What if blockbuster weight-loss drugs and a broken food system are two sides of the same story? We sit down with Dr. David Harlan—physician, researcher, and former NIH diabetes branch chief—to trace the unlikely path from the “incretin effect” to GLP-1 therapies that are transforming care for type 2 diabetes and obesity. Along the way, we ask harder questions about incentives, access, and why lifestyle still matters even when the medicine is powerful.

Dr. Harlan breaks down how GLP-1 receptor agonists amplify insulin release, quiet cravings, and drive meaningful weight loss—often alongside better blood pressure, improved A1C, and fewer heart events. He explains the Gila monster connection, why weekly injections replaced multiple daily shots, and what the latest safety data actually shows. We get candid about what happens when people stop these drugs, why genetics complicate the “just try harder” narrative, and how brain chemistry shapes appetite, compulsion, and energy.

Then we zoom out to the policy level: the rise of food deserts, cheap ultra-processed calories, and the paradox of publicly funding both the problem and the fix. We explore practical steps that work in the real world—SKU-controlled health savings accounts, everyday movement campaigns, healthier default options in public spaces, and community gardens and sidewalks that make active living normal again. The throughline is simple and human: use the science to help people now, and rebuild the environment so fewer need the medicine later.

If you care about diabetes, obesity, prevention, or the economics shaping our plates and prescriptions, this conversation offers clarity and a path forward. Support the show by subscribing, sharing with a friend, and leaving a review with the one insight you’ll apply this week.

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