Episode 66: Your Insurance Company Doesn’t Want You to Lose Weight

In this episode of the Pound of Cure Weight Loss Podcast, Dr. Matthew Weiner and Zoë discuss various topics related to weight loss, including the challenges surrounding obesity drugs, the impact of antidepressants on weight gain, and the effectiveness of bariatric surgery compared to GLP-1 medications. They emphasize the importance of individualized patient care, the flaws in the healthcare system, and the need for a comprehensive approach to weight management that includes nutrition, medication, and surgery when necessary.

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Transcript

Zoë (00:04)
Hello and welcome back to the Pound of Cure Weight Loss Podcast. Dr. Weiner, how are you doing today?

Matthew Weiner, MD (00:10)
I'm hanging in there, Zoe. We record this on Fridays typically. And often this is like the last thing where I'm like, I'm out the door. And one thing I love about being a bariatric surgeon is I have a weekend. You know, in general, I don't have to round. All my patients are more or less out of the hospital. I don't have a lot of emergencies. So I'm looking forward to the weekend. Gonna relax a little bit. It's gonna be a nice day. Hang out by the pool.

Zoë (00:33)
Good.

Yeah, I was just going to ask if you had any good weekend plans, but that sounds pretty perfect.

Matthew Weiner, MD (00:39)
Yeah, hang out by the pool honestly. Try to get some time with the family. ⁓ I love to cook so I'll probably cook a meal for the family.

Zoë (00:43)
Yeah.

⁓

last night I made the most delicious roasted broccolini. Matt, my husband doesn't really like broccoli. I was like, but it's broccolini and I'll make it crispy. So you know, he choked it down, but that meant I had lots of leftovers.

Matthew Weiner, MD (00:56)
Hahaha

Right. What do you do? Garlic or?

Zoë (01:04)
Yeah, so I garlic,

salt, pepper, and I did a little bit of red pepper flakes, a little spray of olive oil, and then I roasted it for quite a long time to make it nice and crispy. So what I plan to do is chop it up and put it into my eggs tomorrow morning.

Matthew Weiner, MD (01:10)
Yeah.

Yeah.

That sounds delicious. Do you like it in the air fryer or in the oven?

Zoë (01:26)
Well, definitely air fryer but our oven because we moved not too long ago and our new oven has the air fryer and it's all like built in and it's in the wall. You'd love it. I don't know. I can't remember how your kitchen is but for me I've never had an oven in the wall and it makes me feel very fancy. I love it. I know. I know it's great. So great.

Matthew Weiner, MD (01:35)
Now that's Yeah.

For little things that matter, Zoe. You've arrived. You've got an oven in the wall. ⁓

Zoë (01:57)
Well, today is a podcast, we have some articles, some really valuable conversations coming from these articles. So Dr. why don't you want to start us off? What's our first article of today?

Matthew Weiner, MD (02:07)
Okay, so this is an article from the New York Times and the title is Why Patients Are Being Forced to Switch to a Second Choice Obesity Drug. So first of all, the Novo Nordisk people must have lost it when they saw their drug labeled as a second choice obesity drug. But,

Novo, I hate to break it to you, the New York Times got this one right. You are the second choice. do not, there's just less weight loss, more side effects, more constipation with those Zempig or Wegovi ⁓ compared to ZepBound. Our practice, we really lean very, very heavily on ZepBound, Monjaro, however we're sourcing it.

Zoë (02:31)
Yeah

Matthew Weiner, MD (02:50)
and really prescribe WeGovi kind of only when insurance mandates it. Turns out insurance now mandates it a lot more. And so Caremark, which is I think like a third.

Zoë (02:58)
You

Matthew Weiner, MD (03:03)
of the prescriptions that are written out there go through Caremark. It's CVS Aetna Caremark, but it's used by a lot of Blue Cross plans too. And so this is of course the evil PBM, right? CVS Caremark is a PBM, a pharmacy benefit manager, right? We don't like them. And so they're in an effort to save money. They have...

Zoë (03:05)
Wow.

Matthew Weiner, MD (03:30)
They will only allow you to cover Wegovi, not ZepBound for weight loss. ⁓ Even though it is clearly an inferior drug. And we all know why they're getting, they make more money. They gave them a bigger rebate. They gave the PBM more money. PBMs choose their formulary to optimize their profits.

not to reduce the drug costs. That's why this drug costs $1,200 list in the US and $200 list in every other country.

And it's because the PBMs allow it and the PBMs when the price is high, they make a lot more money. And so they say it's to reduce drug prices, but it is not. It's to increase their profits. And right now the health insurance companies are dying because the jig is up.

We know what's going on with PBMs. We know how they're screwing people and how they're actually causing not just financial harm, but physical harm to people.

And so these companies, believe me, they are squirming. UnitedHealthcare losing half its value. mean, can you imagine working, just Zoe, imagine our practice. If all of a sudden I was like, listen, we're making half as much money. You'd be like, oh my God, am I going to lose my job? going to happen? This is crazy. What are we going to do? That's crazy. Well, I mean, you know, the same thing's going on in a big company. You cut your value in half. They didn't cut the revenue in half, but that's coming.

the Medicare Advantage decision and PBMs being challenged. ⁓ And so they're doing everything they can to squeeze every last dime out of this before the whole thing comes down. And this is kind of, I really believe we're headed toward a financial collapse of our healthcare payment system. ⁓

And I think it potentially may result in kind of like a housing type recession. We may be headed toward a healthcare recession. I think it's 17 % of our GDP or something crazy like that. And so, you lose 10 % of your healthcare costs, that's a 1.7 % drop in your GDP. That's recession numbers. ⁓

So I think that they made this move, it's a huge, huge pain for our patients. And it's like we immediately had just hundreds of patients calling us saying, I got a letter, I can't get my ZepBound anymore. I gotta switch to Wegovi. At least they made it easy so we didn't have to get prior off for a new drug. They just basically converted the prior off. But the full dose of Wegovi is equivalent to five milligrams of ZepBound.

Zoë (05:58)
Yeah.

Matthew Weiner, MD (06:19)
So if you someone on 10 milligrams of ZAP Bound, they're getting a dose decrease. This person is going to gain weight, most likely. ⁓

Zoë (06:28)
And they may

have already been on Wigovia and it didn't work for them so you switched them to Zeph Bound.

Matthew Weiner, MD (06:33)
and Wigovia has a lot more side effects. you know, patients stop taking the med, you know, we know that there's a nutrition rate with these meds. A lot of it is financial, but also it's side effects too. And there's no question Wigovia has more side effects and especially constipation. Constipation is the number one reason that people tell me that they're stopping the medicine for.

Zoë (06:58)
Which is

valid because that is not something that you want to be dealing with long term. It's not fun.

Matthew Weiner, MD (07:04)
No, daily suppositories is not something that most of us really aspire to have to rely on for bowel management. So, ⁓ know, eventually people give up on these meds and then they don't derive the benefit from them. And then again, this is, you know, better for Caremark, right? Yeah. ⁓ So my...

Zoë (07:26)
It all comes back to what's gonna give them more money.

Matthew Weiner, MD (07:32)
My hunch is that this is going to be short lived. ⁓ We may see Eli Lilly move and make a move to try to get back in and which basically means give them give the care market more money. Although Eli Lilly really seems to be pushing another thing I really don't like, which is the idea that it's all Lilly direct, right? They own the pharmacy and they own right.

They own, ⁓ it's Form Health, Form Health, I think, is the company. They own a couple of telemed companies. Well, they don't actually own them, but they refer every one of their patients to them. And these companies are essentially exist because of Lilly Direct referrals, which means they own them, let's be honest. ⁓ And so, ⁓ so, you know, the pharma company owning the physicians, owning the pharmacy, I don't like that. That's like what we

see with Optum owning the doctors and the Medicare Advantage plans and so they can just spin the whole cycle in order to generate as much revenue as possible. It seems to me like Lilly Direct is kind of moving in that direction. ⁓

and with their so so they may resist this and they may kind of move into the cash pay space. There's plenty of people as the meds come down if we get these meds to 300 bucks a month. I think we're going to see a lot of people very willing to pay out of pocket and that might be like the lilies play. I don't know. I you know, I'm not a healthcare economist. I just kind of play one on a podcast.

Zoë (09:02)
Mm-hmm.

You do, you fool me!

Matthew Weiner, MD (09:14)
one thing I make sure I talk to patients about it. You know, you ever see that glaucoma flock in the tick tock? He's really he's really funny. He's got he's a doctor. He's an ophthalmologist. I feel like he and I are like some potico. He hates insurance companies as much as I do. But he he has a

Zoë (09:26)
I'm

Matthew Weiner, MD (09:31)
Like he does like a PSA and he kind of looks into the camera and he goes, listen, you need to understand something. Your insurance company doesn't care at all about you or your health. They want to extract as much money as they can from you while you're healthy. And as soon as you get sick, they want you to die as fast as you can. And that's what they think about you. Now you know.

Have a good day. And that's what this is. Right? It's they don't care about patients. They don't care about your health. They don't care about your weight. They don't care about your lifelong struggles. And patients will always ask me, what about this? And what about my high blood pressure? And what about the fact that, you know, I tried this and this didn't work. I'm like, they don't care. They don't care. It's not in their policy. So they don't care.

Zoë (10:00)
Bye!

Yeah.

They just

want to keep you on what has many medications as possible for as long as possible for as expensive as possible. And, you know, that's what I mean. This is a kind of unrelated, but also why it's so hard to have insurance companies cover preventative, let's say, dietitian visits, right? You could you only can get your insurance to pay for stuff if it's something that's super obscure or specific and

Matthew Weiner, MD (10:31)
Yeah.

you

Right.

Yeah. Sick care,

sick care. They want to play for sick care. Well, we're headed toward a revolution. I can't wait. My goal is I want to be right.

Zoë (10:54)
Yep,

We're gonna see it!

Matthew Weiner, MD (11:02)
I want to be right on the front lines of this sucker. I want to be there and watching it go down and coming up with solutions as the pillars of healthcare, the Cigna's, the United's, the Blue Cross's and the Aetna's come crumbling down. I want to be there to create ⁓ new ways of paying for healthcare and treating patients.

And I feel like I'm going to see it in my career. I got another 10, 15 years.

Zoë (11:32)
feel like

your politician run is sooner than we think.

Matthew Weiner, MD (11:39)
Yeah, we'll see. I got to make enough money that I can run for

Zoë (11:42)
our next article comes to us from MSN. Some antidepressants contribute to weight gain more than others studies find. And I think, you know, probably in talking with patients, you probably experienced this.

Matthew Weiner, MD (11:49)
Yeah.

Yeah, I mean, I think I made my first video about medications causing weight gain in like 2014 or something. So I've been kind of harping on this for a long, long time. seen it so many times. ⁓ And you know, the SSRIs have kind of slid under the radar. And then in last year or two, there's been a couple of studies, large kind of bigger studies using Epic, which is a big EMR that has a ton of data and you can quickly run research and it has

Zoë (12:01)
Well.

Matthew Weiner, MD (12:24)
weights and it has prescriptions and so you just say how many people with Zoloft, know, what was their weight versus people who didn't take Zoloft and so what we're starting to see is that people gain weight with these meds. ⁓

And it can be half a pound, it can be three or four pounds, it can be even more. And there's a difference in the medications. ⁓ So Lexapro or Isitalopram had more weight gain than sertraline. And I think Paxil was the worst. ⁓

And Paxil's also, think, Paxil's a rough antidepressant. Like if you ever have to stop it, it's one of those that like you can't just stop it or you like lose your mind. You got to like go down slow, slow, slow and wean it over months and months. ⁓ And so that, you know, we do see that there are that most of these SSRIs cause weight gain. And I think that's an important conversation to have around the prescription. ⁓

Zoë (13:26)
Over.

Matthew Weiner, MD (13:28)
So, you know, when you go see the doctor, and again, this really kind of gets into the nature of our broken healthcare system, I think you have to understand how money flows and how this all works in medicine. And, you know, because there's been so much money sucked out of the system, everybody in medicine is kind of like struggling to get by and they're just barely making it. ⁓

financially, least the practices are for sure. And so they just have to churn, right? And if it's an employed physician, they've got to hit their metrics. And if they don't hit their metrics, then their salary goes down. And so everybody's got this incentive to just rush everybody through and treat the chart. And what ends up happening is you get into this, ⁓ you have a problem. Let me listen to your problem. I'll nod sympathetically three times, and then I will write you a prescription.

Zoë (14:24)
Nope.

Matthew Weiner, MD (14:25)
and where a decision to start an SSRI probably should take an hour or two of counseling? Maybe meeting with a therapist?

you know, doing some meditation and some other things and really creating, you you can imagine you and I, Zoe, we could sit down probably in 45 minutes and create a really thorough way that, you know, something you should go through before onboarding an SSRI. None of that happens and there's no incentive for it to happen.

Zoë (14:56)
Mm-hmm.

Matthew Weiner, MD (14:57)
But it really should. so I think these medications are oftentimes prescribed way too quickly. And I don't want to act like they're not important meds. They are incredibly helpful for some people. There's no question. But they also don't work at all for other people. And so, you but you just keep staying on it. And so I think that decision needs to be a little bit more thoughtful. ⁓

Zoë (15:13)
Mm-hmm.

Matthew Weiner, MD (15:25)
particularly if you're struggling with your weight. Because a lot of times your mood and your weight are tightly linked.

Zoë (15:29)
Yeah.

Right, absolutely. And I think, you know, like you mentioned, having this individualized approach, mean, again, treating the chart, just trying to turn the numbers, but ultimately, it's an individual. And I think that's something that you do, especially really well. know, just anybody listening can just read the Google reviews. It's all our practice cares so much about.

Matthew Weiner, MD (15:36)
So.

Thank

Zoë (15:59)
listening to the patient and treating and creating that individualized plans collaboratively and not just, you know, pushing them out the door with a new prescription as quickly as possible.

Matthew Weiner, MD (16:11)
Yeah, yeah, for sure. Yeah, but it's, know, economics of the healthcare system do not support that approach. ⁓ Yeah. So I think, you know, I think the take-home point is that if you're on one of these medications and it's really helpful, you stay on it. Absolutely.

Zoë (16:20)
Yeah, and it's so sad.

Mm-hmm.

Matthew Weiner, MD (16:31)
Another important point is you don't stop it without your physician because Paxil isn't the only drug that will, you'll go crazy if you stop it. And so you have to talk to the prescribing physician and make sure that if you are gonna get off that, that you wean off appropriately and you do whatever needs to be done. But I think the more important thing is that the decision to go on this medication, especially if you're struggling with your weight, is something you should take very, very carefully. ⁓ And really make sure you've explored gratitude journaling

meditation and exercise and all these other things that can actually help reduce your weight before you consider one of these medications. Because you know, just like GLP-1s, when you start on Zoloft, when are you stopping? Right? I think for some people they just lost a loved one or stressful event. Okay, using the med to get them through that, that might make sense, but if it's just generalized depression, ⁓

Zoë (17:06)
Yeah.

Matthew Weiner, MD (17:30)
you now you're on another medicine for life. And so, yeah, it's tough. Again, they can be a godsend for some people. ⁓ You know, a lot of countries barely prescribe them.

Zoë (17:44)
Mm-hmm. It's like they prescribe a walk outside in the sunshine.

Matthew Weiner, MD (17:50)
Sounds very Scandinavian.

Zoë (17:52)
It

reminds me of a trend that I've been seeing on social media where it's like, I'm so sorry to report that. And then they list out, know, like gratitude journaling, going for a walk outside, lifting weights, eating vegetables. It works. It really does work. It's like, yeah, we get to, we get to choose. And I think having that more nuanced conversation and thoughtful approach and

Matthew Weiner, MD (18:06)
Ha ha! ⁓

Yeah.

Zoë (18:18)
soothing what path you want to go on and it might take a little bit of time to get to that and that's okay, we don't need to rush it.

Matthew Weiner, MD (18:24)
Right, for sure, for sure, but yeah, I think that's the piece that's missing too. I'm just wondering why we're not seeing companies popping up that are offering these types of solutions. I gotta believe, if I was struggling with it and was like, oh, maybe I should go on antidepressant, is there something out there? Can I pay 59 bucks a month?

Zoë (18:38)
Mm.

Matthew Weiner, MD (18:48)
meet with like a coach and get a couple of things. I guess there's probably some liability because if you're dealing with

there's some liability there. I feel like that would be a good ⁓ option. Okay, let's put you on a program. Let's start with gratitude journaling. Here's how we do it. Maybe we need.

Zoë (19:06)
hearing a

Pound of Cure Part 2 idea being blossomed. A community, that's right. That's right. All right, last article of the day. Ready? This one's from Medscape. Weight loss surgery instead of GLP-1s or are both best. And I was reading through this article, I was like, this is what Dr. Weider has been saying the entire time we've been doing this podcast.

Matthew Weiner, MD (19:10)
Yeah, maybe it's a community, you know, a wellness community. All right.

Yeah.

Thank

⁓ So ⁓ bariatric surgery has been around since the 80s.

I think actually the first ones were done in the 70s. Gastric bypass was done in the 1980s. There were some other surgeries done in the 80s like vertical band of gastroplasty, also known as stomach stapling. Those didn't stand the test of time, gastric bypass did. Sleeve came out, it's been out I think about 20 years that people have been doing it. There's another surgery, duodenal switch, which has been out I think since the 80s. So we've been doing this a very long time. Laparoscopy really changed it and this talks about a 4 % major

complication rate in this and we see 1 % serious complications and really our sepsis rate is I don't know what it is probably 0.1 % we really just see almost no sepsis after these surgeries ⁓ and so we're able to do these surgeries very safely. I'm not the only safe surgeon in the country I mean actually there's a lot of really good surgeons out there who have done tons and tons of these surgeries and have amazing

track records ⁓ and we get you know all this stuff is tracked nationally and I review this and regularly and honestly people do a really good job there's most bariatric surgeons out there do a very very good job and do the surgery safely ⁓ so

There's some conversation about should you have bariatric surgery or should you use the meds? What's more cost effective? What's more ⁓ successful? There's absolutely no question at this moment in time in 2025, bariatric surgery is more successful and more cost effective. The only problem is you need to have surgery, which most people don't want to do.

⁓ And so I think that, and to be honest with you, I get it. I totally get it. ⁓ So these meds are super expensive. I think the conversation gets much more interesting and much more nuanced at 200 bucks a month, 300 bucks a month. But even you space it out over a lifetime. ⁓ But then most sleeves need the meds too. So it doesn't free you from the need for meds. So there was a lot of talk about

Zoë (21:48)
Yeah.

Matthew Weiner, MD (21:54)
the variable success rates of both. But to me, it's kind of like a moot point because the answer is both. The answer is a step wise progression through this. ⁓ So we talked to us a little bit about the nutritional piece that you need to add if you're considering this. in our practice, we start almost everybody on meds if we can.

and move to surgery if we need additional weight loss. They're a non-responder, they lose access or don't have access to the patient chooses surgery because they don't want to be on the meds long term. ⁓ But we almost always start with the meds. Someone comes in our practice, they're starting with the meds, they're trying to debate about bariatric surgery. What's their nutritional plan?

Zoë (22:43)
Yeah, and it's interesting because there are all these different tools, right? But a lot of times the nutrition changes that we're working on, no matter the path that somebody's trying to take, it's pretty similar, right? We're working on those foundational habits of hydration and movement and trying to shift away from processed foods, eating more aligned with the metabolic reset diet, as you hear us talking about a lot, but.

something that is really important to me when I'm first meeting with people is helping them not feel overwhelmed. And because it can feel very overwhelming if it feels like, my gosh, my journey is so long. I have so much to change. I have so much weight to lose. And we can kind of get stuck in this mindset of I have to do everything all at once. I have to make all of the changes right away. And that might work for a couple of weeks or a couple of months.

Matthew Weiner, MD (23:24)
Bye.

Zoë (23:37)
But just like you said, remember if it was this podcast or an earlier one, but it's, don't really care what you weigh in six months. It's about what are you weighing in six years? And people who are coming to us, it's not that they haven't tried in the past. It's not that they haven't done things, but we want this change, their work with our practice to be the last thing that they have to do. So that means maybe we take a smaller, more stepwise approach of, okay, does the metabolic reset diet

feel too overwhelming? Can we just focus on eating a pound of vegetables a day because it'll naturally crowd out some of the other higher processed foods and you're less snack beyond other things? We see this cascade effect where it's when we start producing results, whether it's being weight loss or feeling better, more energy, less hunger, less cravings, etc, etc. That's really positive feedback to build momentum and to feel motivated to continue that that momentum forward, right? And

Matthew Weiner, MD (24:31)
So.

Zoë (24:37)
that helps not feel overwhelmed and that helps to actually have that confidence and that self-trust to continue moving forward, especially of course with the power of support and the community and the community that we've built. But it's important that people recognize these are habits that, you know, the nutrition changes that we're making, the lifestyle changes, the movement changes. These are habits that I just don't want you to do for a short term.

Matthew Weiner, MD (24:41)
Thanks

Zoë (25:06)
to lose the weight, it's about establishing them as a habit and changing your identity of this is something that I do, this is my identity as a person. I like to go for a morning walk because of how it sets me up for success for the day versus I'm going for a walk in the morning because I'm trying to lose weight. There's such a different power behind those two statements.

Matthew Weiner, MD (25:19)
you.

Yeah.

Yeah, I love that. think that changing of your identity, a lot of people will kind of say, well, you know, I'm not the type of person who likes vegetables or who eats vegetables. I'm not the type of person who enjoys walking outside. ⁓ And I think that that often sells yourself short. Like you can be the type of person that you decide that you are. And I think as soon as you start

Zoë (25:55)
Yeah.

Matthew Weiner, MD (25:58)
posing these limitations because of your history. You're already blocking your path forward. so, getting people to change that idea, and as you say so often, it's success is the greatest motivator. That's why I like to get people on MEDS ASAP. I think first of all, builds trust in the program. first of all, let's be honest, most people wanna get on MEDS ASAP. That's kinda what they're here for. ⁓

but we get them on the meds and we bring the lifestyle piece, we really focus on low dose. The shortage of, or the cost of meds and the way that we use them, really the cost is much less when the dose is lower. And so that puts the pressure on better nutrition, which is so valuable. And I think that low dose, maxing out nutrition approach is just absolutely the single best first step

anybody's

weight loss journey, whether they want surgery or not. And if you're a super responder and that low dose and the nutrition drops 100 pounds, we're done and you're probably happy staying on a low dose. And the risk of long-term use of low dose is minimal and it's probably going to be inexpensive and only get more affordable over time. And so that's a great path. it's that getting that success, building that trust in the program and getting people early results is so critically important.

A couple of other points in this article, some of which I wasn't crazy about was that they talked about, this was in 2023, between 2018 and 2023, 125,000 people took these medications in the study and I think like more than half of them quitted. I don't have the exact numbers in front of me, but a large number people quit it. But if you remember, this is when you couldn't get the med. So there were shortages. People quit because they couldn't get access to it.

I remember those days, those were really tough. You people finding success and then they just couldn't get it. And they're calling around every CVS in town, trying to track the medicine down, their whole day. Patients are like, I spent my last two days tracking these meds down. And so that's what people were facing at this time. So I don't know that you can say like everybody quits GLP-1s. People do, no question. ⁓ Whether it's cost, whether it's tolerance, whether it's results,

Zoë (28:07)
Bye guys.

Yup.

Matthew Weiner, MD (28:24)
It's hard to say, but it's probably not as much as it was exaggerated in this article. But I believe, and of course we're biased because this is what we've been doing since these meds came out, is that if you're not offering the nutrition component and the lifestyle component, and you're not offering the meds, and you're not offering surgery, then you're selling your patients short. You're not giving them that full breath and that opportunity to maximize their results. If you're not offering the meds, you're selling your surgery patients short.

If you're not offering the nutrition, you're offering your GLP-1 meds short and we have to be able to be fluent in everything.

⁓ And that's how our practice is set up. And I think that's the future of a weight loss practice, a quality weight loss practice. We'll be judged by that. Because I think the one thing we're seeing too is bariatric surgery is not something that will be of historical note. Someday it will be. But I don't think in my career, we're starting more new workups than I think, it might be than I ever have. Maybe at one other point in time in my practice I was around, we were starting as many new workups as

as we are right now, there's lots and lots of people who are choosing surgery. And I think it's coming from this understanding of the comprehensive treatment options available for obesity and setting expectations and ⁓ getting people educated so that they're making good choices about their health. So.

Zoë (29:57)
Yeah, absolutely.

if you're out there listening and you want to learn more about how to get on the real medications, maybe because cost is a factor for you, we definitely invite you to check out our Platinum program because that provides you with unlimited support from Dr. Weiner and myself for the nutrition piece while having access to the real prescription medications there.

Matthew Weiner, MD (30:22)
Yeah.

We're getting most people, when I've talked to people, we have a lot of people coming because the compounds are no longer available. And even with our platinum program and the cost of the meds, they're paying less than they were for the compounded meds. And I'm like, geez, you know? Because people are paying like 500 bucks a month for the compounded meds. we have almost, nobody's paying that much in our program. ⁓ Maybe the people on the highest dose, but ⁓ really people are, ⁓

Zoë (30:33)
It's cheaper. Yes.

Mm-mm.

Matthew Weiner, MD (30:52)
most

of our patients are kind of a couple hundred bucks a month for their total all-in costs for our care, the nutrition, everything. And I think, you know, when you put together a pack of something that makes sense for people, it actually doesn't have to be crazy expensive. And that's no insurance co-pays or anything. That's just the total cost of the program. ⁓

So I think another plug for our app, depending on when this podcast drops, may be available. Follow us on social media and we'll be kind of highlighting the features of it. And that really is designed so that all these things we've talked about, the nutrition and lifestyle, the medications, the surgery, all of that is kind of in one place for you to learn about, for you to help track and to optimize your success, no matter which of these three paths you're taking.

Zoë (31:42)
Yeah, it's so cool. I'm so proud of us. And you and everybody who's contributed it's it like you said before, and another time it's it's your baby put so much and we've both have, you know, everyone on the team has put so much into it. And I'm just so excited to see how much everyone loves it because it's going to be so great as such a powerful tool to help people really navigate this weight loss journey long term, right? Whether they're no longer

Matthew Weiner, MD (31:54)
Yeah.

Zoë (32:12)
Maybe they're years out from surgery, but they just want to have that connection with other people going through a similar journey. It's going to be really powerful, in my opinion.

Matthew Weiner, MD (32:19)
Yeah,

I mean I hope you're right. I'm excited about it too. It's kind of been fun because we've been talking about putting something like this together for years now, really.

Um, and it kind of also, when you started, that was really when we first started our nutrition program. That was, think, right when we, when you, when you joined us. Um, and so you've kind of been there from the very beginning of the nutrition program. We've kept, we've just added to it and added to it and added to it. And what about this and what about the, know, and then now it's all kind of coming together with the app. And I think a couple, two things came together too, at the same time. One was AI. AI really, I think adds a ton to this. And it also quite honestly made it something we could develop, like so much AI.

Zoë (32:34)
Mm-hmm.

Matthew Weiner, MD (32:59)
was used to create this thing. ⁓ And then secondly was just the kind of collapsing healthcare system where just people are no longer that trusting in the whole healthcare system and looking for something very transparent and educational and it gives them the power to participate in their weight loss journey and their educational decisions is great. I love it because people are coming in and they have so much knowledge

Zoë (33:07)
you

Matthew Weiner, MD (33:29)
And I love that. know, people are like, I don't want to challenge the doctor. No, bring it. Bring it, baby. I love it. Like, I'm up for the challenge. Read the article. Cite them. Whatever you got. Let's talk. Because when you've done a lot of research, we get to have a really interesting, thoughtful, useful conversation.

Zoë (33:30)
Mm-hmm.

Matthew Weiner, MD (33:51)
And so, you for me, the more you know, the better this is going to go. And the app is really designed to kind of bring everybody up in their education level so that they can make these good decisions about their health care and their weight loss.

Zoë (34:05)
Yeah, very exciting. like Dr. Weiner said, make sure you're following us on social media, because that's where we'll have all of the updates and the announcements. So definitely don't miss out on that. But we hope that you enjoyed this episode. And we love doing this for you. So we we ask that you share this with somebody who you think would get value from it, because that's how we can continue doing this. We want to spread the information and this side of health care and this side of us.

You know, there are people out there wanting to help you and doing everything that we can to help you. So we appreciate you being here. We appreciate you listening and we appreciate you sharing.