Celebrate a milestone with us on the Pound of Cure Weight Loss podcast as we unwrap the perplexing world of medication costs and the light at the end of the tunnel for those striving for approval. We mark our 10th episode with a victory lap, having broken into the top 15% of all active podcasts, and there’s much to discuss. From the cost of weight loss medications, to the sensitive matter of privacy in weight loss surgery decisions, we’re peeling back the curtain on these pressing issues. Plus, we’re sharing clever tips on how to sneak more vegetables into your family’s diet for transformative health benefits – because who knew a simple “veggie drawer” could be so revolutionary?
The power of community in the weight loss journey is immeasurable, as Amy’s story with our program beautifully demonstrates. Her narrative is more than just personal triumph; it’s about the chain reaction of positive change that ripples through a family, reaffirming that support systems and continuous engagement are vital for lasting success. As we navigate these heartfelt tales, we also tackle the controversial presence of Pharmacy Benefit Managers in the healthcare system. With legislation looming on the horizon, we discuss the potential for a fairer landscape and the sparkling promise of transparency models like Mark Cuban’s Cost Plus Pharmacy.
Wrapping up this episode, we acknowledge the hard truths about the viability of certain weight loss options. We also cover weight regain after a sleeve, nutrition options while traveling after surgery, and the weight loss medication Metformin. Don’t forget to subscribe and join us on social media at ‘a pound of cure’ for more insightful, science-backed weight loss discussions. Here’s to health, hope, and the pursuit of knowledge – until next time, keep tuning in for the stories and strategies that can shift the way you approach your wellness journey.
Transcript
Zoe:
Welcome back to the Pound of Cure Weight Loss podcast.
Dr. Weiner:
We just changed the name to that, just now, at this very moment.
Zoe:
We changed it. In this moment, live here with you.
Dr. Weiner:
We realize that nobody knows what The Pound of Cure podcast is about. And I know when I look at podcasts, I like look at the title and oh, that’s what I want to learn more about. So we just now renamed the title to The Pound of Cure Weight Loss podcast Tell all your friends. So we did it, it’s done.
Zoe:
So we are on episode 10. Why your meds cost so much? So we’ve got a really packed episode today. But did you know? Only 8% of podcasts have more than 10 episodes.
Dr. Weiner:
We’re doing. I’ll tell you I think we’re on to something here.
Zoe:
I’m excited, isn’t?
Dr. Weiner:
it.
Zoe:
We’re already in 8%.
Dr. Weiner:
Yeah, yeah.
Zoe:
We also now are in the top 15% of all podcasts which I’m impressed by. All active podcasts.
Dr. Weiner:
Active podcasts, yeah, all active podcasts.
Zoe:
So keep that ranking going. Tell all your friends, tell your family, spread the word. I think that we have so much value here, and if you find this valuable, we definitely would appreciate you sharing the word as well.
Dr. Weiner:
Absolutely. Our goal is really to provide science backed information about weight loss. Taking all the stigma out of it, providing a good, kind of, common sense approach to losing weight that really takes the stigma out of weight loss surgery, out of the medications and also out of the nutritional changes, and just comes up with something that works for patients, and so that we’re looking at obesity like we look at every other disease.
Zoe:
No bariatric patient left behind.
Dr. Weiner:
That’s right. No GLP-1 med patient left behind. That’s our goal. We want everybody to understand that physiology plays a huge role in weight gain and if you’re going to solve this problem, you have to take a physiologic approach, and that’s what this podcast is about. On a different note, our practice is growing and we are hiring. We’re looking specifically for nurse practitioners or physician assistants. We do have room in our practice for an additional one. We’re growing very quickly. We’re really only limited to seeing patients in Arizona because of medical licensing issues. Our hope is ultimately to grow beyond that and we need more staff in order to do that. So if you are a nurse practitioner or a physician assistant want to join a rapidly growing practice with its own podcasts, how many of those are out there? Let’s be honest. Please give us a call. Reach out, call the office, ask to speak to Sierra, our office manager. I also wanted to share that. On two episodes ago, we talked to Kim and Larry and they were both struggling to get their Ozempic approved. We actually have gotten Kim’s Ozempic approved. I spoke to her the other day and she has received her medication. So there is hope for those of you who are facing denials out there. So anyway, Zoe, what are we going to talk about this episode?
Zoe:
Yeah, like I said, we’ve got a packed episode. We are going to be talking a lot about drug costs; why they’re so high and who’s to blame. I think everyone will want to know about that. We do have a patient story. We’ve got another guest which we’re super excited because she actually has a fabulous way of getting her kids to eat more vegetables along with herself. And she’s also going to discuss the privacy around her decision for having surgery, and I think that’s also a very important component as well, and that’s perfectly fine to have that privacy. So she’s going to share a little bit more about that. We have our, of course, nutrition segment. I’m going to share with you a hack for getting more veggies in making it more convenient to eat your vegetables, as well as our questions from our listeners. Weight regain after surgery, specifically the gastric sleeve. Metformin and then staying on track with nutrition while traveling, specifically those first couple of months after surgery.
Dr. Weiner:
Fantastic, all right, great episode. Well, let’s get started. Our first segment is the news, and this article comes from MoneyWatch and it talks about how drug makers are hiking the prices of more than 700 different medications starting January 2024. Ozempic and Mounjaro are both on this list. So in order to understand drug costs, you really have to go way back. When you think about commercial payers, we all think, oh well, there’s United and Cigna and Blue Cross and Aetna, but it breaks down much, much, much more granularly. So there’s like 150 different flavors of United healthcare or more, and the same can be said for Cigna and Blue Cross and Aetna. So there’s all these tiny policies and they’re each kind of trying to create their own contracts with the pharmacies and with the medication manufacturers in order to price out the medications fairly, and so, immediately, we don’t have these kind of big players. The only big player out there that would have the power to really hit the pharma industry hard and negotiate with the pharmacies and the drug makers in order to lower the cost is Medicare. However, if you go back to 2003, GW Bush signed the Medicare Prescription, drug Improvement and Modernization Act and it went into effect in 2006. And this was supposedly one of the most brutal sessions of Congress, where they negotiated whether or not Medicare should be allowed to negotiate drug prices, and so, before this act, Medicare didn’t cover drugs. You had to buy a separate policy to cover outpatient medications. Medicare really only covered inpatient stay and then your doctor’s visits as well, but it didn’t cover medications. And right around this time, it went from most of the medications being generic and costing five bucks to these higher price medications. The law ultimately passed that blocked Medicare, and it’s a law. Medicare is not allowed to negotiate with drug companies, so, whatever the drug company says, the price is. That’s the price to Medicare, which to me seems a little bit crazy. We took the one body that had some power, some influence in reducing drug prices, and we blocked them, put them out of the negotiation. So the first thing is is that Medicare is actually, for the first time in 2025, going to be able to negotiate on drug prices, and the way they did that is they’re phasing this in. They’re adding around 10 drugs per, not around. They’re adding 10 drugs per year to the list, and they’ve already released the list for 2025. When this, when this law, starts. Ozempic, Mounjaro, there’s actually no GLP-1 medications on this list, unfortunately, and so we’ll have to see what happens in 2026. Because of all the obesity bias out there, I would not be the least bit surprised that these medications are pushed out for a few years. All right, there’s a lot to talk about and this is complicated, but I think it’s really important for us to kind of scratch away at this every week to see if we can get a better understanding of why these medications are so expensive, because there’s things that we can do. We can join the Obesity Action Coalition, we can reach out to our Congress people, we can follow some of the laws that are out there, and there are some laws that are currently being voted on that may help reduce drug prices.
Zoe:
And it’s important you know, like the more that we can spread this information. I’m learning so much, you know, and I think the more that more more people know, then there’s more change that we can help facilitate.
Dr. Weiner:
Yeah, All right, let’s move on to something lighter. Why don’t you talk about our next guest here?
Zoe:
Zoe, all right? Well, we want to welcome Amy. She has been a patient with us for two years.
Dr. Weiner:
About that. Yeah, it’s been a while.
Zoe:
Yeah, and so we’re really excited to hear from Amy. All right, now we have our incredible patient, Amy, here to share her story. Amy, thank you so much for being here with us. Thank you for having me. Yeah, we know you have a long drive, so we appreciate you making the trip. Thank you.
Dr. Weiner:
So, first of all, you don’t see Amy here, and the reason for that is because Amy is keeping her story about bariatric surgery private. So, Amy, who have you told about your bariatric surgery?
Amy:
Husband. that’s it.
Dr. Weiner:
That’s it. So talk to us a little bit about just let’s just talk about the nuts and bolts, like how that work? Like you had some time off and there was a recovery and then there was a period of rapid weight loss. Like how’d you kind of explain that to people? Did people ask you know how’d that go, how’d that work for you?
Amy:
So one thing that worked in my favor was that I had my surgery during COVID and so I had limited interactions with everyone outside of work, so I didn’t really see like, for example, anyone outside of my immediate family, so there they weren’t able to notice the changes. And what I did with work is I was honest. I said that I was going to be having surgery for a hernia repair, which was done at the same time that my gastric bypass was, and so I really just made it about that, and as I began to lose weight, people asked me questions about what I was doing, and what I really focused on was the truth. I was eating mainly protein and vegetables and being intentional with my water intake and my exercise.
Dr. Weiner:
Fantastic. Yeah, I actually believe it or not. I have a patient this is back for my Michigan days who didn’t tell her spouse.
Zoe:
What.
Dr. Weiner:
Yeah, she did not tell her. Not even her spouse knew that she had weight loss surgery, and she actually pulled it off. So you pulled this off, right.
Amy:
I have pulled it off.
Dr. Weiner:
Yes, yeah, barely anybody knows that you have had weight loss surgery, and I think this is you know. I love that that you’re on the show sharing this, because I think there’s a lot of people out there who who are afraid of the stigma of weight loss surgery and think, oh, if I want to have this surgery, I want to go through this, but I don’t want everybody judging me. And I get it. Like who likes to be judged and, let’s be honest, people will judge. And there’s also though, I think, the other side of this is that for every one person who judges, there’s gonna be ten people in your corner pulling for you. And, but, I think that the fact that you can go through the surgery and not tell anybody about it, that is totally doable. We do that all the time. Patients will give me instructions. Hey, my mom is with me. She thinks this is hernia surgery. Talk to her about my hernia surgery and my, my responsibilities to my patient is not to my patient’s mother. And so I have no problem with that. I think most surgeons, I’d say probably 98% of surgeons, are gonna go along with that. No problem, I think from an ethical perspective, it’s very clear your obligation is to the patient. So you’ve been able to pull this off. Is there anything else about your decision not to tell people’s that any unexpected side effects or thoughts that you have about this or anything happened where you almost got caught?
Amy:
What I didn’t expect was, so I had surgery with a different provider out of state and had some complications, and then found you about a month after my surgery. And I found the entire community here at Pound of Cure Weight Loss, and so that was the first time where I was able to be honest with anyone about exactly what I was going through. And what I didn’t realize was what a difference it makes to connect with people who have lived what you are living, who have had this shared experience, and so that’s really one thing that sticks out to me.
Dr. Weiner:
Yeah, absolutely, I Totally. We’ve talked about that a lot.
Zoe:
Yeah. Yeah and it’s really cool because Amy has been a. What did you? You saw her on the leaderboard right.
Dr. Weiner:
Oh yeah, you’ve attended more nutrition sessions than any of our other 700 members.
Zoe:
Because it really speaks to the impact and power in the long-term accountability and the maintenance phase I talk a lot about, like we don’t want to be in like losing weight phase forever. We want to be in weight maintenance phase forever, but the reality is, is that that’s just as hard, if not harder. It’s harder. It’s harder. Yeah, and so having the community and like being empowered to continue to show up for yourself and I think that that’s something that you do really well and I’m so proud of you for that.
Amy:
That accountability piece is just phenomenal Um with your program. And I think it really sets everything apart. And it’s a huge reason why I keep my membership with Team- up is I am now three years post-op. I have not had any weight gain and I’ve really attribute that to the two of you and the amazing community that you have built.
Dr. Weiner:
Thank you. Yeah, we’re actually working on some other pieces to enhance the accountability to allow for you to kind of set goals and work with Zoe and and have some accountability for meeting those goals every week, every month, whatever, whatever we work on. So it’s great to hear that that works because we, honestly, we put a ton of energy Into it. It’s not exactly a huge money maker for the practice. There’s a lot more money doing the surgery, I’ll be honest with you, and that’s not what what drives us here, um, but you know, for us, this is what’s really important is making sure that people feel heard, feel safe and and because if you’re not emotionally supported through this process, it’s so much harder. And you had a rough go with things for a little bit initially and being able to connect with people Um makes a huge difference. So we’re really happy about that. But but we’ve also on, I think, on a um more positive note, more practical note, this has changed your family quite a bit. So why don’t you talk about some of the things in your that’s changed in your family after surgery?
Amy:
Sure. So I have several children and, when I had our first kiddos, I was in a lot better shape than I was when I had our last kiddos. And so with our youngest specifically, um, she’s always been in like the 100th percentile for height, or I’m sorry for weight, not height. She’s about 50th percentile for height. And so every time we go to the pediatrician it’s a really big issue when kids have that kind of growth on the growth chart, even though they’re really young. They order all kinds of labs like cholesterol and sugar. She has to fast for the labs, and so it just made me really sad that I I felt like I had set, kind of, my first kids up for success, by prioritizing my health. But I gained a lot of weight with each pregnancy and then with our, our youngest kiddos, I I didn’t do that. And so I was having just a lot of mom guilt, honestly, about that and I really wasn’t sure how to change it. I had um asked our pediatrician who’s amazing, and she basically said you know, eat less, move more, type of advice, and so over the summer I was very nervous about the youngest gaining weight. I thought, oh man, we don’t have the structure of school. She has access to food all day long. What is this going to look like? And I leaned on The Pound of Cure book. And I took that principle and created the veggie drawer at home. So what we do is we prep several different vegetables for the kids to access and really I made it for our youngest. But of course our older kids, they have access to this too. And so what it is is just several vegetables, some of them they choose, some of them we choose. We prep them, we put them in the fridge and they can get anything from the veggie drawer at any time, no questions asked. So it could be two minutes before dinner, it could be right after school, it might be, our youngest favorite is one minute before bedtime, but we decided we were never gonna say no to the veggie drawer. And what happened over the summer was our older kids, they gained weight over the summer. It wasn’t excessive, a few pounds. But our youngest actually lost several pounds. And so when we went to the pediatrician and she asked me right away what did you do? What? What we don’t usually see, you know, um BMI come down like this in in kids. And so I explained everything and, um, she really was so happy that her health is improving.
Dr. Weiner:
That’s awesome. Good job, mom.
Zoe:
Thank you.
Dr. Weiner:
Oh, my God.
Zoe:
And what I love about it too, is it puts some of the ownership in the kids’ hands too when they get to pick out the veggies. They want to be independent, they want to make those choices, and so it really puts the power in. You make them think that they’ve got the power.
Dr. Weiner:
Yeah.
Amy:
Well one thing that I would like to share, too, is it really has empowered her to make really healthy choices outside of home. And so sometimes, as we know, with life happens, we have to go out to dinner and she is the first to order a salad. And she’ll order that salad just vegetables and protein. She doesn’t use any dressing, and she’s even been complimented out for being a kid who’s in public eating a salad.
Dr. Weiner:
Yeah, I think there’s some other really important things that are happening by doing this. How old is she? She is five. She is five, so her genetics are not finalized. And that’s something we kind of think oh, when the sperm and the egg comes together, boom, that’s your genes. But that’s not how it works. There’s this whole thing called epigenetics. And epigenetics is this process where our environment turns on and off certain genes. And so when we’re exposed to highly processed, highly palatable foods, it’s going to turn on genes that promote weight gain. When we’re exposed to lots of vegetables, we’re going to turn on genes that cause weight loss. And so at five years old, that epigenetic process is still developing, it’s still in place. It’s probably in place for a couple more years. And so when you’re getting your children, your young children, on these eating a lot of vegetables, you’re helping to turn on genes that are going to help them with their weight maintenance for the rest of their life. So there’s never an age that’s too young, obviously assuming they can eat the vegetables safely. But I love what you’ve done. What a great story, I think. What a great example, also positive parenting, because with those veggies, whenever they ate the veggies, I’m sure there was lots of positive reinforcement that came along with it, where so much of dieting and so much of treatment of childhood obesity is don’t eat this, don’t eat that. Restrict yourself. You’re bad if you want to eat these foods when you’ve focused on the positive side, which is so helpful for kids.
Zoe:
Focusing on what you can add, not what you have to take away.
Dr. Weiner:
So I love this story. What a great story, Amy. I think you’re an inspiration. Your weight loss success, I think the way you’ve managed your decision about surgery has really been fantastic and you made it work for you. And then what you’ve done to spread some of this healthy eating to your children is amazing. And then for being such a valuable part of our community.
Zoe:
We love you, Amy. Thank you.
Dr. Weiner:
Absolutely.
Zoe:
I love you guys. All right, very good.
Dr. Weiner:
Fantastic.
Zoe:
Well, that was so awesome and I hope that everybody listening got some good nuggets of information. Now my nutrition segment has to do with something similar. Right, making vegetables more convenient to eat. One of the number one barriers that patients tell me about when trying to increase their vegetable intake is the time. Is the convenience, right. It’s not convenient for many people to oh, I’ve got to cut up in this bell pepper. Right, you’ve got to take out the seeds, you’ve got to do this, that the other, and then it’s ready to have as a snack or put into your eggs. And so it’s that time barrier that we need to break down. And so a little hack that I recommend has to do with prepping. So some people love to do their meal prep Sunday, dedicate meal prep. That’s amazing. For a lot of people, meal prep has to look different, and that’s okay. So prepping your vegetables can be a huge time saver and making it more convenient. So this is my challenge for you is to, when you get home from the grocery store, don’t put away your veggies. I want you to put away your other, your other groceries. And then you’re going to take 10 minutes to wash and chop your veggies, put them in Tupperware containers. They’re clean, they’re ready to be added to salads, grabbed as a snack, added to your eggs, whatever you want to have your veggies. And put them at eye level in the refrigerator, that bottom drawer where the veggies go. You know, maybe you have the best of intentions, you buy a bunch of veggies and you put them in that bottom drawer and then, when it comes time to actually eat them, a lot of people say, well, they end up going in the trash because it’s you know, they don’t have the time, the convenience, and then the vegetables die. So do yourself a favor take out five, 10, maybe max 15 minutes, get your veggies ready to go, make them convenient, have them as a snack, add them to meals.
Dr. Weiner:
I love that. That’s a fantastic idea. I think it gets back to some of the things we’ve talked about in past. Shows about your food environment, right, absolutely. When you open the fridge, the first thing you’re seeing are the veggies. There’s not an obstacle. There’s not a barrier to you choosing those as your snack as opposed to something else. That’s one of the reasons why chips and other highly palatable foods are so frequently eaten is that you just grab the bag, open it up. I mean you can pretty much have you know, have the handful in your mouth before you even recognize the conscious decision you just made to eat. So you’re really kind of putting vegetables on par with chips and cookies and other packaged foods and making them just as easy to eat. Exactly, I love it. All right, so fantastic tip and really helps you kind of sinking that as well with Amy’s discussion about the veggie drawer for the kids, can be a great way to make sure the kids have that available. So we’re going to kind of shift back to our topic and extend a little bit more about drug prices and we’re going to talk today about on our economics of obesity segment. We’re going to talk about pharmacy benefit managers, also known as PBMs and again, getting a straight answer on exactly how PBMs are priced and what role they play in medication acquisition in prescription coverage, is very difficult. You know PBMs, you’ve heard of them before. These are companies like CVS, Caremark or Express Scripts by Cigna, OptumRx, which is owned by United, and then Humana Pharmacy, which is owned by Humana. So what’s happened is all of the big insurers have gone out and purchased these pharmacy benefit managers. So again, they control every single part of the prescription drug cost, except for the pharma industry, the manufacturing of the medications. After it’s manufactured. They essentially control everything until it reaches your hands, your insurance, all of that stuff. So a PBM or pharmacy benefit manager sits between the pharmacy and the insurer and they are the ones who come up with the formulary. So every time you go online and you say, okay, hey, is Wegovy covered, is Mounjaro covered, what are the criteria? These are rules that are created by the PBM. The role of the PBM is to lower the prices. And these things have been around since the 60’s and they would work with the insurance company. And their job was to go out to the pharmacies, to go to the pharma industry and say, hey, let’s talk about the cost of penicillin. We’re buying a lot of it. We represent 10,000, 100,000, a million people. Now these PBM’s are representing 20, 30 million people, and we want the price to come down. And so that’s what the role of the PBM is supposed to do. But in fact that’s not how it works. So the big issue is, and something we found time and time again, not just in medicine but anywhere in economics is when profits are linked to a certain behavior, we get more of that behavior. So there’s two components to PBM pricing that misalign the PBM profits and lower drug prices, and the first is something called price spread. And so what happens is the PBM goes out to Walgreens and the drug manufacturer. It’s a very complicated relationship, because they negotiate both with the drug company and with the pharmacies. And so let’s say that they say, okay, this drug costs, we’re going to cost $100. And what they then pass on to the insurer is not $100, but $100 plus 10%. So it’s a percentage, and this is called a price spread. So they’re paying the pharmacy $100, but they’re charging the insurance company $110. Now, technically, the insurance company and the PBM’s are separate entities, but they are owned by the same corporation. And it just allows them to, kind of, they both get to profit in this instead of having to potentially share the cost reduction. So let’s say the drug now costs $200. They get to keep $20. And so the higher the drug cost, the more the profits they make. And in fact, this is an underlying theme that pervades not just the prescription industry but much of healthcare. And that explains so many reasons why our healthcare costs are increasing is that the people who are supposed to be working to lower our healthcare costs don’t benefit from lower healthcare costs. And so until we get the employers, because the employers are who pay the majority of healthcare, like our practice we pay for a percentage of our employees’ healthcare and that we’re paying this cost. Large employers pay for tens of thousands of people’s healthcare and they can either be paying in the form of premiums, like we do, but larger employers are what are called self-funded. Which means they actually pay for each healthcare transaction. So the employers are paying for this, but they don’t really get to sit down and help reduce the cost. It’s the insurance companies, and we see that the insurance companies make more money as healthcare costs go up. So the second component that is extremely opaque about this process is about rebates. So typically, when you purchase something, let’s say you’re in a negotiation, we say, okay, I want to pay $100 for the drug, and the manufacturer goes what about $200? And you say, okay, well, normally you would say, well, let’s settle on $150. But that’s not how it goes in these negotiations. Instead, they say, okay, how about this? It’s $200, but at the end of the year we’ll give you a $50 rebate. Guess who keeps the rebate? The PBM. They don’t pass that rebate back to the insurance company, back to the employers, back to the Medicare recipients, back to the people who are paying for the insurance. And so they say, oh well, the drug cost $200, but it didn’t, because they got that rebate at the end. And so this price spread and these rebates prevent us from really getting an accurate determination of the cost of a medication, and they make it so that there is an incentive for the PBM’s to keep the drug prices high, and they’re the ones involved in the negotiation. But there’s hope. So, first of all, there are two laws that are currently going through Congress. And I would encourage everyone to reach out to their Congressperson and suggest that they vote for these laws. And so the first is Protecting Patients Against PBM or Pharmacy Benefit Manager Abuses Act. And there’s another act called the Patients Before Middlemen. And these acts only apply to Medicare, so they don’t apply to commercial policy. But they essentially have forced the PBM’s to only charge a flat service fee. So for every member they can say okay, it costs 20 bucks a person to participate in our prescription plan. And that’s the only way they can make money. It prevents the spread pricing, so there’s no ability if they pay a pharmacy 200 bucks, they gotta charge the insurance company 200, they gotta charge Medicare 200 bucks. There’s no hidden service fees and there’s no percent charges based on the cost of drugs. Because, again, the higher the cost of the drugs, the higher the percent return for the PBM. And so these laws are actually really helpful and favorable and will bring down costs for Medicare. They do nothing for commercial policies, but so much in healthcare is linked to Medicare. So as we get more of this in place for Medicare, the commercial plans are going to be able to say hey, I want that too. Some other really great things are happening. There’s Mark Cuban’s Cost Plus Pharmacy. And he is extremely transparent through this program. And they sell only generics right now and they are a tiny, tiny, tiny piece of the prescription puzzle. I mean, they’re far less than 1% of all the prescriptions that are sold. But it’s very clear you want this drug. Well, this drug, we bought it for $80. We’re gonna charge 15%. That’s what they charge, a 15% plus shipping and handling fees, and it is just right there on the list. This is our cost, here’s our 15% markup. Here’s your shipping and handling fee and here’s your cost. And we’re seeing drugs for half, a third of what you’ll get from CVS and from Walgreens. We see something similar with GoodRx as well, but of course, the PBMs are onto this. They see this cost plus model as being really well received by the public. Of course, of course, and so now we’ve got CVS Cost Vantage and CVS Caremark True Cost. So these are the PBMs coming out with their own version of this and, honestly, they’re not stupid. They see what’s happening. If I can see it, believe me, they see it too. They know what’s happening, they know they’re gonna have a lot of attention paid to them, they know they’re gonna have some limitations in their ability to profit the way they have been, and so they’re trying to come up with their own solution. But in many ways, this is like giving the fox the keys to the henhouse. If we count on the PBM’s to change their payment model, we’re just going to get more of the same. And it’s really important that this comes from outside of the insurance industry. All right, I’ve talked a lot about drug prices. I think it’s time to move on, okay.
Zoe:
So now we’ll move on to our listener and social media subscriber submitted questions. Sierra, you wanna go ahead and read off our first question?
Sierra:
Sure, okay. So first question is from our YouTube video from episode eight, Paging Dr Lily. And this question is from Angela. Hi, I had a sleeve four years ago. I was losing weight for a year and a half, kept it off for another year and I’m gradually putting on weight. Ever since, I’ve gained 10 kilograms. I’m doing CrossFit five times a week and eating pretty well, but I feel my body is craving more food, so my calorie intake increased. I’m worried the increase will never stop. Is my only option to go on meds?
Dr. Weiner:
So first, why don’t you talk a little bit about her strategy for weight maintenance? She’s now four years after a sleeve.
Zoe:
Yeah well, I mean, even though I’m not the biggest fan of CrossFit, I’m glad she’s doing, you know, structured exercise, both cardiovascular and strength, like we’ve talked about before. However, it’s really important to keep in mind, with the significant exertion weekly with exercise, you know her body needs that extra fuel and clearly it’s asking her for it. So my philosophy is you know, if your body is craving more food, we want to give it more food. It’s just as a matter of what you’re giving it.
Dr. Weiner:
Yeah, and I think you know, but the important piece of this question, she’s gained 10 kilograms. 22 pounds. And so there’s a lot of conversation about CrossFit and eating pretty well, and you know what are your thoughts on exercise versus nutrition in terms of the efficacy of weight loss and weight maintenance, which is more important?
Zoe:
Nutrition, for sure.
Dr. Weiner:
By a factor of five.
Zoe:
Right, it’s. I’m sure everyone has heard the phrase you can’t out exercise a bad diet.
Dr. Weiner:
Absolutely.
Zoe:
Right, we want exercise to build muscle and, you know, maintain your metabolism. But the reality is is that if the nutrition isn’t there, doesn’t really do a whole bunch of good.
Dr. Weiner:
I think I see this over and over and over again. And people who are really exercising a lot is that the nutrition often falls off. And I think, truthfully, you’re in, you’re much better off if you are eating well and exercising a little less than the opposite. And so my suspicion is is that the first thing that I would do if this person was in my office would be to get them on the Metabolic Reset Diet, to get them working through the nutrition program with you. Really dialing in the nutrition. And if you need to scale back the exercise to reduce some of the hunger and the cravings for processed foods, to me that would be worthwhile. Especially CrossFit, which is kind of the most intense of all exercise forms. Not saying give up exercise, but certainly reduce it if necessary and make sure that the nutrition is dialed in.
Zoe:
Well, and also kind of doing a little bit of tweaking and work. Obviously we don’t have a whole food history, but making sure that her nutrition around those exercise bouts, pre and post, are optimizing that exercise as well. Making sure she has the energy to get through it so that later on she doesn’t have more craving.
Dr. Weiner:
Right. Right, I think if the nutrition is dialed in and the exercise is dialed in as much as you’re capable of, then the answer to whether your only option is to go on meds it probably is. It’s either that or tolerate the weight gain, and that’s a personal decision, one you can make with your doctor. I think the meds work really, really well for weight regain after bariatric surgery. And this is something we’re actually looking at, at putting together and getting some hard data on, because we have a tremendous amount of experience treating weight regain after sleeve gastrectomy, particularly in our practice, and we see great results with this. We’re gonna talk in future episodes. We actually have some really interesting guests coming on who have managed to maintain their weight after treating it with their weight regain after sleeve. They’ve maintained it with meds, but they use a very novel dosing strategy. And so I think there is some opportunity that it doesn’t have to be this once a week, every week kind of thing. There’s some opportunity to come up with some creative dosing strategies where you may not be as reliant on the med as you think you have to be.
Sierra:
All right next question. Okay, next question is from Rafael, from our website. How can I stay on track with my nutrition while traveling during the first few months after weight loss surgery?
Zoe:
Great question, and I actually talk with patients all the time about really making sure that they have good tools and strategies while traveling and especially those first couple of months after weight loss surgery, priorities being fluid and protein. And so my main thing is, if you’re flying, bring an empty water bottle with you through security. Fill it up, you know, make sure you have your fluid. You don’t need to buy a $7 bottle of water, no. But then also, whenever it is that you’re getting to where you’re going, hit the grocery store or some sort of place that you can have those food items, those snacks, those protein sources that you have been relying on before traveling, ready to go. Packing some snacks with you, such as nuts, such as you know you can have your like protein shakes. Obviously, you can’t travel with Greek yogurt and vegetables, but making your grocery stop after you’re getting where you’re going can be really helpful.
Dr. Weiner:
Yeah, what are the rules about bringing protein shakes through TSA? I don’t think they’re allowed to, right.
Zoe:
Well, if you have like a sealed, shelf stable, ready to drink protein shake like a premiere protein in your checked bag, that’s fine. I have taken protein powder through the security. I have definitely gotten searched every time. Like I promise it’s just protein powder you can get through.
Dr. Weiner:
Dogs are there, you know, always getting everything wiped down. It’s clean, it’s clean, but not I. Maybe take the chocolate, not the vanilla.
Zoe:
Right. So you know, definitely putting a little bit of extra time and planning into making sure that you are prepared and don’t really worry about being looked at weird if you have to go to the grocery store while on vacation. You know you don’t have to eat out every meal.
Dr. Weiner:
Instacart too? Yeah, definitely, yeah, okay, last question, Sierra.
Sierra:
Okay, this one’s from Sharon, from the website. I’ve heard a lot about Metformin recently. What do you think?
Dr. Weiner:
Yeah, people talk a lot about Metformin. I love the cost of Metformin. Metformin is like $5. That is the only thing I like about Metformin. Unfortunately, it causes a lot of GI side effects and extremely little weight loss. Every now and then we’ll see someone have some modest weight loss from Metformin, but in general we’re looking at three to four pounds if you continue to take this medication that makes you feel lousy. Essentially, I think this medication works by making you feel nauseous and giving you a GI upset and that discourages you from eating a little bit. But I don’t think it does anything metabolically to drive weight loss the way the GLP-1’s do. So it is a reasonable option for someone. Well, it’s not really a reasonable option for anyone, honestly, in my opinion. I wish it was because of the cost, but it just doesn’t work, unfortunately.
Zoe:
Yeah, sounds like that’s that.
Dr. Weiner:
Yeah.
Zoe:
Well, that wraps up another show. Happy to have you guys here listening with us and, as always, be sure to subscribe to our podcast so we can continue climbing in that ranking and also delivering science-backed information about your weight loss journey here to you for free.
Dr. Weiner:
That’s right without judgment.
Zoe:
Right, exactly, make sure you give us a follow on social media. All of your favorite platforms at A Pound of Cure are a nice new sign which we’re super excited about, and we’ll catch you in the next episode.
Dr. Weiner:
See you next time.
