Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky

May 15, 2025

Join Dr. Spencer Nadolsky, an obesity specialist and lipidologist, as he uncovers the truth about GLP-1 medications and their impact on metabolic health. He explains obesity as a chronic disease and discusses the real benefits of GLP-1s beyond just weight loss. Dr. Nadolsky addresses misconceptions around dosing and the potential side effects, emphasizing personalized care. He highlights the importance of strength training and nutrition in maintaining muscle mass while tackling industry biases and the complexities of telemedicine in obesity treatment.

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ANECDOTE

Dose Reduction Revives Motivation

A woman on a high dose of terzepatide plateaued and felt unmotivated to workout or lose weight.
Reducing her dose revived her motivation and helped her break through the plateau to lose more weight.

INSIGHT

Obesity as Chronic Disease

Obesity is a chronic disease driven by brain and genetic changes beyond simple willpower.
Appetite dysregulation is a key pathological driver, making obesity treatment complex.

INSIGHT

PBMs Inflate US Drug Prices

Pharmaceutical pricing and pharmacy benefit managers cause inflated GLP-1 medication costs in the US.
This limits access despite the drugs being affordable in other countries.

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EP. 212: Today I’m joined by Dr. Spencer Nadolsky, obesity specialist, Lipidologist, and founder of Vineyard, a cutting-edge direct care platform. We’re diving deep into the conversation you’ve been asking for: the real story behind GLP-1s, obesity as a chronic disease, and why treating it goes far beyond weight loss.

We break down everything from proper dosing, common side effects, and the dangers of vanity prescribing to the systemic issues with telemedicine and PBMs. Dr. Nadolsky and I also discuss strength training, preserving muscle mass, and how GLP-1s may support metabolic and cardiovascular health beyond their FDA indications.

This episode cuts through the noise and misinformation. If you care about metabolic health, this one’s essential.

Topics Discussed:

What are the real benefits of GLP-1 medications beyond weight loss?
Is obesity truly a chronic disease, and how should it be treated?
What are the risks of GLP-1 vanity dosing and fast titration?
How do GLP-1s impact muscle mass and metabolic health?
Why are telemedicine and PBMs problematic for obesity treatment?

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On This Episode We Cover:

00:00:00 – Introduction
00:02:48 – GLP-1 Dosing
00:06:35 – Side Effects of Vanity Dosing
00:08:51 – Reducing GLP-1 Dosing
00:12:27 – Med Spas & Telemedicine Risks
00:14:20 – Slow Titration for Better Tolerance
00:18:44 – Pharma Profits & Overdosing
00:20:49 – Obesity Treatment Pre & Post GLP-1s
00:27:58 – Obesity Is a Chronic Disease
00:32:45 – Defining obesity
00:36:16 – The Role of Genetics in Obesity
00:38:59 – Lifestyle Factors Beyond Genetics
00:40:46 – Insurance Barriers & PBM Costs
00:44:37 – Anti-GLP-1 Bias in Healthcare
00:46:22 – Why Strength Training Matters
00:51:39 – New Doctors & Role of AI
00:53:38 – Protecting Muscle on GLP-1s
00:58:55 – No Shortcuts to Health
01:02:01 – The Vineyard

Show Links:

Glp-1s Can Help Employers Lower Medical Costs In 2 Years, New Study Finds

Further Listening

Check Out Dr. Spencer

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