This week on Fat Science, Dr. Emily Cooper, Andrea Taylor, and Mark Wright answer listener questions from around the world about metabolic health. This mailbag episode explores widely-debated topics like “starvation mode,” weight loss plateaus, the relationship between metabolism and cognitive health, cannabis and metabolism, metabolic effects of liposuction, and the latest on GLP-1 medications.

Key Takeaways:

• Dr. Cooper dispels myths around “starvation mode,” citing research on the long-term metabolic impact of dieting and caloric restriction.
• Weight loss plateaus are often misunderstood—Dr. Cooper explains the natural adaptations behind them and how to assess true progress.
• Metabolic health plays a major role in brain function, cognitive decline, depression, and dementia prevention.
• Cannabis affects metabolic pathways in complex ways, with regular use potentially causing negative metabolic effects.
• Liposuction can trigger metabolic rebound and rapid fat regain for some patients, especially when leptin levels are low.
• Updates on GLP-1 meds: Liraglutide is available in generic form, but costs fluctuate. New oral and combination therapies are on the horizon.

Personal Stories & Practical Advice:

• Andrea and Mark reflect on their own journeys with dieting, weight plateaus, and medication.
• Dr. Cooper shares clinical experiences with metabolic rebound after liposuction and ways to navigate pharmacologic treatments.

Correction: Lilly has a lower cash pay for Medicare and Medicaid, but Novo Nordisk is not yet.

References related to diet-induced metabolic adaptation, also called biological adaptation and defense of body weight.

1. Keys, A., Brozek, J., Henschel, A., Mickelsen, O., & Taylor, H. L. (1950). The Biology of Human Starvation. University of Minnesota Press.

2. Dulloo, A. G. (2021). Physiology of weight regain: Lessons from the classic Minnesota Starvation Experiment on human body composition regulation. Obesity Reviews, 22, e13189.

3. Müller, M. J., & Bosy-Westphal, A. (2013). Adaptive thermogenesis with weight loss in humans. Obesity, 21(2), 218-228.

4. Rosenbaum, M., & Leibel, R. L. (2010). Adaptive thermogenesis in humans. International Journal of Obesity, 34(S1), S47-S55.

5. Fothergill, E., Guo, J., Howard, L., Kerns, J. C., Knuth, N. D., Brychta, R., ... & Hall, K. D. (2016). Persistent metabolic adaptation 6 years after "The Biggest Loser" competition. Obesity, 24(8), 1612-1619.

6. Johanssen, D. L., Knuth, N. D., Huizenga, R., Rood, J., Ravussin, E., & Hall, K. D. (2012). Metabolic slowing with massive weight loss despite preservation of fat-free mass. Journal of Clinical Endocrinology & Metabolism, 97(7), 2489-2496.

7. Sumithran, P., Prendergast, L. A., Delbridge, E., Purcell, K., Shulkes, A., Kriketos, A., & Proietto, J. (2011). Long-term persistence of hormonal adaptations to weight loss. New England Journal of Medicine, 365(17), 1597-1604.

8. MacLean, P. S., Bergouignan, A., Cornier, M. A., & Jackman, M. R. (2011). Biology's response to dieting: the impetus for weight regain. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 301(3), R581-R600

Resources:

• Connect with Dr. Emily Cooper on LinkedIn.
• Connect with Mark Wright on LinkedIn.
• Connect with Andrea Taylor on Instagram.

Fat Science is a podcast on a mission to explain where our fat really comes from and why it won’t go and stay away. We are committed to creating a world where people are empowered with accurate information about metabolism and recognize that fat isn’t a failure. This podcast is for informational purposes only and is not intended to replace professional medical advice.

If you have a question for Dr. Cooper, email us at [email protected] or [email protected].

Fat Science is supported by the non-profit Diabesity Institute which is on a mission to increase access to effective, science-based medical care for those suffering from or at risk for diabesity. https://diabesityresearchfoundation.org/