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
Is this the end of GLP-1 Compounded meds? Part 2
In Episode 48 of the Pound of Cure Weight Loss podcast, Dr. Matthew Weiner and Zoe Schroeder explore the future of compounded GLP-1 medications, the dangers of the health halo effect, and debunk common diet myths that often lead to confusion for those trying to lose weight.
Compounded GLP-1 Medications: A Controversial Solution on the Brink of Extinction
Dr. Weiner and Zoe kick off the discussion by addressing the fate of compounded GLP-1 medications. Medications like Zepbound and Wegovy, FDA-approved for obesity, have faced shortages, leading to the rise of compounded alternatives. These non-FDA-regulated versions, sourced from China and mixed in US compounding pharmacies, have been a lifeline for patients who can't access the brand-name medications.
However, Dr. Weiner highlights that these compounded versions may soon become unavailable due to regulatory changes. Compounded GLP-1 medications can only be produced during shortages of the original drugs and with supply stabilizing, their production may soon be banned. Patients currently relying on compounded alternatives will need to explore other options, such as the Pound of Cure Weight Loss Platinum Program.
Diet Myths: Dispelling Common Misconceptions
Dr. Weiner and Zoe also tackle pervasive diet myths, particularly the belief that weight loss is simply a matter of calorie counting. This outdated “calories in, calories out” philosophy ignores the body’s hormonal responses to food. They explain that hormones like GLP-1, ghrelin and leptin play crucial roles in regulating hunger and metabolism, which is why focusing purely on calorie restriction often leads to failure.
Another myth they address is the idea that fat is the enemy. While processed and animal fats should be avoided, healthy fats from sources like avocados, nuts, and seeds are vital for long-term weight management. Additionally, Zoe clarifies that not all carbs are bad — distinguishing between refined carbs and whole-food sources like vegetables and legumes is key for sustained energy and weight loss.
The Health Halo Effect: How Marketing Tricks Consumers
The health halo effect is another topic of discussion, focusing on how food marketing can deceive consumers into making poor health choices. Labels such as “organic,” “vegan,” “low-carb” or “gluten-free” often create the illusion of health, even when the products are filled with sugar or unhealthy ingredients.
Dr. Weiner and Zoe stress the importance of avoiding these traps by focusing on real, unprocessed foods like vegetables, lean proteins, fruits, nuts, beans and seeds. This approach helps ensure that you’re making choices that genuinely support your health and weight loss efforts, rather than falling for misleading marketing.
Conclusion
In this episode, Dr. Weiner and Zoe offer valuable insights into the future of compounded GLP-1 medications, clarify persistent diet myths, and explain how the health halo effect misleads consumers. As the regulatory landscape changes and food marketing continues to evolve, staying informed and focusing on a balanced, whole-food diet is crucial to achieving long-term success in your weight loss journey.
One of the biggest problems with alcohol is that we don't have a way to turn it off. So if you go out to a party and you have a couple of drinks and you're a little bit tipsy, imagine if you could take a pill sober up in 20 minutes and drive home. I mean, it would be a game-changing medication if you could somehow do that. My theory about this drug is that it might do that for marijuana.
Zoe:All right, welcome back friends. Here we are at the Pound of Cure Weight Loss Podcast. Is this the end of GLP-1 compounded meds?
Dr. Weiner:It might be. It might be yeah.
Zoe:You predicted this right.
Dr. Weiner:I did predict this. We had an episode. Not a lot of people watched that episode. I thought that was like some of our best stuff that we put out there.
Zoe:Go back and watch it if you haven't.
Dr. Weiner:Yes, it was Because we're going to actually check in and see how we did. We made, I think, 10 predictions for the new year and actually, as I kind of think, a lot of them, I think we were on, and one of them we predicted that this year, glp-1 meds would the compounded GLP-1 meds, which is the kind of Chinese knockoff drugs that we've talked about which have pros and cons, that they would no longer be available, and so we've gotten some news and we'll cover this a little bit later in this episode that that may actually be the case. There's been a brief stave off of execution, but I think that the die is cast on this one. We'll talk more about it.
Zoe:Yeah, very interesting. So what do we have for In the News?
Dr. Weiner:So our In the News segment is about a new weight loss drug that's come out. It comes from the Global News Wire and it says that Novo Nordisk and the name of the drug is, uh, man, man, luna, bunt, and it's they just completed a phase 2a trial and they successfully demonstrated that this medication, which is a pill, does cause weight loss. Um so again, the drug is Monlunibant.
Zoe:It sounds.
Dr. Weiner:German. No, the drug is named how do you say this Monlunibant. Yeah, monlunibant, and it's a small molecule. And what's interesting about this is that it is not a GLP-1 agonist like all, like Monjaro, zempik, all these other meds. This is a totally different class of medications. There's a lot to be excited about when we're talking about a different class of medications, because there's only so many different GLP-1s you can put out there. But that's like one pathway. But they see this in cancer treatments. With cancer treatments, what they look for is agents that work in different ways, and what happens is when you combine them, you can kind of use it to tweak the side effects, and so maybe bring the dose of the one down that's causing the worst side effects and use another one that has a different side effect profile.
Zoe:But still going at it from different pathways.
Dr. Weiner:Exactly so the idea if we could have multiple pathways for these medications and we weren't just, it wasn't just GLP-1s, we had another way, and that's how bariatric surgery works. Bariatric surgery doesn't just work along the GLP-1 pathway. There's probably I think they've identified five or six different biochemical pathways that are changed and altered by bariatric surgery, and that's why it's a more successful weight loss tool than the medications. So this is interesting because it targets the cannabinoid receptor. Now there's two different types of cannabinoid receptors there's a small molecule and a large molecule. There's actually another company working on a large molecule, but this medication is an inverse agonist. So an inverse agonist means it binds to the receptor and it actually causes the receptor to act opposite of the way it normally does. So essentially, to some degree it's a blocker, but biochemically it's not exactly a blocker, and I don't know that anybody out there?
Dr. Weiner:listening really needs to differentiate between the two. I can barely differentiate between the two. So it's the cannabinoid receptor. Do you know what another thing that's out there that triggers the cannabinoid receptor?
Zoe:Hmm, let me think.
Dr. Weiner:Cannabis. Yes, marijuana triggers the cannabinoid receptor, so this is working on one of the receptors that are altered when you use marijuana.
Zoe:Very interesting.
Dr. Weiner:So Novo Nordisk purchased this drug from another company for a billion dollars. I think another important piece of news here is the company. This is Novo Nordisk, and so the problem is that we really have a duopoly right now. Right, we've got Eli Lilly and we've got Novo Nordisk, and they control the entire obesity and really the two best diabetes drugs as well, and so what really needs to happen for the market to open up, for there to be more competition, is for us to get other companies in there. If we saw Pfizer or Roche have a drug out there, that would be really exciting to me, because now we start to see some competition between these large companies. Competition is going to bring the price down, but this is unfortunately, owned by Nova Nordisk, so we're not going to get that same competition. So these meds? The other really interesting thing about this is it's a pill, not an injection.
Zoe:And I think that's something that a lot of people have talked about being interested in learning about.
Dr. Weiner:One of the theories. I don't think it's going to hold up, but one of the theories is that you're going to lose the weight with the injections and then switch to a pill for the weight maintenance. There's been no clinical evidence to support that, but that's something people are thinking about.
Zoe:I'll be honest with you.
Dr. Weiner:We have a lot of people using these injections.
Zoe:Nobody really minds yeah, it's not that big, yeah, I don't think it's a big deal.
Dr. Weiner:They don't hurt. It's once a week. It was. Every day that's a little bit different, but once a week it takes, I think, about 30 seconds to do an injection. So I think we're probably putting a little bit more into this injection problem than we need to.
Zoe:Well, maybe one of the other benefits would be that you wouldn't have to keep it cold and it's cheaper to make.
Dr. Weiner:That's the big. Yes, you're right. The storage, the transport, all of that is much simpler and the half-life is going to be longer, and that it's cheaper to make as well.
Zoe:So anyway this medicine.
Dr. Weiner:They ran this trial. It was a phase 2A trial, which basically means they're starting to dig around different doses and they're looking for safety and they're looking for efficacy. What were the side effects and did people actually lose weight? And so this receptor, this medication, triggers these receptors, and they saw 6.5% total body weight loss at 16 weeks, which is okay. Yeah, that's not great.
Zoe:What would it compare to some of the GLP-1?
Dr. Weiner:Well, Ozempic and again they stopped the study after 16 weeks. So we don't know. But if we look at semaglutide, we're looking at about 15% total body weight loss. If we look at semaglutide, we're looking at about 15 percent total body weight loss. If we look at terzepatide, there's some studies out there showing up to 25 percent total body weight loss. It's definitely over 20. That's at a year. But most people lose I would say they're probably losing about half the weight in the first um 16 weeks. They also didn't talk about plateau or not. There's been some studies that said, oh, they did it for 12 weeks and there were no weight plateaus. They don't comment on whether there's weight plateaus or not.
Dr. Weiner:My suspicion is that this pathway is not going to be as effective as GLP-1. So there's been some concern about these drugs in the past and the concern has been that there's been an increased risk in depression and suicidality when taking these medications. And they did see some non-GI side effects. The majority of the side effects were GI and they're the typical ones that we see. They're heartburn, diarrhea, nausea, vomiting, and so there were GI side effects for sure. But there were also non-GI side effects and we've seen this too with the GLP-1s, the GI side effects people can kind of work through. It's the insomnia, it's the depression, it's the fatigue, and they're less common, thankfully. But those side effects tend to not go away. They tend to be a little bit more lifestyle alteringing and we're seeing more people coming off the drugs for that. So anyway, they saw anxiety, irritability, sleep disturbances with these meds.
Zoe:Which is kind of the opposite, because some GLP-1 studies are showing the improvement of depression.
Dr. Weiner:They absolutely do. But they also show in some people that it worsens depression, and so you know the thing about it. When you're dealing with side effects, it's can be. You know, our tolerance for side effects depends on what that side effect is.
Zoe:Right.
Dr. Weiner:If one out of every a hundred people who took takes GLP, ones end up, you know, getting so like suicidally depressed. That's bad. Even if five have an improvement in their mood if one becomes suicidal. We tend to weigh the side effects much more than we weigh the benefits, and that's always a tricky discussion with patients. I mean, the nice thing about meds is that you can stop them and typically the effect goes away. Yeah, but yes, there was anxiety, irritability and sleep disturbances. Now I have a theory about this yes so I just want to
Dr. Weiner:you know, every time medicine comes along a lot of things like you know. Classic examples viagra, right, was originally going to be used as a hypertension, high blood pressure medicine. Turns out it has this other effect that people you know got very excited about. Yeah, and so now here it is, as an erectile dysfunction medication. My theory is that this probably isn't going to be a great weight loss med, that the side effects won't be great, the weight loss won't be great. Whether we can combine it with the GLP-1s that data, I mean, if all of a sudden this was augmented, a GLP-1 response, that might be interesting. My suspicion is we're not going to see this as a really great, amazing, game-changing weight loss method, but I think it might have another purpose. So just kind of humor me on this one.
Zoe:I'm listening, I'm all ears.
Dr. Weiner:Drinking and driving is a huge problem, huge problem. And so one of the biggest problems with alcohol is that we don't have a way to turn it off Right and, like you got to sleep it off, it's only time. Time is the only way to make yourself less drunk. So if you go out to a party and you have a couple of drinks and you're a little bit tipsy, imagine if you could take a pill, sober up in 20 minutes and drive home. That pill would be so life-saving.
Zoe:Yeah, absolutely.
Dr. Weiner:And it would allow you know it would potentially reduce motor vehicle accidents, drunk driving, I mean it would be a game-changing medication if you could somehow do that. My theory about this drug is that it might do that for marijuana. First of all, look at the side effects. They're like the opposite of the effects of marijuana. Instead of being like chill, you have anxiety right.
Dr. Weiner:Although marijuana can also cause anxiety and can worsen it. Instead of being like relaxed, you're irritable. Instead of being like sleepy you're, you have sleep disturbances. Home, they could take a pill and be able to drive home safely and kind of have the effects wear off. That would to me, that would actually as much as that kind of seems crazy. And you can talk about the moral responsibility and I've talked about my thoughts about harm reduction. Right, I mean we can talk about, you know, and I've talked about this with alcohol use after bariatric surgery and talking about it compared to marijuana, and so marijuana is less harmful than alcohol. It doesn't mean I support the use of marijuana. I don't think people out there should be using marijuana if they can avoid it, but I also know people do and so- we live in the real world, we live in the real world Exactly, and so my idea is maybe that's what this drug is going to end up doing Just a little bit of a loose tear.
Dr. Weiner:Maybe I'll throw that into my 2025 prediction episode.
Zoe:Oh, there you go. Well, I wonder what the turnaround time would be for that. Do you think like a decade?
Dr. Weiner:It'd be a while. It'd be a while, although they're going to move forward with this drug. They're going to do a phase 2B study, and the way they figured out Viagra was they gave this blood pressure pill and they were measuring everybody's blood pressure and the blood pressure was like barely budging and so like, oh, scrap this drug, it's a waste. And so then they called all the people like I'm sorry, we're going to cancel the trial and the people like whoa whoa whoa, whoa. What are you doing here, buddy? Don't do that, Come on.
Dr. Weiner:I like this drug, drug and that's how they kind of figured this out. So I guarantee it in one of these trials someone's going to use marijuana at some point, be like, oh, it doesn't work anymore, or something along those lines, and so anyway, that just my theory about this, but but anyway, the more drugs we have, the better.
Dr. Weiner:I wish this was not nova nordis but another drug company, not eli lily, a third drug company. Um, my take on this pathway is it's probably not going to be a super valuable pathway, but maybe a secondary adjunct Anyway, all right. So what do we have for nutrition this week? Zoe?
Zoe:Yes, well, we have an article from New York Times and the title of the article is 10 Nutrition Myths Experts Wish Would Die. So all of them, I think, are very valuable.
Dr. Weiner:They were good ones, they were all really good.
Zoe:For the sake of time we're not going to talk about all of them, but I picked out three that I figured we could dig a little bit deeper into that are really aligned with what we tell our patients and what we're telling you, listening with what we recommend with nutrition. So the first one is myth number three calories in, calories out is the most important factor for long-term weight gain, and we just know this simply not to be true. I picked out a little blurb here and said what's needed for maintaining a healthy weight is a shift from counting calories to prioritizing healthy eating overall. Quality over quantity. That's the money piece right there Quality over quantity. And we talk about that all the time with the metabolic reset diet. That's why we don't have our patients counting calories or hitting a specific calorie target, because if we can work with the body metabolism, hunger cues satiety signals in order to eat the volume of food that you know most people want to feel full and if they're feeling hungry, then you're going to keep thinking about food, right.
Dr. Weiner:Right.
Zoe:But focusing on those whole real unprocessed foods, so that quality over the quantity, and I think we couldn't agree more with that I love to see that in new york times yeah, oh, you know what, actually, just before this, I was on a support group and, uh, somebody was asking about a specific like a, a protein chips or protein bar, something like that, and I just kind of pulled, pulled some numbers out of thin air, right, and said, okay, for this number of calories, this amount, blah, blah.
Zoe:And you have this small little bag of chips, protein chips, and then let's put on this other plate, let's put on three ounces of chicken and two cups of broccoli and maybe even throw on there, you know, half a cup of quinoa and a quarter of an avocado or whatever, a quarter of an avocado or whatever. How would you feel if you ate that plate of food, as opposed to those 15 chips in that tiny little bag? And for the same amount of nutrition? Quote, quote, nutrition, right, the calories and the macronutrients, but the digestion, the micronutrients, the fiber, all that other stuff, it's so much better for that long-term weight maintenance and, of course, weight loss. Yeah.
Dr. Weiner:I, I, sometimes I joke about um, you know the a hundred calorie snack pack, right? We all know those a hundred calorie snack packs. Or Oreos, right? It's not, even it's not a real Oreo cookie. I think it's just the outside part. It doesn't have any of the the, the white part of the Oreo, and it's like four of them. I mean there's like so few of these things in there. And then I also joke well, there's 100 calorie snack pack of spinach. Has anyone ever seen it?
Dr. Weiner:It's one pound, it's a huge Costco bag of spinach has 100 calories in it, of spinach has a hundred calories in it, and so again, comparing, how you're going to feel if you ate that entire bag of spinach you would be like oh my God, and you eat those four Oreo little, you know just the outside parts and you're like what's next?
Zoe:It does nothing for your satiety, you eat four more of those little hundred calorie packets. That's a reminds me of another example I like to use a lot in our increasing your veggie intake support group that we have on the schedule, and it's like visualizing a slice of pizza. Now, of course it's going to vary a lot depending on the pizza and what's on it and yada yada, but if we think about let's call it, 400 calories for that slice of pizza. That's why it's easy to eat. People eat three or four slices of pizza because you want to feel full from it. You don't feel full from that, but it's so calorie dense, Right? Do you want to guess how many cups of? I bet you can guess, but how many cups of broccoli it takes to get 400 calories?
Dr. Weiner:I would guess I'm going to guess that a cup of broccoli has 40 calories. That's my guess. So times 10, 400.
Zoe:how'd I do so? You want to say 10? 10, 10 yeah, it's about like 8 to 10. Yeah, yeah, and then like think about that on a on a plate, just like you're 10 cups yeah you can't I.
Zoe:I have a stomachache just thinking about it yeah so, thinking about that nutrient density as opposed to caloric density, that doesn't mean that you can't have a slice of pizza, but maybe it's OK. I know that I'm not eating the pizza for the fullness, for the satiety, for the volume, but I can add. Maybe I add two cups of broccoli to it, or a side salad or something like that, to kind of get both.
Dr. Weiner:It's some other interesting things too. Both. It's some other interesting things too, um the, if you think of the largest mammals right, think about just cows, giraffes, um what?
Dr. Weiner:do they eat grass, grass, leaves, leaves yeah, that's all I mean. They eat it all day long, but that's all they eat. So a lot of people like well, you can't get protein, you can't build muscle, but the largest animals are vegetarian, and so I think that's interesting and and the one of the reasons for that is that, calorie for calorie, spinach has more protein than steak I did not know that. Yes, that's so interesting, yeah because again, a hundred calories of spinach is this giant costco bag right but a hundred calories of spinach.
Dr. Weiner:Is this giant Costco bag Right?
Zoe:But 100 calories of steak is like three bites. Yeah, exactly Right.
Dr. Weiner:Especially if you you know especially a more marbled piece of steak Right, it's going to have fat in it and no protein that you're going to actually get more protein from 100 calories of spinach. Now, again, that doesn't mean mean, you know, ounce per ounce, steak has a lot more protein, but calorie per calorie, if you measure it out by calorie, yeah, anyway. So so I'm I'm really happy to see this. I think we're starting to finally get some some penetration into the, the knowledge base that measuring calories is probably wasteful and not necessarily going to get out there. But there's still these Instagram guys who are like you need to be in calorie deficit and if you're not in calorie deficit, then you're not going to lose weight. And there's three things you got to do to lose weight Calorie deficit is one, calorie deficit is two and calorie deficit is three. They're out there, right? They're always young men.
Zoe:Yeah.
Dr. Weiner:You notice that? Yeah, notice that? Yeah, maybe shirtless what? It's always the young men who are um, who are pushing and promoting calorie restriction as a means of weight loss, because nobody can nobody has it easier when it comes to losing weight than young men. No, that's true, yeah, so yeah.
Zoe:So you know, quality over quantity, people. We say that all the time. So then you know we kind of already touched on this with talking about the other one. But myth number eight is the protein in plants is incomplete. And it's not actually that the protein in plants is incomplete. They have all of the 20 amino acids that you need, but the difference is that the proportion of those amino acids, so that means you need to have a variety, that the proportion of those amino acids, so that means you need to have a variety, which I mean, if we think of, culturally, rice and beans going together, that creates a complete protein. So it's, you know, like you were just saying, biggest mammals are, you know, plant-based, and so you know, yes, if you are not eating any animal protein, we need to have a variety of those plant based protein sources.
Dr. Weiner:So I mean, essentially the idea is, if you're going to get plant based protein, you should get some from beans, some from nuts, Right, Some from even grains like rice. So this has always bothered me, this idea that you know that there's and there's a certain number of essential amino acids. There's 20 amino acids.
Dr. Weiner:Amino acids are these little molecules you know that make up all the protein. You string them together and you make protein, and so so we can make these, some of these, but we also can't make some of these. So we think, and so I think there's, first of all, but we also can't make some of these. So we think, and so I think there's, first of all, there's a limit to what we know about our biochemistry, and I think a lot of times this these recommendations are made by someone who like took like biochem 101 and like, oh, they told me this in biochem 101. So now I know it and it's true, but I think it's a complex issue and I think there are probably pathways and ways that we can make some of these non-essential amino acids and out of carbohydrates, out of other compounds, and so that's always kind of bothered me a little bit about that because I wonder if it is really true.
Dr. Weiner:I think that you probably can get by.
Zoe:Yeah, Well, I get, and I mean that leads directly into the last myth, Nimeth. Number 10 that I pulled is fundamental. Nutrition advice keeps changing a lot and there's a lot that we don't know Right and the science is ever evolving. Nutritional sciences is a relatively young, you know study.
Dr. Weiner:Right.
Zoe:Right. But if we think about the main, this is the, this is the quote here. Eat food not too much, mostly plants.
Dr. Weiner:Yeah, that's from Michael Pollan. I think he said that. Uh yeah, uh, omnivores dilemma. Oh, okay, I think that's where it came from.
Zoe:So I mean, the bottom line is that, yes, it's an evolving science, but if we boil it down to what we always say is try to eat as much whole, real, unprocessed food as much as possible, and this is aligned with that. And, yes, it can be complicated, especially with everything online and different influencers, and you're getting information about this diet and you need that supplement, and it is confusing and it is overwhelming when we are taking all of these. You know all that white noise, right, um, taking up space. But if we boil it down to, like, keeping it simple, it really doesn't need to change, it doesn't have to be complicated it's.
Dr. Weiner:It's sometimes it's the stuff your grandmother told you to do. That's really still, I think, the best nutritional advice eat your vegetables. Right, right, that's that was been like, you know, in the fifties. That was like the big, the big advice. Don't eat a lot of sweets, right, and maybe don't eat the fattiest greasiest meats Things along those lines.
Dr. Weiner:Well those lines. Well, and portions, I mean, think about the portion sizes in the 50s versus now, absolutely. But but yeah, I, you know, to me I think part of the there's two problems with it. The first problem is that doing like hard nutrition science double, you know, randomized, double-blinded, controlled trials is like impossible, right, like you would literally have to like keep someone captive and only feed them certain food. I mean, we have institutional review boards that review any type of scientific study that's done to make sure that it's ethical.
Dr. Weiner:And if you're going to really do hard science on nutrition, I don't think it would pass the mustard of any of these IRB boards.
Dr. Weiner:Nutrition, I don't think it would pass the mustard of any of these IRB boards. So it's just impossible to constantly because we eat all through the day, no-transcript accurately, right, right, yeah, it's just not possible. So I think the ability to get that, that kind of definitive answer that we can get with medications, we can get with surgery, we can get into other health fields, it's so much harder nutrition, so much harder. I think that's the first thing. The second thing is what you alluded to, which is that there's too much money to be made in selling processed crap, and it's just, it's such a great business model to take something heavily processed that people like to eat and somehow apply a health halo like you always talk about to that heavily processed food and somehow leverage some obscure scientific or pseudoscientific article that says somehow this would be helpful and good, like Lenny Curb and Chromium Right that there's. So it's so easy to make money doing this and then strap a nice little marketing package on top of it, get some influencers behind it and cha-ching.
Zoe:Yeah.
Dr. Weiner:Right, I mean, it's just such a reliable way to make money, and so that just clouds all the advice out there. So this is what's being pushed in front of us instead of good, old-fashioned advice. Like the green jolly, the jolly green giant, like where's he? Yeah, where's he been? And I don't think he's. You know, offering million dollar influencer deals? Yeah, you know something? Offering a million dollar influencer deals.
Zoe:Yeah, you know something I was just thinking about as we were talking about, like in the 50s. We think about the obesity trend, how much it has risen over the decades. Any graph in front of me but I would. I would put money on the fact that that graph mirrors the rise in diet trends and different fad diets and and that sort of thing. And we know that going on and off diets is one of those predictors of weight gain. Right, and it's, and that's part of the machine that is diet culture and this multi-billion dollar industry. It's sell a product or a program to somebody knowing that it's, and then they fail, they feel like they're a failure, but it's ultimately that that failed them, that failed them, and then it creates a more vulnerable and prey worthy individual to continue buying more of these different products. Like it's just so sad.
Dr. Weiner:You know what that's, that we need an infographic, that infographic of try temporary diet fail, become more susceptible to to next diet fad.
Zoe:try and that and that, that circle and then the weight goes it's like a spiral up, like a little pigtail that probably describes 95 of the people listening to this podcast right now.
Dr. Weiner:Yeah, we need to put something like that together. I bet I bet chat gpt could probably make that happen like that. Yeah, all right, so let's move into the economics of obesity segment, and this is where our title comes from. So here's what's happened recently. On October 2nd, the FDA has said that terzapatide is no longer on shortage. I think we've covered this in detail on a number of episodes in the past and the 503B compounding pharmacies, which is who makes most of these compounded drugs.
Dr. Weiner:Again, quick primer on compounded medications these are not produced by Eli Lilly or Novo Nordisk, which are the companies that hold the patents. They are produced overseas, almost exclusively in China, at FDA-approved facilities, but the products do not go through the same testing process that Zepbound and Wegovi go through, and so there's a lot of it's a gray market area. But because both terzapatide and semaglutide are on shortage, these 503B compounding pharmacies are allowed to import the medication from China, not from the patent-holding manufacturer, mix them together with something to make a novel compound and then sell it. And so they mix it with B12 or thiamine or something like that, and the truth is that adds absolutely nothing to the effect, but it allows them to sell it. Now, as soon as the shortage is resolved, this becomes illegal and it is a patent violation.
Dr. Weiner:So all of the compounding pharmacies want the shortage to last as long as possible, and of course, eli Lilly and Novo Nordisk want this shortage over, and we've talked about this about recently in the release of vials, and so now Monjaro and Zepfoun are available to lower doses as vials as opposed to the injector pens, and that allowed Eli Lilly to meet their manufacturing needs, because it's not the drug that's on shortage, it's the injector pens of all things. Yes, um, so so the 503p compounding pharmacies are no longer able to produce terzepatide. This now, semaglutide, is still um on the shortage, but only for one dose, I think, only for the 0.25 or the 0.5 and, and you can check the FDA proof. So this is all like coming to an end.
Zoe:And they're going to be like legally pursued.
Dr. Weiner:You think yeah.
Zoe:Well, especially if they have Eli Lilly and Novo Nordisk up, you know lighting a fire under their butt.
Dr. Weiner:They already have. I mean Eli Lilly and Novo Nordisk have made it very clear that they will pursue aggressively with filing legal actions any physician's office or compounding pharmacy that is breaking their patent laws. I mean, they want no part of this.
Zoe:And that means all of the like med, spas and weight loss, Clint like that you can go and get If you're not getting your medication from an actual pharmacy. Prescribing provider.
Dr. Weiner:You get a prescription, it goes to CVS, walgreens, your Safeway, kroger, wherever you're getting your prescriptions from. If you're not getting it from there, then it's very close to being no longer available Months. But there's a little bit of action here. There's a little bit of stuff going on.
Zoe:More than getting your prescription from a doctor.
Dr. Weiner:So the Alliance for Pharmacy Compounding actually filed a lawsuit saying that no, you've prematurely, the FDA was unfairly influenced by Eli Lilly Lilly and you prematurely put this drug and taking this drug off the shortage list when it's still going to be on shortage, because look at all these people on compounding meds. There's no way you have the manufacturing capabilities to meet all of these people on the compounding meds. So they filed this lawsuit and it's been filed in federal court and actually they got like a state of execution yeah. So the FDA said you know what? We're going to reevaluate this. So it's still okay for the 503B pharmacies to continue to produce and sell terzapatide.
Zoe:I feel like I've been on a roller coaster listening to this. What's going to happen next?
Dr. Weiner:So, but here's the thing. They're going to probably be able to push this off another month or two.
Zoe:Well, that's it.
Dr. Weiner:Six months maybe, I don't know, but not 10 years, right, this whole compounding thing will be part of history, but it will not be the way that people get these medications, not in the United States. There's other stuff we're going to talk about happening in other countries that are interesting. We'll cover those in future episodes, but as of right now, yes, they did get a little bit of a break, but it literally is a stay of execution. Did get a little bit of a break, but it's, it literally is a stay of execution. It is not a long-term win that's going to allow them to continue to produce these compounded medications for a long period of time. Um, lily and nova nordis will win this battle. They are, I mean, in terms of just scale. They are a hundred, a thousand times, um, wealthier than these compounding pharmacies. Um, and they have the, and also the law is on their side. I mean, they do hold the patent right, and so they're gonna win.
Zoe:That's probably bad for patients yeah, um, I'm just thinking about how many people who utilize compounded yeah.
Dr. Weiner:so so let's say you're out there and you're using compounded meds, so let's talk about what you can do. So I think we're going to see this happen with terzapatide before we see it with semaglutide, I think. So the compounded. There's places that have terzapatide, there's places that have semaglutide, there's places that sell both. If you're using compounded trisepatide, I think you know potentially looking at moving to semaglutide might be the right thing to do right now. It's just going to kick the can down the road. It's not going to solve the problem in a long time, but it is. We've talked about this in the past. We definitely work with patients creatively. We call them, you know, our little code word for this is creative dosing strategies, and we do have people from all over the country reaching out to us and we do have a program. It's called our Platinum Program. There's a little bit of an upcharge but truthfully, it's probably the same, if not cheaper, than using compounded meds.
Zoe:Well, you broke down the cost in a previous episode of compounded versus know whatever, and you know, it's really not a big difference, it's not that big of a difference when you, if you, if you get creative with it, yeah, and so we.
Dr. Weiner:So, like I said, even with our upcharge for the program fee, it probably still is, over the long run, cheaper and it's gonna. This is to us. This is a strategy we think we can continue for years, right, um, without, and we're not breaking any laws or or rules or anything and it's not gonna like you know, you know, be legally taken away at the job I don't think so.
Dr. Weiner:No, I mean, you know the system is screwed up and when a system is screwed up, you can sometimes take advantage of that to benefit you, even though you know it's a lot of what's happening is bad for patients. It can also be good for you if you kind of think creatively. So anyway, that's what we do in our platinum program. I think the third thing to consider is if you know, if you understand the metabolic effects of GLP-1 meds and how metabolic treatments are so much more effective than you know strictly lifestyle mindset, diet and exercise type things that we've been doing all along until surgery and meds came along. Then there's another metabolic treatment and that's bariatric surgery. And the nice thing about bariatric surgery is they can't take it away from you right Once you have it. It's there there and so that's a way to get off the glp-1 roller coaster.
Dr. Weiner:We see that a lot with our patients. They're like you know what? I don't want to be on meds forever. I'm. I see it, it works. I understand obesity is a disease. I understand there's metabolic treatments. I don't want to be dealing with these meds and the cost and getting them and all that kind of stuff. So I'm going to look at surgery and I think we're going to start to see that as the decision making is whether you want to be on the meds long term or whether you want a surgery that kind of fixes it once and for all. The nice thing about surgery is we can do it so safely Less than a 1% serious complication in our practice for these surgeries. So anyway, I do think that the compounded GLP-1s this is their final loop around the spiral and that at some point in the near future we're not going to have them. I don't know if I'm going to make my January 1st deadline, but I think we'll come close for a prediction episode.
Zoe:We'll have to check back in about that when we do that.
Dr. Weiner:Absolutely All right.
Zoe:All right. Well, that's our show today. Thank you so much for listening. I hope this was helpful, and if it was, we would love to have you share it with somebody that you think would find this show valuable as well. Our whole mission is to get this information out to as many people so we can help as many people as possible.
Dr. Weiner:And we've been asking for reviews. We actually have a bunch of reviews now, yeah, and they're actually pretty good.
Zoe:So that makes me happy.
Dr. Weiner:So thank you all of you for your reviews that you put out there on Apple Podcasts or Spotify or wherever you're listening. And again, if you like this, please share it with other people. See you next time.
