Do You Have to Stay on GLP-1s Forever?

You're listening to Weight and Measure, the podcast for GLP-I and metabolic surgery communities featuring person-centric, evidence-based conversations centered around lived experience. Welcome to Weight and Measure. I'm Zach Nemec, and I'm joined by my co-host, Mike Donnelly-Boylan. And today we're tackling one of the biggest questions surrounding GLP-I

medications. Do I have to stay on them forever? For many people living with obesity, medications like Bogovia and Zepbound have changed what's possible when it comes to managing the disease of obesity and someone's health. But as more people begin treatment and reach their goals, an important conversation is going on. What happens next? And that's exactly what we're going to be

exploring today as part of our coverage of FENCI, the Food and Nutrition Conference and Expo. Our guests both bring professional expertise and lived experience of obesity treatment. We are joined today by Anna Reisdorf, a registered dietitian who brings both clinical knowledge and personal experience with GLP-Base treatment, and Melissa Mitri,

a registered dietitian whose work focuses on sustainable weight management and supporting people both on and off GLP-Base medications. Anna and Melissa are also presenting at FENCI, so we're excited to bring this panel to our audience on sustaining success in the GLP-I era, examining the science alongside the personal experience. Thank you both for joining us.

Thanks for having us. Please introduce yourselves a little bit for our audience. I know, Melissa, you've been on the podcast before, but why don't you... Our intro was not enough. Give our audience a little taste of who you are, what you want them to know about you guys. Sure.

So I'm Anna Reisdorf. Like I said, I'm a registered dietitian and I am the host and founder of GLP-One Hub because I am a GLP-One user. It is my anniversary in November. Four years. Congratulations. Four years on and off. So we're going to talk about that, which is what inspired our talk here at FENCI.

And I started GLP-One Hub because I made all the mistakes. on GLP-I. I made all the mistakes on GLP-I. I just didn't eat enough. I didn't exercise. I didn't do anything, even though I knew much better as a dietitian. And so I thought, if I'm making all these mistakes, what are people who don't know as much

as me doing? So that inspired this new direction for my business. And it's a great podcast. If you haven't listened, you should check it out. I know a guy that's been a guest on it. Yes. Well, we've got two guests. Mike has to come on. Yeah.

Yeah. So tell us about yourself, Melissa. Yeah. So I'm Melissa Maitrey. I'm also a registered dietitian, nutritionist. I work in weight management. I have my own private practice where I work with patients taking GLP-I medications. And kind of through the whole gamut of starting starting transitioning off and

that's why, like, and I said, we are going to be talking about that at fancy about, you know, just how to sustain success, whether patient decides to stay on a or not. There's a lot of things that we can do to help support their long term success. So I work directly with patients taking. and I also do a lot of speaking on GLP-I at various conferences like

FENCI, educating healthcare professionals, dieticians, doctors, physicians, et cetera, to help them to better support their patients and to teach them how to eat well on a GLP-I. So I know the first thing I asked my doctor when I walked into his office and was receiving a GLP-I medication is, do I have to stay on it forever? When a patient asks either of you that, what do you say?

Yeah, so what I start by saying is not necessarily. It's a very common question that I hear from patients, and it's a valid question, right? Because I think that, you know, kind of just thinking about the history behind when somebody, a lot of my patients are seeking weight loss, weight management. They're thinking about, you know,

in a sort of like a start and stop sort of fashion. I think that's sort of like the traditional diet culture. Whereas with GLP-I medications, they are thought of as more of a chronic disease management medication, and they are treated as such. However, what I tell patients is that every situation is different, and I think that when it comes down

to it, we need to treat obesity as a chronic disease, whether they're going to stay on a GLP-I or not. So just because somebody is starting on one, that doesn't necessarily mean that they're going to be taking it forever. Some people stay on them long term and others may transition off at different capacities for different reasons.

But the treatment still has to be long term, whether that's diet, lifestyle or others. I think that's the mindset is what I really try to convey to people. I have a stronger opinion than you. Tell us yours. I say, yes, you do for now. I think for now, I think the answer for most people is going to be yes. You do have to stay on it long

term. What that exactly looks like is going to depend on the individual. So for some people, it will be the highest dose. For some people, maybe they'll be able to spread it out. For some people, maybe they'll be able to go down or go to an oral or do something like that. But for now,

I feel that the data is pointing towards Yes, and there are, we were speaking earlier, there's like a million things in development that will maybe change that answer. But as a person who's tried to get off of it twice myself with the support of a registered dietitian to do that, I'm a lifer until a new solution presents itself. Yeah.

Yeah. No, I think those are great points too. And I also agree with that. So I think that the reality behind it is that it is a chronic disease and it does need to be managed long-term. So for many people, that may be their reality. However, I think that sometimes my patients, if I tell them right away, like, yes, you have to take it forever.

Sometimes that might scare them away a little bit from taking them. So it's a little bit of a fine line of having that conversation and saying like, almost just setting the expectation that... And that was the answer I got from my physician, right? It was, we don't know yet. We just, there's a lot we don't know. We might think maybe.

And I think that actually gave me the peace of mind to get started. So what you're saying, I actually appreciate. What do you mean I have to pay four hundred dollars a month for the rest of my life? I had insurance companies at the time. No, I mean... fortunate, but hopefully if we're doing our job advocating that they'll be paying twenty

five or nothing. Well, I also think about your story with all of it, Zach, and how many things you've been through. Oh, yeah. You know, this wasn't like you did this one thing and then that was it. You did like twelve things. Yeah, still doing them. Yeah, right.

So to me, that's just the reality. And the crazy thing is I'm about to hit my three year anniversary on a GLP-I myself, and I just won branded coverage access. So I've been out of pocket utilizing Compounder, paying the cash pay programs over the course of the last three years. And I finally just got a six month approval for obstructive sleep apnea, not even for obesity.

Um, and I had to go through like four or five rounds of denials and appeals to, we had to go to a second level appeal. And how many pages was your PA? Oh, I sent them my first, I working with my doctor, we overwhelmed them with fifty four pages or something like that. And then finally, it was really funny. The last denial that came back was because

I didn't provide proof that I ever had had a CPAP machine. to which I gave my doctor my class action lawsuit settlement papers from a manufacturer that I will just not name on the Internet that had one for owning their CPAP machine. And within twenty four hours of that, being submitted i finally got the approval um it was it was wild but that's to the audience you should fight and save every little piece of paper because you

don't know when that medical information can come back and help you especially when fighting for glp-one access and coverage right now so I do want to turn my attention to what the evidence is actually saying, though, right now about this, because I think we're still researching a lot of this. We're researching maintenance. We're all about science-based information on our podcast.

And so I'd love to know what's happening when someone is stopping the GLP-I. What is the evidence telling us right now? And either of you can jump in. You want me to start? Yeah, go ahead. Yeah, so really the majority of evidence is showing that when people come off GLP-I that at least two-thirds of their weight is gained back for most people within that first year.

So the picture might look a little bit different depending on the person. Some people might regain their weight more quickly than others. But on average, most people gain about two-thirds of their lost weight back within that first year of coming off. And so what that is telling us, like we've been talking about, is that clearly there is some physiological basis that is lost when

somebody comes off, which means that when the treatment stops, then there is a high risk of weight regain. But with that said, there is some new research coming out that shows that some people, a smaller subset of the population, is able to maintain a larger amount of the weight loss. And one thing I like to point out that is a positive with all of this

is that compared to someone that has lost weight without a medication, um and then regains the weight back a lot of people end up gaining more of the weight back and end up at a higher weight so versus at least for the research that we see so far many people are still at a lower weight than they started from However, we do need to see more research longer term beyond that one to two years to

see does the weight continue to increase. I think that's the biggest issue right now with the research that we have is it's all like a year, two years. There's nothing like five years. I wrote my master's thesis on weight regain, psychological factors of weight regain after gastric bypass. And it was like most people gained, you know, significant amount back.

And so, you know, what all the factors were that went into that so that we don't really have that yet for this specific population that's just using it for obesity. What I think is interesting in like the research that's coming out now is people are doing like different experiments about what might work, right? So there's a small study we're sharing where they're spreading it out every other week, the doses, or tapering it slowly,

pairing with intense lifestyle interventions. So they're trying to figure out, like, what is the protocol? Can we figure out, is there a type of person who could keep it off without the medication or who could maybe spread it out or who could go to a two point five dose or whatever? So that's, I think, where the research is going.

We were talking about the oral too, going to an oral medication. So that's where I think there's a lot of exploration going. I think over the next few years, that's kind of what we're leading to, to see what are the different options that can lead to more long-term success. So let's clarify that a little bit, just because for our audience, I want to slow it down a bit. On TikTok, all these places,

you hear people talking a lot about tapering off and also reducing the dose when they go into maintenance. What does the science specifically say right now? And where do you think the patient might be ahead of themselves when they're thinking about this? What is the science versus where we're at? The science hasn't told us that's right yet. Yeah, so the prescribers are really,

the science is not fully there yet. I think the conversations and what the prescribers are doing or suggesting is ahead of what the science is really telling us. And so there is, I think everybody's doing something and recommending something a little bit different. depending on their own experience and maybe what they're seeing anecdotally in their patients to help and be successful.

So with that said, there really is no clear protocol yet. There is no clear tapering protocol yet in terms of the amount of weeks they're tapering down, the ideal dose, or even what a micro dose, lower dose actually means. There's different forms of that for some people you said it's maybe transitioning to taking the medication every other week versus every week or having a lower than the fda

approved dose every week so there's a lot of variations but there's not really a clear standard protocol out there yet um we're hoping that we can when the medicine is ahead of the science right yeah look i was thinking of i think it was dr mitch bierman of last i mean obesity last year did a very small study it was a series of case studies where he looked at a series of patients who had bmis uh below thirty five when they started um and had moved them to

you know I think it was they reduced them by like a little bit. They kept the dose and they went to every two weeks. And twenty eight out of like thirty two had been pretty successful in maintaining their weight. But that's a very, very small sample. And I think sometimes the patient community like hangs its hat on that kind of

I don't know if I have the numbers right to the community, but it's a pretty good representative of what it was. But those small-scale studies, I think, opened the door to say, do we need to study this on a larger scale or not? Did it completely disprove the thesis, or did it give it a little credit that, OK, now we need to step this up?

Explore further, yeah. Um, well, Anna, I want to really dig into your experience as a dietitian, um, and a patient utilizing a GLP-one. Yeah. And I, for the, for the audience, like what did your experience, like knowing everything, you know, as a dietitian and then getting a GLP-one introduced into your life, like how did your world change or did

your view on any of this change because the medication did something for you that you didn't previously experience? Well, I think in the beginning, you know, I thought it was a temporary thing because I had done other weight loss medications before. I used Phentermine and I've used other things. And I thought, well, I'll just continue my healthy lifestyle and I'll keep the weight off.

And then another reason why I got off the first time is because it was five hundred dollars a month and it jumped to fifteen hundred dollars a month because the coupon ran out. And I was like, my husband will kill me. I'd be like, just hire a chef or a trainer. There'll be less than that. There's just no way that I could spend that much on something like this.

So I got off and went back to just normal living. And then the weight came back. And then I was like, well, I know what I did wrong. So I'm going to try again. And then I was more diligent when I got off the second time. The reason was also cost. And that's kind of when I went to see Melissa was about nine months of being off.

And I just saw that weight creeping up and I felt like I was doing all the right things. And the weight was still coming back. I didn't gain quite that much back, but I saw the writing on the wall. And so we had a conversation about it and I decided to get back on. Luckily, at the time, my husband had gotten a new job and it was twenty five dollars a month. which kind of to me was a no-brainer.

But what this medication has taught me as a dietician is how much I really was trying to manage my weight and how there really was something else holding me back. And I started my career working with people preparing for a gastric bypass and they had to go through this class where we would like prepare them and they had to lose a certain percentage and so I'd make them turn in a food journal every week. I know that well.

Yeah. And I'll be honest with you. There's a lot of them that I thought were lying because their food journal was perfect, like a journal better than I could have ever designed as a dietitian. And I thought they were liars. Like there's no way you're eating like this and you're not losing weight. And then there were, of course, those who were,

who like would cut back on one soda a day and lose like forty pounds in a month, right? There were definitely those who did make pretty simple diet changes and were able to see significant results. So that's what the medication changed for me was my attitude towards this where now I look back and these like Facebook memories come up of these like perfect meals that I was eating and this like I've done thirty days in a row of

burn boot camp and I've done like all this effort and like I didn't think I was trying hard enough. And now those memories come back and I'm like, yes, I was. We blame ourselves. This is the way we were taught as dietitians, too, right? Like bringing up... Not so bad that I called them liars. I didn't really call them liars. Right, but it's just...

Whether it's yourself or someone else that we're working with, we were kind of taught in that, and I'm so glad that, you know, your podcast exists and we're having these conversations now because the conversations are changing, that we better understand that it's not, we know it's not the person's fault. And I think that when, even when we were taught, I started at, you know, I started as a dietitian and...

It was, oh, are they really doing, like you said, like you don't think that they're lying, but it's like, oh, they're non-compliant or they're not doing the right things. There must be something that we're missing. And that, you know, that mindset and it's not, but it's not the reality. And that's why I got into this space

too, not as a patient, but as from a dietician perspective, because I saw so many of my clients that they were doing all of the right things that I was working with them for a long period of time. and they were doing all the things like you were doing and they just they couldn't get past a certain point so so i want to follow up with you on that because you spend a lot of time with people lived experience in your office and

you're hearing their stories what do their stories tell you that the clinical trials don't tell us Well, a lot more than what I think the clinical trials are showing us kind of the raw data, but they're not really showing kind of the ups and downs and the emotions that go along with it, I think is the biggest thing. I say data is cold all the time.

Yeah, so really just the ups and downs, the plateaus, the things that still happen, whether somebody is taking a GLP-I or not. I think that the perception is that we see in the studies how effective these medications are, which they are for many people. But people still hit plateaus. People still have slow weight loss, gradual weight loss. I think that the way they're portrayed is

that everyone, you know, a lot of people are losing massive amounts of weight or they're losing it more quickly. And then in the reality, and I see my practice, that's not always the case. Sometimes it's slow, gradual weight loss, but that's weight loss that I actually promote. And that is a healthy weight loss. And I think that that's important for

people to know. It's always helpful to hear that reminder, right? Because it's so easy to kind of go back to, I want to lose weight quickly or I want to see whatever result. I feel like that's when the brain is fighting back against the actual science of what we want to happen versus I want the result and I want the result now.

That's why like so many advertisements is like, you take this pill and you can lose twenty pounds tomorrow or you want to fit into that wedding dress. Hey, I got a plan for you and you can do it in fifteen days. Just eat nothing but cabbage. But how many times has an advertisement promised a speedy result? And I think we've also been conditioned to

that. Right, exactly. So those are really the biggest differences is the emotional factors, the ups and downs, the plateaus, and really the fact that a lot of people need to come off of them for various reasons, because like with cost or lack of insurance coverage or changing insurance coverage. I've had clients that have been on GLP-I

for three months and then come off for a month. and then go back on for three months and then come off for a month because of lack of whether they couldn't afford it, something changed with their job. So there's a lot of, just a lot of nuances or things that are happening, which is why regardless if somebody's actively taking a JLP one, that follow up and check in is really

important. It's maddening to me to think about the patients who are coming on and coming off. And most of it's because they're losing insurance coverage. And somehow the insurance companies think that this is a good thing. It's like, no, let them stay on the medication. You're going to get more benefit. You're not getting benefit when people are coming on, coming off, coming on,

and coming off because of prior authorizations, et cetera, et cetera. fluctuating health conditions too with that because some people who are off of it for a while like their cardiovascular risk goes back up their weight might start to go back up and their sleep apnea might get worse you know all of these things and then of course that just adds back to the risk pool for insurance yes so but you know algorithms are looking at twelve and eighteen month costs not two to

twenty year costs apparently right now for GLP-I but Hopefully that narrative starts to change pretty soon. I'm glad to see some bigger companies like Bank of America, like saying, no, this makes sense and we're going to invest in it. Whereas then there's other big companies right now, like Starbucks that are rolling back their coverage, which, you know, it's, yeah,

it really is. I think I saw Pepsi was too. My favorite, Mass General Hospital, where GLP-I was first discovered, just cut coverage. Wow. They literally discovered GLP-I and Mass General just cut coverage. Oh my gosh. They're going to give some sort of like discount that you could go buy it on the open market or something like that.

Allegedly. We still need to do better. But speaking of people coming on and off the meds, and this question is for both of you. I love both your takes on this. You know, a lot of us go on the med. We start to lose weight and we start to also develop more healthy habits. And then there becomes this mindset that those new healthy habits will help us come

off the medication. So I know you've had experience coming off the med. So, Anna, why don't you jump in and start this? Sure. I still see this a lot just in my community. Oh, well, you didn't adopt the healthy habits. Like, you were still eating. Somebody accused me just this week of

eating Snickers every day. And I'm like, well, lucky. Joke's on you because I don't like Snickers. It wasn't the video Mike took of me eating donuts, was it? Maybe that's where it came from. But yeah, I think that there is definitely still a, oh, well, if you just adopt these healthy habits, I feel like some of it is we

don't realize how much the medication is helping. I think for me, I didn't change my diet, like the composition of my diet. It's that the portions just kind of got larger and I didn't notice. because the medication sort of just kept that under control where I would just eat till I was satisfied and that was enough. And I continued to just eat till I was satisfied,

but that just was bigger than it had been before. So even though I was still eating my vegetables and my protein and all my things, it wasn't enough. I didn't have that suppression that the medication gives to give me just enough to what my body needs. Right. And too much of anything, even if it's healthy foods, right?

If we're not in a calorie deficit. I was recently off my GLP-one for seventeen days. Day sixteen, That was a hungry Zach. Nothing that was going on was satiating anymore. It was like, I'm eating and I just can keep eating at that point. To be fair, that's the longest I've also gone between

my doses, but that was for a medical situation recovering from surgery. But like, just to know that now that I kind of know where my threshold is, I can go like two weeks. But like, I know that that beast is still very much there. But also you may have needed the calories from the surgery.

Oh, I certainly did. And that's part of the reason why I was off of it. And I was instructed to eat more by my dietician. And so like I was, but like just even I had to still push power through it to make sure that I was. Um, because the suppression was largely there still at the beginning and like the

satiation was still there. But as that time crept on, I can remember right before, like I took the dose again. Um, and then when I took the dose right after I was like, whoa, hit a brick wall. Where did all the noise go again? Like, and it was actually, it was a good reminder for me that like how much the med is still very

much doing for me, even though I'm not in an active weight loss phase anymore. It starts to feel normal. Like this is my normal now. So I, I don't feel like the medication is working, but it clearly is because I just, it's been four years. I think, I love the stories oftentimes, and I haven't had to do this, but people,

when they've had to have some sort of procedure and go in and they come off the medication for two or three weeks and they realize what food noise actually sounds like, as opposed to the cravings they may have felt on a GLP-L. They remember what that beast of food noise was like. I find that, I think it's really enlightening when that happens.

So part of your presentation at FENCI here is about nutrition and exercise and preserving lean muscle mass. So what should people actually prioritize to maintain their muscle and overall health while they're on a GLP-I or while they're entering maintenance? I can start. Yeah. So kind of three key things, and this is not all encompassing, but starting with getting enough protein

in the diet, strength training regularly, and meal structure, having good meal structure, which is something that's not always talked about, but having kind of regular consistent meals. Because when someone's on a GLP-I, it's super easy if your appetite is so suppressed to skip meals. And then especially when you come off the medication,

if you don't have a good routine timing in place and you continue to skip meals, then appetite is going to come back more in a vengeance and to be harder to control. So kind of getting almost like the timing of meals in place. A lot of times with a lot of my clients, I almost provide them like a sample meal schedule. and they can follow it how they'd like,

but just to have sort of a template and a suggested timeframe of, okay, let's not go more than three or four hours without eating, even if they're not feeling hungry, because then it just setting up that successful schedule. So then again, if they're coming off, transitioning off, whatever the situation is that, and also that they know that they're getting in enough.

too, right? Because when you're skipping meals and your appetite is so suppressed and you're having smaller portions, then are you really getting enough throughout the day? I mean, research shows that a lot of people taking GOP ones are getting like thirty percent or more fewer calories than they actually need. And so it's a lot less than it

really should be. I love the conversations that come up about this in the patient side of things when they're like, I've hit a stall. um and then they connect with a dietitian and they get well are you eating enough and then they start eating more and all of a sudden the scale starts moving i literally just had a conversation with a client about that this week yeah i had shocked i had a i've been in a long stall so to speak for a while

and i needed to stay in maintenance for a reason i'll keep off the table for now and i decided like you know i'm just going to start having more a couple slices of pizza and those And that dang scale just started shooting down. And I was like, are you kidding me? Are you kidding me? I've eaten like perfectly for two years. And as soon as I'm in a stall for a long period of time,

I start eating like crap. And all of a sudden like, oh, there goes the scale. I clearly wasn't getting enough calories. I think in the beginning there was some level of seduction to not have to be constantly relying on food. My husband, when we first started dating, used to carry banana chips in his backpack all the time because I get hangry. He'd be like, here's your banana chips because I was

always hungry. To be able to go all day long on an iced coffee until three o'clock and the only thing that would make me eat was my blood sugar would drop. That was very empowering. That's why freeing. It really is freeing. And that's wrong. But that's not the way you want to go about it. But being on a GLP-I is actually the

best thing that's happened to my marriage because my husband constantly, exactly, had snacks. And I'd be angry. He'd be like, you're just hangry. I'm like, I'm not just hangry. And he'd give me a meat stick. And I'd be like, oh, yeah, no, it's fine. Hangry is a real thing. And it's really wonderful when the GLP-I sort of takes that piece away.

Absolutely. Yeah. So I'd add make sure you're eating adequate calories. Don't get into that like, oh, I don't really need food anymore because it will backfire. And you see that romanticized on the Internet. And that's that's a problem, too. What? I am on this diet where I eat

nothing at all. And what I'm about to pass out, I eat a small cube of cheese. No, that one is a Devil Wears Prada. Also from that one is I won a stomach flu away from a size zero or something like that, you know. but no it a lot there is a lot of jokes about that on social media and some patients are like no no you do need to eat but like we're we're making fun of it and they use the

comedy as the hook to tell people that no you need to eat but some people just that's all they're turning out and um yeah that can perpetuate the wrong i think mental health picture um and wrong nutrition picture um so we try to we're we're very pro dietitian and pro eating podcast this guy does have videos of me eating donuts so um you can eat donuts on a glp one just saying just i have multiple videos of eating pizza so yeah it's not that the goal is not

eating as little as calories as possible so it's not like golf right lowest score doesn't win no right nope uh all right so let's get into some psychology a little bit um i'm in maintenance or call it maintenance ish um i i would say my active weight loss phase was about eighteen months and for about the last eighteen months i've been in that ish phase and i say that ish because i just went through reconstructive skin removal surgery and

and uh body recomposition as well so the scale and maintenance goals have changed like the benchmarks of what my maintenance should look like have have moved but as someone who's been in the bariatric space for a long time weight reoccurrence I've seen it and it's a lot really discouraging and you know people fight weight their entire lives we literally are when we're trying to lose weight we're trained to focus on that number on the scale watching it go down

and as soon as it starts to creep back up or you're told, hey, it's time to stop losing. How does that affect someone? And how do they also have to shift their eating? Because we hear about calorie deficit all the time. And now are you eating? What is the new nutrition benchmark to just maintain? I could start.

Yeah, go ahead. Yeah, so in terms of how it kind of shifts the mindset a little bit, the big thing I talk about with a lot of my clients with this is that this is one of the main reasons why we don't want to just focus on the scale as a motivator. Because a lot of times we're focusing on the scale as a motivator. When the weight loss stops or someone hits

a plateau, then what happens to the habits? It could be a big dopamine hit to see the scale go down, right? To see it feels good. That's a clear result that people like to see. However, there's a time where maybe someone reached their goal, or they just hit a temporary plateau, which happens to everyone,

and that's normal. um so what i like to to really the main message here is focusing on the habits rather than the what the scale is saying so if we focus instead on i'm doing really great with getting in my fiber today or i'm you know i feel stronger in the gym or i see a difference in the last couple of months with how much i'm able to lift some other measurable results so that when the scale stops moving or even if it starts

increasing then there's other things to focus on to keep those habits going. And then if the scale is not going in the direction that somebody is hoping for, then we can just spend some time and reassess and see what else is going on. But it's also about health too. I think it's really difficult to move out of that mindset because I hear it myself every once in a while.

Well, maybe I should increase my dose and see if I could see a four because I'm like in the one fifties. Maybe I could be in the, you know, maybe I could be in the one forties. You know, maybe I could do this or like every once in a while I'll be like, maybe I should do a low carb diet. Like where does that come from? Yes, it comes back still.

And then I ask myself, who am I trying to impress? The other dads at the pool? Like, I mean, come on, like really? I'm not a model. You know, like, I feel great. I get to wear the clothes I want to wear. I feel like I look great for a forty six year old woman. Like, where am I trying to go with this?

You know, I do better if I focus on getting stronger. Like, that's what's going to let me travel when I'm eighty. That's what my goal is. Like, who cares? Like, it's kind of thinking back to, like, what really matters. Right. Right.

So that's, I have to keep pushing myself back to that is really asking, like, why? When your weight is healthy, your labs are good, you're strong, you're coping with things in your life, like, where is, what is the point of pushing? Like, I can crank my dose up and probably weigh a hundred and ten pounds, but... the purpose of what yeah i think it's

bringing back to the the big picture here of uh you know for example i had a client that um her a one c her um you know hemoglobin a one c which measures your blood sugar control over a three month period um improved significantly since starting on a gop one in the past few months um where i was i was amazed it was a great moment when she told me about that um but then that particular month she lost to her only a couple of months,

excuse me, only a couple of pounds. And she felt that that wasn't significant. So she focused on that and not the fact that she had this other amazing benefit that came from that. So I think it's always bringing, bringing themselves back to all the other benefits that you may be getting and just keep having that conversation. And if you're working with a dietitian, working with a doctor, like having those types of conversations

with other things that are happening. It's tough. I haven't figured it out. It's so tough because they're billed as weight loss meds or skinny jabs and really what they are are health medications, right? But we still are stuck in that toxic diet culture in our heads where it's a weight loss med. It is not a weight loss med. And the more we say that,

it actually reinforces not getting coverage because then health insurance companies, et cetera, can deny us access. Yeah, and I'd be remiss not to mention our friend Renee Rogers on this of making sure that body composition does not become the replacement metric for the scale that we fixate on. Well, it's important. And I have firsthand experience with that because I did that for a period of

time leading up to my skin removal surgery. And then I was like, whoa, my numbers are looking weird. And I mean, I'm going to get a new baseline post. but um those numbers are not the end all be all either they were just um i had broken up with the scale um i haven't weighed myself since the day of surgery and i didn't weigh myself they did before they took me in for surgery um

and like i don't actually anticipate weighing myself until i get my dexa scan um which will be about thirteen weeks post-op That seems to be where consensus was that I should get whatever my new measurement was and take it from there as new clean data. And, you know, like that's a psychological piece though of this. And it is fair to like warn people

like, hey, you are now breaking up with the scale that might be hard to do. I was an everyday weigher. Then I went to every couple of weeks and now sometimes I don't weigh myself for months. It's been two weeks. So let's flip this a little bit and talk about people who maybe had to come off of the medication or maybe they've hit that low stage,

but it seems like their weight is now recurring. And there's a real sense sometimes of I failed. What would you say to patients, you know, as a specialist in this, what would you say to patients? Did they fail? I mean, it's not a failure because we've understood that obesity is a chronic disease that's going to need to be

managed. And so what does failure really mean? that's what needs to be teased out. Did you gain back ten pounds and maybe you had gotten a weight that was maybe too low for you? Because I know that some of the dieticians who are GLP-I users in our community, that's happened to them. They use it, got weight a little bit maybe lower than they needed to be and then gained some

of it back, feel more comfortable at this weight. So is that a failure or just being more comfortable at a weight that you can maintain? And then there's still other options and other solutions that you can go to, but it is going to be something that's going to need to be managed ongoing. Are we going to have to go up? Are we going to have to stay on

it? Are we going to have to add a different medication? Are we going to have to do something different with our diet and exercise? So I think it's never going to be done. Yeah, no, I completely agree. And I think just to add to that, when it comes to all of this, that you could compare it with other chronic diseases.

Again, we see this as a chronic disease, just like if somebody were to come off of a diabetes medication, if someone were to come off a high blood pressure medication and then their blood pressure starts increasing again, that's most likely going to happen because there are chronic diseases. Would we say that we're a failure from that? And so it's really, you know, to compare them can be really helpful.

And so that we're just sharing, like, this is a fact. Obesity is a disease. This is not tied to who you are. This is not tied necessarily to what you're doing. And so just bringing it back to that. And there's a lot of components. There's genetics, right? There's a lot of, you know, just like for someone that has high blood pressure,

they may be doing all the right things, but their blood pressure is still high. Yeah. Because they have a genetic risk. And the treatment failed, not the patient. Exactly. It's not anything that's a failure of the patient at all. And again, I see this time and again with my patients that are taking GLP-I's, whether they come off sometimes,

maybe the medication is not working as well long term or they come off of it and then they gain some of the weight back, it's not a failure on their part at all. It's more let's just take a step back and see what's happening, see what the other options are, like Anna said, whether that's another medication, whether that's surgery,

whether that's a different way of eating. Let's just take that step back and take a closer look. I love that you bring that up because when someone comes to either of you or let's say their primary care or whoever's prescribing them the GLP-I and says, I think I want to come off the med, what conversation should have before that decision is really made? I think first it's starting with having a

conversation of what that might look like if they decide to do that and what to expect. And also just having that conversation as to what prompted them to want to come off the medication. Is it they have to come off the medication? Are they having side effects? Can they no longer afford it? Kind of dictating what the process might look like with that.

And then kind of just having the conversation of, well, supporting whatever decision they decide to do but then also helping to guide them to so that they have the most successful outcome possible whether that's working with their physician on slowly tapering if that's a possibility if they have to come off it cold turkey that's not ideal but sometimes that again that may happen because insurance stops covering there's a lot of reasons then

really just offering support And talking about all the strategies, again, going back to the having small frequent meals, the diet might look a little bit different if somebody is coming off where maybe having more volume eating, you know, volume eating, meaning it's a little bit of the opposite of when someone is on a GOP one and they have smaller meals,

volume eating is having more larger portions of lower calorie foods, like high fiber foods, fruits and vegetables that have a lot of water, a lot of fiber that are filling. So if the appetite comes back, food noise comes back, that can help control that a little bit because there's a larger volume of food that fills the stomach. So just a few strategies there. I never thought of it that way,

of volume eating like that. I'm going to have to dive more into that. I have a lot of clients that it's very helpful for them. I can see how it would be. I want to dig more into that in the future, for sure. So if a patient discontinues the med and then has to go back on it, how should they feel about that? Are they failing?

Or is this just part of the chronic treatment of the disease of obesity? I mean, I think it's probably just part of it. It's disappointing, right? Because they probably got it in their head, but still, it's just part of the treatment. I think we need to really let go of the shame. There's still so much shame. There's shame about being on the

medication. And that's why I tell everybody who will listen that I'm on it. And I still see people not wanting to share with anybody. Nobody in my life knows. There's shame about not about needing it forever. There's so much shame. So there's shame about gaining weight back or not trying the medication. Right.

There's so much. There's so many thoughts surrounding it. So I think that letting go of all of that is really where we need, hopefully, where we can move. Yeah. Absolutely, because I mean, when it comes down to it, if somebody needs to needs to restart like that decision, if they make that decision, it's an informed decision. And that could be a wise decision, really,

because it's it's not thinking of it like, oh, I failed or oh, I need I need this. I have no willpower. It's that I'm actually making a smart decision to know that there are effective treatment options that now that person knows that, hey, I know now this works really well for me because I came off of it. Just like you said, when you came off just for a couple

of weeks, you notice the difference. And that's proof to them that it's very effective and it's a helpful tool for them. So why not utilize a tool that's out there? Exactly. And Mike, before I come to you from our takeaways as we start to come to a close on this episode, I have a question I want to ask

both of you to kind of bring everything we've talked about today together. And as I'm sitting here listening to the questions that we've asked and your panel that's going to be at FENCI here that we're covering, Maybe the question is, do I need to stay on a GLP-I forever is the wrong question for patients to be asking. And I'm actually wondering if you had the chance to rephrase that for long-term,

what you think a patient should actually be asking instead of that question. I can start. Go ahead. I was going to say, instead of asking that question, I would love if they would ask, how can I be most successful long-term? Or how can I... what are the habits or what are the things i need to do to think of this as a long-term treatment but you

really should change the mindset really because when you say they have to be on a glp-one forever it sounds more negative it sounds almost that um you know i have to rely on something but instead of asking that question it's like what are the tools that i can have in my toolbox to help me to be the most successful I think it's also what's right for me with the information I have now and the life I have now.

Melissa and I were speaking earlier. For me, the stress of having to constantly manage my weight was just too much in a part of life where I'm a mom, I'm a business owner, I have all these things that are already stressful. It just wasn't worth it to put that on top. of all of that. So for my life right now,

this is the right solution. And like, maybe it's not for everybody where they are or their health issues or, you know, and there's so, like I said, so much new innovation coming in this space. We're at the very, very beginning of this that it's like a yes, but we'll see what will happen. Wow. Mike,

do you have any takeaways on what we discussed today? Well, I mean, I think my biggest takeaway, even from the conference, is the fact that I was someone who had what I would consider an antagonistic relationship with the dietician I had as a kid, right? Then I felt like I was that person that constantly brought the the food diary in and was told, no, you're a liar.

And to hear you say that and to hear you come back and say, but now I've learned for me, that's going to be a big takeaway. Because when my primary care said, do you think you need a dietitian? And I went, I kind of think I need to know what I need to know. And the doctor said, yeah, probably. And the more I've learned over the last two and a half years,

when I finally brought in a dietitian to my care team, it made a big difference. So that's my takeaway. What you said is going to stick with me for a while. I think mine's short and sweet to the point, which is, do I need to stay on a GLP-I forever? TBD. TBD. TBD.

You know, more science, more research is needed. I want to thank you both for, you know, allowing us to have a little bit of time during this crazy FENCI conference. This episode will air after FENCI even takes place, but, you know, I know you both are very busy, so thank you for giving us your time and helping us to unpack this. Can I ask you both,

are there ways people can work with you or how they can follow you on social media? How can they connect back with you after this? Listen to the GLP One Hub podcast and YouTube channel. Those are my primary places to connect with me. And I try to put out good quality content, interview wonderful people in the space,

and try to stay on top of what's going on. And you can find me on Instagram at theweightloss.dietitian. I post a lot of GLP-I weight management-related content on there and on my website, melissametri.com, where I blog regularly as well. Well, everyone, make sure you go and check out their individual sites and podcasts. And, you know,

I really enjoy getting to have conversations where people recognize obesity as the chronic condition that it is and that all decisions aren't really unilateral for each person. They really are individualized. Yeah, and I hope that the conversations we had today help patients have the right questions to walk back into their care team and to realize that they should expand their care team to include

dieticians. If you've enjoyed this conversation, we hope that you'll subscribe to Weight and Measure wherever you get your podcasts or on our new YouTube channel. And you can easily get to all of our platforms on www.weightandmeasurepod.com. Thanks for joining us. And remember, as always, more science and less stigma. Thanks for listening to Weight and

Measure. Subscribe for evidence-based conversations on obesity, GLP-I, bariatric surgery, and metabolic health. We'll see you in the next episode.