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
A Cut Above - Surgery Outperforms GLP-1 Meds for Durable Weight Loss
Welcome to episode 58 of the Pound of Cure Weight Loss Podcast, where Dr. Matthew Weiner and Zoe Schroeder dive into cutting-edge obesity treatments like GLP-1 medications (like Ozempic and Mounjaro) and their role alongside bariatric surgery and nutrition. This episode delivers insights into new research, nutrition strategies, and the future of affordable Semaglutide production.
GLP-1 Medications vs. Bariatric Surgery: A Data-Driven Comparison
A recent study presented at the American Society for Metabolic and Bariatric Surgery examined 40,000 participants’ weight loss outcomes across three approaches: lifestyle changes, GLP-1 medications, and bariatric surgery.
- Lifestyle changes led to 7% weight loss but most of the weight returned within four years.
- GLP-1 medications like Wegovy achieved 15-22% weight loss, though over 50% was regained upon stopping treatment.
- Bariatric surgery offered the most durable results, with gastric bypass patients maintaining 25% total weight loss after 10 years.
Dr. Weiner emphasized that combining these tools often yields the best results, rather than choosing one in isolation. “When used strategically, they complement each other to lower your metabolic setpoint effectively,” he explained.
Addition vs. Restriction: A New Approach to Dieting
Most diets focus on restriction, which fails over time. Instead, Zoe advocates for an addition mindset, emphasizing nutrient-dense foods like vegetables, lean proteins, and healthy fats.
“When you focus on what you can add rather than what you must cut out, it naturally crowds out less healthy choices and fosters a sustainable, positive mindset,” she explained.
Semaglutide’s Global Impact and the Rise of Generics
Dr. Weiner highlighted a groundbreaking development in the global production of Semaglutide. Due to a favorable ruling in India, generic versions could be available by 2026, potentially lowering costs significantly.
“This could be a game-changer for millions who currently can’t access Semaglutide,” Dr. Weiner noted, though challenges like cold-chain transport and international legality remain.
Nutrition Strategies for GLP-1 Success
For those using GLP-1 medications, Zoe shares essential dietary tips to optimize results and minimize side effects:
- Prioritize vegetables, fruits, lean proteins, nuts, seeds, and legumes.
- Avoid greasy and processed foods that can worsen nausea or digestive issues.
“This unprocessed, nutrient-dense diet mirrors the advice we give post-bariatric surgery patients,” Dr. Weiner added.
Key Takeaways
1. GLP-1 Medications: Transformative but most effective when paired with proper nutrition and, in some cases, surgery.
2. Restriction Diets Are Outdated: Adopt an addition mindset to foster long-term, sustainable success.
3. Bariatric Surgery’s Durability: Surgery offers unmatched long-term weight loss results, especially when integrated with other tools.
4. Affordable Semaglutide Is Coming: Generic production in India could reshape global access by 2026.
Final Thoughts
Episode 58 reveals the synergistic power of combining GLP-1 medications, bariatric surgery, and the right nutrition strategies. If you’re ready to take control of your metabolic setpoint, this episode provides the tools and insights you need.
Let's say I need to eliminate sugar from my diet. And it starts with that chocolate at night. And you're like, okay, I just can't have that chocolate at night. Okay, I'm going to take away that chocolate at night from my diet. Okay, I can't have. And you just focus on what you're restricting. You're hyper fixating on it. You're putting yourself in that restrictive kind of deprivation mindset. Instead of focusing on the restriction side of it, focus on what you can add. Welcome back to the Pound of Cure weight loss podcast. A cut above surgery outperforms GLP-1 meds for durable weight loss.
Dr. Weiner:Yes.
Zoe:That's the name of today's episode.
Dr. Weiner:Yeah, we do everything in our office, right we? If you want to come and see us for weight loss and just want to work on your nutrition, we have a nutrition program. Truthfully, you can do that from anywhere in the country. We write tons of prescriptions for these medications. I think we write more prescriptions for the medications than any practice in Tucson.
Zoe:But what's different is that it's like the specialized dosing versus like. I just feel like I come across a lot of people who get it from their PCP, yeah, and it's just like all the dosings all over the place and they don't really get the best results from that because it's not as specialized.
Dr. Weiner:I mean, I think this and we're going to talk about the news article in just a second but it's comparing lifestyle and medications and surgery, and in my mind they're not three things to compare, they're three things to use and combine as necessary.
Zoe:They're not mutually exclusive.
Dr. Weiner:They're not mutually exclusive, and so the problem is doing any one of those things alone oftentimes doesn't work out great. It's only when you start to combine them that you really see all of the benefits of them. And so you know the GLP-1 meds and people are going to wellness spas or whatever and getting these meds and oftentimes will initially have some decent results. But the long-term nutrition is really what is going to allow that weight to kind of stay where you get it and give you the tools so that you can maintain that. Weight loss Surgery without nutrition makes zero sense at all and often people don't get what they want out of it and sometimes we combine all three. That's the most powerful.
Zoe:Way's our pyramid, it's our pyramid exactly, um and so.
Dr. Weiner:So anyway, I think you know let's, let's move into this segment. Um and so this this is a news article. It comes from medical news today and it says bariatric surgery is better for weight loss than glp-1 drugs such as ozempic, and this comes out of a research study. This is a pretty common theme where someone puts out a paper that's interesting, and we covered one of these a while ago about Osempic making you go blind. I haven't heard a word about it since, like the 24-hour news cycle that it hit, because it's probably nothing there and the scientific article really wasn't a particularly strong scientific article, and so the scientific article kind of gets caught by someone in the press and they publicize it and oftentimes the magnitude or importance of that article is outstated, overstated. So this comes from it wasn't even a peer-reviewed article, so I think this is not published yet. It hasn't been formally peer-reviewed article. So I think this is not published yet. It hasn't been formally peer-reviewed.
Dr. Weiner:So I think that's a really important thing about any news article and journal article is that what happens is you submit it to a journal and then, practicing, can join an editorial board. A lot of times it's kind of leaders and academics and when they submit articles, you review them and you say this is a good article, or this is a bad article, or you didn't explain this and what about this? And so there's this kind of this editing process that goes on, that holds your science up to make sure it's up to snuff. So if your science is flimsy, if your statistics are weak, if they feel like you've kind of misstated something and you don't really have the proof of it, that gets pushed back to you. So that whole editorial process really validates a paper and so it ensures that you can't just write anything and get it published in the journal and have people start to follow it and read it, and so that's an important part of academics and of medicine in general.
Dr. Weiner:This has not been published yet, but it was. They did present at a large conference they presented at the ASMBS, which is the American Society for Metabolic and Bariatric Surgery. I'm a very active member in that group and it's really honestly, it's a group of people I really have a lot of respect for. So there's a lot of great bariatric surgeons out there, a lot of very smart people who are doing very good work, and so I've always really loved being a member of that group and this was a talk given at the national meeting, and so this is someone who comes and they put all this stuff in front of a crowd of two, three, four, 500 surgeons, and so that there's believe me, you know if, if you put a bunch of crap up there, you're going to get oh yeah, it's not going to go well, you're going to get torn apart, and I've seen things like that happen.
Dr. Weiner:Um and uh. It's not pretty. Uh yeah, public evisceration is not necessarily a pleasant experience. Um, it's, yeah, it's not, it's not generally like that, but but you know, there is certainly a standard, and if you violate that standard you will hear about it, and so so the fact that this you know made it to the podium and got that level of attention really does show that there is some merit to this study. Um, I'm sure there'll be a few tweaks, but probably no major substantive conclusions will be changed.
Zoe:Before it's published Before it's published, right, okay?
Dr. Weiner:So this was a meta-analysis and we've talked about meta-analysis in the past. Meta-analysis means you take a bunch of different studies and you combine all of the data and look at 20, 30, 40 studies. What it allows you to do where a normal study might be 100, 200, 500, 1,000 people, this study had 40,000 people in it and it looked at people across all different treatment modalities for obesity, so they had 40,000 patients, which is makes it a huge study. And so with science, the more the people, the larger the number of people in the study, the more likely you're going to get an accurate answer. And something we say in medicine and statistics is you know, I can't tell you at all what's going to happen to one patient, but I can tell you very precisely what's going to happen to 100,000 patients.
Dr. Weiner:And I think, that's an important thing to understand when you're both the patient and when you're reading these scientific articles. So 40,000 people, that's a lot. It's a pretty good study and it came out of my alma mater, nyu, so that's where I did my residency and it was a bariatric surgeon, dr Megan Jenkins, who put this out and she did a meta-analysis and so there were 18,000 patients who'd had a gastric bypass, which is actually a lot. Only 6,000 had a sleeve and that really goes very much against. Certainly over the last 10 years, what the ratio of you know, there's been a lot more sleeves than bypasses, so I think that's also interesting too in some of the conclusions. My theory is, if it had been 18,000 sleeves and 6,000 bypasses, they might not have come to the same conclusion.
Zoe:Oh interesting.
Dr. Weiner:So there were 18,000 bypasses, 6,000 sleep patients, 723 lifestyle patients, 12,000 semaglutide patients and 3,000 trisepatide patients. So about 15,000 people on the meds, 24,000 on the surgery and then a handful of lifestyle patients. And another important thing anytime you want to know what you need to know about, about research, figure out who funded it, and so this was funded by Medtronic, and they are the makers of the surgical staplers that I use every day, and so you know when the money's coming from the company that funds the surgical staplers.
Dr. Weiner:You could fairly accurately predict that there's going to be some favorable things said about bariatric surgery yeah um, you know bariatric surgery, um, volumes are down with glp1 medications and the surgical stapler companies, the robot, all their stocks are down as a result. So, anyway, so they showed 7% total body weight loss with lifestyle change alone and almost complete weight regain at four years, and that unfortunately mirrors what most of us see. And so when they looked at WeGoV, they saw 15% total body weight loss. The data that's out there is usually is around 15, 16%. They showed 22% weight loss was ZepBound that syncs with what we see in the Surmount trial and 21% at one year and I think 25% at 18 months is what most. That's the numbers I usually throw out there. And they said that half the weight was regained after stopping the medication. So they looked at people who stopped the medication. I'm surprised it was only half.
Zoe:I was going to say that too.
Dr. Weiner:Yeah, my hunch is, if they followed it out long enough, it's going to be more complete. That's what we're generally seeing. It may take a year or two to regain all the weight, but when you stop the meds you're almost always going to regain a substantial amount of the weight. I think it also depends how much you lose, right? If you lose 110 pounds, you're probably going to see a lot of that come back quickly. You lose 20 pounds. It might be a little easier to keep that off. So they saw 29% total body weight loss for sleeve, 32% for gastric bypass and for all bariatric surgery they maintained 25% weight loss after 10 years. So that's pretty good. You've maintained total body weight loss of 25% at 10 years. They showed 22% weight loss with Zepbound. So even at 10 years the weight loss after bariatric surgery was better than it was at one year for Zepbound. So this clearly shows and I do agree with this- it's kind of what you've been saying all along.
Dr. Weiner:Surgery does, especially gastric bypass does provide better weight loss than the medications, but you've got to have surgery.
Zoe:Well, yeah, and as we know, there's so many factors for the individual that needs to take into consideration.
Dr. Weiner:And I think the thing that we also often talk about is this idea of a bell curve of response and and you know we talk about sometimes and we've mentioned in past in past podcasts about super compliant eating, which is kind of the hardcore vegan or near vegan, really, really almost perfect lifestyle changes, super clean, not like they just don't eat a lot of crap, but like they never eat crap. That you know. You might see a little bit more than 7%, and people who maintain that behavior are likely to maintain that weight loss for a lot longer, not regain at all for years. With the meds we see some people have these crazy good responses. We see some people not respond at all. And the same thing with the surgery we see some people respond incredibly well. We see some people not respond as well.
Dr. Weiner:One of the reasons I tend to lean a little bit more toward a bypass if someone's not going to use the medications is that the bell curve for a bypass is more narrow, meaning we have a lot fewer poor responders. And we still do see those super responders with a bypass, but we don't see those people losing 20 or 30 pounds only after surgery, like I've seen a couple dozen times after a sleeve, and so, anyway, I think this was an interesting article. 40,000 patients is a lot, funded by the stapler company, so we got to take that with a grain of salt, um, but. But it really shows us. To me, I think this is what we all know, which is that nutrition is the backbone of all treatments, but when used alone tends to not work very well. It's when we add the meds or the surgery that we get the good results, and surgery works a little better than meds. So interesting news article I thought it was worth mentioning. All right, so what do we have for nutrition today?
Zoe:All right. Well, I have two things kind of prepared. One is like a more tactical nutrition tip, which I know a lot of people like, and then another one is more of like that mindset reframe that I find extremely powerful. So I'm going to give them both take what you you know resonates and leave what doesn't. So the first one is coming from we had it on our group class schedule for the nutrition program.
Zoe:One of the sessions we have is a recipe swap party, so everyone comes and brings a recipe that they've made recently and talks about it. So everyone comes and brings a recipe that they've made recently and talks about it. And so the one that I actually was talking about, because I've been seeing online a lot this kind of pizza dough or a dough substitution, so I wanted to put my own spin on it. So, and I've actually used it in two different capacities now. So it's like for the pizza dough, I used whole wheat flour and plain nonfat Greek yogurt and some baking powder. So for those of you who need the exact like measurements, one cup of the whole wheat flour, one cup of the Greek yogurt and a one and a half teaspoons of baking powder and then a little bit of salt. So the recipes I've been seeing online, as they say to use bread flour, which makes sense, it's going to be a little fluffier and whatever.
Zoe:But, um, I don't have that and I don't want it. Um, so the? So you, then you need it into a dough and you, you know, like kind of shrug it out, whatever the word I'm looking for. Spread it out, yep, roll it. I didn't use a rolling pin, but you spread it out and then I built my, you know, pizzas on it and then baked it. You can air fry it whatever, and it was great.
Zoe:It held up. I have my little sister's in college. She lives not too far from me, so she comes over occasionally on Sundays and it's always this funny thing of like what do you want? Do you have any special requests? And she's like nothing with kale, nothing with arugula. She's like I'll eat. You know, she's a pretty basic eater, but anyway she was like, wow, even I like this, so it holds up.
Zoe:The reason why I brought it to bring it up is because we talk a lot or I talk a lot with patients about how so many things in nutrition are on the spectrum Right. Maybe over here we have the Domino's pizza and then over here we have your, you know portobello mushroom crust pizza or you know zucchini boats instead, and it's like, yeah, that's a great option, but maybe sometimes you want to make a swap. That's like not all the way on that end of the spectrum, right. And so I was really happy that I had such great success with this pizza dough. I was telling people about it and it was great. And then the other capacity in which I use is I made pumpkin spice bagels out of that you lost me at pumpkin spice.
Zoe:Oh, you don't like pumpkin spice. Well, I'm sure that there will be some people who like it. So it's the same dough base and I just added a little bit of pumpkin and pumpkin pie spice and did it like that air fried it. It turned out great.
Dr. Weiner:So you air fried the dough.
Zoe:Yes, I cut it into four parts. So it was the one cup of flour. One cup of Greek yogurt makes four servings. Um, rolled it out into little bagels. I put a little egg wash on the top, sprinkled a little cinnamon air, fried it and they were fluffy, they were cooked, they were great. And then, like the next days, I cut in half, put it in the toaster. And then what I used? I made a little spread with light cream cheese, vanilla, protein powder, pumpkin puree and some more cinnamon and blended that all up together just to make like an extra pumpkin-y spread that I'm sure you would love. But anyway, that's kind of my newest recipe obsession. I'm excited to kind of try in some other way.
Dr. Weiner:That's interesting. Yeah, I think it's a solid middle in the Solid middle.
Zoe:Right, we don't want to be using flour all the time, but the reason why I picked whole wheat flour is because it's going to have more fiber. It's going to have more protein, you know, slightly less processed or stripped away from nutrients than the bread flour. So you know that was something that I wanted to share.
Dr. Weiner:I love it. I love it.
Zoe:So let's talk about the mindset piece, then, and it has to do with this idea of addition versus restriction. Okay, so when you are focusing on, let's say, I need to eliminate sugar from my diet, right, and it starts with that chocolate at night let's just use that example. Or you know, whatever it is and you're like, okay, I just can't have that chocolate at night. Okay, I'm going to take away that chocolate at night from my diet. Okay, I can't have. And you just focus on what you're restricting, you're hyper, fixating on it, you're putting yourself in that restrictive kind of deprivation mindset and it's leaving that hole and it's just going to backfire. And so, instead of focusing on the restriction side of it, focus on what you can add. So it's how can I add more vegetables, or add more steps, or add more water, or add more, add more beans, whatever it is? And then maybe you're still trying to take away that chocolate at night but you're focusing on the addition.
Zoe:You're in an abundant positive mindset on what you can add. Wow, Look at all these things I can have. And it naturally crowds out those things you're trying to avoid or restrict without kind of getting caught up in that hyper fixation mindset about it.
Dr. Weiner:And that's the essence of the Pound to Cure program. I mean, it's exactly what we try to get people to do. So, yeah, you're right. I mean when you were talking about like the chocolate, and you can't stop thinking about it, it's like the don't think about an elephant.
Zoe:Yeah, exactly.
Dr. Weiner:All you can think about is a freaking elephant, and so you want to get out of that kind of out of that approach and this, really this, this is this idea of a cat, of your calorie ratio, and so that's something else I like about that approach, which is that if I, let's say, eat something that I shouldn't be eating, and then I, so I'm like, oh wow, most people are like, well, I'm not eating for the rest of the day, which, of course, sets you up to just do the same thing over and over again. Instead, if you're thinking about, well, I just screwed up my ratio, the only way to get the ratio up is to add a bunch of good calories into the mix, and that will bring your ratio up, and so that, to me, is really how I like to focus on things. No-transcript the more good stuff you eat, the healthier your metabolism is, the more it lowers your set point, the more weight you lose and the easier time you have maintaining that weight loss. So, yeah, I love it. Those are two great tips. So let's move into our economics of obesity segment, and this is about something that we've been following pretty closely for a while now.
Dr. Weiner:We've talked in some past episodes. I think it was episode 23, big Food, big Pharma, big Lies. We talked about semaglutide. So just a quick reminder when these pharma companies file these patents for drugs, they don't just file like one patent. They're not like here it is, here's the drug. I have one patent. Oftentimes around one drug there may be five, six, seven different patents, and now you throw the injector pens in. The injector pens each have like 15 patents around them. So there's a lot of patents and a lot of protection that these drug companies rely on, and the patents are the reason why compounded medications are going to come to an end, like we've talked about once the shortage ends, and the reason why the medications are so expensive. If there was no patent law then anybody could be making semaglutide and it'd probably be about 50, 60 bucks a month to be on semaglutide. But we also have to incentivize research and development, and Eli Lilly and Nova Norris put billions of dollars into these drugs and they deserve to get some of that money back. And they also put billions of dollars into drugs that never made it at all and they never made a dime off of those drugs. So we have that balance is something we're constantly trying to work on.
Dr. Weiner:So there's two main patents for semaglutide. The first expires in 2026. So a drug patent is 20 years long, and so it was filed in 2006. And it really was the very first version of taking the GLP-1 hormone and adding a certain compound on it that made it not get metabolized. So if I just took GLP-1, the actual thing that circulates in our body and I injected it into somebody, it would last like minutes, and so that's not useful for a drug. You need a drug to last much longer, especially one that reduces your appetite and helps you lose weight. So they started adding compounds on and that slows down the breakdown on and that slows down the breakdown. And so the first one, that expires in 2026, is fairly vague, and they just kind of use a general chemical compound that they add to the GLP-1 molecule. The one that expires in, I think, 2032 is very specific. This is the actual molecule. Here's all the carbons and nitrogens and hydrogens and oxygen atoms, and here's exactly how it's made up, and so that's the one that they're using to protect the drug. But you can make an argument that it was actually the 2006 patent. That is the real patent and this 2032 is just them playing patent games.
Dr. Weiner:So the thing is in the United States, the law shifts toward the patent holder, so there's definitely a bias to protect the companies that hold the patents, but that's not true in every country. So India, it's really very much the opposite. India has the law, favors the people and giving access to the people and reducing prices and costs and increasing people's availability. So there was a ruling in um in the indian courts, um, that basically the 2026 patent was the one they were going to follow. And so, um, there was actually a company called Mylan and they're a generic drug manufacturer and they have. They won the lawsuit and their parent company, natco, now has the ability to make semaglutide in India. So, as of 2026, the semaglutide patent is over in India the semi-glutide patent is over in India.
Zoe:Do you think they're like having the fact? They're like producing it now so that once the patent's over they can start shipping out in mass quantities?
Dr. Weiner:You know, maybe my suspicion is that this stuff is not that hard to make. It's been the injector pen, the fact that our market is flooded with. You know, I think 19 different manufacturers are making semaglutide right now Right, so that's not the issue. It's not the issue, it's making the drug has never been the hard thing. Making the drug has never really been the cause of the shortages.
Zoe:Or the expensive thing.
Dr. Weiner:It's the pens. It's the stupid freaking injector pens. You know we've had vials and syringes for 100 years and those injector pens. You know we've had vials and syringes for a hundred years and those are cheap and easy to produce. And you know, if this had all been done with vials and syringes, believe me people would have figured this out and they would have figured out the dose and as much as this stuff can cause some unpleasantness. You know, even if you overdosed, it's really probably not. It's not going to be fatal. It might be pretty unpleasant, land you in the er, but it's not going to cause any substantial danger or risk for, except for a very, very small group of people, right, um? And believe me, we see problems with the injector pens all the time. People forget to take the cap off and they fire. And then you know, there's all kinds of stuff that happens with those too.
Dr. Weiner:So so I think the question on everybody's mind is so what's this mean for me here in the US or in a country not in India? If you're in India, you're going to be able to get semaglutide pretty cheap, I think, within a few years. What if you're in the US?
Dr. Weiner:So this is what's where things are going to get a little bit interesting. So you know, we have patients who want to use Zepbound and they're on Medicare and so if you're on Medicare you can't use that $650 coupon, so you got to pay the full price, which is like $1,100. It's available in Canada for somewhere between $600 to 800 bucks, depending on the dose.
Zoe:A month, a month A month?
Dr. Weiner:Yes, and so we write prescriptions to a Canadian pharmacy and that Canadian pharmacy fills the medication. So it's legal in the United States to write a prescription to a pharmacy that's overseas that can then ship you the medication. And so there's no, we don't get any kickback from the Canadian pharmacies or anything like that. We're not the ones selling it, but our patients can get it for a reduced price. So I can pretty much guarantee you someone in India is going to figure out how to ship this stuff over, and if we, if you buy it from India and they ship it to your home, that's not a patent violation because that's subject to India patent law.
Dr. Weiner:Again, I'm not a lawyer. We'll have to see how this pans out. I might be wrong on this, but my suspicion is that we will be able to write semaglutide prescriptions for FDA approved meds in India and have the prescription filled in India, in India, and have the prescription filled in India, which is probably a better arrangement than every wellness spa and every strip mall, you know, selling a Chinese knockoff of it. So I think that's interesting. We'll have to see. The problem is keeping it cold.
Zoe:I was thinking about that.
Dr. Weiner:Yeah, that's going to be difficult.
Zoe:Well, I guess we'll check back in in two years.
Dr. Weiner:Check back in two years for sure. So, anyway, interesting. I thought that was interesting and we'll certainly be following that and talk more about it later.
Zoe:Yeah, absolutely Well. Thank you so much for listening and we'll catch you next time.
Dr. Weiner:Fantastic. See you next time.
