How to Quiet the Food Noise

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: 0:17

All right, welcome back to the Pound of Cure Weight Loss podcast. Here we are on episode number 17,. How to Quiet the Food Noise.

Dr. Weiner: 0:24

Yeah, people like that term food noise.

Zoe: 0:27

Yeah. I think it's pretty telling yeah absolutely, and I think it's kind of relatively new that it's been really popularized and utilized.

Dr. Weiner: 0:35

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 that some people have more of a drive to eat than other people, yeah, 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: 1:04

Well, you know I love doing things that get me outside hiking, running but guess what? I don't do it very often, Unfortunately. I would love to. We were talking how I was able to enjoy some time this weekend to go outside and hiking, 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 with clients and patients about of temptation pairing. So I have the you know 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, listening to a podcast, your favorite podcast your favorite podcast while you do.

Dr. Weiner: 1:55

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 While. Speaking of gyms, our news segment is from CNN and it's Osempic is coming for gyms. Here's how they're responding, and there's kind of two parts of it. The first part is that a lot of gyms are coming up with customized workout plans for people using GLP1 meds, like Osempic, 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. So let's talk first of all about gyms and programs for preventing muscle loss and Osempic.

Zoe: 2:40

You probably know more about this than almost anybody, so 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: 3:07

I think it also takes away some of the bias, like, hey, listen, you're taking these meds. Okay, we got a program for you. No shame, you can, we'll be open about it. Let's talk about battling disease of obesity using these medications. But I think your point about hiring the nurse practitioners. To me I say go for it, Knock yourselves out lifetime fitness and hire some nurse practitioners and start having the same battles with the insurance companies that we have every day.

Zoe: 3:33

They're going to quit real quick.

Dr. Weiner: 3:34

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 and 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: 4:31

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 ones right, like you said, to decrease that but that bias and that stigma.

Dr. Weiner: 4:51

Yeah, I think we're going to see more and more of this as more people get on the medication.

Zoe: 4:55

Well, I think so many people want their hands in this pot.

Dr. Weiner: 5:01

Yeah, so all right. Well, let's move on to our patient story. I think you know our guest, the best Zoe, so why don't you introduce Josh?

Zoe: 5:08

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 for having him share his story, and now he's one of our peer leaders, so he has a lot of good value to add.

Dr. Weiner: 5:30

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 they have that place that they can go, and sometimes guys just want to talk to other guys.

Zoe: 5:44

Exactly.

Dr. Weiner: 5:45

So Josh is here for that, and I think that's a great addition to the program. So welcome Josh.

Zoe: 5:50

All right. So now we'd like to welcome Josh, one of our peer leaders, and Josh has been in the nutrition program for like almost two years.

Josh: 5:58

Almost yeah, July of 22.

Zoe: 6:00

Yeah, so why don't you just tell us your story, tell us a little bit about you, know what you've gone through in the past couple of years, but then also what made you decide to get bariatric surgery in the first place.

Josh: 6:11

Yeah, you bet. So, like many, overweight my whole life and struggled with it, lost and gained, lost and gained 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 him 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 rules. They said I'm fat, yeah, fat, that's what it is. So that was just an interesting thing. I thought there 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 it's kind of whatever built my personality. Now, that's fine, but yeah, so overweight my whole life got thin a couple of times doing different exercise and or diet stuff.

Josh: 7:09

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 I mean 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 pre diabetic, pre diabetic, and then of course I got the diabetes diagnosis.

Josh: 7:41

So I got into a C at surgeon. 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 the sleeve surgery, which I felt was a better choice for me doing it was. I like to say I don't want to brag too much, but I 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, how I got where I am.

Zoe: 8:10

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, that newfound love of exercise in your life?

Josh: 8:32

Yeah. So Exercise I mean just the word is like II, you know I don't do that. And for me, I played sports when I was younger and I was relatively 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 want to hold them back. And so I was like set some sort of soft goals 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 was really, and I followed different disciplines in my life that involve baby steps, and so I just turned it into a baby step Project for myself.

Josh: 9:17

Yeah exactly I did my work we do use smargo, so very familiar with that too. So for me it was one was right after surgery. It was like you got to walk to get that gas paying out, right. So that was the big one was do that. And so I was like this isn't as hard as I thought, I'm gonna walk, and I just started doing 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: 9:47

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 this. And so then it got to 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 minute walk.

Josh: 10:09

And I went and got weight best, 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 anything. I did 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 want to complete it, and so that built some confidence and you can really feel it. And especially After you get back and you take that thing off and then you're walking like, oh my god, this is like incredible, right? How much weight did you lose?

Dr. Weiner: 10:42

So I'm down now at 160 pounds, 160 pounds rough, so more than 10 weight vests yeah.

Zoe: 10:50

You were predicted to lose. What was it? 80?

Josh: 10:52

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.

Zoe: 10:58

Yeah, I knew I had more to go right, so I doubled him up, which I'm proud of the other thing that I think has been a cool development is finding forms of movement that you enjoy. Whether it's cool or the racquetball or soft balls of tall is a little bit more about all these different activities that you've now been able to do and you plug your softball team a little bit.

Josh: 11:20

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 the walks. I can clear my mind and aside from that, I love getting out and meeting people and trying new activities. Pickleball has been a good one for me. I've met a few friends doing that and Then I got last.

Josh: 11:52

So one of my soft goals was and then it became a true goal. It was like I want 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 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 a open practice this guy puts on every Sunday. Do you want to go to that?

Josh: 12:20

Because I was looking for practice because I didn't like how our team was Disorganized, but just it 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 gonna be there. I didn't know anyone and I was just like I'm gonna go 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: 12:47

So this is our team name and logo. And then the Palombecoer team was super awesome to sponsor us there, so I threw that name on the back to make sure we get good advertisement. Thank you, appreciate it 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.

Josh: 13:08

Yeah, I think that's that was fitting, because you know, without your weight loss you're not playing softball, 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 and. 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, never would have gotten there. So yeah, I mean the surgery, the program, everything has been just incredible.

Zoe: 13:37

So you're one of our peer leaders, 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 what Community has. How community has impacted, like your six sustained success.

Josh: 13:57

Yeah, it's pretty interesting because I can see myself and a lot of these 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 are eye-popping for them.

Josh: 14:14

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 things I've done and see oh yeah, I see 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: 15:23

But yeah, it's been a pretty good experience to meet all these other people, hear their stories, what's gotten them into the surgery live, the post surgery live, how they're managing that and and sharing any tips and tricks that I've discovered and so.

Dr. Weiner: 15:39

You are the leader for our guys group. Yeah, 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? What have you done to kind of create that space for for men to kind of feel more comfortable as they talk about their experience after surgery?

Josh: 16:04

Yeah, you're totally right.

Josh: 16:05

I mean, it's Definitely female dominated the people that I interact with in the groups. But we do have the man, 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 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, was super simple and I didn't get it because, like I said, I was always overweight and I didn't understand. Like I didn't know where to wear my pants.

Dr. Weiner: 16:46

And after I lost weight.

Josh: 16:48

I was wearing my pants where I always used to, at like my hip line, where that because that was the Narrowest place I could get them to button before right. So that's where I was wearing them and everybody's pull your pants up, pull your pants up. I'm like what are you talking about? I've got them and now I know you got to wear my oh, that's where your waist. So that was one of the things that I shared and talked about with the the guys group there and there was oh.

Dr. Weiner: 17:08

Yeah.

Josh: 17:08

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 the guys. It's just a little bit different, and you know it'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, right, I can't remember his name offhand, but great guy. And so we, yeah, we've got a nice group and it's One to three people, usually in the men's, which is about right what you'd expect for your clientele splits there. But yeah, 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: 17:47

So that's, that's a good for sure. You I mean there's, and I think it's so great having you as part of our team. We had a patient who he 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, gotta get this guy to Josh. And he joined the group and happened to Coincide with the group, was that night and 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 gonna be like this forever.

Zoe: 18:28

I'm having that safe, like that special space for the guy talk and knowing that it's still within this community of support, just like kind of dedicated, dedicated time. I think it's.

Josh: 18:41

It's really, yeah, everybody likes to feel like something is carved out just for them, right? So there's a nice little red carpet there. Guys 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: 18:55

And then, once I went and I felt the love, I really did and it was just like you know this, there's something to this and I decided this was a good move to stick within. My wife had told me to she goes, dude, you got to do it. I know you think you're too good for that, you're too tough for that. Whatever she goes, just do it, she goes. 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 gonna give the right effort if something's made?

Dr. Weiner: 19:22

it is mandatory for our patient. That's good. Yeah, I didn't do your surgery and you just kind of stumbled on our support group.

Josh: 19:28

Yeah, well, mostly because of her prodding yeah she said I was how much helpful it was for her back in Illinois.

Dr. Weiner: 19:34

But I appreciate the support and us making it mandatory, because we do get pushed back on that. Yeah, like, what do I? What do I need to? I 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. So he hasn't had the surgery, I haven't had the surgery. We're not gonna be able to talk to our patients about the things that only someone who's had the surgery can tell them. Yeah, and so we need to have that. 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 About how the surgeries affected you and what, what's working, what's not, you should definitely check out Josh's support group.

Josh: 20:13

Yep, every other Thursday. Every other Thursday, I think it's guys group this week. I don't know. I gotta check.

Zoe: 20:24

Well, gosh, thanks so much for being here there. Anything else you'd like to to share?

Josh: 20:29

Well, talk about that that's right.

Zoe: 20:32

The other day.

Josh: 20:33

So I'm experiencing, I am Adjacently experiencing this. I guess my daughter is also in the program, looking to have bariatric surgery, and she has Some naysayers in our 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, always been thin, has paid attention to her diet. We'll moderately exercise here, there. She's not like you know, a gym rat or like fit person, but she's thin, she's not heavy at all and Preface it a little bit, she's a judgmental person, but that's fine. But so she, you know, wants to Pooh the idea of various heaven surgery easy way out.

Josh: 21:16

You always hear that easy way out, yeah, so it got me to thinking, and I just only child, so I'm used to entertaining myself when I get alone. I that's. Why do I think? Right? So I'm just thinking one day 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: 21:46

You don't have to outrun the lion, you just got 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 poo poo someone for trying to join that right and better themselves always those people in the middle.

Josh: 22:09

And I started thinking it's these people in the middle, and probably the people near the bubble at the bottom, that are like Subconsciously, survival mechanism I've got competition in the pack now. No, you can't get skinny. No, you might not run me now I'm in danger of the lion. So I 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 gotta hold this person back because they might challenge my position in the herd.

Dr. Weiner: 22:34

That might be the single best explanation for the cause of obesity bias that I've ever heard.

Zoe: 22:42

I dialed in on that, Josh.

Dr. Weiner: 22:44

That's freaking brilliant.

Josh: 22:46

Yeah, I just was thinking of it the other day. I'm thinking why would a person Totally try to block somebody? And it's never those people at the top that are very fit, very active, very healthy. They're always like yes, good for you, come on, let's go.

Dr. Weiner: 22:57

But you know, I think you could extend that and I think in the most primal sense it's like the survival from from getting eaten by the lion, but then it's also competition for a partner and competition for a job and just social standing and everything that you know. As people gets thinner it's like they start to maybe climb the ladder a little bit. Everybody's and everybody's who's been on our show and talked about how much weight they've lost, 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 that abscess out there when you start to lose weight and maybe climb up the ladder a little bit and to add to that, even my own self.

Josh: 23:43

I've got a cousin who's overweight. We've always both been overweight and I would compare myself to him. He's some better than that. At least I can maybe run faster than at least I can whatever than him. But now that I'm where I am, like that comparisons long gone. I'm looking at other peer levels now. Where can I be now? But I mean, if he was ever to do something like that, I would never have held him back. I just I Thankfully I don't have that thought process, but it just. I think that's also another part of it, though someone who would try to like shun someone out is are they their measuring stick? Yeah, now are they gonna get better? And now it challenges me that I have to do there. I can't compare myself to that person anymore. I don't know just something about that's interesting.

Dr. Weiner: 24:19

Yeah, those are really good thoughts. I like that. Josh for more wisdom like that. Join his support for sure.

Josh: 24:24

Yeah, there's room for you.

Dr. Weiner: 24:29

All right, well, thank you, josh. I really appreciate that. That was fantastic, great to hear from you.

Josh: 24:34

All right, well, thanks so much for having me, and it was pleasure.

Zoe: 24:38

Awesome Thanks.

Dr. Weiner: 24:38

Thanks. 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 in a group where you can talk to really just other men, join Josh's support group. Our programs available on our website and it's pretty affordable as well. So let's move on to our nutrition segment. Zoe, what do you got for us this week?

Zoe: 25:01

Well, you know, as we were discussing these gyms dabbling in GLP one medication prescribing, it made me think about how many gyms and trainers dole out these cookie cutter meal plans, right, right. 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 is because they don't teach you the skills to be successful on your own Right. 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: 26:14

Yeah it's kind of that give a man a fish, feed him for a day, teach a man to fish, feed him for life.

Dr. Weiner: 26:21

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 by you know you're giving some kind of cookie cutter meal plans but, like you said, their inspiration that's 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 be moments when we're more focused, moments when we're less focused, and you need to have some, some skills and some things that you lean on in order to get those the meal planning done on those during those tough times.

Zoe: 27:12

Yeah, well, and specifically with the metabolic reset diet we just this morning and our metabolic reset diet session we were going through. Yes, these, these are the core components, but seeing them like just written out as bullet points, that's. 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: 27:36

Yeah, yeah, we actually just made a. We revamped our metabolic reset diet handout and it'll be available on our website fairly soon. But you know, the thing is and I've given that handout 1000 times but I don't know that it's ever really solved the problem Right, it's kind of gotten you that first step. Without that it's a lot harder to follow it. But then you need that regular check in the smart ability, accountability, all of those things. And so you know the truth is 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, one meds and with surgery right, 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, 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. So, so.

Dr. Weiner: 28:34

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 it takes a lot of insight to get it right.

Dr. Weiner: 28:48

Okay, well, let's change gears a little bit and move into our economics of obesity segment and we're going to talk about 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 Zep bound coupon. So if you go to wwwZepBounds the E, p, b, o U N D dot com that's Eli Lilly's website for the drug and you can get a copay savings card and this coupon is is. It's actually a pretty complicated coupon 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 some friction in the way of people using that, that card In order to reduce the number of prescriptions that they have to fill.

Dr. Weiner: 29:40

First of all, there was this huge ransomware attack from some, some Russian hackers. They got a hold of change health care's database and they and change health care is owned by United Health Care and this is I think this is kind of how lucky United Health Care is, just in this space, like so you know what change health care is responsible for paying, paying doctors, paying hospitals, 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 like 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 zip bound 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: 30:57

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 federal 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 BMI of 25 and above and kind of keep people who are looking for that 10-pound weight loss with a zip bound 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 these are her regained and is taking zip bound, 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.

Dr. Weiner: 32:05

On all of our baritric surgery patients charts, 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, $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: 32:46

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 are the ones 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, to GLP1 meds. When I see patients, if I want to make, if I want to predict whether or not they're going to get GLP1 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 med right now.

Dr. Weiner: 33:40

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 ImpactzRx and PayorMatrix 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: 34:37

All right, well, let's move into 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 or Instagram account or YouTube 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's so many good questions that come to us. It's really hard to pick the ones that we have time to answer.

Sierra: 35:08

Okay, 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: 35:28

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 than others.

Dr. Weiner: 35:40

And people who suffer from obesity.

Zoe: 35:42

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: 35:57

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 you're sitting there watching television, talking to your partner and you're just in the back of your mind you're thinking about that one food that's somewhere tucked in your refrigerator and should I eat that or should I not? That kind of that preoccupation with food.

Dr. Weiner: 36:31

Some people can spend hours and hours and hours and really not think much about eating at all. 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 to minimize the process calories. Let's get to the heart of this question. Do you consider this to be a component of the psychophysical, 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: 37:12

Some people just like alcohol. I remember back in college I liked alcohol like everybody else did in college, but I didn't wake up in the morning and think about it. During the week I usually didn't drink, unless and it was only social really, 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, 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: 37:45

If we are intentional about eating whole foods spread throughout the day, not limiting the volume of those certain foods that you're eating and on occasion having those planned indulgences or those little treats, so that it feels more sustainable long-term. I think that absolutely can help reduce food noise, but not as much as the medications and surgery.

Dr. Weiner: 38:08

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: 38:39

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 strategies nutritionally that you can employ to quiet the food noise down. That's what our nutrition program is really designed to do not to put you in the starvation mode, but to allow you to eat lots of healthy food and 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, surgical techniques that we can do to minimize the food noise.

Sierra: 39:28

All right. Next question is from a YouTube short on WeGoV 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 to where I started wondering if I should get a revision. I've heard some real horror stories about revisions.

Dr. Weiner: 39:58

So you know, first of all, my practice is probably 30 to 40% revision surgery and I do a revision from yeah, I do a lot of 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 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 to 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 where patients have either had the surgery performed incorrectly initially or they have chronic ulcers and 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 the bariatric surgery. I do a lot fewer of that type of surgery than I do sleeve to bypass revisions for typically heartburn.

Dr. Weiner: 41:39

The other question is will a sleeve to a bypass revision be an effective weight loss tool? That is quite variable. Some patients I'll see 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 doing the same stuff nutritionally.

Dr. Weiner: 42:02

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 lose 30 pounds and that's just as slow as you went. That sounds more of what we're hearing in this story than doing a revision to a gastric bypass 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 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 a revisional surgery, that's certainly something we can help you with.

Zoe: 42:58

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 the heartburn so much, perhaps going on a GLP-1 could maybe be that answer.

Dr. Weiner: 43:16

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, sleeve reflux it just gets worse and worse and worse it generally does not get better we're going to revise 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: 43:44

Okay. Hi guys. I am two years post-gastric bypassed. I've lost all the weight I needed to 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, loads of veggies and I got the pound of cure book. Just wondered if I should be on 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. Love the podcast.

Dr. Weiner: 44:12

Thank you, we love doing it.

Sierra: 44:13

Thank you.

Zoe: 44:15

All right, here's what I have to say. First off, amazing that you've reached maintenance. That'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 to, instead of weight loss, it's in weight maintenance mode.

Zoe: 44:50

If you are feeling hungry, I would say let's eat more, but of course that key is what you're eating more of. It's not 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 in 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: 45:25

Yeah, and stop counting calories.

Zoe: 45:26

Yeah, yeah.

Dr. Weiner: 45:27

Right, I think you stop counting calories and she's doing everything, right, right, it's. 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: 45:41

And I also just wanted to say it's normal and expected that you naturally will start to feel hungry or you naturally will 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: 45:59

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 and also our podcast. 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.