Big Food, Big Pharma, Big Lies

Episode 23 of the Pound of Cure Weight Loss Podcast is titled, Big Food, Big Pharma, Big Lies. The title comes from our In the News segment where we discuss an article we found on Yahoo that talks about how big food makers like General Mills are paying social media dietitian influencers to push their products as part of the anti-diet movement. They are actually telling people that products like Coco Puffs are part of a healthy lifestyle! Insane!
 
In our Patient Story, we talk to Lupe who came to us on a recommendation from her Primary Care Physician. She ended up having a Gastric Bypass and needed GLP-1 medications to increase her weight loss. She is now helping her whole family make positive changes in their lives. 
 
In our Nutrition segment we talk about the single most important strategy to elicit support from your friends and family on your weight loss journey.
 
In our Economics of Obesity segment we dive into how the gaming of the drug patent process played a role in the generic drug release timeline for Ozempic. It’s Part 2 of our two-part series on drug patents and in it we’ll share when Ozempic will be eligible for a generic version. 
 
Finally, we answer 3 questions from our listeners including, serving size after surgery, compounding pharmacies, and what comes after the Metabolic Reset Diet. 

Transcript

Zoe: 0:17

Episode 23 of the Pound of Cure Weight Loss podcast. Big food, big pharma, big lies yeah Ooh, it's a doozy Dirty, but in other news, we're in the top 10% of all podcasts.

Dr. Weiner: 0:30

I know by episode 23,. We got there I am so excited.

Zoe: 0:33

I'm happy about that, I know.

Dr. Weiner: 0:34

It's really exciting.

Zoe: 0:35

Yeah, there's somebody that you think would get value from this podcast. We would love it if you would share it, because we just want to spread the word of helping people lose weight in a scientific way. No weight loss patient left behind.

Dr. Weiner: 0:51

Absolutely All right, zoe, you're going to take our In the News segment today, so why don't you go with this? I thought this was fascinating. I can't wait to hear your take on it.

Zoe: 1:00

The article today comes from Yahoo News and it is Obesity Rises Big Food Dietitians. So what this article is talking about is the rise of the anti-diet dietitian. And you know there are a lot of them in the space and that's fine, like honestly.

Dr. Weiner: 1:19

And really, let's be honest, to some degree we are a little bit of that mindset, but I think there's some important distinctions here.

Zoe: 1:25

Yes, I agree so you know I was going to say that. You know I can get behind a degree of anti-diet because of the mindset, because of the restriction. However, there's a big difference when the big food industry is paying dietitians to go on their social media eating Cocoa Puffs and telling you that it's a healthy food, right. So basically, this article is breaking down how there is a lot of money that is being thrown around and, specifically with these anti-diet dietitians promoting this anti-diet movement through the sponsorship of big foods like General Mills and other big food companies like that.

Dr. Weiner: 2:14

The first thing and we've talked about this in the past when we talked about paging Dr Lilly, about how Eli Lilly has partnered with a telehealth company Financial relationships matter. People change their behavior based on financial relationships. That is not something that we need to pretend doesn't exist. It's truthfully. It's not something we need to shame, it's just something that we need to know about.

Zoe: 2:40

And the consumer needs to know about.

Dr. Weiner: 2:42

Yes, so if someone is paying your bill, then you are going to change your behavior based on that.

Zoe: 2:50

There's a story in the article about this woman I can't remember the exact number of months or whatever she gained 50 pounds in. I believe about two months. Yeah, I saw that. Yeah, months or whatever she gained 50 pounds in, I believe about two months. Yeah, I saw that, yeah, because of the promotion of the anti-diet movement by a dietitian that she was under the care of.

Lupe: 3:09

Yeah.

Zoe: 3:11

That's concerning, because then her health swung in the other direction.

Dr. Weiner: 3:15

Right.

Zoe: 3:15

And it's not a matter of shaming weight gain. It's about helping people be the healthiest version of themselves and that's, as a dietitian, what we're here to help with. There are many dietitians that you know. There are all sorts of sectors, of course. You know I'm a weight loss dietitian Great. There are transplant dietitians, there are cancer dieticians, there are NICU dieticians, so there are a lot of sectors of dieticians, all with the basis of helping to promote health and helping to have their patients and their clients have the best health possible, have the best health possible, and with the proliferation of the message of oh, you can eat whatever you want, and that's safe and that's healthy.

Dr. Weiner: 4:11

It's actually not. No, there's a code of ethics with dieticians correct, and so do you think that this violated that code of ethics?

Zoe: 4:18

You know that's a really interesting question. I would say it kind of does.

Lupe: 4:24

Yeah.

Zoe: 4:25

However, when the sponsorships are at FENCI, which is the National Dietitian Convention, and you know kind of like passing these goodie bags out and really getting the attendees there hyped up on showing and promoting their products, it feels like it's ingrained in the space and in the industry.

Dr. Weiner: 4:51

Yeah, and we see that with the ASMBS, a lot of the funding comes from the medical device companies, which I think there's some conflict there. What tool do you want your surgeon using? The tool that he or she thinks is the best, not necessarily the one that they had sold to them by a device manufacturer, and so this exists everywhere in healthcare. Healthcare is a multi-trillion dollar industry, and so there's just way too much money for it to be immune from outside influence, and so we're going to see this. I think, when this happens, it's important for us to acknowledge it and say hey, listen, you can't believe everything you see on social media. And while we've talked in the past about the difference between a nutritionist and a dietician and that there's a code of ethics and standards, what we're seeing right here in my mind is someone breaking those standards, but the thing is, there's a code of ethics and standards. What we're seeing right here in my mind is someone breaking those standards, but the thing is there's a big difference too, if you read through the article.

Dr. Weiner: 5:48

These dieticians didn't get off scot-free. There were some consequences. They got called to the carpet on this, and a number of them kind of either just severed their relationship with the food company that had sponsored them originally, and my guess is, a lot of them have second jobs, which is probably their primary source of income, and it's very possible that some of them may have had some issues with their first job. And so I think that, while this is certainly an example of dietitians maybe not performing at their best, it also I think this is probably less than 1% of all the dietitians out there.

Zoe: 6:30

Yeah, I agree.

Dr. Weiner: 6:31

Probably less than 1,000th. We have to understand that when this happens, there is a mechanism to correct it and there are consequences for these dietitians, and I think they did experience some of those consequences. They were held accountable for their actions. That's important. When you're a nutritionist, it's less of an issue. There is no board. You aren't held to those same standards, and so I think that's an important difference here too.

Zoe: 6:58

Yeah, but what I did want to just mention is yes, maybe it's less than 1% of all dietitians, but it's the diet that less than 1% with a big platform.

Dr. Weiner: 7:08

Right.

Lupe: 7:08

So they're reaching more people.

Dr. Weiner: 7:09

You're right, you're right so, but you know, obviously that's what they were selected for, exactly Right.

Zoe: 7:13

Yeah, so being held accountable having the consequence you know. Hopefully we we can see this start to dissipate. But, yeah, I mean it is something to bring light to.

Dr. Weiner: 7:24

Here's an interesting idea. So on YouTube I come up as like a you know, it's basically the knowledge is that I actually am a licensed physician, and the idea is that when you see my videos, you know it's coming from someone who is held to some professional standards. I think they should also, and when I give a talk at a professional meeting, the first slide must be your disclosures. Here's who pays me money. And you know, sometimes you see somebody get up there and they've got like 12 names on there For me.

Dr. Weiner: 7:57

Usually, actually, I don't really have any disclosures right now. I haven't had any disclosures that I would have to reveal for probably five years or more. But I think if we're going to allow people to use their credentials, then they have to have that same disclosure. They have to acknowledge who's paying them money, and so that when we're looking at that, we get the full picture, because that's really what this is about. It's about transparency. And when you're out there watching things on social media or YouTube or whatever and you want to make sure, hey, is this real, is this legit, you need two pieces of information. You need someone's credentials and then you need where they get money, and so that'd be interesting to see if we can come up with something like that. I will tell you right now here's my disclosures I'm not making any money from any drug companies or any big food industry or anything like that. Yeah, me neither, yeah, so disclosure free. We got a blank disclosure slide here, all right, so let's move into our patient story. Who do we have today, zoe?

Zoe: 9:00

Yeah, so we've got Lupe, who is a patient of you, did her surgery and she's been really involved in the nutrition program, so I'm really excited to have her share her story today. Yeah, all right, well, welcome Lupe. We've got Lupe, our guest today to share her story. We're super happy you came, made the drive. Thank you so much. Thank you, thank you for having me. Yeah, so why don't you just go ahead and start us off by sharing a little bit about your journey? Maybe talk to us about what made you decide to get surgery and a little bit about that decision-making process? Sure.

Sierra: 9:37

I have been overweight most of my life and I tried various diets you know the keto fed and you know shakes and all these kinds of things and I took off a little weight, a few pounds, but they always came back. So you have to eat fruit, right, right. And so I was starting to see my doctor more often because my diabetes I'm a diabetic was starting to progress and so she was very worried about that. She would give me additional medication, me to an endocrinologist and said you know why don't you try talking to Dr Weiner in the Pound of Cure? And I didn't know anything about the Pound of Cure at that point. So I said, okay, I'll go ahead and try that.

Sierra: 10:29

She says he has tons of YouTube videos. You know, go ahead and take a look. And I said okay. So I set up an appointment right away with Dr Weiner and just kind of immersed myself in everything. I watched all the YouTube videos. At that point I'm not too sure if the podcast was going on, but I've currently seen or heard all the podcasts, bought Dr Weiner's books, like everything You're like I'm in it, I'm ready.

Dr. Weiner: 11:00

Yeah, that's why they're there, you know, because that whole immersive experience. That's really where people find success, because it's really hard to lose weight. So that's really that's what we're looking for. I love to see it when people they got their book and you can tell they read it. They've like thumbed through all the pages because this is it's a tough problem to solve.

Sierra: 11:19

Absolutely, absolutely figured out a plan, so I had the gastric sleeve surgery. He said a little bit after that if you want to try the GLP-1 medications, I'm on board for you trying that as well. He projected that I'd lose about 45 to 50 pounds in my first year and I'm three and a half months post-op and I'm down 41 pounds. Wow, you're there.

Zoe: 11:50

So you had your surgery in December, and then what month did you start your GLP-1s?

Sierra: 11:58

Like the middle of February, I spoke with Deidre and she said you know, I think you are ready to go ahead and start it, so I did? I started Manjaro.

Dr. Weiner: 12:06

And you know because you were diabetic beforehand, we were able to continue that medication for you. Because you were diabetic beforehand, we were able to continue that medication for you. And first, on one hand, we know that diabetics lose less weight with these medications than non-diabetics, but on the other hand, they have increased access, because that's really who's able to get the meds right now, and so I love a sleeve with the medications. To me it's to some degree the best of both worlds, right, because we get the less invasive surgery. We don't have to worry about ulcers down the road or bowel obstructions although they're uncommon they certainly are things that people keep in the back of their mind and worry about but we get exceptional weight loss. So we get kind of gastric bypass type weight loss, gastric bypass ability to maintain your weight. The other thing that we see is that the sleeve often is enough to start to control the blood sugar.

Sierra: 12:57

Absolutely.

Dr. Weiner: 12:59

And then you now start losing weight like a non-diabetic. And we saw that in the past with BJ when she talked about Monjaro. Second time's a charm. Have you seen that too?

Sierra: 13:59

I believe so. I've seen them all.

Dr. Weiner: 14:01

So did you? No, have you seen more weight loss after using the Monjaro after surgery?

Zoe: 14:06

than before.

Dr. Weiner: 14:07

Yeah, so how much weight did you lose with Monjaro beforehand?

Sierra: 14:11

I did not take it prior to surgery. Oh, you didn't take it prior to surgery.

Dr. Weiner: 14:14

Okay, and, and so did you see the weight loss accelerate once you started Monjaro.

Sierra: 14:19

Yes, yeah.

Dr. Weiner: 14:20

Yeah. So then you're already. We say at three months that's about the halfway point for weight loss. So project that out. We're looking at about 80 pounds. I don't know if we'll quite get there, I don't know if that would look good on you truthfully, but we certainly see great weight loss here.

Sierra: 14:35

So it was very exciting time. I went to see the endocrinologist and she said your numbers are perfect. I'm not sure why you were referred to me, but this was after I'd had surgery already. So she's like I don't think you need to come see me anymore, just handle it with your PCP. And I said, okay, great.

Sierra: 14:53

So I went back to my PCP and I said you know, my numbers are there. Sometimes they even dip lower with all the medication I'm on. And she said, okay, well, let's go ahead and take some of these medications off. So I was on Jardian Smetformin and she took those away, took away my cholesterol med because I was, you know, doing really great with that. So I was very excited.

Zoe: 15:19

I'm glad you mentioned that, because I was going to say why don't you tell us about all the meds you've been able to get off. Yes, absolutely so cool. And also I know that you've made incorporating your family and making it a whole family affair lifestyle change that's really important to you. So tell us a little bit about what you've been able to do to kind of get your family on board with this change as well.

Sierra: 15:42

Well, I am trying my best to get them completely on board and convert to the pound of cure. My husband also went through gastric sleeve surgery and he's seen a little bit of weight regain so he definitely can benefit from it. And my son is on the autism spectrum. He's 24 and he just may not realize how much he's actually consuming with COVID. He was home and around food 24 seven and I couldn't monitor that because I'd be at work or whatever, and so I'm really trying to get him into it and also exercise portion. He goes on walks with me, we go into the gym at my apartment complex, so little movement sprinkles, as you say.

Zoe: 16:33

Yep, that's the best way to do it. Oh, speaking of movement sprinkles, tell us about how you've been able to implement and increase your movement sprinkles throughout the day, because I know we started at like three, five minutes and now we're moving up and up. So tell us about what you're at right now and then also what you do, because I know you do a couple different things.

Sierra: 16:54

I am striving for four 10-minute movement sprinkles, so I'll do a couple of walks throughout the day on my breaks from work I work from home, so it's I'm able to do that and, um, hit the gym with my son. We usually do like a little bit of strength training with weights and things, um, so it's been fun, you know, doing other things and trying to learn more, because I've never been a real athletic person or into exercise, so I'm excited that I'm getting more into it. Yeah.

Zoe: 17:28

And I know just how dedicated you've been working at, you've been putting in the effort, and I know that there are still areas that you struggle with, but you keep showing up and you are, I see you. I see you several times a week and I'm so grateful for that, because you are so dedicated to immersing yourself not only with the content that you consume to be for surgery, but also with the support groups and just really making sure that you're showing up for yourself and keeping it in the forefront of your mind. So I think that's really wonderful, absolutely.

Sierra: 18:05

It's been invaluable All the information, all the support groups and nutrition classes. I try to, you know, get there at least once or twice a day and I just feel at this point it's like a family, a real community we cheer each other on. So I just call it my Pound of Cure family.

Dr. Weiner: 18:28

That's what it's there for. I mean, I think that's really so important this whole process. You know, going through this alone weight loss is hard, but it also can be incredibly joyful, right? I mean I would imagine that you've been pretty happy with these 40 pounds you've lost so far and having people to share that with.

Dr. Weiner: 18:47

You know obviously your friends and your family, but also people going through at the same time to celebrate each other. There's something about building that community and making those connections that just makes it all much more reasonable, really, in the end, that's kind of you know what human beings are like. We need to interact with other people. It's our interactions with each other. That's what really drives happiness and helps us maintain our mental health, and so so that's what the program is for. We're so happy to hear that you're using it for that.

Zoe: 19:15

Thank you. So if you had one piece of advice for yourself before you started this journey, or anybody who might be starting this journey now, what would you share?

Sierra: 19:26

I would say go at your own pace, take it slow, don't think that everything is going to happen overnight for you. You know, it's great to have that ambition, but to be realistic as well with your goals, setting small goals so you can feel more successful, that's really great advice.

Dr. Weiner: 19:47

Yeah, I think you can also extend that to the decision to have surgery. Absolutely, you know, you kind of hadn't even thought about bariatric surgery before your endocrinologist mentioned it.

Sierra: 19:58

I didn't feel that it was possible, like I didn't know if my insurance was going to cover it. It just felt like financially it wasn't something I could reach and your team was able to look into that for me and make it possible.

Dr. Weiner: 20:13

The truth is, 95% of people can get bariatric surgery covered, you know, assuming their BMI meets the criteria of 35 or higher, most people have insurance coverage. I think that's something that is very misunderstood out there. People think, oh, what's this like? 30 grand, 40 grand, you know? I think it's like an exceptional amount of money. Do you remember how much money you ended up paying for in total for your surgery?

Sierra: 20:33

Um, I had a deductible to meet, so I had, um, my endoscopy, which was about $1,200, and then $700 for the surgery, so $1,900. So $1,900.

Dr. Weiner: 20:46

But that really covered all your health care for the year too, right? So blood work and other doctor's visits you didn't have to pay down the road. So you paid $1,900 for the year for health care, which in 2024 is a steal, right, I mean, when you're only paying 1900 bucks for healthcare, you're doing okay. So yeah, that's what we find with a lot of patients is that, you know, the financial costs of the surgery are really pretty modest, and oftentimes we'll see patients say, well, maybe the first year it was about the same that I'd been spending, and then the second year my healthcare costs went down Because of the medications.

Dr. Weiner: 21:23

Exactly, and so GLP-1s may change that a little bit for us. But for those patients not taking GLP-1s we'll probably see the cost of care go down. My guess is, next year you'll probably, or this year I guess it would be you'll probably pay less for healthcare.

Sierra: 21:40

Absolutely.

Dr. Weiner: 21:41

Yeah, anything else you'd like to share? Were you nervous going into surgery? Was that something you were afraid of?

Sierra: 21:47

Not too nervous.

Dr. Weiner: 21:48

No.

Sierra: 21:49

I was on board right away. My husband showed a little reluctance, but he says I'm here to support you and if this is what you feel you need absolutely.

Dr. Weiner: 22:00

And now your husband's also had a gastric sleeve.

Sierra: 22:02

He has in 2016.

Dr. Weiner: 22:04

Okay.

Sierra: 22:05

And he's had a few health complications on the way. Now his diabetes went into complete remission. He did not have to take insulin or pills at all after the surgery From just a sleeve.

Dr. Weiner: 22:18

Yes, right, and it stayed in remission. Yes 10 years later.

Sierra: 22:22

Yes, or eight years later. So I thought oh, my goodness.

Dr. Weiner: 22:25

Am I going?

Sierra: 22:25

to be that lucky.

Dr. Weiner: 22:26

Yeah, can he get on Monjarro?

Sierra: 22:30

That's something that we'll have to look into.

Lupe: 22:32

Yeah.

Sierra: 22:32

Yeah.

Zoe: 22:33

All right, well Again, and I'm so excited to see what the next of this year holds. I know in one of the sessions we set like a year-long goal and broke it down and that kind of thing. So I know I'll be seeing you again soon and it was so great having you here. All right, that was so great. Thank you to Lupe to join us.

Zoe: 22:55

She was a little bit late because she was driving all the way across town, but I'm glad she made it and we got her in. So for our nutrition segment today, kind of piggybacking with what Lupe was talking about and the importance of family support, right, and so something that we talk a lot about in our nutrition program is the importance of that support, but recognizing that oftentimes our family members a lot of times do want to support us. However, what they view as supportive may not align with what the patient needs for support. So, first off, I always recommend reflect on what it is that you need in order to feel supported and then communicate that, because people cannot read your mind and they cannot assume.

Zoe: 23:47

And so, if that's, hey, this is what I need from you in order to feel supported maybe the husband thinks it's supportive because, oh, you told me you wanted pizza, so I got it for you, and that's just. You know not actually what you are wanting him to do, maybe. And so I do recommend having these conversations independent of food time, because that can be maybe a like a little bit more heightened emotional time when it's very in the moment. So sitting down, thinking about what it is that you need for support, communicating that to your loved ones, recognizing that it might not be an easy conversation, but you can do hard things and this is important and it's something that needs to be prioritized.

Dr. Weiner: 24:29

Yeah, I think also it's really important to understand just the difference in how genders communicate. And you know, my wife and I it took us a while to kind of figure this out, but I'm just super pragmatic, I'm like a real computer guy and again, like if my wife says to me and she's learned to do this over time is like okay, this is, you should do this, you should do this, you should do this. She taught me how to apologize. It's step-by-step. She showed me a video that teaches you how to apologize and actually I watched and I was like, wow, that's great. Oh, my God, I've been doing it wrong all this time. That's so much better than what I've been doing. And so sometimes that kind of direct communication about exactly what you need from your partner, from your loved ones, is a really good thing, and it's kind of awkward and you feel like, well, they're my spouse, they should know, but they don't, they just don't. You're about to get married. Maybe I'll share that video about how to apologize with Matt.

Dr. Weiner: 25:27

Yeah.

Zoe: 25:28

I think that's a great idea.

Dr. Weiner: 25:30

So, yeah, I think that's a great suggestion, just very direct, and if you don't ask, you don't get. I think there's probably a lot of fights and a lot of feelings of isolation that could have been prevented with something simple like that. Anyway, all right, great. So let's move on to the next segment, on the economics of obesity. This is part two. We talked last week about drug patents. Today we're going to take what we learned about drug patents last week and apply it directly to Novo Nordisk's Ozempic or Semaglutide. So um, novo Nordisk first patented and the original patent was for something called an acylated, and acyl A-C-Y-L is a chemical component that you add on to a GLP-1. So they acylated GLP-1 compounds, which means that they just modified it slightly, and that made it from something that's metabolized very rapidly in your body to something that lasts for a week or longer. Well, with Victoza or Lear Glutide it lasts a day, but with Ozempic or Semaglutide it lasts a week. And so they took this molecule and they just said we're going to patent only this modification and it's a very general compound, like you can put that anywhere, and it was a very vague and nonspecific patent. But that allowed them to get started with the phase one trials and, as we talked about last time, that phase one to phase two to phase three, it can take over 10 years to get a drug to market. And so there was a lot of people out there have said, well, 2006 was when they filed this first patent, and so 20 years later that's 2026, right around the corner this patent is up. So if we look at Ozempic, it was not FDA approved until 2017. Oh, wow, yeah, so it took 11 years, which is about what we see, and in 2021 for obesity and so.

Dr. Weiner: 27:36

But what happened in Novo Nordisk? They're not rookies, right? And also, 61% of their revenue comes from from acylated GLP-1 medications. It comes from liraglutide or Victoza and it comes from semaglutide or Ozempic liraglutide or Victoza and it comes from semaglutide or Ozempic. So Novo Nordisk, which has experienced just tremendous growth and is a huge, multi-billion dollar company, 61% from this med. So what they did because they're smart, they know what they're doing is in 2013, they patented the actual Ozempic molecule, and so that patent is not up until 2033. And so a year ago, there was a lawsuit from a generic drug manufacturer that said, hey, first patent in 2006 means it's up in 2026. We want to be able to manufacture semaglutide as a generic and sell it. And again, tiny company versus gigantic company. And guess who won?

Lupe: 28:42

Right.

Dr. Weiner: 28:43

Right. The gigantic company won. The US Patent Office decided not to allow them to manufacture this drug and they honored the patent from 2013, which means we're not going to get generic Ozempic until 2033. Again, I think this is a scenario where Novo Nordisk they've made their money here, you know, and the drug patent has served its purpose for them. And if, in 2026, all of a sudden, semaglutide was available as a generic and anyone could manufacture it, it would take this compounded semaglutide that's being manufactured in China and allow it to be sold fairly and honestly and, most importantly, safely, and this would be good for the public. It would be good for all of us.

Dr. Weiner: 29:34

And so this gaming of the patent system it's shifted, it's favoring the pharma industry. And as much as I hate this idea of the march in rights we talked about, which gives the government the ability to license a patented thing to another company, that to me, I don't know that that's the right way to handle this. But all of this like filing multiple patents and essentially just kind of kicking the can down the road and extending the patent, it's probably not for the best, it's not for Pretty screwed, yeah, yeah. So you know, I don't know that there's a solution. March in Rights is kind of how it's being addressed. I wish they came up with something else, but honestly I'm not sure what and also I'm not a patent attorney, so I think this gets pretty complicated pretty quickly. That's what I learned as I did some research on this, but the end result is we won't have generic semaglutide until 2033. All right, so let's move on to our social media questions. We've got Sierra here to read these questions. Sierra, what do we have this week?

Lupe: 30:44

Okay, first question is from Abby. I had surgery two weeks ago and I'm trying to follow the four ounce recommendation that Dr Weiner put in the cookbook, but I still feel hungry. Am I doing something wrong?

Zoe: 30:56

All right. So this is a really great question, and I honestly do get questions about serving sizes after surgery all the time, which is why we don't assign specific amounts, yeah, right. And so, first off, no, you're not doing something wrong, right. And so, first off, no, you're not doing something wrong. And if you are feeling more hungry, we want you to honor that hunger. But more importantly than how much you are eating is how you are eating. Of course, what you are eating too, but how you are eating.

Zoe: 31:26

We really need to prioritize mindful eating. So that means eating slowly, chewing thoroughly, eating without distraction, taking small bites, so that you can learn your body's new anatomy and new satiety signals, so you can recognize when you need to stop, because that's going to be different than before surgery. And so if that means you are eating five ounces in a serving, then that's fine. And, again, it's important about what it is that you're putting in your body. If you're eating five ounces of milkshake, then no, we don't want to be doing that. But if it's five ounces of a smoothie that you've made with Greek yogurt and fruit and greens and these great things, then that's perfectly fine. So I would more. So, focus on how you are eating. Prioritize mindful eating, focus on what you are eating and then, once you get to the phase that you have introduced non-starchy vegetables, add that extra volume with that.

Dr. Weiner: 32:27

We've talked a lot about this and how there's different stages.

Dr. Weiner: 32:29

There's a pre-op stage, there's a recovery stage, there's the honeymoon stage, there's the end of the honeymoon stage, and the recovery stage is, in my mind, really about learning to eat mindfully.

Dr. Weiner: 32:40

And you have a support group on mindful eating where you really teach people kind of very explicitly this is how you chew, this is how you eat, this is how you think about every bite.

Dr. Weiner: 32:51

And it's kind of like what you talked about with relationships where, like, it seems like you shouldn't have to explicitly state that but you actually do and it helps people when you do. And so in the recovery stage, that amount of food, as you mentioned, for one person it's an ounce, for the next it's two, and then third person is three ounces and four ounces for the fourth person. Everybody has a different experience and so how we teach people is that they kind of figure out what their number is and how it works and every bite has to be explored and really understood. Also, like chicken one day and chicken the next day, it can be one ounce one day and four ounces of the other chicken. There's so many subtle differences between foods that your ability to tolerate things that you view as the same may be very different, because if you really pay close attention, it's not the same.

Zoe: 33:44

Right, and then also thinking about what your feeling of fullness was before surgery is very likely not going to be the same, for surgery is very likely not going to be the same. And so, being on the lookout for those other satiety signals, whether that's a runny nose, a shoulder pain, you know the hiccups you might experience, those things. And if you weren't thinking about it, you're waiting for that feeling of fullness that you're used to, and that's counterfact.

Dr. Weiner: 34:10

Yeah, it's not going to come. It's going to be something different after surgery. All right, sierra, what do we have for our next question? It's actually more of a comment, so yeah, so I comment. Is this about some of the comments I've made about compounded medications and how they're not FDA regulated and why we should be careful with choosing those medications. So, sierra, you can read the comment real quick.

Lupe: 34:32

Yeah, it just says there are compounding pharmacies in the US that are regulated.

Dr. Weiner: 34:43

Yeah, actually, all of them are going to be FDA regulated, so all compound pharmacies are going to be FDA regulated. All regular pharmacies are going to be FDA regulated, so the FDA is going to make sure that these facilities are clean and are doing things appropriately. The problem is, what's not FDA regulated is the manufacturing plant that made the medication. It's overseas, almost always in China, and the FDA does have standards for manufacturing. They call this the CGMP or current good manufacturing practice, and the FDA does not. It doesn't only inspect pharmacies compounding pharmacies it also inspects the plants that manufacture these medications to make sure that they're being done safely, that the product that they're turning out is pure and clean and free of toxins and free of bacteria. And the compounded drugs, although they're brought into an FDA-regulated pharmacy, the substance that they're using is not going to be tested. It wasn't FDA-regulated and it might not be what we think it is, and so that's really.

Dr. Weiner: 35:51

It's not the compounding pharmacies themselves. In fact, i's not the compounding pharmacies themselves. In fact, I've been using compounding pharmacies for decades. You know way back when, especially early on, when we thought bariatric patients couldn't take pills and you know that they had to take liquids, we would have patients go to compounding pharmacies and change every one of their drugs to a liquid or some type of more easily tolerated medication. So we've been using them for a long time. They serve a purpose. I mean, there's a lot of people out there who've used compounding pharmacies for other reasons and they are good and important parts of our health care system. So please do not take anything I'm saying as a jab against the pharmacies themselves, because in general they are good.

Zoe: 36:33

It's about the medication itself.

Dr. Weiner: 36:36

And where you get it right, and we don't know where it's coming from. So that's really the underlying issue in these compounded medications. All right, what's our last question, sierra?

Lupe: 36:47

Okay, this one is from Ellen, from the website. I've done the metabolic reset diet for two weeks, just like in your book. What's next?

Zoe: 36:56

I get this question a lot.

Dr. Weiner: 36:58

Me too.

Zoe: 36:59

So you know, my thoughts are if you can do it for longer, do it for as long as you can, and then what I always recommend is come chat with me or identify what are those small tweaks that you need to make in order for the metabolic reset diet to be sustainable for you long-term. And as I have said before on the podcast, the metabolic reset diet embodies both definitions of the word diet. It is your two-week or longer reset diet, but it's also what we want to work towards as being your diet, just how you eat, Right, and so if that includes some adjustments and tweaks that are individualized to you and your preferences and that allows you to continue eating that way, then that's beautiful.

Dr. Weiner: 37:45

You're right. This, this kind of just like what we talked about with that mindfulness. Where you go from there is up to you. And you know the book was written so that you would then all of a sudden be like, okay, I learned a lot, now I'm going to focus on eating vegetables. And you go into that next station in the book. And but you know, when you write a book, that's, you know, you just kind of try to make it apply to as many people as possible.

Dr. Weiner: 38:10

But when we work with people individually, we have a lot more freedom. We can really dive in and figure out, hey, what was your experience on those two weeks? How did it make you feel? Did you lose a lot of weight? Was this a good experience? What did you miss? Like you talked about, and really start to take that metabolic reset diet and say, hey, this is kind of our gold standard for how you should be eating. And now let's work to get you as close to that gold standard as you can in a sustainable fashion. And that's really what we do in the nutrition program, that's what we do in our weight regain program. That's when we start working with people personally, we're able to take that step and you can't really write a book like that, and so I think it's important to understand what's in a book and what we're going to do in practice. There's going to be some variation. That practice gives us that flexibility to really create an individual program for each person we're working with.

Zoe: 38:59

Right, and if you're interested in learning more about the metabolic reset diet, of course you can read about it in the Pound of Cure book, but also we have recently created a new free handout the metabolic reset diet handout that you can just go to our website, poundofcureweightlosscom and download it from there.

Dr. Weiner: 39:20

Yep, there'll be a little guy in the corner who asks if you want, if you want it.

Zoe: 39:24

All right. Well, we just really want to take a moment to send our gratitude and acknowledgement to Sierra Miller, who's produced the podcast, and acknowledgement to Sierra Miller, who's produced the podcast, Rhiannon Griffin, who has also produced the podcast, and then the editing team over at Autogrow with Vincent C. And then, of course, a special thank you to our guest today, Lupe.

Dr. Weiner: 39:44

Right, so please check us out on social media or our website.

Zoe: 39:50

Consider joining our nutrition program or our weight regain program if you need some more personal assistance, all right, see you next time.