Watch:
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See what we did there? If you’re struggling with weight and wondering if GLP-1s could be your answer, Dr. Houssock and Lindsey break down everything to expect from your first consult, like BMI requirements, lab work, and how we safely adjust your dose along the way.
Once used to treat diabetes, GLP-1 medications are now revolutionizing weight loss, helping people shed pounds after nothing else works. These prescriptions quiet cravings and regulate blood sugar, often leading to results once only possible with surgery.
Find out why protein is so important, why patience pays off, and why your path (and your dose) should be as unique as you are.
If you need to hit a certain weight before moving forward with surgery like liposuction or a tummy tuck, or if weight loss leaves you with loose skin, we’ll tell you more about how we can help.
Transcript
Dr. Houssock (00:01):
You are listening to another episode of Perfectly Imperfect. All right. Hi Linds.
Lindsey (00:06):
Hi Dr. Houssock.
Dr. Houssock (00:08):
What do you think of this new setup?
Lindsey (00:09):
It’s a lot less awkward. I don’t have to look at myself, but not looking at myself in the corner of the screen, which I like.
Dr. Houssock (00:17):
Listen, it’s a process. I think that there’s so many podcasts now that people just assume that this is easy, but it’s actually not easy.
Lindsey (00:25):
No.
Dr. Houssock (00:26):
At all.
Lindsey (00:26):
No.
Dr. Houssock (00:27):
So this feels a little bit better. So we’ve been adjusting and kind of working through how we’re going to do our podcast and so first and foremost, welcome to the Perfectly Imperfect podcast.
Lindsey (00:35):
Thank you so much.
Dr. Houssock (00:37):
We are trying something new, but we think updated, which is to actually be in the same room, which is fun. You’re the second person do it. Val did it the first time. We liked it. It seemed to work out nice.
Lindsey (00:49):
I’ll let you know my opinion.
Dr. Houssock (00:50):
It’s like we’re chatting, like we’re chatting, but not chatting.
Lindsey (00:53):
With headphones on.
Dr. Houssock (00:54):
Usually you’re standing in the doorway of my room or I’m sitting on your little bench when we’re chatting. So slightly more formal. Anyway, today we are talking about GLP-1s. Apparently these are really popular.
Lindsey (01:08):
They are pretty popular. They’re all around the mainstream media. They’re all around Facebook, Instagram.
Dr. Houssock (01:14):
Yeah, they sure they actually are probably the most. What would you say, they have made the most impact in weight loss, probably, I’d almost say in history. It’s hard because weight loss surgery has been around obviously for a long time too, and made a huge change for many patients who had significant obesity. But I would probably argue that these medications might be even more powerful to mankind because in some ways they are able to be utilized by a larger population.
Lindsey (01:53):
I think they’re more accessible to people.
Dr. Houssock (01:54):
Yeah.
Lindsey (01:54):
That’s the difference.
Dr. Houssock (01:56):
So historically, I would say this is probably the most dramatic treatment that we have for obesity in history, which is awesome. So what are we talking about? What is a GLP-1?
Lindsey (02:14):
Basically, they have been around since about 2005 is when they were first approved, and they mimic your glucagon peptide basically and suppress your appetite and reduce your blood sugar levels. So they’re an appetite suppressant when you really look at it.
Dr. Houssock (02:33):
Pretty awesome.
Lindsey (02:33):
And they’re used to treat diabetes because of their impact on blood glucose levels. So for people that are struggling with obesity many times and we see those numbers come down because that’s what the drug is supposed to do,
Dr. Houssock (02:46):
Right. It’s one of the reasons why it was originally used at least, and because it’s been around since 2005, a lot of people listening might say, well, if it’s been around that long, why are we just really seeing it in mainstream media now? And it’s because its purpose has changed. A lot of medicine does that. So there’s medications that Lindsey and I use for other things that were originally created for one reason, and then they have dual need or they have dual accessibility for other things. So for instance, one of them that we use is Minoxidil for hair. That was a blood pressure medication, and that is a medication that’s been around for a very long time for hypertension. But it was discovered that it also works really well to promote the growth phase in hair. And so medicines happen like that a lot where we see it for a while being used for one thing and then it’s utilized for something else. Another one of those medications is actually Viagra. Viagra was originally created for pulmonary hypertension, and lo and behold, it works really well for erectile dysfunction. So I would say GLP-1s were originally utilized in a very similar way. They were used for the morbidly obese and for the most part, they were really utilized in the early stages of their journey if they were working towards a gastric bypass.
(04:07):
Because there is a limit in BMI that is even safe to undergo that surgical procedure, which is hard to kind of grapple with when you think patients are going under these gastric bypass operations for obesity, but there is a limit to what is safe to undergo a surgical procedure. And so a lot of them would go on these GLP-1s to bring their weight down to a safe level for surgery.
(04:29):
So they’ve been around and they’ve also been around for diabetes for a long time because they work really well in the diabetic population. Yes. So nothing new to the medical world. But then as they’ve been used, there’s an obvious advantage to a much greater population. So much so that I would argue we are probably seeing a downgrade in a lot of patients undergoing the knife, meaning that there are probably less patients who are needing to undergo gastric bypass and can then just, no pun intended, bypass surgery.
Lindsey (05:02):
It was a good one.
Dr. Houssock (05:02):
That was good. That was a good one.
Lindsey (05:05):
Everyone to acknowledge that was excellent. We’ll move on now.
Dr. Houssock (05:08):
A bypass, an operation for a bypass and can just utilize the medication, which is awesome for many, many reasons.
Lindsey (05:17):
Absolutely.
Dr. Houssock (05:17):
So the two popular ones that people famously know are the semaglutide and the tirzepatide.
Lindsey (05:23):
Yep.
Dr. Houssock (05:24):
What’s the difference between the two?
Lindsey (05:25):
So semaglutide is your ozempic that everyone’s familiar with. And your tirzepatide would be like your Mounjaro, your Zepbound. So semaglutide is a GLP-1 agonist, tirzepatide is a dual GIP and GLP-1 agonist. So it works a little better in weight loss, a little less side effect profile too for tirzepatide versus a semaglutide. So I think what you find is most people who are very successful in their weight loss journey at some point end up on the tirzepatide rather than a semaglutide.
Dr. Houssock (05:56):
Is there, I mean we’re dealing in an aesthetic population, and we’ll get into that in a minute, who we’re giving it to versus who out in the world is taking these GLP-1 agonists. But is there anything as far as the label goes where one is better than the other for say the diabetics or anything like that?
Lindsey (06:16):
No. I mean they work very, very well for diabetics. And I think you find that they’re used depending on insurance.
Dr. Houssock (06:23):
Got it.
Lindsey (06:24):
In that world, it’s really what are you approved for?
Dr. Houssock (06:26):
Yeah, it makes sense.
Lindsey (06:27):
And you get what you can get.
Dr. Houssock (06:28):
And in some ways, again, it’s like this, but it’s not like this. It’s like when you think about Botox and Dysport, it’s not that ozempic doesn’t work well in patients. It certainly does have efficacy and there are some very successful people on it. But the more we’re learning about these medications, the more we’re finding that tirzepatide may have a, and we need more data obviously to formulate this for sure, but it may have and increased efficacy. And so in our particular practice, we are offering tirzepatide right now. But certainly I’ve seen patients in my surgical side of the practice that have been on Ozempic and have done very well. So they’re both very successful medications. So Lindsey is the one in the practice who sees patients for consultation to undergo these medications. I often see them either in their early stages where I’m meeting patients who think that they want an operation and maybe I think that they would have the best outcome if they lost some weight eight or I’m seeing them after they’ve done the journey either with Lindsey or outside of our practice and have been on GLP-1s.
(07:37):
And I would say for all the surgeries we do, I would say at least every other week, one of the patients that’s on my surgical table is on a GLP-1. So they’re exceedingly common. Exceedingly common to the point now where it’s just seeing any other medications for us when we are doing our preoperative planning with these patients. Talk a little bit through this Lindsey, because seeing them in the beginning, what is it like they walk into the office and they’ve come in for consultation? Kind of take us through your consultation and how that kind of goes.
Lindsey (08:13):
So some of it is goals, some of it is where you would you like to be. I mean, that’s an easy first start. If we’re really five to 10 pounds off, likely this isn’t going to be the best way to get that five to 10 pounds off. Traditionally we say a BMI greater than 27 with a comorbidity. So something like diabetes, hypertension, there’s another something that’s happening for you to be a BMI of 27 and get these or a BMI over 30, that’s something like 30 pounds overweight. I mean that can be significant.
(08:45):
And so those are the people that are best candidates for these medications. And then the other side of it is are you overeating? And so sometimes there’s other causes of weight gain, post menopause, especially. In that population sometimes those people really aren’t eating a lot. We’re talking about primarily an appetite suppressant. If your appetite is not the problem, this might cause more harm then Good.
Dr. Houssock (09:10):
Interesting.
Lindsey (09:11):
Because I’m going to suppress your appetite to the point where you could become dehydrated from not drinking. It can impact your kidneys at that point, we can see some other side effects that GI related, nausea, vomiting, diarrhea, that can then exacerbate all of those things. So part of it is really what do you eat during the day?
Dr. Houssock (09:29):
Yeah, that makes sense.
Lindsey (09:30):
What are you eating? Because if you’re telling me that you really have a protein shake in the morning, a little bar for lunch and you might have a salad for dinner, this is not the answer. And I certainly have those patience when we start talking and I’m like, this isn’t, isn’t the right move. But then conversely, if you’re the person that, well, every time I drive by Chick-fil-A, I like to get a large fry. How many times you’re driving by Chick-fil-A? My sugar lovers,
Dr. Houssock (10:00):
Yeah.
Lindsey (10:00):
I’m one of them.
Dr. Houssock (10:01):
Yeah.
Lindsey (10:03):
As I ate my nerds this morning, my cookie lovers who are like, I might sit down to have a couple Oreos and maybe I’ve eaten a whole sleeve. Okay, well this will help because it decreases your sugar craving. It decreases the amount that you can eat. So when we talk about what these medications will actually do, if you picture your meal and maybe that meal is a sandwich, everyone can picture a Turkey sandwich. You’re really going to only be able to eat a quarter to half of that sandwich before you start to feel full and really gross. So you have to be thinking you’re literally eating half of what you would normally eat. And so I have to make sure that that half is reasonable. And if it’s a half a protein bar that you’re eating all day, that’s not enough. That’s not going to be enough.
(10:48):
And so then the other side of it is, what else are you doing? Because these medications only work with lifestyle modification. So for the people that are snacky or are eating way too many french fries or whatever it may be, they also have to modify what they do on a daily basis because you’re not going to be on these medications forever. Eventually we’re going to go into maintenance mode and then what? You’re going to get your appetite back, and if your lifestyle modification has not changed, you’re going to gain your weight back. And we see that in the studies. And so we see that people are gaining 50% or more of the weight they’ve lost right back because they didn’t actually change anything. So the other question is who does the best? It’s the people who are already doing things. They’re walking, they’re working out, they have some sort of regimen and gosh, I just can’t seem to kick those extra snacks that I have. Or my people that are like, man, I’m really good during the week, but man on those weekends, I am a snacker and I just go nuts. And okay, well they’re going to do really well because they’re already doing the other things they need to be doing.
Dr. Houssock (11:52):
How much do you think you see patients who I think almost don’t know that they’ll walk in and they might say to you, honestly, my diet’s fine. And then you dive in and you find out actually the diet isn’t fine. How many patients, because I find most of us don’t really understand nutrition, like we think we do. Even in medical school we barely talked about it. So you think you’re not eating that much, but then you start talking, you’re like, yeah, you’re eating the salad, but also how much dressing are you putting on the salad and that adds up to like 500 calories Or how often are you finding patients think they eat healthy and when you really dive in, they’re not?
Lindsey (12:27):
It’s funny, not many. And I say that because most people are here knowing that they’re not eating right.
Dr. Houssock (12:34):
I see they’re admitting it.
Lindsey (12:35):
They’re admitting I don’t eat well. The ones that I do see are my under eaters that there’s another cause. They really are doing everything that they could be doing diet wise, but there’s something else going on.
Dr. Houssock (12:48):
Whether it’s physical activity or it’s a hormonal issue and whatnot. And that’s tough. And so one of the things Lindsey probably does more than anything in that first consult is just determine whether you’re right for this because it might seem magical when you see the amount of results you see out in the world. You might think, oh my gosh, this is for me. But it really isn’t for everyone. It isn’t. And if you aren’t going to, like she’s saying, agree to some modifications in lifestyle, it’s kind of a mute point to go through it because while you might lose the weight, you may not do it as effectively and you also may not keep it off. And so you’ve gone through all of this, you’ve put your body through it, and then like she’s saying, as you wean from the medication, whether you wean completely off of it or to a lower dose, you need to have your lifestyle match this new amount of energy that you’re able to take in.
(13:40):
Because if you don’t, you’re bouncing right back. And we know that already and it’s something that she talks about where we know you’re going to gain some of it back. It’s like anything. It’s like when you go on any type of diet, you know that your lowest is never going to be right when you come up, you’re going to have some ebb and flow in that. So we have to account for that. But if you haven’t changed your way of living during that process, it’s going to be really, really hard to not just head back where you were. One of the things she also mentioned was the BMI. So you’ll see everywhere these superstars who are on ozempic and losing a couple of pounds on ozempic. And while that might be something that is happening in the world, I can tell you that in the medical world it’s really frowned upon and it’s not because we don’t want people to feel good and look good. That’s what we do for a living, literally. But there are side effects and risks to these medications and they have to be worth the outcome of what you’re going to get off of it. And so if you’re looking to lose five pounds and you think this is the best way to do it, you have to take on the risks of side effects that come along with this medication versus doing something like diet modification or extra exercise that typically can get you those five pounds when we’re talking five pounds, right?
Lindsey (15:04):
Yes, a hundred percent.
Dr. Houssock (15:05):
So talk about the side effects that we really have to worry about these medications. Not that we want to scare everybody away from these meds. We are huge proponents of these drugs being utilized in the right way, but we want to make sure that if people understand why we are sticklers for a certain BMI, right?
Lindsey (15:19):
Right. So part of it is this will also take muscle. So yes, you will lose fat, but if you don’t have enough fat to lose, you are also going to lose muscle mass. And that is never a good plan, that’s never healthy and it is not going to be sustainable for you. So that comes with its own set of side effects and those are our lower BMI people, and that’s where it gets a little bit dangerous. And even for my patients that are on it, it’s a conversation that we have at some point you are going to get down to where it’s going to start taking muscle. So I do need you to be eating protein and I do need you to be working out to build muscle and we also need to get you off of it at a certain point. Now the Obesity Medicine Association also came out just one more token on BMI that actually our Asian population a BMI of 25 for starting these medications. We look at them a little bit differently, is acceptable.
Dr. Houssock (16:13):
Why is that?
Lindsey (16:13):
Just their body habitus is a little bit different. And so sometimes you weigh things a little bit different in the Asian population and they do acknowledge that, but they are very strict on the other regulatory BMI because it is so important. Your GI side effects can be significant. You can have major nausea, vomiting, diarrhea that you can’t even tolerate really eating. You can have gastroparesis, so you can have, it slows your motility. And so for surgery patients, we actually have you hold it before surgery because it slows down gastric emptying. And so you can have a major slowdown of that area and have side effects from that. There is also different than traditional thyroid cancers, thyroid medullary cancer. And so there is a known risk of that. And so you want to make sure that there’s not a family history of thyroid medullary cancer in the family. So there’s not no side effect for these. Everyone has something.
Dr. Houssock (17:12):
Yeah. Yeah.
Lindsey (17:13):
And you have to still be able to eat on them. And so I think what happens to some people is they get to a point where they really don’t tolerate food and then we’ve got a whole nother set of issues, dehydration impact to the kidneys, impact to the GI tract that you just end up in the hospital quite honestly. And we do see that we have people that have to go to the hospital on these medications because they’re so dehydrated.
Dr. Houssock (17:34):
And that’s obviously not what we want out of these. And every medication has side effects. And these are again why we have to be smart about going on them. They are a pharmaceutical, they’re not just a supplement that has low risk or low efficacy, it has high efficacy. Don’t get us wrong. It works, but it does come with its own side effects and you have to be prepared for that and ready for it, and it needs to be worth what your gain is. When you look at the original, again, the original use for these medications, for the patients that were taking it, it was truly life giving. I mean, we were saving lives with these medications because they were so morbidly obese that they were going to die from their obesity. I mean, that is truly where they all started. And even in the sense of it’s still to this day, a gastric bypass is for that type of patient where the risk of a huge operation is absolutely worth the benefit of all of the comorbidities that these morbidly obese patients had.
(18:30):
And so you can’t ignore that in the sense of that now we’re using it more mainstream that those risks don’t still exist. They do. And they’re not advertised like the drug is and the results are. And while we understand, most patients do very well with them, we just know that these are the risks you have to be aware of and hopefully you’re being educated on when you’re being put on them. And obviously the higher the dosing, the higher the risk of things happening and so on and so forth. And so we do try to keep you at the lowest dose possible in order to gain your results with minimizing your side effect profile.
Lindsey (19:06):
And we expect about one to two pounds a week. So a pound a week, I’m happy that is a successful trip on this medication is a pound a week and you’re down 12 pounds in 12 weeks. Fantastic.
Dr. Houssock (19:19):
Because your body’s had time to acclimate. So you’ll see the stories of people losing more or faster, and it all sounds exciting, but you got to remember your body is a place of homeostasis, of balance. And you want to make sure that anything you’re doing, the slow and steady always wins always. Whenever you’re doing anything, it’s going to be more sustainable, it’s going to be easier on your body, it’s going to mean less side effects. And so all of those things are why we say a pound a week. When you look at any good diet, again, whether it has to do with these medications or just straight up restriction or exercise, a pound a week is a really wonderful level and it sounds slow, but in the end it’s really not. I mean that’s a significant amount over time and you are much more likely to be successful if it’s a slow and steady process. So that’s kind of the goal. And we watch that very carefully. Lindsey has you weigh, how often do you have them come in and weigh in?
Lindsey (20:16):
So they weigh in once a month here at the very least when they pick up their medications. But I actually have them weigh weekly because I like to keep an eye on it because if I need to change a dose, I need to know. Everyone knows that you can certainly stay the same weight a couple weeks in a row.
Dr. Houssock (20:32):
Of course
Lindsey (20:32):
Things happen. You had a weekend out where you went a little crazy, you had a vacation, you had whatever. So we have to take all of that into our consideration when we up our dose. But if you’re sort of steady and you really haven’t lost in a couple of weeks, then I might say to you, okay, let’s go up. And so that’s a conversation point too. And I’ll have people either message in or call or they come in and we have a conversation and decide is it time or did we have a kind of cheat week? The other thing I would say is that some people lose a little bit differently. And so you have to also keep that in mind. I have some patients that have lost a couple of pounds one week and then really not much the next, then they lose a few more pounds. So if it averages out to about a pound a week, I’m okay where we are, we don’t need to go up. Even though you might’ve had two weeks that you were the same, you lost four pounds in one week.
Dr. Houssock (21:20):
Right.
Lindsey (21:21):
So it’s not also necessarily that you have to just jump up every single time you don’t lose.
Dr. Houssock (21:26):
Yeah, makes sense.
Lindsey (21:27):
You want to be thoughtful about it
Dr. Houssock (21:28):
Makes sense.
Lindsey (21:29):
There’s only so high you can go quite honestly, and your side effect profile increases every time you increase, you have side effects again. So when you start, you have your most GI side effect, then you get used to it. And then when you increase, you have GI side effects again. So usually around an increase, people don’t feel so great for a week or two. And so that’s a consideration too.
Dr. Houssock (21:51):
No, that makes sense. And again, just monitoring very carefully, and that kind of brings me to my main kind of thought on this is making sure that you’re going and being prescribed these medications with the right person so you can get these medications almost just off the internet now, order ’em and get them. And there’s no question that the medication alone is not going to be successful without very good and safe monitoring. And so Lindsey is with you the entire way. So one of the things I will highly suggest, we understand, not everyone can come here for their treatment and we do offer virtual treatment. So if anyone’s interested, you absolutely can sit and chat with Lindsey virtually. But keep in mind you want someone who’s going to be very invested in your entire journey, not just handing you medications every week. Lindsey also does pre therapy lab work. So whether you’ve had it at home already with your physician or we’ll send you for it, there’s ways that she wants to make sure that there’s something else going on or that there’s something else we have to look at before you get started. She takes a very thorough history, she talks you through your goals.
(23:03):
All of those things are absolutely paramount. And then it doesn’t end there. It’s not like one consult and then we get you on. She’s on top of you throughout your entire journey. She’ll start you where you need to. And then she monitors very carefully to make sure that your progress is successful. Also, your side effects are minimal and that you’re dosing appropriately if you have questions about that, how is your diet? And that is absolutely paramount. Is there anything else about a program that people listening should know about and look out for when they’re diving in if they decide they want to go ahead and do this?
Lindsey (23:35):
So a couple of things that I’ve seen through my time is I’ve had a couple of people who’ve come in actually not knowing that they were hypothyroid. Hypothyroidism needs to be treated, but it can also cause weight gain. So I got their blood work and looked at it and said, well, have you been diagnosed with hypothyroid? No. Okay, well, you need to go back to your primary care and you need to have another blood work check and make sure that this is accurate. If it is, you need to be on another medication,
Dr. Houssock (24:03):
This might be the right and probably.
Lindsey (24:04):
You’re going to lose weight because your thyroid’s going to go back to where it should be. The other thing that I’ve seen is people coming from other offices where the medication is mixed in the office or where it’s dosed in the office and they’re getting a syringe. I don’t love that.
(24:20):
So how we do it is we do go through a pharmacy and you get your vial. So your vial is made for you, it’s got your name on it and then you take your vial. I’m happy to keep your vial here and inject you from your vial or you can do your injections at home, which I personally think is easier because you’ve got to do it every week. So who wants to come in here every week? We’re know. Everyone does really. But I also recognize you’re busy. You have your own vial though. I don’t love that, I’m hearing that people are getting multi-dose vials basically, where different patients are getting out of the same vial. Not a huge fan of that, and not a huge fan of you just taking a syringe with an unknown medication. And I like to have that linked together as your syringe, your med.
Dr. Houssock (25:05):
We give you supplies for everything every time.
Lindsey (25:07):
Absolutely.
Dr. Houssock (25:07):
You get it all. You get everything you need, but it’s your vial and there’s something to be said for that because it’s not just some sketchy blank syringe that you’re taking. And again, we can talk you through that and we definitely are happy to inject you if it’s something that is important to you.
Lindsey (25:28):
And we do have a few people that come in,
Dr. Houssock (25:30):
Sure.
Lindsey (25:31):
And they come in for their injection and that is a okay, but
Dr. Houssock (25:33):
Happy to do it.
Lindsey (25:34):
I have their vial here and their vial is pulled for their injection, not just a random vial.
Dr. Houssock (25:40):
Makes sense. Again, everything is done. You’ll find that unfortunately something this popular is going to be done a million different ways and you just want to protect yourself and make sure that you’re ultimately safe, but also that you’re getting the medication. You’d hate to know that things weren’t accurate or watered down or whatever it might be. So there’s no better way than to know that your vial is yours. For sure. So the other side of this that we see in our practice, because of course we have our nonsurgical side, which Lindsey runs, and then you’ve got the surgical side, which is the side I run. I am seeing all of these patients after the fact. And so patients will come in, they’ll have gotten to their goal weight, and for some people that is a very dramatic, significant weight loss.
(26:28):
I mean amazing. When it first started and I was seeing patients in, I was seeing results and I still am of equivalency to gastric bypass, which I couldn’t believe. I mean, coming as a surgeon and being a part of those gastric bypass surgeries for decades and being able to see it all and seeing that result and then to be able to see patients who say, no, actually this was Ozempic was so amazing seeing it in my own mother had gone through this medication treatment, she still is on it. She’s prediabetic. She no longer is pre-diabetic, she is off of her blood pressure medications, everything. I mean, it’s just amazing to watch and how active she can be with my son and all of those things. So I have a personal story about how exciting and great they are. And for some patients it kind of just stops there and they can live their life and they’re able to just kind of move on.
(27:23):
Some are placed at different dosing and we’ll talk about that kind at the end as what happens at the end. But there is this part of the journey where if you’ve lost a significant amount of weight, you may end up in my room because you end up with a ton of excess skin and that’s all major weight loss. It happens. And there’s a little bit of a scare about ozempic face, no ozempic body, but everyone needs to know. Unfortunately, that’s just a part of losing weight, a lot of weight. And we’ve gotten so effective at it that unfortunately we are seeing more of that. But really truly, it’s not related necessarily to just ozempic. It’s not just that kind of, it’s weight loss in general. It’s not like we weren’t seeing these patients before from gastric bypass for instance.
Lindsey (28:10):
No, we’re just seeing a lot more of them.
Dr. Houssock (28:11):
More of them, totally.
Lindsey (28:13):
And we’ve talked about this, but Galderma has recently started a study of weight loss and the difference it causes to your face. And so they’re using Sculptra and either a contour or lift in the cheek and they’re kind of doing a one-two punch to give you more volume back where you’ve lost it and lift the cheeks and they’re seeing great results with that. But that’s just weight loss.
Dr. Houssock (28:33):
Yes, it’s weight loss,
Lindsey (28:34):
Doesn’t matter.
Dr. Houssock (28:35):
We’ve just gotten really good at it. As a society we’ve all of a sudden gotten really good at weight loss, something that we’ve been fighting and fighting and fighting for decades. This medication has allowed it to be doable for many people. And because of it, we’re seeing it. And unfortunately, I tell all my weight loss patients says, you don’t get to choose where the weight loss happens, so you’re going to lose it in the spots that you may not want to in the face. You may lose it in the butt, you may lose it, you might lose it in the boobs. Unfortunately, wherever we carry fat, you’ll lose it. And so you may need augmentation in those areas. And Lindsay’s seeing that more and more in her facial, her facial cases. And then they sometimes get to the point where they’re so extreme that they may need a facelift early.
(29:18):
And we did a recent podcast talking about face and how what’s too young for a facelift? Well, that whole thing is thrown out the window because now we’re seeing young patients who are losing a hundred pounds, and unfortunately for them that means sometimes extra skin in that area. And so we are finding that we’re needing to facelift earlier because their skin is there, they’ve lost all this weight. It happens. Then there’s body contouring portion of this where you just have a lot of skin. What we say in general is you should be stable in your weight for a good six months, six to 12 months before we think about operating, because number one, we want to make sure you’re stable and you’re not losing more because you wouldn’t want to go through removing skin and then you have more skin. But we also don’t want to see you gaining it very quickly back too. And then you’ve gone through this procedure and then you’re kind of back to square one. So we like stability both ways. No longer losing but also not gaining. And that’s within 10 ish pounds. You’re never going to stay at the exact weight. No, that’s not going to happen. Even when Lindsey looks at her successes as far as the medication goes within a 10 pound range is very reasonable. You’re going to have that, which goes back to the who’s a candidate for this GLP-1. If you’re trying to just lose 10 pounds, keeping that 10 pounds off, it is tough. Five to 10 pounds is a toughie When you’re thinking about this medication, you come in and you need to lose 30 pounds. This is going to be for you and it’s going to do great and you’re going to do well.
Lindsey (30:55):
Now what about people who for surgery, they may be a good candidate to do this first?
Dr. Houssock (31:01):
Yeah.
Lindsey (31:02):
Who are those people?
Dr. Houssock (31:02):
That’s a great point too. There is a group. So let’s say a patient comes in and wants maybe a tummy tuck and they come in and see me first. They don’t even think about the medication,
Lindsey (31:12):
Not on their radar.
Dr. Houssock (31:12):
Right. They just want a tummy tuck. And so I see them and a candidate of that would be maybe somebody who still has a little bit too much adipose tissue or fat in the belly where if I’m going to go and do that tummy tuck, it’s really not going to hit that inner abdominal fat below the muscles. So we work on everything on the exterior. I can liposuction that, I can remove skin, but if someone is generally still overweight, they also harbor fat or adipose tissue around their organs and we can’t get to that. And that actually can make you look quite round even after I do my tummy tuck. So those patients, if they haven’t, I always ask, where are you in your, have you tried losing weight? Where are you? Depending on where they are in that whole journey? Most of the time they haven’t tried or they have tried and they weren’t successful. I’ll mention these medications to them and say, listen, I think your result will be optimized if we work on some of that intra abdominal or peri organ fat before we get into the OR, because I’ll be able to give you a better result overall.
(32:17):
And so those patients are really, they do really well if we give them an opportunity to do that. And so before ozempic and before these medications, I used to say, I want you to take 12 weeks, go out, do the best you can with diet and exercise. And I always was very clear that I didn’t have an overall goal for them, but I wanted them to try their best. And the best is different for everybody and only if you’ve given it your whole self. That used to be the conversation. Now I’ll say there’s that of course, and that is a great way to do this. But we also have the addition of these medications now, which can kickstart you as well and work in synergy with that diet and exercise. And if they’re interested, they can talk to Lindsey about it. And they do. And it works out really well. I mean, some patients end up not being surgical candidates, actually. They might’ve come in for lipo and they go to Lindsey and that’s it. Or we’ll work in tandem. We’ll plan to start them on the tirzepatide, and at the same time we’re going to do some lipo contouring and they work together to give them a little bit of confidence and kind of a kickstart to their weight loss. And that’s been very successful for us too.
Lindsey (33:27):
It has. And I think people like how their clothes fit differently almost immediately after the lipo, and then they sort of keep going.
Dr. Houssock (33:34):
Yes.
Lindsey (33:34):
It’s like a little jumpstart to their journey. And I think Lipo has a nice role in that.
Dr. Houssock (33:39):
Yeah. So let’s talk about that. So let’s say we have a patient that we share together. They’re about to go to the OR where does the GLP-1 go with my surgery? How do we limit them and whatnot?
Lindsey (33:50):
Well, we’re going to hold it before surgery. That’s it. Just you have to, and then usually we’re okay starting them back on it pretty quickly after surgery, but we want to wait a little while. So we want to give you a couple weeks after surgery. I do want you eating after surgery. So the other side of it is, I don’t want to take your appetite completely away. You need it to heal. So usually it’s a few weeks either way before and after, and then you’re good to keep going. Most of the time, that means you just keep your vial in your fridge and then when you’re given the all clear to go ahead and restart, you just restart.
Dr. Houssock (34:21):
Yeah, no big deal. It’s obviously a little bit panicky for patients when you’re like, you’re stopping my medication. But swear to you, I’ve never yet seen a patient who’s gained a significant weight in between that time period. We’re only talking about a month, so two weeks before and two weeks after. And their reasons are different. The two weeks before is because I want to make sure that you are optimized, but also that your transit time is slower in your tummy. So we don’t want you to have any food in your stomach the day of the operation. So that’s number one. And then on the other side, just like she said, we want you eating. We want you healing. And if you don’t eat optimally, it could be a problem. The one thing that we really want to hit home about this weight loss is that just like she had mentioned, the weight loss is universal. It doesn’t care whether it’s fat or muscle. And so we really, really have to push hard and home that the fact that your protein has to be a priority through every meal. You’re not going to want to eat a lot. And if you’re only eating a little bit of carbohydrate on a daily basis, you’re actually going to be at such high risk for losing more muscle mass than fat. So prioritizing your protein at every meal is an absolute must, right?
Lindsey (35:30):
Yep. Yeah. And it can be that you’re just eating chicken,
Dr. Houssock (35:33):
Correct.
Lindsey (35:34):
I don’t care. But you got to be getting something in.
Dr. Houssock (35:36):
Yeah. And your diet, your appetite’s not going to feel like eating it. So this is going to be a little bit of a push for all patients who are on their GLP-1s at the time, but it’s absolutely paramount to get the optimum result. And we’re talking, the data’s all over the place, but generally speaking, you’re really shooting for a gram of protein per pound that your ideal weight is. So if your ideal weight is 150 pounds, you should be having 150 grams of protein a day. That’s a lot of protein. And when you’re on these medications, it may be pretty much all you’re eating. We are not saying we don’t want eating carbs,
Lindsey (36:08):
No.
Dr. Houssock (36:08):
We do, but we want you prioritizing your protein for sure.
Lindsey (36:12):
Absolutely. And sometimes also fiber for the side effects of constipation. And so many times I’ll recommend people get a small protein and a small fiber bar, something you can keep in your purse and have little tiny, small meals throughout. And it’ll add up. It will add up, but you got to be able to get that in. So even if that means, all right, well, I’m driving for, I think I could get that little bar in. Okay, go ahead. Do it. Because likely you might not eat as much as you’re thinking you’re going to eat throughout the day.
Dr. Houssock (36:38):
Right, right. It’s interesting. It’s kind of a counterintuitive thing where we need you to eat, but also you’re not going to want to eat. So it’s tough. It really is, but it’s doable. And the most successful are those who prioritize appropriately. So let’s say they’re, they’re at their goal weight Linds. We’ve made it, we’ve done it. I feel good. What happens now?
Lindsey (37:02):
Well, we’ve got a couple options on maintenance dosing, and this is something that everyone has done something slightly different. And I’m okay with that because it’s a conversation point. So everyone does a little better on one or the other. So we either keep you at your same dose and start spacing out the time in between your doses. So let’s say you’re on our 0.63 dose and you’re going to do that now instead of every week, every other week, then you’re going to do it every third week. Then you’re going to lower your dose to the half dose of that 0.31, and you’re going to do that every three weeks.
Dr. Houssock (37:35):
You’re just monitoring their weight through this. And we’re basic, basically, we’re just watching.
Lindsey (37:38):
Yeah, and how hungry are you? And so some people will space out that higher dose and say, well, I had more side effects that way. Alright, well let’s space out the lower dose then. So let’s drop you down to the lower dose. Try that every week for a while and then we’ll start spacing it out. And sometimes people tolerate that better. And so it’s all a conversation point and there’s no hard and fast rule of how you have to do it. But the goal is I want to get you down to the lowest dose possible and hopefully maybe once a month you’re doing that. And then hopefully you get to a point where you don’t need to be on it anymore and you’re just cruising.
(38:16):
Right. That’s probably different for everybody. And that’s still, we are treating, treating many different body types with the same medication. And so when you look at it that way, you have to think not everyone’s journey will be the same. Some especially diabetics may need this for the rest of their life at a small microdose and it might be forever. Just like you take a hypertensive medication, high blood pressure medication, you may need this. And we don’t know yet because unfortunately we’ve discovered this medication works really well for many people, but unfortunately we’re still kind of in the early phase of using on so many different patient types. So I do think we’ll get better at this as a society, as medical society, we’ll learn it. But for right now, like Lindsey said, it’s not the same for everybody. And you may need to be on it forever, you may not. And we are trying to figure that out. But her goal always is the lowest dose possible to keep you where you want to be safely and also health wise, but also give you back the appetite so you could live a fruitful life.
(39:20):
And I tell people all the time, I’ve got two patients now that are traveling and a patient that traveled a few weeks ago, I said, hold your dose. Go on your trip. I mean, nothing is going to dramatically change in your weekend trip or your two week trip. I’ll see you when you get back. Go enjoy your time, especially when you’re going somewhere with really good food. Go eat the food. It’s okay.
Dr. Houssock (39:42):
Yep, totally.
Lindsey (39:43):
And you’re doing usually so much walking, so much other things while you’re traveling that you’re fine, you’re fine. So it’s also something that you can start, stop as you need to. So it’s something that you can adjust. And it is a okay to do that.
Dr. Houssock (39:57):
Right? If you get sick, you probably don’t want, you got the flu, you probably want to hold that week because you’re going to want to be able to just let your body focus on getting in what it needs to get.
Lindsey (40:06):
Yes, a hundred percent. So I do like that aspect of it in that we can kind of customize to what’s going on. It’s not something that you’re going to lose all your progress in one week. It just doesn’t happen.
Dr. Houssock (40:16):
No, it’s science, just like anything else. We’re trying to fine tune it. We’re trying to figure it out. It’s going to continue to get better and better and streamlined and it’s very exciting. It can be scary because you see all of this that they’re trying, there’s a lot of regulation. I think people just don’t know what’s going to happen yet. But we do know that it’s effective and it’s here to stay. I mean, there’s no question it’s here to stay. I think we’ll continue to learn more about it and its side effects and the proper way of using it. For now, we’re just very conservative about it because we want to make sure that we keep you safe.
Lindsey (40:47):
Yes. Hundred percent.
Dr. Houssock (40:48):
Than anything else. So at the end of the day, we think it is an absolute important part of weight loss in today’s world and society. We support it. What we don’t support is its misuse. And unfortunately that’s going to be continued to have to be monitored. And as the patient, your probably best thing you can do for yourself is just make sure that you’re going to somebody reputable who’s educated. Talk a little bit about the education you have, Lindsey, since you are a primary care nurse practitioner, what are you a member of and what kind of education have you had on obesity and weight loss?
Lindsey (41:28):
Technically, I’m a family nurse practitioner, which means I take care of patients across the lifespan, babies all the way up to adults. So that was my training. A member of ANP, the Society of Nurse Practitioners. And then when we started this journey and we talked about starting weight loss here, I was like, well, I need to learn more about it and I need to have the data of what is currently going on. Of course, we covered in school, but we’re covering it for diabetes. And I’ve gone to conferences where we talk about GLP-1s for diabetes because it’s primary care. That’s what we’re using it for. We’re not seeing people for weight loss. So I joined Obesity Medicine Association, which is a national organization that focuses on obesity treatment. So whether it’s GLP-1s, whether it’s other medications, whether it’s surgery, so you’ve got surgeons in there, you’ve got nurse practitioners, PAs, all kinds of people in that organization with tons of good information.
Dr. Houssock (42:22):
So highly recommend finding someone who’s part of that, who who’s doing this, because it really helps so much in our practice. My training is plastic and reconstructive surgery. And so while I see weight loss patients all the time, when you get down to the nitty gritty, you need someone who specializes in this and has the education in it. And so make sure when you are diving in, if you’re excited to learn more about it, you’re going to someone who knows what they’re talking about.
Lindsey (42:50):
Absolutely. And I think the other thing, we see this all the time with our fillers, with everything else. If someone tells you no, there’s probably a reason that we’re telling you no. I don’t take turning people away lightly. But sometimes I really think it’s best based on our assessment and what you’re coming in with and what your goals are to tell you this probably isn’t a good fit for you. And there’s a reason. And I always share those reasons, and most patients completely at that point are, oh, I totally get that. That makes sense. But if you go somewhere and someone does say no, there’s probably a reason.
Dr. Houssock (43:23):
Yeah, totally. It’s like bad plastic surgery. You’ll find someone to operate on you anywhere, even if it’s not right for you. You’re going to find, unfortunately, in this world, and especially with this medication, somebody will prescribe it to you if you push hard enough, even if you’re not the best candidate. So keep that in mind. Go to someone reputable who’s going to tell you what you really need and the truth
(43:43):
To keep you safe and really most successful. Because if we’re saying no, there may be another way that’s better for you to lose weight or it might be a danger to you for you to be on this medication. So those are the two reasons we’re going to turn you away, and ultimately we take that seriously.
Lindsey (43:59):
Absolutely.
Dr. Houssock (44:00):
Alright, Linds, very good topic. Carry on.
Lindsey (44:02):
Carry on. Dr. Houssock.
Dr. Houssock (44:03):
Perfectly Imperfect is the authentically human podcast. navigating the realities of aesthetic medicine. Got a question for us? Leave us a voicemail at perfectlyimperfectpodcast.com. JEV Plastic Surgery is located in Owings Mills, Maryland. To learn more about us, go to JEVplasticsurgery.com or follow us on Instagram @DrCareHoussock, spelled D-R-C-A-R-E-H-O-U-S-S-O-C-K, or just look in the show notes for links. If you enjoyed this episode, please share it and subscribe to Perfectly Imperfect on YouTube, apple Podcasts, Spotify, or wherever you’d like to listen to podcasts.