Eva (00:06):
You are listening to Less of You. I'm Eva. My name is Kami. Come with us as we confront our reasons for being obese while losing weight on semaglutide and roasting our past selves.

(00:19):
Hi listeners, it's Eva. This bonus episode is an excerpt from an interview I did with Dr. Johnny Franco about semaglutide and where it's headed on one of my other podcasts called Meet the Doctor. Dr. Franco lost more than 70 pounds himself on semaglutide and tirzepatide, and he's the doctor that introduced me to the skinny shot back in January, 2023. One thing I want you to be open-minded about if you're on a GLP1 or considering it, is that a plastic surgery office might be as good or an even better resource for a weight loss program than an online telemedicine or through the usual primary care channels for a few reasons. First, plastic surgery offices are really nice places with really nice people. The other reasons are that shortages are making the brand name medications really hard to get. And I hear that insurance doesn't cover it for a lot of people, and even when it does, it might still be more expensive than a compounded medication.

(01:16):
Those compounded medications are safe when you can trust the source. And for me, knowing the doctor and the staff personally makes me feel a lot safer. When you start losing, you'll also have other wants and I won't call them needs, but aesthetic things start to emerge, like loose skin and wrinkles. And in my case, I wanted to get rid of all those red spots on my legs so I could feel good wearing shorts again. So it's been great to have all those things in one central place. I've started curating a list on our website of trusted Doctor's offices that I know of where you can the skinny shot, and you can find that list on lessofyou.com at the bottom. And it's also linked in the show notes of this episode. Hope you enjoy getting to know Dr. Johnny Franco. Here you go. The Skinny Shot revolution is not something we can ignore.

Dr. Franco (02:08):
It's been super interesting. We see about 2000 weight loss patients a month in our office, and I think that number is only going to grow. We've even started talking a little bit about something that I call beyond the weight loss revolution because I think now you're going to see all these patients who have skin laxity, some changes in their body, and I think being able to address and speak to that, I think as a plastic surgeon, whether you want to offer weight loss treatments in your office or not, you can't ignore this. The amount of people that are going to be on these medications is just going to be innumerable. I have to check the final stats about where it finished off, but it was on pace last year to finish the year as the number one, tirzepatide, Mounjaro was on pace to be the number one most sold drug ever in America.

Eva (02:53):
More than Viagra.

Dr. Franco (02:55):
More than Viagra, more than if you think about how many people are on heart medications. I mean, it's just an enormous amount. They recently released a tirzepatide medication, which is basically the same medication as Mounjaro, but called Zepbound. That was FDA approved for chronic weight management, which also is such an interesting pivot of how the FDA views obesity and weight management in the United States. I mean, so they no longer see it as an acute issue of needing to course correct. They see it as a chronic issue, and I think there's a lot more to weight than just self-control, so forth. And I think it had a bad stigma in the past, but now with a lot of people coming out, Oprah recently after denying it for a year and a half that she was on some of the weight loss medications. Charles Barkley recently was on TV saying that it was the biggest change in his life for himself.

(03:48):
I think it's interesting because it normalizes the conversation of weight. I think in the past there was sort of this weird view of it that the people thought it was just a personal issue that, you just weren't eating right, you just didn't have any self-control, and by you, I mean me, I had all of this. I mean, I had a BMI of almost 40, I was 260 pounds at five eight. And so I'm in that category, but I think we now see that there's more to it. I also see that there's going to be a change. And now that we see it, if you look at the statistics, it's just groundbreaking. I mean, we were on pace that by the year 2030, 80% of Americans would've either been overweight or obese. 80%, I mean, the healthcare system couldn't support that. And not to go down a rabbit hole, but it just shows you the ripple effect this could have.

Eva (04:35):
I love this rabbit hole. It's completely changed my life too. And that is actually directly because of you. And so what happened to me was I had already heard it from my internal medicine doctor and I said, no, no, no, I'm going to go back to Orange Theory and do the transformation challenge again for the third time. And I happened to go to your office for something else, I think I was dropping something off for you. And they were like, Hey, we're practicing consultations today. Can Dr. Arredondo practice consultation on you? They weren't like, Hey, you're overweight, you know, you should to do this. They were like, can you practice on it? And I love doing that kind of stuff, so I was like, sure, I have time. And at the end, he talked to me for about half an hour. He had a really compelling case. And at the end I was like, yeah, no, I'm going to do this, I'm going to go back to the gym. And he goes, if you say no, you're only going to be the second person out of the 30 that I've already talked to who said no. And that really made me mad, and I still don't know why it made me so mad that he said that, but I wasn't mad at him. And so I said, fine, if I try it and I don't like it, I just stop, right? And he said, yeah, just stop if you don't like it. And so I noticed my anniversary was two days ago.

Dr. Franco (05:56):
Oh wow.

Eva (05:57):
Of one year, and I've lost 67 pounds in one year. And I have an absolutely great experience with your team, and I'm not doing a commercial for you right now. It is completely transformed my entire life.

Dr. Franco (06:10):
But I think people like you who are using this as a jumpstart, they're still doing the other things, they're still trying to make changes, they're still being active. So it's not like you're just using this as a get out of jail free card. I mean, this is a jumpstart. This is to adjunct the people like you who are still being active, still trying to make lifestyle changes. Those are the people that succeed. We have people that do the shot still come in with their venti frappuccino with extra whip cream and sprinkles on top, and they're like, I haven't lost any weight. I'm like, yep. Kind of interesting. Even if you look at the study last year on coronary artery disease, most people say like, yeah, you lost weight, of course, their coronary artery risk disease should go down. But if you actually normalize the study to take out the environment and match them up for weight loss in those two groups, still the people on the semaglutide medications still lower their risk. So interesting. Obviously they lowered it pretty substantially because you did lose the weight, which definitely helps decrease the risk of coronary disease. But even if you factored that in, they were still at a lower risk. So agree. I think there's a little bit more to this. It is pretty interesting too, they're also doing some studies ongoing now for using some of the semaglutide, the GLP stuff or other type of addictions and cravings. And so interesting how it's going to affect that for smoking, alcohol abuse, other things like that. So still TBD.

Eva (07:30):
I think one weird thing that happens to me, and maybe this happens to you too, is there's days where I'm like, I need a cookie. I can't do anything else until I have a cookie. It's not like it used to be where I'd be like, I need a bag of cookies, but my body's telling me I need something and I listen, but I don't, like there's no binge eating anymore. So one of the things I've started to confront, and actually I'm going to confront on a podcast, is how did I end up there? And I'd never, ever admitted to myself that I was a binge eater. We ate to celebrate. We ate when we felt bad. We ate because we were bored. We ate for a lot of really stupid reasons.

Dr. Franco (08:14):
And it's interesting because one of the things that we actually educate our patients on, most of us that eat through our emotions and so forth, life's going to happen. Shit's going to happen. And so whether it's a marital thing, a relationship thing, a work thing, a death in the family or a friend or something, I mean, something's going to happen. And so just being a little cognizant of that, if you need to change your doses, restart, do something like that. You don't want to slip back into bad habits.

Eva (08:40):
You're giving me a perfect transition. So I have such great support from your team. I see Ashley, I've seen Sarah, I've seen a number of really great people there. And I don't want to say they're interchangeable, they're all special, but they really know what talking about and most of them have done it. What we have a big opportunity for is people will go to their regular doctor and get a prescription. They may run into a shortage or they may run into the problem that they're not covered by insurance, and then they don't think, oh, I should ask a plastic surgeon for this. And I think there's a lot of people going online and using potentially dangerous sources, and that's really troubling. So how do we make people aware in the middle that this is a great resource and it's safe, if not safer. I could argue that it's safer because you have support, someone cares about what's happening to you.

Dr. Franco (09:36):
I think it's us as plastic surgeons. I think it's us as aesthetic providers to really be part of the conversation. I think in the past some providers offered it, they didn't really want to talk about it, they were worried about misstepping. I'll say to the credit of ASPS and their president, Steven Williams, he actually reached out last week, and we're actually looking at how we can integrate some of the weight loss wellness overall into the next ASPS meeting in San Diego. Because some of the idea is just that this stuff is out there for us not to be part of the conversation is not doing a service to the public, but also to our plastic surgeons, to not educate them, not to be a resource for them, not for them to be able to feel like they're getting information from a good place and patients are going to be talking about it.

(10:21):
And if we can't answer questions or be educated about, they're going to go somewhere else and ultimately get procedures and things done by someone that's not trained. So I think it's pretty phenomenal that they've taken a big step in terms of really trying to educate its members, which will filter into educating the public in terms of these treatments. And even if they're not going to offer the medications, I still think that you need to understand the process. You need to understand what's going on. You need to understand what the conversation is so that you can make sure that you're involved. When am I getting people off these medications? What do I need to educate them on? What do I need to know about it? And so I think to just try and avoid the conversation as a whole as not doing your patients a service.

Eva (11:05):
How are you thinking about getting people off? What does that look like?

Dr. Franco (11:09):
I mean, even for myself at this point, I think I've done one, maybe two shots in the last two months right before the holidays and that was it. So for the most part, we usually get people to a good goal weight, keep 'em there for at least two months and then slowly start to wean down, and then monitoring them to making sure that they are holding into a good spot. If we need to tweak, we can do that, and then phasing people out. So I think there's going to be some set of people that need to chronically be on a low dose. I think there's going to be a small set that can completely come off. I think there's going to be some people that are going to have to be a little aware of their body of when they need to come back on.

Eva (11:43):
So you're only taking it here and there. What's your own criteria for taking it, and are you hungry again? Is any of that stuff coming back that was there before?

Dr. Franco (11:52):
I've kind of done it prophylactically. I've only taken it when I was going to go see my brother for Thanksgiving, and I knew I was going to be surrounded by stuff, so it was more of a preemptive than really I needed it.

Eva (12:04):
Wait, didn't you tell me you ate too much on Thanksgiving anyway?

Dr. Franco (12:07):
Oh, well that was the year before.

Eva (12:10):
Oh, that's right. That was a year ago, I can't believe how much time has gone by.

Dr. Franco (12:14):
Yeah, honestly, I still feel really, really good. We'll see. I still monitor my weight weekly to make sure I'm staying in a good spot. And so I'm definitely not closing the book and that I need to get back on it on any regular basis. But as long as I can hold the line and still do good, and I think I've gotten into a better workout. I've gotten better into eating well and those type of things, so I think that's helped. I've definitely got some work to go, but still a work in progress.

Eva (12:41):
Well, if someone's listening and they want to find out more about you or Austin Plastic Surgeon, tell me again where the three offices are and the best place to follow you online.

Dr. Franco (12:50):
Yeah, easiest place to follow us is on social media at Austin Plastic Surgeon. We've got three offices, one in North Austin by the Domain, one in Westlake, and then San Antonio as well. And then our website is www.austinplasticsurgeon.com.

Eva (13:06):
Wonderful. Thank you Dr. Franco.

Dr. Franco (13:08):
Thanks for having me. Appreciate it.

Eva (13:11):
Follow us on Instagram at Less of You podcast. Are you confronting the same challenges and have a story to tell? I'd love to hear your story on our Skinny Shot Stories podcast. Contact me for more details at skinnyshotstories.com. If you're a doctor and would like to learn more about sponsoring this or any of our cosmetic surgery and weight loss podcasts, go to lessofyou.com. Less of You is a production of The Axis, theaxis.io.