I had some friends, and it just seemed like they enjoyed alcohol so much more than I did. Now, fast forward 20 years, and I still know some of these people, and they still enjoy alcohol, probably more than they should. We all have these inherent drives for different things, and I think food is one of them. Can nutrition, quiet food noise, Zoe?
Zoe: 38:01
If we are intentional about eating whole foods spread throughout the day, not limiting the volume of those certain foods that we’re eating, and on occasion having those planned indulgences or those little treats, it feels more sustainable long-term. I think that can absolutely help reduce food noise, but not as much as medications and surgery.
Dr. Weiner: 38:24
There’s no question that nutrition does not quiet those. I mean medication and bariatric surgery. It just shuts it down. In some patients, not in everybody. Everybody responds differently. The idea of food noise too, I think, is part of this set point concept that we talk so much about, that when your body weight is at this set weight, you tend to have a reasonable amount of chatter about food. But if you restrict your calorie intake, like you talked about, and the hunger drive increases, then the food noise starts to get really, really loud.
Dr. Weiner: 38:55
Focusing on something like our metabolic reset diet, where it’s not about calorie restriction but about eating lots of really healthy foods like fruits, vegetables, nuts, seeds, and beans, and eliminating the processed foods because a lot of these processed foods cycle that blood sugar up and down, and sometimes those low blood sugars can increase the food noise. I do think there are a lot of nutritional strategies that you can employ to quiet the food noise down. That’s what our nutrition program is really designed to do—not put you in starvation mode, but to allow you to eat lots of healthy food, have plenty of good stuff, and lower that set point naturally over time. So yeah, food noise is complicated. I love that people are talking about it. It’s definitely a real thing, and there are medications, nutritional strategies, and surgical techniques that we can use to minimize the food noise.
Sierra: 39:45
All right. The next question is from a YouTube short on wegovy being shown to reduce the risk of heart attacks by 20 to 25%. This question is: how dangerous is it to go from a sleeve to a bypass revision? Originally, I wanted the bypass, and the surgeon directed me to a sleeve. He felt it was a much easier surgery. However, I’m quite large and only lost about 20 pounds. Here I am, four years later, wondering if I should get a revision. I’ve heard some real horror stories about revisions.
Dr. Weiner: 40:14
So you know, first of all, my practice is probably 30 to 40% revision surgery, and I do a lot of revisions from a sleeve to a bypass, and I actually do a lot of gastric bypass surgery as well. The first thing I’ll tell you is that a gastric bypass is a much more difficult surgery to perform than a sleeve. It took me probably 250 gastric bypasses to get really good, to get to where my numbers are well below the national average in terms of complications. It probably took me about 50 sleeves to get to that same skill level. So it’s a much steeper learning curve. If you were to watch the surgery, there’s a lot more suturing and connecting and some difficult things. But we can still do a gastric bypass with a 1% serious complication rate. I can do a sleeve for a bypass revision with a 2% serious complication rate. So it is a little bit riskier, but still, 98% of my patients sail through that procedure. Now, that’s the simplest and most straightforward of all types of revisions. Other revisions I do involve patients who have either had the surgery performed incorrectly initially or who have chronic ulcers or some type of bowel obstruction. Those are more complicated, where you’re actually treating pathology where something is just not hooked up right. There’s an ulcer; there’s a problem. Those are much more challenging procedures. Those are going to have higher complication rates, but typically those aren’t driving additional weight loss. Those are treating a problem that’s resulted from bariatric surgery. I do a lot fewer of that type of surgery than I do sleeve to bypass revisions for typically heartburn.
Dr. Weiner: 41:55
The other question is: will a sleeve to a bypass revision be an effective weight loss tool? That is quite variable. I’ll see some patients, and I think we had Stacey on the show a couple of weeks ago,and she lost like 80 pounds in the first few months from her sleeve to bypass revision. We’ll see other patients lose 20 pounds and do the same nutritional stuff.
Dr. Weiner: 42:18
One of the things I think is that this surgery works well to treat regain, more than inadequate weight loss. You had a sleeve, and you lost 30 pounds, and that’s just as slow as you went. That sounds more like what we’re hearing in this story than doing a revision to a gastric bypass, which typically doesn’t work that well. Now, actually, the exception would be someone like Stacey. Again, that’s a generalized statement that’s not necessarily accurate for you. I think that doing that surgery for weight loss has modest results—sometimes good results, sometimes pretty minimal results. Doing it for acid reflux is super effective. Patients wake up the next morning with acid reflux gone. Years later, still no acid reflux. If you’re in Arizona or anywhere in the Southwest, I do a lot of revision surgery. We’re happy to take patients from nearby areas or even a little bit further away. If you’re looking for revisional surgery, that’s certainly something we can help you with.
Zoe: 43:15
Yeah, it sounds like if she’s experiencing a lot of heartburn along with the sleeve and minimal weight loss, then the revision would help with maybe both of those things. If she’s not really experiencing heartburn so much, perhaps going on a GLP-1 could be the answer.
Dr. Weiner: 43:32
Yeah, that’s exactly the way I approach things. If someone comes to me and they’re not happy with their weight loss, if they have bad acid reflux or sleeve reflux, it just gets worse and worse and worse; it generally does not get better. We’re going to refer that patient to a gastric bypass. Hey, maybe we’ll get lucky and they’ll lose a ton of weight, and then we don’t need the GLP-1s. But if not, we can use the GLP-1s after the fact. If you’re just coming with inadequate weight loss, if we can get you on the GLP-1, we’re going to. All right. Last question, Sierra.
Sierra: 44:00
Okay. Hi guys. I am two years post-gastric bypass. I’ve lost all the weight I needed and am in maintenance. I’m hungry, especially in the evenings. I eat between 1,000 and 1,200 calories per day, 80 grams of protein, and loads of veggies, and I got the Pound of Cure book. I just wondered if I should be eating more calories. I am concerned about starvation mode or ending up like the folks on the biggest loser. Any insight would be greatly appreciated. By the way, great job, guys. I love the podcast.
Dr. Weiner: 44:28
Thank you; we love doing it.
Zoe: 44:29
Thank you.
Zoe: 44:31
All right, here’s what I have to say. First off, it’s amazing that you’ve reached maintenance. It’s really great that you’ve lost the weight that you desire. Now, keeping in mind your honeymoon period is that period of time after surgery generally about a year, could be longer, could be less where you lose the majority of your weight not just because of the volume restriction but because of that hormonal change. Then there’s that shift to maintenance, which you’re in right now. The hormone shift is that instead of weight loss, it’s in weight maintenance mode.
Zoe: 45:06
If you are feeling hungry, I would say let’s eat more, but of course, the key is what you’re eating more of. It’s not “Oh, okay, I’m feeling a little bit hungry; I’m in maintenance, so let me add some pizza and ice cream each day.” That’s not what I mean. But if you’re feeling hungry and you’re already eating a ton of veggies, maybe you’re adding in some more fruit. Maybe you’re adding in some more nuts and beans, adding those high-volume, high-fiber foods to help you feel full and continue with weight maintenance. But it sounds like you’re doing a great job. I just want you to honor that hunger so your set point doesn’t push you higher.
Dr. Weiner: 45:41
Yeah, and stop counting calories.
Zoe: 45:43
Yeah, yeah.
Dr. Weiner: 45:43
Right, I think you should stop counting calories, and she’s doing everything right, right? The only thing is that she’s not eating a ton of calories right now. Over time, that will probably increase a little bit without waking, yeah.
Zoe: 45:57
And I also just wanted to say that it’s normal and expected that you will naturally start to feel hungry or that you will naturally be able to eat a bigger volume of food, and we want you to honor that hunger, honor that extra volume, and eat more if your body is asking for it, but eat more of that good stuff.
Dr. Weiner: 46:15
Yeah, absolutely. All right, Zoe. That wraps up Episode 17. I think it was a great episode. Thank you, Josh, for joining us. If you are out there and want to see more from us, our books are available. And also follow us on TikTok, Instagram, YouTube, your favorite social media platform. We’re getting more and more lessons every week, and we’re really excited about that. Please, if this is valuable, share it with someone that you think would appreciate it as well. See you next time!
I had gastric bypass surgery in 2006 and lost 110lbs. If i had a revision would i have the same success?