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Hone your obesity medicine skills in primary care! We discuss overcoming barriers, patient counseling, obesity pathophysiology, motivational interviewing, tools and tips from a weight loss program, and how to discuss medications for weight loss including phentermine/topiramate, bupropion/naltrexone, orlistat, oral superabsorbent hydrogel, and GLP1 agonists. We’re joined by obesity medicine expert, Dr. Kimberly Anne Gudzune of @HopkinsMedicine, recorded @SocietyGIM #SGIM23 in Denver, Colorado Claim free CME for this episode at https://curbsiders.vcuhealth.org! Show Segments Intro Barriers to treating medicine in primary care Patient counseling and obesity pathophysiology Motivational Interviewing Telemedicine for obesity Tools and tips for a weight loss program Medications for Obesity GLP1 agonist prescribing tips Outro Credits Written and Produced by: Matthew Watto MD, FACP Show Notes: Matthew Watto MD, FACP Cover Art and Infographic: Matthew Watto MD, FACP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP Reviewer: Leah Witt MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP In-studio Technical Production: Chris Chiu MD, FACP, FAAP Technical Production: PodPaste Guest: Kimberly Anne Gudzune MD, MPH

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Ketosis is a natural metabolic state in which your body burns fat for fuel instead of carbohydrates. When you restrict your intake of carbs, your body enters ketosis and starts producing ketones, which are molecules that your body can use for energy. This process can lead to weight loss, increased energy levels, improved mental clarity, and many other health benefits.

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Apple cider vinegar (ACV) has been used for centuries for its health benefits, including supporting weight loss, improving digestion, and balancing blood sugar levels. ACV is rich in acetic acid, which has been shown to help regulate blood sugar levels, reduce inflammation, and promote weight loss.

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1. Enhanced Ketosis: Ketosis ACV Gummies are specifically formulated to help support your body’s natural ketosis process. By providing your body with essential nutrients and ketones, these gummies can help you achieve and maintain ketosis more effectively.

2. Improved Digestion: ACV is known for its ability to improve digestion and promote gut health. By incorporating ACV into your daily routine with Ketosis ACV Gummies, you can support a healthy digestive system and enhance nutrient absorption.

3. Increased Energy Levels: When your body is in ketosis, it has a steady source of energy from fat stores. By supplementing with Ketosis ACV Gummies, you can boost your energy levels and feel more alert and focused throughout the day.

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Yes, Ketosis ACV Gummies are made with high-quality, natural ingredients that are safe for consumption. However, if you have any underlying health conditions or concerns, it’s always best to consult with a healthcare professional before starting any new supplement regimen.

2. How many gummies should I take per day?

The recommended dosage of Ketosis ACV Gummies may vary depending on your individual needs and goals. It’s always best to follow the instructions on the packaging or consult with a healthcare provider for personalized recommendations.

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It can feel confusing knowing which diet plan is right for you with all of the popular diets and meal plans out there. Dr. Samantha Harris, a Scripps endocrinologist specializing in weight management, discusses two of the most popular weight-loss approaches, the keto and paleo diets, including key differences and similarities, who each diet benefits the most, what you eat on each diet and more. Get the facts about each diet plan and find out if either one is right for you. http://www.scripps.org/7258y 0:31 - What is the keto diet? 0:45 - What is ketosis? 1:06 - How do you know when you've entered the state of ketosis? 1:45 - What effect does intermittent fasting have on ketosis? 2:23 - What foods can you eat on the keto diet? 2:55 - What foods do you need to avoid on the keto diet? 3:16 - What kind of fruit should you eliminate on the keto diet? 3:34 - How long can you stay on the keto diet? 4:08 - Who is a good candidate for the keto diet, and who should avoid it? 4:59 - What is the paleo diet? 5:36 - Can you eat meat on the paleo diet? 6:09 - Who is a good candidate for the paleo diet? 6:29 - What are the health benefits of the paleo diet? 7:28 - What is the pegan diet? 8:09 - What is the benefit of the pegan diet? 8:34 - Final thoughts

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Weight Loss Effectiveness (Annual Averages): Rybelsus: ~8 percent Ozempic: ~13 percent Wegovy: ~16 percent Tirzepatide (Zepbound): ~22 percent — most effective so far. 2. Mechanism of Action: Ozempic (Semaglutide) mimics GLP-1, which: Suppresses appetite Slows gastric emptying Increases insulin Decreases glucagon This leads to lower blood sugar and reduced food intake. 3. Not FDA-Approved for Weight Loss: Ozempic is only approved for Type 2 diabetes, while Wegovy (same molecule, higher dose) is approved for weight loss. 4. Risk of Vision Loss (New Concern): Rare cases of non-arteritic anterior ischemic optic neuropathy reported. Normally: ~10 per 100,000 people With Ozempic: ~30 per 100,000 (300 percent increase) Still rare but permanent if it occurs. 5. Most Common Side Effects (~25 percent): Nausea Vomiting Diarrhea Constipation Occur in about 1 in 4 users. 6. Gallbladder Issues (2–3 percent): Rapid weight loss can lead to: Gallstones Gallbladder inflammation 7. Pancreatitis (Rare but Serious): Less than 1 percent, but can be life-threatening. Symptoms include severe abdominal pain and vomiting. 8. Thyroid Cancer Warning: Based on mouse studies, not humans. However, still contraindicated in people with MEN2 or family history of MTC. MEN2 patients almost always develop MTC by age 40. 9. Patent Timeline for Semaglutide: Core patent expires in 2026 → generics possible by 2027 Secondary patents (like pen design) expire by 2033 → price drop expected 10. Price Differences: USA: ~$1,000/month without insurance Georgia (country): ~$500 for 3 months Disclaimer: This information is provided for general knowledge and educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult with your doctor for any questions or concerns you may have about your health.

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How to Gain Weight Fast for Skinny People (Diet & Workout Plan for Hardgainers) - Easiest Way To Gain 10 kg Weight and Muscle Fast Weight gain is not rocket science but if you are naturally skinny or a hardgainer, you already know that just eating more food & lifting weights doesn’t always work. I was also an ectomorph and I understand the struggle of not gaining weight no matter how much you eat. People make fun of you – stick figure hanger walking skeleton, and whatnot. But all that ends today because in this video, I am sharing the ultimate weight gain formula for skinny guys that is science-backed & tested. Download FITMUSK and follow EXTREME GAINS PLAN : Coaching starts at just ₹149/month or ₹59/month with 6-month plan. Visit https://www.fitmusk.com Or Download Now: Download FITMUSK App 1. Playstore Link: https://openinapp.link/7mu9kar 2. Apple Store Link: https://apple.openinapp.co/m2f40 Links to My Youtube Videos of Weight gain and fat loss: How To Gain Weight Fast : https://yt.openinapp.co/r748b How To Lose Fat Fast : https://yt.openinapp.co/lf508 Recommended Brands for Supplements: •⁠ ⁠Creatine Monohydrate: https://amzn.openinapp.co/jvdsa •⁠ ⁠Magnesium: https://amzn.openinapp.co/k31xq •⁠ ⁠Zinc: https://amzn.openinapp.co/xvhos •⁠ ⁠Vitamin C: https://amzn.openinapp.co/lumr7 •⁠ ⁠Ashwagandha: https://amzn.openinapp.co/g8jsm •⁠ ⁠Multivitamins: https://amzn.openinapp.co/9t4w6 •⁠ ⁠Omega 3: https://amzn.openinapp.co/17hmq Follow these 5 STEPS & I GUARANTEE YOU WILL GAIN WEIGHT 1 build don’t bulk Most people think that bulking means eating as much as possible. That’s what bodybuilders do in the offseason – they eat thousands of calories to get bigger before cutting. But you are not a bodybuilder. we are regular people who want to gain weight without feeling bloated and unhealthy. If you eat too much junk just to gain weight you’ll gain fat not muscle. Instead focus on BUILDING MUSCLE NOT JUST BULKING UP Set a REALISTIC target: Aim for 5 kg in 6 months, not 20 kg in 2 months That means only 800g per month, which is sustainable. Maximize MUSCLE gain, not just fat gain 2 train smart & eat right If you think just eating will help you gain weight you are wrong. You need progressive overload resistance training (lifting heavier over time) to force your muscles to grow. Workout Plan for Skinny Guys • Train 3-4 days per week with weight training or resistance workouts • Keep workouts short & intense (45-60 mins) • Focus on compound movements Squats Deadlifts Bench Press Rows • Avoid too much cardio (it burns too many calories) DIET PLAN Eating random foods won’t help. You need the right macros (Protein, Carbs, and Fats) in the right amounts. PROTEIN = Muscle Growth • 2g per kg of bodyweight → If you weigh 60kg, eat 120g protein daily • Best sources: Paneer Tofu Soy Chunks Lentils Whey Protein Eggs Chicken Fish FATS = Hormone & Recovery • 1g per kg of bodyweight → 60kg person = 60g fats daily • Best sources: Nuts Seeds Peanut Butter Olive Oil Ghee (in moderation) CARBS = Energy & Recovery • 4g per kg of bodyweight → 60kg person = 240g carbs daily • Best sources: Rice Roti Oats Fruits Potatoes Pasta Lentils Chickpeas Slowly increase your calories each week → DO NOT force-feed yourself or you’ll get bloating digestion issues and fat gain instead of muscle 3 sleep more stress less Muscles grow when you rest NOT when you workout. If you’re sleeping only 4-5 hours a night you are slowing down your weight gain. Sleep 7-8 hours minimum Reduce screen time before bed (stop scrolling on Instagram all night) Manage stress – stress increases cortisol, which kills your appetite & stops muscle gain 4 stop worrying about abs (for now) Weight gain means a little bit of fat is ok Don’t be scared of a tiny belly fat – your goal is to gain muscle first, then later you can lean down Mistake most skinny guys make • They gain a little belly fat and start cutting • Lose all their muscle gains • Become skinny again Best strategy • Reach your goal weight (eg 70kg) • Maintain it for at least 3 months • Then do a slow fat loss phase Keep training abs 2-3x a week, but don’t worry if they aren’t visible yet 5 stop obsessing over weight Skinny guys make 1 big mistake – they check their weight every single day and get demotivated. Weight gain is NOT linear – some weeks you gain 1kg, some weeks only 500g. That’s normal Only check weight ONCE a week (Sunday morning empty stomach) Track other progress • Are your clothes fitting better • Are you lifting heavier weights in the gym • Are people noticing the difference If yes → YOU ARE MAKING PROGRESS Don’t quit just because of the scale. Timecodes: 00:00 Introduction 01:30 1) Build, don’t bulk 02:49 2) Exercise & Diet 07:33 3) Recovery & Stress Management 08:54 4) Forget About Abs (for now) 09:54 5) Weight obsession

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