Episode 61: 2024 Weight Loss Predictions Recap

In this episode, Dr. Matthew Weiner and Zoë discuss their predictions for weight loss trends in 2024, including the rise of ZepBound over Ozempic, the ongoing debate between plant-based and keto diets, and the challenges of insurance coverage for GLP-1 medications. They also explore the increasing role of AI in weight loss management and the future of compounded medications in the healthcare landscape. In this conversation, Zoë and Dr. Matthew Weiner discuss the complexities of weight loss, the evolving landscape of fitness trends, and the integration of GLP-1 medications with bariatric surgery as a new standard for obesity treatment. They explore the societal shifts in caffeine and alcohol consumption, the potential of AI in meal planning, and the future of dietary products related to GLP-1s. The discussion emphasizes the importance of individualized approaches to health and nutrition, while also addressing the challenges and expectations surrounding weight loss treatments.

Learn more about our Pound of Cure Platinum Program here.

Transcript

Matthew Weiner, MD (00:00)
think I had the screen over here. That's what I, yeah, I had this. So I have the screen like right under the camera and I look at you and then have also, I have the predictions over on the side. But I think I'm looking, am I looking at the camera right now? Does it look okay? Okay, all right.

Zoë (00:03)
Mm-hmm.

Right.

Yeah, yeah, looking straight ahead. don't think, you know, like a

couple inches above or below, I don't think it's gonna make that big of a difference.

Matthew Weiner, MD (00:22)
Okay, all right, I think we're good. Go for it. Always. You're so, like, here we are, we're here. Yeah, starting now, this is the start and then we're gonna do this. You're so natural, it flows so nicely. Okay.

Zoë (00:25)
Would you like me to do the intro?

We are here with another episode of the Pound of Cure Weight Loss Podcast. We've been teasing this episode for a while. We've actually waited over a year to make this episode. Dr. Wiener, what is our episode today?

Matthew Weiner, MD (00:53)
Yes.

So we're gonna review that you're right. It's 15 months for our year long review. But we've been talking about our review show that we made and we made this back in November of 2023 for 2024 predictions. I personally, I love that show like nobody watched it though. That was one of the problems with it. So we'll see what happens with this recap. But listen, we're not gonna let nobody watching something stop us from making another one.

Zoë (01:27)
And that's right. Well, if you're interested and you do want to go back and watch that beach, I'll link it so you can go ahead and take a listen. We're going to be recapping all of them today anyway, though.

Matthew Weiner, MD (01:29)
you

Yes. So we're going to recap our 10 predictions. So last year before the 2024 new year, Zoe and I each made five predictions about what we thought was going to happen for weight loss. Turns out I thought we did pretty good. Yeah. So

Zoë (01:53)
would say so. So let's

dig right in.

Matthew Weiner, MD (01:56)
Let's

dig right in and then as a bonus at the end, we're going to give you five predictions for 2025. A little bit cheating because we're like two and a half months in, but you know, a lot of time left on our timeframe. We'll probably review it in June of 26.

Zoë (02:07)
Hahaha.

Well, and we know how many things can change in the span of a couple months So I don't think it's that big of a deal that we're a little late

Matthew Weiner, MD (02:20)
Yeah.

I mean, honestly, Zoe, is so true.

When I meet with patients, because we just kind of uncovered something that we're working on in our platinum program, that we already had some really great ways to save money, but I think we have better ways, easier for patients, and even probably a little bit of additional cost savings. And I tell patients like, this is good, but you got to give us some time. It came out like a week or two ago, and we're trying to catch up. We can't even give you instructions on how to use it because it came out so recently. So there's so much flux and so much change.

in this space right now, which makes it so exciting, which makes the need for a podcast so substantial. But it can be frustrating sometimes for patients because like, tell me what to do. We're working on it, we're working on it. But yeah, that's something we do in our practice every day is figure out ways for people to get these meds or surgery at a lower cost so that you can lose a lot of weight, keep it off for the long run and not go bankrupt doing it. All right, so let's.

Zoë (03:23)
Right, and

with our new platinum program, we're now able to, you and me of course, are able to see people from all over the country, not just in Arizona, which I think is a huge game changer.

Matthew Weiner, MD (03:37)
Absolutely, I'm having a really good time seeing these patients. mean, you know, they're coming in They've really thought things through people kind of you know people come to you in different stages of the process Sometimes people come in like I want to lose weight don't know what to do Can we talk nutrition? Can we talk surgery? Can we talk meds and we can talk all those things? But you know, that's a very different stage versus someone who's like, okay I had surgery in 2018 and I regained this and I tried this med and this didn't work and here's my

and here's my food logs and I think that the next step is this, what do you think about that? And it's just very different conversations. And we're seeing, I think, a mixture of both in the platinum program, but definitely more people kind of coming in with an understanding of where they're going in this whole process and just kind of ready to execute that. And I think we've really figured out how to get people on these meds, get them to lose the weight and not have to

Zoë (04:13)
Bye.

Matthew Weiner, MD (04:36)
to completely redo your entire household budget in order to make it work. So let's review our top 10 predictions from 2024. So the first prediction I made was ZepBound is in and Ozempic is out. And I think, first of all, I had the benefit of clinical trials and the clinical trials where they reviewed ZepBound and Ozempic or Wegovi,

Zoë (04:42)
Right.

Matthew Weiner, MD (05:06)
it really showed a very substantial difference with a lot more weight loss with ZEPP Bound.

And there's no question that's what we're seeing in our practice. I almost never prescribe Wegovi or Ozempic. I don't wanna say never, I do. But if a patient has coverage for both, I'm always gonna offer ZepBound. And also when it comes to cost savings, we see a lot more opportunities with ZepBound to get the cost savings. Now interestingly, and we'll probably address this in a future episode, Wegovi just dropped their self-pay price

substantially

so it's 650 for ZepBound and ZepBound is always little cheaper than WeGoVee but WeGoVee just dropped it I think to 500 bucks a month which is substantially cheaper and getting to the price but still a lot of money and we get people on these meds for much cheaper than that still so You know WeGoVee I think is understanding their place in the market. They're fighting back.

Zoë (05:46)
Mm.

Do you think that they were

hurting and so they were like, we're losing patience because we're way too high. We're not getting as best, better results as the ZEPP Bound. So we've got to drop our price to try to get more people in the door.

Matthew Weiner, MD (06:20)
I mean, when you have more demand than you can meet, you don't drop your price. mean, Eli Lilly and Novo Nordisk have made it very clear to us that their primary goal is to make a lot of money. So if Novo Nordisk is dropping its price on WeGovi, they didn't do that out of the goodness of their hearts. think the pharma companies will never do anything out of kindness.

and yeah so.

Zoë (06:51)
or yeah, I was gonna say our

main motto is do what's right for the patient. And I think we've seen that the insurance company's motto is do what's right for our pocketbooks.

Matthew Weiner, MD (07:02)
For our for our shareholders. Yes. Yeah, that's really that's who they answer to

Zoë (07:04)
Yeah, right. Yep.

Matthew Weiner, MD (07:09)
So anyway, that yeah, so, so I think we're right on this. The market is certainly leaning towards that bound. have patients, you know, actually just today I have a patient and people come, know, she came in and she had all these notes she'd taken and she did some research, which again, I love that. I love when people come in prepared to have a thoughtful conversation that they've really thought this through. They've done their research. It just makes for such a really powerful, enjoyable partnership in this whole.

weight loss journey and on her thing right at the top I could see her notes is like want Zep Bound not Ozempic and so people are seeing this and you know at this point it's really not clear. Now we'll talk about Retrude Tide a little bit later in the show that'll be a different story but anyway yeah so Zep Bound is in Ozempic is out. Alright Zoe what prediction are you reviewing?

Zoë (07:47)
Ha ha!

Yeah.

Well, I'd say prediction number one, you nailed it. prediction number two, we have plant-based and keto out. Now, you know, I'm not too sure how I feel about this prediction here because yes, we definitely are seeing more plant-based, right? We had.

a vegan bodybuilder on the podcast not too long ago, we see a lot more, you know, shift towards plant based absolutely with more products on the market and that sort of thing. Of course, the metabolic reset diet and what we work on it with our patients. However, I do still see a lot of

keto-minded weight loss attempts, right? A lot of people still feel fear carbohydrates to that extreme because of maybe keto trauma and just kind of what they've been ingrained upon with that diet. So even though we're seeing that plant-based kind of come up still, I'm not sure that out is so far out that we can say it that it's out. Do you agree?

Matthew Weiner, MD (09:14)
I totally agree. I think nutrition can become very ingrained in you.

and it's a little bit of a pun, know, grains and carbs and, but it can become very ingrained and it's hard to change. And once people kind of adopt their philosophy, especially if when they were younger, they lost like 40 pounds on keto, they kind of say, well, okay, that's how it works. Cause I had that one experience, not understanding that the diet that worked at 25 may not be the diet that worked at 52. And so that change,

it's

just really hard for people to make those changes. And so I think, I do agree, there's still a strong keto mindset. I think the interesting conversation, and this is something that I think you do really, really well with our patients, and it's a very challenging conflict really, is when are you pushing and focusing on protein and kind of optimizing your protein intake?

And when are you focusing on a produce plant-based diet? And I think when you're on meds, if you have had surgery, how far out from surgery, how long you've been on the meds, how much weight you're losing, there's so many variables in that question. Yeah, how do you handle that in your practice when you're working with our patients?

Zoë (10:33)
very nuanced. Yeah.

It definitely depends on, like we said, so nuanced, has so many variables, depends on where they're at in their weight loss journey, if they're in maintenance, right? But something I did want to say about keto as well, and something that I hear a lot of people use, the phrase I hear a lot of people use is, well, what worked for me in the past, right? So like what you mentioned, keto helped them lose 40 pounds, however long ago, but...

the mindset around it is that's what worked, but did it work if you gained the weight back? Did it work if you couldn't sustain that way of eating? So I think that definition of it worked, so I'm gonna go back to what worked for me before, but it didn't actually work, so can we do something different?

Matthew Weiner, MD (11:17)
Yeah. Yeah. All right.

Now that's a great point. All right. Prediction number three. It's going to be harder to get GLP-1s through insurance. So well yes and no. I did and I didn't. So when I made that we were going right into 2024. so in 2023

Zoë (11:42)
Nailed that one!

Matthew Weiner, MD (11:52)
Most insurance plans did not require prior auth for the diabetes versions, Monjaro and Ozempic. And not only that, but they had like $25 copays for these meds. Because the insurance companies said, these meds reduce heart attacks. These are diabetics. They're admitted to the hospital frequently. We don't want to put a large copay in front of the patient because they know copays impact people's utilization of medications. And they wanted them to take these meds. And so we were getting everybody.

And what that allowed us to do as a practice, and believe me, we weren't the only people doing this, everybody was doing this, is we just write people a script for Ozempic and they literally would take it and go right down to the pharmacy and fill it and get on Ozempic for $25 a month. And so yeah, it was really easy in 2023 to get people, and we knew that was gonna disappear, it was in the medical policy, so that was kind of a chip shot. Now, if we look at coverage for obesity, coverage for Zep-bound or Wegovi,

I don't know if I got this one right. I don't know if it got harder. mean we still we see people I think I'll tell you what did happen. We saw higher copays.

Zoë (12:55)
Hmm.

Matthew Weiner, MD (13:04)
So we had a lot of people getting ZEP-bound obesity coverage at $100 a month. The copay went up to $200 $300 a month. This is a question I'm really interested in working with corporations. Is anybody listening who's an HR director? We have some creative ways that we're working on to...

to where you could partner with us and we can get you the medications and figure this out at a lower cost. And so I think that's gonna be a really interesting field and I think some creative ways and a lot of the stuff we're doing, it's working in our platinum program for individual patients, but could we take that and apply it to an entire employer group? And I think the answer is yes, that's not something we've done, but I would love to talk to somebody

So if there's anybody who has some influence over that decision and wants to chat, please hit me up. I would love to hear from you. But I think maybe I was a tiny bit right but for the most part I think when we're looking at obesity coverage, I don't know that there was a huge change. Maybe it costs increase in the copay but yeah.

Zoë (13:54)
Mm-hmm.

Yeah.

Well, so you

do you feel as though because I feel like I heard a lot of people say that their insurance dropped coverage for maybe they were on the medication and then, you know, in the new year, their medication, their insurance dropped the coverage for the medications. Do you not see as much of that?

Matthew Weiner, MD (14:21)
Yeah.

think

that was the diabetics.

Zoë (14:33)
Mmm.

Matthew Weiner, MD (14:34)
I think that was people who we were getting it at. never had coverage for obesity. They only had coverage for diabetes, but their diabetes didn't require prior auth. So we never had to submit a form. could literally, you know, like not every medicine requires a prior auth. your pediatrician writes your kid for some amoxicillin and they go down to the, you go down to the pharmacy, amoxicillin is like $3. They're not going to do the prior auth. It's just not worth it. It's $3.

And so there's a lot of medicines that don't require that. And so that's what I think you were seeing there. But if you're talking about insurance coverage for Zep-bound for treatment of obesity, there hasn't been a huge change this year. A little bit. We were a little bit right but not drastically right. Which is think probably a good thing. My hope is that it'll get, maybe get a little...

Zoë (15:13)
Okay.

Mm-hmm. Mm-hmm.

Interesting

Matthew Weiner, MD (15:32)
little maybe that could be my bonus. It wasn't one of our five that we made but it might get a little easier next year. We might see a little more insurance coverage. Yeah, a little more. I think as much as we saw worse, it'll be better.

Zoë (15:43)
Well, hopefully, yeah, hopefully

next time when we do our 2025 prediction recap, we can give it up a positive update on that.

Matthew Weiner, MD (15:54)
Yes. All right, what's the next prediction?

Zoë (15:56)
All right prediction number four from last year is that AI uses for weight loss error So prediction number four AI uses for weight loss and I feel like we have seen a huge

Increase in AI not just for weight loss not just in in what we use it for but it has truly taken over so many fields and it being useful in so many capacities, but this is something that we are Integrating into our new custom app that we are working on This is the AI use of weight loss. I think we talked about meal planning and you know kind of helping with that and that's

exactly what we are working on having our AI sage use it for as well. And what I really like about this is it's trainable and it can be very personalized to

You know your preferences your you know food intolerances and allergies and maybe I've seen it where you type in know what you have in the refrigerator and it spits out what meals you can make with it So I think that in terms of what we saw for 2024 in terms of ai Absolutely has come in with a landslide and I think we're going to see it increase even further and I know we're really leveraging

Matthew Weiner, MD (17:03)
Yeah.

Zoë (17:26)
it in order to take that care and that personalization and the accountability to that next level.

Matthew Weiner, MD (17:32)
Yeah, and I think I can just tell you personally, I'd like to hear what your thoughts are on this, but personally, I've always kind of been against it because I've had so many patients over the years have said, just tell me what to eat Dr. Weiner and I'll just eat it. And that is, you know, it's great for those first few weeks, but I think I've always been of the mindset of, no, you have to learn how to create these meal plans for yourself because I can't be there. You're not going to you're going to eat for the rest of your life.

You know, me and Zoe can't be there for you for every meal. So this is something you need to learn to do going forward. But now with AI, maybe, you know, can AI write your meal plans for the rest of your life? Yeah, it could, right? You know, it's not that big of a deal.

Zoë (18:12)
Mm.

And you know,

I'm right there with you dr. Warner I say the exact same thing, you know me giving you a meal plan or sage giving you a meal plan and You following it perfectly for two weeks if you're doing the metabolic reset diet You're only eating it that's not teaching you the skills to be successful on your own So I do still think that utilizing AI to create these meal plans. Maybe you use them longer term, but they're still like

integrating these skills and they're maybe without using so much conscious thought around it, they're still getting these skills and learning how to build their meals according to what's aligned with their goals and perhaps the metabolic reset diet. So I do think that it's one of those things where how we previously used meal plans as kind of the here's a template.

It can be more personalized that you can use more frequently, but you're still going to be learning the skills along the way, which we both are huge fans of.

Matthew Weiner, MD (19:20)
Right,

yeah and I think you know that just like you said working with the AI that's you're going to learn to meal plan for yourself and so it's just an extra tool. Another thing I've learned about weight loss if it's easy you'll be more likely to do it and stick to it and so

Zoë (19:27)
Mm-hmm

Mm-hmm

Matthew Weiner, MD (19:40)
You know what? Sitting down mapping your own meal plan every week. That's harder than paying write me a meal plan for the week, you know? And so I think that's anything that makes it easier. I'm always in favor of that because life is hard. Meal planning is hard. Weight loss is hard. If we can make it easier with meds, surgery, AI meal planning, I'm all for it. So I think that we did nail that one. There's definitely we're not the only app doing this for sure.

And I think we're going to start seeing this as being a big part of nutrition, nutritional guidance in the future. yeah. So lots of people will get Monjaro from Canada. I think for 2024, I was wrong on this.

Zoë (20:10)
Go.

Path of least resistance.

Matthew Weiner, MD (20:31)
But for 2025 I was right, I was just looking a little bit too far ahead. The big reason, you know in 2024 for a substantial portion of it, we had shortages here in the US.

Zoë (20:31)
Hmm.

Matthew Weiner, MD (20:45)
And then we finally got rid of the shortages. When we had shortages here in the US, they had shortages in Canada too. And because Canada is a little bit more of a free market in terms of using market forces to set prices, where in the US we have just crazy PBMs and pharma companies and prices are set arbitrarily, Canada, the prices were pretty high.

Now that the shortages are up in the US and we're starting to see some shortages in Canada but they're minor and they're getting better. so just really like right now we're starting to see the prices come down in Canada to the point where they may start falling to the same level if not even lower than what you can get in the US for.

Zoë (21:33)
Hmm.

Matthew Weiner, MD (21:33)
And

so I think we were, really, you know, we had patients getting it primarily on Medicare patients who couldn't use the coupon. That's who was getting it, but really nobody else. I think in 2025, we may see more people getting it from Canada, even if you're not Medicare. So I think we were half right, half wrong, but big picture long-term, we're gonna, you Canada is gonna be a very valuable part of the supply chain for GLP-1 meds.

Zoë (21:52)
Mm-hmm.

Hmm interesting to see what might happen in a year with that Alright, so our next prediction non diabetes glucose monitoring becoming more popular so this is one that I think we see a spike of in kind of that influencer space or the you know, the wellness influencer definitely higher and like this is a

Matthew Weiner, MD (22:06)
Yeah, for sure.

Yeah.

Zoë (22:29)
Expensive this is an expensive device and this is kind of one of those upper echelon kind of

Yeah, it's techie. It's cool. I know we talked last time about it being kind of one of the tech bro type of Trends which I still agree with there have been very few people that I've come across with in actual practice actual Conversations with real-life people who do this But I do think we see it online in terms of that, you know increase of getting data And I'm sure that there's a ton of AI that's in you know kind of compatible with that and getting more data from it

Matthew Weiner, MD (22:46)
Thank

Yeah.

Zoë (23:08)
However, for the average person, average person trying to lose weight and you know, there's a huge, what I will say is that there's a big trend of talking about blood sugar stabling, blood glucose, you know, stabilization, but through diet, which we do, which we work on anyway. So I think it's kind of this, it's staying in that kind of unaccessible

Matthew Weiner, MD (23:25)
Right.

Zoë (23:36)
expensive piece of tech that is cool to have or cool to watch your favorite influencer do the experiment with but not very accessible.

Matthew Weiner, MD (23:47)
Yeah, I agree. think this is a 1 % kind of, know, people in the top 1 % kind of trend. Have you ever used it? Me neither. I've never used it.

Zoë (23:58)
Mm-mm.

I feel as though there are that's also a reason why I don't necessarily like tracking my sleep, right? I know there's like an aura ring that you can use to track your your steps and your sleep and all those things and the Data is great. Don't get me wrong. I love data. I love looking at trends That's why we look at trend for you know weights rather than getting hung up in the individual Fluctuations, that's why having trend of trends of food data and all of these data is great for looking at trend

However, I think when you get too stuck in that nitty-gritty Daily fluctuation it can just add more stress and it can add just another thing to have to track and data to look at that's maybe big picture not as Important or you know, obviously sustainable long term and you know if we're using it as a tool to build awareness and using that awareness to make meaningful change

Great, but if we're getting caught in the weeds and adding more stress and overwhelm based on yet another piece of data to track, I don't know how valuable it is.

Matthew Weiner, MD (25:10)
Yeah,

I think it's very easy to confuse data with efficacy.

Zoë (25:15)
Mmm.

Matthew Weiner, MD (25:16)
So just because we have

a bunch of numbers and now we have all this data and here's all the points and here's how much you slapped and here's what your blood sugar does when you eat beans versus nuts versus fruit versus carrots versus celery. And so you know you get all this data you're like wow man I'm going to figure this all out. But the question is what are you going to do with that data and is it actually going to impart a meaningful change in your health. And I think that's where all this stuff breaks down.

is number one, how do you even process all this data? Maybe AI can do it, we'll have to see, but maybe also there's nothing meaningful in it, it's just a bunch of noise. And kind of like the stock market, I we have so much data, an incredible amount of data about stocks and trades and outputs and calls and options and trader volume and all that stuff, and yet none of it allows you to predict the stock market in the future. And so I think we may be

Zoë (26:13)
Mm-hmm.

Matthew Weiner, MD (26:15)
kind of in that space with a lot of this biohacking stuff that we see like this. But we'll keep watching it. But yeah, I think it's gotten some traction. bet the device sales have increased this year. But as far as it being like, this is going to be a big thing, you think it's going to be a big thing in 2025?

Zoë (26:31)
Mm-hmm.

Know if we're gonna see a significant change in one direction or another I like to think about it as Paralysis by over analysis right having too much data you're overwhelmed and then you don't make any change So I think you know, it's more valuable and powerful to make Sustainable behavior change smaller changes that don't require as much Overwhelm because that's more sustainable

Matthew Weiner, MD (26:46)
Yeah.

Yeah, absolutely. All right, number seven. Compounded medications on their way out. So I think this was obvious. We knew this was gonna happen because it was all based on a shortage and we knew this med was inexpensive to produce and that these companies had billions and billions and billions of reasons why they needed to fix this problem. And so,

We knew they were gonna fix it. Once they fixed it, the law was on their side. These huge companies are gonna win. And that's what happened. In our episode last week, we announced the dates, but basically by the second half of April, compounded meds are no more. I think we, I've heard from a number of people in our weight loss space that they were selling compounded meds and they got cease and desist letters. We never got one, we never sold them.

So, so.

That's that they're over. They're done. Like the, you know, put the tombstone up for compounded medications. And, you know, I had a conversation in a group of people, a group of surgeons. were talking about it and I brought up the fact that the shortages are almost over and this is going to happen and compounds are going to shut shut, get shut down. And one of the people said, yeah, but then, you know, the next meds going to be up and it's going to be on shortage and then they're going to do compounds. I thought that was an interesting conversation to have, like, because we've got like, you

five, six meds in the pipeline, are they going to be on shortage and then we're going to see more compounds coming out? I think the drug companies learn their lesson and when it comes to once a drug is approved then it has to then get on the formularies for insurance companies. You can set the price and you can control that. You know it's kind of like when Napster came out.

It was crazy for all the downloaded music and everyone was like, Naps or Naps? You know, it went crazy. It was the beginning of it. And then over time, now we have Spotify, Apple Music. It becomes very stable and very market driven. And I think we're going to see that. So my hunch is the pharma companies are not interested in letting these compounded pharmacies knock their drugs off. And so I think they're going to control the release. There are alternatives. So if Zep Bounds 300 bucks a month and Retrode Tides

900 bucks a month we're not going to see a shortage of retrutatide and we're not going to see the compounders able to move in. So that to me is the bigger question is what's going to happen with the next batch of drugs? Are they going to be compoundable? I don't think they are. I think compounding is going to be of historical significance only and I think that's good.

Zoë (29:55)
Mm-hmm.

Matthew Weiner, MD (29:55)
It

was not necessarily a good thing for this space. Weight loss is complicated. These meds are nuanced. There's a lot on the nutrition side. There's health issues, safety issues. And so we need these to be in the hands of people who are managing them responsibly, sourcing them reliably so that the dose you're taking is really the dose that you've gotten.

Zoë (30:06)
Safety.

Matthew Weiner, MD (30:25)
And so I think this is a good thing and it's going to bring a little bit of sanity to this space.

Zoë (30:31)
Definitely. Well, guess we'll see.

Okay, so number A, less hit high intensity interval training, more strength training. This is definitely something I would say I've seen. Now group classes as a whole still are very popular because of a lot of reasons. know, obviously that sense of community, the accountability, they like being, kind of like how why people like meal plans, because it's you're being told what to do and all you have to do is show up. You don't have to use your brain. You don't have to have that additional decision fatigue around.

So in that sense, and a lot of workout classes are more hit based. However, with a lot of people that I work with, maybe they still do those group classes, but.

Shifting how they're utilizing it. you know going up in weights and telling the instructor ahead of time Hey, don't get on me for not going as fast because I'm really focusing on my form and slower tempo and increasing my weight So maybe they're utilizing something like an orange theory or an f-45 but in a more strength break based progressive overload Style, which I think is really great I think it will always be around because of the the essence of it being a

Short-burst

right you can do I know we have a couple people who do something like a Tabata and their office at work over lunch because it's the only thing that they have time for which You know seven minutes of something high intensity is better than no minutes of nothing at all, right? So Yeah, it makes a big difference. Absolutely. So I think it really depends on

Matthew Weiner, MD (32:04)
Yeah. It's actually pretty good. It makes a pretty big difference. Yeah. Yeah.

Zoë (32:13)
Again, very nuanced, many factors, but a big piece of it is also goals, like your physique goals, your strength goals. You know, if you're trying to build muscle, HIIT isn't gonna be the way to do it. But if you're trying to just increase your movement to help lose weight, then yes, that can definitely have a piece of it. We need to be careful, of course, with injury and injury prevention and lots of those other components, but both are valid.

with whether you're doing high intensity or strength training, right? Maybe if you're just getting started working with somebody, whether it's a personal trainer or that instructor at your group fitness class that can really make sure you're doing things safely. So I'm not sure if I nailed this one, less hit, more strength training, maybe a little bit, but I think, you know, obviously both have a place, both are gonna be around is my take.

Matthew Weiner, MD (33:07)
Yeah,

I think you nailed the more strength training but maybe not the less hit. Is there an age where hit is not advised and is that also true for strength training?

Zoë (33:12)
Yep.

So not for strength, even as you get older, it's more advised to make sure your strength training, right? Not just for the increase of muscle strength, but also bone health, because as you age, know, you're more risk to, more prone to falling and having those strong bones, those strong muscles, better balance, right? All of those things can really help with that injury prevention. Hit, I think is very individual driven. I can't say, oh yes, that's 65, you should stop doing hit.

Matthew Weiner, MD (33:26)
Yeah, right.

Zoë (33:51)
But you know we see that naturally happen maybe instead of doing Sprints you're going for walks, but that lower intensity list is what it's called low intensity steady state cardio as opposed to hit high intensity interval training You know I think I read something where the calorie burn now of course

The caveat here is we don't want to think about exercise as solely a way to burn calories. But in this research, it was you basically burn the same amount of calories if you're going the same distance. So if you're sprinting for a total of one mile or if you're walking for a total of one mile, I can't remember exactly, but I don't know how I feel.

Matthew Weiner, MD (34:21)
out.

I don't buy

that. Yeah. I don't buy that.

Zoë (34:42)
It seems like it wouldn't quite

compute. anyway, what I'm getting at is I think that taking on an individualized approach, just like with nutrition, but knowing that regardless, having both is important. You need to have resistance training or strength training. You need to have some sort of cardiovascular exercise.

Matthew Weiner, MD (35:06)
Yeah, I'm 52 years old. I lift weights a couple times a week. I truly believe in it in terms of keeping you feeling young. I think there's more I could do with stretching and that kind of stuff, but I wouldn't set foot in a CrossFit class or an F45 class. I wouldn't last two weeks in those classes before something bad would happen to me.

Zoë (35:30)
Exactly.

Matthew Weiner, MD (35:30)
So yeah, I

hear you. But I think with this, you know, the question of what, how old is too old for strength training? That's an easy question to answer, right? It's like almost there is no limit for hit. Hold on. Not so like you got to be a lot more careful. And I think that just that shows that it might not be for everybody at every age.

Zoë (35:54)
Mm-hmm.

Matthew Weiner, MD (35:54)
Okay

so number nine, bariatric surgery plus GLP-1s is the gold standard for obesity treatment. I think I was partly right, partly wrong. Surgical volumes are definitely down. Our surgical volumes were down about 10 or 15 % this year. And I don't know that that's necessarily a bad thing. You know, the way I kind of look at this and there's kind of...

this, let's talk about 50 pounds and more to lose. If less than 50 pounds to lose, it's very obvious bariatric surgery is not the right option. But if you have 50 pounds or more to lose, there are three reliable ways that you can lose that weight, keep it off for the rest of your life. The first way is meds with a pretty good response. And it depends on where your starting weight is, know, 50 pounds is maybe not the best

measurement, maybe 25 or 30 % total body weight loss, but a substantial amount, but mostly meds are gonna max out around 20, 25 % total body weight loss, except for about 10 or 15 % of people who have that crazy weight loss. And I think we had someone on the podcast last year who lost 100 pounds on 2.5, a ZEP bound, and basically cut her weight and had 50 % total body weight loss on 2.5, a ZEP bound. She was a super responder to the med. Her genetics were favorable.

So if you're in that 10 or 15 percent, you can lose crazy weight, you know, from 350 to 200, like bariatric surgery weight from the meds alone. But 85 percent of people can't. The next reliable option is a sleeve and the meds.

Combined, need both. A sleeve alone is not, in my opinion, a reliable long-term weight loss tool. There's some people who will get it, but it's not gonna be the majority. The majority of sleeve patients are gonna need to add the meds in.

And the third option is a gastric bypass. And so I think when we're looking at 50 plus pounds of weight loss, surgery's still gonna play a role, but we're gonna be able to select out some people who might have been getting surgery in the past, but now find success with the meds. What do you think, Zoe? You talk to people with meds, surgery. People tend to be pretty happy as long as they're losing weight. That's been my experience.

Zoë (38:19)
Yes, absolutely and I think you know in terms of what we see in our practice is that the the glp1s if somebody who has a history of bariatric surgery whether it was a couple months ago or a couple years ago adding in that glp1 If it's for weight regain or if it's helped getting them to that total body weight loss that they're they're after Or just also very low dose when they're seeing that rampant food

coming back in I do find it to be a very powerful tool for so many patients.

Matthew Weiner, MD (38:57)
I think just as GLP-1s may kind of replace some bariatric surgery, they also take one of the weight regain, which has been one of the major and appropriate critiques of bariatric surgery, and they essentially eliminate it. know, meds plus surgery, I almost feel like we're looking at like 99 % long-term success. I don't have data on that to support that, but I'll tell you in my practice, it's like if I see a post-surgical patient who

Zoë (39:11)
Mm-hmm.

Yeah.

Matthew Weiner, MD (39:25)
doesn't lose the weight regain it that would be like shock I can't even think of someone who didn't respond to GLP ones after surgery so so that to me is is you know that's really exciting that's a sweet spot in our practice for sure I love doing that and we're seeing great great results so if you are a go ahead

Zoë (39:44)
And I think also a go ahead.

I was gonna say, I think also a big piece of this is expectation management because some people are, you go in and say, you know, I wanna get surgery and they feel like that's kind of the one and done, but we have to reframe kind of how we think. It's not that you're going on the medications, meaning that.

Matthew Weiner, MD (39:52)
Yeah.

Zoë (40:08)
You failed or the surgery failed it's about this is the like we talked about the the better results the gold standard of how we can really Not only lose that maximum amount of weight but maintain it long term and knowing that it's part of the treatment and not necessarily a an indicator of failure

Matthew Weiner, MD (40:31)
Absolutely, it's like, you know, like people have hip replacements and then 15 years later they gotta have their hip replacement done again. Did that mean their first hip failed? No, they got 15 years out of it, you know. So it's more complicated. All right, I think you nailed the second one of this, the second part of this next prediction, so go over that, because I think one of them you really got exactly right.

Zoë (40:43)
Right.

Yes, so our last prediction here is that people are starting to reduce their caffeine and alcohol intake I see way way way more decrease of alcohol use Maybe maybe a little bit of caffeine. I will say I've seen a lot of people, know still getting their latte or still getting their coffee but using decaf maybe more often especially with the rise of

People struggling with anxiety. I also see a lot of people trying to decrease their caffeine intake to try to help combat that but the winner of this prediction for number 10 is definitely the alcohol have you seen there have been so many I've been seeing so many ads for

like alcohol or alternatives, whether it's with THC or even mushrooms or whatever it is that they are kind of replacing the alcohol with what have you seen much of that?

Matthew Weiner, MD (41:50)
Yeah, I I

was at the Total Wine or one of the beverage places and they had a whole wall of weed drinks. So I mean I think there's no question, and on our patient intake, how much do you drink? Do you use marijuana? Any other drug use? And I'll tell you what I see, I don't see a ton of alcohol use. I see a ton of marijuana use, tons.

and way more marijuana use than alcohol use. When it comes to weight loss, that is better. There's no question. People think, well, marijuana gives you the munchies. The data doesn't show any correlation between marijuana consumption and obesity. Alcohol consumption is definitely linked to obesity. You're drinking two glasses of wine at night. It's really hard to lose weight, no matter what else you do.

Zoë (42:23)
Mm-hmm.

Yep.

Matthew Weiner, MD (42:43)
The nice thing too I like about the GLP-1s is the anti-alcohol desire effect and that's not a bunch of junk, that's real. People just quit drinking once they start taking it. I think that's for the best. just had the, now they want to put warning labels on alcohol, any amount of alcohol causes cancer, there's zero safe amounts of alcohol and I think that's really...

important. That's probably a good message for us as a country.

Zoë (43:16)
It is very interesting to me. You I think it's all societal right, you know, however many decades and it go go when everybody was smoking cigarettes and that was what was accepted and that was what was normal and and a societal norm but then of course the research comes out and now it's You know kind of this much wider, you know kind of likes snubbed

Matthew Weiner, MD (43:37)
yeah.

Zoë (43:42)
And it is interesting to know that there is the research there that supports, you know the the cancer in that alcohol can cause and and all of these other health side effects and like you were saying the warning labels But it will take a cultural shift. I think we're starting to see that but I do think it's going to take more time to see that really robust cultural shift where

Matthew Weiner, MD (43:50)
Yeah.

Right.

Yeah.

Zoë (44:06)
It kind of has that same messaging around where you know cigarettes used to

Matthew Weiner, MD (44:12)
Yeah, mean, cigarettes really turned in the 90s when I California was the first place to outlaw it in bars and restaurants. And it took 20 years before it became like, what's up? Look at them, they're smoking? Who smokes anymore? It took 20 years for that to happen. I think 2025, this is the year that alcohol peaked. That's my...

Zoë (44:36)
And soon we're going to be seeing

alcohol being barred in bars.

Matthew Weiner, MD (44:42)
No alcohol in bars. Only weed and mushrooms. Mushrooms are going to be the next big thing. I mean, they're already

legal in Colorado. So yeah, no alcohol in bars. That's funny. All right. Well, let's get into our five predictions for 2025 or the last nine months of 2025. Okay. The first one.

Zoë (44:51)
That's so funny.

Matthew Weiner, MD (45:02)
All of the sleep apnea, fatty liver, cardiovascular, FDA approval, all the data that's coming out that show that these meds are effective treatments of these problems will not change a thing for insurance coverage. And this is, it's out there, the data is clear, but, and Medicare is now covering it, but the truth is Medicare is becoming a really small player in health insurance. It's all being sub-

Subjected

to Medicare Advantage plans and they can set their own rules and their own guidelines and their own prior off process and they can make it next to impossible to get coverage for these meds for fatty liver or sleep apnea or Cardiovascular risk reduction and that's what we're seeing right now. So I think Deidre got our first patient approved for rego V for sleep apnea and she said it took her like five letters and four appeals and

two phone calls to do it. It was a tremendous amount of work on her part credits, you a lot of credit to her for doing that and going to that extra mile for the patient.

all of this data is probably not going to change whether insurance covers it, whether your insurance covers it. The only thing that's going to change it is price. The price comes down, everybody covers it, the price stays high, nobody's going to cover it. And that's really what's going to determine it. And that's why I like to see a self-pay market, a Canadian market evolving to get some competition. Unfortunately, the next big drug, Retrudeitide, is produced by Eli Lilly, who also produces Upbound.

need a third and a fourth, we Pfizer in there, you know, we need other big drug companies in there producing these meds so that we can see a actual market and we're not there yet and so the price is going to remain relatively high this year and insurance coverage is going to be relatively lacking. Alright Zoe, what's next?

Zoë (46:57)
Mm-hmm.

Hmm.

Okay, so my next prediction is that AI meal planning will be the next craze and obviously we've already seen a huge increase of this last year we like we talked about are really making this one of the key features and that we're really excited about it with our app, but I'm also seeing this happen like, you know, being able to take photos of

know, pantries and refrigerators or being able to train the AI about your preferences and what you have available and the key here is though, yes, AI can make meal plans all day long and not get tired, which is a beautiful thing, but it's still required.

in terms of implementation, right? Now we have the what, but we still need to bridge that gap with the how, right? And that's what I do with patients and what I think having that accountability of maybe working with a registered dietician or working with whomever it is that you might be working with in terms of a weight loss coach or provider, but taking all of this great AI.

Data and tools, but how can I implement this in a realistic and sustainable way for my life? And that's gonna be individualized and that's something that I'm not sure AI is quite If we're quite using AI in that way yet

Matthew Weiner, MD (48:34)
Yeah, you know I'll take the counterpoint of that but if you give AI the weights, your weight, you give AI your food log and you let it write your meal plans, it might figure that stuff out, you know.

Zoë (48:50)
Well hey, listen Dr. Wynne, I'm not trying to get fired.

Matthew Weiner, MD (48:53)
Yeah

So you'll never get fired. I think, I'm not

saying AI is going to replace dieticians. I think, you know, did Weight Watchers replace dieticians? It didn't. In many ways, it kind of created a space for diet. Weight Watchers hired dieticians. Dieticians participated in the development of Weight Watchers. And I think that's going to be more, and that's honestly, that's a big part of how your role has changed in our practices. You know, you're still seeing patients and providing that individual

Zoë (49:21)
Exactly.

Matthew Weiner, MD (49:23)
guidance, but you're also structuring and helping us build the system that because you know there's only one of you, you can only see so many patients, but an AI bot can see millions of patients. And so I think the role of the dietitian is going to change a lot from that kind of boots on the ground talking and counseling to the patients to more of the building the system and creating a tool that people can use to eat better. And you know whether you like it or not,

Zoë (49:44)
Mm-hmm.

Yeah.

Matthew Weiner, MD (49:53)
to me is I think where we'll see more dietitians. There's always going to be a role and in our program too you can use the bot and you can also meet with you so you get the best of both worlds and I think there's some things that you can do that AI will never be able to do.

Zoë (50:02)
All

Matthew Weiner, MD (50:09)
But I think that we're gonna see this in Weight Watchers and Atkins and Keto and Jenny Craig and all the commercial programs are gonna start using more meal planning and automated recipe and grocery lists and all that stuff for their nutrition program. So I think that.

Zoë (50:27)
Yeah, and I have to say

with training our Sage, our AI bot, it's been really cool from my perspective to be able to help, you know, write that training of how she responds with aligned with our philosophy, aligned with, you know, not just what's gonna be pulled off of the internet, but what, you know, we actually work with patients on. So yeah, I completely agree. It'll be very interesting to see.

Matthew Weiner, MD (50:39)
right.

Yeah.

Yeah,

and with AI, there can be an angle. You can create an AI that does only keto. You can create an AI that does low fat. You can create an AI that counts calories. You can choose a different approach. And so I think that's gonna be something you'll start to see is different AI bots, ones on a high protein diet, ones on a high produce diet, and how that kind of gets managed. yeah, I don't think dieticians are going

Zoë (51:09)
Mm-hmm.

Matthew Weiner, MD (51:22)
anywhere but I think their jobs gonna change but I honestly that's true for about half of us when it comes to it right so all right the next prediction is a lock step dose advancement will no longer be the optimal way to take GLP-1 meds so the standard teaching and we've even run into insurance companies where we have someone on 2.5 milligrams and the next month we're like they should stay on 2.5 milligrams and we submit a prescription and their insurance company's like

Zoë (51:27)
A lot, yeah.

Matthew Weiner, MD (51:52)
know they have to go to five milligrams and I'm like what where are you coming up with this yeah yeah

Zoë (51:57)
you're like hello I'm the doctor.

Matthew Weiner, MD (52:00)
So this idea that first month 2.5, second month 5, third month 7.5, we ramp the dose up just like the clinical trials did and we follow this very structured advanced dosing strategy. I think that is going to become less and less accepted. It doesn't make any sense. Patients don't tolerate it. You're going to be on this med for a very long time. I believe the less med you take to achieve

the weight loss that you desire, the better. And an analogy I use is, know, if these meds are messing with your biology, they really are, to say that they're just no big deal is, that's not accurate. You know, is there a difference between having one drink a night and six drinks a night? Massive.

maybe 2.5 milligrams of Zep-Bound and 15 milligrams of Zep-Bound is gonna impact your body, your metabolism differently. And so we have to respect that dose difference. It's such a huge therapeutic window that we're using that just going up to the highest possible dose, I don't think is the right strategy. I think over time we'll start to see this no longer being accepted and more of a flexible dosing strategy and involving the patients more

and more in determining the right dose is going to become how these medications are used. All right, we're running low on time. This has been a long episode. I'm gonna kind of crank out my last prediction. This is a bold one. I'm really going for it with this one.

Retrutatide is going to come out, it should be FDA approved later this year and it is showing even better weight loss than ZepBound. It's produced by Eli Lilly and it is going to be pulled off the market at some point in the next few years. It is a triple agonist, meaning it works on GLP-1, it works on GIP, and it works on glucagon.

and it's the glucagon component. Glucagon is a stimulant. It's similar to epinephrine.

My concern is that we're going to see cardiovascular events. Their initial data shows a reduction in cardiovascular events, but I think if you're trying it on young, healthy people, we're not gonna see it. But I think you start using this medication on older people, people with pre-existing cardiovascular disease, and I think we could see this medication causing cardiovascular events. And so I know when this med comes out, I'm gonna be very, very careful.

in using it, particularly in older people. It's a great med, it's showing a lot of promise, it's not FDA approved, but I have lot of concerns about cardiovascular safety, particularly in older patients. And so we'll have to see where that turns out. I'm saying that speculatively, please don't take that as Dr. Weiner says this med is bad, it's not even out, there's not even a lot of data on it, but I'm gonna look at that very, very carefully. And I don't know if it'll be pulled off the market,

Zoë (55:15)
Thank

Matthew Weiner, MD (55:20)
may come with a very, you know, not to be used over the age of 55, not to be used in people with pre-existing cardiac conditions.

I think we're going to see some concern about that glucagon agonist and the cardiovascular risks associated with it. All right, Zoe, you get the last prediction. What do you got for us?

Zoë (55:41)
Well, we know how popular GLP-1s are and how many other, and how many companies are trying to get in on the action. So I predict that there will be a ton of GLP-1 specific support products, but they're gonna be a waste of money and not very useful. We've already seen this. I think we've reviewed a while back a protein specific for it.

I've been you know, we've been seeing those freezer meals like, you know, the lean cuisine specific to GLP ones and you know, I've been seeing you know, who was it the one of the Kardashians had her like, GLP one gummy or whatever. So I think we need to be very, weary of all of these GLP one specific products and knowing that they are likely just a way to make more money.

and to prey on people who are on the medications and obviously want to get the best results, but also to know that you're never going to out supplement your nutrition choices. So just because you're taking a GLP once, you know,

what's the word I'm looking for promoting, know, result promoting supplements along with your GLT one. If you're not changing the way you're eating, you're still not going to get the best results. So I would say we're going to see a lot of products and I'm sure we'll pop them on the podcast as we see them, you know, as the year goes on. But definitely be careful if you you know, I know that in in our sessions and the nutrition program, I review products all the time. People are like, what about this one? Right. So

We look at that a lot, but reading labels, looking at ingredients, and knowing that most of the time, your best bet is to eat whole, real, unprocessed foods that's going to help you get the most well-balanced nutrition, getting in the nutrition that you need to not only get the best results for your weight loss, but also to feel your best and to minimize those symptoms.

Matthew Weiner, MD (57:52)
Yeah, I mean I think GLP-1s, work to lower your set point. They kind of cause your body to lose weight in a natural way. And so they're not gonna change the rules about what's right nutritionally and what's right from a supplement perspective. There is one thing, amylin, which we can talk about on another episode. That I think is worth diving into a little bit more.

And there's some reasons why I think that but we'll cover that another time. But other than Amalin, I'm right there with you.

Diet products follow the fads. Atkins is out there, everybody's got a high protein, low carb product. What's the new diet fad? GLP-1s, that's the new diet fad. So we should expect to see a lot of products following that, but the data behind, they don't need the data to put it out there, to put the marketing claims out there. So just be wary that that's gonna happen.

Just because you're taking a GLP-1 doesn't mean you should be looking for these other products to support you. You should be supporting yourself with exactly what Zoe said. Unprocessed Eaten appropriately. Alright, great episode. A lot of content. We reviewed a lot and I look forward to going over this in 2026 and seeing how we did.

Zoë (59:05)
Yes.

Yes, absolutely. And you know, if you found this episode valuable or helpful in some way, we encourage you to we ask we please ask share this stuff with somebody that you think is going to get some value out of it. You know, we know how much of a trend and how much of a craze this

these, you know, medications and this whole conversation is so chances are that if you're listening to this, you probably know somebody who also could benefit from it. And our main mission is to give the most scientifically sound advice and to give it to you with none of the BS. So that is unlike a lot of social media content out there. So we're trying to help us

Make our mission possible by sharing the good information.

Matthew Weiner, MD (1:00:04)
Absolutely. All right. We'll see you guys next time. Bye. All right. A little long but good. Right at one hour. Yeah. Now, I think we'll try to keep them shorter but this one was a little bit more. Yeah. So, whatever. We'll...

Zoë (1:00:08)
Okay, bye.

Great.

Bye!

Obviously I know that the next one scheduled for the 20th. Do we have a specific time we want to try to get this out by or the week after maybe or anything specific there?

Matthew Weiner, MD (1:00:38)
Let's see what happens on Thursday. I mean, I think I would edit it up just so you may as well get it edited. But I think let's see what happens Thursday. Let's see what happens with the seminar. I don't think I would rush to try to get this out before the seminar. I don't think that'll help. So let's just hold it after the seminar and we'll regroup it at whatever that meeting is. We should know by the Monday meeting.

Zoë (1:00:40)
Okay. of course. Sure.

No, I don't think so either. Okay.

Matthew Weiner, MD (1:01:07)
on fourth, like we'll know how many people are coming and how many people signed up. So I say we just kind of let's just put it in the back pocket.

Zoë (1:01:07)
Sure.

Yes.

So it looks like we actually moved the 24th meeting to the 26th. you'll have, so exactly, well then we'll have a little bit more time and data to see what happens. So I'll plan to see you on Monday then.

Matthew Weiner, MD (1:01:22)
even better.

Okay, yeah, so we do that.

Okay, perfect. All right. Great. are going see me on Monday for the meeting? This coming Monday. Okay, perfect. All right. Have good weekend. Bye.

Zoë (1:01:33)
Alright, bye. Have a good weekend. Yes, yes. Alright, you too, bye.