The Pound of Cure Weight Loss Podcast
Zepbound to Happen: More Drug Shortages
Episode 24 of The Pound of Cure Weight Loss podcast is titled, Zepbound to happen: More Drug Shortages. The title comes from our Economics of Obesity segment where we discuss the Zepbound shortages and offer strategies that you can use to ride out the shortage.
In our In the news segment, we discuss an article from the New York Times titled, The Miracle Weight-Loss Drug Is Also a Major Budgetary Threat. In the United States, we pay more for medication than any other country in the world - often 3-4 times more. So, what can we do to bring those prices down? Tune in to find out!
In our Patient Story, we talk to Janet who started gaining weight after pregnancy. She lost well over 100 pounds on Mounjaro and is currently using a creative dosing strategy to save money during maintenance.
For the first few months after surgery and while taking a GLP-1 medications, you might not feel like eating but your body still needs fuel. So, in our Nutrition segment, Zoe offers advice about what to do when you just don’t feel like eating.
Finally, we answer 3 of our listeners' questions including, how to transition from weight loss to weight maintenance, why does a revision carry more risk, and how to keep your set point lower while on weight gaining medications.
Episode 24 of The Pound of Cure Weight Loss podcast is titled, Zepbound to happen: More Drug Shortages. The title comes from our Economics of Obesity segment where we discuss the Zepbound shortages and offer strategies that you can use to ride out the shortage.
In our In the news segment, we discuss an article from the New York Times titled, The Miracle Weight-Loss Drug Is Also a Major Budgetary Threat. In the United States, we pay more for medication than any other country in the world - often 3-4 times more. So, what can we do to bring those prices down? Tune in to find out!
In our Patient Story, we talk to Janet who started gaining weight after pregnancy. She lost well over 100 pounds on Mounjaro and is currently using a creative dosing strategy to save money during maintenance.
For the first few months after surgery and while taking a GLP-1 medications, you might not feel like eating but your body still needs fuel. So, in our Nutrition segment, Zoe offers advice about what to do when you just don’t feel like eating.
Finally, we answer 3 of our listeners' questions including, how to transition from weight loss to weight maintenance, why does a revision carry more risk, and how to keep your set point lower while on weight gaining medications.
Drugs cost way more money in this country than they do in any other country. By a lot, not by 5%, but by a substantial amount.
Zoe:Here we are, episode 24 of the Pound of Cure Weight Loss Podcast. Zep Bound to Happen. More drug shortages, yes, yeah, more drug shortages. For sure We'll talk about it. Yep, it is Zep Bound to Happen.
Dr. Weiner:Zep Bound to Happen. More Drug Shortages, yes, yeah, more drug shortages, for sure, we'll talk about it. Yep, it is Zep Bound to Happen, zep Bound to Happen. So, zoe, by the time this episode airs, you will be a married woman.
Zoe:I will, three days from today, of recording.
Dr. Weiner:I know? Yes, I'm heading up to Chandler.
Zoe:I'm looking forward to it. I got my dancing shoes. I'm bringing them Good, good, good.
Dr. Weiner:I have a pair of sandals to change into, in case I need to, because I plan to be dancing most of the time. Perfect, yeah, I'm looking forward to it and I'm really excited for you. It's such an exciting time of your life, right. I feel like you got a lot of good things going on right now.
Zoe:Life is good. I feel very grateful.
Dr. Weiner:Yeah. So you got to pause and just soak it all in and just you know, cause there's good things and there's bad things. Everybody has bad things happen to them and I think that's that's one of the things I've kind of learned about marriage over the years is like we all have this vision of this. Our marriage is going to be perfect and I love my wife and you. You know my wife, I have an amazing wife. We have this vision of this perfect marriage. No, marriage is perfect. There will be difficult times and it's the understanding that just because at one moment in time your relationship isn't everything that you want it to be doesn't mean that it's not a good relationship and that that is just part of the nature of marriage. It's not the easiest thing being married, but with the hard work it it, it is awesome, it's like you.
Zoe:all right, we know it's not always going to be great, but I want to do this with you.
Dr. Weiner:Yes, exactly Right. I want someone that I'm going to spend the tough times with and the good times with, yeah, and so I think you've got that in in in your mat. He's a good guy and I think you guys are both very lucky to have each other, so we're looking forward to celebrating with you in a few days.
Zoe:Thanks yeah.
Dr. Weiner:All right. Well, now let's move on to the podcast. First segment is in the news, and this is an article from the New York Times called the Miracle Weight Loss Drug is Also a Major Budgetary Threat.
Zoe:No kidding.
Dr. Weiner:Yeah, how about that? Have you heard? They're expensive, hard to get sometimes, yeah. So I think, first of all, we've talked about this quite a bit and a lot of the things that we've been talking about over the last 24 episodes, about this fact that our healthcare system has constantly struggled with this tension between incentivizing the pharma industry to develop new medications but, at the same time, keeping breakthroughs affordable for patients. Right, and it's a pendulum. We talked about that last time with the drug patents and so what I think we all have to acknowledge is that right now, that pendulum has shifted toward the pharma industry. The classic example of this is that drugs cost way more money in this country than they do in any other country by a lot, not by 5%. So Ozempic in the United States costs 10 times as much as it does in Britain, australia or France 10 times, and in Denmark, which is where Novo Nordisk is headquartered the manufacturers of Ozempic the drug is $3,500 a year. Wow, compared to about $15,000 a year in the.
Zoe:US, and I wonder what percentage of the population needs it versus you know ours.
Dr. Weiner:I think our need is pretty high in the US. Yeah for sure. Right now in the US we're paying out $15,000 a year for this medication. Do you know what the average healthcare cost is per capita in the US? No, $13,500. So just this drug alone more than doubles a person's healthcare expense. So 40% of the US population is obese. If we were to provide everybody who needs this medication at our current cost, it would be over $1 trillion per year. Trillion, right, a thousand billion. A billion is a thousand million, so it's a million million dollars, that's hard to fathom.
Dr. Weiner:Yeah. And then a lot of people say well, what about all the healthcare benefits? What would the cost savings be if we got 40% of our population who's obese on these medication? How much money would we save in not paying for heart attacks, strokes, cancer, all that stuff? Any ideas Gosh well.
Zoe:I all that stuff, any ideas Gosh? Well, I would hope it's more than a trillion dollars.
Dr. Weiner:It's not, that's the problem, it's 200 billion.
Dr. Weiner:Oh, wow so these medications are five times more expensive than the cost savings, and so that is really the crux of the matter, because, truthfully, if it was even even, then we could probably figure out a way to make this work.
Dr. Weiner:But what this article points out is that we have no chance whatsoever of being able to adequately provide these medications to the people that need them in this country at the current price, and I think it doesn't take a New York Times author to realize that that's true, and that is really the fundamental issue behind the shortages, behind the excessive costs and behind the problem that our country is going to have to face when it comes to treating patients who need these medications.
Dr. Weiner:So Medicare costs about a trillion dollars a year, and so a big conversation is is Medicare going to cover this? And this is something we see. We have tons of Medicare patients in our practice, and last year we could get them on it because a lot of Medicare policies didn't require prior authorization, and come January 1st it was just like annihilation, like everybody lost their coverage, and so just the cost of Medicare is $1 trillion per year. If we put everybody on these drugs, we would probably increase the cost of Medicare by 50%. We can't even afford Medicare at its current rate. So there's absolutely no question that if we're going to figure this out, there has to be new policies.
Zoe:Something's got to give Something's got to give.
Dr. Weiner:We talked about the Inflation Reduction Act in the past, which is what allows Congress to negotiate, or Medicare to negotiate, with the pharma industries on certain medications, and come 2025, we're going to see the first round of medications come up. None of them are GLP-1 meds. So now that Wegovy is approved by Medicare for cardiovascular risk reduction, the question is is Wegovy going to become one of these drugs where Medicare can negotiate with the pharma industry? And the answer is no, not for seven years, because in the Inflation Reduction Act, the drug has to be on the market for seven years before it's eligible to be negotiated, and so there's absolutely no question that this problem won't be solved without new policies.
Dr. Weiner:We talked in the last episode about march-in rights, where the government can basically say Novo Nordisk, great, you've got this patent, you've made enough money.
Dr. Weiner:Sorry, charlie, we're taking over.
Dr. Weiner:We're going to license this to a generic drug manufacturer because you can't produce enough of it and our people need it and we need to bring the cost down, and the government does have the potential to do that.
Dr. Weiner:I think we all agree that's a little heavy handed and maybe not the best way to do it, but these medications are really bringing to a boil the conflict between the pharma industry and Medicare and all of you out there who need these medications but can't afford them. The pendulum has swung far more to the side of encouraging innovation and away from improving access, and the pharma's quest for profits is interfering with our ability to deliver care to the people of our country. The bottom line here is that policymakers need to intervene if we're going to bring the cost of these medications down to a reasonable level. So great article in the New York Times. I encourage any of you who are passionate about healthcare economics, passionate about access to these medications, to look through this, because I of these issues, if they are important to you, and let's see if we can get some people in to the government who are willing to take a stand up against the pharma industry and take action so that these medications can become more affordable.
Zoe:Well, now we have Janet here, our patient story of the day, super excited to welcome Janet, all right, so now we've got our patient guest Janet. Welcome Janet. Thanks so much for coming in and thank you for being patient, because we're running behind.
Janet:Not a problem, not a problem. Thank you for having me.
Zoe:Yeah, of course. So we'd love to just have you share a bit about your story and maybe what brought you to our office and what led you to the decision that you made.
Janet:Okay, Well, I had a normal childhood, pretty active, and was a dancer in high school, so I was pretty slim.
Sierra:Sure.
Janet:Had my first child and I did okay with the weight loss after that. But the second one I had to hold on to a little bit of that and that's when I started all the different techniques, all the different things that people try. So it was shakes and you know, extra exercise, and I joined a weight loss study and Meridia, which was a favorite of mine. It worked well for me. I was very upset when they took it off the market.
Sierra:Yeah.
Janet:But you know, then I continued on with my life. I didn't lose a lot. It was kind of like it would come and go and after gosh my third child, I had gained 100 pounds with that pregnancy.
Dr. Weiner:So it was really pregnancy.
Janet:I think so.
Dr. Weiner:Now, do you have a family history of obesity? I do. Did it also start with pregnancy?
Janet:I am not sure.
Dr. Weiner:Family members I'm not sure I think, just like there's, you know, genetic predisposition to weight gain, there's also some genetics about things that cause weight gain more than others it's probably it's possible that that's where it started.
Janet:I'm thinking about my sister now and, yeah, it's very likely.
Sierra:Yeah.
Janet:And even you know just, I remember growing up and seeing my mom struggling with the same things, and so you know that's why I did a lot of things, that she did Some work.
Dr. Weiner:Were you able to successfully lose weight?
Janet:I was.
Dr. Weiner:And how much could you lose.
Janet:You know when you would diet 30 was probably the lowest weight, and then 80 pounds on my own.
Dr. Weiner:And how much did you weigh when you first came to our office?
Janet:264,.
Dr. Weiner:I want to say Okay, yeah, and was that the heaviest you'd ever weighed?
Janet:No, the heaviest was 275.
Dr. Weiner:It was 275. So what made you kind of seek out treatment? Because you were kind of one of our earliest non-surgical weight loss patients, oh, okay.
Janet:I did not come to you trying to lose weight. Believe it or not, that was a good side effect. I had a lot of pain, I had some injuries and things were just not working well for me. And I continued to gain weight during the time that everybody was forced to stay at home and I just kept putting on weight and it happened so fast that it was like before I could do anything about it. But that really wasn't my focus. My focus was okay, I have this pain If I can get rid of this pain. But that really wasn't my focus. My focus was okay, I have this pain. If I can get rid of this pain, I can exercise.
Zoe:You know, I can go back to what I usually do. I can go back to my old methods to lose weight Exactly.
Janet:Okay, exactly, and that really came from my older sister who was taking Manjaro at the time, suggesting that you know, for her it had worked to remove some arthritis pain that she had. And I thought, well, if I could do that, you know, if I can do that, I don't care if I lose weight or not. This is how bad I was feeling at the time. I'll be happy, you know, I can move myself again if I can just get rid of the pain, started losing weight and got very excited about that. So then I was okay.
Dr. Weiner:You're like oh, I like it, it was joint pain that kind of drove you to see.
Janet:It was a lot of joint pain and also I had lymphedema, we discovered, and so I was holding a lot of water. So it was just like I was just miserable at the time.
Dr. Weiner:And so your sister also was taking Monjaro.
Janet:Yes.
Dr. Weiner:Was she also successful? Yes, just like there may be some genetic components that cause weight gain, there's also, particularly when it comes to medications but we see this with surgery too is that there is a genetic tendency towards success or failure to respond to certain medications, and so we call that. There's a whole field, it's called pharmacogenetics.
Zoe:So how long have you been on Manjaro now?
Janet:Gosh, I think it's. We're at 18 months now.
Zoe:And how much have you lost total?
Janet:About 120 pounds. Wow, wow.
Dr. Weiner:And how are your?
Zoe:joints feeling, they're a lot happier.
Janet:They're a lot happier. Yeah, I can stand up and just be there for a moment and not have any throbbing. You know, nothing starts to ache, so that's good.
Dr. Weiner:So you lost almost you know 40% of your total body weight.
Janet:Quite a bit Right. Did I do the math right? You're doing the math thing.
Sierra:More than that 45%.
Dr. Weiner:You lost about 45% of your total body weight when we look at the success rate for. And what dose of Monjar are you on?
Janet:Seven and a half, now Seven and a half. I made it up to 12 and a half.
Dr. Weiner:You're not even you made it up to 12 and a half and you've kind of backed off the seven and a half. We'll talk about why you've done that in a moment. First of all, we look at greater than 25% total body weight loss. We see only about a third of people do that and if we look at the dose, those patients are either 10 or 15 milligram dose and so you were kind of in that range but you've been able to maintain it at seven and a half, but that's 25%. So we're looking at. So I think the first thing for those of you out there, these are atypical results. This is really exceptional weight loss.
Zoe:Super responder. Super responder yes.
Dr. Weiner:Yes.
Zoe:So what did you do with your nutrition to combine with the medication? Did you make a lot of nutrition changes?
Janet:Changes were made for me. Mount Jaro did that.
Dr. Weiner:Yeah.
Janet:I lost my appetite and so it was a fight to eat. At times it was almost like I was repulsed by food and so I had to overcome that and we're just trying, like oil heating or you know, I'm partnered with a chef, so anything that she's cooking, you know, if it's the wrong thing, I'm like open windows open doors, you know because I can't stand the smell of it. So any butter or anything like that.
Dr. Weiner:Fast food restaurants probably repulse you.
Janet:French fries.
Dr. Weiner:Yeah.
Janet:Yeah, I used to love them, but yeah.
Dr. Weiner:Not anymore.
Zoe:Do you find that you're craving, like the vegetables and the whole foods now?
Janet:I'm craving fruit a lot of like cold fruity things, so smoothies are one of my go-tos at this point so.
Dr. Weiner:So let's talk a little bit about dosing. You were on 12.5. You're originally getting this covered by your insurance company, correct?
Janet:no, oh, you've always been self-paying, always been self-pay. You've spent a lot of money on this. I have. I have, unfortunately, yeah.
Dr. Weiner:So we're using some of our creative dosing strategies. How much are you paying per month right now to keep you on the medication? What are you doing? Because you're much more of a weight maintenance phase. You're much more of a weight maintenance phase correct, Right.
Janet:So I would be breaking it down because I'm spacing things out a little bit at times. I'm still paying the full cost because I did have a bit of stock. Yeah, because there were times before where it wasn't available. Right, I was able to hold on to probably a couple of boxes and so that's helped. So I haven't had to pay out anything else yet, okay.
Dr. Weiner:Are you taking it weekly? No, how often are you taking?
Janet:it Every 14 to 21 days.
Zoe:Okay, 21 is the longest I've gone. So talk us through that change, like when you start to notice the medication decreasing in your system and if you notice, like your hunger coming back, that food chatter coming back. Is there anything like that, um?
Janet:one of the things that I noticed is that my appetite definitely comes back. Um, I don't have to fight as hard to. I'm just ready to eat Um, and I can finish my plate if I want to um, so that's. That's one of the main things that I notice is, but other than that, I still. There are still things that I don't want, so that sticks with me, which is I'm happy about that. Um, the other thing that I noticed recently is that I start to retain water from your routine fluid and so once I take Manjaro again, then I'm peeing it out. That's fascinating, yeah.
Dr. Weiner:So you're taking the drug every two to three weeks. You're kind of shelling out a lot of cash for it. Still, yes, we're using some dosing strategies by moving you down to 7.5. We may be able to cut some, cut the cost down a little bit that way. Um, and so your goal is to stay on this med long term.
Dr. Weiner:Yes, you feel comfortable staying on the med I'm comfortable staying on the med long term yeah you know, interesting, I had someone you know talk to me today and they're like what do you think, dr, why you think these things are really safe? And and I think my answer is at this point and again, keep in mind.
Dr. Weiner:I'm a bariatric surgeon, right? This is what I trained to do. My entire life is also being threatened by a medication and and. But you know, I, what I've also been trained to do, is to treat patients who are suffering with obesity, and so that's where all the nutrition work that we've done comes in. And so the medications to me, just they do, kind of they work with what I like to do. But my answer is yeah, I really do think that these medications are going to be proven to be safe. I think in 10, 15, 20 years, we'll still be using some form of them, probably a slightly better version.
Zoe:Hopefully a cheaper version. Hopefully a cheaper version for sure, I think in 10, 15 years, we will have a cheaper version.
Dr. Weiner:It might take that long, though, zoe. So, and the reason I think that is because with every single medication we take, with every single surgery that we perform, there are risks and there are benefits. We know that. That's just the nature of medication and science and medicine is that nothing's for free medicine?
Zoe:is that nothing's for free? Yeah, do you have like a specific memory or a specific non-scale life-changing moment that you can kind of like taste and want to share?
Janet:Um, yes, I don't like football, but we went to a Superbowl game and I we went down the stairs, sat in our seat and I was like I have all this space I could cross my legs and lean back. You know, I had all this space and that's. That's something that mattered to me, because, you know, when you have extra here and you've got arms, you know armrests there and everything's pressing up against there, you're uncomfortable and you're not focused on anything. That's fun. You're thinking about how uncomfortable you are, so that was great.
Dr. Weiner:It takes the joy out of the moment.
Janet:Yeah.
Dr. Weiner:And so you were able to really fully enjoy that moment.
Zoe:Be present. Have you found yourself being able to be more present in other situations?
Janet:Absolutely, and it's nice because this is not something that's preoccupying my mind. I'm not always thinking about what I have to do. You know that's. It just frees up so much space in your head.
Dr. Weiner:Yeah, have you noticed the medication not working as well after a certain amount of time?
Janet:I think when I got to maybe the 10th month in, I want to say that's when my hunger came back. It came back with a vengeance and I was like what is this, you know? Did I get a faulty pen? You know what's happening here and um it, it kind of tapered off. So I guess, after it was held back for so long, it was just, like you know, rushing out to yeah, exactly that's what it felt like yeah but, um, it's not nearly as as bad as as that, that's.
Janet:That's the one thing that I really noticed. So the medicine's still working pretty well, the medicine is still working and I think that's what we're going to find.
Dr. Weiner:It's going to take tweaking and adjusting. It's going to be like high blood pressure, like diabetes, like anything where we're going to need to make adjustments. Right now we only have two drugs to work with, but over time we'll have more and more options and different doses and even second drugs that you can add in if necessary, and so I think we'll have more and more tools over time to support people through this. But you know it's so good to see how well you've done. You've really put a lot of energy and effort into this too. You kind of made up your mind that you were going to figure out a way.
Janet:One way or another it was going to happen. But this is a wonderful tool. I mean, it takes so much of the weight off of you so that you literally and figuratively, you know, can work on the other things in your life that you need to focus on.
Dr. Weiner:Yeah, it's the fishing pole, right, yeah, you know, you want to give a man a fish feed him for a day. Teach a man to fish feed them for life. But maybe if you give them a fishing pole they might help them out a little bit. And I think that's what this medication does for you is it just gives you that extra so that you can make the good food choices, so that you can focus on the things that are important. And you know people think there's no effort involved in this. That's not true, yeah.
Janet:You know, there are times where I was like, do I really want to continue with this? Because I was nauseated or, um, I felt tired and it was just like that. That can be work too. You know, figuring out how to deal with those little issues that come up is also work. So, um, but it's worth the work. I think it's worth worth it. I think you're worth it. People are worth it, yeah.
Zoe:You're worth the work You're worth the work, absolutely.
Dr. Weiner:Anything that's good comes with work.
Zoe:Yeah. Do you have anything else you'd like to share? Anything to share with our listeners, any nuggets of helpful information that you think would be helpful to?
Janet:share. One of the things that I think is important is to go ahead and check with your doctor. Don't feel ashamed about how you feel about yourself. It's your body. So if you're uncomfortable in your body, don't listen to TikTok and whoever else Any social media that's telling you that you should like yourself the way you are. If you're struggling with that, then you go talk to someone who can a professional who can help you, make a plan or do something that's going to be good for you.
Zoe:Thank you so much for making the trip and we really appreciate you sharing Thank you.
Dr. Weiner:Thank you for having me. Absolutely Congrats on your success. Thank you, I appreciate it.
Zoe:All right. So for our nutrition segment today, I want to talk a little bit about something that Janet was mentioning but that I help people with all the time, which is what to eat when you just don't feel like eating, whether you just had surgery, you know, a couple of months ago, or you're adjusting to a new dose of a GLP-1 and you have maybe that food aversion or you're just like ugh food aversion, or you're just like ugh. And we have to toe this line and this is a conversation I have with patients a lot between listening to your body and being mindful and like, yes, we want to have that awareness and presence in our body, but then also recognizing that those hunger signals are being suppressed and your body still needs fuel. So it's okay, I want to listen to my body, but I also know my body needs nutrition, and so when we're experiencing that, what I find is actually drinking like a smoothie and having these little spaced out throughout the day mini meals or snacks, so that you aren't sitting down to a big plate, which will just make that desire to eat not to eat even greater.
Zoe:But, like Janet was mentioning, she is craving, like fruit smoothies and that kind of thing. So of course we want to make sure you get a protein source in that smoothie or that little mini meal snack, whatever you're having. But just even if you make a smoothie and then maybe you drink a third of it, put it in the refrigerator, go back to it later on and just kind of sip on it throughout the day. It's a really great way to deliver a lot of nutrients, a lot of protein, micronutrients, fiber, great stuff in there, without necessarily force feeding yourself to eat a big plate of food if you don't feel like eating it.
Dr. Weiner:Yeah, no, I think that's great. It's really a delicate balance because we talk so much about mindful eating Right, but there are moments when what we're doing is maybe not the most natural thing. Let's be honest Bariatric surgery not the most natural thing. Glp-1 meds not the most natural thing. But our whole food chain has gotten out of whack and there's so many environmental factors that are causing obesity. We're having to kind of push the envelope on some of these medical things to try to bring things a little bit back in check.
Zoe:Well, because most of the food on the market for us these days are not the most natural thing.
Dr. Weiner:Absolutely, absolutely. So we're doing in response to unnatural foods, we're using some unnatural medication and surgical therapies and there's that balance response to unnatural foods, we're using some unnatural medication and surgical therapies and there's that balance, that pendulum. And there are moments when you kind of shift out of balance. And we see that in the first few months after surgery. We see that right after starting GLP-1 meds or increasing the dose, and so at that moment you have to realize, hey, listen, maybe listening to my body exactly is not going to work at this time because we've just kind of shifted a little bit out of balance. But you want to keep the faith that once you get through this it will shift into a more natural balance and you will be able to really be more mindful.
Zoe:It reminds me of this, something that someone was talking about online a while ago is you have to go through periods of unbalance, or imbalance, like you were just saying, in order to get to balance?
Sierra:whether it's you know.
Zoe:I'm just going to eat whatever I want, screw it to the extreme of being super strict and then finding your way back to incorporating mostly healthy, whole, real foods with the balance of some treats every now and then. But you have to kind of figure out that pendulum swing in order to find that middle ground.
Dr. Weiner:Yeah, I think that's. To get to balance, you have to have moments of imbalance.
Zoe:Because then you don't appreciate what balance is. Yeah.
Dr. Weiner:So let's talk about the economics of obesity. We're going to do an update on the shortage. You know, a couple of months ago Eli Lilly came out. They're the manufacturers of Zepbound or Monjaro and they said we do not see any shortages coming. We've got this covered. We have planned for this. We don't see anything on the horizon at all for shortages. Let's now fast forward three months when all of the doses except for one of both Monjaro and Zepbound are on shortage. And so I think the first thing that I've learned and I learned this back with Novo Nordisk, so I don't want to point a finger at Eli Lilly Novo Nordisk has done the same thing, and they told us over a year ago that the shortage was going to disappear, and the shortage is still in place a year later. So I think the first thing that you can tell about these drug shortages is ignore whatever the pharma industry says. They're not telling the truth.
Zoe:They're saving face.
Dr. Weiner:They're saving face, I think. Also, the demand is just unprecedented. I think, whatever their calculations were going to be for how many people were going to prescribe this drug, they were based on other drugs that have come out in the past, and the truth is there's no other drugs like Zepbound or Wegovi. There's nothing like this, even like the SSRIs which kind of took over our culture. People weren't clamoring for them, they weren't running from pharmacy to pharmacy, there weren't celebrities talking about it Totally.
Dr. Weiner:Totally Exactly so. These medications are unprecedented and so, as much as the pharma industry, they haven't necessarily been truthful. I think it did exceed even their best case scenario for demand. So both Zepbound and Monjaro are on shortage. They do have new manufacturing plants that are coming online. So does Novo Nordisk, but you can't just build a manufacturing plant in a few months. I mean, this takes a long time.
Dr. Weiner:So there are a lot of strategies that we use in the office to help patients get through, and we do have our Pound and Cure Platinum Program, which is kind of our best version of what we can offer for non-surgical weight loss and also for surgical weight loss, if you're looking for revisions, and so if that's something you're interested in, we do have a lot of techniques that we use in the office to help patients navigate through these shortages. So we just heard from Janet about some of the strategies she's using about increasing the dosing interval. There's other things as well that can help reduce the cost, but I think getting through this can be tricky, and guidance by someone who has a kind of an open and creative mind can help you. You get through it. Um, there are websites available. So if you go to supplylilycom slash Monjaro or slash ZepBound uh, it will list all of the drugs that are available. And also you can look on the FDA site. Uh, there's an FDA shortage list, and so if you, if you Google this, it's pretty easy to find which doses are available. Right now.
Dr. Weiner:When it comes to Monjar and Zepbound, the 2.5 milligram is available, but all other doses are listed as limited availability. It doesn't mean you can't get it, it just means it's going to be hard. We're using Lilly Direct Pharmacy a lot. Even we're seeing shortages with them as well. In fact, I've had people who were able to get the drug at their local CVS who weren't able to get it through Lilly Direct, and so just because they do have that direct relationship with the pharmacy doesn't necessarily mean that they have a better supply than everybody else. The drugs they're out there. They're hard to find. If you work through it, you can often track them down, but it's going to take some work. I talk a lot with patients about timing and when you want to be aggressive with your weight loss and when it might be time to circle your wagons, and so I think right now, if you're really relying heavily on these medications, it's time to circle your wagons.
Zoe:Hunker down for a little bit of maintenance.
Dr. Weiner:Exactly yeah. So this is not the time to be pushing the envelope and going up to that next dose and really working to drive the weight off through medications. It's time to be working with someone like Zoe and focusing on nutrition and getting the weight down and maximizing your nutrition.
Zoe:And that's what we're actually doing in the new group that I started Navigating. Glp-1 shortages is about like how to bridge the gap. Maybe if you're just chugging along on a lower dose than normal or you have kind of like a hiatus waiting until you can find another dose, what can we do nutritionally and lifestyle ways to really get you through until you get your medication again?
Dr. Weiner:Yeah, there's a lot of people frustrated about these shortages. I get it, but the truth is, this is, above all, of our pay grades Like we are not able to change this shortage, and things happen in your life that are unfortunate. Every single person billionaires, you know, movie stars, actresses, Instagram, famous people they all have bad things happen in their life too, and so when these bad things happen, it's very. Actresses, Instagram, famous people they all have bad things happen in their life too, and so when these bad things happen, it's very. You know. A lot of times we're like, oh my gosh, this is so terrible, how could this ever happen?
Dr. Weiner:But sometimes these bad things that happen are a gift and you know, perhaps right now, if you're having trouble getting that medication, it's a sign that you should be focusing as much energy as possible on improving your nutrition. I think if there's one mistake we see over and over and over again out there, it's people over-relying on the medications and under-relying on nutrition to drive weight loss and to help them with weight maintenance, and so if you're struggling with a shortage out there, maybe this is the universe telling you hey, time to focus on nutrition a little bit more than you have been in the past. All right With that. Let's move on to our questions from social media. We've got Sierra here to read the questions. I think the first question is for Zoe, so why don't you let us know what? We've got Sierra.
Sierra:First question is from our YouTube video, durable Weight Loss. Please could you do a video or podcast on how to transition from the weight loss phase towards maintenance? I'm still losing weight rapidly after my bypass October of 2023, and wish to slow it up and maintain now so I don't get too thin. Love your books, videos and pods.
Zoe:Well, I think this question goes beautifully with Janet's story because she's in her weight maintenance phase and she's really great at attending nutrition sessions and she's really involved in the nutrition program. So I really I wanted to applaud her when she was here but I forgot to. So that's the little shout out. But anyway, let's talk about what the priority is. While you are losing weight, post-op, you are prioritizing protein because we want to minimize muscle loss, right, maximize fat loss. So you're prioritizing protein because of that volume restriction and then filling in the gaps with your produce, your vegetables and your fruit.
Zoe:Then, once your hormones shift to weight maintenance, we want to flip those priorities. We want to eat primarily vegetables and fruit and plants, filling in the majority of your volume, and then, yes, still getting high quality whole food protein. But it's not going to be your main priority. This is also where we kind of dabble a little bit into those planned indulgences and how we can find that pendulum swing right. We were just talking about being in a period of imbalance to then find your balance. Perhaps maintenance is you finding that balance of mostly real, whole, unprocessed foods, but then we want the majority of your life to be in maintenance anyway and real life says you're probably going to have some birthday cake on your birthday. You might have a piece of pizza at your kid's birthday.
Dr. Weiner:A piece of wedding cake on your wedding A piece of wedding cake, for heaven's sake.
Zoe:And that's part of life. And we want you to have this new relationship with food that allows you to have those things without letting that pendulum swing in the opposite direction and say, well, screw it Right. So that's what I would say Shift towards eating more volume through plants, still prioritizing whole foods, and maybe we want to work a little bit into some of those planned seldom treats.
Dr. Weiner:Yeah, so I think another thing is that people get so hung up on the 60, 80 some practices say a hundred grams of protein. What's your thought on that? Is that a lifelong goal? Do people need to track protein forever?
Zoe:I will say it depends on their activity level. So if somebody is just, you know, maybe like getting the most of their movement through walking, maybe they're not super active and they're just kind of maintaining mostly through their nutrition, then being on the lower end of protein is fine. If someone has really, you know, found themselves in love with fitness and they're exercising a lot and they're lifting weights and those sorts of things, then in and their goal might be to build muscle, which means we need more protein. So I would say it depends on the person, but as a blanket recommendation, we don't need to worry so much about tracking that protein long-term.
Dr. Weiner:Yeah, track the pound of vegetables. Yeah yeah, if you want of vegetables, yeah yeah.
Zoe:If you want to track anything, track that.
Dr. Weiner:Yeah, and maintenance phase for sure. All right, what's our next question, sierra?
Sierra:Okay, this one is from our YouTube short on bariatric revisions and it's from Fanny. She says why does a revision carry more risk?
Dr. Weiner:When I go in for a primary surgery, everything's right where it should be, just like in the textbooks. When I go in for a revision surgery, somebody else has been there before and so there's going to be a lot of scar tissue. I want to get to the stomach. I may have to cut down scar tissue for 20, 30 minutes to get there, and cutting down scar tissue has risk. It's everything stuck together and I have to separate the intestine or the colon or the stomach or the liver from another structure. And when you're doing that it's difficult. You have to be very, very careful.
Dr. Weiner:I do lots of revision surgery as I've kind of worked out a lot of the kinks, but it takes extra time.
Dr. Weiner:There's risk involved in that. So the scar tissue is really the major issue, and then scarring also causes the stomach or the intestines to be thick and inflamed, so it's not going to hold suture as well as that kind of native tissue that we operate on the first time, and so you know your suturing has to be. You just have to be a little bit more careful. Things don't line up just as nicely as they do in primary surgery and so it just is more difficult. So when normally a gastric bypass might take me an hour and 15 minutes or so. If I'm doing a complicated revision surgery, that surgery can take two or three hours, and so when you're dealing with previous surgical anatomy, you never know what you're going to get. There's always going to be a lot more scar tissue. The tissue is not going to be as soft and pliable as it has been, and it just requires a lot more time and care and therefore has more risk.
Sierra:Okay, last question. Here is from our Instagram reel on durable weight loss how can we keep a set point lower when on medication that causes weight gain? Ozempic has been a godsend, but now my benefits won't cover it. I'm very active and already had a bypass five years ago.
Zoe:Well, the first thing that comes to my mind, because we've talked about this before, is how to lower your set point. Well, one of those ways is to build muscle. It sounds like you're very active, and if you are not already incorporating strength training into that activity, I would recommend it.
Dr. Weiner:Yeah. So I think yeah. Four ways to lower your set point right Nutritional change not eating less, but eating differently. And that's where our metabolic reset diet comes in. And so the first way I would have you do is get on the metabolic reset diet. You can go to our website and download the handout for free.
Zoe:Yeah, actually, if you haven't done that yet, anybody listening, everyone's loving it, even the people already in our nutrition program. They've, like, I've downloaded that handout, so definitely get that. It just pops up on the chat widget in the bottom of the screen.
Dr. Weiner:Right, and then you can join Zoe when she gets back from her honeymoon on the metabolic reset diet support groups and kind of really taking that handout and learning how to put it into action and then building muscle, absolutely, absolutely. And then I think the other thing to consider is you know, the medications are a godsend, particularly in the situation where you're taking a medication that causes weight gain, and so, again, I like to fight fire with fire, and you didn't. It's not covered by your insurance. We do have some ways. We only use real medication. We don't use compounding medication. Again, our Pound and Cure Platinum program. We we are able sometimes to get people the medication at a more reasonable price than you would expect. I'm not going to tell you it's simple, straightforward way, but there's. There's some tricks and some things that can be done, and so you may want to consider looking into that or working with us or another creative provider. Just see if you can come up with something that would potentially fit within your budget.
Zoe:All right. Well, I think that about wraps us up. Thanks so much for listening and, of course, we'd like to acknowledge and thank our wonderful team. We've got Sierra Miller and Rhiannon Griffin, the podcast producers, and the editing is done by Autogrow. And, of course, we need to thank our special patient guest again, janet.
Dr. Weiner:So please check us out on social media. Our website we can download our Metabolic Reset Diet handout. Consider joining our online nutrition program or our Pound to Cure Platinum program if you need more assistance. See you next time.