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.

In Episode 49 of the Pound of Cure Weight Loss Podcast, Dr. Weiner and Zoe examine the steep costs of obesity medications like Wegovy, the influence of pharmacy benefit managers (PBMs), and the role of big pharmaceutical companies in shaping healthcare. Highlighting recent Senate hearings led by Bernie Sanders with Novo Nordisk’s CEO Lars Fruergaard Jørgensen, this episode sheds light on how the current system prioritizes profit, often at the expense of patients’ access to care.

Wegovy Cost: Breaking Down High Prices in the U.S.

Wegovy, a GLP-1 medication, costs around $1,349 per month in the U.S., while in other countries like the U.K., prices are as low as $92. Dr. Weiner explains that this discrepancy illustrates a broken healthcare model, where the U.S. market fuels corporate profit but leaves millions unable to afford essential treatments. With 72% of Novo Nordisk’s revenue coming from U.S. sales, the company’s pricing strategy relies on American consumers, who are left paying significantly more for the same medications.

Big Pharma’s Influence on Policy and Profits

This episode delves into Big Pharma’s control over drug pricing, particularly the stark contrast between their research and development costs and their profits. For example, while Novo Nordisk spent $21 billion on R&D, they spent twice as much—$44 billion—on stock buybacks and dividends. Dr. Weiner highlights how political influence plays a crucial role, with both major parties receiving substantial donations from pharmaceutical companies, leading to stalled efforts in drug price regulation and patient access.

Pharmacy Benefit Managers (PBMs): Hidden Gatekeepers Driving Up Costs

PBMs, the intermediaries between insurers and pharmacies, are supposed to negotiate better prices, but Dr. Weiner and Zoe point out that they often drive costs higher through hidden fees. In many cases, PBMs have financial incentives to push higher-priced drugs, creating a “pay-to-play” system that limits patient access. For example, PBMs profit by taking a percentage of negotiated drug price savings, meaning higher drug list prices generate greater profits for them. Dr. Weiner underscores how PBMs complicate and inflate pricing, making it even harder for patients to get GLP-1 medications through insurance.

Do We Need Health Insurance Companies and PBMs?

Dr. Weiner questions the necessity of insurance companies and PBMs in the healthcare system, arguing that they don’t provide direct patient care yet extract billions from the system. He suggests that healthcare can function without these financial middlemen, allowing for a more transparent, patient-centered system where costs are lower and patients have better access to needed treatments.

The Morality of Obesity Treatment Costs

The episode closes with Dr. Weiner and Zoe discussing the stigma surrounding obesity and the moral implications of restricting access to life-changing medications like Wegovy. They emphasize that obesity is a complex, chronic disease requiring comprehensive treatment, not simply a “lifestyle” issue. Dr. Weiner advocates for recognizing obesity treatment as essential, which could lead to a shift in how these medications are accessed and covered.

Final Takeaways

While the healthcare landscape remains challenging, Dr. Weiner believes patient advocacy, legislative changes, and innovation can improve access to these life-saving treatments. This episode offers insights into navigating the current system while emphasizing the need for systemic change to prioritize patient health over profits.

In Episode 48 of the Pound of Cure Weight Loss podcast, Dr. Matthew Weiner and Zoe Schroeder explore the future of compounded GLP-1 medications, the dangers of the health halo effect, and debunk common diet myths that often lead to confusion for those trying to lose weight.

Compounded GLP-1 Medications: A Controversial Solution on the Brink of Extinction

Dr. Weiner and Zoe kick off the discussion by addressing the fate of compounded GLP-1 medications. Medications like Zepbound and Wegovy, FDA-approved for obesity, have faced shortages, leading to the rise of compounded alternatives. These non-FDA-regulated versions, sourced from China and mixed in US compounding pharmacies, have been a lifeline for patients who can't access the brand-name medications.

However, Dr. Weiner highlights that these compounded versions may soon become unavailable due to regulatory changes. Compounded GLP-1 medications can only be produced during shortages of the original drugs and with supply stabilizing, their production may soon be banned. Patients currently relying on compounded alternatives will need to explore other options, such as the Pound of Cure Weight Loss Platinum Program.

Diet Myths: Dispelling Common Misconceptions

Dr. Weiner and Zoe also tackle pervasive diet myths, particularly the belief that weight loss is simply a matter of calorie counting. This outdated “calories in, calories out” philosophy ignores the body’s hormonal responses to food. They explain that hormones like GLP-1, ghrelin and leptin play crucial roles in regulating hunger and metabolism, which is why focusing purely on calorie restriction often leads to failure.

Another myth they address is the idea that fat is the enemy. While processed and animal fats should be avoided, healthy fats from sources like avocados, nuts, and seeds are vital for long-term weight management. Additionally, Zoe clarifies that not all carbs are bad — distinguishing between refined carbs and whole-food sources like vegetables and legumes is key for sustained energy and weight loss.

The Health Halo Effect: How Marketing Tricks Consumers

The health halo effect is another topic of discussion, focusing on how food marketing can deceive consumers into making poor health choices. Labels such as “organic,” “vegan,” “low-carb” or “gluten-free” often create the illusion of health, even when the products are filled with sugar or unhealthy ingredients.

Dr. Weiner and Zoe stress the importance of avoiding these traps by focusing on real, unprocessed foods like vegetables, lean proteins, fruits, nuts, beans and seeds. This approach helps ensure that you’re making choices that genuinely support your health and weight loss efforts, rather than falling for misleading marketing.

Conclusion

In this episode, Dr. Weiner and Zoe offer valuable insights into the future of compounded GLP-1 medications, clarify persistent diet myths, and explain how the health halo effect misleads consumers. As the regulatory landscape changes and food marketing continues to evolve, staying informed and focusing on a balanced, whole-food diet is crucial to achieving long-term success in your weight loss journey.

In Episode 47 of the Pound of Cure Weight Loss Podcast, Dr. Matthew Weiner and Zoe Schroeder, RD dive into weight loss topics like compounded GLP-1 medications, ultra-processed foods and their link to heart disease, and processed meat alternatives.

Ultra-processed Foods: Are Some Worse Than Others?

A recent study published in The Lancet found that ultra-processed foods make up a shocking 73% of the U.S. food supply, with significant consequences for heart health.

Dr. Weiner and Zoe discuss how this study highlighted an 11% increased risk of heart disease for those who consumed the most ultra-processed foods. The study particularly focused on the worst offenders: processed meats and sugar-sweetened beverages. These foods were shown to have the strongest links to heart disease.

One fascinating finding from the study is that not all ultra-processed foods have the same impact. When processed meats and sugary drinks are removed from the equation, the difference in heart disease risk between people who eat a lot of ultra-processed foods and those who don’t becomes much smaller. This reinforces the idea that not all ultra-processed foods are equal when it comes to heart disease risk. Avoiding processed meats and sugary drinks can significantly lower your risk, while focusing on healthier food choices can improve your long-term health.

Nutrition and Heart Health: How to Eat Smarter

When it comes to improving heart health, Dr. Weiner and Zoe offer practical advice on what foods to choose instead of processed meats. Zoe emphasizes the importance of focusing on whole, unprocessed foods, such as:

• Fruits and vegetables: These are packed with vitamins, minerals, and antioxidants that help support heart health.
• Lean animal proteins: Opt for fish, chicken, and lean cuts of red meat as alternatives to fatty cuts of red meat and processed meats. These options provide high-quality protein without the unhealthy fats found in processed meats.
• Nuts and seeds: Rich in healthy fats, fiber, and protein, these are great plant-based alternatives to meat.
• Legumes: Beans, lentils, and chickpeas are nutrient-dense and provide a satisfying source of protein and fiber.

The key is to focus on nutrient-dense, whole foods rather than simply trying to restrict calories or follow fad diets. The Pound of Cure philosophy encourages a shift in mindset toward eating for nutrition and long-term health and weight loss rather than fast weight loss which will, ultimately, come back.

Zoe also mentions the importance of minimizing food noise—the constant mental distraction and cravings for unhealthy foods—by incorporating satisfying, high-quality meals into your daily routine. By making smarter food choices, you can naturally reduce your cravings for processed foods and improve both your heart health and overall well-being.

Replacing processed meats with nutrient-dense foods like fruits, vegetables, lean proteins, nuts, seeds, and legumes is a smart strategy for improving heart health and managing weight.

The Role of GLP-1 Medications in Weight Loss

The episode concludes with an in-depth discussion on the role of GLP-1 medications in weight loss, particularly focusing on the recent shortages and their implications. These medications, like Wegovy and Zepbound, have been highly sought after due to their ability to lower the body’s set point. However, earlier shortages led many patients to seek compounded versions of these drugs.

Dr. Weiner explains that compounded GLP-1 medications are custom-made by compounding pharmacies, which mix the active ingredients (Semaglutide or Tirzepatide) with saline, B12 or other additives.

Release the GLP-1 Vials

The shortage of GLP-1 medications, like Wegovy and Zepbound, was primarily caused by the manufacturing of inj