Mailbag: Your GLP-1 Questions on Pregnancy, Dosing, and Why Diets Cause Fat Gain

What happens when you stop GLP-1 medications before getting pregnant? Why might your thyroid numbers change on Zepbound? And why do people gain more body fat after dieting — even when they're still eating well? Dr. Cooper tackles your toughest questions.

This week on Fat Science, Dr. Emily Cooper, Mark Wright, and Andrea Taylor answer listener questions covering pregnancy planning on GLP-1s, unmasked thyroid problems, injection site reactions, mechanical eating after bariatric surgery, why diets cause fat regain at a cellular level, and discussing with your doctor whether you should (or shouldn't) increase your medication dose.

Key Takeaways

• GLP-1 medications aren't causing gestational diabetes — they may have been masking underlying metabolic dysfunction that becomes visible when the medication is stopped

• Thyroid problems can be "unmasked" by GLP-1 treatment because the medications signal to your brain that you're not starving, allowing the pituitary TSH to rise, sometime uncovering a pre-existing thyroid issue

• Zepbound may improve iron absorption — if iron levels go too high, testing for hemochromatosis may be warranted

• To reduce injection site reactions: warm the medication to room temperature, clean and prep skin but don't over-rub with alcohol, inject at exactly 90 degrees, don't pinch the skin, and stay relaxed

• Diets cause fat regain at the cellular level — it's chemistry, not willpower — and the fat often accumulates in the visceral area around organs

• There's no need to increase your GLP-1 dose if you're making good progress — an annual weight loss rate of 15% or higher is considered strong

Notable Quote

"You can't think that just because somebody's weight is high, it's because something they're doing is wrong. That is just not founded in science whatsoever." — 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.

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

Wegovy Pill: Who's It For?

The new Wegovy pill is generating massive buzz — but is it actually better than the injection? Before you ask your doctor to switch, there are some surprising requirements that could make or break whether this option works for you.

This week on Fat Science, Dr. Emily Cooper, Mark Wright, and Andrea Taylor break down the new oral semaglutide approved for obesity treatment. They explain how the Wegovy pill differs from Rybelsus, who's a good candidate to switch (and who isn't), the strict dosing protocol most people don't know about, and what's coming next in the GLP-1 pill landscape — including a less fussy competitor from Eli Lilly.

Key Takeaways

• The Wegovy pill uses an upgraded "version two" formulation with enhanced absorption — it's not the same as Rybelsus

• Semaglutide targets deep metabolic dysfunction, not just appetite — reducing inflammation, visceral fat, and cardiovascular risk

• The pill must be taken first thing in the morning on an empty stomach with minimal water, then nothing else for 30 minutes — breaking this protocol negates effectiveness

• The pill is slightly less effective than the highest-dose Wegovy injection, so switching isn't ideal for patients still making progress at maximum dose

• Novo Nordisk's cash pay program starts at $149/month for lower doses and $299/month for the highest dose

• Eli Lilly's upcoming orforglipron pill uses small molecule technology that won't require the strict dosing ritual

Notable Quote

"When people say it works because it just makes you eat less, that's really missing the point of the sophistication of these meds." — 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.

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

What if the scale isn't moving, but your health is dramatically improving?

If you've ever felt discouraged because the number on the scale won't budge—even on a GLP-1 medication—this episode will change how you think about these drugs. Dr. Cooper breaks down the research showing that the biggest benefits have nothing to do with weight loss. It's all about metabolic health.

This Week on Fat Science

Dr. Emily Cooper, Mark Wright, and Andrea Taylor explore the research proving GLP-1 medications are far more than "weight loss drugs." The team explains how cardiovascular outcome trials revealed unexpected heart protection, why inflammation reduction may be the real mechanism behind these benefits, and what the latest FDA approvals for kidney disease, sleep apnea, and fatty liver mean for patients. Plus: the new oral Wegovy pill, what's coming next in metabolic medicine, and why everyone should be screened for metabolic dysfunction regardless of weight.

What You'll Learn

• Why two-thirds of cardiovascular risk reduction from GLP-1s is completely independent of weight loss

• How these medications reduce inflammation, stabilize arterial plaque, and improve vascular function

• The difference between MASLD and MASH—and why the name change matters

• What the Flow Trial revealed about kidney protection (and why it was stopped early)

• How Zepbound earned FDA approval for sleep apnea

• Why metabolic screening should happen regardless of what the scale says

Notable Quote

"You can still become incredibly healthier even if the weight is more stubborn. So I think that's the thing, is to discuss with your doctor not 'Oh, I want to lose X amount of pounds' or 'How much weight do you think I should lose?' That is not the conversation. It's more, let's take a look at the health parameters."

— Dr. Emily Cooper

Links & Resources

• Podcast Home: fatsciencepodcast.com

• Cooper Center for Metabolism: coopermetabolic.com

• Resources from Dr. Cooper: coopermetabolic.com/resources

• 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.

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