The Pound of Cure Weight Loss Podcast
Hosted by obesity specialist Matthew Weiner, MD and dietitian Zoe Schroeder, RD, The Pound of Cure Weight Loss Podcast provides a comprehensive approach to weight loss. We cover nutrition, the new GLP-1 medications, and Bariatric Surgery in depth and answer tons of questions from our audience every week. Check out our website for video versions of the podcast: www.poundofcureweightloss.com/podcast
The Pound of Cure Weight Loss Podcast
Bariatric Secrets: What Really Influences Weight Loss after surgery?
In episode 43 of the Pound of Cure Weight Loss Podcast, Dr. Matthew Weiner and Zoe Schroeder, RD, explore key bariatric surgery weight loss factors, the best diet for weight loss, and how to manage malabsorption after bariatric surgery. The episode emphasizes that post-surgery success involves much more than effort alone.
Bariatric Surgery Weight Loss Factors
Dr. Weiner explains that multiple factors influence weight loss after surgery, including age, gender, and genetics. For example, younger patients lose more weight than older people do. And men, tend to lose more weight than women. Diabetes also complicates weight loss due to higher insulin levels. However, following the Metabolic Reset Diet can help reverse diabetes and promote more weight loss both before and after surgery. Factors like mobility issues and medications can also slow the process.
Best Diet for Weight Loss
The hosts highlight that the best diet for weight loss focuses on nutrient-dense foods like fruits, vegetables, beans, lean proteins, and nuts. Dr. Weiner stresses that it's not about eating less but rather, eating differently. Highly processed foods pack in “bad calories” that hinder your metabolism, while whole foods support weight loss and overall health. The goal is to shift your calorie intake toward nutrient-dense foods and away from processed junk.
Malabsorption After Bariatric Surgery
Dr. Weiner also addresses concerns about malabsorption after bariatric surgery. Particularly after procedures like a gastric bypass, where certain nutrients like iron, calcium, and vitamin B12 may not be absorbed efficiently. Lifelong supplements and regular blood work are crucial to manage these deficiencies.
Long-Term Success: More Than Just Surgery
While surgery can significantly lower your body’s setpoint, long-term success depends on lifestyle changes. Dr. Weiner and Zoe recommend combining surgery with nutrition and movement in order to produce the best, most durable weight loss.
When those aren’t enough, Dr. Weiner will also combine surgery with GLP-1 medications to reduce hunger and make it easier to maintain a healthy diet. These medications lower the setpoint and help manage "food noise," but they need to be taken consistently to prevent weight regain.
Conclusion
In this episode, Dr. Weiner and Zoe emphasize that bariatric surgery weight loss factors include things beyond effort, like age and the type of surgery chosen. The best diet for weight loss focuses on nutrient-dense foods, and malabsorption after bariatric surgery is manageable with proper care.
If you have a question that you would like answered on the podcast, comment on our website or any of our social media platforms.
The more of your calories you're eating in a day are coming from good sources fruit, vegetables, nuts, seeds, beans, lean animal protein and the fewer calories you get from processed foods. That's what you want to push to the limit and that's how I would measure nutritional change.
Zoe:Lower than 20%, ideally Lower than 20% exactly.
Dr. Weiner:Yeah, 20% bad calories, yeah.
Zoe:Okay, Welcome to episode 43 of the Pound of Cure Weight Loss Podcast. Bariatric Secrets what really influences weight loss after surgery.
Dr. Weiner:Huh.
Zoe:Huh.
Dr. Weiner:Yeah, common question. I think everybody thinks it's like, well, how hard you try, but listen, I've done this for a while. Everybody's trying pretty hard.
Zoe:Yeah, exactly, there's so much more that goes into it, we'll get into it a little bit more. Yeah yeah, so do you take like online quizzes?
Dr. Weiner:I mean I don't go and like take them all the time, but I've definitely taken them.
Zoe:If it's in your, you're like oh, that sounds interesting, yeah, so no, I've taken them If it's in your.
Dr. Weiner:You're like, oh, that sounds interesting, yeah, so no, I've taken them. Okay, do you have a favorite? I think my favorite quiz that I took was the which house of Harry Potter you are in. It asks you a bunch of questions. It tells you, guess, which house I am.
Zoe:I don't know Harry Potter well enough. You don't know Harry Potter. I watched halfway through the third.
Dr. Weiner:So I'll give you a little. I'm a classic Gryffindor.
Zoe:Okay, that's great.
Dr. Weiner:No question, I'm a Gryffindor.
Zoe:Glad to hear it. I don't know well enough, but it's kind of like those. What are they?
Dr. Weiner:The BuzzFeed ones. Yeah, I would strongly encourage you to start reading some Harry Potter.
Zoe:My husband would be very happy about that.
Dr. Weiner:Really, your husband's a big Harry Potter guy.
Zoe:We just watched. It took us like four nights, but we just watched the first one.
Dr. Weiner:Oh yeah.
Zoe:Yeah.
Dr. Weiner:So I mean, we're a huge Harry Potter family, big time We've gone to the Harry Potter world. My daughter has probably my older daughter has probably watched each of the seven movies 15 times each. Oh my gosh, I mean, it's like her. Just I'll walk in and she'll be sitting there at 17, 18 years old, watching Harry Potter.
Zoe:Fully engrossed. Fully engrossed, loving every second of it. Wonderful.
Dr. Weiner:So anyway, so we do have quizzes on our website. We have a lot of quizzes, yeah, and I kind of like that because I like computer stuff and I like putting these things together.
Zoe:And it's fun for people to find out.
Dr. Weiner:Yeah, so our first question does come from a quiz on our website, which is the how much weight will you lose after bariatric surgery? And so someone said you know what are the factors that influence it? Like, why do some people lose more weight than others? And we've talked about the genetic component a lot in the past and unfortunately we can't measure that. We've also talked about that. But there are other factors. The truth is, the majority of them are not modifiable, meaning you know, like, the first is your age.
Zoe:Can't change it.
Dr. Weiner:Can't change your age, and so the younger you are, the more weight you lose, right, and that anybody who's aged like me knows like it was a lot easier to lose weight when you're younger than when as you get older and it's like physiological protective right. Absolutely, yeah, absolutely, yeah for sure. Gaining weight. You know, we know that that a little bit of weight as you're older is better, and gender can't modify that, and so men lose more weight than women, right?
Zoe:I think many women listening can think back to a time where they're like, yeah, I did all this stuff and my husband I'm remembering from a session not too long ago my husband just quits drinking soda, didn't change anything and he lost 10 pounds and it's so frustrating, it's so frustrating right, the woman's trying twice as hard and the guy's losing all the weight right Diabetes.
Dr. Weiner:So diabetes insulin resistance causes higher baseline insulin levels and higher insulin levels make it harder to lose weight. So if you have diabetes you're going to lose less weight than if you don't have diabetes. And I think that's really one of the factors where diet can make a huge difference in weight loss, as if you can kind of get onto the metabolic reset diet and we see the metabolic reset diet can really dramatically improve and even reverse diabetes in a lot of patients. And so if you can use nutrition to kind of get rid of the diabetes, then you can lose weight like a non-diabetic. And so in my mind, for diabetics nutrition is particularly important and we really have to kind of go that extra mile if at all possible.
Dr. Weiner:Mobility right. If you're using a walker, limited mobility injuries that's gonna slow down your weight loss, lead to less weight loss. Psych meds, weight gaining meds big factor In the original calculators. When they first did the studies, they linked and they found that people with mental health disorders had less weight loss than people who didn't have mental health disorders. When they dug into that further-.
Zoe:They're like it's not necessarily about the person, it's about the meds.
Dr. Weiner:Exactly right. As they dug in further, they found out it was the meds that are. That it's if you have a bipolar disease but aren't taking the weight-gaining med, you lose weight just like everybody else. So psych meds and that's something you know that's potentially modified. We've talked about how you know you shouldn't be adjusting these on your own, but there sometimes is a more weight-neutral regimen that you can use Access to GLP-1 meds. This is the biggest.
Dr. Weiner:And bariatric surgery isn't perfect, glp-1 meds aren't perfect, but maybe the combination of the two of them are Pretty dangerous. For sure. That's the closest thing to a perfect weight loss treatment that we can find, and we do a ton of that in our practice. And I think whether or not you're going to take GLP-1 meds long-term, that's going to have a major influence. That's probably, without a question, the most significant modifiable factor.
Dr. Weiner:The surgical procedure that you choose the sleeve gastrectomy you're going to lose less weight than with the gastric bypass, the duodenal switch and the SADY, which I'm not a huge fan of either of those procedures especially. I'd rather put someone on, do a gastric bypass and put them on GLP-1s. I think we'll see as much, if not more, weight loss without the side effects of these fairly malabsorptive procedures. But there's definitely a hierarchy where the more surgery, the more weight loss, and then finally, socioeconomic status. We've talked about this in the past, that if you come from a lower socioeconomic status, have less money, less resources, that you're going to lose less weight after surgery, and so these are all factors that influence weight loss after surgery. If you're curious, have I lost the expected amount of weight after surgery? Or if you're planning on surgery and want to see how much you'll lose with a gastric bypass or a sleeve gastrectomy, our website. We've got these calculators everywhere. They should be pretty easy to find. Plug in your info and we'll get you the results.
Zoe:We won't tell you what Harry Potter house you'll be in, but we'll tell you how much weight you're predicted to lose after surgery?
Dr. Weiner:Absolutely. There are other quizzes that will tell you that.
Zoe:Yeah, well, and then also something that we focus on in our nutrition program is yeah, this really great, powerful tool surgery or the meds but by itself isn't going to get you as much weight loss if you're not combining that with your nutrition and your other lifestyle habit modification. So I'd say that also predicts how much weight you're going to lose after surgery is how well you embody the lifestyle change that you're dedicating to.
Dr. Weiner:I think it's. You know all the data we get for these calculators and they're based on kind of historical averages, so this isn't like a theoretical thing, it's more like we've, you know, 100,000 people have had surgery and we've created these statistical models that you can use to predict weight loss, and so you're really comparing yourself against other bariatric patients, and I think bariatric patients tend to eat pretty well, right Better than the average person in the US, that's for sure. And so if you're going to really get extra weight loss on nutrition, you have to eat even better than the average bariatric patient, which means you really it's a pretty extreme level of nutrition which some people are capable of after the surgery. Especially, you put the GLP-1s and you really take the food noise out and you give people the right tools and support so that they can adjust their lifestyle. We see people who eat amazingly well after surgery, but it's important that it's that level.
Zoe:Yeah, one of our peer leaders, lori. Actually, her peer group is every other Wednesday night.
Dr. Weiner:Okay.
Zoe:She is very like I've made the decision to do surgery. This is how I'm. She is like a diehard metabolic reset and she has done that kind of what is the word? I'm looking for Excelled nutrition, if you will. Yeah.
Dr. Weiner:Yeah, we should come up with a term for that. I think, yeah, so all right. So let's move on to our next question.
Sierra:Okay, great. This question comes from Instagram, from Lucrecia On our video lower your set point through nutrient-dense food. When you say to change what you eat, do you mean eating nutrient-dense foods like fruits, vegetables and nuts?
Zoe:So, yeah, when we're talking about changing the way you're eating because I think we say that a lot on this podcast right, it's not just about eating less, it's about changing how you're eating and, to go to your question, absolutely, eating more nutrient dense foods like vegetables, because you get those phytonutrients, you get the fiber, you get that volume right. The fruits, the nuts, the beans, all of these whole real, unprocessed foods, in order to bring down your metabolic thermostat, as one of the four ways to lower your metabolic thermostat is change the way that you're eating. So your question was absolutely right yes, eating more nutrient-dense whole foods. Yes, eating more nutrient dense whole foods.
Dr. Weiner:Right and I like to talk a lot about your calorie ratio, the ratio of the good calories you've eaten to the bad calories. And you know the difficult part of it is is that you know spinach has no calories and French fries have lots of calories. So it really doesn't take much to throw off your calorie ratio, but kind of the further you can push it, where the more of your calories you're eating in a day are coming from good sources fruit, vegetables, nuts, seeds, beans, lean animal protein and the fewer calories you get from processed foods. That really that's what you want to push to the limit and that's where that's how I would measure nutritional change.
Zoe:Lower than 20%.
Dr. Weiner:Lower than 20%, exactly. Yeah, 20% bad calories yeah, all right.
Sierra:Next question Next question comes from Jill from our website. I'm interested in having a gastric bypass performed but I'm afraid of malabsorption of vitamins after surgery. How often does this occur, and with what vitamins and minerals?
Dr. Weiner:So, yeah, a lot of patients are concerned, particularly with the gastric bypass, about malabsorption of nutrients and that's kind of a generic term. Hey, what about malabsorption of nutrients? And so I think it's important to look at what we're seeing in our post-op patients. And we check blood work all the time and we see vitamin D deficiency, but not necessarily with a particularly higher rate than we see in the general population. And we check these labs on patients before surgery and we see plenty of vitamin D deficiency before surgery. When it gets to the more important vitamins like thiamine and folate, we see very, very few significant deficiencies. Every now and then someone drops a little low, but I can count on one hand the number of times I've seen an actual nutritional deficiency from B12 or folate or thiamine one of these critical B vitamins.
Dr. Weiner:What we see and we see a lot of this is iron deficiency. Um, and iron is preferentially absorbed in the first portion of the small intestine and so when it's bypassed after surgery it's very easy to become iron deficient. And I actually just saw a patient today who had her surgery in another state. Um, she just moved to tucson and she came in and she's like I'm losing hair, I'm fatigued and I have dry skin and we know that. That you know. I can pretty much guarantee you she's had iron. She hasn't been taking her vitamin, didn't know what vitamin to take, hadn't had it checked in a long time.
Zoe:Thank goodness she came to see you.
Dr. Weiner:Thank goodness, because what ends up happening is people end up, they can't walk up a flight of stairs, they become exhausted and they're profoundly anemic severe, severe iron deficient anemia to the point where they check it and their hemoglobin normal hemoglobin is like 10, 12, 14 even, and they come in with a hemoglobin of four which is like potentially life-threatening. When you come slowly onto it, your body will adjust. But they're basically told immediately. Go to the emergency room. Immediately, do not pass. Go, go there right now. You are bleeding. You need emergency blood transfusion. This is a serious emergency. It's not as serious of an emergency, but it certainly is a health crisis and these patients will often get a couple of pints of blood iron infusions and they go through a lot when it could have been prevented with about 10 bucks worth of iron every month.
Zoe:Wow.
Dr. Weiner:So make sure that that doesn't happen to you. If you've had a gastric bypass, you should be checking your iron a minimum of once a year and if it's low, twice a year, and supplementing with a chelated iron formulation, as opposed to a ferrous sulfate, the iron salt. They're much better tolerated. So if in the past you haven't been able to tolerate iron because of constipation or GI symptoms, try bariatric iron, much easier to tolerate. I'd say 99% of people can tolerate a bariatric iron.
Zoe:Yeah, oh, and we actually do have some the iron that we recommend for our patients and that iron bisglycinate from Thorne.
Dr. Weiner:We have that linked on our website as well, right under, I think, nutritional products or recommended products, recommended products, yeah.
Zoe:So if you're not, sure which ones to do. There's so many out there. Definitely take a look at those yeah.
Dr. Weiner:Zoe went through and picked out the best ones, and we really focused on price with that too.
Zoe:Yeah, oh wow. Yeah, we found Got some discount codes on there for you.
Dr. Weiner:Found the least expensive. So I think you'll be surprised at how low the prices are, because, honestly, this stuff is cheap. Iron is not. You know, should not be. If you're paying 45 bucks a month for iron, I think you're overpaying. So all right.
Sierra:Next question Next question comes from our YouTube video on episode 32, why we hate keto. Heather says keto is how every human being is born and how every human being should be.
Dr. Weiner:So, zoe, let's talk again about why you know, I knew we'd get some, because some of the keto people they're zealots you know, yes, yes, yes. So I knew we'd get a little bit of pushback. So first of all, talk to us a little bit about you. Know what your opposition to keto is.
Zoe:It all boils down to sustainability, right? We talk about this all the time. Our mission here is to not only help you lose the weight, but actually keep it off right. That's the hardest part, that's the most important part, and that's why I don't care for keto, just as I don't care for 99% of fat diets right it's because they're not sustainable.
Zoe:Just like we hear from our guests on the podcast that it's about having that balance in their diet or be able to enjoy a vacation in moderation or different types of things like that. There are going to be life circumstances and nobody is ever going to be perfect. And the reason why keto, in my opinion, doesn't work long-term for most people right, we're not making blanket statements, I'm not saying it doesn't work for everybody, but it's because eventually, you want to have some carbohydrates God forbid a banana or fruit or beans, right Things that we know are really nutrient dense, rich in phytonutrients, rich in fiber. So it's not so much about that. We don't want to have a healthy balance of all of those macronutrients, right, the fat and the carbohydrates and the protein, because your body needs all of those.
Dr. Weiner:Right, absolutely. I mean, there's four types of diets, right. There's low calorie, low carb, low fat and nutrient dense. And the truth is, whatever you follow for the long run will probably work, and we know some diets work better for some body types versus others. We've adopted the nutrient-dense because we believe that we can get the greatest number of people to follow that for the longest period of time, and that's really what nutritional change and feel not as hungry, better energy, energy and not depleted, exactly.
Dr. Weiner:And so that's really why I adopted this diet and where it comes from, and so I see a lot more people able to stick with our program than stick with keto Right, and I think the last thing is that if you've got 10, 20 pounds to lose, nutrition is a great option. Most people cannot lose 50 pounds with nutrition. That's just the honest truth. It's unfortunate. A few younger people can, and if you can, I mean kudos to you. That is the best way of doing it. But losing the weight, keeping it off with nutrition alone usually fails, unfortunately. That's really a sad truth, but we have to look at the data, we have to look at reality and understand that is the truth, and that's where the meds and the surgery and all the other therapies in combination with nutrition work. Just like nutrition alone doesn't work, meds and surgery alone doesn't work either.
Zoe:Exactly Yep, all right, well, again, head on over to our website, take a quiz or two. We've got lots of them and we would also really, really appreciate it if you would take a couple minutes to leave us a review. It helps us get our message and this podcast out to more people so that we can break down the obesity bias, help people feel not alone on their weight loss journey and help give them the tools to be successful for the long term.
Dr. Weiner:Absolutely Check us out on social media, on TikTok Instagram, youtube. See you next time.
