The Ozempic Craze and how to Properly Lose Weight for the Long Run with Dr. Philip Rabito MD

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Speaker 3 My guest today, Dr. Philip Robito, is one of the top U.S.

Speaker 3 endocrinologists and weight loss experts and treats a variety of hormonal disorders, including thyroid, diabetes, prediabetes, cholesterol, low testosterone, hair loss, and many, many more.

Speaker 3 He focuses on wellness, disease prevention, and specializes in weight loss medicine, general nutrition, and fitness medicine. He's a triathlete, triathlete, open water swimmer, and cyclist.

Speaker 3 Therefore, he understands so much the importance of nutrition and fitness in our overall health.

Speaker 3 I met him in New York City a little while ago, and we discussed the Ozempic craze, how important it is to be well informed about it before considering taking it, who should take it, who should not take it.

Speaker 3 So, this is a super important conversation about wellness, weight loss in the long term, and and the best avenues for long-term health.

Speaker 3 I hope you guys enjoy this super important special episode with Dr.

Speaker 1 Rabito.

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Speaker 3 Dr. Philip Rabido, welcome to Carondaluz.
It's such an honor having you here.

Speaker 1 Thank you, Catherine. Thank you for having me.

Speaker 3 So I met you in New York a few weeks ago, and when you told me you are a specialist in weight loss, I immediately asked you the question regarding Ozempic because it's been in the news so much lately.

Speaker 3 And I get so many questions from my listeners about it. So if it's okay with you, I want to jump right on the subject because there's so much we have to cover.
Let's do it.

Speaker 3 I remember I asked you because obviously I'm not a doctor and I see all these celebrities on TV talking about it. A lot of people who are not doctors giving their opinion.

Speaker 3 Oh, it's fantastic fantastic for weight loss, la la la la. And I was curious.
And I remember the first question I asked you was, what do you think about it?

Speaker 3 And I remember you told me, I think it's great. And that really piqued my curiosity.
So for everybody out there listening, can you explain to us when is Ozempic a great idea?

Speaker 1 Right. So ozempic is the name, the name of the compound that's palsanoglutide.
And it's... it's really indicated or used in patients with diabetes.

Speaker 1 Of course, it's being used in so many different ways now outside of the indication. Wagovi is ozempic in a different formulation.
It's the same exact medicine indicated for weight loss.

Speaker 1 So these medicines are fantastic for diabetics because they lower the blood sugar, they lower the weight, which is really important for diabetes, and they lower the risk of cardiovascular disease in patients with diabetes.

Speaker 1 And now there's more and more evidence coming out that these medicines in a certain population that's not diabetic has some cardiovascular benefits.

Speaker 1 So for instance, patients with obese, with known coronary disease, known heart disease, actually have a dramatic reduction in cardiovascular events in a very short period of time that the patients were studied.

Speaker 1 So we know that

Speaker 1 these patients typically will benefit from the medicine, from a cardiovascular risk reduction.

Speaker 1 And then there's the weight loss component, which is just incredible.

Speaker 1 The medicine simply works to suppress your appetite in your mind, and your brain, suppress the appetite centers, it reduces your caloric intake, and it lets you gain control of your dietary habits.

Speaker 1 And

Speaker 1 even if you don't have structure in place, which none of my patients don't have structure, all of my patients have some plan in place nutritionally, even if you don't, you're going to lose X percentage of your body weight and probably be healthier.

Speaker 1 So the

Speaker 3 okay, so let's break this down, okay, part by part by part, because I know there's a lot of confusion out there.

Speaker 3 And at least that's my impression that a lot of people, even people that don't really need it, go to doctors and we're going to talk about that non-ethical doctors and they want the prescription.

Speaker 3 The prescription itself, Ozempic, for people that don't know, like you said, was created not for weight loss, it was created to treat diabetes, correct?

Speaker 3 And then someone along the line a while back, I don't know, a doctor, someone find out, wow, whoever is taking this is also losing a lot of weight.

Speaker 1 That's correct. Yeah.

Speaker 3 And then, so initially, some doctors were prescribing Ozempic,

Speaker 3 not for diabetes, but for weight loss, off-label.

Speaker 1 Is that correct? That's correct.

Speaker 3 So can you explain to people that don't know? Yeah, we're going to get to the semi-deal type, but people that don't know what off-label means, can can you explain that to us?

Speaker 1 Sure. Off-label means that a doctor is prescribing a medicine not for the indication for which that medicine

Speaker 1 got the original FDA approval for treatment of. So for instance, metformin is something

Speaker 1 that's used to treat polycystic ovary disease and pre-diabetes, but it doesn't have the FDA indication. other than treating diabetes.

Speaker 1 Ozepic is a medicine that's only indicated for the treatment of of type 2 diabetes, and it's being used off-label for weight loss.

Speaker 3 Okay, so, and is it okay for the doctors to prescribe Ozempic for weight loss, although the FDA is saying it's just for diabetes? Is that like completely fine?

Speaker 1 Yeah, well, there's an ethical

Speaker 1 you know, there's an ethical part, and then there's, then there's the insurance part. There's so many different pieces to that puzzle.

Speaker 1 So, so, as I mentioned earlier, Ozempic is semaglutide for diabetics. The company geniusly came out with Wigovi, which is the same semaglutide, same exact chemical compound treated for weight loss.

Speaker 1 The issue is, so you can treat obesity, that's a BMI of more than 30, with Wagobe and get the patient covered, should the patient's insurance allow for the coverage.

Speaker 1 Okay, it's a process, and the doctor has to jump through quite a few hoops to get that done. But, you know, it is, but

Speaker 1 the medicine is is indicated, that medicine, Wagobi, is indicated for weight loss.

Speaker 1 So, yes, people do use Wagobe off-label for weight loss, but in those situations, the insurance will not pay for it anymore because

Speaker 1 now you need to show proof that the patient is diabetic. So, I need to show them, the insurance company, that the patient has a hemoglobin A1C of 6.5, an average sugar of 6.5.

Speaker 1 So, they're cracking down on it. So, it's becoming more and more difficult to write write prescriptions off label in this realm.

Speaker 3 Okay. So how are so many people getting? Because you're in New York.
I'm in L.A. As you know, LA is the land of women wanting to be thin, right?

Speaker 3 And I don't know about you, but it drives me crazy when celebrities, whatever, people with TV shows that are not doctors.

Speaker 3 go on these talk shows and talk about it because I think it's such a personal experience and they influence millions of people. And there is all reports out there, right?

Speaker 3 Ozempic is sold out, la, la, it's so hard. There's a shortage.
And we see TV commercials about Ozempic. How are so many people getting their hands on this prescription?

Speaker 3 And many of them, I think, without the proper medical advice.

Speaker 1 So a lot of people are getting these medicines compounded. So there are so many compounding pharmacies that are making it without any FDA scrutiny.
So there's not necessarily the proper

Speaker 1 sterile technique being used, and you don't know exactly what dose you're getting. You sort of have to trust

Speaker 1 that pharmacist, that particular compounding pharmacy, to, you know, that what they're saying is in there, the dose is in there, is correct.

Speaker 1 So I'm getting one or two consults a week from Mount Sinai, where I work, for patients who are getting compounded ozenepic from their dermatologist or from their trainer.

Speaker 1 And, you know, they're capitalizing it monetarily. and making

Speaker 1 money on this, and a lot of them don't have a whole lot of experience in dosing or managing the side effects or managing expectations with these medicines.

Speaker 1 So, patients are taking the medicines, they're not sure what dose to use, they're getting gastroparesis. The effect that this medicine has on the stomach to slow the and what is what is that?

Speaker 3 Can you translate it for us that don't understand what that means?

Speaker 1 Yeah, sure. So,

Speaker 1 one of the side effects of this medicine, most of the side effects from this medicine, in this class of medicine, is gastrointestinal. It slows the whole,

Speaker 1 the movement of food from your mouth to your body.

Speaker 1 So most of the symptoms, the side effects from this class of medicine are gastrointestinal. Constipation, some people get diarrhea, nausea is very common, reflux.

Speaker 1 So if the doctor, of whoever is prescribing the medicine, say it's a trainer or a dermatologist or someone outside of the, of the,

Speaker 1 outside of the realm of people who would have a lot of experience in treating patients with this class of medicine, they're not properly managing the dosing and patients are getting too high a dose and they're going to seek medical care because they're having issues with contractable vomiting and nausea.

Speaker 3 Which is horrible, right? I mean, you're taking something for many times for vanity.

Speaker 3 A lot of people don't even are not even obese and are taking it. And like you said, a lot of people are capitalizing and just taking advantage of it.

Speaker 1 Yeah, absolutely true. There's money to be made.

Speaker 1 And a lot of people are paying out of pocket anywhere from $1,000 to $1,500 per month because they're not covered by their insurance with the pharmaceutical grade medicine.

Speaker 1 So people are looking to other ways to get the medicine. And

Speaker 1 sometimes that can work against you.

Speaker 3 Oh, my God. So for everybody out there listening to us, this is a good warning.

Speaker 3 I guess with Ozempic or any other medication, I think there's a reason why they need to be prescribed, but it's always the smartest idea to do it with a great doctor. Is that correct?

Speaker 3 It can be really dangerous to get this prescription without proper doctor supervision.

Speaker 1 You want to get it from a physician or a healthcare

Speaker 1 practitioner that's got experience in treating patients with this class of medicine.

Speaker 1 That is someone who treats diabetes, someone who treats weight loss, who's got a lot of experience, who knows how to prepare you for the medicine, manage expectations, to let you know what could go wrong, to give you a schedule of how to advance the dose slowly, that you're getting the efficacy that you need from the medicine and also avoiding or mitigating the risks of the side effects, and also knows how to manage the side effects should they arise.

Speaker 1 So, yes, it's important to get the medicine from someone with experience.

Speaker 3 Yeah, and one thing that you said that I think is very important: this is

Speaker 3 usually something

Speaker 3 for somebody who is really obese, correct? It's not for somebody that's like, oh, I want to lose five, seven pounds for the summer.

Speaker 3 Yeah, I wish you guys could see his face. So if you're listening to the episode, please go to watch the YouTube,

Speaker 3 the episode on my YouTube channel, because you're laughing and smiling, Dr.

Speaker 1 Rabid.

Speaker 1 Yeah.

Speaker 1 Well,

Speaker 1 yeah, I mean, mean,

Speaker 1 you know,

Speaker 1 ask me the question again. So, because I.

Speaker 3 Yeah, the question was, as we know, this is supposed to be for people who are really obese, that really need help.

Speaker 3 Really obese, like you said, it's a body mass index of 30% or more. But as you know, I tell me if in New York, it's the same, but in LA,

Speaker 3 Miami, a lot of girls are like, oh, you know, I want to look like whatever, the housewife on TV. I want to look like Kelly Clark.
So I want to look like this. I want to look like that.

Speaker 3 I want to lose five, seven pounds for the summer. And that Ozempic or the semaglutide is not for that.
Is that correct?

Speaker 1 Well, I think if people, the indication very clearly stated is for ozampic and munjaro for diabetes and Wegobi and

Speaker 1 zepp bound for weight loss. So yes, those patients who are getting wigovi or zetbound should have a BMI

Speaker 1 of more than 30, which is your height over weight. It's a formula to measure the minimum criteria to be able to be eligible for this medicine.

Speaker 3 Can you tell us if somebody wants to find out how they figure out their body medic, how do you do it?

Speaker 1 Just go to Google and type in BMI and you could type in your height. There's a chart.
You could type in your height and your weight and it'll tell you what your BMI is. Okay.

Speaker 1 So if BMI is 30 and your insurance plan will allow you to get the medicine and your doctor would be willing to to do the legwork to get you approved for this medicine, which is draconian.

Speaker 1 It's a process to get it approved because these insurance companies don't want to approve these expensive medicines,

Speaker 1 then you could potentially get that medicine. If

Speaker 1 your BMI is less than 30 and you just want to lose a couple of pounds, I don't really recommend this medicine unless you meet some of the other criteria for this trial.

Speaker 1 Okay, so my recommendation for patients who just need a few pounds is to do what I do with all my patients, and that's to give them some structure and some lifestyle guidance and

Speaker 1 avoid the medicines and the potential side effects.

Speaker 1 So none of my patients who come to me for weight loss do get the weight loss medicine without showing me that they have some skin in the game, that they can do something.

Speaker 1 And I recommend fasting and done in a very specific way, two days of fasting. It's a very it's a very pragmatic, practical way to lose weight.

Speaker 3 Yeah, we're definitely going to talk about that. I want to finish talk about Ozempic, and then we're definitely going to talk about the right way to lose weight and keep it off.
But before,

Speaker 3 are all of these medications the same company? Ozempic? It's different people, different manufacturers.

Speaker 1 So Ozempic and Wagobi, which is semaglutide for diabetes. Right.
And weight loss for obesity is Noble Nordis.

Speaker 1 And Eli Lilly or Lilly is the company that manufactures Munjaro, which is Terzapatide, and Terzapatide for weight loss or obesity is Zeppbounds, E-E-P-B-O-U-N-D.

Speaker 1 So they're two different medicines, and then there are medicines coming up the pipe from companies like Amgen and other drugs coming out of Lilly that will even be more efficacious than what we're using now.

Speaker 3 In the meantime, is there any reason why, for example, because Ozempic was created to treat diabetes, then when doctors, whoever it was, found out that it helped so much on weight loss, and now they know that they're making millions and millions and millions because it's being prescribed off-label.

Speaker 3 And the FDA still didn't approve it for weight loss, correct? Is there a reason why they still don't get the approval for weight loss?

Speaker 1 Well, they do have the approval for weight loss in the setting of being obese in the strictest sense. Typically, they don't really,

Speaker 1 the insurance company is never going to come and weigh your patient nor measure the height of your patient. So, you can fib, doctors can fib and say that the patient's obese.

Speaker 1 So, there are ways around that. For the Ozepic and the Munjaro, there's no way around it because now the insurances are asking for documentation biochemically that the patient is diabetic.

Speaker 1 So, you need to prove to them that they're fasting. Blood glucose is more than 126 in a lab report, or a hemoglobin A1C is

Speaker 1 6.5 or better.

Speaker 3 Okay, so let's talk about diabetes diabetes for a second because a lot of obese people become diabetic. Is that correct?

Speaker 1 Correct.

Speaker 3 So being overweight

Speaker 3 highly increases your chances of becoming diabetic.

Speaker 1 That's correct. It's a genetic component, and that's the environmental component in your body habitats.
That's correct.

Speaker 3 Yeah. So a lot of people, because I get these questions.
And of course, it's something that women talk and we talk with our friends and everything.

Speaker 3 When, like we were saying, I think most of us we fluctuate, right? Five pounds here, four pounds there, you go on vacation, you gain some pounds, la la la la.

Speaker 3 But so, as a doctor, how do you recommend, or how do you think someone like you look at yourself in the mirror and you say, wow, okay, I gained five pounds, maybe I shouldn't stop everything.

Speaker 3 When is the time to see a doctor and like reel this in before you become an obese, diabetic person? Because a lot of people lose control before they come seek help, correct?

Speaker 3 How do we

Speaker 3 stop this process of losing control? And when is the right time to seek help?

Speaker 1 Yeah, a lot of people seek help when they gone off the deep end, they've gained too weight, and then it becomes a real effort.

Speaker 1 So listen, I have all different types of patients that come see me. I practice wellness medicine.

Speaker 1 So a lot of patients come through my door and they just want to be healthier and they want to lose five pounds. Or I'm an endocrinologist.

Speaker 1 So patients come to me for a thyroid disorder and they express that they've gained a couple of pounds. So that's an opportunity for me to talk to them about lifestyle.

Speaker 1 So when should a patient come? You know, that's

Speaker 1 patients should be getting this advice from their internal medicine doctor or their primary care provider. Unfortunately,

Speaker 1 In medical school, out of four years and three years of residency, most medical schools only provide about a month of nutrition training, which is to me mind-boggling.

Speaker 1 So very few primary care physicians pay attention to detail as it relates to nutrition, vitamin supplementation, weight management, lifestyle changes, cardiovascular risk reduction through lifestyle.

Speaker 1 So I try to take every opportunity I have when a patient comes to see me for whatever it is, for osteoporosis even, and I'll address their lifestyle with them. So

Speaker 1 yeah, I mean, that's how I do it in my practice, but I think it's something that's overlooked in general.

Speaker 3 Yeah, and I agree. And I'm not a doctor, and I definitely think the lifestyle is the biggest part of it.
So let's jump to that. This morning, I saw a doctor, and I forgot her name.

Speaker 3 I know I was going to forget her name. She's a contributor on Good Morning America.
So she has a great reputation. She's very well known.
And she was.

Speaker 3 She did a video on her Instagram and Good Morning America Instagram, if you guys want to find it. She was talking about Ozampic and all these weight loss drugs.

Speaker 3 And she was actually saying that most people gained the weight back,

Speaker 3 which doesn't surprise me because I think a lot of people think this miracle, I'm putting quote unquote drugs. Oh my God, I'm going to be so thin.

Speaker 3 And then when they stop taking the drug, if they didn't change the lifestyle, it's very likely that they're going to go backwards. Do you see a lot of that, Dr.

Speaker 3 Robiru, that people like take a drug because they think it's a miracle? And then they stop seeing a doctor, they stop taking the drug, they go all backwards again.

Speaker 1 Absolutely. So in the realm of weight loss and obesity, in my practice,

Speaker 1 the key is to preach or teach, manage the lifestyle, give the patient structure and a program that they can live with, that they can do, that's pragmatic, that's practical, that allows them to live a normal life.

Speaker 1 but they make enough sacrifice that they can get the caloric restriction and the carbohydrate reduction that they need to lose the weight.

Speaker 1 The medicine in my practice for weight loss, for obesity, is simply an adjunct. It allows them to live the lifestyle, right?

Speaker 1 So, for my practice, most of the time is spent counseling the patients on how to do the lifestyle.

Speaker 1 The medicine is added on after the patient demonstrates they can do that lifestyle, whatever it might be. Some patients balk at the idea of doing a 24-hour fast.

Speaker 1 Most patients are excited to do it and they do it well.

Speaker 1 In my practice, people don't gain weight back because

Speaker 1 let me back up a little bit.

Speaker 1 any practitioner can put a patient on a program or get them to lose 30 pounds where is that patient six months after they lose that 30 pounds recidivism is so high most patients gain the weight back and we see this all the time with those empic in that class of medicines because the patient doesn't have a plan in place my patients i pride myself on giving them a plan such that they rely on themselves and they're not you know if the if the medicine goes away for whatever for whatever reason and and they're left to their own devices, they can maintain their weight.

Speaker 1 The hardest part of weight loss medicine is getting a patient from 250 pounds down to 200.

Speaker 1 Maintaining your weight at 200 is much easier to do because the caloric restriction it takes to get that kind of weight drop is dramatic.

Speaker 1 So it really is a lot of my patients decide to come off the medicines once they achieve their target weight. And then they live the lifestyle and they're able to maintain themselves.

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We're all out of the ordinary.

Speaker 1 And if they gain the way back, then we revisit the medicine in the future.

Speaker 3 So I think the really important message here is don't go to a doctor such as yourself thinking you're going to sign off the prescription and say, here you go, goodbye, go have fun, you're gonna be skinnier in two, three months, because this is the part that scares me.

Speaker 3 It's this weight loss culture. And you turn the TV on and there's all these ads and then there's all the celebrities saying, yes, I tried it.
Yes, I did. And then some of them deny it.

Speaker 3 And then some of them admit it. And of course, people are highly influenced.

Speaker 3 And it really worries me because I'm thinking like, These people are not thinking about the most important thing, their health.

Speaker 3 Because in the long run, at least for for me, what works is my lifestyle, right?

Speaker 3 I don't like taking medication, but the way I keep myself from, because I love to eat, you know, I'm half Brazilian, half French, both cultures eat a lot.

Speaker 3 But, like I said, to me, in the long run, is like

Speaker 3 80% of the time, I think I do everything right. I work out, I eat super clean, I started biohacking my life, my health, you know, et cetera, et cetera, et cetera.
But I think so many,

Speaker 3 I'm not going to say celebrities, but so many people on TV just make it seem like, oh, yes, I took a Zempic and I'm thin and that's it. Do you cringe when you watch that at all as a doctor?

Speaker 1 I do, but you have to look at the big picture, Catherine. A lot of people don't have the fortitude and the will that you have, right?

Speaker 1 So it would be great if we can all work out five days of the week and really, you know, put our minds to that and really practice with nutritional habits. For some people, that's a stretch.

Speaker 1 And it's important to be thinner. If you're obese or significantly overweight, it's important to be thinner because there are so many conditions that are associated with that.

Speaker 1 Diabetes, cholesterol, arthritis, sleep apnea, cardiovascular disease, even cancer. So it's important to get your patients' weight down, no matter what their lifestyle is.
I totally agree with you.

Speaker 1 You always want to preach the lifestyle first and get patients to change. But there are some situations where people can't make those draconian, those drastic changes in their lifestyle.

Speaker 1 And sometimes sometimes they have to rely on the medicines to get them where they need to be to make them healthier.

Speaker 3 Yeah. But do you think, and this is just, I'm not an American, but I've been here my entire life.
So I think, you know, the American culture is all over me.

Speaker 3 And I think it's a country where people have horrible eating habits.

Speaker 3 Sorry, I know I'm going to get a lot of, you know, messages about that, but the way people eat and the food industry, and I've interviewed a lot of experts in the field.

Speaker 3 But honestly, like even kids, they're being fed like junk, junk, junk. They grow up eating junk, they grow up eating crap.
And it's heartbreaking to me when I watch it.

Speaker 3 I don't even like the portions, right? You go to the Cheesecake Fact, the portions are like the size that my mom will use to serve a whole family.

Speaker 3 Do you think that's a huge part of the problem, the food habits in the United States?

Speaker 1 Of course. I mean, we become more sedentary as a population, population and

Speaker 1 the readily available, less expensive foods are typically high in fat and high in carbohydrate. Kids are drinking things they have no business drinking.

Speaker 1 Children should never be drinking anything with calories, ever.

Speaker 1 There's no reason for it. So, you know, it's starting at an early age, and then it just sort of patulates itself.
And it's a huge issue. And the obesity epidemic is just that.
It's an epidemic, and

Speaker 1 it's still growing, even with

Speaker 1 these class of medicines.

Speaker 1 The amount of obesity is still increasing.

Speaker 3 Yeah. So if somebody comes to you, like a new patient, let's say someone is listening to us out there.
They're like, yeah, I really want to turn my life around. I'm super

Speaker 3 overweight. I'm obese, la la la.

Speaker 3 Can you guide us, like, how do you take care of someone? Because the first steps are super tough, right?

Speaker 3 One thing is if you have to lose five pounds, like you said a little while back, but if you have to lose 50 pounds, 60 pounds, that's a lot.

Speaker 3 And I think a lot of people get discouraged and embarrassed even, right?

Speaker 3 To seek help. So can you maybe just do like the first steps, what you would tell that person?

Speaker 3 What do they have to do to get help? How does it work?

Speaker 1 Sure. I mean, losing 60 pounds or more, which a lot of patients need to lose more, it can be daunting.
So, you know, I explained to them that this is a process.

Speaker 1 This isn't going to come off in two months or three months. This is a lifestyle change.
It's going to require a lot of effort.

Speaker 1 So I make sure the patient understands they're going to have skin in the game.

Speaker 1 They have to to have success because the medicine at max will cause them to lose or allow them to lose about 15 to 20% of their body weight. And most of them need to lose significantly more than that.

Speaker 1 So this is all about managing expectations. explaining to them a lifestyle, learning from them, trying to understand what kind of lifestyle they would be willing to try.
Okay.

Speaker 1 And then getting a full set of labs. So I check all my patients as an endocrinologist, as a weight loss physician.
I check all my patients a full set of labs as if they've never seen a doctor before.

Speaker 1 And I look for reasons why they might be having trouble losing weight. Is their thyroid off? Is their cortisol levels high?

Speaker 1 Do they have significant vitamin deficiencies that are making it impossible for them to work out and have the energy levels and the cognition that they could potentially have if we corrected those?

Speaker 1 So I look at all those. I give them the lifestyle that we talked about, the fast thing briefly, where I mentioned it to you.

Speaker 1 And then I have them do their homework on what I think would be the best choices in regards to weight loss,

Speaker 1 should I think there'd be candidates for those weight loss medicines. They do their homework.

Speaker 1 And then in the second visit, it's even more comprehensive visit where we talk about the results of all the labs.

Speaker 1 I give them supplementation, any hormone that needs to be replaced or their fibroid needs to be replaced or their vitamins need to be replaced or iron deficiency needs to be replaced.

Speaker 1 We do all of that, okay, with pills, over-the-counter pills typically. And then we talk about how they did with their lifestyle.
So how did you do in the last week or two weeks?

Speaker 1 You know, did you lose any weight? Did you struggle with the lifestyle that we talked about? And then we go through that in detail and make

Speaker 1 adjustments in the program according to how they adopted that or how they responded to that. And then we talk about about the weight loss medicines.
Should they be candidates for those?

Speaker 1 And we have a higher level discussion because my patients have done their homework on it. And I tell every patient that I treat them as if they were my family member.
And I love my family.

Speaker 1 Otherwise, that's so sweet.

Speaker 3 I love that.

Speaker 1 So I tell them that I treat them as if they're a family member. And this is what I would do if I was you.
I've been doing this a long time, very comfortable with these medicines.

Speaker 1 I think you would benefit from Zapbound at this dose. We'll start with a low dose.
We'll gradually gradually titrate the dose up.

Speaker 1 I'll be here if you have any issues, if you have any problems, side effects,

Speaker 1 you reach out to my office and

Speaker 1 we'll either adjust the dose or we'll treat the side effects. And then you just take it month by month because patients would like to have results quickly.

Speaker 1 And it's really important to manage expectations, not only for the side effects of the medicine, but also for what the patients can expect as far as weight loss.

Speaker 1 I do not want my patients losing more than two pounds per week because

Speaker 3 that sounds very reasonable, right? Two pounds a week is something like, it's kind of like a marathon. It's something that you can keep up and keep doing.

Speaker 3 Yeah, it doesn't sound, sounds pretty good. Yeah, it sounds attainable.

Speaker 1 Yeah, yeah. And it's, you know, and the data supports that people who lose weight faster than that have a higher risk of recidivism or going back to where they were because

Speaker 1 they're making too much of a sacrifice. And you can't always sacrifice and be on and be perfect.

Speaker 1 You need to have a program that allows you to have your cheat meals and your family parties and your nights out. It's really important

Speaker 1 because life's too short.

Speaker 3 No, I completely agree. Like I said, for me, I think it has to be a lifestyle that is sustainable to the person, that makes you happy, that doesn't make you miserable.

Speaker 3 That's why I don't believe in this fat diet. That's another thing that drives me crazy.
Oh, you can never eat a carb. Kilo, kido, kiro.
Or, oh, whatever, Jenny Craig, weight loss.

Speaker 3 I don't even know which one is still around, you know, or like these meals, because I don't think these things are sustainable in the long run. Because the minute you're out of a diet,

Speaker 3 so what do you do? You go back to what you were doing before. Just, I don't think you should eat junk, junk, junk, junk all the time.
And I definitely don't think you should be on a diet.

Speaker 3 I think it should be on a lifestyle that makes you happy. Do you agree?

Speaker 1 Yeah, Catherine,

Speaker 1 and this is what I tell all of my patients: Diet is a cursed word in my office. No one uses the word diet.
It's lifestyle modifications, right? You can't always be on a program.

Speaker 1 You can't watch every morsel. Nobody in my practice counts their calories.
No one weighs their food. This can't be an obsession.
This needs to be something that's manageable and doable. And it is.

Speaker 1 And I asked my patients on the first visit, I said, what do you think your target weight should be? And invariably, that number is always 30 or 40 pounds higher than what they ultimately get to.

Speaker 1 I shouldn't say very,

Speaker 1 in many cases, for my patients who aren't dedicated to the cause.

Speaker 1 And they don't realize, so they lay up and they say a number and they don't realize that with this, this program, that they can actually achieve where they ultimately want to be.

Speaker 3 Yeah, I think anybody that if you put your mind into it and you're like, and you think about your health, not just about your body, right?

Speaker 3 If you think like, I don't want to die of a heart attack, I want to fit in my clothes. I think you need to have like a good mental goals.
Anybody should be able to do it.

Speaker 3 But do you think most people that become morbidly overweight are also

Speaker 3 very sedentary, right? They don't do any exercise. And I think that's a problem as well, because I know most doctors say that losing weight is mostly the calorie issue, right? Calorie intake.

Speaker 3 Do you also recommend that they start doing something? Like if you do zero, if you're completely like if you sit in an office all day long

Speaker 3 and then on the weekends, you sit on the couch eating potato chips and watching sports.

Speaker 3 How do you convince a person like that to do a little something, to become a little more active?

Speaker 1 Yeah, so, you know, exercise is so important for every facet of your health, physical, mental.

Speaker 1 Exercise a huge part of weight loss medicine? No, it's adjunctive. It's an adjunct.
The lifestyle is what gets people.

Speaker 1 It's not necessarily just the caloric intake. It's the nature of the calories that patients take in, right? So

Speaker 1 that said,

Speaker 1 obviously we know the benefits of exercise, you know, lowering cardiovascular risk, cancer risk, diabetes, hypertension. So it's so important to really encourage exercise.

Speaker 1 And a lot of patients who are obese, you know, they're deconditioned.

Speaker 1 So, you know, and a lot of patients, I would ask to see a cardiologist before I even get them on a program because I want to know that they have a stress test, if they have cardiovascular risk factors and are obese and haven't worked out in a while.

Speaker 1 So if patients are deconditioned and that they haven't worked out in a little while, then you want to maybe think about having them walk, just exercise, just

Speaker 1 getting a brisk walk.

Speaker 1 And then you have them walk a little faster. And then you do one block fast or one block slow.
You want to build in intervals at some point with every form of exercise.

Speaker 1 Or maybe it's a treadmill, right?

Speaker 1 So once they built up a treadmill where they can walk for 15 minutes, maybe the next time they do 30 seconds a little faster where their heart rate is up, and then and then 30 seconds where they're going a little slower, okay?

Speaker 1 So, you know, building in high intensity or higher intensity. And then gradually, whatever the exercise is, you do it for longer periods of time, and then you eventually increase the intensity.

Speaker 3 And I think eventually you start really enjoying it because I know a lot of people

Speaker 3 they think they don't like it. And to me, exercise is kind of like we were talking about the diet.

Speaker 3 If you do something you hate, like let's say you hate going to the gym, maybe you're going to go for two weeks.

Speaker 3 You know how in January the gyms are packed and then in February, half of the people gave up the membership. I think you need to find something that you really enjoy doing.

Speaker 3 Like for me, I love being outdoors. I have to rescue dogs.
So any given day, we walk five, six, seven, eight miles a day. But I'm not doing like, oh my God, I got to do this.

Speaker 3 You know, it just became my lifestyle and I appreciate it so much. And I enjoy it.
And when my friends ask me, how the hell do you walk so much?

Speaker 3 Like, yeah, because I take these little breaks during my workday. And when it's nighttime, I get the little beep on my phone, you know, from the app, like, congratulations, Catherine.

Speaker 3 You know, you walk whatever, six, seven miles a day. But it's something that I enjoy.
And I think this is the message that I try to send people.

Speaker 3 Find anything like appreciate that you can move your legs, right? Or play a sport or go play pico ball.

Speaker 3 Because if you start doing something that you hate, like this diets, I'm only going to eat broccoli and salad. I'm only going to do, it's not going to last.

Speaker 1 Yeah, 100% correct. And I tell my patients the same exact thing.

Speaker 1 And I tell them that you need to find some form of cardiovascular exercise where you can get your heart rate up. that you enjoy doing.
So maybe it's Zumba, maybe you like to dance.

Speaker 1 Maybe you're the type that, you know, if you're, if you have a newborn at home, maybe you get a video and watch a video and do something fun at home. Get all you need is an ad.

Speaker 1 You know, it's inexpensive and it's practical and it's in your home or, you know, walking or jogging or biking or whatever it is that you like to do. I really encourage the classes.

Speaker 1 I love Orange Theory. I love the CrossFit cardio.

Speaker 1 I like Barry's Boot Camp. I don't know if you have Barry's Boot Camp out there.

Speaker 3 Yes, we do.

Speaker 3 We have Barry's Boot Camp. We have the F45, you know, the Mark Wahlberg.
It's so good.

Speaker 3 We have a bunch.

Speaker 1 It gives you structure. It gives you these are well-thought-out plans.
They're resistance training with cardio-adiovascular component that also have stretching involved.

Speaker 1 So, basically, for 45 minutes for an hour, you check your brain at the door, you go in there, you give your best effort, and you leave there feeling like you've really done something.

Speaker 1 And hopefully, you didn't hurt yourself.

Speaker 1 Well-planned-out

Speaker 1 programs, and you know, I really encourage people to do do

Speaker 1 the classes.

Speaker 3 Totally agree. I love those classes.
Now let's talk about intermittent fasting before we run out of time because I have so many more questions. Oh my God.

Speaker 3 Me, I've been doing it for a really long time.

Speaker 3 I just started well over 10 years ago. And I think it's fantastic.
I read a million studies about it. It helps you digest food, right? It gives your body a break, all of these things.

Speaker 3 I'm not a doctor, but I always say it works for me. So usually, and of course, if I'm on vacation,

Speaker 3 exceptions, except, but on my everyday life, I normally stop eating between, usually 6 p.m., maybe, 7 p.m., and I only start eating 11 or 12 the next day.

Speaker 3 I don't do 24 hours, but I do usually 16, 17 hours. And I got used to it and I love it.
And if I wake up and try to eat food, my body doesn't even want the food.

Speaker 3 But a lot of people that never did intermittent fasting, I know it's overwhelming because I know I get messages about it. My girlfriends are like, how do you handle it? The body gets used to it.

Speaker 3 So anybody listening to us as a doctor, since I like talking to experts, I don't want anybody to listen to what works for me.

Speaker 3 If someone wants to try it, can you give them pointers and how long is an ideal one for a beginner? Can you help us out a little bit, someone that never did did it?

Speaker 1 Of course. First of all, Catherine, you mentioned a couple of times that you're not a doctor, but you seem to know more about nutrition than I do.
I know. I know.

Speaker 1 Let me just say that.

Speaker 3 I'm very impressed. It's thanks to you guys, by the way, thanks to my wonderful guests that come and teach me so much.
That's how I learn.

Speaker 1 Well, you know, for my patients,

Speaker 1 there are so many different ways to do fast. What you're describing that you do is basically called time-restricted eating.
You're eating between this hour and this hour, which is great.

Speaker 1 structure, right? For a lot of people, that's difficult. I mean, to have your schedule that way every day, seven days of the week, it's difficult.

Speaker 1 You have the ability to do it. I'm sure you do it on a regular basis, and it's great.

Speaker 1 What I recommend is a little different. I recommend longer fasts, and then I recommend people to liberalize their diet a few days of the week.
So they have their cheap days, right?

Speaker 1 So I recommend long fasts, two 24-hour fasts

Speaker 1 out of the week, non-consecutive days. It's too much to ask for someone to fast more than 24 hours.
At that point, your body is catabolizing its own protein.

Speaker 1 So you're getting what's called sarcopenia or loss of muscle mass. So you don't want that.
Okay.

Speaker 1 So I do recommend that patients go long periods of time without, you need to stay hydrated, but you don't need to eat. Our bodies are not meant to eat three meals a day the way we do, right?

Speaker 1 We're hunters and gaps. you know, historically.
So we're, you know, we're,

Speaker 1 you should be eating less frequently. The way I promote this is to have dinner to dinner with no calories.

Speaker 1 And then I have my patients break their fast at the 24 hour mark with a protein and a vegetable, a lean protein and a vegetable, and then nothing else for the rest of the night.

Speaker 1 So it's a lot to ask because you're going 24 hours without a calorie and then

Speaker 1 you're having a meal.

Speaker 3 So what's the benefit of that? Like if you tell, like you said, you tell someone to do it twice a week, not eat for 24 hours, what are the health benefits of that?

Speaker 1 So when we study animals, who obviously have shorter

Speaker 1 lifespans than ours, when we study animals and subject them to this style of living, they have longevity. They have less hypertension, they have less diabetes, less cholesterol, less heart disease.

Speaker 1 So we know that there's an association with, in animals at least, with longevity, with these long fasts, particularly.

Speaker 1 And we know also epidemiologically from human populations that live these type of lifestyles. Of course, there's so many confounding variables to tease them all out, but we know that,

Speaker 1 but people who live this kind of lifestyle tend, these populations tend to live longer. So

Speaker 1 the basic chemistry behind this is that, or the hypothesis, is that

Speaker 1 when you're fasted for more than 24 hours, your body doesn't have its preferred fuel, which is carbohydrate. Carbohydrate is glucose in the blood, sugar in the blood.

Speaker 1 and also the sugar that's stored called glycogen in the muscles and in the liver. After 12 hours of fasting, pretty much all of that's gone.
So your body is forced to catabolize

Speaker 1 fat, your own endogenous fat, right? Your own fat in your body, your adipose tissue as a source of fuel. Now it's not the most efficient source of fuel,

Speaker 1 but your body breaks out its own fat, okay?

Speaker 1 When that fat is broken down, insulin will potentially cause that fat to be redeposited.

Speaker 1 By going long periods of time without having a carbohydrate, your body doesn't need to produce insulin because insulin is meant to push the sugar, the glucose from your carbohydrate meals back into the cell so it can be stored.

Speaker 1 Okay,

Speaker 1 without insulin,

Speaker 1 you're not able to not only store glucose, but you're not able to store fat because insulin is a storage hormone.

Speaker 1 So all of the fat that's broken down from your endogenous, your only fat tissue doesn't get reincorporated. It gets metabolized.

Speaker 1 So you're breaking your own fat down by keeping your insulin levels low. And this is the key.
So this is.

Speaker 3 And sorry for interrupting, but so that only starts happening after how many hours?

Speaker 1 Well, you know,

Speaker 1 it differs in individuals, but typically 12 hours, you start to get ketotic. Okay.

Speaker 1 So the byproduct of these ketones are, I'm not going to get into the woods about it, but beta-hydroxybutyric acid, acetoacetate, these chemicals from ketones actually have been shown to have positive impacts on blood vessels.

Speaker 1 So there's science behind this, okay?

Speaker 1 So, you know, you know about the key to the keto diet. Yeah.

Speaker 1 That's another curse word in my practice.

Speaker 3 Yeah, I don't like diets. Yeah.

Speaker 3 I don't like diets. Yeah.

Speaker 3 I like to eat clean, like clean, you know, things that are not processed in a factory.

Speaker 3 That's kind of like my room. I like the vegetables, the fruits, lean

Speaker 3 protein, grass fat. I try to stay away from anything packaged, anything with weird colors, weird names.
To me, that's kind of like my rule. You know, the cleaner, the better.

Speaker 3 And then, like you said, we deserve to cheat. We deserve like a dessert, a glass of wine, whatever it is that you like every now and again, because otherwise, life gets too boring.

Speaker 1 Exactly right.

Speaker 1 You need that for sure. You can't always be on.
Yeah. That's for sure.

Speaker 3 So, but for your patients that you say, do two days a week, 24 hours fasting, How do you recommend eating the other days?

Speaker 1 I tell them they don't need to change anything on their other day. Really?

Speaker 1 Well, just by them doing those two days, they're committed and they're going to change their ways on the other days. They don't want to sabotage their efforts on their fast days.

Speaker 1 So I've no, even though I give them no guidance on the other five, on the other five days, I'm noticing my patients are being better. I give them some basic guidelines.

Speaker 1 I tell them more protein, clean proteins, maybe more egg whites, maybe more vegetables, spinach, you know, lean steak, sirloin steak, not ripped steak, not skirt steak.

Speaker 1 I tell them to eat more chicken, take the skin off the chicken,

Speaker 1 cauliflower, cruciferous vegetables, fish,

Speaker 1 fish.

Speaker 1 Fish, of course. So all great choices, okay?

Speaker 1 Even like 0% yogurts, 0% fat yogurts with blueberries on your non-fast day, right?

Speaker 1 So these are all things that I recommend, but I don't tell anyone to eat a specific way five days in the week because I understand that if I make wholesale changes in their lifestyle, the chances of them sticking with this is not

Speaker 1 good.

Speaker 3 It's very small. Now, the people that do this kind of intermittent fasting, they call it colloquially, like the one I do.

Speaker 3 Does it really have health benefits to not eat for 15, 16, a period of 15, 16 hours in a day?

Speaker 1 It does, but the data supports that people are less likely to stay with it, right?

Speaker 1 So dieting, getting your weight down, is caloric restriction partly, and it's also changing the nature of the macronutrients that you take in, more proteins, you know, more vegetables, less fat, obviously less carbohydrate.

Speaker 1 So

Speaker 1 in this particular instance, a lot of patients are not able to stay with that on a daily basis. So people are more likely to stay with the program that I'm suggesting the two days.

Speaker 1 And it's also a little less, obviously, it's a longer period of time that you have to go without eating, but people are more likely to stay with it.

Speaker 1 So the key is to get people on a program that they could stay with for the long term, not something that they do for two or three months. And then

Speaker 1 recidivism happens and they gain that weight back.

Speaker 3 And always a great idea. Do it with.
a great doctor, right? Don't start something crazy. Like you said, don't get a prescription from your trainer.
Don't go nuts.

Speaker 3 It's always great to do all the exams and have a fantastic doctor such as yourself guiding the person. You have a much better chances of success, correct?

Speaker 1 Yeah, I think so.

Speaker 1 You know, a lot of, listen, it's so difficult for lay people to understand nutrition because everyone's got a blog and everyone's got their opinion.

Speaker 1 So, I mean, you want to be with a doctor who practices evidence-based medicine, who's got science behind, you know, or what she,

Speaker 1 a healthcare practitioner, I should say that's practicing evidence-based medicine that has

Speaker 3 proof that what they do is it works and is done in a safe and a safe and effective way yeah before i let you go because we're running out of time i have another question that someone sent me obviously each person is a case we know that but in general a lot of people that cannot lose weight or i don't know do not want to lose weight they you know they have this i don't know if it's excuses but they're like oh it's my age i'm getting old uh oh it's my hormones i'm menopause or perimenopause or premenopause you know they are they put these excuses in their head do you think it's true that most people that cannot lose weight it's something internal or it's the famous you know, math, calories in, calories out, exercise, and I don't know.

Speaker 1 So there are conditions that cause people to hold on to weight. Certainly, the menopause is one of those where people gain a few pounds.

Speaker 1 There are medicines that people take that cause them to gain weight. There are other metabolic issues like hypothyroidism or hypercortisolism that can, but they're few and far in between, right?

Speaker 1 This is lifestyle. And I think it's important to listen to your patients and not tell them that they're wrong.
Do the appropriate biochemical testing, simple lab tests.

Speaker 1 Show them the lab tests and the results and that they don't have any medical problems, and then talk to them about a lifestyle. Now, even

Speaker 1 from individual to individual, people have different metabolic rates.

Speaker 1 So I have patients who sit there with their husband and they complain that, you know, he eats everything and he's not gaining weight, but I eat one cracker and I gain five pounds.

Speaker 1 You know, that's your metabolism. So you need to adapt and change your lifestyle and learn to live with your metabolism.
You can't change that. That's your constitution.

Speaker 1 So there are so many things that affect weight, but you can impact people's health in a positive way and get people to lose weight with a good balance of lifestyle and sometimes medicines.

Speaker 3 Yeah, fantastic. I think

Speaker 3 you are an incredible doctor, the way you approach it in terms of the lifestyle. Like you said, it's the long run.

Speaker 3 And the most important message, I think, is If somebody comes to your office or any ethical doctor for that matter, they're like, hi, doctor, I saw so-and-so on TV and they look so thin and they lost all this weight on Ozampi.

Speaker 3 Can you please write up a prescription and I'll be right out of here? The answer is, you're not going to do it, right?

Speaker 1 Well, I mean, listen, I like to hear what the patient has to say. Right.
I'd like to risk stratify them because some of these medicines are indicated for people who have higher cardiovascular risk.

Speaker 1 So, you know,

Speaker 1 I'll always entertain the idea, but it's always lifestyle first. You know, it's labs, making sure everything's the hormonal milieu is okay, and then it's and then it's lifestyle.

Speaker 3 Yeah, Dr. Abito, thank you so much.
It was such an honor having you. How do people find you? If someone wants to come and talk and do a consultation?

Speaker 3 Well, you're in California, so I mean, well, I listen, I have an audience

Speaker 3 worldwide and a massive audience in the United States. And I'm sure a lot of people in New York are listening.

Speaker 1 Well, you know, about 30% of my patients are treated by correspondence, by telemedicine. So a lot of my patients are just, you know, a lot of what I do is counseling.

Speaker 1 Do I prefer to have a face-to-face and

Speaker 1 do an exam on my patients and blood pressure? Of course, I do, but sometimes it's not practical. And a lot of what I do is correspondence.
So I do a lot of telemedicine.

Speaker 1 So, yeah, my practice is on the Upper East Side of Manhattan on Mount Sinai affiliated. I'm an endocrinologist with a background in nutrition and lipidology.

Speaker 1 And, you know, you can find me online. My office number is 877-703-3775.
And my name is spelled R-A-B-I-T-O.

Speaker 3 And I'm going to put the link of your website on this episode and on my website, cataldoloose.com, as well, because I think this is such an important resource.

Speaker 3 And for anybody out there that wants to lose weight and live well, it's for the long term, right? It's for the long run. It's a lifestyle.

Speaker 3 Thank you so much, Dr. Abit It was such an honor.
Guys, be safe out there. Don't go getting Ozampic prescriptions in the black market.

Speaker 3 Thank you, Dr. Abit.