April 7, 2023

Podcast 314: What You Should Know About Weightloss Drugs, Part 2

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Can Ozempic, Wegovy, or another drug help you lose weight?

Are they effective?

Do you need to stay on them forever?

On today’s podcast, I interviewed Dr. Matthea Rentea, MD and Dr. Cris Berlingeri MD, who also completed The No BS Weightloss Certification to answer all your burning questions.

Make sure you listen whether you’re taking them or not even interested in the latest class of weightloss drugs.

This conversation is so important because women can’t spend another minute judging themselves or anyone else for their personal choices in how they lose weight.

Listen to Podcast 314: What You Should Know About Weightloss Drugs Part 2.

If you want to learn more about Dr. Rentea and Dr. Matthea, their information is here:

Dr. Rentea:

Website: www.RenteaClinic.com

Podcast: The Obesity Guide with Matthea Rentea MD 

TikTok: MattheaRenteaMD

Instagram: MattheaRenteaMD

Dr. Berlingeri:

Instagram: CoachCrisBerlingeriMD

Facebook: CoachCrisBerlingeriMD

Podcasts: 1. The Joyful Weight Loss Podcast

2. Una Cita Contigo

TikTok: CrisBerlingeriMD

Transcript

Corinne:

Hello, everybody. Welcome back. So as promised, we are doing a part two to our podcast where if you’ve listened to part one, or you haven’t listened to part one, I would go back to it, where we were talking about weight loss drugs. I gave you what I would call my psychological perception of it, like Corinne’s thoughts and opinions. Just a lot of people are seeing them everywhere right now, and I wanted to make sure that you know kind of how this all fits in with what you’re learning in terms of listening to my podcast. And then today, I’ve brought the doctors in.

The last thing anybody needs is Corinne trying to explain concept medical things. I always tell everyone, “I am your common sense girl. I will read lots of things, I will tell you what I think,” and all that kind of stuff, but I do not pretend to be a doctor. So I have two doctors who came through my own personal advanced certification. Well, I’ll just let y’all tell about yourself. So Matthea, why don’t you go ahead and start and just tell everybody who you are, what you specialize in, and that kind of thing.

Matthea Rentea:

Yeah. Hi. Thank you for having me on. I’m really excited to be able to talk about this, because I feel like it’s very misunderstood out there right now. So I’m Dr. Matthea Rentea. I’m a double board-certified physician in internal medicine and obesity medicine. And I have a practice called the Rentea Metabolic Clinic, and I help patients with this chronic weight management from a very loving perspective. But part of that, potentially one of the tools that we’ll use are medications. And so this is really what I help people with all day long.

Corinne:

That’s awesome. All right. Cris, tell them about you.

Cris Berlingeri:

Yeah. So I’m Cris Berlingeri. I’m a doctor specialized in dermatology, but I went through Life Coach Certification, did the No BS advanced certification and I was doing weight loss coaching. So when Matthea was going through the certification for the obesity medicine board, she just motivated me and encouraged me, and I went through the certification as well. So I’m board-certified as well in obesity medicine. And it just changed my perspective and my approach to both coaching and my own patients. Even in dermatology, we see skin manifestations of patients with obesity. So it has helped me tremendously in that sense, in how I approach my patients and my clients.

Corinne:

So before we get into some of the more technical questions, I just want to ask y’all this. And correct me if I’m wrong, because we just literally did the original podcast before… It all happened so fast. Did y’all get a chance to listen to it? My stance? I know you read my outline. I know you both got to at least see my outline, which I told all of my listeners, I have never done an outline so long. I am a talk out your ass kind of girl. I just need a couple of points, and then we’re just going to rail for a good hour. This one I was like, boom, it was a little novel. So I know you read it. What are your thoughts just on that, in terms of the weight loss tool of a weight loss drug and the psychological part that goes with it, the whole thought work piece that needs to be added?

Cris Berlingeri:

I would like to start by saying that from a medical perspective, this is much more than weight loss. Particularly when it comes with patients with obesity or clients with obesity, it’s much more than weight loss. It’s like getting skinny is not the goal, because with obesity, it’s a condition that affects almost every system in the body, right? And it also messes up your hormones, your hunger hormones, satiety hormones. So when we are talking to our clients about concepts as eat when hungry and stop at enough, in a patient who has had obesity, it’s going to be much more challenging. So just the knowledge of that I think helps thought work, right? Because oh, there’s nothing wrong with me. This is just how my brain is functioning. Another thing is not only in a patient with obesity, the hunger hormones are going to be higher, there’s going to be resistance to the satiety hormones, and there’s going to be a lot of brain chatter for food. Why? Because our body’s were designed to store energy.

That’s it. Our body is convinced that it needs to retain that energy. And energy in our body is fat, so it’s going to do whatever it takes to get you go and get the ice cream, get you the chips because that’s what it thinks it needs. It’s trying to protect you. So I think just understanding that eases up, I think the brain and the nervous system to do a much more effective, if we could talk about effective, thought work because we are kind of understanding what’s going on inside of us. So these newer medications, they just help with that chatter and all of that. But I see it more now as a whole complimentary to the thought work.

Corinne:

So let me ask this, because this is where I legit get confused. And I have some thoughts about it, and I would love for y’all’s opinion, but how does it lower chatter? Because that’s what I think I get confused on, is… I know our brain does a lot of stuff. Is it because the drug itself, when it’s reducing how much hunger, is it the chatter that comes naturally with hunger is reducing, so that’s why it’s reducing it? Or what’s actually happening? Because that’s the piece I get confused on.

Matthea Rentea:

So I’ll say this. So here’s how I explain it to people. So it’s not an either or conversation. If we look at kind of chronic weight management, there can be about 12 different areas that we look at that highly influence weight, some of it being genetic, some of it being environmental, food choices, all of that, right? So it’s not a decision of do I do thought work or do I do a medicine? It’s a potentially yes, and. And we’re not here to sit here only promoting medicine. It’s not the right choice for everyone. But what ends up happening is, so when you’re living at a higher body weight set point, you can be insulin resistant. You can also have something called leptin resistant. So we have these hormones in our bodies. And what ends up happening is you can’t sense when enough is.

So you might not want to be overeating, but you literally don’t ever get the off signal. And then when you try to lose weight, as you’re reducing down calories and you’re losing weight, because there are so many things physiologically happening in your body, the thoughts usually greatly increase. So one, if we’re getting very medical, we’re going to say your reward system. So you start to have all these thoughts because your body’s trying to get you to put back on weight, but underlying that can be a physiological problem. And so that’s why the medications can be helpful in some ways. The way I like to describe it, this might sound like a horrible analogy, but just go with me for a second, it’s like we’re going to inject heroin into your veins, and we’re saying now sit there and do thought work. It’s like it’s not going to work.

You’re sitting there, and that’s what ends up happening. As you’re losing weight, you have more of the hunger hormone. We know this that’s been studied. We know that this happens. So hunger hormone goes up, satiety hormone goes down. Put those two together. You are more hungry, you’re thinking about food more, but now you want to keep achieving this goal, right? And it’s never aesthetic. Okay? So anyone that’s talking about Hollywood sensationalized losing a few pounds, that’s not what we’re talking about. We’re talking about people that have excess weight on them, and likely it’s contributing to medical problems, either physically, so biomechanically there’s arthritis, they’re having a hard time moving around, moving around in bed, things like that, or neurohormonally, they’re more hungry, they’re having diabetes, things like that. So it’s a much bigger conversation. Did that answer kind of where the thought work comes in?

Corinne:

Yeah. And I guess my next question, and I know we have lovely questions over here that we will get to, but I’m just so into this right now. I just really want to understand it. And honestly, I trust y’all more than I would trust anyone to talk to about this because you do have the thought work background, and I know how passionate the two of you are about all this stuff. So for all of my listeners who don’t know y’all, I would never bring people on my show to talk about something serious that I do not trust all the way with y’all. It’s like your babies. It’s like I’m not going to just leave my baby with some rando and say like, “Hey, take care of this kid while I go do something.” I think of my listeners as my babies. So I think, I guess, again, what I’m kind of going back to is, so before we even had these things…

Because I think this is what’s going to come up. Somebody’s going to hear this and say, “So am I screwed? I want to do Corinne’s podcast. I don’t want to do weight loss drugs, but I do fall into these categories. And when I am losing weight, my chatter does go up.” We’re not really saying that that stuff doesn’t work. Just know that for some people, that’s happening. There is a way to still still get through it with thought work, but weight loss drugs… I don’t know. From what my clients are saying, it’s like for some people, it feels like their body is in this.. It’s just off kilter state that for them, it could help them access the thought work so much easier. Is that kind of what we’re saying? I’m not sure. You can disagree, and you can re-explain it to me.

Cris Berlingeri:

Yes. So this newer class of medications, which I think is what we’re talking about, right?

Corinne:

Yeah, we’re talking about the new class medications. Yeah.

Cris Berlingeri:

Yes. So they’re what we call what is called GLP one analogs. So it’s like a big name for a hormone that we have that is shown to be decreased with excess weight. So these medications work by normalizing the levels of that, and it’s going to increase satiety because it slows down the movement of food from your stomach to your back, to your intestines, right? So that’s why you’re feel fuller for longer periods of time, and then also decrease hunger, because one of the ways hunger hormones gets activated is by an empty stomach. So by having a fuller stomach for longer periods of time translate into less hunger, increased satiety. And Matthea, maybe you can also explain how it works at that kind of reward system in the brain, reducing the brain chatter of food.

Matthea Rentea:

Yeah. So GLP-1, it’s not just slowing down gut motility so you’re satisfied with less food, but it’s also affecting the… In our brain, we get enough signaling with it. And it also by the way, has many other benefits in the body, it affects the heart positively. So we’re finding out they’re truly one of these wonder children in the sense that at where we keep looking, we keep finding better and better things. But I just want to come back to this. No, it is not that everyone has to do a medicine, but let’s look at… If we look at, for example… Again, and this is just me medicalizing it for a minute, what percentage of body weight are you looking to lose? And if you are someone that has, let’s say 20 plus percent of your body weight, what we see statistically is it is harder for you to do it just on lifestyle alone.

Doesn’t mean it’s impossible, but if I just give a number, it’s about 5% of people that can lose 20% of their body weight and keep it off with lifestyle alone. Now, let me give context here. I feel the people that are finding you, they’re very motivated coming to weekly calls, they’re doing daily journaling, they’re doing all those things. So we’re talking global picture here. But the point is, if you have a higher percentage of weight, I don’t want people to be thinking about weeks or months keeping weight off. It’s really about how, for the next 10 years, can we lose that weight and keep it off so that you feel okay? It’s a different conversation.

Corinne:

Well, and I think that’s an important conversation, because one thing… Every person that I coach is always like, “I want to lose it fast.” And these drugs are not intended for fast weight loss. A lot of times people, they bitch and gripe. They’re like, “No BS takes so long.” It’s like, it doesn’t take long. You are either in this for the long haul, and you want to get the weight off or you’re not. It takes as long as it takes. And what you were just saying is… If somebody’s thinking this is my express train to fast weight loss, it’s like 10 years is not exactly what I would call the fast train.

Matthea Rentea:

No. And we’ll get into so much of this as we go through questions, but I’d even tell patients, “I don’t want you losing more than one to two a week. If you get into the three plus pound weight loss per week, you’re losing muscle. Metabolically later, you’re in a much worse position.” So fast weight loss, that’s not ever the answer, even on these medications. So again, that’s just so much misconception. Hopefully as we go through here we can kind of address some of that.

Corinne:

Yeah.

Cris Berlingeri:

And I think… Oh, I’m sorry.

Corinne:

Oh, you go ahead. [inaudible 00:13:15]

Cris Berlingeri:

I think that’s when thought work becomes really important. Why does it need to be quickly? Because we’re looking to feel a certain way afterwards, right? So I think that’s when thought work is so important, addressing why does it need to be fast? And also, you always mention all the time, maintenance… Do you think this is all just going to be a light switch that goes off, all that chatter in the brain in maintenance? No. So the longer it takes, the more apt you’re going to be at maintenance to maintain that new body weight.

Corinne:

The one thing I want to go back to, and then I promise we’ll get to the questions. I’m just so curious. So when we talk about 5% of people with lifestyle change, I do want to say this about, I think what makes No BS different. And Matthea, you brought such a good point up. That statistic takes everybody who’s trying to lose weight doing all things, including jackass dieting, all the things. If you were to take my people out… Now, somebody’s going to write in, and I know they’re going to be like, “What your study?” I don’t have one because I don’t spend time developing apps to track the actual things that my members are doing. I spend time with my members, very different. So I will never apologize for spending time with humans over developing technology so somebody’s ass can get a statistic. But here’s what I will say, we don’t just do lifestyle change inside of No BS.

So to me, a lifestyle change is simply I’m changing my habits around stuff, and maybe I’m going to move more or whatever. We are doing mental change. And when you layer in that mental change on top of lifestyle change, on top of everything, this is where you fundamentally shift as a person, where you lose the identity of someone who can’t lose weight, struggles with weight, has problems with food and all that stuff. We’re working on developing you into someone who feels… I feel so good in my body. I love my life. I feel comfortable around foods. We want to shift just all of it. So I just wanted to say for everyone listening, it’s like we want to remember that a lot of the… One big problems in the diet industry right now is there’s not a lot of thought work being included in weight loss programs.

And I think that’s why, even during the weight loss surgery, because I have a lot of members who’ve had weight loss surgery, they come to me because they’re like, “It didn’t fix my brain. It altered how I ate, but now I have a whole nother crop of problems I didn’t even know I was going to have.” Now I’ve lost weight, but I realized I just never liked myself on all kinds of levels. It wasn’t just my weight. Now that the weight’s gone, now here all the other reasons why I don’t like me, or all the other reasons why I’m paranoid. I’m not paranoid around food anymore, but now I’m paranoid around how I show up at work.” So we work on a lot of that stuff. All right.

Cris Berlingeri:

Yes. I wanted to add that, while I was studying for the obesity medicine board, I learned that… I don’t know the number again, the statistics. Maybe Matthea remembers. After bariatric surgery, weight loss surgery, there’s a higher incidence of a alcoholism because we’ve removed one buffer and substituted with another. So thought work is a must. Thought work really, because it’s what you’re saying, it really changes who you are in the sense of how you see yourself and your relationship with your body and with food. So it’s definitely has to be there with any weight loss method that you choose.

Matthea Rentea:

Yeah, so transfer addiction shows up if we don’t do the work. But here’s the thing that we’re going to get to do, Corinne, when we do the questions. It’s that it’s not if it’s when the work is required that’s needs to be done in your program. Because what ends up happening is, with these newer medicines, we see from the studies, yes, people lose weight, we know the percentage, all of that, but what ends up happening is they actually do keep the weight off if they stay on the medicine, but the thoughts return. And so then, they’re sitting there thinking, oh my gosh, I’m going to start binging again. I’m going to go back to this old way. And the weight’s actually staying off, so they’re in a better spot, but then they need to do the thought work. So I’m always like… Because I even do some in my clinic. That’s what’s unique about mine. I say, “Hey, well do you want to do the work now? Do it later.”

But at some point, that component, it’s going to need to come in, because one of the… And again, we’re talking medical here. Okay? We’re not talking as a coach today. It’s a chronic unremitting condition, meaning it keeps coming back. It keeps popping its little head. Oh, I’m okay for a few years, and then bam, you have something stressful happen and it comes back. And if you’re not having the type of tools that you have in your program, then it’s not if it’s when you usually run into a problem again. And I’m not being negative, it’s just a reality of long-term data. And sometimes that’s actually very comforting for people to say, “Yeah, I’ve struggled with this for decades, and I finally actually feel heard and understood that there’s not a quick fix.” That’s not what’s being sold here.

Corinne:

Yeah, I think that’s amazing point, both of you. And I love how you said it’s not if you’re going to do thought work along with this, it’s when are you going to do it? And I have said this forever because I have believed this about my program, no matter how we’re losing weight. I have watched too many people lose weight, and then they’re excited that they’re thin and they like buying the clothes and they get a hit every time they weigh in [inaudible 00:18:51] those momentary blips don’t out… They can’t outrun, I wonder if I’m going to gain my weight back. And they can’t outrun anxiety around, should I go out to eat or not? If you’re an overthinker about all that, if you worry about what people think and stuff, weight loss drugs and losing weight and just doing my four basics cannot solve those things.

You have to include… We have to rewire our identities. Because I think when we’ve struggled with our weight, we have this… I struggle with my weight identity, and so you can have that even when you’re thin. I remember this one guy, dear friend of mine, his name’s Bill. I travel with him. His wife, she will flip out. She’ll make him listen to the podcast. She’ll be like, ” [inaudible 00:19:40] Bill, she’s talking about you.” But he and I were just alike. We grew up the big kids. It ran in our families. We really struggled with our weight. And when I met Bill, him and his wife were losing weight. They were some of my original clients from day one of No BS. And one day, he and I, we were just sitting and we were talking at a restaurant, we were eating, and he just said, “I think I’ll always be a fat kid on the outside trying to get out.”

He’s like, “No matter what I look like on the inside, I’ll probably always be a fat kid and I’m just waiting for when he’s going to come back.” And I was sitting there thinking about that just even this week. That’s why it’s so… And this was before I taught thought work, so no wonder poor Bill had that thought. But it’s really important that we shift our identities as we’re losing weight, because the worst thing that can happen is you finally get your dream and you realize it’s a nightmare. It’s filled with anxiety and fears, and you didn’t escape any of it. So let’s actually get into the medical portion of our show. I know sometimes I [inaudible 00:20:54]. It’s like I’m riding a wagon. I’m not taking the express train. All right, we’re just going to go in order of the questions that we got because I think that’s the easiest way to do it.

First one that my members want to know is if you lose weight on like Wegovy or Ozempic, do you have to take it forever to keep the weight off? If not, how do you taper?

Cris Berlingeri:

Well, I think this goes back to what we originally were saying, both Matthea and I, that this is… Obesity is a chronic condition. There’s a hormonal imbalance that is going on. And the medicine, it’s going to work, that 10, 15% weight loss. And as long as you keep taking the medicine, you are going to keep that weight off. If we remove the medicine, and particularly if you haven’t done that work, that weight most likely is going to come back, because again, it helps with increasing your satiety, decreasing the hunger, and helping you with that brain shatter about and food seeking behavior.

Corinne:

Okay.

Matthea Rentea:

Yeah. So if you look at the studies, we have year long studies at this point, and basically if you remove it, the weight does come back, but it would make no sense to stop. Here’s the thing I want people to question for a second. Take the term obesity and replace it with high blood pressure, diabetes, anything else. Do you have thoughts about the minute your blood pressure is controlled that you’re going to stop taking the medicine? It literally makes no sense, right? Because the medicine is keeping your blood pressure where you need it to be. So why is it any different with a tool for weight management? I think there’s just so much stigma and bias, and frankly misinformation. But one of the things we really want to prevent long-term with weight management is weight cycling. So up and down. Because number one, it’s not great metabolically for us, and it becomes harder the future times we try to lose weight.

So anything we can do to stabilize your weight, even if that means no weight gain, that’s a win. No one actually talks about that enough, a big win to either stabilize weight, not gain more. But if we can get weight off and keep it off, I don’t like to play the Russian roulette game of take away the med. How do you do? Did enough fiber do you well? That’s like I think if the medicine’s working, maybe if you… And I know it’s a big commitment to decide you’re going to try it, right? But right now, I would say if you’re going to go on it, likely not coming off of it too soon. Maybe future studies show us different things, but that’s where we’re at right now.

Corinne:

What does it mean-

Cris Berlingeri:

Also-

Corinne:

Can I ask… Well, go ahead, Cris, I’ll ask this.

Cris Berlingeri:

No, I just wanted to add that from the medical point of view, it only requires five to 10% of your body weight, weight loss to start seeing improvements in heart disease and diabetes, cancer prevention. There’s some cancers that are associated with obesity. So I also like to explain that to patients so they don’t get discouraged, right? Like, oh, it’s only 10% weight loss. Again, we’re talking here about all the other major benefits that you can get from five to 10% weight loss.

Matthea Rentea:

So this is something I like to tell… Everyone’s focused on the pounds they’ve lost, and what I really like to focus on is body percentage weight loss. So take your current weight, divide by where you started, and then a hundred minus that number. And so when you’ve reached about that 5%, like Cris was talking about, 5% is like pre-diabetes, can be reversed, things like that. Maybe it needs to be closer to 10, 15, 20% if you’re wanting to reverse fatty liver, things like that. But realize that 5%, no matter what your starting weight is, we see as clinically significant. So there’s something about either how people are changing or what they’re doing that is having that significant impact, because we see it across the board.

Corinne:

What does it mean… So when y’all say you can expect to lose 15% of your body weight, does that… Because this is what my listeners are going to hear. So are you telling me I can’t lose all my weight? If I take these drugs, I don’t lose all… Because they want to get… I understand completely that we need to look at all the things that come along for the ride with weight loss. I’m always trying to tell clients, “Look for all the ways your life is improving. The more you see the picture of your life improving, you’ll want to do other amazing things for yourself.” But they also are like, “But, I want to weigh 150 and I’m weighing like 200. Are you telling me I’m not going to get there?” I’m speaking for that lady who’s having a pissy fit right now.

Matthea Rentea:

Corinne, I’m so glad that you brought that up, because the reason we bring up the number, so let’s just talk for a minute. Specifically, this question was asking about Wegovy or Ozempic, that’s the same medication at… The generic name is semaglutide. So one is FDA approved for weight management, the other one diabetes. Again, same thing. Okay, so it’s about 15% total body weight loss. So you take your body weight times 0.15. That’s the pounds that the average person could expect to lose. I always tell people don’t get locked into the number. So some lose less, some lose more. We have some that are called hyper responds, meaning they’re on… Because you monthly go up on the dose with people, they’re losing tremendous amounts on a low amount, we don’t even have to go up. So you don’t get locked into the number.

But one of the things that’s going to be different about an obesity medicine doctor is that we are looking at evidence. So we’re looking at randomized controlled trials, we’re looking at what the average person achieved on it. You might not fit that, right? And it’s one tool out of many. So we don’t know all the other areas that you’re doing. Maybe you’re making massive strides in your exercise and the ways you’re changing nutrition. So it’s all going to come together, but that’s what the study showed us. And then the other thing is it’s the right tool at the right time. So sometimes it’s not just one medicine, we might actually add another medicine on. Now, you get a higher percentage. We have newer medication that have higher percentages. Maybe you do lifestyle first, then you do a medicine. Maybe later, you need a surgery. It’s what you need when you need it. It’s so complex figuring it out long-term.

Corinne:

I think one thing I’m hearing from both of you that is very refreshing is we’re being open-minded, not close-minded, and we are… I think this is a conversation that has to be had more in the entire… It’s either in the diet industry, or I’m so anti losing weight because it’s all evil and stuff, and I think there’s a middle ground that needs to be met. People want to lose weight. They should never be shamed for their reasons. We want to teach people how to be comprehensive about the way they look at it. We want people to… I just don’t think people should be shamed for anything when it comes to their bodies or their choices about what they’re going to do for their weight and stuff. Anyway, it’s just a refreshing conversation. I just wanted to tell y’all that I really appreciate the way that you’re approaching all of this

Cris Berlingeri:

And I want to compliment to that by saying, even in my own weight loss journey, and yours, and probably everybody, the first 10 pounds look very different than when you lose the next one and the next one, and the last five or last 10 pounds. So why stay focused? Oh, I’m not going to lose all the weight with this, but what if that just gives you the starting point, and then we’ll figure out the next step to do? So it’s and, not either or. It’s all of these beautiful tools that we have together.

Corinne:

I have a question. So what if someone’s listening… And I know you can get Wegovy anywhere you want. You can get it if you want it, even if you don’t have, I guess much weight to lose. What are y’all’s opinions on that? Because I know a couple of my friends who they just have 10 or 15 pounds to lose, and they’re taking it. And I don’t want to shame them or anything. That’s their choice. But is that going to be coming on the horizon? Or what are the current medical stances on that? Do we know?

Matthea Rentea:

So let me say this. I’m going to say what the actual guidelines are and when it’s actually medically appropriate, but then there’s always going to be people that are medical providers that are doing things in a shady way. If you are seeing an obesity medicine physician or someone that has appropriate training, an endocrinologist, a primary care doctor that is appropriately trained in this, the recommendations are… And again, this is based on the average person. There are slight changes based on certain ethnicities. Okay? So this is in general. BMI, so body mass index, it’s a height for weight measurement, we’re not here to have a talk on the validity of it because I know that I don’t agree with all aspects of it, but it categorizes things. So BMI 27 up to right under 30 is overweight with medical comorbidities, so you need to have medical problems, whether it’s cholesterol, diabetes, things like that, or a BMI of 30 or above without problems.

So when someone has five, 10 pounds and they’re on it, they’re not getting it in the routine medical ways. I’m going to put it that way. Because if you would do height for weight, unless they truly meet the BMI of 27, which sometimes you actually don’t know when you look at someone what the numbers are, because I think everyone… We’ve actually seen this from studies, if you look at people and you try to predict their weight, or people try to predict the weight for themselves what category they’re in, they don’t get it right. So really, we need to look at the data. But if they truly only have a few pounds to lose with no medical problems, they’re not getting it in a way that is medically recommended.

Corinne:

Okay. That was one of the things I was wondering, just because I can tell you, I can’t go anywhere right now… I guess maybe, well, it’s probably hard for me to go anywhere right now and somebody not want to have a conversation about weight loss. But I feel like with these new drugs, I feel like it’s just everywhere now. And I’m like, “All right, well, let’s dive in.” Okay, next question, “My doctor prescribed phentermine…” Is that how you say it, phentermine?

Matthea Rentea:

Phentermine.

Corinne:

Okay. “…to me year after I explained how miserable I was at being so overweight. I did some research and it said it would reduce my appetite, but that it can be addictive. For that reason, I never started the prescription.”

Cris Berlingeri:

Yes, so phentermine is another medication used for weight loss actually being used for more than 50 years, and it belongs to another category. It’s not like this newer Ozempic and Wegovy. It’s more on the stimulant. It’s categorized as a stimulant. And again, it has been used for 50 plus years. Matthea, you maybe can add more to this.

Matthea Rentea:

Yeah, so one of the challenges with treating the chronic weight management is that insurance doesn’t want to cover it. So some of these older medications that we have, they actually are highly effective and work great. And even if you don’t have insurance, they’re very cheap to get monthly. The drawback is that because it’s a stimulant, I like to describe it as having a bunch of cups of coffee at once. So some people, they’re going to have side effects, maybe like heart palpitation., if they may think cardiac going on, it’s not a good idea. Maybe dry mouth, things like that. And because it’s in the stimulant category, it’s always going to have the warning of an addiction potential. We actually don’t see that long term and weight management with this. But one of the challenges has been that historically, it was written as only a three month at a time, and then you would stop it. That was the old school way, where everyone puts the weight right back on the minute they stop it.

I used to hate this medication for that reason. But nowadays, it’s used more in a longer term capacity if your state allows for it, and it’s covered. So I think if you don’t have medical contraindications, it can be a good option to have access to care.

Corinne:

Okay. So just to be clear, for all the listeners, the main drugs that we are looking at are the new class, which is all the ones that… It’s semaglutide, right? How do you say it?

Matthea Rentea:

Semaglutide. So it’s the GLP-1 category that the newer ones that most people care about right.

Corinne:

Yes. Okay, next. Someone said they currently weigh 358, and she’s 353. Basically she needs double knee replacement. She’s bone on bone, but because of her weight she can’t get the surgery. I really want to stick with the No BS program because I know it will work. But with my knees, do I need to add some weight loss tools to speed it up? I feel like I don’t want to do that, but I’m not sure what the best decision is. Can I just give my opinion, my one piece here as the thought work? I know y’all are coaches too. It’s not like I got to speak for all of us. But the first thing that I would do if anybody is having this thought is ask yourself, why don’t I want to do it? To me, that is the red flag in this whole thing, is there is a lot of shame going around right now around all this.

And I get it because four years, there have been ways that we’ve tried to lose weight that have not been safe at all. And I think it’s natural, when something new comes on the market, for all of us to just assume this must be like it was. That’s how brains work. Brains are not open-minded. Brains like to go to the past, what’s happened in the past to inform me of how… At least I should start to think right now. And that’s just a normal human reaction. But we all have to be aware of this because these drugs could be amazing or helpful. And this goes with everything in life. This next thing you’re going… Even when people join No BS, they bring their bullshit with them. They’re like, “Well, I’ve done all these other diets in the past. This will be just the same,” even though we’re doing it completely different.

So we have to watch that thought. You really want to figure out for yourself, why? You may have an amazing reason, but you might not. It may be just steeped in, ‘Well, 34 years ago when Dr. [inaudible 00:34:48] gave me this drug, I was a crazy maniac for two years and yelled at everybody.” Well, if that’s the opinion that is informing, you might want to just check it real quick and not cut yourself off from something you may or may not need. Now, I will let y’all go into this.

Matthea Rentea:

Here’s what I would say with this. First of all, you hit it on the nail. I was going to say it’s… Notice whenever you start to get into a spot where it’s either or, what if it’s a yes, and. And so if you are really scared of taking the medicine and just it’s not within what you feel is possible for you right now, it sets you in a panic, then what about setting some, hey, let me try for three months just doing No BS. Let me see where that lands. One of the things that’s thrown into the mix here, when there’s a pending surgery that’s elective, meaning a joint replacement, it’s this sense of urgency. So everyone’s trying to give you the answer right now. They’re saying, “Go do bariatric tomorrow. Go get a surgery today.” What if you don’t need to do all that?

What if you can try for three months, you see where you land, and then if you need more help, you can get that answer? Right? The one thing I want to throw in here too is sometimes I see this put in it’s bone on bone, so activity is less. And then people have this misconception that exercise is the weight to weight loss. We see really does not move the needle as far as getting weight off. It’s really good for lots of other reasons, but you can have tremendous results working on the dietary and other things first. And so sometimes people need to do that before they entertain if they need a medicine or not. And the other thing I would say here is just a question, how long are you willing to work on this before you would consider other options? I think that’s something to just throw out there.

Corinne:

That’s a great question. Yeah.

Cris Berlingeri:

Yes. I think the answer to this question is more kind of the thought work, like you were saying, first, have some compassion because your fears, why do you have them? Why would you want to do this? Why you wouldn’t want to do that? Assess that first. And like Matthea is saying, it’s not a this or that. Maybe. And I even would wonder if there’s such thing as a right decision. We think there’s the perfect answer to everything. And maybe what’s right for me is not right for you or right for another patient. You have your own particular situation. Nobody’s in your own body, and nobody has lived through what you have lived. So assess all of that, assess your fears, and like Corinne was saying, do you like your reasons for saying no or yes? And of course, don’t give up No BS. Stay there, and try it and give yourself a timeline. Okay, by this time I’m going to decide whether to do medicine or the surgery. And by this time… Give yourself those timeline marks.

Corinne:

So our next question, it’s a long one. I’m going to try to summarize it as I read, but it’s a really important one, so I’m going to adjust it just a little. So this person’s a nurse, and she’s also an obese woman who has consistently been fat shamed by doctors who say, “Just lose the weight.” And I get that. I do want to say this for everyone listening, because I say this all the time, and I want to say it one more time. I think there’s a difference between somebody shaming you for your weight and someone who doesn’t understand the struggle you have with your weight. So sometimes what we have to do as the patient is remember if I’m feeling shame, what am I internalizing their words as? There are lots of people in the world who don’t struggle with weight and they don’t get it, and they do just think eat less, and they do just think those things. To them, it seems so simple.

But I think usually when someone is saying that to y’all, they’re not sitting there, “I can’t wait to fat shame someone today. The first overweight person, I’m going to tell them, ‘Just eat less.’” It’s usually because they don’t think that’s a shame. They think that’s just stating a fact. And so just for all of our own emotional safety, it would be helpful. Because here’s what I do know, it’s really hard to educate the world on how to talk to clients. If you’ve never had a weight problem, you just don’t have their point of view. And from what I understand, doctors are not getting any kind of education on the point of view of their obesity clients when they go through medical school. So if you’re seeing a GP, they didn’t go to How Not To Fat Shame 101 in school.

So I just want to say that because I have a… You have an example of two doctors, they really do give a about this population. And they’re studying it, and they’re doing advanced thought work certifications with me, and they’re going to get in their own certifications. But not every doctor is going to go do all of that, and that’s okay. So I just wanted to say that to begin with. She said she’s also been told to perhaps try a weight loss program associated with local hospital. She paid for it and discovered the doctor a recommended weight loss surgery right off the bat, or to do their low calorie shakes and to sell there are no solid foods at all. She said she opted out of that, found No BS and has decided to do that because she didn’t want to just do shakes and do surgery and stuff, which is a choice.

That’s a choice. Some people opt for that stuff, and some people don’t. She said her biggest concern right now about these medications is now being presented as weight loss drugs, and they don’t have a track record. So I would love for y’all to speak on the track record, which we’ve kind of talked about just a little bit already, and potential side effects for the people who are obese without diabetes. And then one of the other things that I think I would love for y’all to talk about is, are doctors getting kickbacks because of this. I hear this all the time, that doctors are profiteering off of drugs and stuff. And from what I’ve heard from doctors is like, oh, they would be doing a lot more with their life if they were pirating away, prescribing things. I’m like, a lot of the doctors I know are just trying to pay the bills like everybody else.

Cris Berlingeri:

Yes.

Corinne:

So I’ll default to y’all now. Y’all can go ahead and answer.

Cris Berlingeri:

So I would like to first of all, yes, recognize all the bias and stigma regarding obesity, including the medical community. I myself would like to apologize for all the medical professionals, because honestly, I’ve been a doctor for almost 20 years, and like Corinne was saying there’s no training, as of the latest years, in these issues in medical school. There’s just not. And it wasn’t until now when I went through the training for the obesity medicine board that I became aware of certain phrases, words, all the implications, all of that. So the majority of the doctors, they just have not received this training. And like you were saying, no doctor, or I would dare to say at least 99% of them, they’re not going to come that day, “Let me see, how can I change my patient today?” So we’re coming usually from that place of first do no harm.

We can just be very ignorant about certain stuff. So I just want to put that out there. That’s a real thing. And also, I would also encourage… One of the things that I learned… In your question, it says an obese woman. And one of the things that I learned instead of saying I’m an obese woman, to consider saying, “I’m a woman with obesity.” Because otherwise we are over-identifying with a condition. We’re kind of making that means that that’s us, who we are. So just create that separation. I’m a woman with obesity, instead of an obese woman. And the other thing, big pharma, yes, it’s another whole big monster and issue, but we don’t get kickbacks. Some doctors, they do give conferences, but the federal government has ensured a way that we all have to disclose all of those things.

I, myself and Matthea, we don’t receive any kickbacks, for the record. Let just say here, there’s no conflict of interest. And so what I would say, when I read this, yes, there’s a big issue with big pharma, but the obesity population has been underserved for many years. And finally, we have some medications that really can help not, only with weight loss, but with all the medical issues that can come with obesity, so I would just focus on that sign of, how can I benefit from this scenario? And I’m going to let Matthea take over all the rest of the data and stuff like that.

Matthea Rentea:

When I saw this question, I was like, I have so much to say. Yeah, so it’s public record who’s getting paid. So if you have concerns about it, look up your doctor. It’s out there. But what I would say also, just to validate how she talked about how she went to a clinic and they recommended shakes and wonky things, what’s so frustrating, even if you see a physician, is that there’s so much variation within the industry. So one of the things, I got out there and started to talk on social media because it was just radical to me that no one was just talking common sense. And then people all over were always saying, “Well, how can I find a physician like you?” And it’s tricky because even if they have the American Board of Obesity Medicine certification, not everyone’s practicing in the same way.

So again, I want to also validate it is so frustrating, because not only are we stigmatized and biased and so many other things happening, then you try to go get help and you don’t know some of the answers of who’s going to be there. So I want to validate all of that. It’s definitely real. I hear it every single day. I want to talk real quick though about when you say a statement like this writer wrote, “It’s not a proven track record,” I want to just give a little bit of context here. So overnight, Hollywood learned about these medicines, but GLP-1 agonists, that family has been around since 2005. We had Exenatide come out. 2010, we had Victoza, which turned into Saxenda, same medication. It’s a daily injection instead of weekly. So it’s not true that it just came out. We’ve got two decades of safety testing. And then I think one of the other questions was, well, what about safety testing if someone doesn’t have diabetes or they don’t have many other medical problems?

Again, those studies have been done actually seven, eight years ago in my clinic. I remember some of my patients were involved in a university study where they didn’t have the problems, but they were on a GLP-1. So it didn’t exactly come out yesterday. Everyone found out about it yesterday, but if you’re a physician, we’ve been writing these a long time.

Corinne:

And usually, this is what happens, is once something gets in the water and is mainstream, we think it just happened, when a lot of times, things have been around a while, or it just hasn’t been popularized enough to even get in your sphere of hearing about it. So I appreciate y’all talking to us about just like this has been around for a little bit longer. It’s not like three months ago, they dropped all this, and now everybody’s on it. That’s the way that we always in interpret things. And the moment you think, well, I don’t know about these weight loss drugs, if it gets into your brain, and you are like, well, I don’t know, or seems like a lot of people are taking it, you’re actually turning on a function of your brain. I just talked about this morning on my internal podcast that I do for my members where it’s that reticular activation system, and that is your brain’s filter.

So for all of the listeners, all that happens is if something suddenly you notice it and it becomes important, your brain now starts looking for it everywhere. Whereas before, it didn’t give a two shits and it missed it every time. So the example I used this morning was my uncle, who died suddenly and tragically two years ago… He lived with my mom. He had autism and stuff, and died of a traumatic head injury. And he smoked a lot of pot, all his life. He was cool with pot before pop was cool. So after he died, she started noticing… She always said that when she would see the number 420, she like, “Oh, that’s Edwin talking to me. That’s Edwin talking to me.” So she sees 420 everywhere. She sees it on clocks. Just yesterday, she was like, “Oh, it’s 420. Edwin’s saying hello.”

Prior to his death and her making that connection, she never saw 420 anywhere. It was always around her, but her brain did not filter for it because it wasn’t important. Probably what’s happening with a lot of you right now is it’s been around for a while. It’s probably even been discussed, there’s been articles, there’s things happening, but because now it’s important and everybody’s talking about it, you can’t help but hear it everywhere. Just like that Ozempic commercial, I swear to God, I see it every time it comes on, and I sing the jingle. I was telling everybody the other day how annoying that jingle is, because once it starts, I’m just singing it all day. So all right, here’s the last question that my members asked. What is in the medication that helps you focus better in moments of hunger? We kind of touched on that earlier, but can you just recap it real quick for us?

Cris Berlingeri:

Yes. So the medication, one of the ways that it works is slows down the emptying of the food from the stomach into the small intestine, so you get that feeling of fullness for longer periods of time. It stimulates like the hunger hormone to remain low so you don’t get as hungry, and you feel full for longer periods of time, and it works also in the brain with that food seeking behavior, turning off that chatter,

Matthea Rentea:

A lot of people have, again, they’ve never had effective treatment for obesity. And I know we touched on that briefly, but some people truly describe it to me as they feel like they’ve had a brain transplant because… And this breaks my heart, they’ve never had a world where they were not racing food thoughts 24/7. They’ve never experienced that. And that’s a lot of what you work on in your membership. For sure, you can thought work your way there, do other techniques to get there. But sometimes, for someone to so radically experience the change, they didn’t realize how hard life was before. And that is one of the aspects that people notice the most, I find.

Corinne:

And one thing I want to add onto this just for all my listeners, because it would be really easy for me to bash these drugs. I have a weight loss business that is all about changing simple behaviors, changing how you think, and weight loss drugs is not a part of that protocol. Doesn’t mean that I’m like anti. It just means it’s not been a part. And it would be simple for me, like, oh my God, this could put me out of business, so now I need to be somebody out there shaming this and doing all the things. I just don’t want to be that person. But here’s what I do know. It may be able to quiet all that chatter and stuff, but as someone who’s an expert in weight loss, what it also could be happening though for a lot of you, and why you need No BS on top is, when that food chatter goes down, there’s probably other chatter right behind it, ready to take its place.

So you may not be racing about food all day long. For a lot of us, that food chatter has been covering up a lot of crap we think about ourselves, a lot of crap we think about our bodies, how hard we are on ourselves, guilty mom syndromes. They’re all interrelated. I love what you keep saying, Matt Matthea. This is not an either or thing. This is like it’s an and. These things have to go hand in hand because I do not want to see someone suddenly remove the food chatter, and then all of a sudden a whole nother crop of self-loathing comes up that they’ve been covering up for years and years and years, and they’re miserable. And now they don’t have food to distract them. They just now are focused on their misery. They have to work on both sides.

Matthea Rentea:

It comes back though. So that’s what I want to say, is the weight might stay off, but those same things come back. I see that with people. Now, this isn’t everyone, but having done this long enough, that’s why you need to do this work, because it’s usually not an if, it’s a when that same type of thinking comes back, even with food.

Cris Berlingeri:

I have had clients in coaching, physician clients that are on this medicine that I have to coach on their thoughts about feelings of guilt about their motherhood and all of this. So when we talk about all the benefits of these new newer classes of weight loss medications and how could be another tool, this is not like… What’s that word when it’s kind of the thing that it’s going to cure at all and nothing else is needed? Not at all. We stand that thought work has to happen, because in maintenance, and this I learned through the obesity medicine certification, your brain is going to think that you’re eating less, because again, it wants you to remain at the same way. It wants you to gain weight.

And one of the ways that you can do that is by planning, showing yourself your plan by writing all those things, all your thoughts about it. Thought work is a must. Like Matthea is saying, it’s not if, it’s when you’re going to need it. So again, this is not… There’s a phrase in English for the thing that is going to… The golden whatever. I don’t know the phrase. It’s not a cure [inaudible 00:52:54]

Corinne:

I don’t know what phrase you’re trying to come up with, but it’s just like that overall. This is not the silver bullet. Maybe that’s that what you-

Cris Berlingeri:

The silver bullet. This is not the silver bullet.

Matthea Rentea:

No, if you look at the chronic weight management registry of people that actually lose good amounts of weight and keep it off, Corinne, 99% of what you do in your programs on their. I always come back to that. Well, there should be an episode on that, to be honest. Look, this is what people do that actually keep the weight off. We actually do that here. So yeah, that’s awesome.

Corinne:

Well, I appreciate that. So let me wrap up by saying a couple things. I do do have… So these two wonderful humans, they did do my advanced certification. They were life coaches. They came through my weight loss advanced certification. They also are getting more certifications. I applaud you. I think when you are hiring your coach for your weight loss, you want to hire coaches that invest in themselves. You do not want to hire coaches that don’t, and these two ladies definitely do that. So number one, tell us where people can find y’all, so that if they want to work more with a doctor, they’re like, “Fuck Corinne. I want somebody with some medical knowledge. Let’s go,” can they work with y’all? What can they do?

Cris Berlingeri:

Okay. So you wouldn’t be able to come with me as a patient because I’m a dermatologist, and I honestly don’t practice, obviously medicine per se. But I am CoachCrisBerlingeriMD on Instagram, and CrisBerlingeriMD on Facebook. And I have a podcast called the Joyful Weight Loss Podcast. And for those of you who prefer Spanish, or have friends that I prefer to listen to content in Spanish, I have a new podcast in Spanish called Una Cita Contigo, a date with you. So yeah, that’s where you can find me.

Corinne:

Awesome.

Matthea Rentea:

And if you are someone that lives in Indiana or Illinois and you want help with obesity medicines, you want a physician that helps with this, I do pair thought work in that as well. But again, I’m informed from having done Corinne’s advanced certification. We’re not doing calorie counting, things like that. I have a very different approach than most physicians. You can go to renteaclinic.com, that’s R-E-N-T-E-Aclinic.com. And that’s the best way to get on my newsletter. So if you click on podcasts, I have a podcast called The Obesity Medicine Guide with Matthea Rentea MD, and you can get on my list there so that I update you what’s happening. And actually next week, perfect timing, I’m going to be talking about the weight loss medications. So if you want to know more about all of this, it’s really evidence-based knowledge that I share.

Corinne:

Well, I just really thank y’all, because when I asked them if they would be willing to help, they immediately said yes. I think I had this idea it was either on Sunday or Monday. This is Wednesday. We are already recording. And honestly, it’s like, well, I have this practice that it’s very limited to what I can do, but they just have such giving hearts, and I just appreciate y’all so much. For anyone, one of the new things that I’m doing now with my advanced certification, I’ve had a lot of doctors contact me and say like, “Well, I’m not a life coach, but I would love to do this certification so I can learn how to have those kinds of conversations with my clients, what I’m going to do.” We are going to be accepting anyone into our advanced weight loss certification. So if you’re a doctor or someone who wants to help people with all of this stuff, you can sign up for it. The applications will start being taken on April 1st.

So you can go to theweightlossuniversity.com to get on the weight list. We’ll send you out all the information and all the things. I, again, thank you. This was comprehensive. This was amazing. I just really appreciate y’all so much. Thank you.

Matthea Rentea:

Thank you for having us on, Corinne. I think you’re doing amazing work out there and helping so many women, and I’m just so glad that you’re in this space and that you allowed us to even talk about this. Thank you.

Cris Berlingeri:

Thank you. Thank you. Thank you.

Matthea Rentea:

Y’all have a good week everybody.

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I'm Corinne Crabtree

Corinne Crabtree, top-rated podcaster, has helped millions of women lose weight by blending common-sense methods with behavior-based psychology.

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