Episode 1: Ways to Lose Weight - We Talk ALL

Are you ready to revolutionize your approach to weight loss? Join Maria and Tammie for an informative exploration where they reveal the truth about weight management and debunk the myths surrounding it. They share their professional and personal insight into the role of bariatric surgery, dispelling common fears and misconceptions. They emphasize that surgery isn't a quick fix, instead, it's a potent tool that aids in long-term weight loss and boosts overall health.

Maria and Tammie present a detailed discussion on GLP-1 analogs that not only regulate blood sugar but also curb your appetite, making weight management a less daunting task. They also shed light on other medications and their effects, emphasizing the importance of understanding these treatments to find the one that suits you best.

From exercise routines to the options of diet, medications, and surgery, they present a holistic picture of weight management options. Maria encourages you to explore and find a balance that works best for your individual needs. Maria and Tammie round off the discussion by highlighting the importance of long-term maintenance and addressing the mental aspects of weight management. Let's embark on this weight loss journey, equipped with the right knowledge and tools, and remember, your victories extend beyond the scale. Tune in and let's transform your weight loss journey together.

Citations:

1. Benaiges D, Goday A, Pedro-Botet J, Más A, Chillarón JJ, Flores-Le Roux JA. Bariatric surgery: to whom and when? Minerva Endocrinol. 2015 Jun;40(2):119-28. Epub 2015 Feb 10. PMID: 25665592.

2. Christoffersen BØ, Sanchez-Delgado G, John LM, Ryan DH, Raun K, Ravussin E. Beyond appetite regulation: Targeting energy expenditure, fat oxidation, and lean mass preservation for sustainable weight loss. Obesity (Silver Spring). 2022 Apr;30(4):841-857. doi: 10.1002/oby.23374. PMID: 35333444; PMCID: PMC9310705.

3. Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, de Luca M, Faria SL, Goodpaster KPS, Haddad A, Himpens JM, Kow L, Kurian M, Loi K, Mahawar K, Nimeri A, O'Kane M, Papasavas PK, Ponce J, Pratt JSA, Rogers AM, Steele KE, Suter M, Kothari SN. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Obes Surg. 2023 Jan;33(1):3-14. doi: 10.1007/s11695-022-06332-1. Erratum in: Obes Surg. 2022 Nov 29;: PMID: 36336720; PMCID: PMC9834364.

4. Freedhoff, Y. (2014). No, 95 percent of people don't fail their diets. Retrieved from https://health.usnews.com/health-news/blogs/eat-run/2014/11/17/no-95-percent-of-people-dont-fail-their-diets

5. Fuentes Artiles R, Staub K, Aldakak L, Eppenberger P, Rühli F, Bender N. Mindful eating and common diet programs lower body weight similarly: Systematic review and meta-analysis. Obes Rev. 2019 Nov;20(11):1619-1627. doi: 10.1111/obr.12918. Epub 2019 Aug 1. PMID: 31368631.

6. MacEwan JP, Chiu K, Ahmad NN, Sacks N, Shinde S, Poon JL, Kan H. Clinical, economic, and health-related quality of life outcomes in patients with overweight or obesity in the United States: 2016-2018. Obes Sci Pract. 2023 Dec 13;10(1):e726. doi: 10.1002/osp4.726. PMID: 38263999; PMCID: PMC10804324.

7. Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J. Medicare's search for effective obesity treatments: diets are not the answer. Am Psychol. 2007 Apr;62(3):220-33. doi: 10.1037/0003-066X.62.3.220. PMID: 17469900.

8. Martínez-Gómez MG, Roberts BM. Metabolic Adaptations to Weight Loss: A Brief Review. J Strength Cond Res. 2022 Oct 1;36(10):2970-2981. doi: 10.1519/JSC.000000

Transcript

Tammie Lakose: 0:00

Welcome to Core Bariatrics podcast, hosted by bariatric surgeon Dr Maria Iliakova and Tammi e Lakose, bariatric coordinator and a patient herself. Our goal is building and elevating our community. The Core Bariatric podcast does not offer medical advice, diagnosis or treatment. On this podcast, we aim to share stories, support and insight into the world beyond the clinic. Let's get into it. All right, Maria, the sun is finally shining. It's been how many days of cloudiness.

Maria Iliakova: 0:33

Oh goodness, Our patients have been cranky.

Tammie Lakose: 0:35

Our patients have been cranky, I know.

Maria Iliakova: 0:37

I've been cranky, sorry Me too. Me too, don't worry. Don't worry, sad has already started, and it's only. Yeah, we're not even into winter yet. So, this is. This is how it is.

Tammie Lakose: 0:47

Sometimes the sun is shining, it's a good day, so today we are going to dig into all of the options, whether it be surgical, whether it be non-surgical, whether it just be diet and exercise. But we're going to talk about, like the success rates, if the limitations, expectations, how people or if they gain weight afterwards. Right Right, Because that is huge.

Maria Iliakova: 1:11

That's a big one. You know, when we're talking about weight loss strategies, I almost think of it in terms of you had a really good point recently of like how do we end, how do we, what's the goal, what's the end game here? I think that's a really good way to think of it, because you can lose weight a million different ways, but are you losing weight just to lose weight for now, or are you losing weight to lose weight for a lifetime? Because maintaining weight loss is really the name of the game and that's the hard part.

Tammie Lakose: 1:39

That's the hardest part. I feel like we always need to have a goal, yeah, exactly, whether it even not be weight loss.

Maria Iliakova: 1:46

That's such a good point, because weight, you know, I kind of think of weight as the gateway drug in a lot of ways, like that's the way that we hook people to start a conversation about health and goals and all those things, and weight it's a number so people can kind of wrap their minds around it. Insurance companies can wrap their minds around it, all that stuff. I know it's kind of a pain, but weight is really just the beginning of a conversation. Yes, right, the very first question out of my mouth when I meet someone in a visit is what are your goals? What would you like to accomplish? Because when we're talking about weight, we're really talking about all of these other things that people want to be able to do in their lives.

Tammie Lakose: 2:20

Yes, and that's where I have wanted to highlight things with our program is sure, I want to know what your weight is like, what your starting weight is, what your end weight is, but I really try not to bring up weight at all, because weight, you know, it is the big picture, but I want to know the other things, the non-scale victories. These are the things we need to be really looking at and so, again, that'll probably be another episode of, just like you know, really talking about just not focusing, just on weight, Right?

Maria Iliakova: 2:54

Yeah Well, and so you know to kind of beat a dead horse a tiny bit, but we're actually going to focus on weight today and how we accomplish weight loss and weight loss maintenance, so like how you accomplish that for a long time. But again, I want to emphasize that while we're talking about weight, we're really talking about the big picture of how you live a healthier life, how you live the life you want to and how you're able to use your body the way that you were to do that. So, we're going to touch on, just like Tammie said, diet and exercise, medications, surgery and kind of beyond, because a lot of times these things are not one or the other, it's combinations. It's combinations what we want to accomplish. So let me just talk about real quick surgery. I think surgery is the elephant in the ring a lot of times and I am a surgeon, so you know I am biased. Obviously, I wouldn't have become a very anti-ex surgeon if I didn't believe in it very, very strongly. But here's why it works and what does it work for? Well, that's a really good question. And it works to help people lose weight and keep weight off.

Tammie Lakose: 4:00

Keep it off. That is your main factor there.

Maria Iliakova: 4:02

Exactly.

Tammie Lakose: 4:03

That's something I need to wrap my head around, exactly Like for me. Losing weight was difficult at times, but I mean I could drop 30 pounds in a month, but it's keeping it off.

Maria Iliakova: 4:16

Exactly, yeah, exactly. And that's not to say that you can't regain weight after bariatric surgery. In fact, we now have data that shows like one in three patients almost regain weight after surgery. So that's definitely possible and we'll talk about that in another episode for sure, but it's the most likely way that you're actually going to be able to come off of medications for things like diabetes and high blood pressure. It's the most likely way that we're going to be able to treat joint pain for people who have arthritis and other joint issues, and it's the most likely way to get to your goals and stay there whether they're weight or whether they're lifestyle or whether they're both. So surgery really should be considered more like sooner than you think, and it should be considered even if you're also working on diet, exercise and even medications yeah, it's surprising.

Tammie Lakose: 5:08

So patients come in here thinking that surgery is the key. Right, I don't have to do anything. Right, you're going to do, you're going to reroute things or cut things out, and I don't have to do anything.

Maria Iliakova: 5:21

So, Tammie, tell me, has it been a journey where you had to do nothing for you?

Tammie Lakose: 5:23

I wish Right, right. No, you still got to do all the things. You still got to focus on what you're eating and moving your body. Exactly. The tool just makes it a little, a little easier. Exactly.

Maria Iliakova: 5:41

And so bariatric surgery, I think a lot of people think a number of things about. They think it's the easy way out, they think it's a shortcut, they are scared of it because it is surgical and it's going to change your lifestyle. There's so many different viewpoints and it goes. It's so funny because this is one of the things in our lives where people hate it for all of the reasons, 100%. People are scared of it for all of the reasons and as a surgeon, I totally get it, because if somebody was excited to go to the OR and didn't have some anxiety about it or didn't give it a second thought, I would be nervous, right, right, yeah, because for me, this is my daily life, but for most people, you're going through surgery once, maybe twice in your life for this purpose. So, honestly, I think the whole process is exciting and the whole outcome can be really exciting. But I totally understand that the idea of surgery itself can be scary, 100%, and that's fair, yeah, and even in our field, even with other physicians, other doctors, other people in the industry, you do see a lot of fear and misunderstanding. So, I do want to mention, with surgery, what are the expectations? Yes, right, Because, Tammie, I think we even discussed through your process what those expectations could be.

Tammie Lakose: 6:56

Yes, yes, I'm going to look like a supermodel, right, yeah? I'm going to say it in your word, all of it.

Maria Iliakova: 7:01

Hey, I love it. No, okay, first of all, you can be a supermodel any size, okay, so let's say that, and I wish more supermodels actually looked a little bigger, because I think that's beautiful, but anyway. But expectations after surgery is not all of the weight loss that some people expect. Correct, right? So typically you're losing between 50 and 80% of extra weight as opposed to all of your weight, right? So that's the type of people that's not going to bring them into a weight that is their high school weight or that is, like you said, a supermodel on a billboard weight, but at the same time, like that's not really the purpose either, right, right, the point of these surgeries is to help you get up and off the ground easier. Yes, help you keep up with other people in your life easier.

Tammie Lakose: 7:48

Yes, like my three little kids running around like crazy. Yeah, I've stopped weighing myself for the most part. Yeah.

Maria Iliakova: 7:56

And I think that's a super healthy thing. Like I encourage people to weigh themselves at most once a week. Yes, because otherwise it can become really obsessive. Yes, in a negative way and also weight fluctuates.

Tammie Lakose: 8:06

Yeah, especially women. Oh gosh, Especially women. Yeah, you're on your period.

Maria Iliakova: 8:10

You happen to eat something a little too salty. You're right you know like that catches up with everyone. So you know weight. Actually, did you know that weight can fluctuate up to five pounds in a day?

Tammie Lakose: 8:20

In a day In a day. So that's why your scale is telling me that I'm five pounds heavier than when I'm at home, butt naked after I've done all my business.

Maria Iliakova: 8:29

There you go. Yeah, there you go. We all know that the wintertime in Iowa people are at least wearing like five pounds of clothes too, so there's that. So, unless you're just stripping naked in your doctor's office, which you know, that's up to you, but there's going to be a couple of extra pounds there anyway, yes, so, anyway. So that's surgery, and we will definitely have another episode that goes more into the nitty gritty of what kind of surgeries are out there and what they're for and what the differences are. But I just want you to know that surgery is something to consider, and even converting from one surgery to another is an option for a lot of patients. So if you're in the position, had a surgery and you've regained weight or you've had other things like reflux or other things pop up along the way, that might be a conversation to have with someone who does surgery and think about maybe taking the next step with a different surgery or yeah.

Tammie Lakose: 9:20

So we also want to change mindset of or you've said you want to change other providers' mindset of. This is your last ditch effort, this is your extreme. We need to look at that differently. Why do we have to wait until we have diabetes and high blood pressure and all of that stuff before we look into surgery? Why aren't we looking at people that, oh, their BMI or their weight has gone up a little bit in the past six months Exactly, for no significant reason? Let's battle this now. Oh yeah, absolutely.

Maria Iliakova: 9:55

And it's this whole idea of an ounce of cures worth a pound of prevention kind of thing. But what it means basically is we plan ahead for everything. We plan ahead for Thanksgiving, for Christmas, for our kids to go kids' games and things like that. For your vacation. You plan ahead, but we don't really plan ahead for our health the same way.

Tammie Lakose: 10:18

We just dig around and see what happens. Yeah, we kind of dig around and see what happens, and then I will say.

Maria Iliakova: 10:22

Insurance companies, for the most part, are not helpful in this 100% not Because surgical care or just in general weight care even though it's really, really important is very limited, so there are restrictions that are placed on access to these things. That I mean, I even talked to a patient today, actually, who is a person who has med weight loss on board, but her access is very, very limited because it's expensive and she doesn't have health insurance coverage for it and she's desperate and I really, really want to be able to help her, but we don't have policies in place that really allow people to get help before it gets worse. In fact, that's kind of crazy. But she's not a diabetic. Being a diabetic can help you qualify for some of these meds, like you've seen. And she literally said well, I wish I were a diabetic.

Tammie Lakose: 11:12

Right. How crazy is that A lot of her patients have said that because Right.

Maria Iliakova: 11:16

Yeah, yeah, and this is exactly like the probably 40th time I'm hearing this now from a patient which is messed up.

Tammie Lakose: 11:22

Yeah, because we got to wait until now. We have this diagnosis before we start thinking about it, right, so?

Maria Iliakova: 11:28

And that applies yeah, that applies across the board for access here.

Tammie Lakose: 11:30

So, yeah, so let's talk about the diet and exercise that should work for everybody.

Maria Iliakova: 11:35

Right, yeah, tell her in, tell her out, guys. Hello.

Tammie Lakose: 11:37

Obviously, all of our providers, our primary care doctors, are telling us you better move more Right and not getting down on them because I am in the health field and health care field and understand that we're sitting at a desk, most, but most of our providers Don't yeah, don't necessarily know, and that's true.

Maria Iliakova: 11:58

So the way that I think of it is diet and exercise are essential, right. And when I say diet I don't mean like eating no carbs. In fact, when I say diet I mean like making sure that you eat a good diet that's full of carbs and proteins and fat and fiber and lots of fluids, and I mean just overall eating stuff like you would if you lived 150 years ago and you lived on a farm, like if you ate healthy and ate what you needed to that, yeah, not over limiting yourself, not overdoing it pretty moderate. I know that's really boring, but no, no, that kind of approach to food, right, yes, not food as fuel. You can enjoy food, but also understanding that food is there to serve you, not the other way around. That's unfair. Yeah, 100%. And then exercise is kind of the same right. Moving your body can be awesome if you find something you like to do.

Tammie Lakose: 12:53

That you enjoy Exactly and like.

Maria Iliakova: 12:54

Tammy, what do you enjoy to?

Tammie Lakose: 12:56

do I enjoy like HIIT training High

Maria Iliakova: 12:59

Identity training. I love that too.

Tammie Lakose: 13:03

And I love not being able to breathe for a hot second. Honestly, most of my workouts come stem from when I'm angry and I just go balls to the wall. Is that appropriate?

Maria Iliakova: 13:16

Oh, I mean it is now. It is now. No, that's great.

Tammie Lakose: 13:20

That's what I enjoy. I really do enjoy feeling or having that sweat.

Maria Iliakova: 13:25

Yeah, having the sweat on, and there's so many ways to move your body right. So when we were putting together some of our materials, I was looking online and I kind of felt like an idiot because I was like, ok, give me activities, google or chat, gpt, give me activities. And it was like walking and running and volleyball and I was like, yes, I know these things, but it's kind of hard sometimes to wrap your head around what you're going to pick because, it's almost like if you're starting from somewhere. it can be intimidating to get started with anything and it can be overwhelming to choose something. Has there been something that you recommend in terms of making a choice or?

Tammie Lakose: 14:03

getting started. Be comfortable with being uncomfortable. Honestly, that's a good one. My first time into a gym. I was lucky enough that they had a promotion going that you would get five free sessions with a personal trainer. Actually, I think it was more so that they could cover their butt and teaching me how to use the equipment.

Maria Iliakova: 14:29

And not get injured. That's great.

Tammie Lakose: 14:33

But that gained confidence for me. I mean, people are going into a gym and being like I'm just gonna do the treadmill or the elliptical. Why? Because it's easy, because you can't make fool yourself and oh, let me tell you fool yourself.

Maria Iliakova: 14:51

So I have fallen off of an elliptical broken iPad doing that Yep. So you can make it fool yourself even on an elliptical.

Tammie Lakose: 14:57

Where is?

Maria Iliakova: 14:58

that video clip. It is sealed. It is sealed. It's not boxy old, no, but I have also fallen off of a Stairmaster and oh man, so there's, that is talent something like that. No, there's ways to injure yourself doing anything.

Tammie Lakose: 15:12

And that's actually an important part here too.

Maria Iliakova: 15:14

So overdoing it with exercise and not actually starting somewhere and kind of taking it low and slow first is a great way to get injured and then sideline yourself for a whole lot of time.

Tammie Lakose: 15:26

I do question sometimes because you know we will preach you need to exercise and move your body every day. But I'll be open and honest. I'm not exercising every day. I do need to.

Maria Iliakova: 15:39

I am moving my body obviously You're moving your body and I think there's a difference between moving your body and exercising. Yes, there is I think the recommendation really should be moving your body a little more than you would normally, for 30 minutes a day.

Tammie Lakose: 15:52

I think I just go a little too extreme and honestly I should not Like when I told you I was angry and I went home and ran a 16 minute mile. I should not have. Like my heart probably did not appreciate that. So I think I need to find I need to work out to that.

Maria Iliakova: 16:11

There's a lot of rage exercising that happens.

Tammie Lakose: 16:13

We've all done it.

Maria Iliakova: 16:15

I used to box and I understand.

Tammie Lakose: 16:16

That's a great way to get some aggression out.

Maria Iliakova: 16:19

That's not to say that that's wrong. Whatever approach works for you, that's great, but the whole idea behind like moving your body is do anything. If it's jamming to a TikTok video, if it is yoga, if it is walking your dog, if it is doing HIIT, high intensity interval things, if it's golfing, playing with your kids.

Tammie Lakose: 16:41

Absolutely, throwing a 30 pound toddler in the air is intense. But it's not something that you think, oh, I worked out today because I was playing with my kids, exactly, and it is.

Maria Iliakova: 16:54

And like there's actually a lot of studies that show that continuous movement and engagement, even if it's low intensity, can be very helpful over time Because it's doable, you're not gonna injure yourself as likely. So really finding things and then, like you said I love that you said this of just doing it and not being afraid to kind of look new or not be good at something, Lord knows. When I first tried high intensity interval stuff, I mean you look like a fool in a hat.

Tammie Lakose: 17:22

Oh 100%. I am not saying I look beautiful and I ain't about to do it in front of a whole bunch of people. Oh no, oh no, no, no no, and then actually.

Maria Iliakova: 17:30

so I got to the point that I liked it so much I actually started teaching classes about a year, year and a half after that. So you absolutely do not know what your limits are, you don't know what your possibilities are, until you get started doing something.

Tammie Lakose: 17:43

Right, and don't hesitate. Yet Don't hesitate to ask for help. I mean, that young buff guy at the gym would probably like enjoy teaching you. He's going to the gym every day. He would probably enjoy teaching you how to do it correctly, right? So put yourself out there a little bit too.

Maria Iliakova: 18:04

Absolutely. I would totally do that now, Absolutely. And if he hits on you don't want that, then move along.

Tammie Lakose: 18:10

Right, or even a woman. There's a lot of women out there. There's a lot of women. There's way more women.

Maria Iliakova: 18:15

weight training, absolutely, and I remember I actually took a high school class in weight training, which can you believe my high school had. Weight training is so cool. But it set me up to have another skill that I could use to move my body anywhere anytime, to the point where now I have those things at home and I'm able to create a workout for myself anytime that I'm at home and it's kind of it's cool. So I think anytime you're thinking about fitness activity, moving your body, just try something, do anything Something. Physical therapy counts. Oh yes, getting walking around the mall counts, everything counts.

Tammie Lakose: 18:52

If you are doing absolutely anything, you are passing the person that's still sitting on the couch.

Maria Iliakova: 18:57

That's so true. Laps around the couch. I love it.

Tammie Lakose: 18:59

You can run laps around the couch.

Maria Iliakova: 19:01

I remember when I was a kid, and it was really bad weather outside. My mom would be like run around the dining table and I did my boys do that often.

Tammie Lakose: 19:08

Yeah, I remember that.

Maria Iliakova: 19:09

Anyway.

Tammie Lakose: 19:10

But what is the success of diet and exercise? Because, let's be honest, I've been on a lot of diets.

Maria Iliakova: 19:16

Yes, and they always fail. Who hasn't? I mean, I've been on a million diets too. So diet and exercise alone for weight loss. What do you think is the rate? How often do you think that works Long term?

Tammie Lakose: 19:28

5%, you're right.

Maria Iliakova: 19:30

Really yes, oh, isn't that crazy.

Tammie Lakose: 19:32

Yeah, ok, that is it.

Maria Iliakova: 19:34

It literally is the statistics are it works less than 5% of the time. That's crazy, isn't that wild? So 95% of people, 95% who try diet and exercise alone, will regain the weight and most of them will regain more.

Tammie Lakose: 19:49

But it's just you.

Maria Iliakova: 19:51

It's just that you're not a problem, not eating well and moving. That's the mentality we're getting out of here, like we are getting out of here that if it worked, we would all do it and be successful. Yeah, if it all worked, then all the 60% of people who have an extra pound or something on their body wouldn't have it. But that's okay, so, yeah, so diet and exercise alone do not work for weight loss they absolutely. It does work really really well, though, for maintaining 100. Yes, yes, keeping your body active.

Tammie Lakose: 20:23

Yes.

Maria Iliakova: 20:23

Keeping your body healthy, keeping your gut happy and working.

Tammie Lakose: 20:27

Yes.

Maria Iliakova: 20:28

Your mind happy and working. So for those reasons, having a good, healthy diet and staying active every day, those are that's really important, just for overall wellness.

Tammie Lakose: 20:37

Yes, and maintaining and just feeling good, exactly so. Okay, that doesn't work, doesn't work. I'm coming into your office Right and I'm telling you surgery, ain't it for me. Yeah, that's fair, okay. So what's? What can we look at now?

Maria Iliakova: 20:51

What else is out there? Well, I'm sorry, Tammie, you're going to have to leave now.

Tammie Lakose: 20:53

No, I'm kidding, no, no, no, no, I'm totally kidding, I'm totally kidding.

Maria Iliakova: 20:56

So luckily there's actually a lot of other options. So one thing is we definitely look at mental health too as part of the picture and we will have another episode about mental health and bariatric surgery and things definitely. But you know, you have to remember this is not mind versus body. This is mind and body when we're talking about weight, because oftentimes the way that we move our bodies, the way we think about what to eat, the way we kind of the whole picture, is also how we feel.

Tammie Lakose: 21:25

Yes, a lot, because when I I'm not feeling good, I want all the junk food.

Maria Iliakova: 21:29

That's right, that's right. So, surprisingly, pretty much every visit we also talk about mental health. Yes, Right, and that's scary. I get it Not. Nobody wants to be told oh, you need to.

Tammie Lakose: 21:40

You know, go see someone and figure things out Right and work on yourselves and all of that.

Maria Iliakova: 21:45

But actually, you know, I've gone through mental health like therapy myself. I've gone through things and I think the only thing that happened was either it was not helpful, that can happen or it was helpful, right yeah, and I felt better and I felt more empowered and I felt more capable and I didn't feel like the problems in my life were scary anymore. Yes, I mean okay. So those are pretty decent outcomes. I really have yet to hear somebody going through therapy and it making things worse. Right, but anyway. So something to consider. Definitely, if you already have someone that's helping you with mental health, that's great, but if not, I would actually say consider.

Tammie Lakose: 22:23

Yeah, and if you do have somebody and it's just not working, break up with them, that's okay, yeah.

Maria Iliakova: 22:27

That's true. Well, throughout all of this, breakups are part of the equation sometimes yes, oh yeah, and you can break up with your yeah with anybody providing you care. Yes, yeah, that's that is in your yeah, that's in your balls in your court on that one, yes it is For sure, so, but okay, but also, I think it's really important to think about med weight loss, so medications that can help you lose weight or help you maintain weight, and that topic has exploded lately.

Tammie Lakose: 22:52

Yes.

Maria Iliakova: 22:52

Right Like you cannot go on Facebook or Instagram or TikTok and not hear about Mozambique and Wagovie and Wajarro and all of these. Yes.

Tammie Lakose: 23:01

Yes. And let's just start here, with us here in a provider's office. Yes, we want to give it to all of you, I promise. Yeah, like, if it obviously fits for you, put it in the water. But it's not that easy. Yes, but if we could, we would, because it works.

Maria Iliakova: 23:18

It does work, and that's the thing. And let me caution that by saying, though, it doesn't work for everyone Right, because, to be honest with you, none of these sort of things work for everyone, right To be. Yeah, weight is pretty. It's a customizable approach for everyone, yes, and it's a lifelong approach for everyone, but with medications, you know these GLP ones, which is glucagon, like peptide one, analogs, which is what the category of medications that these all fit into, these Saxenda, Mounjaro, Ozempic, Wegovy medications. They are also diabetes medications, yes, so they help with insulin resistance, if you've heard of that. They help your body basically regulate blood sugar better, but they also help your stomach slow down and how it processes food. Yeah, and so it's really, really it works very well at decreasing appetite, helping people lose weight, helping people overall their metabolic function get better. So, yeah, like Tammie said, I would love to be able to give this medication to many more people than we currently do Now appetite, appetite with these medications oh yeah, like, is it working like Phentermine of just shutting off your hunger, or why does it make you less hungry? So, to be honest with you, we don't fully understand why a lot of these medications work the way that they do in terms of appetite. Appetite is complicated, very, yeah, and I mean that not just because we don't know, like the one pathway that affects that, but probably because there's something like five to 10 different pathways that actually impact appetite. Yeah, because think about even like okay, what's your favorite food? What's your favorite food? Mexican, mexican. So think about Mexican food, think about the best place you like to eat.

Tammie Lakose: 24:58

Oh, now you're taking me to lunch, yeah right.

Maria Iliakova: 25:01

So that's what I mean is just by talking about food that you like.

Tammie Lakose: 25:05

My mouth is watering.

Maria Iliakova: 25:06

We got Tammie mouth watering right, we got Tammie fantasizing over here and that's very powerful, and I didn't do anything in terms of medications. I didn't do anything in terms of showing you a picture. There was no smell involved. That's your mind. That's your mind at work, right there, right. But that, what we just did, probably has started to activate some of your stomach enzymes, some of your digestive enzymes in the rest of your gut certainly made things work in your brain and you're probably feeling your tongue get a little, a little more saliva than it had before in that wild, so appetite is very complicated.

Tammie Lakose: 25:43

But you made a good point where and educate me here, where these injectables? Yeah, yeah, they slow down.

Maria Iliakova: 25:54

Yeah, they slow down basically how the stomach processes food Right and think of it as and that keeps you fuller longer. That's right Now something like Phentermine. That's right, Phentermine doesn't it's really just an appetite suppressant. It's an appetite suppressant because it stimulates your nervous system.

Tammie Lakose: 26:09

Ok, so it is a different function, but that's something I want people to know is that these injectables are not just an appetite suppressant. There's more going on. No, people don't understand this. It makes me frustrated.

Maria Iliakova: 26:20

It may be bad.

Tammie Lakose: 26:20

There's more going on.

Maria Iliakova: 26:22

There's more going on behind the scenes.

Tammie Lakose: 26:25

Like the empty of the stomach. It's slowed down. Also the insulin resistance. There's more going on than just appetite suppressant, and that's what I want people to know.

Maria Iliakova: 26:39

Yeah, absolutely, and I think an approach to medications that help with weight is unfortunately nuanced. There's not one size fits all solution at any of these strategies, and certainly not with medications, because right now so there's nine medications that are approved by the FDA to help people with weight management. Like specifically approved for obesity and weight and things like that, and they all work differently. They're in multiple categories, but they all work differently. And then the other thing that we really have to think about here, too, is they're expensive. So Phentermine, not expensive, a lot of side effects, a lot of side effects, and we can talk about some of those. But like Contrave, a little bit more expensive, less side effects, but some that are really severe. And then Ally or Orlistat, same thing, less expensive, lots of side effects. And then these GLP-1, Saxenda, Mounjaro, Wegovy, also a very expensive medication if you're paying out of pocket and still have side effects.

Tammie Lakose: 27:35

Yeah, and then the other side effects are less, though I have been on a lot. I've been on the Phentermine so I've also tried Saxenda too.

Maria Iliakova: 27:44

I feel like Phentermine just made me crazy, but I mean I did have side effects with Sexenda but I just feel like they were a little less little less mental wise. Oh, absolutely.

Tammie Lakose: 27:55

Because that's the thing is.

Maria Iliakova: 27:56

So these the GLP-1s Mounjaro, Ozempic, Wegovy they don't really have a lot of mental side effects that we've noticed at least. They don't really have a big impact on anxiety or depression or any of those things, or sleep Phentermine definitely does. Oh yes, so Phentermine can cause or make worse things like anxiety, insomnia, your heart feeling like it's racing and, to be fair, that's also part of how it works, because you're constantly adding a little bit of stimulation to your nervous system, so you're adding stimulation to all those functions too, and in fact, one of the other side effects people don't necessarily know about Phentermine is that with some medications it can increase your risk of seizures. So, like I said, these are not one size fits all approaches. If you're on medications for anxiety and depression. Phentermine may be a dangerous medication that you take and then, no matter what, phentermine also affects your heart muscles and can cause heart arrhythmias or palpitations, which means that your heart rhythm can get knocked off normal or even heart attacks down the road. I know people have heard of like Fen Fen, probably right From like the 90s and things like that and that was yanked off the shelves. Phentermine is safer than Fen Fen, but Phentermine is actually one of the components of Fen Fen and so long term use of Phentermine definitely can increase risk of heart problems and for some people can increase heart problems off the bat if they already have them, so definitely not appropriate for everyone. Contrave I actually use a lot of Contrave and it's a combination of medications called bupropion and naltrexone, so bupropion you probably have heard Wellbutrin as . I take it. There you go, A lot of people take it right, yes, they do. So the funny thing about this medication is actually started as something that helped people stop smoking.

Tammie Lakose: 29:38

Yep, I come from a pulmonary clinic and alot of Wellbutrin of was given out for smoking cessation and it did help a lot, absolutely, and so the other interesting thing about this is it's a medication that's used to help with anxiety and depression.

Maria Iliakova: 29:52

Yes A bunch of other mental health conditions too, and it's like the only one that they noticed helped people lose weight, right. And so you know, obviously, this drug company decided oh hey, people are losing weight, let's get it approved for weight loss too. And it works, yeah. So the results between, by the way, all these different medications can be about the same in terms of overall weight loss and overall what you can achieve. Contrave does still have side effects though, yes, right, and you can still have some of the nausea, some of the GI symptoms, and then a lot of people actually have improved sleep by taking it. Less anxiety, less anxiety. So two birds one stone for some folks. But you know, with better sleep or more calm, sometimes people can get a little too sleepy, yeah, right, right. And a little too sedated, right. And then there's actually a black box warning on this medication of suicidal thoughts. Oh, okay, so rare, but I actually did have a patient who that applied to, and we had to take her off of this medication and switch to something else. So there is no free lunch here. That is bottom line. No, none of these medications are qualified for any of that. Yeah, and then the other one to talk about is Orlistat, or Ally, which some folks will know because it made its way to a bunch of late night talk show hosts, like monologues, back in like the early 2000s, because it stops your body from absorbing some of the fat that you're eating, so guess where that fat goes To the right places you poop it out, oh, okay, okay, and sometimes, when you don't expect it, oh snap, oh snap is right. So folks can have really bad diarrhea with this medication, or even something worse called anal leakage, which is about as fun as it sounds Certainly not everybody has these side effects but but because you're also not absorbing fat, the same way, you're also leaching your body of some fat soluble vitamins, like vitamin A and D and E and K and we were talking about the weather earlier, right, and the sunshine not being out in the wintertime and everything vitamin D, for instance, which your body absorbs from food but also comes from sun activation. A lot of people are already low on some of these vitamins, right? So adding another medication to the mix that makes these vitamins even lower not always the safest option not always a good option. So then and we've already talked about the injectable medications to there's options.

Tammie Lakose: 32:17

There's options, they're good. They're good. What if my insurance stops covering it? What if I stop?

Maria Iliakova: 32:22

taking it. Yeah well, it stops working Because, just like any other medication you take, if you're not taking it, it don't work.

Tammie Lakose: 32:29

What is the?

Maria Iliakova: 32:29

percentage of people gaining that weight back? Yeah, pretty much everyone. So when you stop taking these medications, you gain the weight back Because there's no long lasting effect of these medications. If you stop taking your medications for your blood pressure, guess what your blood pressure is going to?

Tammie Lakose: 32:45

go back up again, especially if you're doing all the same things. So, I feel like we see a lot of patients using these medications but not seeing dietary and really making those changes. So once you get that, take that away, yeah, then people can regain weight.

Maria Iliakova: 33:04

So you're right, Because sometimes people can use these medications to help people change their habits and to have better access to mental health and sort things out for themselves. They're really effective for people who are going through life changes, whether job or family or other, or even age changes like menopause, things like that, Because it kind of helps to take away the edge off of some of these more difficult situations in life. But ultimately you're right If people are not really taking a look at the bigger picture, changing some of their habits, guess what? You go back to the same habits. You start regaining the weight back.

Tammie Lakose: 33:40

And I want to throw this out there that when people talk about medical weight loss or surgery, well, we're not really talking about them anyways. People are not going up to each other. Be like, I'm on no zimp because I want to lose weight. But something that really stuck with me is that even myself before surgery, I always thought what am I having for breakfast? Ok, I ate breakfast. What am I having for lunch? Oh, I can't wait to have dinner. So there's a lot of food noise and these medications help with that food noise of being able to focus on making good choices. And when all you're thinking about is food, of course, all you're thinking about is the bad food, absolutely so that's something I just wanted to put out there, that, though medical weight loss and surgery people say it's the easy way out, it's just a tool to help quiet that food noise amongst other things?

Maria Iliakova: 34:42

Exactly.

Tammie Lakose: 34:42

Food noise is a. Thing.

Maria Iliakova: 34:44

Oh, food noise is definitely a thing. Oh, my goodness, food noise is a thing so having. I think it's difficult for some folks to relate to that because they may not have experienced it, but if you have and I have experienced food noise in my life too it can overwhelm everything in your life 100%.

Tammie Lakose: 35:01

That's all you're thinking about.

Maria Iliakova: 35:02

That's all you're thinking about, meaning your family obligations, your work obligations, your anything else that's in your life. It all revolves around your thoughts, around food. If you have food noise going on, so you're obviously right. These medications can help cut that back or help to eliminate it entirely, with the kind of freedom that you can experience as a result, either through medications or even through surgery, of that food noise can be a life changer. That completely for people.

Tammie Lakose: 35:33

And so I personally have ADHD just found out in my adult life, actually after or right before surgery, I found out. And so I like to compare it to when an unmedicated ADHD person 100 tabs are open 100 tabs are open, so when I'm able to take my medication usually only take it at work, but I'm able to focus on one thing, so again it's the noise of being able to focus on the important things Exactly.

Maria Iliakova: 36:06

And as somebody who's guilty of having 100 tabs open all the time, I understand, because it's really difficult to focus on the things you want to when you have something that's taking all your attention. And food and weight and these kinds of topics can do that and do that for a lot of people, and so acknowledging that and trying to find ways to deal with it is really important. So just to kind of tie it all together, because I know we've talked about surgery and diet and exercise and medications the other thing I really really want people to know is that it's not either or. When we deal with weight it is not the same as dealing with a cocaine problem or an alcohol issue or anything like that. It's a lot more like dealing with diabetes or dealing with a mental health issue or something like that.

Tammie Lakose: 36:58

It's a lifelong approach. The thing is with drugs and alcohol you can eliminate those.

Maria Iliakova: 37:03

Exactly, guess what. You got to eat, food you got to eat right, and you've got to attack that mental aspect Exactly. It's all about maintenance. It really is. It's all about long term, because sometimes people think of these things as a one time fix. Oh, I'm going to get some medications, I'm going to take them for some months and it's going to fix everything. Or oh, I'm going to get surgery and it's going to fix everything, and then I'm going to move on and my life can be great. That's not how it works at all. All of these approaches require maintenance. They also sometimes combine with each other. So we're sometimes using medications before or after surgery. We're sometimes moving on from medications to surgery. We're sometimes not able to have medications because of cost, or we're not able to have surgery because of insurance restriction. There's all kinds of things at play here. So I just want to make sure everyone kind of knows that there's a lot of options there and that there's a lot of work being done to develop more options but also ways to combine them.

Tammie Lakose: 38:06

Yeah, ultimately, there is a choice for everybody or there's an option for everybody, and don't hesitate to bring it up to your provider, and if that provider is not listening, break up with them.

Maria Iliakova: 38:19

That's fine, sorry, yeah, it's so easy to find another one. By the way, it's really not. It's really not, but yes.

Tammie Lakose: 38:26

But. But you're onto something Everybody deserves a Provider that is listening to them, is on their side. At that, I agree with yeah, and wait, it's not an easy topic.

Maria Iliakova: 38:36

It's not an easy topic and I will say you know. As a provider myself, I will say that I have been very undereducated on this topic Until I started doing it myself every day, in and out, and even now I realize I don't know very much About these topics. Yeah because there's so much to learn, right, there's so much we don't understand and we've got a long way to go to figuring out solutions to these issues, and then not even just like the solutions, but how do people get to them right?

Tammie Lakose: 39:07

and don't hesitate to Reach out to a bariatric program.

Maria Iliakova: 39:11

Oh yeah, this is something I learned that bariatrics does not mean Surgery right, right, and a lot of programs are now offering a more comprehensive approach. Right, that's more of a spectrum of like diet and exercise and mental health and medications and surgery and all kind of fine Bariatrics for me, oh yeah. Yeah, yeah, yeah for sure. So bariatrics actually comes from the word Barry Bari, which means weight. Okay, so the whole idea is bariatrics is the study or the field of weight. All right right not just surgery, not just surgery. So bariatrics is just referring to weight and we talk again. We talk about weight because it's the easiest way for us to all kind of have the same language, right, but when we're talking about bariatrics or weight or any of these things, it's about a much bigger picture, right, right?

Tammie Lakose: 40:03

right and that's why I chose core bariatrics, the core of it all. Very at you got, you did get caught up on the bariatrics, part part of people don't understand what bariatrics mean right so for those that keep listening, I'm, I'm, I feel like I'm gonna bring it up. Continue to bring it up, just so that, if people miss an episode, that they understand that bariatrics is more than just bariatric surgery.

Maria Iliakova: 40:26

Absolutely, absolutely Well. Thanks so much for joining us. I would love to hear your story about your journey in Trying these different things yet, cuz I've done it all.

Tammie Lakose: 40:35

Yeah, and just like.

Maria Iliakova: 40:37

Tami, a lot of people who, who, who get to One stage have tried a lot of other things before they got there and probably will try other things after they, after whatever stage they're at now. So in our comments, please don't hesitate to tell us about your experience and how you've gone through either med, weight loss or surgery, or diet and exercise, how things are working for you.

Tammie Lakose: 40:59

I would love to hear about or even how they're not working for you, oh, even better, yeah, we want it as much as all you know. All of this is good, positive stuff. We also want to get down to the Not so great stuff, absolutely. So, yeah, don't forget to follow us to get notified for another episode and thanks for hanging out with us. Thank you, you.