Have you been told your metabolism is broken and there's nothing you can do about it?

This mailbag episode tackles tough questions about medication effectiveness, unexpected side effects, and the complex realities of treating metabolic dysfunction. Dr. Cooper addresses why some people regain weight while still on GLP-1s, explores the connection between hair loss and weight loss medications, and explains why leptin levels can remain stubbornly low even with proper nutrition.

KEY TAKEAWAYS

• Weight regain while on GLP-1 medications is more common than most people realize

• Hair loss from weight loss medications is usually related to nutrient deficiencies, not the medication itself

• Leptin dysfunction involves both hormone levels and signaling pathways throughout the body

• Hypoglycemia after meals often indicates complex metabolic issues that require specialized testing

• Starting elderly patients on GLP-1s requires careful monitoring of nutrition, blood pressure, and side effects

• Mechanical eating differs from intuitive eating and remains important even when medications are working

• Annual weight loss rates of 10% or higher indicate medications are still effective

NOTABLE QUOTE

"It is not uncommon to see the weight go up while on these meds, contrary to what people think. They're great, but we always wanna point out some people don't even respond to these." — Dr. Emily Cooper

Links & Resources

Podcast Home: fatsciencepodcast.com

Cooper Center for Metabolism: coopermetabolic.com

Resources from Dr. Cooper: coopermetabolic.com/resources

Join Our Community: patreon.com/cw/FatSciencePodcast

Submit Your Question: questions@fatsciencepodcast.com or dr.c@fatsciencepodcast.com

Fat Science is supported by the Diabesity Institute, a nonprofit dedicated to increasing access to effective, science-based metabolic care.

This podcast is for informational purposes only and is not intended as medical advice. Please consult with a qualified healthcare provider for personalized recommendations.

Ever wonder why you can improve your health but still feel like you're failing because the scale isn't cooperating?

Dr. Cooper breaks down groundbreaking new clinical guidelines from three major obesity organizations that are completely reframing what success in obesity treatment actually means. For the first time, these groups are saying quality of life, energy levels, and overall health matter more than the number on the scale.

KEY TAKEAWAYS

• Three major obesity organizations worked collaboratively to issue guidelines prioritizing quality of life over weight loss as primary treatment goals

• Guidelines explicitly address medical stigma as a structural barrier to care requiring systemic change

• Treatment is positioned as long-term management similar to other chronic conditions like thyroid disorders

• Document notably avoids calorie restriction language, focusing instead on healthy lifestyle alongside medication

• Setmelanotide receives strong recommendation for rare genetic obesity conditions with available genetic testing

• Strong medication recommendations now include GLP-1s like semaglutide and tirzepatide, plus bupropion-naltrexone combination

NOTABLE QUOTE

"Nobody ever asked. Nobody ever looked. Nobody ever said anything. I was like, 'I think there's something wrong with my metabolism or something because I'm not eating a ton.' They're like, 'Well, you must be.' And I'm like, 'N- n- no, I don't think so. I mean, unless it's happening when I'm sleeping. I don't know.'" — Andrea Taylor

Reference Link

Alexander L, Purnell JQ, et al. Pharmacological management of obesity in adults: a clinical guidance statement from The Obesity Society, the Obesity Medicine Association, and the Obesity Action Coalition. Obesity. 2026;34(4):851–870. doi:10.1002/oby.70164 https://onlinelibrary.wiley.com/doi/10.1002/oby.70164

Links & Resources

Podcast Home: fatsciencepodcast.com

Cooper Center for Metabolism: coopermetabolic.com

Resources from Dr. Cooper: coopermetabolic.com/resources

Join Our Community: patreon.com/cw/FatSciencePodcast

Submit Your Question: questions@fatsciencepodcast.com or dr.c@fatsciencepodcast.com

Fat Science is supported by the Diabesity Institute, a nonprofit dedicated to increasing access to effective, science-based metabolic care.

This podcast is for informational purposes only and is not intended as medical advice. Please consult with a qualified healthcare provider for personalized recommendations.

Have you been told you have PCOS but nothing seems to help?

In May 2024, after 14 years of global collaboration involving 56 organizations and 22,000 stakeholders, the medical community officially changed PCOS to PMOS - and the reason why reveals everything that's been wrong with how this condition has been understood and treated for decades. Dr. Cooper breaks down why this isn't just a name change, but a complete reframe that puts metabolic dysfunction at the center where it belongs.

KEY TAKEAWAYS

• PCOS is now officially called PMOS - Polyendocrine Metabolic Ovarian Syndrome - shifting focus from ovarian problems to metabolic dysfunction
• 70 million women globally are affected during reproductive years, with 70% remaining undiagnosed
• The condition can occur at any weight and is driven by insulin resistance and other metabolic signals, not ovarian problems
• Treatment should focus on metabolic health rather than weight loss or ovarian interventions
• The name change parallels similar shifts in medicine like MASLD replacing non-alcoholic fatty liver disease

NOTABLE QUOTE

"Most patients with this label that they've had in the past, the PCOS label, feel a sense of hopelessness, and even join support groups and things like that, and thinking that this will be a condition they have forever. And what I try to do is explain, no, this is just a physical manifestation of the metabolic disruption that we treat all the time" — Dr. Emily Cooper

Links & Resources

Podcast Home: fatsciencepodcast.com

Cooper Center for Metabolism: coopermetabolic.com

Resources from Dr. Cooper: coopermetabolic.com/resources

Join Our Community: patreon.com/cw/FatSciencePodcast

Submit Your Question: questions@fatsciencepodcast.com or dr.c@fatsciencepodcast.com

Fat Science is supported by the Diabesity Institute, a nonprofit dedicated to increasing access to effective, science-based metabolic care.

This podcast is for informational purposes only and is not intended as medical advice. Please consult with a qualified healthcare provider for personalized recommendations.