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
Protein or Produce for Weight Loss
In this episode of the Pound of Cure Weight Loss podcast, Dr. Weiner and Zoe explore the key strategies and medical options available for weight loss, focusing on GLP-1 medications, a comparison between gastric bypass and sleeve gastrectomy, and effective obesity treatment plans. This episode provides valuable insights for individuals exploring weight loss surgery, those using GLP-1 medications, and anyone interested in long-term, sustainable weight management.
GLP-1 Medications and Their Role in Obesity Treatment
The episode starts with an in-depth discussion about GLP-1 medications, such as Wegovy (semaglutide) and Zepbound (tirzepatide). Dr. Weiner explains that these medications represent a significant development in the medical treatment of obesity. GLP-1 medications work by modifying hormonal pathways that regulate hunger, fullness, and metabolism, thereby influencing the body’s internal set point for weight. Rather than simply curbing appetite, these medications help adjust how the body manages energy and fat storage, making weight loss more achievable and sustainable over time.
Dr. Weiner emphasizes that while GLP-1 medications can be highly effective, they are most beneficial when combined with a structured nutrition program and, when appropriate, surgical intervention. He notes that addressing obesity often requires a multi-faceted approach that goes beyond medication alone. Zoe adds that integrating these medications into a comprehensive weight management strategy that includes lifestyle changes is key for long-term success.
Gastric Bypass vs. Sleeve Gastrectomy: What’s the Difference?
One of the central discussions of this episode is the comparison between Gastric Bypass vs. Sleeve Gastrectomy. Dr. Weiner explains the key differences, benefits, and considerations for each procedure, helping listeners understand which option might be best suited for their specific situation.
Gastric Bypass: This procedure involves rerouting the digestive system, creating a small stomach pouch that is connected directly to the small intestine. Dr. Weiner explains that gastric bypass tends to result in greater weight loss and has a strong track record for addressing severe GERD (Gastroesophageal Reflux Disease). For patients who experience significant acid reflux, gastric bypass is often the preferred option since it bypasses the portion of the stomach that makes digestive enzymes.
Sleeve Gastrectomy: Also known as VSG (Vertical Sleeve Gastrectomy), this surgery removes a large portion of the stomach, leaving a sleeve-like structure. Dr. Weiner notes that while the procedure is less invasive and has a shorter recovery time, it may not be ideal for patients with pre-existing acid reflux. Studies show that up to 5-10% of patients who undergo sleeve gastrectomy can experience worsening GERD symptoms, which may necessitate a revision to gastric bypass.
Dr. Weiner explains that the choice between these procedures often depends on factors such as the patient's starting BMI, the presence of GERD, and individual health goals. He encourages patients to work closely with their surgical team to determine which option is most effective for their needs. Additionally, online tools and assessments provided by the practice can help patients explore which procedure might suit them best based on their health history and weight loss goals.
A Comprehensive Approach to Obesity Treatment: Combining Surgery, Medication, and Nutrition
Dr. Weiner emphasizes that obesity treatment is most effective when it includes a combination of surgical, medical, and nutritional strategies. For many patients, integrating GLP-1 medications with bariatric surgery can amplify weight loss results, as these interventions work synergistically rather than in isolation. Both approaches target hormonal pathways that influence hunger and fullness, creating a more comprehensive shi
The idea that you're going to eat one less piece of pizza with your GLP-1 medication and that's your weight loss plan. That's not a solid, lasting, long-term plan. Nutrition alone isn't a great treatment for someone who's 400 pounds, but neither is GLP-1 medication alone and neither is bariatric surgery alone.
Zoe:All right, welcome back to the Pound of weight loss podcast. We are here, we. I'm excited.
Dr. Weiner:Look, look at what we got for you I know, pretty cool huh yeah, your wife made this my wife made this so talented I know she really is and uh, we, you know, I don't think when she made it it wasn't originally for a podcast background. I think, as we put this together, we're like why haven't we been doing this all along?
Zoe:It's what it always was meant for, yeah.
Dr. Weiner:Well, this kind of leads into our title for today, which is Protein or Produce for Weight Loss. Certainly something we talk about a lot, absolutely.
Zoe:Unfortunately, it's not really a binary answer, is it Just like so many things in nutrition, there's so much gray area and nuance, which is why it's so great that we have this podcast and this platform so we can actually dive into these topics and give the explanation that they deserve, because it's so dang hard to do it in a 60-second clip for you on social media.
Dr. Weiner:Yeah, that's not really. My forte is summing up something in 30 seconds. So let's move into our question and answer session. So we'll hear from Sierra. We've got our first question out there and this is coming from Phillip. So, Sierra, what do we have?
Sierra:First question is from Phillip from our YouTube video. Should I have Weight Loss Surgery? I watched a number of videos before my gastric bypass last year. At a year post-op I can say he is almost 100% spot on. The only thing I completely disagree with is not eating more red meat, chicken and fish. A lot of us who get bariatric surgery have that cracked out. Look around eight months Meat and strength training, especially in women, is important. It helps build muscles and help your overall health.
Dr. Weiner:So, zoe, what do you think about this? Is meat and strength training important, and is there a difference between women and men?
Zoe:So, absolutely, strength training is important and we've talked about that a lot right, and yes, protein is important for muscle protein synthesis and building muscle, but it does not have to come from meat. It can come from beans and Greek yogurt and, yes, in moderation, meat and chicken and those sorts of other animal based protein sources, but we really do lean on the side of plant-based protein.
Dr. Weiner:Yeah, I think anybody who challenges the idea that you need meat in order to build muscle should just Google vegan bodybuilders.
Zoe:I know one.
Dr. Weiner:Yeah, and so you can build a tremendous amount of muscle. Another thing I think that's important is think about the largest animals out there Elephants, hippopotamuses, rhinoceroses. They are all plant-based. They eat only plant-based. Well, look at that. Remember dinosaurs? Well, we don't remember them, but remember learning about dinosaurs. The brontosaurus was like the gigantic one that was. You know, 50, 60 feet long. Right yeah, they were plant-based. It was the T-Rex. They were the meat eaters. They're a little bit smaller and more agile, so you can absolutely build plenty of muscle with plants. I think that they call it I don't know why I like that term, but I think it's very descriptive this cracked out. Look, we see some of that with rapid weight loss. I think you can see it from either the GLP-1 meds or the surgery. What do you think about that? What's causing that? What can you do to prevent that?
Zoe:Absolutely, and you know, like you said, even though we don't love the phrasing of it, Right.
Dr. Weiner:We all understand what it is.
Zoe:So what we really need to focus on during that kind of fast weight loss phase or that honeymoon period whether it is after surgery or after GLP-1, is that protein, you know, and really preserving muscle tissue to your muscles, to not only just maintain them, but maybe build a little muscle as well in that weight loss phase, so that the weight that they're losing comes primarily from fat and not from muscle.
Dr. Weiner:Right, I think you know that. Look that they're talking about. To me, that's malnutrition.
Dr. Weiner:I was going to say yep, that's really what we're seeing the temples, the clavicle. So in my mind there's three, three different types of malnutrition. Right, there's protein malnutrition not getting enough protein in, and that's where, again, either a waste whey protein or other supplement, or a plant-based protein like beans and nuts, or animal protein chicken, fish, beef that's how you counteract that protein malnutrition. Then there's the vitamin B12, the thymine, the folate, your micronutrients. Generally, taking your vitamin is going to cover that, I think, in patients who are able to eat comfortably and are taking a bariatric vitamin and I think bariatric vitamins are a good idea for GLP-1 patients, especially if they're losing weight rapidly You're going to cover that with that.
Dr. Weiner:But then there's this third kind of component that not as many people talk about and that's the phytonutrients. And the phytonutrients are these kind of magical compounds found in plants. Only Phyto means plant, and these are things like resveratrol and the lecithins and all these other compounds that help aid in metabolism that you're going to get from plants. In my mind, again, not so simple, especially in that rapid weight loss phase. Protein malnutrition is a real threat in those first few months when you're losing weight rapidly. But after that you really have to start bringing in the plants if you're able to, and that can help you with that phytonutrient malnutrition. So yeah, unfortunately it's not just this one thing. It really is a very comprehensive and thoughtful approach where you're bringing in animal protein but you're also bringing in the plants as much as possible.
Zoe:Absolutely.
Dr. Weiner:All right, so our next question.
Sierra:Next question comes from Lucy from our website. I'm struggling to decide between a sleeve and a gastric bypass. What factors are the most important when making this decision?
Dr. Weiner:Okay. So to me, this is a question I've worked with, I don't know, probably about 3,000 or 4,000, probably more, probably 5,000 patients. I've kind of gone through this how do I decide? Should I have a sleeve or a bypass? And there really are a lot of factors. It's a complicated decision. We do have a quiz on our website. You can plug all your information in and it'll give you actually an assessment of which surgery may be a better choice. Of course, don't consider it a formal recommendation. It's kind of an educational jumping-off point. But I think when we look at it there's a bunch of different factors. I'll just kind of list through them. The first is starting BMI right. If you have a lot of weight to lose, then you should choose a gastric bypass over sleep. You just get more weight loss from it.
Dr. Weiner:The GLP-1s have changed this a little bit and I think access to GLP-1 meds is another really important factor, and I think if you're watching this podcast, you're starting to come to the conclusion that we're not going to be able to get these meds affordably for a minimum of five more years Minimum, and so you have to be committed to getting through these next five years at least. It might be 10, honestly it could be. At least it's going to be eight, I think, until we can get them affordably. So if you can't get these meds, a sleeve where we're seeing 30%, 40%, 50% of patients requiring GLP-1 meds for weight maintenance or adequate weight loss might not be a good choice. And so I kind of look at the starting BMI and the access to GLP-1 meds and now we're getting more people on these meds before surgery and seeing what their response is and kind of putting all those things together to help determine hey, if you're a great responder to GLP-1s, maybe we can do a sleeve. If you don't have a great response to GLP-1s, we should definitely be going with a bypass Diabetes as well, and this also impacts your access to GLP-1 meds because diabetics have a lot more access to the meds than non-diabetics.
Dr. Weiner:So I think if you're a diabetic, you're going to lose less weight from either surgery. A gastric bypass is a more effective diabetes treatment as well. Also, things like weight-gaining meds. If you're taking medications and we've talked about that a lot and how it's important to try to get off them if you can, but you can't always If you're going to be dependent on weight-gaining meds again, don't bring a knife to a gunfight.
Dr. Weiner:Don't choose a sleeve when you need all the weight loss help you can get to be successful. Your past surgical history if you've had a complicated abdominal surgical history like lots of big hernias, multiple bowel resections, things along those lines, then choosing a sleeve is a much better option because we're not going to have to go in there and do that work. That's going to be safe. Also, heartburn A gastric bypass is essentially curative for heartburn. Where with a sleeve it can worsen heartburn. That's another option. I think the last two pieces are alcohol and smoking. If you are a heavy alcohol consumer you have to be very careful choosing a gastric bypass. We see alcoholism after a gastric bypass surgery.
Zoe:Which we discussed in one of our previous episodes how gastric bypass can ruin your life?
Dr. Weiner:Yes, and it can, and we have seen that, and so we do try to. If you're a heavy alcohol consumer and you want to have a gastric bypass, I think, a commitment to avoiding alcohol altogether after surgery. And then, finally, smoking. Smoking is a hard no after a gastric bypass, and so we put all these things together and we help patients make a choice. But the truth is is, I think, even though we have this great calculator, it's a great jumping off point To me. This is a way for you to sit down with your provider, with your surgeon, and make this decision, because it really is a complicated decision.
Zoe:Again so much nuance.
Dr. Weiner:So much nuance? Yeah, all right. What's our next question here, sierra?
Sierra:Next question comes from one of Zoe's one-on-ones. I follow a lot of social media accounts and influencers online and there are so many different supplements they talk about that it makes me confused about if I'm taking the right things or if I need to be taking more. For example, I recently heard this woman talking about gut-healthy GLP-1 booster. Is this something I need?
Zoe:All right. So this is actually something, not necessarily this specific supplement, but just supplements in general. This is a multibillion dollar industry. I mean, yes, and we've talked about health halos, we've talked about different products jumping on the GLP-1 train as a money grab. So this specific product and we might be able to pop it up on the screen if you're watching on YouTube it's the Gut Healthy GLP-1 Booster. Great marketing, great, it's very targeted, right?
Zoe:She was like oh my gosh, do I need this? It's fiber, it's basically Metamucil, but do you know what else? It's specifically resistant starch. Do you know where we get resistant starch? Produce Yep Beans.
Zoe:Yeah, so our whole philosophy of eating whole, real, unprocessed foods, primarily produce. Guess what? You don't need to spend your money on a fancy. What is this? $26 for how many servings? 15 servings, so it's what? $1.50a serving. Basically, you can do so. You can get so many more benefits by eating the fiber rich produce by itself. You're also getting satiety. You're getting all of those other benefits instead of just spending your money on a product. So my main recommendation when we're thinking about supplements is, first, you can't out-supplement a bad diet and second, you have to have a very discerning eye, especially with these products that are targeted specifically to a pain point, if you will, or a very niche demographic now, specifically the GLP ones, or you know we were talking about those freezer meals, right? So, yeah, just be careful. And no, you do not need to go and spend $30 on a fiber powder when you could be eating the beans and vegetables instead.
Dr. Weiner:Yeah, I think it's important to understand, like where did this thing come from? Here's this product. Right, let's walk through how that made it onto Amazon. So somebody said, hey, listen, I want to make some money. Right, that's where it started and there's no question it started with I would like to make money. They said, well, let me think about this. What's big? They did a little bit of market research. Honestly, you don't need to do much market research to know that these GLP-1 meds are big right now.
Dr. Weiner:Then they went out and said, well, let me think about this. They did a little bit of Googling maybe two, three hours, I would bet anything. There wasn't even a dietician or medical professional involved in this. They said we think fiber is going to be good. Then they went out to these factories and said, hey, who makes some fiber for us? Anybody out there making fiber? Oh, I make fiber. I sell it as Metamucil, I sell it as Citrus Cell, I sell it as this other stuff, and we're selling that for seven, eight bucks.
Dr. Weiner:Well, I'm going to market this. I'm going to hire a fancy graphic designer, I'm going to put a new label as a GLP-1 gut booster and I'm going to go to the factory, the same one that sells the exact same product. I'm going to take the bag and I'm going to put it in a new box. So you're paying literally seven bucks probably for the product and I'm going to put it in a new box. So you're paying literally seven bucks probably for the product and $19 for the box, and that's how these products come to be.
Dr. Weiner:And so all you have to do is look at the active ingredient and then shop, google that active ingredient and purchase it from someplace. It will be a third the price, most likely, and you can get the same thing. We're big believers in the placebo effect. We've talked about this, but what's the rule about the placebo effect Is that it works. Get it at a good price. If you're going to get to use a placebo effect, get it at a good price. And I think I don't know that there's any evidence that these enhanced post-operative weight loss, post-glp-1 weight loss, whether there is or there isn't, if you want to try it, just find it as cheaply as possible.
Zoe:So and actually we recently did a post on social media or I was kind of responding to a very similar product. This gentleman was reviewing it and it was putting this fiber powder into the water bottle and drinking it before he ate his pizza because he won't digest his pizza, and so just another example of everything that's out there to try to get your money.
Dr. Weiner:Absolutely All right. We have one more question, Sierra. What's our last question for the episode?
Sierra:Our last question comes from our YouTube video on episode 29. We go V for the long run. This is from Portal Creek. I stalled at 2.4, so I went back down to 0.5, and I'm following Zoe's suggestions on the podcast for nutrition and kickstarting. I came in at almost 400 pounds and stalled for months at 335. Ironically for me, going down in dosage did the trick. Is this a good strategy for breaking a plateau All?
Dr. Weiner:right. So, zoe, you're talking to a lot of people who are using GLP-1 meds. What kind of nutritional advice are you giving? We're seeing stalls. We see stalls with GLP-1s, just like we see stalls with bariatric surgery. What are you advising people to do to help get through a stall?
Zoe:So there are a couple different avenues that we talk through right. One is stalls are going to happen and we need to remain consistent with those habits that you know you can control. Those habits that you know you can control when you're putting all of your energy and focus on that scale not going down and why am I not losing weight? You're on that scale every day and that's all you can focus on. Of course it's not going to go down. Instead, we want to transfer that energy into controlling what you can actually control and making sure you get your hydration and making sure you get your produce and your making sure you get your produce and your protein and your walk all of those habits right. And oftentimes, when we take that energy away from focusing on the scale, it helps get through it a little bit easier.
Zoe:So that's kind of my first nugget. But then you know, of course we want to take a bird's eye view. I always like to say zoom out, look objectively at what's going on. Have you let something slip? Have you maybe had a little bit more treats than normal and that's maybe impacting your progress? Can we make small but meaningful tweaks to what you're currently doing to help push through that. And then again, if it's everything's, you know, quote, quote, perfect, which, there is no such thing, right, but that's when we can maybe dig a little deeper and amplify things and and it might be time for a dose increase right, right, I think what happened with this person.
Dr. Weiner:I think that some interesting things here. First of all started 400 pounds. They got down to 335. So that's 65 pounds of weight loss. So we go V at the max dose. The average weight loss is about 15, 16%. So you take 15% of 400 pounds and that's what? Is that 60 pounds? So they're right at that 15% total body weight loss. So the first thing I'm seeing is I think this person had the expected amount of weight loss after we govi and we know there's variability, we know some people lose more, we know some people lose less. It looks to me like this person stalled right at that 15% or 16% point, which to me says the medication has done as much as it can.
Dr. Weiner:They then lowered the dose all the way back down to 0.5. So, first of all, I don't think that that is a reasonable strategy. Once you get on the dose, you kind of work the dose, you stay on that dose. These are long-term medications To some degree. Playing around with your GLP-1 dose is like playing around with your blood pressure dose. Right, you got to stay on the same dose over the long run and that controls your blood pressure medicine, and so we don't advocate going back down to 0.5 milligrams or restarting it. What I think happened is when they went down to 0.5, they also paired it with improved nutrition, and that, to me, shows the importance and necessity of really good nutrition with these meds, and that's how you optimize weight loss. The idea that you're going to eat one less piece of pizza with your GLP-1 medication and that's your weight loss plan, that's not a solid, lasting, long-term plan.
Dr. Weiner:Nutrition alone isn't a great treatment for someone who's 400 pounds, but neither is GLP-1 medication alone and neither is bariatric surgery alone. You need all of these things. You need the nutrition, you need the exercise if it's safe, you need the GLP-1, and you probably need the surgery. In this case, I think when I meet with a 400-pound patient, especially if their goal is, hey, I want to get down to 200 pounds, that's going to take everything we've got. It's going to take nutrition, it's going to take surgery, it's going to take the medication. It's going to take all of these things together, and so I think we can kind of play around with it and rearrange things. But my sense is, in this person we're seeing the amount of weight that we're going to see from GLP-1s. They got a little bit extra with some nutrition, and it's probably time to start thinking about bariatric surgery. All right, so that wraps up this episode.
Zoe:Yeah, hey, we want to hear if you're watching on YouTube. What do you think of our new background?
Dr. Weiner:Absolutely.
Zoe:We're excited about it. We want to hear your thoughts.
Dr. Weiner:Absolutely. We're on social media, on TikTok, on Instagram, on YouTube, and you can check out our website, poundicureweightlosscom. We're putting out a lot of new content on our website as well, so so, um so, keep in touch and we'll see you next time.
Zoe:Bye.
