Jan. 7, 2025
Weight Loss Medications and Beyond
We’re in a new era of obesity medicine, where innovative medications are transforming weight management.
Dr. Bass shares the latest updates since our last weight loss episode, including new brands, ongoing shortages, and insights into their long-term effects, like whether people regain weight after stopping these medications.
This wave of weight loss is also reshaping the aesthetics industry. Surgical procedures like liposuction and skin removal, along with non-surgical options like RF microneedling, are becoming increasingly popular as people refine their bodies after shedding pounds.
Find out:
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Are compounded medications safe?
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How can you ensure your prescriptions come from a reliable pharmacy?
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Why does losing muscle instead of fat pose serious risks?
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How do these advancements impact bariatric surgery’s role?
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Do studies confirm rebound weight gain after stopping medication?
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What are Dr. Bass’ predictions for the future of weight loss medicine?
Links
- Learn more about tummy tuck and liposuction
- Learn more about Ultherapy and SculpSure
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
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Welcome to Park Avenue
Plastic Surgery Class,
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the podcast where we explore controversies
and breaking issues in plastic
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surgery. I'm your co-host, Summer Hardy,
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a clinical assistant at Bass
Plastic Surgery in New York City.
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I'm excited to be here with Dr. Lawrence
Bass Park Avenue plastic surgeon,
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educator, and technology innovator.
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Today's episode is Weight
Loss Medications and Beyond.
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You've talked about this topic before
on the podcast, haven't you, Dr. Bass?
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That's right, Summer. I have.
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But here we are again. So there
must be some new information.
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What are the updates?
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Our last episode on this
topic released in November of
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2023,
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right at the point where
FDA approved Zepbound.
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Today, I'd like to update on new
medications that may be coming,
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medication shortages,
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and what we've learned about how these
medications performed since our last
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episode.
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Okay, let's take those
one at a time. First,
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what have we learned about the amount of
weight loss and the stability after the
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medication?
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So just to back up for a second,
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these are a group of medications
which stimulate different
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receptors.
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The main group stimulate
glucagon-like peptide one
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receptors and
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Mounjaro or Zepbound
also stimulates a second
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receptor,
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glucose-dependent
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insulinotropic
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polypeptide
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So GLP-1 and GIP for short.
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So those medications, and
these are the main ones.
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And we talked in previous
episodes about some of the others.
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That main one is semaglutide.
That's the generic name,
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which goes by the brand name,
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Ozempic for diabetes treatment and Wegovy
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for weight loss treatment.
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And it has specific FDA approvals
for each of those things in certain
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circumstances.
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And the second main medication
nowadays is tirzepatide,
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which goes by the brand name
Mounjaro for diabetes treatment
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and Zepbound for weight
loss. And on average,
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15% of your weight can be lost on Wegovy
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and 20% on Zepbound in a typical
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six month course of medication.
So a
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15% weight loss if you weigh 200 pounds,
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puts you down to 170 pound and
a 20% weight loss would put
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you to 160 pounds. That's
quite a lot of weight loss.
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That's very difficult
to do with diet alone.
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But we've learned some things
about these medications, as I said,
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since we last ran an episode,
and this isn't the final answer,
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but this is an update on where
things stand now. So as I said,
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you can lose up to 15%
body weight on a course
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of Wegovy, Ozempic,
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but sometimes it's less than
that. And not only that,
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but about 15% of patients
can be non-responders.
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So they take the medication
and they don't lose weight.
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So that's the bad news.
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The good news is people who are taking
medications for weight loss seem to do
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better at losing weight than people
who are taking them for diabetes.
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But I pointed out very clearly
on the previous episode,
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and we now have more study data that
we didn't know how much rebound we were
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going to get when you
go off the medication.
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But we now have some study data
that answers that question.
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And that's a big deal because think
about it, when you go on a diet,
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sometimes it's really
hard to lose the weight,
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but even if you succeed in losing weight,
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you often rebound back to where you
started when you go off the diet.
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That doesn't happen overnight, but
over a few months it certainly does.
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And so in one study that looked
at this issue with semaglutide,
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the medication in Ozempic,
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in patients who were
trying to lose weight,
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because that's a different study group
than patients who have diabetes who stay
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on the medication to manage
their diabetes. So this group,
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on average lost the predicted amount of
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weight on average in that 15% range.
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It was actually 17% in
this particular study,
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but about two thirds of that
weight came back within a year
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after stopping the medication.
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So that tells us that we
may need to stay on it or we
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may need some kind of a
maintenance dose and where
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we need more studies to
confirm this kind of result.
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But it's been clear that there's
some rebound when going off the
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medication.
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So given the shortage of the
pharmaceutical manufactured product,
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what are the alternatives?
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As I mentioned in terms of things
I wanted to put in this update,
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I did want to discuss shortage
because a lot of people in
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the United States of America and
around the world have non-insulin
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dependent diabetes,
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and a lot of them are
now being treated with
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Ozempic or Mounjaro.
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And there are some other
medications being used as well,
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but have become very popular.
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And that alone has created a shortage.
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And then added to that is
the need for more of the
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medication for treatment of obesity.
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And on top of that,
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some people who are not obese but
are having trouble losing weight are
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taking the medication as well.
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So there is a shortage and it can
be difficult to get a supply of the
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medication. The medication
is also quite expensive.
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A thousand dollars a month is a
typical number can be as high as
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$1500. And even if your
insurance is covering it,
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you may be paying several hundred
dollars a month, three to five hundred,
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to be on these medications.
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And that's a big deal if you think
about that cost at the end of the year.
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So one of the alternatives
is to obtain the same
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kind of medications, not
from the main manufacturers,
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Eli Lilly and Novo Nordisk,
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but from compounding
pharmacies that make the same
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medication, but not
through the FDA-approved,
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FDA clinical trial studied process.
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Is compounding safe?
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So that's the key question because
I just said it's not that FDA
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process in terms of everything about the
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medication.
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And the FDA approved medication
goes through typically half a
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dozen to a dozen clinical
trials before it's FDA approved
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and has all kinds of studies done.
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And the FDA looks at every
phase of the production
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of that medication, the distribution,
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the plants that it's made in or inspected
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by FDA and so forth.
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So that's our best assurance of quality
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compounding pharmacies or
pharmacies that make medications.
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And in particular,
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this is used in circumstances like
this where there's a shortage.
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So they make essentially a
generic equivalent. But again,
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they're not even a generic
pharmaceutical manufacturer.
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They're a pharmacy and that
simplifies who they are
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because they're bigger than
your neighborhood pharmacy.
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But they're preparing a medication for
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use by prescription
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just like other prescription medications
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where there's a shortage and
you can't readily get it from a
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regular pharmacy.
Now it's kind of a little more complicated
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than that because if you are
getting a medication by mail order,
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that may not even be coming
from a compounding pharmacy.
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It's not clear where it's coming from.
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If you're getting a medication
without a prescription,
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you should be highly suspicious that
this may not be a legitimate pharmacy.
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So there are all kinds of medications
because of the popularity of
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Ozempic and Mounjaro that purport to be
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generic equivalents but
are really counterfeit.
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If you're being treated by a
physician in a weight loss program
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in the physician's practice,
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then it's their job to do the due
diligence if they're treating you with the
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medication of getting it
from an appropriate pharmacy.
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And there are different categories
of compounding pharmacies.
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So there are 503A pharmacies and 503B,
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503B pharmacies are actually inspected by
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FDA and FDA holds them
to good manufacturing
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practices the same way it
holds pharmaceutical companies.
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And so there's more
oversight of 503B pharmacies.
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But given the shortage
of these medications,
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the compounding route offers a greater
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supply to help us meet the
clinical needs of patients
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until it's more readily available
or more price approachable.
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Okay. So what do you see for
the future of weight loss?
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So likely,
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this is me looking in the crystal ball.
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And so we can never say
what FDA is going to do.
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They're going to base that on the
clinical data that they receive,
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and we can't say for sure how
clinical studies are going
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to work out,
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but it's pretty clear that
a few things are likely and
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likely very soon. And when I say soon,
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I mean sometime in the next year,
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not talking about something that's
five or 10 years down the line,
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but in the next year or
next two years at the most,
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we'll almost certainly have instead of
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injectable medications,
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because currently Ozempic and Mounjaro are
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injected once a week,
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we will likely have oral
versions of the GLP-1
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receptors.
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We will likely have medications
that target other receptors besides
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GLP-1.
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And the biggest thing that I
think is going to be the focus
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of obesity treatment in the future
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is it's going to be
about fat loss more than
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weight loss.
Currently,
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these medications are demonstrating in
their clinical studies that when someone
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stands on the scale,
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the number goes from a higher number
to a lower number, you've lost weight,
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and that's a good thing. We always
feel happy when we lose weight,
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but what we really want to lose is fat.
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And there's a lot of reasons
why we don't like fat.
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We don't like fat because we don't
like how we look in clothing.
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We can't get into the clothing that we
used to get into maybe if we've gained
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weight. Fat also,
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metabolically drives illnesses
like hypertension and
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diabetes,
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which are two massively common chronic
illnesses in the United States.
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So there are a lot of reasons
why we don't like fat,
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but we'd like to keep our
muscle. And in reality,
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when we go on a diet, for
example, and lose weight,
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we lose some fat and some muscle,
and we're hoping it's mostly fat,
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but muscle is hard to
get back, and as you age,
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we naturally lose some muscle anyway.
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This is a condition called sarcopenia,
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which just means a low amount of
muscle because we're losing it with
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aging and we don't want to
amplify that as part of weight
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loss programs.
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So likely in the future there'll
be a focus on figuring out
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how to help people lose fat and preserve
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muscle.
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Where does all this progress with
pharmaceuticals leave bariatric surgery?
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So we discussed on the last podcast
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that a few years ago,
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the indications for bariatric
surgery were greatly expanded
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and there was a refinement
and how bariatric
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surgery was done many years ago
when this was mostly converted
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about 20 years ago,
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a little more to being done
laparoscopically instead of with
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open surgery.
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So that was a big growth
and expansion for bariatric
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surgery and to finally
redefine definitions of who was
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appropriate for bariatric surgery.
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That hadn't changed since
sometime in the 1990s,
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but at this time,
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these non-invasive pharmacologic options
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really despite some side effects,
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and we talked about those
on the last podcast,
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still don't have the major life
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impact of having a surgery
like bariatric surgery.
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And so these seemingly,
despite any disadvantages,
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are much more popular both
with physicians and with
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patients.
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So there's likely to be a
reduced role for bariatric
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surgery, although
certainly not eliminated.
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00:15:02,750 --> 00:15:07,670
And currently the amount of weight
loss typically with bariatric
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00:15:07,680 --> 00:15:12,410
surgery remains greater than the
amount of weight loss that could be
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00:15:12,410 --> 00:15:16,610
expected on average
with these medications.
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00:15:17,300 --> 00:15:21,440
Despite that there's a rebound
rate with bariatric surgery,
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00:15:21,440 --> 00:15:23,360
just like with these medications.
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00:15:23,360 --> 00:15:27,170
So you don't keep a hundred
percent of the weight loss off,
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but
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00:15:31,700 --> 00:15:36,590
we don't tend to see as
many non-responders as you
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00:15:36,590 --> 00:15:40,850
see with something like Ozempic
where we said there was that
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00:15:40,850 --> 00:15:43,160
15% non-responder rate.
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00:15:44,180 --> 00:15:46,640
Now that you've explained
bariatric surgery,
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where does that leave plastic
surgery options like liposuction?
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00:15:51,050 --> 00:15:51,830
So okay,
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00:15:51,830 --> 00:15:56,600
now we get to go back to my
field where we're talking about
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00:15:56,600 --> 00:16:01,520
beauty and plastic surgery
because it's important to
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00:16:01,520 --> 00:16:05,720
realize that weight loss is about health.
250
00:16:06,620 --> 00:16:09,890
It's not about body contouring. Of course,
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00:16:09,890 --> 00:16:13,490
if we lose a lot of
weight or smaller thinner,
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00:16:14,150 --> 00:16:17,690
we like that shape better.
It contributes to our beauty,
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00:16:17,690 --> 00:16:22,640
but it's really a health
issue in these medications or
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00:16:22,640 --> 00:16:27,560
our proof for treatment of obesity
where the amount of excess weight
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00:16:27,560 --> 00:16:31,580
is at a level where it
impacts health and wellbeing.
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00:16:33,260 --> 00:16:36,200
So there's a lot of
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00:16:37,730 --> 00:16:42,560
lessons in body contouring
that have grown out
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00:16:42,560 --> 00:16:46,700
of the bariatric surgery past 20 years.
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So
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00:16:50,150 --> 00:16:53,720
we treat people who've
lost a lot of weight
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00:16:54,830 --> 00:16:59,210
with a range of plastic surgery
treatments because there are
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00:17:00,650 --> 00:17:03,260
unfinished business, so to speak,
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00:17:03,800 --> 00:17:08,060
even after you've lost a
massive amount of weight.
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And all of the plastic surgery options are
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00:17:11,090 --> 00:17:12,800
still appropriate,
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00:17:13,130 --> 00:17:18,050
preferable for certain body shaping
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00:17:18,050 --> 00:17:21,800
applications.
If you're already at a normal weight,
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00:17:21,830 --> 00:17:25,460
if you're at a normal or maybe
even an ideal body weight,
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00:17:25,850 --> 00:17:29,930
you don't want to lose a lot of weight
because now you're losing muscle
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00:17:30,470 --> 00:17:33,230
and not much fat with it.
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00:17:34,070 --> 00:17:36,170
So that hurts you more than it helps you.
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00:17:36,530 --> 00:17:40,430
And there are certain areas of the body
that just tend to have bulges that are
273
00:17:40,430 --> 00:17:44,750
formed by fat that don't
respond well to diet and
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00:17:44,750 --> 00:17:47,180
exercise. Love handles,
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00:17:47,180 --> 00:17:50,490
the outer thigh area or
saddle bags are two typical
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00:17:50,490 --> 00:17:54,750
areas that just don't diet
and exercise off very well.
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00:17:55,200 --> 00:17:57,510
So even despite being at ideal weight,
278
00:17:57,540 --> 00:18:01,530
there are many people with fatty contours
there that they don't like and that
279
00:18:01,530 --> 00:18:06,510
don't show well in clothing. So that's
ideally what liposuction is for.
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00:18:06,840 --> 00:18:11,610
And to a lesser extent, the nonsurgical
options. If the area is small,
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00:18:11,970 --> 00:18:13,920
things like CoolSculpting and SculpSure
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00:18:16,350 --> 00:18:20,970
can knock down those areas a little bit.
But the weight
283
00:18:20,970 --> 00:18:25,710
loss patients likewise
are still going to need
284
00:18:27,060 --> 00:18:29,040
some shape adjustment.
285
00:18:29,040 --> 00:18:33,730
There may be residual shapes
even if they lose weight going on
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00:18:34,440 --> 00:18:37,950
Ozempic or Ozempic-like medications.
287
00:18:39,180 --> 00:18:42,750
So there's still a role for
liposuction, and in fact,
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00:18:43,140 --> 00:18:47,940
if people have gotten goods, they
often want to finish the job.
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00:18:47,940 --> 00:18:49,950
And so in fact, on some level,
290
00:18:50,310 --> 00:18:54,120
it amplifies the volume of
those procedures going forward.
291
00:18:55,530 --> 00:19:00,240
The other issue that arises
when we start to think about
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00:19:01,020 --> 00:19:05,820
significant weight loss
is loose skin and the
293
00:19:05,820 --> 00:19:10,740
skin will tailor to an extent
when you diet and when you have
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00:19:10,740 --> 00:19:13,830
liposuction. But if
you lose enough weight,
295
00:19:13,920 --> 00:19:17,040
there is substantial
extra skin. And again,
296
00:19:17,130 --> 00:19:19,740
this is a lesson that was known,
297
00:19:19,740 --> 00:19:24,480
but that a great deal of experience
was gained after bariatric
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00:19:24,480 --> 00:19:27,570
surgery became more mainstream.
299
00:19:28,320 --> 00:19:32,640
And many patients who have had
massive weight loss need skin excision
300
00:19:32,640 --> 00:19:36,480
procedures, skin removed from arms,
301
00:19:36,480 --> 00:19:40,440
tummy area, chest, waist, thighs,
302
00:19:40,950 --> 00:19:45,480
and sometimes again with
more modest weight loss,
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00:19:46,170 --> 00:19:50,820
that can be dealt with
without actual surgical skin
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00:19:50,820 --> 00:19:55,500
excision.
But with energy devices like RF
305
00:19:55,500 --> 00:19:59,810
microneedling, Ultherapy, TempSure,
306
00:19:59,810 --> 00:20:00,840
things that sculpt,
307
00:20:00,930 --> 00:20:04,710
things that put energy into
the skin and stimulate some
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00:20:05,460 --> 00:20:08,910
smoothing, tightening,
remodeling of that skin.
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00:20:09,630 --> 00:20:11,940
And there are even injectable
techniques like Hyperdiluted Radiesse
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00:20:13,680 --> 00:20:18,360
where a very diluted filler that is what's
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00:20:18,360 --> 00:20:20,790
called an active dermal matrix filler,
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00:20:20,790 --> 00:20:24,330
one that stimulates collagen
production in the skin,
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00:20:24,690 --> 00:20:29,670
can help stimulate a little
smoothing of skin that's
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00:20:29,670 --> 00:20:31,560
modestly loose.
315
00:20:31,980 --> 00:20:36,720
So all of those things
are also part of what's
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00:20:36,720 --> 00:20:41,700
needed after weight loss
and also as a part of aging,
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00:20:42,300 --> 00:20:46,710
and that is going to have
a growing role as these
318
00:20:46,720 --> 00:20:48,850
medications become more popular.
319
00:20:50,290 --> 00:20:52,390
Before we wrap up this episode,
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00:20:52,390 --> 00:20:55,990
can you share any important takeaways
with our listeners, Dr. Bass?
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00:20:56,590 --> 00:21:01,420
We're at the dawn of a new era
where pharmacologic approaches
322
00:21:01,690 --> 00:21:06,670
are at the forefront of
obesity medicine as well as
323
00:21:06,670 --> 00:21:11,380
the forefront of weight management.
Even for non-obese individuals,
324
00:21:12,220 --> 00:21:14,710
diet and exercise are not done.
325
00:21:15,130 --> 00:21:18,130
They're still an important
part of health and wellbeing.
326
00:21:18,610 --> 00:21:22,660
And bariatric surgery
likewise, is not done.
327
00:21:23,470 --> 00:21:24,580
However,
328
00:21:25,210 --> 00:21:29,560
every time there's a paradigm
shift or a major new innovation,
329
00:21:30,010 --> 00:21:34,450
all of the options most of
the time stay on the table,
330
00:21:35,530 --> 00:21:38,650
but the pie gets sliced
up a little differently.
331
00:21:38,650 --> 00:21:42,460
The role for each option
shifts and adjusts.
332
00:21:43,120 --> 00:21:45,850
So all of these things
are still important.
333
00:21:45,850 --> 00:21:49,600
A multimodality approach
probably gets you there best.
334
00:21:50,050 --> 00:21:55,030
That's very clear with these
GLP-1 medications that using
335
00:21:55,030 --> 00:21:59,260
the medication in
combination with some dietary
336
00:21:59,260 --> 00:22:03,700
management and an active lifestyle greatly
337
00:22:03,730 --> 00:22:07,600
improves the chances that you're
going to achieve your goals.
338
00:22:08,800 --> 00:22:12,370
So body contouring and skin treatments,
339
00:22:12,370 --> 00:22:17,110
the plastic surgery side
of it are not really weight
340
00:22:17,110 --> 00:22:21,850
loss themselves.
They're part of the beauty or appearance
341
00:22:21,850 --> 00:22:24,670
side of it, but they're
going to play an increase,
342
00:22:24,670 --> 00:22:29,350
not a decreased role to
finalize and perfect the
343
00:22:29,350 --> 00:22:33,040
changes that are started
by the weight loss,
344
00:22:33,070 --> 00:22:35,320
whatever modality you're pursuing,
345
00:22:35,920 --> 00:22:38,080
and that's the same as it ever was.
346
00:22:39,550 --> 00:22:43,480
We've already seen this in the massive
weight loss patients after bariatric
347
00:22:43,480 --> 00:22:44,313
surgery.
348
00:22:44,440 --> 00:22:49,330
And the same will be true with the
more moderate weight loss that's
349
00:22:49,330 --> 00:22:52,360
seen with these new GLP-1 medications.
350
00:22:53,140 --> 00:22:58,000
The biggest unknown is the mix
of surgical and nonsurgical
351
00:22:58,000 --> 00:23:02,470
treatments for chasing these
residual unwanted shapes.
352
00:23:03,130 --> 00:23:05,350
The bulges of fat and the love handles,
353
00:23:05,350 --> 00:23:10,030
the saddle bags and the looser
crepey skin that remain after weight
354
00:23:10,060 --> 00:23:14,050
loss. So this was the
original role of liposuction,
355
00:23:14,050 --> 00:23:18,790
contouring unwanted shapes made
of fat in people at ideal body
356
00:23:18,790 --> 00:23:19,623
weight,
357
00:23:19,780 --> 00:23:24,640
but it's in recent years
played a growing role
358
00:23:24,640 --> 00:23:28,900
in people after weight loss as well.
And both
359
00:23:28,930 --> 00:23:29,730
categories,
360
00:23:29,730 --> 00:23:34,510
the surgical and nonsurgical are going to
361
00:23:34,510 --> 00:23:37,720
have a role in these post weight loss
362
00:23:37,720 --> 00:23:42,700
patients again, however they
managed to lose the weight.
363
00:23:43,330 --> 00:23:47,990
So selecting the best option
requires that relationship with an
364
00:23:47,990 --> 00:23:52,850
experienced plastic surgeon who's up
to date on the latest capabilities and
365
00:23:52,850 --> 00:23:57,650
technologies and can put together
a program for you to get to
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00:23:57,650 --> 00:24:00,530
your best appearance after weight loss.
367
00:24:01,880 --> 00:24:05,150
As you can see, this area
is undergoing rapid change.
368
00:24:05,150 --> 00:24:08,120
We're learning a lot in
a short amount of time,
369
00:24:09,080 --> 00:24:13,880
and this will continue to evolve
as we look increasingly at
370
00:24:13,880 --> 00:24:16,460
muscle maintenance and restoration,
371
00:24:16,940 --> 00:24:21,830
both in aging patients and
in patients who have lost
372
00:24:21,830 --> 00:24:22,670
a lot of weight.
373
00:24:23,600 --> 00:24:28,550
The future is going to be
focused on fat loss with muscle
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00:24:28,550 --> 00:24:29,383
maintenance.
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00:24:30,110 --> 00:24:30,770
Wow,
376
00:24:30,770 --> 00:24:34,340
those are really interesting points that
I didn't think about when looking at
377
00:24:34,340 --> 00:24:37,310
the number on my scale.
Thank you, Dr. Bass,
378
00:24:37,310 --> 00:24:41,000
for sharing your expertise and
updating us on this rapidly changing
379
00:24:41,000 --> 00:24:45,830
subject. Thank you for listening to
the Park Avenue Plastic Surgery Class
380
00:24:45,830 --> 00:24:48,590
podcast. Follow us on Apple Podcasts,
381
00:24:48,650 --> 00:24:50,900
write a review and share
the show with your friends.
382
00:24:51,080 --> 00:24:54,590
Be sure to join us next time to avoid
missing all the great content that is
383
00:24:54,590 --> 00:24:58,130
coming your way. If you want to
contact us with comments or questions,
384
00:24:58,130 --> 00:24:59,360
we'd love to hear from you,
385
00:24:59,450 --> 00:25:04,100
send us an email at
podcast@drbass.net or DM us on
386
00:25:04,100 --> 00:25:05,780
Instagram @drbassnyc.
00:00:01,020 --> 00:00:03,900
Welcome to Park Avenue
Plastic Surgery Class,
2
00:00:04,080 --> 00:00:08,070
the podcast where we explore controversies
and breaking issues in plastic
3
00:00:08,070 --> 00:00:11,010
surgery. I'm your co-host, Summer Hardy,
4
00:00:11,070 --> 00:00:14,490
a clinical assistant at Bass
Plastic Surgery in New York City.
5
00:00:14,970 --> 00:00:19,440
I'm excited to be here with Dr. Lawrence
Bass Park Avenue plastic surgeon,
6
00:00:19,500 --> 00:00:21,630
educator, and technology innovator.
7
00:00:22,350 --> 00:00:25,650
Today's episode is Weight
Loss Medications and Beyond.
8
00:00:27,030 --> 00:00:30,480
You've talked about this topic before
on the podcast, haven't you, Dr. Bass?
9
00:00:31,140 --> 00:00:33,060
That's right, Summer. I have.
10
00:00:33,510 --> 00:00:36,750
But here we are again. So there
must be some new information.
11
00:00:36,840 --> 00:00:37,950
What are the updates?
12
00:00:38,640 --> 00:00:43,050
Our last episode on this
topic released in November of
13
00:00:43,050 --> 00:00:44,370
2023,
14
00:00:44,970 --> 00:00:48,840
right at the point where
FDA approved Zepbound.
15
00:00:49,740 --> 00:00:54,300
Today, I'd like to update on new
medications that may be coming,
16
00:00:54,840 --> 00:00:56,430
medication shortages,
17
00:00:56,430 --> 00:01:01,200
and what we've learned about how these
medications performed since our last
18
00:01:01,200 --> 00:01:02,033
episode.
19
00:01:03,000 --> 00:01:06,300
Okay, let's take those
one at a time. First,
20
00:01:06,390 --> 00:01:09,840
what have we learned about the amount of
weight loss and the stability after the
21
00:01:09,840 --> 00:01:10,673
medication?
22
00:01:11,130 --> 00:01:13,260
So just to back up for a second,
23
00:01:13,500 --> 00:01:17,700
these are a group of medications
which stimulate different
24
00:01:17,700 --> 00:01:18,840
receptors.
25
00:01:19,440 --> 00:01:23,640
The main group stimulate
glucagon-like peptide one
26
00:01:23,640 --> 00:01:25,800
receptors and
27
00:01:28,000 --> 00:01:32,100
Mounjaro or Zepbound
also stimulates a second
28
00:01:32,100 --> 00:01:33,420
receptor,
29
00:01:33,420 --> 00:01:37,100
glucose-dependent
30
00:01:37,100 --> 00:01:37,100
insulinotropic
31
00:01:37,100 --> 00:01:37,100
polypeptide
32
00:01:38,550 --> 00:01:41,790
So GLP-1 and GIP for short.
33
00:01:43,470 --> 00:01:47,940
So those medications, and
these are the main ones.
34
00:01:47,940 --> 00:01:50,850
And we talked in previous
episodes about some of the others.
35
00:01:51,270 --> 00:01:55,680
That main one is semaglutide.
That's the generic name,
36
00:01:55,680 --> 00:01:57,180
which goes by the brand name,
37
00:01:57,180 --> 00:02:01,620
Ozempic for diabetes treatment and Wegovy
38
00:02:02,340 --> 00:02:04,530
for weight loss treatment.
39
00:02:05,430 --> 00:02:10,290
And it has specific FDA approvals
for each of those things in certain
40
00:02:10,290 --> 00:02:11,640
circumstances.
41
00:02:12,570 --> 00:02:16,350
And the second main medication
nowadays is tirzepatide,
42
00:02:17,820 --> 00:02:22,590
which goes by the brand name
Mounjaro for diabetes treatment
43
00:02:22,590 --> 00:02:27,000
and Zepbound for weight
loss. And on average,
44
00:02:27,810 --> 00:02:32,730
15% of your weight can be lost on Wegovy
45
00:02:32,760 --> 00:02:37,440
and 20% on Zepbound in a typical
46
00:02:37,440 --> 00:02:41,520
six month course of medication.
So a
47
00:02:41,520 --> 00:02:45,300
15% weight loss if you weigh 200 pounds,
48
00:02:45,510 --> 00:02:50,460
puts you down to 170 pound and
a 20% weight loss would put
49
00:02:50,460 --> 00:02:54,600
you to 160 pounds. That's
quite a lot of weight loss.
50
00:02:54,600 --> 00:02:57,510
That's very difficult
to do with diet alone.
51
00:02:57,930 --> 00:03:02,710
But we've learned some things
about these medications, as I said,
52
00:03:02,710 --> 00:03:07,600
since we last ran an episode,
and this isn't the final answer,
53
00:03:07,600 --> 00:03:12,070
but this is an update on where
things stand now. So as I said,
54
00:03:12,070 --> 00:03:17,050
you can lose up to 15%
body weight on a course
55
00:03:18,510 --> 00:03:23,190
of Wegovy, Ozempic,
56
00:03:23,190 --> 00:03:28,090
but sometimes it's less than
that. And not only that,
57
00:03:28,090 --> 00:03:32,680
but about 15% of patients
can be non-responders.
58
00:03:32,680 --> 00:03:35,890
So they take the medication
and they don't lose weight.
59
00:03:36,640 --> 00:03:38,320
So that's the bad news.
60
00:03:38,770 --> 00:03:43,360
The good news is people who are taking
medications for weight loss seem to do
61
00:03:43,360 --> 00:03:48,100
better at losing weight than people
who are taking them for diabetes.
62
00:03:49,210 --> 00:03:53,560
But I pointed out very clearly
on the previous episode,
63
00:03:53,560 --> 00:03:58,240
and we now have more study data that
we didn't know how much rebound we were
64
00:03:58,240 --> 00:04:00,700
going to get when you
go off the medication.
65
00:04:01,360 --> 00:04:04,900
But we now have some study data
that answers that question.
66
00:04:05,800 --> 00:04:09,580
And that's a big deal because think
about it, when you go on a diet,
67
00:04:10,960 --> 00:04:13,120
sometimes it's really
hard to lose the weight,
68
00:04:13,120 --> 00:04:15,490
but even if you succeed in losing weight,
69
00:04:15,970 --> 00:04:20,620
you often rebound back to where you
started when you go off the diet.
70
00:04:20,620 --> 00:04:24,340
That doesn't happen overnight, but
over a few months it certainly does.
71
00:04:24,940 --> 00:04:29,620
And so in one study that looked
at this issue with semaglutide,
72
00:04:29,620 --> 00:04:31,570
the medication in Ozempic,
73
00:04:32,230 --> 00:04:35,530
in patients who were
trying to lose weight,
74
00:04:35,530 --> 00:04:40,120
because that's a different study group
than patients who have diabetes who stay
75
00:04:40,120 --> 00:04:44,650
on the medication to manage
their diabetes. So this group,
76
00:04:44,650 --> 00:04:49,390
on average lost the predicted amount of
77
00:04:49,390 --> 00:04:52,780
weight on average in that 15% range.
78
00:04:52,780 --> 00:04:56,380
It was actually 17% in
this particular study,
79
00:04:56,770 --> 00:05:01,210
but about two thirds of that
weight came back within a year
80
00:05:01,870 --> 00:05:04,060
after stopping the medication.
81
00:05:04,990 --> 00:05:09,940
So that tells us that we
may need to stay on it or we
82
00:05:10,300 --> 00:05:15,070
may need some kind of a
maintenance dose and where
83
00:05:15,310 --> 00:05:19,150
we need more studies to
confirm this kind of result.
84
00:05:19,270 --> 00:05:23,890
But it's been clear that there's
some rebound when going off the
85
00:05:23,890 --> 00:05:24,723
medication.
86
00:05:25,450 --> 00:05:29,830
So given the shortage of the
pharmaceutical manufactured product,
87
00:05:29,890 --> 00:05:31,330
what are the alternatives?
88
00:05:32,440 --> 00:05:35,920
As I mentioned in terms of things
I wanted to put in this update,
89
00:05:36,340 --> 00:05:41,290
I did want to discuss shortage
because a lot of people in
90
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the United States of America and
around the world have non-insulin
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dependent diabetes,
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00:05:47,230 --> 00:05:50,950
and a lot of them are
now being treated with
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Ozempic or Mounjaro.
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00:05:54,010 --> 00:05:56,770
And there are some other
medications being used as well,
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00:05:56,770 --> 00:05:58,820
but have become very popular.
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And that alone has created a shortage.
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00:06:02,000 --> 00:06:06,170
And then added to that is
the need for more of the
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medication for treatment of obesity.
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And on top of that,
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some people who are not obese but
are having trouble losing weight are
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taking the medication as well.
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So there is a shortage and it can
be difficult to get a supply of the
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medication. The medication
is also quite expensive.
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A thousand dollars a month is a
typical number can be as high as
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00:06:32,210 --> 00:06:36,410
$1500. And even if your
insurance is covering it,
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you may be paying several hundred
dollars a month, three to five hundred,
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to be on these medications.
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And that's a big deal if you think
about that cost at the end of the year.
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So one of the alternatives
is to obtain the same
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kind of medications, not
from the main manufacturers,
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Eli Lilly and Novo Nordisk,
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00:07:00,830 --> 00:07:05,540
but from compounding
pharmacies that make the same
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medication, but not
through the FDA-approved,
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FDA clinical trial studied process.
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Is compounding safe?
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So that's the key question because
I just said it's not that FDA
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process in terms of everything about the
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medication.
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And the FDA approved medication
goes through typically half a
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dozen to a dozen clinical
trials before it's FDA approved
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and has all kinds of studies done.
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And the FDA looks at every
phase of the production
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of that medication, the distribution,
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the plants that it's made in or inspected
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by FDA and so forth.
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So that's our best assurance of quality
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00:08:00,080 --> 00:08:04,910
compounding pharmacies or
pharmacies that make medications.
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And in particular,
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this is used in circumstances like
this where there's a shortage.
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So they make essentially a
generic equivalent. But again,
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they're not even a generic
pharmaceutical manufacturer.
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They're a pharmacy and that
simplifies who they are
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because they're bigger than
your neighborhood pharmacy.
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But they're preparing a medication for
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use by prescription
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just like other prescription medications
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00:08:42,860 --> 00:08:47,510
where there's a shortage and
you can't readily get it from a
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00:08:47,510 --> 00:08:52,430
regular pharmacy.
Now it's kind of a little more complicated
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00:08:52,430 --> 00:08:56,550
than that because if you are
getting a medication by mail order,
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00:08:57,240 --> 00:09:00,870
that may not even be coming
from a compounding pharmacy.
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00:09:00,870 --> 00:09:02,760
It's not clear where it's coming from.
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00:09:03,060 --> 00:09:06,090
If you're getting a medication
without a prescription,
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00:09:06,420 --> 00:09:11,190
you should be highly suspicious that
this may not be a legitimate pharmacy.
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So there are all kinds of medications
because of the popularity of
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Ozempic and Mounjaro that purport to be
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00:09:20,970 --> 00:09:24,060
generic equivalents but
are really counterfeit.
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00:09:24,630 --> 00:09:29,430
If you're being treated by a
physician in a weight loss program
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00:09:29,580 --> 00:09:32,190
in the physician's practice,
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00:09:32,190 --> 00:09:36,270
then it's their job to do the due
diligence if they're treating you with the
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00:09:36,270 --> 00:09:39,930
medication of getting it
from an appropriate pharmacy.
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00:09:39,930 --> 00:09:43,020
And there are different categories
of compounding pharmacies.
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So there are 503A pharmacies and 503B,
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00:09:47,970 --> 00:09:52,860
503B pharmacies are actually inspected by
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00:09:52,860 --> 00:09:57,210
FDA and FDA holds them
to good manufacturing
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00:09:57,270 --> 00:10:01,950
practices the same way it
holds pharmaceutical companies.
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00:10:02,640 --> 00:10:07,320
And so there's more
oversight of 503B pharmacies.
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00:10:07,320 --> 00:10:09,810
But given the shortage
of these medications,
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00:10:09,810 --> 00:10:14,250
the compounding route offers a greater
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00:10:14,250 --> 00:10:19,080
supply to help us meet the
clinical needs of patients
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00:10:19,170 --> 00:10:23,130
until it's more readily available
or more price approachable.
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00:10:23,760 --> 00:10:27,030
Okay. So what do you see for
the future of weight loss?
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So likely,
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00:10:30,060 --> 00:10:33,450
this is me looking in the crystal ball.
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00:10:33,450 --> 00:10:36,840
And so we can never say
what FDA is going to do.
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They're going to base that on the
clinical data that they receive,
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00:10:40,770 --> 00:10:45,690
and we can't say for sure how
clinical studies are going
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00:10:45,690 --> 00:10:46,530
to work out,
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00:10:47,190 --> 00:10:51,570
but it's pretty clear that
a few things are likely and
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likely very soon. And when I say soon,
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I mean sometime in the next year,
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not talking about something that's
five or 10 years down the line,
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but in the next year or
next two years at the most,
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we'll almost certainly have instead of
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injectable medications,
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00:11:11,190 --> 00:11:15,870
because currently Ozempic and Mounjaro are
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00:11:16,050 --> 00:11:18,210
injected once a week,
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00:11:18,990 --> 00:11:23,100
we will likely have oral
versions of the GLP-1
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receptors.
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We will likely have medications
that target other receptors besides
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GLP-1.
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And the biggest thing that I
think is going to be the focus
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00:11:36,780 --> 00:11:40,830
of obesity treatment in the future
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00:11:41,280 --> 00:11:45,990
is it's going to be
about fat loss more than
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weight loss.
Currently,
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these medications are demonstrating in
their clinical studies that when someone
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00:11:52,170 --> 00:11:53,740
stands on the scale,
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the number goes from a higher number
to a lower number, you've lost weight,
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00:11:59,620 --> 00:12:04,480
and that's a good thing. We always
feel happy when we lose weight,
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00:12:05,260 --> 00:12:09,340
but what we really want to lose is fat.
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00:12:10,030 --> 00:12:12,610
And there's a lot of reasons
why we don't like fat.
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We don't like fat because we don't
like how we look in clothing.
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00:12:16,750 --> 00:12:21,130
We can't get into the clothing that we
used to get into maybe if we've gained
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00:12:21,130 --> 00:12:25,230
weight. Fat also,
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00:12:25,230 --> 00:12:28,630
metabolically drives illnesses
like hypertension and
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00:12:28,630 --> 00:12:29,440
diabetes,
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00:12:29,440 --> 00:12:34,240
which are two massively common chronic
illnesses in the United States.
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So there are a lot of reasons
why we don't like fat,
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00:12:39,940 --> 00:12:43,510
but we'd like to keep our
muscle. And in reality,
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when we go on a diet, for
example, and lose weight,
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we lose some fat and some muscle,
and we're hoping it's mostly fat,
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00:12:51,250 --> 00:12:55,240
but muscle is hard to
get back, and as you age,
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00:12:55,570 --> 00:12:59,320
we naturally lose some muscle anyway.
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00:12:59,320 --> 00:13:01,720
This is a condition called sarcopenia,
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00:13:03,010 --> 00:13:07,960
which just means a low amount of
muscle because we're losing it with
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00:13:07,960 --> 00:13:12,880
aging and we don't want to
amplify that as part of weight
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00:13:13,060 --> 00:13:13,893
loss programs.
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00:13:14,230 --> 00:13:19,090
So likely in the future there'll
be a focus on figuring out
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00:13:19,090 --> 00:13:23,380
how to help people lose fat and preserve
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00:13:24,250 --> 00:13:25,083
muscle.
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00:13:26,080 --> 00:13:30,100
Where does all this progress with
pharmaceuticals leave bariatric surgery?
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00:13:30,730 --> 00:13:35,440
So we discussed on the last podcast
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00:13:35,440 --> 00:13:37,810
that a few years ago,
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00:13:37,810 --> 00:13:42,730
the indications for bariatric
surgery were greatly expanded
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00:13:43,540 --> 00:13:48,070
and there was a refinement
and how bariatric
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00:13:48,070 --> 00:13:53,020
surgery was done many years ago
when this was mostly converted
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00:13:53,020 --> 00:13:54,460
about 20 years ago,
217
00:13:54,460 --> 00:13:59,050
a little more to being done
laparoscopically instead of with
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00:13:59,380 --> 00:14:00,400
open surgery.
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00:14:01,090 --> 00:14:05,770
So that was a big growth
and expansion for bariatric
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00:14:05,770 --> 00:14:10,330
surgery and to finally
redefine definitions of who was
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00:14:10,450 --> 00:14:13,630
appropriate for bariatric surgery.
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00:14:14,320 --> 00:14:17,740
That hadn't changed since
sometime in the 1990s,
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00:14:18,940 --> 00:14:20,920
but at this time,
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00:14:21,670 --> 00:14:25,900
these non-invasive pharmacologic options
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00:14:26,530 --> 00:14:31,120
really despite some side effects,
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and we talked about those
on the last podcast,
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00:14:34,510 --> 00:14:38,470
still don't have the major life
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00:14:39,430 --> 00:14:43,180
impact of having a surgery
like bariatric surgery.
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00:14:43,210 --> 00:14:47,830
And so these seemingly,
despite any disadvantages,
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00:14:48,640 --> 00:14:53,450
are much more popular both
with physicians and with
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00:14:53,450 --> 00:14:54,283
patients.
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So there's likely to be a
reduced role for bariatric
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00:14:59,630 --> 00:15:02,750
surgery, although
certainly not eliminated.
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00:15:02,750 --> 00:15:07,670
And currently the amount of weight
loss typically with bariatric
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00:15:07,680 --> 00:15:12,410
surgery remains greater than the
amount of weight loss that could be
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00:15:12,410 --> 00:15:16,610
expected on average
with these medications.
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00:15:17,300 --> 00:15:21,440
Despite that there's a rebound
rate with bariatric surgery,
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00:15:21,440 --> 00:15:23,360
just like with these medications.
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00:15:23,360 --> 00:15:27,170
So you don't keep a hundred
percent of the weight loss off,
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but
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00:15:31,700 --> 00:15:36,590
we don't tend to see as
many non-responders as you
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00:15:36,590 --> 00:15:40,850
see with something like Ozempic
where we said there was that
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00:15:40,850 --> 00:15:43,160
15% non-responder rate.
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00:15:44,180 --> 00:15:46,640
Now that you've explained
bariatric surgery,
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00:15:46,760 --> 00:15:50,300
where does that leave plastic
surgery options like liposuction?
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00:15:51,050 --> 00:15:51,830
So okay,
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00:15:51,830 --> 00:15:56,600
now we get to go back to my
field where we're talking about
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00:15:56,600 --> 00:16:01,520
beauty and plastic surgery
because it's important to
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00:16:01,520 --> 00:16:05,720
realize that weight loss is about health.
250
00:16:06,620 --> 00:16:09,890
It's not about body contouring. Of course,
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00:16:09,890 --> 00:16:13,490
if we lose a lot of
weight or smaller thinner,
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00:16:14,150 --> 00:16:17,690
we like that shape better.
It contributes to our beauty,
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00:16:17,690 --> 00:16:22,640
but it's really a health
issue in these medications or
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00:16:22,640 --> 00:16:27,560
our proof for treatment of obesity
where the amount of excess weight
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00:16:27,560 --> 00:16:31,580
is at a level where it
impacts health and wellbeing.
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00:16:33,260 --> 00:16:36,200
So there's a lot of
257
00:16:37,730 --> 00:16:42,560
lessons in body contouring
that have grown out
258
00:16:42,560 --> 00:16:46,700
of the bariatric surgery past 20 years.
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00:16:47,600 --> 00:16:48,433
So
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00:16:50,150 --> 00:16:53,720
we treat people who've
lost a lot of weight
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00:16:54,830 --> 00:16:59,210
with a range of plastic surgery
treatments because there are
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00:17:00,650 --> 00:17:03,260
unfinished business, so to speak,
263
00:17:03,800 --> 00:17:08,060
even after you've lost a
massive amount of weight.
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00:17:08,060 --> 00:17:11,090
And all of the plastic surgery options are
265
00:17:11,090 --> 00:17:12,800
still appropriate,
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00:17:13,130 --> 00:17:18,050
preferable for certain body shaping
267
00:17:18,050 --> 00:17:21,800
applications.
If you're already at a normal weight,
268
00:17:21,830 --> 00:17:25,460
if you're at a normal or maybe
even an ideal body weight,
269
00:17:25,850 --> 00:17:29,930
you don't want to lose a lot of weight
because now you're losing muscle
270
00:17:30,470 --> 00:17:33,230
and not much fat with it.
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00:17:34,070 --> 00:17:36,170
So that hurts you more than it helps you.
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00:17:36,530 --> 00:17:40,430
And there are certain areas of the body
that just tend to have bulges that are
273
00:17:40,430 --> 00:17:44,750
formed by fat that don't
respond well to diet and
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00:17:44,750 --> 00:17:47,180
exercise. Love handles,
275
00:17:47,180 --> 00:17:50,490
the outer thigh area or
saddle bags are two typical
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00:17:50,490 --> 00:17:54,750
areas that just don't diet
and exercise off very well.
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00:17:55,200 --> 00:17:57,510
So even despite being at ideal weight,
278
00:17:57,540 --> 00:18:01,530
there are many people with fatty contours
there that they don't like and that
279
00:18:01,530 --> 00:18:06,510
don't show well in clothing. So that's
ideally what liposuction is for.
280
00:18:06,840 --> 00:18:11,610
And to a lesser extent, the nonsurgical
options. If the area is small,
281
00:18:11,970 --> 00:18:13,920
things like CoolSculpting and SculpSure
282
00:18:16,350 --> 00:18:20,970
can knock down those areas a little bit.
But the weight
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00:18:20,970 --> 00:18:25,710
loss patients likewise
are still going to need
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00:18:27,060 --> 00:18:29,040
some shape adjustment.
285
00:18:29,040 --> 00:18:33,730
There may be residual shapes
even if they lose weight going on
286
00:18:34,440 --> 00:18:37,950
Ozempic or Ozempic-like medications.
287
00:18:39,180 --> 00:18:42,750
So there's still a role for
liposuction, and in fact,
288
00:18:43,140 --> 00:18:47,940
if people have gotten goods, they
often want to finish the job.
289
00:18:47,940 --> 00:18:49,950
And so in fact, on some level,
290
00:18:50,310 --> 00:18:54,120
it amplifies the volume of
those procedures going forward.
291
00:18:55,530 --> 00:19:00,240
The other issue that arises
when we start to think about
292
00:19:01,020 --> 00:19:05,820
significant weight loss
is loose skin and the
293
00:19:05,820 --> 00:19:10,740
skin will tailor to an extent
when you diet and when you have
294
00:19:10,740 --> 00:19:13,830
liposuction. But if
you lose enough weight,
295
00:19:13,920 --> 00:19:17,040
there is substantial
extra skin. And again,
296
00:19:17,130 --> 00:19:19,740
this is a lesson that was known,
297
00:19:19,740 --> 00:19:24,480
but that a great deal of experience
was gained after bariatric
298
00:19:24,480 --> 00:19:27,570
surgery became more mainstream.
299
00:19:28,320 --> 00:19:32,640
And many patients who have had
massive weight loss need skin excision
300
00:19:32,640 --> 00:19:36,480
procedures, skin removed from arms,
301
00:19:36,480 --> 00:19:40,440
tummy area, chest, waist, thighs,
302
00:19:40,950 --> 00:19:45,480
and sometimes again with
more modest weight loss,
303
00:19:46,170 --> 00:19:50,820
that can be dealt with
without actual surgical skin
304
00:19:50,820 --> 00:19:55,500
excision.
But with energy devices like RF
305
00:19:55,500 --> 00:19:59,810
microneedling, Ultherapy, TempSure,
306
00:19:59,810 --> 00:20:00,840
things that sculpt,
307
00:20:00,930 --> 00:20:04,710
things that put energy into
the skin and stimulate some
308
00:20:05,460 --> 00:20:08,910
smoothing, tightening,
remodeling of that skin.
309
00:20:09,630 --> 00:20:11,940
And there are even injectable
techniques like Hyperdiluted Radiesse
310
00:20:13,680 --> 00:20:18,360
where a very diluted filler that is what's
311
00:20:18,360 --> 00:20:20,790
called an active dermal matrix filler,
312
00:20:20,790 --> 00:20:24,330
one that stimulates collagen
production in the skin,
313
00:20:24,690 --> 00:20:29,670
can help stimulate a little
smoothing of skin that's
314
00:20:29,670 --> 00:20:31,560
modestly loose.
315
00:20:31,980 --> 00:20:36,720
So all of those things
are also part of what's
316
00:20:36,720 --> 00:20:41,700
needed after weight loss
and also as a part of aging,
317
00:20:42,300 --> 00:20:46,710
and that is going to have
a growing role as these
318
00:20:46,720 --> 00:20:48,850
medications become more popular.
319
00:20:50,290 --> 00:20:52,390
Before we wrap up this episode,
320
00:20:52,390 --> 00:20:55,990
can you share any important takeaways
with our listeners, Dr. Bass?
321
00:20:56,590 --> 00:21:01,420
We're at the dawn of a new era
where pharmacologic approaches
322
00:21:01,690 --> 00:21:06,670
are at the forefront of
obesity medicine as well as
323
00:21:06,670 --> 00:21:11,380
the forefront of weight management.
Even for non-obese individuals,
324
00:21:12,220 --> 00:21:14,710
diet and exercise are not done.
325
00:21:15,130 --> 00:21:18,130
They're still an important
part of health and wellbeing.
326
00:21:18,610 --> 00:21:22,660
And bariatric surgery
likewise, is not done.
327
00:21:23,470 --> 00:21:24,580
However,
328
00:21:25,210 --> 00:21:29,560
every time there's a paradigm
shift or a major new innovation,
329
00:21:30,010 --> 00:21:34,450
all of the options most of
the time stay on the table,
330
00:21:35,530 --> 00:21:38,650
but the pie gets sliced
up a little differently.
331
00:21:38,650 --> 00:21:42,460
The role for each option
shifts and adjusts.
332
00:21:43,120 --> 00:21:45,850
So all of these things
are still important.
333
00:21:45,850 --> 00:21:49,600
A multimodality approach
probably gets you there best.
334
00:21:50,050 --> 00:21:55,030
That's very clear with these
GLP-1 medications that using
335
00:21:55,030 --> 00:21:59,260
the medication in
combination with some dietary
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management and an active lifestyle greatly
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00:22:03,730 --> 00:22:07,600
improves the chances that you're
going to achieve your goals.
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00:22:08,800 --> 00:22:12,370
So body contouring and skin treatments,
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00:22:12,370 --> 00:22:17,110
the plastic surgery side
of it are not really weight
340
00:22:17,110 --> 00:22:21,850
loss themselves.
They're part of the beauty or appearance
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00:22:21,850 --> 00:22:24,670
side of it, but they're
going to play an increase,
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00:22:24,670 --> 00:22:29,350
not a decreased role to
finalize and perfect the
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00:22:29,350 --> 00:22:33,040
changes that are started
by the weight loss,
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00:22:33,070 --> 00:22:35,320
whatever modality you're pursuing,
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00:22:35,920 --> 00:22:38,080
and that's the same as it ever was.
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00:22:39,550 --> 00:22:43,480
We've already seen this in the massive
weight loss patients after bariatric
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00:22:43,480 --> 00:22:44,313
surgery.
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00:22:44,440 --> 00:22:49,330
And the same will be true with the
more moderate weight loss that's
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00:22:49,330 --> 00:22:52,360
seen with these new GLP-1 medications.
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00:22:53,140 --> 00:22:58,000
The biggest unknown is the mix
of surgical and nonsurgical
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00:22:58,000 --> 00:23:02,470
treatments for chasing these
residual unwanted shapes.
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00:23:03,130 --> 00:23:05,350
The bulges of fat and the love handles,
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00:23:05,350 --> 00:23:10,030
the saddle bags and the looser
crepey skin that remain after weight
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00:23:10,060 --> 00:23:14,050
loss. So this was the
original role of liposuction,
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00:23:14,050 --> 00:23:18,790
contouring unwanted shapes made
of fat in people at ideal body
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00:23:18,790 --> 00:23:19,623
weight,
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00:23:19,780 --> 00:23:24,640
but it's in recent years
played a growing role
358
00:23:24,640 --> 00:23:28,900
in people after weight loss as well.
And both
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00:23:28,930 --> 00:23:29,730
categories,
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00:23:29,730 --> 00:23:34,510
the surgical and nonsurgical are going to
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00:23:34,510 --> 00:23:37,720
have a role in these post weight loss
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00:23:37,720 --> 00:23:42,700
patients again, however they
managed to lose the weight.
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00:23:43,330 --> 00:23:47,990
So selecting the best option
requires that relationship with an
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00:23:47,990 --> 00:23:52,850
experienced plastic surgeon who's up
to date on the latest capabilities and
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00:23:52,850 --> 00:23:57,650
technologies and can put together
a program for you to get to
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00:23:57,650 --> 00:24:00,530
your best appearance after weight loss.
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00:24:01,880 --> 00:24:05,150
As you can see, this area
is undergoing rapid change.
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00:24:05,150 --> 00:24:08,120
We're learning a lot in
a short amount of time,
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00:24:09,080 --> 00:24:13,880
and this will continue to evolve
as we look increasingly at
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00:24:13,880 --> 00:24:16,460
muscle maintenance and restoration,
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00:24:16,940 --> 00:24:21,830
both in aging patients and
in patients who have lost
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00:24:21,830 --> 00:24:22,670
a lot of weight.
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00:24:23,600 --> 00:24:28,550
The future is going to be
focused on fat loss with muscle
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00:24:28,550 --> 00:24:29,383
maintenance.
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00:24:30,110 --> 00:24:30,770
Wow,
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00:24:30,770 --> 00:24:34,340
those are really interesting points that
I didn't think about when looking at
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00:24:34,340 --> 00:24:37,310
the number on my scale.
Thank you, Dr. Bass,
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00:24:37,310 --> 00:24:41,000
for sharing your expertise and
updating us on this rapidly changing
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00:24:41,000 --> 00:24:45,830
subject. Thank you for listening to
the Park Avenue Plastic Surgery Class
380
00:24:45,830 --> 00:24:48,590
podcast. Follow us on Apple Podcasts,
381
00:24:48,650 --> 00:24:50,900
write a review and share
the show with your friends.
382
00:24:51,080 --> 00:24:54,590
Be sure to join us next time to avoid
missing all the great content that is
383
00:24:54,590 --> 00:24:58,130
coming your way. If you want to
contact us with comments or questions,
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00:24:58,130 --> 00:24:59,360
we'd love to hear from you,
385
00:24:59,450 --> 00:25:04,100
send us an email at
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00:25:04,100 --> 00:25:05,780
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