Episode 60: The End of Compounded GLP-1s: What’s Next?

In this episode of the Pound of Cure Weight Loss Podcast, Zoë and Dr. Weiner discuss significant updates in the weight loss medication landscape, including the end of compounding medications and the implications for patients. They explore nutritional strategies for those transitioning off medications, the emerging trend of microdosing medications, and the long-term effects of Ozempic. The conversation emphasizes the importance of combining medication with lifestyle changes for sustainable weight loss and introduces an innovative AI nutrition app designed to support users in their weight loss journey.

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Transcript

Zoë (00:21)
Well, hello, friends. are so excited to welcome you back to the Pound of Cure Weight Loss Podcast. We know it's been a little bit, but we have not forgotten about you. We've taken a little bit of a break, but we are here. are back. More episodes to come. We just wanted to come in, drop some really exciting updates, and chat with you a little bit before we get completely ramped up.

We know that we actually have on the schedule, Dr. Weiner, the recording for the podcast of reviewing our predictions from 2024. If you have not already listened to that episode, definitely go back, listen to our predictions for the 2024 weight loss trends. That's gonna be the episode we're recording next. So stay tuned for that, Dr. Weiner.

Matthew Weiner (01:09)
How are you? Good to see you, Zoe.

Zoë (01:12)
Good to see you too.

Matthew Weiner (01:14)
So we've got some interesting stuff to talk about. think the biggest piece of news and we've discussed this and this was actually kind of talking about our prediction episode. This was one of our predictions, which was that compounding medications is going to end, that this is not going to be a long-term viable option for patients to be able to use these medications for years and years and years. And that's absolutely proven to be true. In fact, now we

finally have dates. There was a whole court case where the compounding pharmacies were trying to fight back and say, no, actually it is a shortage and because we're doing all this compounding, as soon as you stop the compounding, there'll be another shortage again and they were trying to make this circular argument but quite frankly, we're not seeing shortages in our practice. Every now and then a patient has to go to another pharmacy just for that one dose but that is still very uncommon. the shortages are really over.

Now the problem is the cost. price of these things is through the roof. But we have dates. these things, are, compounding is officially going to be illegal for semaglutide. Yeah. For semaglutide, which is Ozempic, Wegovi, that is going to be illegal. There's two different types of pharmacies. There's 503A, which is kind of the small mom and pop pharmacy. And then 503B is the larger scale ones. That's where most compounding meds come from. So for semaglutide,

Zoë (02:24)
Wow.

Matthew Weiner (02:43)
It's the 503 A's have to stop April 22nd of this year and for the 503 B's it's May 22nd. So that is right around the corner time flies like that these days, you know, so

Zoë (02:57)
Yeah, I'm really interested

to see what sort of legal act, mean, you know, how they're going to be coming, going after these sorts of compounding pharmacies and even the med spas and those sorts of things that are distributing them.

Matthew Weiner (03:09)
Yeah.

Well, we do have some information. mean, we're already seeing what they're doing. First of all, Terzepatide, which was the original source of the lawsuit, that's up even sooner. It's actually officially already up February 18th for 503A pharmacies, 503B, it's March 19th. So we're filming this on March 5th, so that's two weeks from today. Terzepatide is officially illegal. So we know what's going to happen. So it's not illegal. They're not going to throw you in jail, but it is a patent violation. And so if

If you are selling a compounded medication after these dates, you are in violation of a patent that is held by Eli Lilly or Novo Nordisk. These are multi-billion dollar companies. They have already made it very clear that they are going to defend these patents very aggressively. And they have a team of attorneys

Zoë (03:44)
So.

Matthew Weiner (04:02)
and they send out cease and desist letters and they're going after the med spas. And you know, what I heard, and I actually heard this from Chanel,

One of our previous guests she told me and she's in Vegas in Vegas People are selling these like on the street like you're meeting it like a strip mall And you know like like your old weed guy that you used to have back when weed was was illegal You know there be now people have their GLP one person So they're literally like selling these things under the table just like they'd sell any other illegal drug

Zoë (04:22)
my gosh.

Wow, it reminds me of that South

Park episode that we talked about a while ago.

Matthew Weiner (04:45)
Yeah, so I mean there's a lot, there's so much here to talk about.

you first of all, if you are using compounded meds, what does this mean for you? It means you're not going to be able to get compounded meds. There's still like I said, it's this is, where compounded meds have kind of been the gray area where it was technically illegal, but still a little sketchy. It's not quite as regulated as it is when you get to the pharmacy. These are now very much a black market product. And that changes the safety in my mind, because if I legit 503B

Zoë (05:18)
Mm-hmm.

Matthew Weiner (05:20)
pharmacy and I value safety and I run a business and I want to keep this business alive and all of sudden this opportunity comes for me to make a lot of money selling these meds because of the shortage and I run it through my attorneys and I know it's legit and I'm a legit businessman and I'm going to source this and I'm going to test it and I'm safety is really important to me because I have an obligation as a as clinician. That's the product that a lot of people were using and that product was safe and we saw

for many years that these things were sold and there really wasn't a lot of bad things that came out of them. But now that person is out. That person is no longer like, listen, I got other stuff to do. I'm not interested in fighting a lawsuit against Novo Nordisk. And so I'm gonna not sell these things anymore. I'm gonna sell other medications. There's a lot of medications that are compounded. so that now what you have is you have sketchy people. They're like, you know, it's illegal, but the...

the drug company, yeah, the money and who knows where they're getting it from. They're certainly not testing it for safety. And so all of this legal pressure is going to really weed out any legitimate honest people from this space. And this market is about to get very dangerous. And so I were in the past, I was like, yeah, compounding. don't do it, but probably okay. I would warn anybody out there. Do not go down that route.

Zoë (06:22)
The money!

Matthew Weiner (06:50)
So, Zoe, we're going to talk about this a little bit more, but let's say I'm using compounded meds. I haven't found a practice like ours that's able to help you reduce costs on the legit meds. What do I do nutritionally to help prevent the weight gain, to help quiet that food noise that comes raging back when you stop these meds?

Zoë (06:51)
Yeah.

Yeah, it's so interesting to see that, you know, it's not about forcing yourself to eat the same amount that you were eating on the medications. If you're fighting against that raging hunger, that food noise is gonna be louder than ever. So it's very key to.

actually eat very high volume. That's where the metabolic reset diet comes in. It's very high volume, focusing on lots of fiber, lots of vegetables, being able to eat till you feel full and basically working with those hunger and satiety signals rather than fighting against it. That will quiet the food noise that allows you to continue to eat more food as your hunger dictates it. But it's about what you're eating more of, right? It's we don't want to fall into that.

portion control trap from before when maybe you were having that volume restriction. So yeah, I'd say if you are coming off of compounded medications and you're not sure what to eat, whether or not you choose to try to go down the insurance or self-pay route for the actual medication, feel free to reach out and join our nutrition program.

very affordable and available to everybody whether or not you are on a medication or surgery and it's available to everybody who wants to lose weight and change their eating habits.

Matthew Weiner (08:35)
Yeah, for sure. We do, I do a seminar monthly. We've got one coming up. What's the date on that Zoe? think, do you know the date?

Zoë (08:43)
The

24th, Monday, May 24th at 5 p.m. That's going, oh, March, right, I have it written down and my notes wrong. March 24th, that's at 5.30 p.m. Pacific Standard Time. We used to be, for everybody who's doing daylight savings, Arizona does not change.

Matthew Weiner (08:47)
March 24th, Monday, March 24th.

Mountain, we're on

mountain standard time now.

Zoë (09:07)
No, right now, but on the 9th, we're going to be on Pacific time.

Yeah, the ninth. Don't worry, I've been very like, trying to keep everything straight, but it's all every single year. It causes chaos because Arizona, everybody else springs forward an hour on the ninth. So starting on the tenth, we are being on the same time as Pacific. Mountain will be one hour ahead. Central will be two hours ahead and Eastern will be three hours ahead.

Matthew Weiner (09:37)
Thank

God you did that. I probably would have showed up late.

Zoë (09:41)
Well, would have been the same for us, so that's

okay.

Matthew Weiner (09:44)
So during this webinar, kind of, you we do have ways that we help patients save money. And we actually, help people save a lot of money, a substantial reduction. It's, you know, when we talk about, when I talk to patients about this, I almost offer these solutions apologetically, because it's kind of crazy that this is how we have to do it so that you can afford this medication that solves or helps you with this really devastating

debilitating problem that you've been struggling for decades over. It's not the cleanest, smoothest way through it, but it works and it's doable. We've done it with hundreds and hundreds of patients. And so we'll talk about how we are able to do this. It's legit meds. We don't use compounded compounds or anything like that, but it does work. And we do have a program that's open to anybody in the country where we can help them save some money. I wish we didn't

to do it this way, but our healthcare system is sick, like a lot of us. And, you know, I'm not sure if we should just make a DNR and reset the whole thing. I think we got a rocky few years ahead of us. We got a rocky few years ahead of us in terms of this healthcare system. but in the meantime, we still need care, we still need meds, we still need to go see the doctor. And, and so how you do that, it's, it's tricky, but we're, we're working.

Zoë (10:46)
Yeah.

Something's gotta happen. Yeah.

Now.

You gotta be creative.

Matthew Weiner (11:12)
We gotta be creative. We're fighting the good fight, that's for sure.

Zoë (11:16)
Yeah, so if you want to

register for that free webinar, I don't know if we mentioned that it is a free webinar, we'll put the link to register for that on March 24th at 530 in the show notes. So you can go ahead and register that and join Dr. Weiner on this webinar.

Matthew Weiner (11:33)
Yes, perfect. So we have two articles we want to talk about and I think these are things that to me are really fascinating concepts. So the first is from the Hollywood Reporter and it says, forget psychedelics, everyone's microdosing ozempic now.

Zoë (11:53)
Okay.

Matthew Weiner (11:54)
and what it talks about is people taking very low doses. It doesn't go into a lot of details and the dose of these medications is something that I think doesn't get nearly as much attention. We look at it like binary, you're on it or you're off it, but really the low dose of these medicines and we will talk about this at our upcoming webinar, the lower dose of these medications, they kind of are that there's a little bit of a sweet spot.

Zoë (12:13)
Okay.

Matthew Weiner (12:24)
save some money on the cost. They work pretty well at low doses, not quite as well at the highest, but they work well at low doses. But this is talking about even like sub well below even the introductory dose. So let's take terzepatide or now we're not going to be calling it terzepatide anymore

because the compounding is over. We're going to call it either Monjaro or ZepBound. So the starting dose is 2.5. So they're using one milligram, half a milligram. And there's people, a lot of people are using it not for weight loss. They're using it

for potentially to reduce their drive for alcohol and help them curb some tendencies toward alcohol overuse. They're using it to prevent dementia and there's been a lot of evidence that they call dementia type three diabetes and so perhaps low doses of these meds will stave off dementia if you have a strong family history where, you

Zoë (12:58)
Good.

Matthew Weiner (13:19)
the age of 72 everybody starts to kind of develop dementia and you're 45 years old like that's

That's a little terrifying and so there's something like this that you could do that would help prevent it. We're going to see a lot of that as well. So Zoe, what do you think about microdosing maybe to help with food cravings or just to kind of act as that nudge to get people on a better diet?

Zoë (13:31)
Yeah.

I think that this could be a really powerful tool because it's to me, it's not just about what the medication is actually helping with. It's about the what you think it's helping you with. And we all know the placebo effect is the most well studied drug in the world. And so I feel like if you are taking a microdose of

Matthew Weiner (14:08)
Yeah.

Zoë (14:19)
the ZupBound or whatever the case may be and in your mind you're knowing I'm taking this drug because it's going to help curb my cravings and it's going to help me stay on track with making the food choices that are aligned with maintaining my goals. That extra nudge is for sure going to help whether...

Whether or not the medication is actually scientifically shown to do that or not, think there can be a lot of power in the intention and the mindset and story you're telling yourself around that dose.

Matthew Weiner (14:51)
Yeah, the other thing I really like about this idea of low dose on these meds.

is that it in the you we we see a lot of people and I think the public out there is like well, they obviously this person obviously doesn't want to do the hard work. So they take the meds instead and there's you know, there remains that obesity bias. It's still it's still out there. It's still strong and the assumption out there and then let's be honest there are patients absolutely who come at it from this angle to which is I'm just going to take the med I'm going to eat less garbage and I'll just

Zoë (15:14)
Mm-hmm.

Matthew Weiner (15:28)
not eat as much and I'll lose the weight and that's how I'm going to solve this weight loss this weight problem I have.

When we start to look at low dose, we're not relying on the medications to the maximum extent. And so if you're not relying on the meds, it means that you got to put more energy into the nutrition. And just like you mentioned, if it just takes the edge off of those food cravings and just nudges you in that right direction, you pair that low dose of the medication with a really great diet and we see fantastic results.

Zoë (15:50)
Mm-hmm.

Matthew Weiner (16:06)
in it and this isn't a perfect analogy because anabolic steroids have a lot of health issues and you know it's not something that I'm like yeah you should you know take your roids and build big muscles but if you take anabolic steroids and you don't go to the gym nothing happens.

Zoë (16:18)
Yeah.

Matthew Weiner (16:25)
you've got to take the anabolic steroids and then do the weight lifting and then you build the big muscles. And to some degree, kind of and I think everybody who's watching this is very likely had the experience of they changed everything. They were so dialed in. They did it all right nutritionally and they lost four pounds in a month and then a pound the next month. And then it was like, you know, they ate a bad meal and they gained five pounds in a week. And so many people have had that experience. And if there was

Zoë (16:43)
Great.

Matthew Weiner (16:55)
this medication that allowed those efforts to work better. That's what I how I look at micro dosing. So it doesn't absolve you any way of the need to change your diet. I'm sure you're seeing I'm sure you're seeing a ton of this in our support groups. We have a lot of people on low dose and really with a lot finding a lot of success with it.

Zoë (17:04)
Mm hmm.

That's a really good analogy. I like that.

Absolutely. And

also anything that goes directly into our next article that we have to discuss, which is most people stop ozempic after two years, what happens to weight and health from the site from Scientific American. And the reason why I wanted to segue right into this is because it it has this really and I'll let you kind of dig into the article a little bit more, but kind of bridging that gap between

the low dose and kind of potentially viewing that as your long-term care plan so that you're not going on and off and on and off. So you want to talk a little bit more about the article, Dr. Weiner?

Matthew Weiner (17:53)
Bye.

Yeah, so this was from Scientific American and the title of it is most people stop ozepic after two years. What happens to weight and health? And so there's a lot here too. So the first is most people stop ozepic and that is true. We see that in our practice. I think one out of eight people in this country have tried these meds at this point. But one out of eight people are not taking them right now. So people are starting and stopping.

The article, takes like two thirds of the way through until it talks about like the cost, which is what we see as without question, the number one cause of people stopping to take these medications is losing insurance access. And this, you know, they looked back at 2023 and 2024. I'll just give you some, some kind of background about what happened in 2023, 2024 and 2025. So 2023, we were prescribing these meds. This is really right when it came out.

And were using this loophole where we prescribe Monjaro or Ozempic, the diabetes version in non-diabetics because they didn't require prior off and their insurance plans allowed us to do this. And we got tons of people on the meds. And then starting January 1st, 2024, it was like an annihilation. All of these patients lost their coverage. They went to the pharmacy to pick up their January dose and they're like, sorry, you need a prior off. And then as soon as you had to get authorized,

for a diabetes med and you didn't have diabetes it got denied and I had a mixed feelings. I always do the very best thing for the patient in front of me that's just our mantra and so if the best thing is using a loophole that I know exists I'm gonna do it. I had some moral issues because I didn't like that we had to do it this way but it worked and it was good for the person who I was working with. So then we lost it had a ton of people stop and this was they were in this study these are

Zoë (19:50)
Yeah.

Matthew Weiner (20:00)
people

who lost it because they were getting it for diabetes and then there was a policy change. We saw in 2025 of this year almost every single employer who covered these meds raised the copay and and it's now most people it's two or three hundred bucks a month minimum for your copay and so that caused a lot of people to stop taking it. Some other things people don't talk about is 15 % of people do not

Zoë (20:28)
Right.

Matthew Weiner (20:29)
do not respond very well to these meds. They lose 5 % or less of their total body weight and that's just not enough to continue taking these meds. So one out of six people, and everybody says, these meds are miracle and they change everything. They do for most people, but not all people. And so we're gonna see these people have this experience and basically be like, it's not worth taking this med, spending all this money to lose eight pounds.

So they talked a lot about food cravings coming off of Ozempic and about weight maintenance. What are you seeing in your practice? Are people, when they stop these meds, are they able to maintain the weight loss or are you seeing it's hard, right?

Zoë (21:12)
It's hard and you know, there's something that stood out to me in the article and it's it's a kind of just a mindset shift around I think how I talk about the medications too is instead of saying it's a tool, it's a treatment. It's a treatment for a disease, just like, you know, taking lisinopril is a treatment for

high blood pressure, if you take that treatment away, the blood pressure goes back up. These medications are, and I always talk about them as a tool, as a tool to lose the weight, but it can't just be a tool to lose the weight and then get off of it. It's a treatment for the disease of obesity that needs to be, we have to have that expectation. And I think having a shift in expectation when you start the medication,

is a big piece of this.

Matthew Weiner (22:11)
So the article said, they had a great line, said, it's a treatment not a cure. And I think that's exactly, you know, we look at like antibiotics, you've strapped throat, you take antibiotics, you're cured. You don't have strapped throat anymore. You don't have to keep taking antibiotics. But with these meds, you're have to keep taking them. So.

Zoë (22:16)
Yeah.

Matthew Weiner (22:32)
There were some other interesting points. think first another thing that I saw was that people do maintain the weight loss. Not all of it. So if you lose, if you're losing 25 pounds, you still end up as much as a year later, you're still five pounds down. So there is that little residual amount. A question I get asked all the time Zoe is,

Zoë (22:45)
small percentage.

Mm-hmm.

Matthew Weiner (23:01)
Well, if I take the meds and then I change my lifestyle and I do the exercise and I do the eating right, will that prevent me from regaining the weight? What do you think?

Zoë (23:12)
Yeah, well, that's what I talk about all the time. This is what I always say. The tool helps give you that push in the right direction, but the tool by itself is not the end all be all as we know. But you know, now we need like maybe have a slightly different mindset, but we need to combine the tool with the lifestyle modification while you're getting the positive reinforcement of seeing the weight loss. It's so much easier.

to make these behavior changes, change your nutrition, start an exercise habit, take care of yourself in the way that is aligned with maintaining your goals when you are seeing that success and progress versus waiting until after you go off of the medication, I'll wait till then to start changing my habits. It's going to be so much harder. So if and when the medication goes away, which we've seen happen a lot, I always like to say that's why we put so much emphasis and why

Our practice has built the robust nutrition program that it has because we know the value of combining the tool with the lifestyle change because if and when this tool goes away, we can then rely on these great nutrition habits, this great exercise habits, sleep hygiene, more productive stress management, mindset, all these things that maybe you're gaining a little bit of the weight back, but at least it'll mitigate it in a way that you still can't,

know how to navigate this increased food noise, this increased hunger, just like we talked about before.

Matthew Weiner (24:44)
Yeah, I mean, the combination of the two is just, it's such a critical strategy. And to use the meds without putting a ton of energy and effort into the lifestyle changes is really setting yourself up for failure. I think the question that I have, and I still don't know the answer to it is, and I think the answer, like, you know, most things that we talk about is it depends, but

Zoë (25:00)
Yeah, absolutely.

Matthew Weiner (25:12)
Can we reduce the dose? Can we extend the dosing interval as someone moves from that weight loss phase to that weight maintenance phase? And I think the answer is yes, if the lifestyle changes are there. But I also think it depends on how much weight you lose. Like if you lost 100 pounds, then and you stop the medicine, you're now 100 pounds away from your set point.

Zoë (25:33)
Mm-hmm.

Matthew Weiner (25:42)
And that's like a very strong rubber band. Exactly. If you lost 20 pounds, 10 % of your body weight, it's probably less. A thing I loved about this article is they talked about set point theory.

Zoë (25:46)
Your body's like, ahhh!

Yeah, yeah that

Matthew Weiner (25:58)
So I

Zoë (25:58)
was great.

Matthew Weiner (25:59)
love to see this coming out and you know we've seen this and we've known about this for really over a decade from bariatric surgery but the meds and the idea of stopping the meds or cutting back on the dose really is making this like why do you gain the weight back? It doesn't make any sense if you just do everything right and maintain your calorie deficit then you'll keep the weight off right? That's how it works. No it's not how it works it's a physiologic regulation and the meds shift

that set point you stop the meds the set point starts to creep back up and the weight follow it's very very hard to keep your weight away from your set point your body doesn't like it

Zoë (26:33)
Yeah. Yeah. No,

but, you know, we've been working on something to help with those changes and to really kind of solidify.

changing your nutrition and helping to combine the tool with the lifestyle change, right? You know, we haven't been not doing anything while we haven't been making the podcast, we promise.

Matthew Weiner (27:06)
I've my ass off lately. Yeah, so we have a new app coming out. We're just getting into the stages of testing it, but I'm really excited about this. Zoe and I have taken like every podcast, everything, every book I've ever written, every blog article. Zoe put tons of time and energy into creating meal plans and recipes, and we put it into an AI agent.

Zoë (27:07)
Yes you have.

Yeah.

Matthew Weiner (27:36)
and we trained an AI bot, we call her Sage for many reasons. she will, and then in the app, you can put your weight in, you can put what medications you're taking. If you've had bariatric surgery, you can list your surgical history and all of that gets fed into the bot and it will provide meal plans and recipes. It'll give you talking points to discuss with your healthcare provider.

Zoë (27:38)
So, thank

Matthew Weiner (28:05)
and help guide you through this whole process and it's available 24-7 and it can do meal plans all day long and it will not get tired.

Zoë (28:14)
Yeah.

Matthew Weiner (28:14)
Yeah, we're

also bringing back Caloratio to log your food. so that will it'll also let that bot will know what you've been eating if you put it in the system and can give you some feedback on maybe some changes you should make. And so we're hoping to get this thing out in a month or two, probably more likely to let's be honest. Technology always takes longer. But we're excited about it. And we think it's going to be a real really great tool for anybody who's trying to lose weight through meds or

Zoë (28:18)
Yep.

Matthew Weiner (28:44)
surgery, even just nutrition.

Zoë (28:47)
Yeah, we're really excited about it. That Sage is something that I think we both are like, this is so good. That's actually also something we're going to talk about more on our review of the predictions from last year, because we talked about AI.

Matthew Weiner (28:59)
Yeah.

Zoë (29:02)
but there are also so many more features in this app that we're not going to share quite yet, but know that there's a lot of good stuff in there and it's going to be so valuable. So we're really excited to bring this to you.

Matthew Weiner (29:16)
Believe me, you'll hear all about it when we start to get closer to the launch. All right, well I'm glad we did this. This was fun. It's been way too long and we've got some more schedules. So we'll keep them trickling and then hopefully after we've got the app launched and ready to go, we'll restart more of a normal release schedule.

Zoë (29:19)
yeah.

Absolutely. And

thanks so much. And again, the link to register for the webinar on the 24th will be in the show notes. And we'll see you then.

Matthew Weiner (29:48)
Fantastic, see you next time.