Ever wondered how setting smart goals could redefine your health journey? Prepare to be inspired as we unveil a revolutionary goal tracker. In our nutrition program we tackle the Ozempic debate head-on, refocusing on its clinical prowess for those battling obesity and diabetes. Episode 13 isn’t just about the nuts and bolts of health tech; it features the powerful narrative of our patient story, Laura, a peer leader whose story of triumph underscores the monumental difference community support can make in our lives.
Big Pharma, insurance profits, and healthcare policies might sound like a snooze fest, but not the way we talk about them! We’re dissecting the economic barriers to life-changing GLP-1 medications and offering up real solutions to make them accessible for everyone who needs them. But it’s not all policy talk; we hear firsthand experience in building a community where health and weight management are open-book subjects, proving that the right support system is a catalyst for lasting wellness.
Finally, imagine facing the post-bariatric surgery world without a compass—daunting, right? We’re here to map out that journey, emphasizing the importance of peer support, hydration, movement, and the tailored nutritional strategies you’ll need, especially if you’re a weightlifting warrior. As we answer your questions on everything from Pfizer’s weight loss pill to doctors’ nutrition education, get ready for an episode that’s packed with actionable advice, real talk, and the kind of storytelling that doesn’t just inform—it transforms.
Transcript
Zoe:
All right, this is episode lucky number 13.
Dr. Weiner:
That’s Taylor Swift’s favorite number, by the way.
Zoe:
I did not know that.
Dr. Weiner:
Yeah, I did.
Zoe:
Well, I wonder if it’s because you have two teenage daughters.
Dr. Weiner:
It might have something to do with you but honestly, I’m a Taylor Swift fan.
Zoe:
You know, I remember we were walking outside I think, I’m not sure if we were filming a podcast or something and we were like, oh my gosh, look at the sky. And you’re like, yeah, like the Taylor Swift song, Lavender Haze. Yes. And I was like, wow. Okay. Great, love it.
Dr. Weiner:
Yeah, we’re a Taylor Swift family.
Zoe:
We’ve got some exciting news for our nutrition program. A new kind of techie capability that Dr Weiner slash/ surgeon slash/ our IT guy.
Dr. Weiner:
I am our practices IT specialist.
Zoe:
It’s very impressive actually. But anyway, you hooked us up with this new smart goal tracker, which I am just loving.
Dr. Weiner:
Fantastic.
Zoe:
Basically, we can go in each one of our groups, I can make a little note in terms of what each patient is working on. And then, next time I see them again it’ll pop up and I can make any updates to their goal and I think it’s just working beautifully. And then you can also see it on your side.
Dr. Weiner:
So it passes from Zoe to Me and Deidre and Bether and all of our providers. And then we can modify it and pass it back to Zoe. And that kind of integrates the nutrition program a little more tightly into our practice. And I think also for the patients it really dials in on that accountability factor that we talk about, which is, and that’s how you make progress. People think well, progress is just something that happens organically. It usually doesn’t. You have to be intentional about it. We do that in our practice. We make goals. We hold people accountable. We meet together and we’re very intentional about the decisions that we make. And I think for any time you want to get better, you have to set something that you can do over a short period of time. Smart goals, meaning: specific, measurable, attainable, realistic and time-based and then check in in a fairly short period of time to confirm that you’ve been able to meet those goals. And so our program now really has built that into every one of our support groups and our sessions. So that’s going to be fun. I’m glad to hear that that’s working out. I’m excited about that. I think that’s an important piece of the puzzle.
Zoe:
Right, definitely. All right, let’s get into the episode today, because we’ve got a lot of great things to cover, as usual. So, in the news, what if Ozempic is a really good thing? I guess we’ll find out. Who would have thought. We also have Laura, one of our peer leaders and patients, here to share her journey and her experience as a peer leader. I’m so excited to have her in on the show today because she is just a gem. I’ve got some information about how to stay motivated, because I think we all know motivation is fleeting, so I’ve got some tips for you to stay motivated. In our economics of obesity segment, are GLP-1 is really unaffordable. In our patient-submitted questions, we’re going to be discussing the future of bariatric surgery, how to know you’re actually eating enough, and what your doctor really thinks of your weight.
Dr. Weiner:
That is the title of today’s episode, by the way. It’s what your doctor really thinks about your weight, based on our last user question. All right, so this article is from New York Magazine and it says, “the moral panic over Ozempic misses the point. And honestly, I thought this was such a fantastic article because it is exactly what I’m seeing in my practice, in my office, every day. Zoe, I think you’re seeing the same thing. You’re working with patients on their nutritional health while taking these medications, and there was a couple of really great lines. I’m going to just put a quote out there from this article. It says, “most of the big juicy, deep dives into what the medications are, what they do and what they mean, have focused not on their astounding clinical effects but on what Ozempic reveals about our morals and values, about identity and our obsession with thinness. And this is to me this really strikes on the essence of the problem that I’m seeing with GLP-1’s on social media, in conversations. Clearly there’s this feeling out there where there’s this resentment about Ozempic. I don’t know if it comes from people and their thinness, they believe, makes them morally superior to people who haven’t been blessed with the same thinness. To people who kind of tell themselves a story about their weight and other people’s weight and somehow derive some form of emotional satisfaction from it. I don’t know where this is coming from, but it is out there. And these medications are really effective. They work really well and they’re very safe. And this is a really good thing for a lot of people. 40% of Americans are obese. 12% have diabetes. And these medications will dramatically change their health trajectory, more than any other pharmacologic intervention. You have diabetes we can put you on medications that don’t cause weight loss but help your hemoglobin A1c. You have high blood pressure we can put you on medications that help with your high blood pressure. You have high cholesterol? We’ve got meds for that. We can stack all of these meds on top of it and in general, the obesity keeps worsening. The diseases keep worsening. We start people on these GLP-1 medications and they can come off all of those meds. And the health trajectory instead of these diseases getting worse, they get better, they improve. You’re able to come off medications. Isn’t this a really good thing? We need to celebrate this. I almost never see type two diabetics on insulin anymore. When I started my practice, a third of the type two diabetics were on insulin and we saw higher hemoglobin, A1c’s and insulin causes weight gain. This article really highlights what I see dozens of times a day. Which is that most people think that obesity is caused by their own personal failure. Often, the patients suffering are the ones who believe this the most strongly. And that a spiritual awakening is necessary in order for them to finally lose the weight and keep it off. And this is simply not true. Obesity is a crippling disease that decreases your quality of life as much as most cancers do. And metabolic treatments, medications and bariatric surgery can provide tremendous relief from this burden. And it’s time for us to stop transferring the shame bestowed on reality stars and celebrities using this medication to lose 10 pounds, to those who are finding relief from their daily suffering as a result of the complex disease of obesity, diabetes, high blood pressure, cardiovascular disease and cancer. So I urge anyone who’s struggling with their weight or has a loved one who is to please read this article and reconsider your previous thoughts on the medical and surgical treatments of obesity. Let’s move on to your nutrition segment, Zoe. I need to calm down a little bit.
Zoe:
Okay. So something that I hear all the time is, “I just need more motivation. I’m just waiting to feel motivated. I’m just not motivated. Here’s the thing motivation is fleeting. If you wait until you feel motivated in order to take action, you’re gonna be waiting, and that’s why we just kind of keep kicking the can down the road. right Right? we We think that it goes motivation, then we take action, then we see results. It doesn’t work like that. I mean it can, but it’s much slower. So we wanna rescramble re-scramble that and create a different cycle known as the arms ARM cycle. So, this is action, results, motivation. Okay, so taking action, to then see results. Results doesn’t necessarily mean the scale going down right away. Right? That means more energy, a better night’s sleep, like those sorts of things. And then, over time, of course, the scale and your other goals catching up with you. And using those results as your motivation to continue taking action. It’s a positive feedback loop. I always like to say, “success is the biggest motivator. You’re feeling successful and you’re feeling proud of yourself, no matter how big or small that win is. It’s specifically non-scale victories, right, that is what’s going to motivate you. So use your action to feel better, see results and use that as your motivation to continue going on. And how you can see those results are by setting SMART goals. Setting a SMART goal that you can then see that win. So maybe the smart goal is that you are going to drink a glass of water first thing in the morning before you drink coffee. You do that a couple of days in a row. You will see results in that, “Wow, I feel more energy. Wow, I feel less tired during the day, right, like you’re not relying on that caffeine so much. And so using that as the win, as the result, and to see that motivation to continue that positive behavior change.
Dr. Weiner:
As you were saying that, I was like this is what we see after bariatric surgery. So patients have bariatric surgery. The first week, they lose eight pounds. And it’s like all of a sudden they’re like, “oh my gosh, this is going to work, I can do this. I can do this. And bringing it back to the smart goals, too is key is that the A in smart is attainable. Exactly. Right. Set yourself, don’t set a goal that you dream of hitting. Set a goal you’re going to hit. Break it off into tiny pieces and then use each of those tiny pieces to achieve the bigger goal. Exactly. Yeah, that’s a great segment. Let’s move on to the Economics of Obesity. And we’re going to talk about the affordability of GLP-1 medications, which, of course, is pretty much on everybody’s mind. Our entire practice is essentially set up around this and we’ve created. If there’s a way to get these medications affordably and safely, we have employed it in our office. And I won’t tell you it’s perfect because we are working in a broken system, but we’re able to get a lot of patients on these medications. Not every patient, unfortunately, but a lot. But I want to talk to you about something I think is kind of like the smoking gun of GLP-1 economics. Let’s take, for instance, Zepbound or Mounjaro. When you go and purchase it on GoodRx or using a coupon or however you purchase it, the 2.5 milligram dose costs exactly the same as the 15 milligram dose. That’s like walking into a grocery store and there’s a sign up that says one pound of oranges $3, six pounds of oranges $3. It never happens. It doesn’t make sense because there’s a cost to an orange and the more oranges that you purchase, the greater the cost that the store has to provide. But the fact is that the economics of GLP-1 medications has very little to do with the manufacturing cost. It has to do with the research and development. It has to do with the marketing. It’s another topic for another day. So we really do, as a country, have a lot more capability to provide these medications. The reason that these medications are so cost prohibitive is because of the health policies in place, it’s not because of the cost of producing them. That’s a really important thing to understand. We have policies in place and we have mechanisms in the way that we deliver these medications to the patient. From the time they’re produced to the time they are in your pocket, there’s a whole series of pathways. And it’s that pathway, and the policies we have around the pathway, that makes them unaffordable, not the manufacturing costs. Now, I’m not so naive to think well, we should just get rid of drug patents and give them all for free. And I understand that it’s complex. But there are PBM’s (Pharmacy Benefit Managers), like we’ve talked about, sucking a tremendous amount of profit out of this drug purchasing process. The drug patents are far too long. They should be shortened, especially for blockbuster drugs. There should be some element where the revenue drives the end of the patent, not the time. The inability for Medicare to negotiate with the pharma companies is thankfully being remedied, but very, very slowly. And then, I think the greatest culprit of all is the insurance companies. United Healthcare makes $10 billion in profit every quarter. Billion.
Zoe:
Every quarter.
Dr. Weiner:
Every quarter!
Zoe:
Like unfathomable.
Dr. Weiner:
It’s unfathomable. This is money that we are paying for healthcare that is not being spent on healthcare. Instead is going to United Healthcare the company. So if you took that $10 billion, and let’s say we were able to purchase GLP-1’s for the same cost that every other country except the United States does, which would be about $1,000 a quarter, about 350 bucks a month, that’s $1,000. 10 billion divided by 1,000 is 10 million people. So just United Healthcare alone, their profit could be used to purchase GLP-1 medications for 10 million people. Do you know what would happen to our nation’s health if you put 10 million people who need these medications on them? We would see reductions in cardiovascular disease, reductions in cancer, diabetes would improve. We’d see people losing weight. We would see remarkable improvement in healthcare. And so the problem, it’s important that we understand, the problem is the policies, not the cost. And obesity care is becoming ground zero in our fight for reasonable healthcare policies. The costs of treatment are high. The burden of the disease is substantial. And there’s a lot of people, 40% of Americans have obesity. And the insurance companies and the pharma industry are making record profits. Has anyone seen Eli Lilly and United Healthcare stock? They are doing extremely well. So we have to urge Congress people to let Medicare negotiate with Novo Nordisk and Eli Lilly by putting Ozempic and Mounjaro on the list of meds that Medicare is able to negotiate with in 2024. This is when we decide them and they’ll be active in 2027. Still a long timeline, but we got to start doing things now. There are things that can be done. This is going to become an important issue coming into our election cycle. And I urge all of you to become knowledgeable about each of the candidates stands on healthcare, the pharma industry, the insurance industry and starting to take stances that improve our health rather than the quarterly profits of these companies.
Zoe:
All right. Well, now we’re going to hear from our peer leader and patient, Laura, who came in. I’m super excited to hear her story and she’s going to talk to us a little bit more about her peer group. Which is super duper popular. Super popular. All right, so we’re really excited to have one of our amazing peer leaders, Laura, here with us. Laura, thanks so much for making the trip.
Laura:
Absolutely.
Zoe:
So why don’t you tell us a little bit about, you know you can give us a bit of background of your own journey. And we might want to loop background to that in a little bit. We can. However it feels natural to you, but I would love for you to share with us a bit about your experience as a peer leader in our nutrition program.
Laura:
Well, you know I was, I have told you both many times that I appreciate it. I was very flattered and honored to be asked to do it. I definitely like having this platform. I like being able to talk to others that have been in this journey. So, basically, I like to. I always start the group off by saying that you know, this is my living room. When we’re just a bunch of friends sitting around talking about something. Like that. I love that.
Zoe:
You have like a cult following.
Dr. Weiner:
Totally. totally.
Laura:
I love everybody that comes in there and I want everybody to feel that they are included, because we are involved in a very unique group. The thing that I think I like to promote the most in there is that there’s no dumb questions. There’s nothing that’s out of reach. I’m definitely not a dietitian to the stars, as you are, and I definitely don’t have the medical advice to give, but I can tell them that these are things that are feeling normal, we share. Last week we actually had somebody new come in and she was just completely vulnerable from the get go. She told us her story, told us the beginning of her journey, and she said she’s many times in her life felt very, you know, not included and you know the fat girl and things like that. And by the end there were so many people in that group last week that were just giving so much warm welcome and praise and sharing. So it’s fantastic. I appreciate being able to have that, because I really do feel that peers getting advice from one another is a little bit more comforting than just coming from you guys, you know. So it’s interesting.
Zoe:
Well, I think, how you have been able to cultivate such a safe space where people can, from the beginning, feel comfortable and to be vulnerable, and that is a very special skill, so I’m glad that you have this. You know you found like this outlet in order to have this community of people and you’re really good at it, so we really are grateful to you.
Dr. Weiner:
I appreciate it. Yeah, for sure. You know a lot of people will talk and we actually, you know, I’m constantly talking to people from outside of the kind of obesity treatment space. And though a lot of times will say, like well, you know the psychological issues that you have to deal with in your patient population. I’m like, what do you mean? The psychological issues? My patients are as normal as everybody else out there. We’re all a little bit crazy. Let’s be honest about that. Obesity isn’t caused by some form of mental illness or personal weakness or a wound that you’re feeding and instead of treating. But being overweight, being taught from an often very young age that your body is a source of shame and that you should be embarrassed about how you look and that this is actually your fault, is incredibly damaging. And so what do you do in your support groups to kind of address this and help people start to heal?
Laura:
You know we’ve talked a little bit about different things. You know, to me, I think, that when you go ahead and are treated differently in society, as I’ve lost 125 pounds, I noticed people giving me eye contact. And I’m a big eye contact person. There’s more people that make eye contact with you. There’s more people that open doors for you. And that is, psychologically, messing up with how you feel. So definitely we discuss the fact that you know, having self confidence in oneself is a big thing. So we talk a little bit about that. I really kind of reinforce self care. And, you know, starting your day off with positive things. And so, you know, having that boost of feeling good about yourself. Whether you are 360 pounds or whether you’re 130 pounds, you have to respect yourself before you can expect others to, you Know, respect you.
Dr. Weiner:
Yeah, that’s huge. And that’s something that I think we really try to push and promote with our patients as they’re losing weight. And you know, it kind of sucks that the weight loss is often part of that healing pathway. And that really just speaks to some of the things we’ve just talked about earlier in the podcast about how obesity really just looks, how society looks at patients who suffer from obesity very differently than everybody else. To some degree. You know that’s what’s setting the curve and we have to kind of move in that direction.
Zoe:
When I first met you, I remember we were going through, you were kind of getting ready for surgery and you were in that boat of, “listen I eat as well as I can and you were in this state of such frustration. Right? And helplessness. And because it’s not just a matter of having to clean up the diet, as we’ve harped on over and over again. Right? And it’s a medical issue. And so because you were able to get to the, Dr. Weiner was able to help you get to the root of what was going on medically, now you’ve been able to, I mean, you’re working out so much, you’re feeling so much better. You want to tell us a little bit more about where you were before surgery and what that journey has been like for you since.
Laura:
Absolutely. You know, in the news we talk a lot about, you know, all the different medications that help people lose weight and things like that, and it’s definitely something that helps us. And you know, in the bariatric community they call it a tool. And this is definitely a tool. But if you don’t have guidance and support, I truly believe that you can’t go forward. I come from big people. Both of my parents are heavy. My mom had bariatric surgery 20 years ago. She’s actually had it twice in her life. And we were raised with eating fast food and takeout just because of all the things we had, and so genetically, I’ve got that behind me. About eight years ago, I was faced with some health challenges and was told let’s take this medication. I did not want to take the medication at all. And so I had asked the doctor, “you know, can you give me 60 days to change things up and that’s when I really fell in love with exercise and healthier eating. I lost 100 pounds on my own, naturally. Wow. And that stayed off for about seven years. And then 2022 was a rough year. I had some medical challenges and rapidly I started to develop a lot of different problems. Type two diabetes was one. I developed non-alcoholic fatty liver disease. I gained 80 pounds in four months and nobody knew what was going on with me. Wow. After I had an endo, I was then referred to come to see you guys. And that was what late September of 2022. By time you and I talked, I had met with Claire, the non-surgical portion of it at that time, and we had determined surgically was going to be my best bet. I had all these things behind me genetically. I needed to reset that thermostat that we discussed. I had surgery on December 23, 2022. And by March, type two diabetes was gone. The non-alcoholic fatty liver, my liver is 100% healed. I saw my doctor recently about that. Things just disappeared. And I do work out and I use that tool to the best of my ability and I believe that following your plan and your guidance is a big deal. Having you and your help is a big deal for that too. So I am so much healthier. I’m almost healthier than I was in my 20s and I am grateful for your help. But I’m also grateful for the work that I put in for myself to make sure that I have that ability to feel good.
Zoe:
So powerful. Would you say that being a peer to leader and having that group each week to show up for has helped you stay more accountable to your own goals as well.
Laura:
Absolutely. There are many times on Tuesday nights is when we meet. Sometimes I’m having a rough day. I take care of both of my parents, who are both ill, and sometimes it’s challenging. And I just, I don’t want to have group tonight. And they pull me through by some of their stuff, and so absolutely it helps keep me accountable. It helps me make sure that they’re feeling good. And usually by the end of the night, even if I’m having a rough day or if I’m not, but definitely it helps a lot.
Dr. Weiner:
There’s something incredibly valuable about just connecting with other people. And especially when you kind of have shared the same experience, and now, especially, the way you have the group set up where you’re kind of meeting with the same people. And you’ve got your core and you’re becoming friends with these people and having that community and that connection is really, really valuable and important for anybody going through this process. I think you’re uniquely good at building that community and networking with people and making people feel safe and heard and validated, and that’s one of the reasons we’ve made you a peer leader. But you’re kind of taking this to the next level now, aren’t you? So talk to us about how some of these things that you’ve done through our support group is kind of changing your life and your career path a little bit.
Laura:
Again, with your wonderful optimism and support and by asking me to do this, I have started the journey to become a wellness and health coach. I’ve been told multiple times in my life that I should be a therapist. Clearly have the gift of gab. I’ve had several people in group tell me that I’ve helped talk them off the ledge. And so, yes, I started the journey to become a coach and I want to have my, basically my specialty if you will, be on bariatric support. Because I believe that postoperative support is the biggest thing.
Dr. Weiner:
It’s everything.
Laura:
I’ve talked to several people who have had surgery, whether it’s here or elsewhere. Or whatever, not here at Pond of Cure, but you know they go ahead and here’s surgery. With no instructions, no guidance, and they feel alone. And you know, I think the thing is is knowing that we can reach out and ask questions, whether it’s online, through the portal or whatever way. We have that support, and knowing that there’s other people that are on that journey. And so I want people to come to me and say you know, “hey, you’ve been through this, can you tell me if this is what I’m doing, Because everybody’s got that feeling of failure? Someone recently shared that they failed and ate something they shouldn’t. Well, we’re human beings who can still eat food. We just have to be careful. And I think that’s that slippery slope for so many people that they need to know that this tool that we’ve been given is going to be something that we need to take charge of as we get further out from surgery. We’re not going to always have that restriction. We’re not going to always have that feeling of fullness after three bites. But we need to learn that this is what I need to do instead of this. So making healthy changes, things like that, and talking people through it. That’s my plan. Yeah.
Dr. Weiner:
I think that’s that’s such a great point. You know, the thing about bariatric surgery is it’s kind of like like this one chip that you get. And you really only get one of them. Last week we heard from Stacy and she happened to do well with the revision surgery, but that to some degree, is the exception. For most people it’s you get that one surgery and you don’t want to screw it up. A lot of times If we’re not supporting people, we’re not setting them on that right path to make the best that they can out of that surgery. There’s other things too, and I think it’s our responsibility and I know Zoe does a lot of this in support group of saying, well, let’s talk about medications that can cause weight gain. Let’s talk about what to do if you get injured and it impacts your ability to exercise. Let’s talk about stress management, because if you kind of fall off the rails emotionally, often the eating follows. And so making sure that we have that support network, to me, post-op support isn’t about that one pre-op class and helping people through their four weeks after surgery. It’s about two years, five years, 10 years. Whether it’s through emotional support, whether it’s through nutritional support, whether it’s through medications to help, kind of guide people through this. And so we’re so happy to have you as part of our team, because we can’t get the best outcomes, we can’t help people the way we want to help them, unless we have peer leaders as well. There’s things that you’ve experienced that Zoe and I just we don’t know. We haven’t had the surgery, we don’t know how it works. There’s things that once we have to get out of the room sometimes and let you guys just kind of talk this out and share your own experiences and build that community, because nobody understands what you’ve been through the way you do.
Laura:
I agree and, like I’ve shared, that’s what I talk about in our group. This is my living room. I want everybody to feel safe and comfortable with just a bunch of friends shooting something in common that we have, and so absolutely I think that makes a big, big difference.
Dr. Weiner:
So, laura, how was your recovery after surgery? What are some things that you did that you think helped you get through the surgery smoothly?
Laura:
Well, like I said, with my history of not feeling well prior to surgery, I was suffering from so much inflammation and everything else just didn’t feel good. I wanted to do everything that you guys told me to do, to a T. And so I followed your rules. I followed the guidelines and I moved. I moved my butt. I walked a lot. My dog was really happy with that. I’m grateful that I live in Arizona, because it was January, February, but I walked a lot. Movement is key, I really believe, to healing. Getting that water intake, even on the days that you struggle, things like that. But movement, keep moving. And if you can’t walk or if you can’t run, there’s a lot of other movement out there that can be done. I say the internet is our friend, so definitely movement.
Dr. Weiner:
I think you’re right. Movement and hydration are the two most important factors to a smooth recovery.
Zoe:
Yeah, I agree. Well, Laura, we just are so grateful that A you came and shared your story with us today on the podcast. I think our listeners are going to get so much value out of hearing from you. And also, just how lucky we are to have you as a peer leader, and we’re really excited for what this year has to hold, and we know that you’re going to continue to flourish in your new pathway to becoming a health coach.
Dr. Weiner:
Yeah, and there’s space in your support groups too, right?
Laura:
Absolutely. Yeah, everybody’s coming.
Dr. Weiner:
So if you’re listening to this and you’re saying, “hey, I want to join this community, I want to meet with other people, I want to share my experience, there’s going to be a lot of value for me.” You can log in and sign up with Laura for her support group. You have them Tuesday evenings.
Laura:
Tuesday nights at 6.30.
Dr. Weiner:
Tuesday nights at 6.30. All right, thanks for coming, laura. Thanks.
Zoe:
I love hearing from Laura. She’s the best. Every time I talk with her, I just I love feeling her energy and her passion and she’s doing so much for our patients and she’s so successful. It’s really awesome to hear from her.
Dr. Weiner:
Absolutely, we’re so lucky to have her in our practice. All right, Sierra, let’s move on to our patient questions, our social media submitted questions.
Sierra:
All right. First question is from Instagram on our post about Pfizer nixing the twice daily pill for weight loss, and this is from groovy mom. What do you think that means for the future of surgeries? Do you think surgeries will always be used in tandem?
Dr. Weiner:
First of all, great username, groovy mom.
Sierra:
I like it.
Dr. Weiner:
Right. So our practice is focused on treating obesity. And we use nutrition, medications and weight loss surgery to find the right fit for each individual patient. This decision is complicated. It depends on patient’s wishes. Would you rather have lifelong meds or surgery? The answer varies tremendously from person to person. So your overall health, your medical history and, unfortunately, the ultimate determining factor – insurance coverage – that’s how these decisions are made right now. Weight loss surgery, especially gastric bypass, when performed by an experienced surgeon, is much more economical than the medications for the short term. Surgery is going to remain a critical part of the treatment algorithm for treating obesity as long as our drug patent laws will prevent any medications that are equally effective from being a cost efficient solution for at least another 20 years. So I probably have another 10 or 15 years of practice. I’m fairly certain that there’s going to be a lot of bariatric surgery performed. It’s very interesting because some patients come to me and say, “I only want surgery. Some patients say I only want meds. The best answer is probably the two together. But no, I don’t think the medications are going to replace surgery. Believe me, our national society there’s been some discussion about that fear. I don’t know that that’s realistic. I think surgery plays a role. This idea of having this one surgery, recovering in a few weeks and moving on and putting yourself on a much, much better metabolic pathway without the need to worry about insurance authorization for these meds for the rest of your life, is very attractive to a lot of people. We have one of the lowest complication rates in the country. We’re able to do these surgeries and get patients home with really not a lot of issues or difficulties. That’s going to be hard for the medications to compete against for a while. That being said, the medications are also fantastic and we see amazing weight loss from those. To me, it’s great to have both options. The two together are the most powerful treatment which allows us to get, find success for 95, 98% of all of our patients. No, I don’t think surgery is going anywhere. I think it’s going to continue to remain an important part of the treatment algorithm. In many ways, the medications may enhance it.
Sierra:
Okay, next question is from YouTube, from our video on fast weight loss. This is from EK McKenzie. I’ve been sleeved, but I have a very hard time eating the amount of food I need to eat for the amount of weightlifting that I do. I’m just at a loss in what to do. Also, I just do not want to eat any more food, so it would be so difficult to eat the amount of food I need. Any suggestions.
Zoe:
I love to hear that you’re doing a lot of weightlifting. That’s great. I always get excited about that, but ultimately that means your energy and protein needs are higher. If you are at a loss, and are like, “I just cannot eat any more food. I would recommend making a smoothie. You can put so much great nutrition protein. You can really pack that thing full and it could be something that you sip on. It doesn’t feel as much of a commitment as sitting down and eating more like another plate of food. That’s what I would recommend, also trying to space out your meals what I like to call mini meals, you know, evenly spread throughout the day so you’re not sitting down and forcing yourself to eat a big volume in one sitting. That can be very helpful. But, of course, exactly what your protein needs and that sort of thing. I don’t know what that is because I haven’t spoken with you, but that would be my suggestion in terms of trying to make a really chock full smoothie with a lot of good nutrition and protein in there could probably help get up those energy needs without feeling like you’re eating a whole bunch of extra food.
Dr. Weiner:
Yeah. No. Great suggestion. I think smoothies are certainly better. The store bought protein shakes, we’re not huge fans of them. They definitely play a role in the immediate phase after surgery. And you know, this patient is kind of talking a little bit like they’re early in the post-op process. And so it’s not that we forbid them. We use them a lot in the first few months after surgery, but we want to make sure our body realizes that’s not part of your long-term plan. I think the other thing to recognize and again, we don’t know when this person was sleeved but whatever you’re feeling now, you’re going to feel differently in a few months. Later in that first year. So it changes a lot. So, all right, Sierra, what’s our last question for the show?
Sierra:
Okay, this was actually a comment on our Instagram posts on Pfizer nixing the twice-daily pill for weight loss. Ah, so the reason that doctors never really cared about weight loss for most people was because they didn’t have a medicine to fix it.
Dr. Weiner:
So I put this on because, you know, this isn’t the kindest comment that we’ve had come through our social media, but that’s okay. Because I think this is something that is out there. The truth is, I think you’re right. That there is some truth to that. But if you’re going to dive into this, it’s not because doctors are bad people. It’s because obesity treatment is complicated. It’s, I think, two important things. The first is up until recently, nutrition and exercise were what we had. And then surgery, for kind of the one or 2% of people who met the criteria for surgery had it. Bariatric surgery was very uncommon. It was nutrition and exercise. That was what was out there. And let’s be honest, Zoe, nutrition and exercise are not the most effective treatments for obesity.
Zoe:
Can only get you so far.
Dr. Weiner:
It only gets you so far. And there’s always a few people who do really really well with this approach, but the majority of people who use nutrition and exercise as their only means of weight loss don’t end up being successful. And keep in mind, I wrote a book on nutrition. I mean, I’m all in.
Zoe:
Also. The other piece of it that I just wanted to mention is, like most, you probably agree, is like in med school you get maybe a lecture on nutrition.
Dr. Weiner:
I didn’t get that lecture.
Zoe:
Right. So it’s like doctors are not there meant to be, medical doctors not do nutrition counseling. That’s why dietitians are here. So it also is like, yeah, eat healthy and exercise, but it’s like there’s not that connection of what that actually means or the accountability and the follow through.
Dr. Weiner:
If you do it exactly right, it doesn’t always work. And so, first, nutrition and exercise, It doesn’t work for everybody. If it did, doctors would get behind it, no question. The second is that doctors are people too, and in general, they’re honest. I’ll tell you, I’ve met some dishonest doctors. There’s no question about it. They are out there, but they are really few and far between. I know lots of doctors, and in general they are good and honest people who really just want to help their patients. That most likely, when you’re sitting down with a doctor, that is who that person is. They may not act like it at the moment that you see them. But that is, in general, who they are as a person. They’re working in a very broken system right now. Doctors did not create the system. Doctors are not the ones making massive profits off of the system either. And so it’s important that when you’re sitting down with someone and they may, as a physician, they may not be helping you with your weight the way you would like them to. It’s not because they don’t care about you. It’s because they don’t have the tools to make this work. And so if you’re in that scenario, what you should ask is, “hey, is there someone you can refer me to?
Zoe:
A specialty in obesity medicine.
Dr. Weiner:
Also little to no compensation for nutritional therapy and obesity. That’s why our patients all pay for our nutrition program out of their pocket because insurance will not pay for it. To just today I had a conversation with an insurance company about how we could get this paid for, and they were like, “you can’t do that. That doesn’t work, it’s just we’re not going to pay for it. In general, we’re just not seeing insurance companies being open to providing care for nutritional care for obesity. So I think if you’re facing this, it’s not that you, the patient, are annoying the doctor. Or that the doctor just wants to give you a pill and move on to the next patient. It’s that the system is designed in such a way to kind of push that type of treatment along. And up until recently there really hasn’t been much, except for surgery, that we could do for patients who are struggling with their weight. magine if you, every day, saw a dozen people whose health was failing from a single underlying problem that you had no resources to treat. Imagine the frustration that that would cause. And I’ve talked to primary care doctors about this. It’s really frustrating. And they see all of these problems and there’s nothing that they can do about them. And they see people suffering from them and there’s no compensation to treat them, or to help them, and no means to get to help these people out. That gets really frustrating at the end of the day. And this is what the doctors are feeling. But now we’ve got more options. We’ve got medication. Surgery is safer than ever. So, yeah, doctors are excited that there is a medication that can fix obesity. So what’s your take from a nutrition perspective on all of this? I mean, as you were kind of growing up in the nutrition world, what was your view on doctors and nutrition?
Zoe:
Well that they shouldn’t be giving nutrition advice. Honestly, just kind of like what I mentioned before. You’re not given nutrition training, which is very valid. You have much different priorities. But I also think that that then leads the opportunity for PCP’s and other doctors who are not specialized in nutrition, to refer out rather than maybe telling patients what I hear so many times is, “oh, my doctor just told me to eat less and exercise more, which gets so many people in the position that we’re trying to help right now. And so I think referring to not only dietitians but also obesity medicine specialists, such as our practice, just to really, you know, you don’t you know, if somebody’s experiencing maybe a really bad GI symptoms, you refer them to a gastroenterologist. It’s a similar situation, and so I think that it’s a matter of directing people to the right resource.
Dr. Weiner:
Or as if you’re the patient asking for it. I think you know, so, doctors aren’t given a lot of instruction on how to counsel people on diet nutrition. They may now, and you know I’m not really attached to a medical school, and so my suspicion is there may be a little bit more of, kind of, the they may be trained in like motivational interviewing. Which is a technique that you can use with patients to get them to change their behavior. I think there is some more of that. The thing that’s probably missing is the value of nutrition. There are a lot of diseases that respond very powerfully to substantial nutrition interventions. Diabetes kind of comes to mind. You know I’ve seen patients cut their A1C from 10 to 6 through diet alone. That is possible, and I don’t know that I ever got that lecture and I’m not sure that lecture, maybe that lecture is being given, maybe it’s not. I think if you’re out there and you’re a medical student or somehow closer to training than I am, I’d love to hear if that is something that’s being done. But this is a complex problem and, but in general doctors are good people and they’re working in a not so good system. And so a lot of times what you’re experience with your doctors from is based on that frustration that the doctor’s having with the system. Not necessarily with you or judgment against obesity or whatever other health problem you’re seeking care for.
Zoe:
Well, that wraps up another episode.
Dr. Weiner:
Unlucky episode 13.
Zoe:
Hey, it’s lucky.
Dr. Weiner:
Taylor Swift.
Zoe:
Yeah, exactly. All right.
Dr. Weiner:
So now you know what your doctor really thinks about your weight. A little more complicated than you might have thought, huh.
Zoe:
I’m so shocked.
Dr. Weiner:
I know everything in healthcare is complicated right now. Probably more complicated than it needs to be.
Zoe:
Yeah, well, that’s true. All the hoops.
Sierra:
Yeah.
Zoe:
Lots of hoops. Anyway, thanks for being here with us. We’re really excited to be back next week and we’ll see you in the next one.
Dr. Weiner:
Absolutely.
