In this Q&A-packed episode of the Pound of Cure Weight Loss podcast, Dr. Weiner and Zoe answer listener questions about navigating post-surgery challenges like dumping syndrome, food noise, and pregnancy after weight loss surgery. Here are the highlights:

How to Lower Your Set Point Without Food Noise Sabotaging You

Listener Rain asked about dealing with chocolate cravings after losing just five pounds. The team shared practical tips:

• Balanced Meals: Avoid skipping meals and eat nutrient-dense foods like vegetables, lean proteins, and fiber.
• Curb Sugar Cravings: Plan indulgences and make healthy swaps, such as Greek yogurt with cocoa powder and banana.
• When to Consider Medications: GLP-1 medications like Wegovy or Zepbound may help reduce food noise for sustained weight loss.

Considering Gastric Bypass Revision Surgery

Priscilla asked about revising her sleeve gastrectomy to address severe reflux and weight regain. Dr. Weiner outlined key points:

• Improved Safety: Advances in surgical techniques make bypass surgery much safer today.
• Risks: Be mindful of dumping syndrome, ulcers, and iron deficiency, which require diligent management.
• Benefits: Revision can alleviate reflux and improve long-term health outcomes. Mindful eating is essential for post-revision success.

What is Dumping Syndrome?

Dr. Weiner explained that dumping syndrome, common after bypass surgery, occurs when sugary or fatty foods enter the small intestine too quickly. To manage it:

• Prioritize lean proteins and vegetables.
• Avoid large meals and overly processed foods.
• Practice mindful eating to control portions and prevent discomfort.

Should You Avoid Drinking After Eating?

A listener wondered whether post-op patients must separate eating and drinking. Dr. Weiner dispelled the myth:

• No Universal Rule: The stomach pouch empties quickly, and drinking doesn’t affect fullness.
• Listen to Your Body: Some may feel bloated when drinking with meals, so adjust based on personal comfort.

Pregnancy After Weight Loss Surgery

Amanda sought advice on preparing for pregnancy post-surgery. Key recommendations included:

• Vitamin Adjustments: Switch to prenatal vitamins to ensure proper iron and folate levels while avoiding vitamin A toxicity.
• Mindful Nutrition: Focus on protein-rich, well-balanced meals while avoiding excessive weight gain.
• Manage Risks: Pregnancy slightly increases the chance of bowel obstruction, but with a proactive care team, this can be managed effectively.

Key Takeaways

This episode provides actionable advice for navigating challenges like dumping syndrome, food noise, and post-op pregnancy:

• Manage food noise with balanced meals, planned indulgences, or GLP-1 medications if necessary.
• Gastric bypass revision surgery can resolve reflux but requires careful post-op management.
• Dumping syndrome is manageable with mindful dietary adjustments.
• Pregnancy after surgery is safe and healthier with proper preparation and care.

Join the Conversation

Submit your questions for future episodes and let Dr. Weiner and Zoe guide you with science-backed strategies for success after weight loss surgery.

In this heartfelt episode of the Pound of Cure Weight Loss podcast, Dr. Matthew Weiner and Zoë explore Raquel’s inspiring story of transformation. Raquel shares her experience undergoing gastric sleeve surgery, navigating emotional and spiritual healing, and embracing her cultural roots, including the meaningful gifting of an Ojo de Venado. Her journey exemplifies resilience, recovery, and the powerful connection between medicine and spirituality.

Gastric Sleeve Surgery: A Key to Recovery

Raquel’s path to healing began with her decision to pursue gastric sleeve surgery, a life-changing step to address obesity, chronic pain, and limited mobility. Weighing over 387 pounds and coping with trauma from the tragic loss of her husband and struggles with addiction, she found hope through Dr. Weiner’s guidance. The surgery not only enabled her to lose weight but also paved the way for essential double knee replacement surgeries, significantly improving her quality of life.

Ojo de Venado: A Spiritual Connection

A standout moment in this episode is the gifting of an Ojo de Venado by Raquel to Dr. Weiner. This sacred Yaqui symbol of protection and blessing was offered to Dr. Weiner on the day of her surgery as a gesture of gratitude and trust. For Dr. Weiner, wearing the Ojo de Venado became a source of grounding and strength during challenging times, embodying the interconnectedness of patient and caregiver.

Recovering from Trauma: Finding Strength Through Healing

Raquel’s life is a testament to overcoming adversity. After the loss of her husband, addiction, and the temporary loss of her children, she found recovery through a Native American program. Her determination to heal extended beyond physical transformation, as she regained custody of her children, pursued a meaningful career, and embraced her cultural identity. “Healing from trauma isn’t just about the events—it’s about finding strength and purpose in their aftermath,” she reflects.

Spirituality in Medicine: Honoring Cultural Practices

This episode highlights the profound role of spirituality in healing. Raquel shares how practices like sage cleansing and the Ojo de Venado provided comfort and focus during her journey. Dr. Weiner emphasizes the importance of recognizing and incorporating diverse cultural practices in healthcare, fostering a deeper bond between patient and caregiver.

Life After Gastric Sleeve Surgery: A New Chapter

Now nearly two years post-op, Raquel has lost over 150 pounds, achieved mobility through knee surgeries, and embraced a healthy lifestyle. Beyond her personal success, she dedicates her life to helping others as a domestic violence facilitator, embodying her philosophy: “We go through these things, we fight, we heal, and then we teach.”

Conclusion: Resilience and Renewal

Raquel’s story, shaped by gastric sleeve surgery, cultural traditions like the Ojo de Venado, and recovery from trauma, inspires hope for those on similar paths. This episode serves as a reminder of the strength found in resilience, community, and embracing holistic approaches to healing.

In Episode 55 of the Pound of Cure Weight Loss podcast, Dr. Matthew Weiner explores the complex causes of obesity and shares innovative strategies for achieving lasting weight loss. Drawing from decades of experience as a bariatric surgeon and his deep understanding of physiology, Dr. Weiner delivers actionable insights into weight loss surgery, GLP-1 medications, and the power of healthy food.

Understanding the Root Cause of Obesity

Obesity is not just about overeating or inactivity—it’s deeply tied to our evolutionary biology. While our ancestors thrived with fat-storing mechanisms, modern diets rich in processed foods have disrupted this balance. These diets push our body’s metabolic thermostat to a higher "setpoint," making weight loss increasingly difficult.

The Metabolic Thermostat: A Key to Weight Regulation

Your metabolic thermostat regulates body weight, hunger, and metabolic rate. It aims to maintain a specific "setpoint," making it hard to lose weight with calorie restriction. Efforts to lower calorie intake often backfire as the body slows its metabolism and increases food noise (cravings and hunger).

Why Does the Setpoint Increase?

• Processed Foods: Disrupt hormonal signals and promote fat storage.
• Weight-Gaining Medications: Certain drugs, such as insulin and antidepressants, elevate the setpoint.
• Hormonal Shifts: Pregnancy, menopause, and chronic stress all contribute to weight gain.

Four Proven Ways to Lower Your Setpoint

Dr. Weiner outlines four key strategies for achieving sustainable weight loss:

1. Focus on Healthy Food

Adopting a diet rich in fruits, vegetables, nuts, seeds, beans, and lean protein is more effective than calorie counting. These whole foods support long-term metabolic health and help reset the body’s physiology.

2. Build Muscle

Strength training helps alter fat storage mechanisms and improves overall metabolic health. While not as powerful as other methods, maintaining muscle mass can complement other weight-loss efforts.

3. Leverage GLP-1 Medications

Medications like Wegovy and Zepbound mimic hunger-regulating hormones to reduce food noise and lower the setpoint. These drugs are highly effective when used long-term, achieving up to 25% total body weight loss in some cases.

4. Weight Loss Surgery

Bariatric procedures such as gastric bypass or sleeve gastrectomy lead to hormonal changes that lower the setpoint. When paired with GLP-1 medications, surgery can result in transformative weight loss of up to 50% of total body weight.

The Importance of Combining Treatments

Dr. Weiner emphasizes the power of integrating healthy eating, GLP-1 medications, and weight loss surgery. This approach customizes weight-loss strategies to individual needs, enhances results, and provides durable, long-term weight control.

Support and Community: Keys to Success

Dr. Weiner highlights the value of support networks and peer-led groups. These resources, paired with professional nutritional guidance, help patients stay motivated and achieve their weight loss goals.

Takeaways:
Obesity is a complex condition that requires a multifaceted treatment plan. Combining weight loss surgery, GLP-1 medications, and healthy food provides the best path to success.

For more resources, visit Pound of Cure Weight Loss to join support groups and access expert insights.

In Episode 54 of the Pound of Cure Weight Loss Podcast, Dr. Matthew Weiner and Zoë Schroeder sit down with Dr. Ethan Larson, a plastic surgeon specializing in lipedema care. Together, they delve into the complexities of lipedema, available treatment options, and the transformative role of plastic surgery for lipedema.

What is Lipedema?

Dr. Larson explains that lipedema is a chronic condition that primarily affects women. It manifests as an abnormal accumulation of fat in the legs, arms, and sometimes the abdomen, often triggered by hormonal shifts like puberty or menopause. Unlike normal fat, lipedema fat does not respond to diet or exercise, leaving patients frustrated.

Key Facts About Lipedema:

• Resistant to metabolic breakdown.
• Often accompanied by pain and swelling.
• Can coexist with obesity, which is treatable.

Lipedema Treatment Options

While diet and exercise support overall health, they do little to address lipedema fat. Dr. Larson highlights lymphatic-sparing liposuction as the most effective treatment, designed to:

• Remove abnormal fat while preserving the lymphatic system.
• Improve functionality and reduce pain.
• Enhance cosmetic appearance as a secondary benefit.

The Role of Plastic Surgery for Lipedema

Plastic surgery for lipedema is more than cosmetic; it’s a functional solution that addresses discomfort and mobility challenges. Dr. Larson answers common questions about the procedure:

• Does the fat return? Not in treated areas, but untreated regions may develop new fat pads.
• How much fat can be removed? Up to 8–10 liters per session, depending on individual needs.
• What about risks? Safety measures ensure optimal outcomes while minimizing complications.

Comprehensive Lipedema Care

Effective lipedema treatment often requires a multidisciplinary approach:

• Dietary Adjustments: Anti-inflammatory diets can help manage secondary symptoms.
• Surgical Interventions: Lymphatic-sparing liposuction is the cornerstone of treatment.
• Patient Advocacy: Self-education and persistence are key to navigating insurance challenges.

Addressing Barriers in Lipedema Treatment

Dr. Larson discusses systemic challenges, including:

• Limited awareness among healthcare providers.
• Lack of insurance coverage due to insufficient diagnostic and procedural codes.
• High out-of-pocket costs, with surgeries starting at $12,000 per session.

He stresses the importance of awareness and advocacy to improve access to care.

When to Consider Plastic Surgery for Lipedema

Dr. Larson advises patients to stabilize their weight for at least three months before surgery. For those using GLP-1 medications like Wegovy or Mounjaro, he recommends completing weight loss before planning surgery to ensure long-term success.

Lipedema Support and Resources

Organizations like the Lipedema Foundation are vital for raising awareness and advocating for systemic change. Dr. Larson encourages patients to utilize resources like Lipedema.org to connect with knowledgeable specialists and support networks.

Final Advice for Lipedema Patients

Dr. Larson’s key recommendations:

1. Get Diagnosed: Work with a specialist to confirm your condition.

2. Set Priorities: Identify treatment goals to guide your care plan.

3. Plan Ahead: Ensure long-term weight stability and realistic expectations.

Connect with the Experts

Visit www.larsonplasticsurgery.com or www.poundofcureweightloss.com to learn more

In Episode 53 of the Pound of Cure Weight Loss Podcast, Dr. Weiner and Zoe dive into meaningful topics, from celebrating non-scale victories to understanding the limits of BMI and exposing the troubling influence of pharmacy benefit managers (PBMs) on healthcare costs. This engaging episode not only informs listeners about these issues but also empowers them to advocate for a better, patient-centered healthcare system.

Celebrating Non-Scale Victories on Your Weight Loss Journey

Weight loss is about more than numbers on the scale, and non-scale victories (NSVs) are a powerful reminder of the progress often missed. Dr. Weiner and Zoe discuss these achievements, which include everything from improvements in flexibility to walking up stairs without fatigue. Zoe suggests keeping a running list of NSVs to stay motivated, especially during weight loss stalls. This practice can give you a balanced perspective on success, showing that even small victories matter. Tracking NSVs is a great way to remember that you’re moving forward, even when the scale doesn’t reflect it​​.

The Limits of BMI as a Health Measure

The Body Mass Index (BMI) has been widely used to assess health, but it’s far from perfect. Dr. Weiner and Zoe critique the BMI’s shortcomings, explaining how this 200-year-old formula, which simply compares weight to height, fails to account for muscle mass, body composition, and other essential factors. Dr. Weiner points out that BMI often mislabels individuals, especially those with high muscle mass, as “overweight.” They discuss alternatives, like the Body Roundness Index (BRI), that consider waist and hip measurements, offering a more nuanced health picture. Dr. Weiner underscores the importance of moving beyond BMI and adopting more accurate, holistic measures​​.

Pharmacy Benefit Managers: Putting Profits Over Patients

In their discussion on pharmacy benefit managers (PBMs), Dr. Weiner and Zoe reveal how these intermediaries have shifted from helping lower drug prices to prioritizing profits. PBMs now control nearly 80% of pharmacy claims, often inflating prices to serve their bottom line. For example, PBMs have been known to hike up the cost of drugs like Zytiga from a wholesale price of $229 to as high as $6,000, placing a heavy burden on patients and taxpayers. Dr. Weiner argues that PBMs’ monopolistic practices highlight the urgent need for more transparency and regulation in healthcare. By better understanding the role PBMs play, patients can advocate for policies to lower drug costs and improve access to care​​​.

How to Advocate for a Patient-Centered Healthcare System

In the final segment, Dr. Weiner and Zoe encourage listeners to take an active role in changing healthcare. They urge you to research healthcare legislation, support representatives pushing for lower drug prices, and vote for candidates focused on putting patients over profits. Advocacy, they emphasize, is essential for reforming healthcare to make it more accessible and affordable for everyone​​.

Episode Takeaways

This episode tackles the critical issues of weight loss success, BMI’s limitations, and the role of PBMs, leaving listeners with actionable steps to navigate the healthcare system and celebrate their own achievements. Episode 53 of the Pound of Cure Weight Loss Podcast is a must-listen for those interested in health reform, practical weight loss advice, and a more compassionate approach to healthcare.

In Episode 52 of the Pound of Cure Weight Loss Podcast, we delve into Vanessa Ruiz’s (@myvanety) personal and transformative journey with sleeve gastrectomy, her experiences with body dysmorphia, and her decision to include compounded semaglutide in her weight management plan. Her story provides insight into the challenges many face with obesity treatment and the importance of the “Choose Your Hard” mindset.

Vanessa’s Journey to Sleeve Gastrectomy

Vanessa grew up struggling with weight, influenced by family dynamics and cultural pressures around food. In her 20s, life changes, depression, and a PCOS diagnosis caused further weight gain, prompting her to pursue a sleeve gastrectomy in Mexico. Despite undergoing the surgery during the pandemic and navigating limited post-op care, she took her recovery into her own hands by researching and preparing herself, leading to successful early results.

The Role of Compounded Semaglutide in Long-Term Success

Three years post-op, Vanessa began to experience weight regain—a common hurdle for many sleeve gastrectomy patients. Compounded semaglutide, a variation of GLP-1 medication, became essential in helping her control food noise and support her appetite regulation, enhancing the long-term success of her sleeve gastrectomy. This medication, while not a replacement for lifestyle changes, provided Vanessa with the support to maintain her achievements, highlighting its importance in post-surgical weight management.

Navigating Body Dysmorphia After Weight Loss

A surprising challenge for Vanessa was body dysmorphia, a disconnect between her physical transformation and her self-perception. Despite her progress, Vanessa struggled to see herself as others did, facing persistent negative perceptions about her appearance. Therapy and mindfulness practices proved valuable in helping her manage these emotional hurdles, emphasizing the importance of psychological preparation for those undergoing significant weight loss.

Advice from Vanessa: “Choose Your Hard”

Vanessa’s motto, “Choose Your Hard,” speaks to the importance of making difficult but rewarding choices. She shares how the challenges of surgery, weight regain, and mental health management all contribute to a healthier life—a difficult but preferable alternative to the hardships of obesity. Her message encourages listeners to face the tough journey with resilience, as the outcome is worth the struggle.

Building Community and Support

Vanessa’s story also highlights the critical role of community support. By connecting with others facing similar experiences, she found encouragement to push through both the successes and setbacks.

Final Thoughts: Empowering Yourself for Sustainable Health

Vanessa’s journey offers a realistic look at the emotional and physical dedication needed to achieve weight loss success after a sleeve gastrectomy. For those managing body dysmorphia, considering GLP-1 medications like compounded semaglutide, or simply seeking encouragement, her story is a testament to the power of determination and the strength that comes from “Choosing Your Hard.”

In Episode 51 of the Pound of Cure Weight Loss Podcast, Dr. Matthew Weiner and dietitian Zoe Schroeder tackle listener questions on NAION vision, mocktail ideas, limited weight loss after a sleeve gastrectomy, and managing the “murky middle” phase after surgery. Here’s a quick recap of the insightful advice and tips offered in this Q&A episode.

Understanding NAION Vision Risks with GLP-1 Medications

The episode kicks off with a question about the connection between GLP-1 medications (like Ozempic and Wegovy) and NAION vision, a rare eye condition that can cause sudden vision loss. Dr. Weiner explains that NAION is often linked to low blood pressure, a risk that can increase with weight loss. He advises patients on GLP-1 medications to monitor for symptoms like dizziness upon standing, as these may indicate hypotension and increased NAION risk. Adjusting blood pressure medications may be necessary as weight drops.

Key Takeaway: If you’re taking GLP-1 medications and blood pressure medicine, monitor your blood pressure closely. Weight loss may require medication adjustments to lower the risk of hypotension and NAION.

Mocktails: A Fun, Alcohol-Free Way to Celebrate After Surgery

The next question dives into mocktails, a perfect option for those who want to celebrate without alcohol after gastric bypass surgery. Zoe shares ideas for tasty, sugar-free mocktails, like mixing sparkling water with hibiscus tea and adding frozen watermelon cubes for flavor. She also encourages listeners to use fancy glasses and creative garnishes to make the drink feel special.

Mocktail Idea: Hibiscus tea with sparkling water and frozen watermelon cubes makes a refreshing, celebratory drink that’s low in sugar and calories.

Key Takeaway: Mocktails can help you enjoy social occasions without alcohol. Use sugar-free ingredients and fun presentation to keep them bariatric-friendly and festive.

Limited Weight Loss After A Sleeve Gastrectomy

A listener who had a sleeve gastrectomy but lost less weight than expected wonders why their experience differs from others. Dr. Weiner explains that weight loss results vary widely, with some patients experiencing more dramatic changes than others. He emphasizes the importance of combining surgery with lifestyle changes and, if necessary, GLP-1 medications to amplify weight loss.

Key Takeaway: Every weight loss journey is unique, and surgery alone may not guarantee specific results. Combining surgery with lifestyle changes and, if needed, GLP-1 medications can enhance weight loss success.

Navigating the Murky Middle Phase of Weight Loss After Surgery

The episode concludes with advice on navigating the “murky middle” phase around six months after surgery. This stage involves adjusting to a slower weight loss rate and a returning appetite. Zoe suggests shifting from a protein-focused diet to one rich in vegetables, fruits, and nutrient-dense foods to avoid the “portion control trap,” where patients eat small portions of high-calorie foods, risking long-term regain.

Key Takeaway: Use the murky middle to build healthy habits with nutrient-dense foods, setting up a foundation for sustainable weight loss and maintenance.

Conclusion: Small Changes for Long-Term Success

In Episode 51, Dr. Weiner and Zoe underscore that bariatric surgery and GLP-1 medications are tools, not quick fixes. By making mindful adjustments and focusing on healthy eating, patients can set themselves up for long-term success.

This episode of the Pound of Cure Weight Loss podcast follows Denise’s inspiring journey through bariatric surgery, bodybuilding, and discovering the transformative power of muscle and strength. Joined by Dr. Weiner and Zoe, Denise shares how she’s redefined her goals and found lasting wellness, showing that post-surgery life is about much more than just weight loss—it’s about building resilience and confidence.

A Fresh Start with Bariatric Surgery

Denise’s journey began in 2018, six years ago, when she moved to North Carolina and sought bariatric surgery to improve her health. She invested time in therapy beforehand to address anxiety and its impact on her relationship with food, which helped her approach surgery with full commitment. Within a year, she lost 110 pounds and transformed her mindset about food and body image.

Shifting Focus: From Weight Loss to Building Muscle and Strength

As Denise reached her lowest weight, she realized her new goal was not just to stay lean but to build a strong, muscular physique that reflected her resilience. She shifted from focusing on the scale to prioritizing muscle growth, redefining her goals based on body composition and the satisfaction of seeing her body change. By accepting a slight increase on the scale as a sign of muscle gain, Denise embraced her evolving body and set the foundation for a balanced, sustainable fitness journey.

Creating a Consistent Bodybuilding Routine for Success

Supported by her husband, a personal trainer, Denise started with three full-body workouts per week and a daily walking goal of 10,000 steps. This gradual start allowed her to build confidence, focusing on proper form and avoiding injury. As she progressed, Denise increased her workout frequency and noticed significant changes in her muscle tone and strength, finding new motivation as her goals evolved.

Nutrition for Muscle and Strength After Bariatric Surgery

Achieving muscle and strength after bariatric surgery required a new approach to nutrition. Denise learned to incorporate carbs strategically, pairing them with protein and healthy fats to fuel her workouts. Tracking her food intake helped her develop a balanced relationship with food and allowed her to fuel her body for optimal strength gains.

Long-Term Goals: Muscle and Strength for Healthy Aging

Now nearly 50, Denise continues to set and achieve fitness goals with the long-term view of staying healthy as she ages. She trains four days a week, with muscle-building as her strategy for healthy aging. Dr. Weiner calls muscle “the fountain of youth,” noting how Denise’s commitment to strength training will help her maintain her health and vitality for years to come.

Denise’s journey is a powerful reminder that bariatric surgery can be a gateway to lasting health and strength. Her experience shows that muscle-building and mindfulness can help post-surgery patients thrive, offering them a foundation for confidence, resilience, and a strong future.