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About two years ago, we released a podcast with Dr. Thomas Wadden of the University of Pennsylvania describing work on a new generation of medications to treat diabetes and obesity. They were really taking the field by storm. Since then, much more is known since many additional studies have been published and so many people have been using the drugs. So many, in fact, the market value of the Danish company, Novo Nordisk, one of the two major companies selling the drugs, has gone up. It is now greater than the entire budget of the country of Denmark. This single company is responsible for about half of Denmark's economic expansion this year. So, a lot of people are now taking the drugs and this is a great time for an update on the drugs. And we're fortunate to have two of the world's leading experts join us: Dr. Wadden, Professor of Psychology and Psychiatry at the University of Pennsylvania School of Medicine and the inaugural Albert J. Stunkard Professor of Psychiatry at Penn. Joining us as well as Dr. Robert Kushner, a physician and professor of medicine at Northwestern University and a pioneer in testing treatments for obesity. Interview Summary Tom, you and I were colleagues at Penn decades ago. And I got frustrated the treatments for obesity didn't work very well. People tended to regain the weight. And I turned my attention to prevention and policy. But you hung in there and I admired you for that patience and persistence. And Bob, the same for you. You worked on this tenacious problem for many years. But for both of you, your patience has been rewarded with what seems to me to be a seismic shift in the way obesity and diabetes can be treated. Tom, I'll begin with you. Is this as big of a deal as it seems to me? Well, I think it is as big of a deal as it seems to you. These medications have had a huge impact on improving the treatment of type 2 diabetes, but particularly the management of obesity. With older medications, patients lost about 7 percent of their starting weight. If you weighed 200 pounds, you'd lose about 15 pounds. That was also true of our best diet and exercise programs. You would lose about 7 percent on those programs with rigorous effort. But with the new medications, patients are now losing about 15 to 20 percent of their starting body weight at approximately one year. And that's a 30-to-40-pound loss for a person who started at 200 pounds. And with these larger weight losses, we get larger improvements in health in terms of complications of obesity. So, to quote a good friend of mine, Bob Kushner, these medications have been a real game changer. Thanks for putting that in perspective. I mean, we're talking about not just little incremental changes in what treatments can produce, which is what we've seen for years. But just orders of magnitude of change, which is really nice to see. So, Bob what are these medications that we're talking about? What are the names of the drugs and how do they work? Well, Kelly, this transformation of obesity really came about by finding the target that is really highly effective for obesity. It's called the gut brain axis. And when it comes to the gut it's starting off with a naturally occurring gut hormone called GLP 1. I think everyone in the country's heard of GLP 1. It's released after we eat, and it helps the pancreas produce insulin, slows the stomach release of food, and reduces appetite. And that's where the obesity story comes in. So pharmaceutical companies have taken this hormone and synthesized it, something similar to GLP 1. It mimics the action of GLP 1. So, you could actually take it and give it back and have it injected so it augments or highlights this hormonal effect. Now, that same process of mimicking a hormone is used for another gut hormone called GIP that also reduces appetite. These two hormones are the backbone of the currently available medication. There's two on the market. One is called Semaglutide. That's a GLP 1 analog. Trade name is Wegovy. Now, it's also marketed for diabetes. Tom talked about how it is used for diabetes and increases insulin. That trade name is Ozempic. That's also familiar with everyone around the country. The other one that combined GLP 1 and GIP, these two gut hormones, so it's a dual agonist, the trade name for obesity is called Zep Bound, and the same compound for diabetes is called Mounjaro. These are terms that are becoming familiar, I think, to everyone in the country. Tom mentioned some about the, how much weight people lose on these drugs, but what sort of medical changes occur? Just to reiterate what Tom said, I'll say it in another way. For Semaglutide one third of individuals are losing 20 percent of their body weight in these trials. For Tirzepatide, it even outpaces that. And I got a third of individuals losing a quarter of their body weight. These are unheard of weight losses. And with these weight losses and these independent effects from weight, what we're seeing in the trials and in the clinic is that blood pressure goes down, blood sugar goes down, blood fats like triglyceride go down, inflammation in the body goes down, because we marked that with CRP, as well as improvement in quality of life, which we'll probably get to. But really interesting stuff is coming out over the past year or two or so, that it is improving the function of people living with congestive heart failure, a particular form called a preserved ejection fraction. We're seeing improvements in sleep apnea. Think of all the people who are on these CPAP machines every night. We're seeing significant improvements in the symptoms of sleep apnea and the apneic events. And lastly, a SELECT trial came out, that's what it was called, came out last year. Which for the very first time, Kelly, found improvements in cardiovascular disease, like having a heart attack, stroke, or dying of cardiovascular disease in people living with obesity and already have cardiovascular disease. That's called secondary prevention. That, Tom, is the game changer. Bob, I'd like to go back to Tom in a minute but let me ask you one clarifying question about what you just said. That's a remarkable array of biological medical benefits from these drugs. Just incredible. And the question is, are they all attributable to the weight loss or is there something else going on? Like if somebody lost equal amounts of weight by some other means, would these same changes be occurring? Those studies are still going on. It's very good. We're thinking it's a dual effect. It's the profound amount of weight loss, as Tom said. Fifteen to 21 to even 25 percent of average body weight. That is driving a lot of the benefits. But there also appear to be additional effects or weight independent effects that are working outside of that weight. We're seeing improvements in kidney function, improvement in heart disease, blood clotting, inflammation. And those are likely due to the gut hormone effect independent of the weight itself. That still needs to be sorted out. That's called a mitigation analysis where we try to separate out the effects of these drugs. And that work is still underway. Tom, one of the most vexing problems, over the decades that people have been working on treatments for obesity, has been long term results. And I'm curious about how long have people been followed on these drugs now? What are the results? And what was the picture before then? How do what we see now compared to what you saw before? The study that Bob just mentioned, the SELECT trial followed people for four years on Semaglutide. And patients achieve their maximal weight loss at about one year and they lost 10 percent of their weight. And when they were followed up at four years still on treatment, they still maintained a 10 percent weight loss. That 10 percent is smaller than in most of the trials, where it was a 15 percent loss. But Dr. Tim Garvey showed that his patients in a smaller trial lost about 15 percent at one year and while still on medication kept off the full 15 percent. I think part of the reason the weight loss in SELECT were smaller is because the study enrolled a lot of men. Men are losing less weight on this medication than women. But to your question about how these results compare to the results of earlier treatment, well with behavioral treatment, diet, and exercise back in the 70s beyond, people lost this 7 or 8 percent of weight. And then most people on average regain their weight over one to three years. And the same was true of medication. People often stopped these earlier medications after 6 to 12 months, in part because they're frustrated the losses weren't larger. Some people were also worried about the side effects. But the long and short is once you stop taking the medication, people would tend to regain their weight. And some of this weight regain may be attributable to people returning to their prior eating and activity habits. But one of the things we've learned over the past 20 years is that part of the weight regain seems to be attributable to changes in the body's metabolism. And you know that when you lose weight, you're resting metabolic rate, which is the number of calories your body burns at rest to maintain basic bodily functions. Your resting metabolic rate decreases by 10 to 15 percent. But also, your energy expenditure, the calories you burn during exercise decreases. And that may decrease by as much as 20 to 30 percent. So, people are left having to really watch their calories very carefully because of their lower calorie requirements in order to keep off their lost body weight. I think one thing these new drugs may do is to attenuate the drop both in resting metabolic rate and energy expenditure during physical activity. But the long and short of it is that if you stay on these new medications long term, you'll keep off your body weight. And you'll probably keep it off primarily because of improvements in your appetite, so you have less hunger. And as a result, you're eating less food. I'd like to come back to that in a minute. But let me ask a question. If a person loses weight, and then their body starts putting biological pressure on them to regain, how come? You know, it's disadvantageous for their survival and their health to have the excess weight. Why would the body do that? Well, our bodies evolved in an environment of food scarcity, and our physiology evolved to protect us against starvation. First, by allowing us to store body fat, a source of energy when food is not available. And second, the body's capacity to lower its metabolism, or the rate at which calories are burned to maintain these basic functions like body temperature and heart rate. That provided protection against food scarcity. But Kelly, you have described better than anybody else that these ancient genes that regulate energy expenditure and metabolism are now a terrible mismatch for an environment in which food is plentiful, high in calories, and available 24 by 7. The body evolved to protect us from starvation, but not from eating past our calorie needs. And so, it's this mismatch between our evolution and our appetite and our body regulation in the current, what you have called toxic food environment, when you can eat just all the time. I guess you could think about humans evolving over thousands of years and biology adapting to circumstances where food was uncertain and unpredictable. But this modern environment has happened really pretty rapidly and maybe evolution just hasn't had a chance to catch up. We're still existing with those ancient genes that are disadvantageous in this kind of environment. Bob back to the drugs. What are the side effects of the drugs? Kelly, they're primarily gastrointestinal. These are symptoms like nausea, diarrhea, constipation, heartburn, and vomiting. Not great, but they're generally considered mild to moderate, and temporary. And they primarily occur early during the first four to five months when the medications are slowly dose escalated. And we've learned, most importantly, how to mitigate or reduce those side effects to help people stay on the drug. Examples would be your prescriber would slow the dose escalation. So. if you're having some nausea at a particular dose, we wait another month or two. The other, very importantly, is we have found that diet significantly impacts these side effects. When we counsel patients on these medications, along with that comes recommendations for dietary changes, such as reducing fatty food and greasy food. Reducing the amount of food you're consuming. Planning your meals in advance. Keeping well hydrated. And very importantly, do not go out for a celebration or go out to meals on the day that you inject or at least the first two days. Because you're not going to tolerate the drug very well. We use that therapeutically. So, if you want to get control on the weekends, you may want to take your injection on a Friday. However, if weekends are your time out with friends and you want to socialize, don't take it on a Friday. Same thing comes with a personal trainer, by the way. If you're going to have a personal trainer on a Monday where he's going to overwork you, don't take the injection the day before. You'll likely be nauseated, you're not eating, you're not hydrating. So actually, there's a lot that goes into not only when to take the dose and how to take the dose, but how to take it to the best ability to tolerate it. Two questions based on what you said. One is you talked about these are possible side effects, but how common are they? I mean, how many people suffer from these? Well, the trials show about 25 to 45 percent or so of individuals actually say they have these symptoms. And again, we ask them mild, moderate, severe. Most of them are mild to moderate. Some of them linger. However, they really do peak during the dose escalation. So, working with your prescriber during that period of time closely, keeping contact with them on how to reduce those side effects and how you're doing out of medication is extremely important. And the second thing I wanted to ask related to that is I've heard that there's a rare but serious potential side effect around the issue of stomach paralysis. Can you tell us something about that? I mentioned earlier, Kelly, that these medications slow gastric emptying. That's pretty much in everybody. In some individuals who may be predisposed to this, they develop something called ileus, and that's the medical term for gastric paralysis. And that can happen in individuals, let's say who have a scleroderma, who have longstanding diabetes or other gastrointestinal problems where the stomach really stopped peristalsis. In other words, it's moving. That's typically presented by vomiting and really unable to move the food along. We really haven't seen much of that. We looked at the safety data in a SELECT trial that Tom mentioned, which was 17,000 individuals, about 8,000 or so in each group. We really did not see a significant increase in the ileus or what you're talking about in that patient population. Okay, thanks. Tom had alluded to this before, Bob, but I wanted to ask you. How do you think about these medicines? If somebody takes them, and then they stop using the medicines and they gain the weight back. Is that a sign that the medicine works or doesn't work? And is this the kind of a chronic use drug like you might take for blood pressure or cholesterol? That's a great way of setting up for that. And I like to frame it thinking of it as a chronic progressive disease, just like diabetes or hypertension. We know that when you have those conditions, asthma could be another one or inflammatory bowel disease, where you really take a medication long term to keep the disease or condition under control. And we are currently thinking of obesity as a chronic disease with dysfunctional appetite and fat that is deposited in other organs, causing medical problems and so on. If you think of it as a chronic disease, you would naturally start thinking of it, like others, that medication is used long term. However, obesity appeared to be different. And working with patients, they still have this sense 'that's my fault, I know I can do it, I don't want to be on medication for the rest of my life for this.' So, we have our work cut out for us. One thing I can say from the trials, and Tom knows this because he was involved in them. If we suddenly stop the medication, that's how these trials were definitely done, either blindly or not blindly, you suddenly stop the medication, most, if not all of the participants in these trials start to regain weight. However, in a clinical practice, that is not how we work. We don't stop medication suddenly with patients. We go slowly. We down dose the medication. We may change to another medication. We may use intermittent therapy. So that is work that's currently under development. We don't know exactly how to counsel patients regarding long term use of the medications. I think we need to double down on lifestyle modification and counseling that I'm sure Tom is going to get into. This is really work ahead of us, how to maintain medication, who needs to be on it long term, and how do we actually manage patients. Tom, you're the leading expert in the world on lifestyle change in the context of obesity management. I mean, thinking about what people do with their diet, their physical activity, what kind of thinking they have related to the weight loss. And you talked about that just a moment ago. Why can't one just count on the drugs to do their magic and not have to worry about these things? Well, first, I think you can count on the drugs to do a large part of the magic. And you may be surprised to hear me say that. But with our former behavioral treatments of diet and exercise, we spent a lot of time trying to help people identify how many calories they were consuming. And they did that by recording their food intake either in paper and pencil or with an app. And the whole focus of treatment was trying to help people achieve a 500 calorie a day deficit. That took a lot of work. These medications, just by virtue of turning down your appetite and turning down your responsiveness to the food environment, take away the need for a lot of that work, which is a real blessing. But the question that comes up is, okay, people are eating less food. But what are they eating? Do these medications help you eat a healthier diet with more fruits and vegetables, with lean protein? Do you migrate from a high fat, high sugar diet to a Mediterranean diet, or to a DASH like diet? And the answer is, we don't know. But obviously you would like people to migrate to a diet that's going to be healthier for you from a cardiovascular standpoint, from a cancer risk reduction standpoint. One of the principal things that people need to do on these medications is to make sure they get plenty of protein. And so, guidance is that you should have about 1 gram of dietary protein for every kilogram of body weight. If you're somebody who weighs 100 kilograms, you should get 100 grams of protein. And what you're doing is giving people a lot of dietary protein to prevent the loss of bodily protein during rapid weight loss. You did a [00:20:00] lot of research with me back in the 80s on very low-calorie diets, and that was the underpinning of treatment. Give people a lot of dietary protein, prevent the loss of bodily protein. The other side of the equation is just physical activity, and it's a very good question about whether these medications and the weight loss they induce will help people be more physically active. I think that they will. Nonetheless for most people, you need to plan an activity schedule where you adopt new activities, whether it's walking more or going to the gym. And one thing that could be particularly helpful is strength training, because strength training could mitigate some of the loss of muscle mass, which is likely to occur with these medications. So, there's still plenty to learn about what is the optimal lifestyle program, but I think people, if they want to be at optimal health will increase their physical activity and eat a diet of fruits and vegetables, leaner protein, and less ultra processed foods. Well, isn't it true that eating a healthy diet and being physically active have benefits beyond their impact on your ability to lose the weight? You're getting kind of this wonderful double benefit, aren't you? I believe that is true. I think you're going to find that there are independent benefits of being physical activity upon your cardiovascular health. There are independent benefits of the food that you're eating in terms of reducing the risk of heart attack and of cancer, which has become such a hot topic. So, yes how you exercise and what you eat makes a difference, even if you're losing weight. Well, plus there's probably the triple one, if you will, from the psychological benefit of doing those things, that you do those things, you feel virtuous, that helps you adhere better as you go forward, and these things all come together in a nice picture when they're working. Tom, let's talk more about the psychology of these things. You being a psychologist, you've spent a lot of time doing research on this topic. And of course, you've got a lot of clinical experience with people. So as people are losing weight and using these drugs, what do they experience? And I'm thinking particularly about a study you published recently, and Bob was a coauthor on that study that addressed mental health outcomes. What do people experience and what did you find in that study? I think the first things people experience is improvements in their physical function. That you do find as you've lost weight that you've got less pain in your knees, you've got more energy, it's easier to get up the stairs, it's easier to play with the children or the grandchildren. That goes a long way toward making people feel better in terms of their self-efficacy, their agency in the life. Big, big improvement there. And then, unquestionably, people when they're losing a lot of weight tend to feel better about their appearance in some cases. They're happy that they can buy what they consider to be more fashionable clothes. They get compliments from friends. So, all of those things are positive. I'm not sure that weight loss is going to change your personality per se, or change your temperament, but it is going to give you these physical benefits and some psychological benefits with it. We were happy to find in the study you mentioned that was conducted with Bob that when people are taking these medications, they don't appear to be at an increased risk of developing symptoms of depression or symptoms of suicidal ideation. There were some initial reports of concern about that, but the analysis of the randomized trials that we conducted on Semaglutide show that there is no greater likelihood of developing depression or sadness or suicidal ideation on the medication versus the placebo. And then the FDA and the European Medicines Agency have done a full review of all post marketing reports. So, reports coming from doctors and the experience with their patients. And in looking at those data the FDA and the European Medicines Agency have said, we don't find a causal link between these medications and suicidal ideation. With that said, it's still important that if you're somebody who's taking these medications and you start them, and all of a sudden you do feel depressed, or all of a sudden you do have thoughts like, maybe I'd be better off if I weren't alive any longer, you need to talk to your primary care doctor immediately. Because it is always possible somebody's having an idiosyncratic reaction to these medications. It's just as possible the person would have that reaction without being on a medication. You know, that, that can happen. People with overweight and obesity are at higher risk of depression and anxiety disorders. So, it's always going to be hard to tease apart what are the effects of a new medication versus what are just the effects of weight, excess weight, on your mood and wellbeing. You know, you made me think of something as you were just speaking. Some people may experience negative effects during weight loss, but overall, the effects are highly positive and people are feeling good about themselves. They're able to do more things. They fit in better clothes. They're getting good feedback from their environment and people they know. And then, of course, there's all the medical benefit that makes people feel better, both psychologically and physically. Yet there's still such a strong tendency for people to regain weight after they've lost. And it just reinforces the fact that, the point that you made earlier, that there are biological processes at work that govern weight and tendency to regain. And there really is no shame in taking the drug. I mean, if you have high blood pressure, there's no shame in taking the drug. Or high cholesterol or anything else, because there's a biological process going on that puts you at risk. The same thing occurs here, so I hope the de-shaming, obesity in the first place, and diabetes, of course, and then the use of these medications in particular might help more people get the benefits that is available for them. I recommend that people think about their weight as a biologically regulated event. Very much like your body temperature is a biologically regulated event, as is your blood pressure and your heart rate. And I will ask people to realize that there are genetic contributors to your body weight. just as there are to your height. If somebody says, I just feel so bad about being overweight I'll just talk with them about their family history of weight and see that it runs in the family. Then I'll talk to them about their height. Do you feel bad about being six feet tall, to a male? No, that's fine. Well, that that's not based upon your willpower. That's based upon your genes, which you received. And so, your weight, it's similarly based. And if we can use medications to help control weight, cholesterol, blood pressure, blood sugar, let's do that. It's just we live in a time where we're fortunate to have the ability to add medications to help people control health complications including weight. Bob, there are several of the drugs available. How does one think about picking between them? Well, you know, in an ideal medical encounter, the prescriber is going to take into consideration all the factors of prescribing a medication, like any other medication, diabetes, hypertension, you name the condition. Those are things like contraindication to use. What other medical problems does the patient have that may benefit the patient. Patient preferences, of course and side effects, safety, allergies, and then we have cost. And I'll tell you, Kelly, because of our current environment, it's this last factor, cost, that's the most dominant factor when it comes to prescribing medication. I'll have a patient walk in my room, I'll look at the electronic medical record, body mass index, medical problems. I already know in my head what is going to be the most effective medication. That's what we're talking about today. Unfortunately, I then look at the patient insurance, which is also on the electronic medical record, and I see something like Medicaid or Medicare. I already know that it's not going to be covered. It is really quite unfortunate but ideally all these factors go into consideration. Patients often come in and say, I've heard about Ozempic am I a candidate for it, when can I get it? And unfortunately, it's not that simple, of course. And those are types of decisions the prescriber goes through in order to come to a decision, called shared decision making with the patient. Bob, when I asked you the initial question about these drugs, you were mentioning the trade name drugs like Mounjaro and Ozempic and those are made by basically two big pharmaceutical companies, Novo Nordisk and Eli Lilly. But there are compounded versions of these that have hit the scene. Can you explain what that means and what are your thoughts about the use of those medications? So compounding is actually pretty commonly done. It's been approved by the FDA for quite some time. I think most people are familiar with the idea of compounding pharmacies when you have a child that must take a tablet in a liquid form. The pharmacy may compound it to adapt to the child. Or you have an allergy to an ingredient so the pharmacy will compound that same active ingredient so you can take it safely. It's been approved for long periods of time. Anytime a drug is deemed in shortage by the FDA, but in high need by the public, compounding of that trade drug is allowed. And that's exactly what happened with both Semaglutide and Tirzepatide. And of course, that led to this compounding frenzy across the country with telehealth partnering up with different compounding pharmacies. It's basically making this active ingredient. They get a recipe elsewhere, they don't get it from the company, they get this recipe and then they make the drug or compound it themselves, and then they can sell it at a lower cost. I think it's been helpful for people to get the drug at a lower cost. However, buyer beware, because not all compounded pharmacies are the same. The FDA does not closely regulate these compounded pharmacies regarding quality assurance, best practice, and so forth. You have to know where that drug is coming from. Kelly, it's worth noting that just last week, ZepBound and Mounjaro came off the shortage list. You no longer can compound that and I just read in the New York Times today or yesterday that the industry that supports compounding pharmacies is suing the FDA to allow them to continue to compound it. I'm not sure where that's going to go. I mean, Eli Lilly has made this drug. However, Wegovy still is in shortage and that one is still allowed to be compounded. Let's talk a little bit more about costs because this is such a big determinant of whether people use the drugs or not. Bob, you mentioned the high cost, but Tom, how much do the drugs cost and is there any way of predicting what Bob just mentioned with the FDA? If the compounded versions can't be used because there's no longer a shortage, will that decrease pressure on the companies to keep the main drug less expensive. I mean, how do you think that'll all work out? But I guess my main question is how much these things cost and what's covered by insurance? Well first how much do the drugs cost? They cost too much. Semaglutide, known in retail as Wegovy, is $1,300 a month if you do not have insurance that covers it. I believe that Tirzepatide, known as ZepBound, is about $1,000 a month if you don't have insurance that covers that. Both these drugs sometimes have coupons that bring the price down. But still, if you're going to be looking at out of pocket costs of $600 or $700 or $800 a month. Very few people can afford that. The people who most need these medications are people often who are coming from lower incomes. So, in terms of just the future of having these medications be affordable to people, I would hope we're going to see that insurance companies are going to cover them more frequently. I'm really waiting to see if Medicare is going to set the example and say, yes, we will cover these medications for anybody with a BMI of 40 or a BMI of 35 with comorbidities. At this point, Medicare says, we will only pay for this drug if you have a history of heart attack and stroke, because we know the drug is going to improve your life expectancy. But if you don't have that history, you don't qualify. I hope we'll see that. Medicaid actually does cover these medications in some states. It's a state-by-state variation. Short of that, I think we're going to have to have studies showing that people are on these medications for a long time, I mean, three to five years probably will be the window, that they do have a reduction in the expenses for other health expenditures. And as a result, insurers will see, yes, it makes sense to treat excess weight because I can save on the cost of type 2 diabetes or sleep apnea and the like. Some early studies I think that you brought to my attention say the drugs are not cost neutral in the short-term basis of one to two years. I think you're going to have to look longer term. Then I think that there should be competition in the marketplace. As more drugs come online, the drug prices should come down because more will be available. There'll be greater production. Semaglutide, the first drug was $1,300. Zepbound, the second drug Tirzepatide, $1,000. Maybe the third drug will be $800. Maybe the fourth will be $500. And they'll put pressure on each other. But I don't know that to be a fact. That's just my hope. Neither of you as an economist or, nor do you work with the companies that we're talking about. But you mentioned that the high cost puts them out of reach for almost everybody. Why does it make sense for the companies to charge so much then? I mean, wouldn't it make sense to cut the price in half or by two thirds? And then so many more people would use them that the company would up ahead in the long run. Explain that to me. That's what you would think, for sure. And I think that what's happened right now is that is a shortage of these drugs. They cannot produce enough of them. Part of that is the manufacturing of the injector pens that are used to dispense the drug to yourself. I know that Novo Nordisk is building more factories to address this. I assume that Lilly will do the same thing. I hope that over time we will have a larger supply that will allow more people to get on the medication and I hope that the price would come down. Of course, in the U. S. we pay the highest drug prices in the world. Fortunately, given some of the legislation passed, Medicare will be able to negotiate the prices of some of these drugs now. And I think they will negotiate on these drugs, and that would bring prices down across the board. Boy, you know, the companies have to make some pretty interesting decisions, don't they? Because you've alluded to the fact that there are new drugs coming down the road. I'm assuming some of those might be developed and made by companies other than the two that we're talking about. So, so investing in a whole new plant to make more of these things when you've got these competitor drugs coming down the road are some interesting business issues. And that's not really the topic of what we're going to talk about, but it leads to my final question that I wanted to ask both of you. What do you think the future will bring? And what do you see in terms of the pipeline? What will people be doing a year from now or 2 or 5? And, you know, it's hard to have a crystal ball with this, but you two have been, you know, really pioneers and experts on this for many years. You better than anybody probably can answer this question. Bob, let me start with you. What do you think the future will bring? Well, Kelly, I previously mentioned that we finally have this new therapeutic target called the gut brain axis that we didn't know about. And that has really ushered in a whole new range of potential medications. And we're really only at the beginning of this transformation. So not only do we have this GLP 1 and GIP, we have other gut hormones that are also effective not only for weight loss, but other beneficial effects in the body, which will become household names, probably called amylin and glucagon that joins GLP 1. And we not only have these monotherapies like GLP 1 alone, we are now getting triagonists. So, we've got GIP, GLP 1, and glucagon together, which is even amplifying the effect even further. We are also developing oral forms of GLP 1 that in the future you could presumably take a tablet once a day, which will also help bring the cost down significantly and make it more available for individuals. We also have a new generation of medications being developed which is muscle sparing. Tom talked about the importance of being strong and physical function. And with the loss of lean body mass, which occurs with any time you lose weight, you can also lose muscle mass. There's drugs that are also going in that direction. But lastly, let me mention, Kelly, I spend a lot of my time in education. I think the exciting breakthroughs will not be meaningful to the patient unless the professional, the provider and the patient are able to have a nonjudgmental informative discussion during the encounter without stigma, without bias. Talk about the continuum of care available for you, someone living with obesity, and get the medications to the patient. Without that, medications over really sit on the shelf. And we have a lot of more work to do in that area. You know, among the many reasons I admire the both of you is that you've, you've paid a lot of attention to that issue that you just mentioned. You know, what it's like to live with obesity and what people are experiencing and how the stigma and the discrimination can just have devastating consequences. The fact that you're sensitive to those issues and that you're pushing to de-stigmatize these conditions among the general public, but also health care professionals, is really going to be a valuable advance. Thank you for that sensitivity. Tom, what do you think? If you appear into the crystal ball? What does it look like? I would have to agree with Bob that we're going to have so many different medications that we will be able to combine together that we're going to see that it's more than possible to achieve weight losses of 25 to 30 percent of initial body weight. Which is just astonishing to think that pharmaceuticals will be able to achieve what you achieve now with bariatric surgery. I think that it's just, just an extraordinary development. Just so pleased to be able to participate in the development of these drugs at this stage of career. I still see a concern, though, about the stigmatization of weight loss medications. I think we're going to need an enormous dose of medical education to help doctors realize that obesity is a disease. It's a different disease than some of the illnesses that you treat because, yes, it is so influenced by the environment. And if we could change the environment, as you've argued so eloquently, we could control a lot of the cases of overweight and obesity. But we've been unable to control the environment. Now we're taking a course that we have medications to control it. And so, let's use those medications just as we use medications to treat diabetes. We could control diabetes if the food environment was better. A lot of medical education to get doctors on board to say, yes, this is a disease that deserves to be treated with medication they will share that with their patients. They will reassure their patients that the drugs are safe. And that they're going to be safe long term for you to take. And then I hope that society as a whole will pick up that message that, yes, obesity and overweight are diseases that deserve to be treated the same way we treat other chronic illnesses. That's a tall order, but I think we're moving in that direction. BIOS Robert Kushner is Professor of Medicine and Medical Education at Northwestern University Feinberg School of Medicine, and Director of the Center for Lifestyle Medicine in Chicago, IL, USA. After finishing a residency in Internal Medicine at Northwestern University, he went on to complete a post-graduate fellowship in Clinical Nutrition and earned a Master's degree in Clinical Nutrition and Nutritional Biology from the University of Chicago. Dr. Kushner is past-President of The Obesity Society (TOS), the American Society for Parenteral and Enteral Nutrition (ASPEN), the American Board of Physician Nutrition Specialists (ABPNS), past-Chair of the American Board of Obesity Medicine (ABOM), and Co-Editor of Current Obesity Reports. He was awarded the ‘2016 Clinician-of-the-Year Award' by The Obesity Society and John X. Thomas Best Teachers of Feinberg Award at Northwestern University Feinberg School of Medicine in 2017. Dr. Kushner has authored over 250 original articles, reviews, books and book chapters covering medical nutrition, medical nutrition education, and obesity, and is an internationally recognized expert on the care of patients who are overweight or obese. He is author/editor of multiple books including Dr. Kushner's Personality Type Diet (St. Martin's Griffin Press, 2003; iuniverse, 2008), Fitness Unleashed (Three Rivers Press, 2006), Counseling Overweight Adults: The Lifestyle Patterns Approach and Tool Kit (Academy of Nutrition and Dietetics, 2009) and editor of the American Medical Association's (AMA) Assessment and Management of Adult Obesity: A Primer for Physicians (2003). Current books include Practical Manual of Clinical Obesity (Wiley-Blackwell, 2013), Treatment of the Obese Patient, 2nd Edition (Springer, 2014), Nutrition and Bariatric Surgery (CRC Press, 2015), Lifestyle Medicine: A Manual for Clinical Practice (Springer, 2016), and Obesity Medicine, Medical Clinics of North America (Elsevier, 2018). He is author of the upcoming book, Six Factors to Fit: Weight Loss that Works for You! (Academy of Nutrition and Dietetics, December, 2019). Thomas A. Wadden is a clinical psychologist and educator who is known for his research on the treatment of obesity by methods that include lifestyle modification, pharmacotherapy, and bariatric surgery. He is the Albert J. Stunkard Professor of Psychology in Psychiatry at the Perelman School of Medicine at the University of Pennsylvania and former director of the university's Center for Weight and Eating Disorders. He also is visiting professor of psychology at Haverford College. Wadden has published more than 550 peer-reviewed scientific papers and abstracts, as well as 7 edited books. Over the course of his career, he has served on expert panels for the National Institutes of Health, the Federal Trade Commission, the Department of Veterans Affairs, and the U.S. House of Representatives. His research has been recognized by awards from several organizations including the Association for the Advancement of Behavior Therapy and The Obesity Society. Wadden is a fellow of the Academy of Behavioral Medicine Research, the College of Physicians of Philadelphia, the Obesity Society, and Society of Behavioral Medicine. In 2015, the Obesity Society created the Thomas A. Wadden Award for Distinguished Mentorship, recognizing his education of scientists and practitioners in the field of obesity.

In today's episode, we are joined by Jordan Boehler, the founder of the Institute for the Relief of Suffering, Licensed Clinical Social Worker, Author of A Practical Manual for a Healthy Relationship: A Chiropractic Approach, Mimetic Therapist, lives in San Ramon, CA with his wife, two daughters, and cat. He is also a musician, artist, and explorer!In this episode, we delve into the power of Rapid Resolution Therapy and how it can change our thinking and enhance our connections. We explore transformative experiences and ideas that can change our lives. We will discuss mimetic communication, memetic therapy, and the potential for speed and comprehensive healing. Communication can be affected by various distortions, including biases, misinterpretations, and assumptions but recognizing and addressing these distortions can foster healthier and more effective relationships.Connect with Jordan:WebsiteNon-Profit - The Good IRSBookConnect w. Holly FinucanJoin Holly's Community Instagram FacebookEnjoying the show? Please leave a review here, and post a screenshot of you listening on your social platform. Don't forget to tag us, @finucanholly.Music: https://www.bensound.com

This is a bonus podcast where I simply talk about the book, The Mountain Leader - a practical manual. How the book came about, what it covers, who it's aimed at and much more. Just a bit of insight for you really.

There are many ways to track your stats these days, and golfers can get a little confused with all the available data. In this episode, Jon and Adam explore multiple ways to track your stats, what to pay attention to, and most importantly - how to answer the question of "why?" With the holiday season approaching, both of our books make great gifts and are a way to help support The Sweet Spot. You can purchase them both on Amazon using the links below: The Practical Manual by Adam Young The Four Foundations of Golf by Jon Sherman Thank you to our show sponsors: Take your mental game to the next level with the #1 app, Imagine Golf. With over 500,000 downloads and 10,000 5-star reviews, their 3-minute audio lessons can take your game to the next level. Download the app and get your free 7-day trial with no strings attached by searching Imagine Golf on the app store or Google Play. You can learn more on their website here. • Tanasi CBD is a university-developed formula of CBD+CBDa, and 2x better than CBD alone. Their full range of products allows you to find the right formula for you. Achieve calm, soothe aches and pains, and rest more effectively. Go to tanasi.com and enter promo code sweetspot for 50% off your first order. Learn more about your ad choices. Visit megaphone.fm/adchoices

Another episode of the Independent Thinking Show for @FifthWrist Radio. This is a place dedicate to showcasing the great people doing interesting and cool things in the world of horology. In this episode, hosts Roman (@TimesRomanAU) and Adam (@mediumwatch) sit down for a chat with the ever fascinating Brittany Nicole Cox (@nicocurio) - an antiquarian horologist, conservator and educator specialising in the preservation and restoration of automata, mechanical magic, mechanical music, engine turning and complicated clocks and watches. Join us as for a wide-ranging conversation about antiquarian horology, automata, stewardship, preservation and restoration of historically-important mechanical objects, museums to visit; as well as Brittany's passion for learning and teaching engine turning and other mechanical crafts. Make sure you also check out Brittany's website for commissions and bespoke handmade items available for the discerning collector. It was an absolute pleasure and a privilege to speak with Brittany on FWR. Brittany's work can be seen at @memoria_technica and @nicocurio and www.mechanicalcurios.com The book I mention on the podcast is called: "The Feather Thief" by Kirk Wallace Johnson (see episode of This American Life podcast about it here). Calina Shevlin's book: "Guilloche: A History and Practical Manual" can be found here. Also check out Calina's work @atelierguilloche Make sure you check out Brittany's presentation for the Horological Society of New York, and her role in the recently released "Keeper of Time" Film. The Quill & Pad article about Brittany's own automaton "Cochlea" can be found here. Recommendations from this episode: Brittany - @sk_mechanician and @ludovicballouard Adam - @itsbeenalangeday Roman - Annette Beyer Automata Collection New Theme Music for 2022: The Wrong Time by Silent Partner (via YouTube Free Music Channel) Follow us on Instagram: @FifthWrist To join our crew group chat then please email us at contact@fifthwrist.com and if you have time please leave us a review wherever you listen to our podcast. We hope you enjoy listening to this episode as much as we enjoyed making it! Stay On Time

Practical Manual for Job Hunters and Career Changers Part 3

Practical Manual for Job Hunters and Career Changers

Welcome to another episode of Develomentor. Today's guest is Peter Mckee.Peter McKee is the Head of Developer Relations and Advocacy at Docker and maintainer of the open source project Ronin.js. Originally from Pittsburgh, PA but currently residing in Austin, TX, Peter built his career developing full-stack applications for over 25 years. He has held multiple roles but enjoys teaching and mentoring the most. When he’s not slapping away at the keyboard, you can find him practicing Spanish and hanging out with his wife and seven children.If you are enjoying our content please leave us a rating and review or consider supporting usA note from GrantPeter Mckee is currently a developer relations manager for Docker, the de facto standard in software containers, but his career has taken a number of turns throughout the years. After working on a comp sci degree from Point Park College and then leaving early, Peter has held down a variety of roles in the tech industry including programmer, software architect, principal engineer, front end engineer, director of technology, and senior software engineering manager. Over the years, Peter has worked for the likes of Dell, Perficient, MarketVine, SuperNaut and ClickVine. He’s even co-founded his own company, Checkmate Technologies and served as their Chief Marketing Officer. Quotes“Folks coming out of boot camps or learning on your own, you’re writing a lot of things from scratch. In the real world, you don’t do that a whole lot. That’s rare, especially in larger companies. So I learned how to read code, how to understand code and how to hold a lot of information in my head.”“What really drives me now is mentoring and teaching. I love research, I love to build things. I’m a great starter but not a great finisher. But I found that I could explain technical things to lay people and to more junior technologists and even to senior technologists.”“I do about 5 or 6 people at a time and take them through about an 8 month program. I can tell you what to do, but having someone there alongside you and mentor you will 10X your development.”—Peter McKeeAdditional ResourcesLearn more about Peter’s mentoring – https://codingadventures.io/Books:Please Understand Me: Character and Temperament Types – by David Keirsey & Marilyn BatesWhat Color Is Your Parachute? 2019: A Practical Manual for Job-Hunters and Career-Changers – by Richard N. BollesAdditional ResourcesYou can find more resources in the show notesTo learn more about our podcast go to https://develomentor.com/To listen to previous episodes go to https://develomentor.com/blog/Connect with Peter McKeeLinkedInTwitterConnect with Grant IngersollLinkedInTwitterSupport the show (https://www.patreon.com/develomentor)

In today's episode I speak with Tricia Nelson, Partner at EY and head of their 300 person strong People Consulting Business. This is an interview that's been almost two years in the making and I'm pleased to say, it was certainly worth the wait. When you hear about a senior leader like Trish, in one of the world's biggest consulting businesses, it's easy to think they've followed the traditional consulting career path. Went to a good university, got on the right grad scheme and made the right moves to climb the ladder from there. But as you'll hear in today's interview, Trish's story has been anything but. In today's episode we dig into Trish's story and discuss the hugely important topic of diversity. An area that Trish is extremely passionate about having seen first-hand many of the challenges that underrepresented groups face in climbing the career ladder in our industry. In this episode, we go deep into the topic of diversity and inclusion and cover some really important and impactful areas, many of which I've not covered with any guest before, including: - The challenges for young people right now and Trish's own experiences of building a career having left school at 18 and not going to university at a time when this wasn't the done thing. - The challenges that our industry faces when it comes to diversity and what consulting leaders like you can and should be doing to help increase awareness and accessibility of consulting as a career and supporting those from underrepresented groups to thrive within the industry. - And the unseen diversity impacts of the Covid-19 pandemic and the hidden challenges that the new ‘remote working world' creates that consulting firms need to think about. In an industry that is still largely dominated by white men, Trish is both a fantastic role model and a true champion for those underrepresented in our industry. Whether you're a woman who's looking for advice and guidance on how to climb within the industry or you're one of the privileged many – white men like myself – that want to know what you can do to help those in your team to thrive, you're going to love this episode. You can get in touch with Tricia at - https://www.linkedin.com/in/tricia-nelson-826a8212/ And visit EY at - https://www.ey.com/en_gl Specific things we discuss in the show: Beyond the Boys' Club: Achieving Career Success as a Woman Working in a Male Dominated Field - https://amzn.to/2Sb4S73 Lean In: Women, Work, and the Will to Lead - https://amzn.to/2EIF7rF How Remarkable Women Lead: The Breakthrough Model for Work and Life - https://amzn.to/30fu94i The 100-Year Life: Living and Working in an Age of Longevity - https://amzn.to/2EIdb77 What Color Is Your Parachute? 2020: A Practical Manual for Job-Hunters and Career-Changers - https://amzn.to/3jdtMyx Invisible Women: Exposing Data Bias in a World Designed for Men - https://amzn.to/33gMHDf

In this episode, I talk about the steps to take to build a skills inventory. I'll cover some of the resources that we spoke about in Episode 17 as well as the specific approach for creating your skills inventory. We'll also talk about why having a skills inventory is important and how you can use it to support your career and learning journeys.Key TakeawaysBroadly, skills can be grouped as transferable skills (what you can do), special knowledge (what you know), and self-management skills (how you conduct yourself) Transferable skills are the most important and these are skills like constructing, creating, researching, analysing, teaching, organising, repairing, initiating, networking, communicating, planningSpecial knowledge is skills like physics, graphic design, bookkeeping, mathematics, data analysis, French, and psychologySelf-management skills are skills like being adaptable, self-confident, dependable, supportive, loyal, persistent, innovative, and resourcefulThe more transferable skills you have, the more choice you will have when it comes to jobs and careersTransferable skills can be further broken down into people skills, information or data skills, and skills working with thingsIdentify and describe seven stories that are significant to you. These can cover both your career and personal life. Typical things might be something that stood out in your life, publicly displaying your skills, a really good outcome, something that gave you pride or was a particular challenge, something that your colleagues or peers could not do, something that you would like to do or experience again, something that excited you Matching skills to these stories will provide you with a skills inventory, highlighting your strongest skills and also any gapsUse this inventory to compare against still that are in demandResources MentionedI used the following resources in this episode:The OECD Skills for Jobs websiteThe OECD Skills Needs websiteRecommended ReadingI used and recommend reading What Colour Is Your Parachute? 2020: A Practical Manual for Job-Hunters and Career-Changers by Richard N. Bolles Support the show (https://www.buymeacoffee.com/gunterrichter)

What if You Hate Your Cleaning Job? The energy you put is contagious like a virus. Here's some ways you can cope at work when the cleaning job is frustrating. Everyone gets the "I hate my job" bug when a job gets repetitive or boring, it's normal! But, when you can't stand working for your cleaning company, how you act is important. Attitude is everything, it's time to release negative energy and change your outlook. Today's #AskaHouseCleaner sponsors are Savvy Cleaner Training. A training program for professional house cleaners, cleaning business owners, and maids #SavvyCleaner #AngelaBrown *** RATE THIS SHOW *** https://sotellus.com/r/savvy-cleaner *** RATE THIS PODCAST *** https://ratethispodcast.com/askahousecleaner *** FAST TRACK TO CLEANING SUCCESS *** https://SavvyCleaner.com/Calendar-of-Courses *** MOST REQUESTED LIST OF CLEANING STUFF I USE *** https://www.Amazon.com/shop/AngelaBrown *** MORE VIDEOS ON THIS TOPIC *** How to Stay Positive When You Hate Your Job - Live on Purpose TV - https://youtu.be/tf3bqGPsK_o 10 Ways to Feel Happier at Work - Vanessa Van Edwards - https://youtu.be/TJz60uUH8uE The happy secret to better work | Shawn Achor - TED - https://youtu.be/fLJsdqxnZb0 Should You QUIT Your Job? - The Most Life Changing Speech Ever - The Outcome - https://youtu.be/SZEo1KFjTn4 Attitudes are Contagious - Katherine Lee - https://youtu.be/Q7kBoyXR0cc *** GOOD KARMA RESOURCES FROM THIS EPISODE *** These good karma links connect you to Amazon.com and affiliated sites that offer products or services that relate to today’s show. When you click on the links and buy the items you pay the exact same prices or less than if you found the links on your own elsewhere. The difference is that we make a small commission here at the show for sharing these links with you. Happiness at Work: Be Resilient, Motivated, and Successful - No Matter What - https://amzn.to/2XyobdU How to Be Happy at Work: The Power of Purpose, Hope, and Friendship - https://amzn.to/2A17COS How to Quit Your Day Job and Live Out Your Dreams: Do What You Love for Money - https://amzn.to/2XvnwtC What Color Is Your Parachute? 2020: A Practical Manual for Job-Hunters and Career-Changers - https://amzn.to/370F6sy Attitude Reconstruction: A Blueprint for Building a Better Life - https://amzn.to/2MvWvAe *** CONNECT WITH ANGELA ON SOCIAL MEDIA *** LinkedIn: https://www.linkedin.com/in/savvycleaner/ Facebook: https://Facebook.com/SavvyCleaner Twitter: https://Twitter.com/SavvyCleane Instagram: https://Instagram.com/SavvyCleaner Pinterest: https://Pinterest.com/SavvyCleaner *** GOT A QUESTION FOR A SHOW? *** Email it to Angela[at]AskaHouseCleaner.com Voice Mail: Click on the blue button at https://askahousecleaner.com *** FREE EBOOK – HOW TO START YOUR OWN HOUSE CLEANING COMPANY *** http://amzn.to/2xUAF3Z *** PROFESSIONAL HOUSE CLEANERS PRIVATE FACEBOOK GROUP *** https://www.facebook.com/groups/ProfessionalHouseCleaners/ *** VRBO AIRBNB CLEANING FACEBOOK GROUP *** https://www.facebook.com/groups/VRBO.Airbnb.Cleaning/ *** LOOKING FOR WAY TO GET MORE CLEANING LEADS *** https://housecleaning360.com *** WHAT IS ASK A HOUSE CLEANER? *** Ask a House Cleaner is a daily show where you get to ask your house cleaning questions and we provide answers. Learn how to clean. How to start a cleaning business. Marketing and advertising tips for your cleaning service. How to find top quality house cleaners, housekeepers, and maids. Employee motivation tactics. Strategies to boost your cleaning clientele. And cleaning company expansion help. Our host, Angela Brown, ran and managed one of the largest independently owned cleaning companies in the Southeast for 25-years. She’s the CEO, and founder of Savvy Cleaner Training for House Cleaners and Maids. *** SPONSORSHIPS & BRANDS *** We do work with sponsors and brands. If you are interested in working with us and you have a product or service that is cohesive to the cleaning industry read this: https://savvycleaner.com/product-review *** THIS SHOW WAS SPONSORED BY *** SAVVY CLEANER - House Cleaner Training and Certification – https://savvycleaner.com MY CLEANING CONNECTION – Your hub for all things cleaning – https://mycleaningconnection.com SAVVY PERKS – Employee Benefits for Small Business Owners – https://savvyperks.com VRBO AIRBNB CLEANING – Cleaning tips and strategies for your short-term rental https://TurnoverCleaningTips.com *** VIDEO CREDITS *** VIDEO/AUDIO EDITING: Kristin O https://savvycleaner.com/reviews/kristin-o POST PRODUCTION: Amber O https://savvycleaner.com/reviews/amber-o HOST: Angela Brown https://savvycleaner.com/reviews/angela-brown PRODUCER: Savvy Cleaner https://savvycleaner.com

Is perfectionism getting in the way of your life? Are you facing the idea of a career shift? In this episode, I am joined by Julian Reeve, a speaker, coach and motivator for people going through career transitions. Right now, many people are facing career changes so I thought you'd really enjoy Julian's take on how to navigate transition with ease. We chat about his experience of going from being a Music Director for HAMILTON to what he does now. Julian shares his experience with perfectionism and how to get back to your real, authentic self. He also dives into letting go of the pressures of society and the world. About Julian Reeve: Critically acclaimed for his work as the Music Director on the 1st U.S National Tour of the Broadway musical HAMILTON, Julian Reeve has enjoyed a successful career in music, business, and education. Born and educated in Cambridge, England, he has toured the world with over twenty-five theatrical productions, whilst remaining dedicated to his work as an educator in the U.S, Europe and Japan. Outside of music, he has founded three businesses in the creative sector, including the boutique talent agency ‘Boland & Reeve' in London's West End and The Elev8 Workshop Series in Los Angeles. Julian experienced a major life change in early 2019, having to quit his career as a performer due to injury. He now works as a speaker, coach, and motivator, helping people facing career change find clarity in their situations through coaching and workshops. He is also a regular speaker on the keynote circuit, with talks across numerous subjects including Perfectionism, which was also the focus of his TEDx Talk released earlier this year. Connect with Julian: Website | Instagram What You'll Hear: 2:11 Who Julian is and why he's an expert in transition 8:08 The moment he realized he had to quit due to his injury 11:32 How everyone experiences transition differently based on their life experience 14:22 Making decisions that don't take you away from your true authenticity 16:13 When he realized that it was real and he was leaving HAMILTON 21:21 His advice for people in the inquiry of what they might want to do 26:37 Why your destination needs to be true before moving to the next level 30:29 How to get to real authenticity 34:17 Why it's okay to not know what you want to do 37:25 The dilemma he faced when he had a heart attack and how this made him realize his relationship with perfectionism 42:14 His experience of recovering from perfectionism 44:18 How perfectionism is bringing people to you 51:50 Julian's definition of uncivilized Links: What Color Is Your Parachute? 2020: A Practical Manual for Job-Hunters and Career-Changers Reframing Perfectionism TEDx Talk If you look at the civilized work and think, “no thank you,” then you should subscribe to our podcast so you don't miss a single episode! Also, join the uncivilized community and connect with me on my website, Facebook or Instagram so you can join in on our live recordings, ask questions to guests and more.

Debra was a delight to talk to. She is an author, professional speaker and marketer extraordinaire. She is not afraid to go after what she wants in life and is doing what she loves. We spoke to her about her career and how she got there. We also had fun learning about Debra’s disco dancing past. She is a true disco diva and we love it! She definitely knows all about the hustle on and off the dance floor. Show Notes:Badass Woman of The Week: https://en.wikipedia.org/wiki/Nellie_Blyhttps://www.newyorker.com/books/page-turner/nellie-blys-lessons-in-writing-what-you-want-toPurchase Debra's Book!Millionaire Marketing on a Shoestring BudgetGuest Promotional Links/Information:https://debrajason.com/https://writedirection.com/https://worldsingingday.org/events/boulder-usa/http://facevocalband.com/https://www.toastmasters.org/What Color Is Your Parachute? 2020: A Practical Manual for Job-Hunters and Career-Changers:https://amzn.to/37l7g0k

About this Episode Army veteran Anthony Detoto from 1836 Veterans talks about networking and creating collisions with veterans and veteran business owners.  Texas veterans chase their entrepreneurial dreams. The group casts a wide net and will soon hear pitches in Houston, Dallas, San Antonio and Austin, but it is careful about whom they back. When they invest, though, the commitment is total. Key Points of Discussion with Anthony DeToto Anthony’s transition from the Army to a civilian job Significance of jobs in the Army and as a civilian Lessons Learned Networking Family Offices How do veterans self assess? Key Milestones of this Episode [01:11] Anthony’s introduction [03:12] Going to school at West Point [06:24] How Anthony transitioned from the military to civilian sector [07:43] Those who helped along the way [10:37] Naive Networking [15:50] Self Assess [24:59] What is your value proposition? Key Resources 1836 Veterans What Color Is Your Parachute? 2020: A Practical Manual for Job-Hunters and Career-Changers by Richard N. Bolles  Key Quotes by Anthony Detoto “We always feel like we’re not good enough for that threshold.” “So many of the civilian jobs are not going to make you feel as significant as the jobs in the Army.” “I wanted to touch a wider swab of people sooner.” “All I could do is promise them that I would help others that were in a similar position.” “1836 is a beachhead to help veterans find capital in all four of those different forms.” “If you want to get paid ask for money, if you want to get paid twice ask for advice.” “A veteran is a person who has written a check at least once in their life payable to the United States of America.” About our Guest Anthony Detoto Anthony Detoto is Servant Leader, helping military veterans decide on entrepreneurship or intraprenuership.  As with all things military-related, DeToto built 1836’s operations plan around an acronym: FISH, for the four types of capital every entrepreneur needs. F is for financial. Funding can come in two primary forms, debt or equity. Should the business take on debt, and from where? Should the entrepreneur sell a share in the company, and to whom? I is for intellectual. Every company is built around a product or service. But in a competitive market, new ideas are what make a company prosper or fail. S is for social. Does the founder have the connections to get the business off the ground? Where are the customers, who are the advisers, and from where will the money come? H is for human. Most businesses need more than one employee. Who is going to help run the business?  About Our Sponsor Bench Bookkeeping is this episodes sponsor.  Being an entrepreneur, bookkeeping is a necessary evil.  To put your bookkeeping needs on autopilot check out Bench Bookkeeping and get one month free at veteranonthemove.com/bench. To hear more about Anthony’s success, download this episode now. Don’t forget to leave us a 5-star rating and review if you enjoyed the show. We would love to hear from you! Download Joe Crane’s Top 7 Paths to Freedom or get it on your mobile device. Text VETERAN to 38470.   Join the Veteran on the Move on Facebook! Check out Veteran on the Move on Facebook to connect with our guests! It’s a great place where you can stay in touch with other veterans who are transitioning to entrepreneurship.  Get updates and free gouge on the people, programs and resources to help you in your transition to entrepreneurship. Veteran On the Move podcast has published over 250 episodes. Our listeners have the opportunity to hear in-depth interviews conducted by host Joe Crane . The podcast features people, programs and resources to assist veterans in their transition to entrepreneurship.  As a result, Veteran On the Move has over 1,000,000 verified downloads through Stitcher Radio, SoundCloud, iTunes and RSS Feed Syndication making it one of th...

In this episode: You will get clear on why it's important to build a brand, how to build a quality reputation, and what you need to being doing to build a unique personal brand that attracts opportunity tailored towards your values and beliefs. If you are an Ambitious VET who can't ever shit it off, look I get it, Dan does a great job in explaining how he balances work with what really matters in his life and manages to even leverage experiences to create more brand equity.    "Don't go to the grave with that music still inside of you. You gotta let it out!" -Dan Evans  Once the show begins: 0-5:00 Minutes: How he found direction and began to build a reputation after 13 years of Military Service 5:00-11:00 Minutes: The small investments he made that paid off as life threw him challenges  11- 17:40 Minutes: Dan, leveraging technology to solve organizations problems  17:40- 23:07 Minutes: What to do when you are dealing with the unknowns of life's transitions  23:07- 29:27 Minutes: What he does to prevent burn out and keep life balance while still building brand equity  29:27- 32:00 Minutes: What Dan wants to be known for in life    32:00- END: Dan's three Golden Grenades and how to implement them right now in your life  Connect with Dan here: Website: https://www.danevansonline.com  Linkedin: https://www.linkedin.com/in/danjevans/  Facebook: https://www.facebook.com/evans.daniel.ja  Instagram: https://www.instagram.com/evansdanielj/   Book Dan referenced: "What Color Is Your Parachute? 2019: A Practical Manual for Job-Hunters and Career-Changers: Click the link to view: https://amzn.to/2XwygsK  To take advantage of the FREE 30 minute "Sniper Focus Strategy Execution" call with me to empower you to execute on that next fulfilling mission in life, click here: I am ready to WIN    

When promised an "intimate relationship with God", many of us are left either disappointed or wondering what is missing to bring about that experience. This sermon explores two essential elements for drawing near to God. Watch this and other messages in video at www.islandecc.hk/messages.

We all have people in our lives that drive us crazy. Their control and criticism can ruin our day, or worse, distract us from the joyful life God has called us to. This sermon shares biblical wisdom on how to address these people in our lives. Watch this and other messages in video at www.islandecc.hk/messages.

We all have people in our lives that drive us crazy. Their control and criticism can ruin our day, or worse, distract us from the joyful life God has called us to. This sermon shares biblical wisdom on how to address these people in our lives. Watch this and other messages in video at www.islandecc.hk/messages.

God does not expect you to live in your own strength. He knows you need His Strength.Psalm 37 offers a Practical Manual for Life Discover to help you align your life with God's plan and live joyfully.Psalm 37 is a powerful and practical manual for life. Within its first eight verses are rich insights for finding joy and ridding yourself of negative thinking.Psalms 37:1 – Don't worry about the wicked or envy those who do wrong. Psalms 37:2 – for like grass, they soon fade away. Like spring flowers, they soon wither. The Bible states: But, beloved, do not forget this one thing, that with the Lord one day is as a thousand years, and a thousand years as one day. The Lord is not slack concerning His promise, as some count slackness, but is longsuffering toward us, not willing that any should perish but that all should come to repentance. (2 Peter 3:8-9)“For all flesh (mankind) is like grass, and all its glory (honor) like [the] flower of grass. The grass withers and the flower drops off, But the Word of the Lord (divine instruction, the Gospel) endures forever. And this Word is the good news which was preached to you. [Isa. 40:6-9, 1 Peter 1:24-25Trust in the Lord rely on, and be confident in Him and do good. Then you will live safely in the land and prosper. Feed surely on His faithfulness, and truly you shall be fed. (Psalm 37:3)Rather than becoming incensed because of the wicked, it is far better to look beyond the present circumstances by trusting in God and continuing to do good. By this means the righteous are assured security and sustenance. For God is not unrighteous to forget your work and labour of love, which ye have shewed toward his name . . . ” (Heb. 6:10). When you trust in the Lord, His promise is to give what one longs for-the desires of the heart. Elsewhere we are admonished: “Trust in the LORD with all thine heart; and lean not unto thine own understanding” (Prov. 3:5). Trusting in our own understanding can lead to irreparable damage to ourselves and others. Trusting in the Lord is emphasized in Jeremiah 17:7-8:Most blessed is the man who believes in, trusts in, and relies on the Lord, and whose hope and confidence the Lord is. For he shall be like a tree planted by the waters that spreads out its roots by the river; and it shall not see and fear when heat comes; but its leaf shall be green. It shall not be anxious and full of care in the year of drought, nor shall it cease yielding fruit. (Jeremiah 17:7-8)Take delight in the Lord, and he will give you your heart's desires and secret petitions of your heart. (Psalm 37:4)Commit everything you do to the Lord, roll each care of your load on Him, Trust him, and he will help you. and He will bring it to pass. (Psalm 37:5)The counsel here is that one should rely on God to carry life's burdens, as the word “way” means to “roll your way upon the Lord.” The meaning is to remove the burdens from our shoulders and place them upon the shoulders of God. God should be relied upon for whatever one undertakes in life. “Humble yourselves therefore under the mighty hand of God, that he may exalt you in due time: Casting all your care upon him; for he careth for you” (1 Pet. 5:6-7). What is the promise if one does this? “Cast thy burden upon the LORD, and he shall sustain thee: he shall never suffer the righteous to be moved” (Ps. 55:22). “And he shall bring forth thy righteousness as the light, and thy judgment as the noonday” (Ps. 37:6).He will make your innocence radiate like the dawn, and the justice of your cause will shine like the noonday sun. He will make your uprightness and right standing with God go forth as the light, and your justice and right as the shining sun of the noonday. (Psalm 37:6)Be still in the Presence of the Lord, and wait patiently for him to act. Don't worry about evil people who prosper or fret about their wicked schemes. Be still and rest in the Lord; wait for Him and patiently lean yourself upon Him; fret not yourself because of him who prospers in his way, because of the man who brings wicked devices to pass. (Psalm 37:7)Stop being angry! Turn from your rage! Do not lose your temper— it only leads to harm. Cease from anger and forsake wrath; fret not yourself–it (Psalm 37:8 )For the wicked will be destroyed, but those who trust in the Lord will possess the land. (Psalms 37:1-9)To summarize1. Trust in the Lord (verse 3).Whatever bothers you, trust God to be able to handle it better than you can.2. Do good (verse 3).Life is about choices. Know that God will honor you when you do the right thing.3. Delight yourself in the Lord (verse 4).Fall in love with Jesus. Take time every day to sit quietly in his presence. Learn to delight in him.4. Commit your way to the Lord (verse 5).Trust all you do, every day, all your life, to God; he is able to handle it best.5. Be still before the Lord and wait patiently for him (verse 7). This does not mean to do nothing. Rather, it means that after you have done all you can, you should relax in the knowledge that God will take care of the rest.

Most of us will spend more hours each day with our colleagues than with our family and friends. And yet, recent studies show 32% of people are unhappy at work. We will look at how our faith can lead us to be more fulfilled at work and experience a greater level of satisfaction. Watch this and other messages in video at www.islandecc.hk/messages.

This message is the third in a five-week series on relational health. It focuses on family relationships, which are shown to be both dynamic and imperfect. The message contains practical help for any family. Watch this and other messages in video at www.islandecc.hk/messages.

True friendship is a tremendous blessing. We need people in our lives to walk with us and support us through good times and bad. In this sermon, we will look at how the Gospel encourages real friendship. Watch this and other messages in video at www.islandecc.hk/messages.

This message begins a five-week series on relationships. It lays out a theological foundation for the series, and gives practical help for how you can relate to yourself. Watch this and other messages in video at www.islandecc.hk/messages.

Everyone’s journey to becoming an impact maker is different and unique. Today, Jennifer talks with business coach Ben Brooks, the founder and CEO of Pilot, Inc about his path from a rental car company to founding his own digital coaching service, aimed at democratizing career coaching. Ben provides some insights into how he has forged great relationships, created innovative products and built up award-winning initiatives throughout his career. Ben is an impact maker through and through. Jennifer asked Ben about where his journey started and the key moments of his life that led him to where he is today. Ben talks about his “life statement” and his early formative days after graduating from university working at Enterprise Rent-a-Car and Lockheed Martin. Ben delivers some takeaways from what he learned during these years and his mantra for approaching new problems. Whether its fate, destiny or just plain chance, inspiration can arrive at the most unexpected times. Ben talks about how working job at Oliver Wyman as a management consultant all started from reading a quote in USA Today on a flight home. After sending off a meticulously written letter, an ambitious slide deck, and a Singapore Airlines A380 model airplane to the right person, followed by a series of interviews and flights to and fro, Ben received an offer to start the next leg of his journey. Sometimes a bold and targeted approach to getting noticed can be incredibly successful. Ben tells Jennifer his thoughts on the merits of an aggressive approach to getting your dream job and why within the context of modern click-to-apply recruiting technologies, makings a memorable impact is more important than ever. Even in a recession Ben is a force to be reckoned with. During his time off from Oliver Wyman, Ben turned down a job driving a tractor in West Texas – found by his very endearing parents, and saw an opportunity for a rotation at Wyman’s parent company Marsh & McLennan Companies, Inc. Ben tells the story of how he ended up as there in talent management and some of his duties in his new role. For example, Ben created a succession risk index chart that had top-level executives sweating bullets. Management consulting is an incredibly diverse field; you never know what project, industry, or region you’ll find yourself immersed in. Ben relays some of the greatest challenges and hurdles he’s had to overcome and focuses on some of the key concepts, tools and frameworks he uses to deliver results. He also tells the story of how he got his job at Marsh LLC (insurance). While taking some time off, the entrepreneurial call found Ben Brooks in the form of a mislabeled nametag at a conference. Ben reached what he calls his fork in the road and decided to take entrepreneurship seriously. After getting some advice from some successful people in his life, Ben started building out a diverse coaching business using his problem solving skills from his management consulting background. With the ambitious idea of democratizing coaching, Ben founded Pilot, Inc. with his life savings. While at first they focused on individual sales, Ben’s team now strives to help employers and companies cultivate and retain the best talent they have. Democratized coaching? Sounds too good to be true! Jennifer asks Ben how exactly Pilot works and why it’s so effortless. Satisfaction in your career – and your life – is unique to you. Jennifer and Ben talk about some of central drives behind Pilot and the larger questions that Ben considers instrumental in finding your own definition of satisfaction. We know all about the journey of Ben Brooks but what does satisfaction look like for him? Jennifer asks Ben to shine the light on himself and talk about what drives him as an impact maker. Ben shares some stories about how Pilot has changed people’s lives for the better. In the workplace, LGBTQIA individuals face adversity in all sorts of different ways. Ben talks about his experience navigating his career path as a gay man and the beginning of his trailblazing diversity and HR efforts at Oliver Wyman that have won various industry awards. He also talks about his contributions towards repealing the military’s Don’t Ask, Don’t Tell policy and the potential for creating change by taking a risk and leveraging your identity while in key positions. Ben’s secret? Meditation. Ben gives Jennifer a peek into how he prioritizes self-awareness and being present so that when the wrong nametag comes along, he’s ready to step into the role that’s truly right for him. Find Ben Brooks: Pilot, Inc.  Ben Brooks LinkedIn   Ben Brooks Twitter Great Read: What Color Is Your Parachute? 2017: A Practical Manual for Job-Hunters and Career-Changers  Give us a hand getting the word out! Do you want to spend your personal and professional time making a lasting impact on others? Do you want to be the kind of leader people love? Subscribe today and we will bring you new ways to change the world every single week. Want to raise your game at work? If you want to raise your game at work, you’ve got to raise your impact. Find out Jennifer’s 10 best strategies to make more of an impact at work.

Hire me! I want to be a house cleaner. Hire me because I want to work for a cleaning company. Where do I find a cleaning company who will hire me? Truth is not every house cleaner, housekeeper or maid is cut out to be a business owner. Some are content to just show up and do the work. Today on Ask a House Cleaner we dig into house cleaner training. Learn tips on landing a job with a house cleaning company. Angela Brown, The House Cleaning Guru will show you how you can be a savvy cleaner to get the job of your dreams. THIS SHOW WAS SPONSORED BY SAVVY CLEANER - House Cleaner Training and Certification. COMPLETE SHOW NOTES for this episode found at https://askahousecleaner.com/hire-me RESOURCES FROM THIS EPISODE: How To Find A Job: When There Are No Jobs - http://amzn.to/2fueA1r What Color Is Your Parachute? 2017: A Practical Manual for Job-Hunters and Career-Changers - http://amzn.to/2x9IeRd How To Get A Job In 30 Days Or Less - Discover Insider Hiring Secrets On Applying & Interviewing For Any Job And Job Getting Tips & Strategies To Find The Job You Desire - http://amzn.to/2wA0dyo How to Answer Interview Questions: 101 Tough Interview Questions - http://amzn.to/2jCtlnn How to Get Any Job, Second Edition: Career Launch and Re-Launch for Everyone Under 30 - http://amzn.to/2jEvoHF The Interview Expert: How to get the job you want - http://amzn.to/2xe7Aih 15 Minutes to a Better Interview: What I Wish EVERY Job Candidate Knew - http://amzn.to/2xedC2l How To Ace Your Phone Interview - http://amzn.to/2yj1fAH eTopic: How to Ask For a Raise - http://amzn.to/2ftapCU Think And Grow Rich - http://amzn.to/2jAW7EW DID YOU KNOW YOU CAN WATCH THIS EPISODE ON YOUTUBE? https://youtu.be/betDE0XtQd4 GOT A QUESTION for the show? There is a microphone at http://askahousecleaner.com/show click on the blue button and record. HOUSE CLEANING TIPS VAULT (VIP Premium Tips – Free) https://savvycleaner.com/tips FOLLOW SAVVY CLEANER FOR TIPS AND TRAINING ON SOCIAL MEDIA https://Facebook.com/SavvyCleaner https://Twitter.com/SavvyCleaner https://Instagram.com/SavvyCleaner https://Pinterest.com/SavvyCleaner https://Linkedin.com/in/SavvyCleaner Ask a House Cleaner is a daily show where you get to ask your house cleaning questions and we provide answers. Learn how to clean and what chemicals to use on various surfaces. Learn the fastest way to start a cleaning business as well as marketing and advertising tips to grow your cleaning service. Ever wonder how to find top quality house cleaners, housekeepers, and maids? We’ve got you covered from recruiting to employee motivation and retention tactics. Discover strategies to boost your cleaning clientele and how to provide outstanding customer service. And we’ve got time-saving hacks for DIY home cleaners and more. Hosted by Angela Brown, 25-year house cleaning expert and founder of Savvy Cleaner Training for House Cleaners and Maids. DISCLAIMER: During the shows we recommend services, sites, and products to help you improve your cleaning and grow your cleaning business. We have partnerships or sponsorships with these companies to provide you with discounts, and savings. By clicking on and buying from these links we may receive a commission which helps pay for the production costs of the show. Support the show so we can continue to bring you free tips and strategies to improve your cleaning and help you grow your cleaning business. THANK YOU! SPONSORSHIPS & BRANDS: We do work with sponsors and brands. If you are interested in working with us and you have a product or service that is cohesive to the cleaning industry reach out to our promotional department info[at]AskaHouseCleaner.com

LearnChair Radio host Bob Dragone takes a look at leadership in the arts in this interview with up and coming metals artist Calina Shevlin.  Callie is an expert in the art of guilloche, a technique used to engrave the elaborate and delicate patterns found on top end Swiss watches Faberge eggs, and increasingly in fine jewelry.  She is one of only 27 artists in the world who have mastered the machines and methods used to produce the guilloche patterns.  Recently, Callie published a book, Guilloche, A History and Practical Manual by Schiffer Publishers. This is the most comprehensive text on the art of guilloche ever published and will certainly be the defining publication on the topic for years to come.  In the interview Callie explains how she first became interested in guilloche and her search to find a mentor to teach her the techniques.  After a time working for Swiss watch companies she has now established her own business to further the art of guilloche in own creative manner.  Callie’s talent, perseverance and creativity are a lesson in leadership for those who have a vision and wish to establish themselves in whatever field they choose to pursue. 

Arthur Findlay College tutor, Matthew Smith has been working with the Spirit for over 30 years, and teaches mediumship at various organisations around the world. He is the perfect guest to celebrate our 100th episode of www.wedontdieradio.com Matthew is a member of The Spiritualists' National Union and holds various awards in Speaking, Demonstrating, Administration, and has been granted the appointment as a Minister of The Spiritualists' National Union. Matthews approach to the subject matter is direct, at times tinged with humour but the techniques uses in his training will help you understand the truth in your own potential and abilities which are your birthright. Matthew is the author of the book “Entrancement - A Theoretical and Practical Manual” and two CD's - “Embracing the Spirit” and “Spirit Communication” He gives demonstrations of survival publicly and privately. He tutors students all over the world on mediumship via Skype. Matthew Smith also holds workshops on how we can develop our own mediumship.   This coming August, 2016, Matthew will be in the Unites States giving a 5 day workshop in Wisconsin….for anyone interested in learning mediumship or anyone who wishes to deepen their skills please visit: http://bit.ly/1UfknYW Visit the website of the Arthur Findlay College at: http://arthurfindlaycollege.org/ Minister Matthew Smith's website is: http://www.matthewinspires.co.uk/ "Life is indeed eternal and as we progress through this life we are indeed preparing and creating our own Heaven or Hell as we walk the physical path. This applies to everyone for we are all Spirit NOW."  - Minister Matthew Smith

Show Summary In this episode, Leslie shares his story about the vow we made early on in our relationship, and how losing sight of it in his professional life cost him. Laura chimes in with her own perspective during that time. Show Resources Haywire Consulting, the new thing Leslie cofounded that launched this week! Bowen’s Differentiation of the Self What Color Is Your Parachute? 2015: A Practical Manual for Job-Hunters and Career-Changers (affiliate link) EllisLab Penelope Trunk My Kingdom Come (Megadeth song Leslie referenced. It’s metal. It’s loud.Youhave been warned.) “I never knew how empty my soul was until it was refilled.” Show Transcript Download the transcript here. Support Glimmering Podcast

G8 summit calls for greater transparency with tax authorities -- OECD provides update on BEPS project -- House Ways and Means Committee hearing highlights MNCs’ use of tax havens -- Senate Finance Committee Chairman supports “clean” federal debt ceiling increase -- IRS expands automated Form 5471 penalty program to Form 5472 -- IRS retroactively applies Notice 2012-39 to outbound F reorganization -- US-Brazil TIEA is effective -- US, Japan sign FACTA “statement” -- UN launches Practical Manual on Transfer Pricing for Developing Countries

United Nations launches Practical Manual on Transfer Pricing for Developing Countries