The Obesity Doctor Podcast

Do you find yourself thinking about food all day, even right after a meal? It’s called food noise, and it is not a character flaw. In part two of my CagriSema series, I walk you through a new study that used appetite testing, questionnaires and brain scans to see how this medication changes appetite, cravings and the brain's response to tempting foods, over a full year.

In this episode:

- The three systems that control eating, and why food noise happens
- How appetite and cravings changed, and why that held at one year
- Why eating a bit more at maintenance is a new steady state, not the medication wearing off
- The shift away from high-fat, sweet foods
- What changed in the brain, from reward to the brain's own "brakes"
- Side effects, study limitations, and my clinical pearls

Missed part one? Go back and listen to "Meet CagriSema" first.

This episode is for education only and isn't personal medical advice. Please speak with your own healthcare provider.

Reference: Abstract presented by Dr. Anthony P. Goldstone at EASD 2026. Effects of CagriSema on appetite, eating behaviour and food cue reactivity using functional MRI in adults with overweight or obesity. (V.F. Uhre et. al.)

WORK WITH ME
O​​ntario-Wide Virtual Obesity Management Clinic
https://www.highmetabolicclinic.com

Join my Weight Loss Coaching Program for women, Best Weight https://www.sashahighmd.com/bestweight

Recover Strong for Binge Eating
https://www.sashahighmd.com/bed

Taking the first step toward weight loss can feel overwhelming — but you don’t have to do it alone. I’ve created a curated list of my podcast episodes to gently guide you as you begin your journey. https://www.sashahighmd.com/podcast-guide

FOLLOW SASHA
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The New Kid on the block, coming 2027 (ish?), is CagriSema. Today, I’m giving you a clear, evidence-based introduction.

In this episode, I explain what amylin is, why combining it with semaglutide is a new approach, and what the REDEFINE trials actually showed.

In this episode:
- What amylin is, and how it differs from GLP-1 and GIP
- REDEFINE 1: about 20% average weight loss in people without diabetes
- REDEFINE 2: results in people living with type 2 diabetes
- REDEFINE 4: how CagriSema compared with tirzepatide, and how I interpret it
- Side effects, and practical ways to manage them
- Where approval stands, and why to avoid unapproved sources

Part 2, coming next week, goes inside the brain: what CagriSema does to appetite, cravings and food noise.

Resources:
- Garvey WT et al. Coadministered Cagrilintide and Semaglutide in Adults with Overweight or Obesity (REDEFINE 1). N Engl J Med. 2025.
- Davies MJ et al. Cagrilintide–Semaglutide in Adults with Overweight or Obesity and Type 2 Diabetes (REDEFINE 2). N Engl J Med. 2025.
- Novo Nordisk company announcement on REDEFINE 4, February 23, 2026.

This episode is for education only and isn't personal medical advice. Please speak with your own healthcare provider.

WORK WITH ME
O​​ntario-Wide Virtual Obesity Management Clinic
https://www.highmetabolicclinic.com

Join my Weight Loss Coaching Program for women, Best Weight https://www.sashahighmd.com/bestweight

Recover Strong for Binge Eating
https://www.sashahighmd.com/bed

Taking the first step toward weight loss can feel overwhelming — but you don’t have to do it alone. I’ve created a curated list of my podcast episodes to gently guide you as you begin your journey. https://www.sashahighmd.com/podcast-guide

FOLLOW SASHA
Instagram - https://www.instagram.com/sashahighmd/

In this episode, I’m joined by Dr. Ariel Dalfen, a psychiatrist and women’s mental health specialist, to explore the intersection of reproductive hormones, mental health, body image, eating disorders, and metabolic health.

We talk about why reproductive transitions—from the menstrual cycle to pregnancy, postpartum, perimenopause and menopause—can be particularly vulnerable times for mental health, and how clinicians can distinguish expected changes from symptoms that warrant treatment.

We also discuss:
- PMDD: what it is, how it differs from PMS, and why tracking symptoms across the menstrual cycle can be so helpful

- Mental health during perimenopause and menopause, including anxiety, depression, sleep disruption and emotional dysregulation

- How a history of PMDD, postpartum mental health concerns, or other psychiatric illness may influence risk during the menopause transition

- When menopause hormone therapy, psychiatric medication, or a combination may be appropriate

- How we should consider weight gain and metabolic health when choosing psychiatric medications

-The significant impact of menopause on body image and the risk of eating disorder relapse

- The growing pressure around food, exercise, protein, and body composition—and when healthy behaviours can become obsessive

- What we know, and what we still don't know, about the relationship between GLP-1 medications and mental health

- Why individualized, multidisciplinary care matters so much in women's mental health

Most importantly, we talk about the importance of listening to women, taking their symptoms seriously, and looking at the whole person rather than reducing complex experiences to either "just hormones" or a psychiatric diagnosis.

Dr. Dalfen is the CEO and co-founder of BRIA, a virtual women's mental health and hormone clinic. She is also an Assistant Professor of Psychiatry at the University of Toronto and previously led the perinatal mental health program at Mount Sinai Hospital in Toronto.

Learn more about BRIA at betterbria.com and BRIA Academy at briaacademy.com.

Follow BRIA on instagram: @bria.health

Why does staying on track with weight loss often feel so much easier during the week, only to become more challenging once Friday afternoon rolls around?

In this episode, Tedi Glik, RD will break down what the “weekend effect” is, and how the way we approach food from Friday through Sunday can influence overall weight-loss progress. With more social events, meals out, brunches, alcohol, and time with family and friends, the weekend naturally looks different—but that doesn’t mean it needs to become a completely different eating pattern.

We will talk about planning for indulgences rather than thinking in terms of “cheat meals.” The goal isn’t to eliminate the foods you enjoy, but to be more intentional about which foods and experiences are actually worth it to you. Whether that’s a favorite dessert, a croissant, or a glass of wine with friends, there’s a way to incorporate enjoyable foods while still building meals that are satisfying and supportive of your goals.

We will also explore some of the thoughts that can drive weekend eating, including “I’ve been good all week, so I deserve to enjoy myself,” “I don’t want to think about food on the weekend,” and “I’ll just start again on Monday.” Sometimes the biggest shift isn’t changing what we eat, but changing the way we think about the weekend. Planning doesn’t have to mean restriction—it can actually create more freedom by reducing the number of food decisions you have to make.

Ultimately, you don’t need to choose between losing weight and enjoying your life. The goal is to learn how to do both, and make your weekend part of the plan!

MEDICAL PROGRAM FOR OBESITY

O​​ntario-Wide Virtual Obesity Management Clinic
https://www.highmetabolicclinic.com

Join my Health & Consistency Coaching Program for women, Best Weight https://www.sashahighmd.com/bestweight

Recover Strong for Binge Eating
https://www.sashahighmd.com/bed

Taking the first step toward weight loss can feel overwhelming — but you don’t have to do it alone. I’ve created a curated list of my podcast episodes to gently guide you as you begin your journey. https://www.sashahighmd.com/podcast-guide

FOLLOW SASHA
Instagram
https://www.instagram.com/sashahighmd/

What happens after you’ve lost the weight you wanted to lose?

In this episode, I’m looking at what we actually know about maintaining weight loss with GLP-1–based medications. The evidence so far suggests that for most people, continuing treatment at the dose that produced their weight loss provides the best chance of maintaining that weight loss and its associated health benefits.

But what if staying on the same dose isn’t possible because of side effects, cost, access, or personal preference?

I break down what we’re learning from SURMOUNT-MAINTAIN and ATTAIN-MAINTAIN, including evidence that reducing tirzepatide to a lower dose or switching from injectable semaglutide or tirzepatide to oral orforglipron can preserve substantially more of the weight loss achieved than stopping treatment altogether.

We still have important questions about tapering, extending dosing intervals, and whether some people can eventually come off treatment successfully. But for now, the evidence suggests that if we need to reduce treatment intensity, maintaining some active treatment may be a much better strategy than simply stopping and waiting to see what happens.

Ultimately, maintenance is about finding the level of treatment that allows an individual to maintain the health benefits they’ve achieved—while recognizing that for many people with chronic obesity, ongoing treatment at their effective dose will be necessary.

MEDICAL PROGRAM FOR OBESITY

O​​ntario-Wide Virtual Obesity Management Clinic
https://www.highmetabolicclinic.com

Join my Health & Consistency Coaching Program for women, Best Weight https://www.sashahighmd.com/bestweight

Recover Strong for Binge Eating
https://www.sashahighmd.com/bed

Taking the first step toward weight loss can feel overwhelming — but you don’t have to do it alone. I’ve created a curated list of my podcast episodes to gently guide you as you begin your journey.
https://www.sashahighmd.com/podcast-guide

FOLLOW SASHA
Instagram - https://www.instagram.com/sashahighmd/

In this episode, I sit down with Dr. Tasneem Sajwani, Medical Director of the Edmonton Weight Management Centre, for a behind-the-scenes look at the world of obesity medicine. We discuss how she found her passion for this field, the challenges and rewards of building a successful obesity medicine clinic, and the key elements that drive long-term patient success.

We also explore the critical role of allied health professionals, lessons learned from years in practice, and practical clinical pearls that patients can apply to their own health journeys. Whether you're a healthcare professional or someone interested in understanding obesity treatment more deeply, this conversation offers valuable insights into the science, systems, and support that make effective obesity care possible.

Find Dr. Tasneem Sajwani’s practice in Edmonton, Alberta, here: https://www.ewmc.info/

Find Dr. Sasha High’s practice in Ontario here: www.highmetabolicclinic.com

Significant weight loss can be life-changing for your health—but it can also lead to changes in facial volume, skin laxity, and the way we see ourselves in the mirror.

In this episode, I’m joined by dermatologist Dr. Kucy Pon to unpack what happens to the face after significant weight loss, including weight loss associated with GLP-1 medications. We discuss why these changes are a result of weight loss itself—not a toxicity of the medication—and why age, genetics, skin quality, and the speed and amount of weight loss can all play a role.

We also explore what can be done to support skin quality and facial volume, including skincare, nutrition and resistance training, as well as aesthetic options such as hyaluronic acid fillers and biostimulators like Sculptra® and Restylane®.

As part of today’s episode, we also discuss Sculpt and Lift by Sculptra® and Restylane®, and how these treatments may be used as complementary approaches to address different aspects of facial volume loss and skin quality.

Most importantly, we talk about the importance of individualized assessment, realistic expectations, choosing an experienced, medically trained injector, and remembering that aesthetic treatment is entirely optional.

My biggest takeaway: improving your health and wanting to feel good about how you look are not competing priorities. We pursue obesity treatment for health and longevity, but it’s completely okay to want your outward appearance to reflect how vibrant and healthy you feel inside.

Please speak with your trusted injector to discuss Sculptra and Restylane’s safety profiles.

Learn more at galdermaaesthetics.com/ca or @aestheticsbygalderma.ca

Thank you to Galderma for sponsoring this episode.

Feeling like your metabolism is “broken” can be frustrating, especially when you’re eating well and exercising but not seeing the results you expect. In this episode, Tedi Glik, RD, MPH, breaks down three common factors that can make sustainable weight loss more challenging—and what you can do about them.

In This Episode We Will Explore:
 
- How fad diets are working against you: Aggressive calorie restriction can increase hunger and cravings and make long-term weight management more difficult.
- Why sleep is essential: Poor sleep can affect hunger, cravings, movement, recovery, and your ability to stick with healthy habits.
- How to protect your muscle: The importance of focusing on preserving as much lean muscle as possible.
- Looking beyond the scale: How body composition can provide a more meaningful picture of your progress than body weight alone.

WORK WITH US
Ontario-Wide Virtual Obesity Management Clinic
Join my Weight Loss Coaching Program for women, Best Weight
Recover Strong for Binge Eating

Taking the first step toward weight loss can feel overwhelming—but you don’t have to do it alone. I’ve created a curated list of podcast episodes to gently guide you as you begin your journey.

Explore the Podcast Guide

FOLLOW SASHA
Instagram

Summer can make healthy eating feel more challenging, but you don’t need to be perfect to stay on track. In this episode, Tedi Glik, RD, MPH, shares practical strategies for navigating unexpected meals, social pressure, cravings, and all-or-nothing thinking.

In This Episode
- Have a Plan B: Keep easy protein-rich snacks on hand to prevent getting overly hungry when your schedule changes.
- Practice the pivot: When plans change, ask, “What’s the next best decision I can make from here?”
- Build balanced meals: Think vegetables + protein + carbohydrate rather than trying to eliminate certain foods.
- Handle cravings: You can want more of a highly palatable food without automatically having more. Pause and check in with your hunger and fullness.
- Navigate food pushers: You can appreciate someone’s food without accepting another serving. - - Let go of judgment: Make food choices based on what you actually want—not what you think others expect you to eat.
- Avoid all-or-nothing thinking: There’s a middle ground between eating perfectly and giving up.

Your Summer Takeaway
You don’t need to be perfect. Plan when you can, pivot when you can’t, and don’t turn one meal into a reason to give up.

You can enjoy your summer and continue working toward your goals.

WORK WITH US
O​​ntario-Wide Virtual Obesity Management Clinic
https://www.highmetabolicclinic.com

Join my Weight Loss Coaching Program for women, Best Weight https://www.sashahighmd.com/bestweight

Recover Strong for Binge Eating
https://www.sashahighmd.com/bed

Taking the first step toward weight loss can feel overwhelming — but you don’t have to do it alone. I’ve created a curated list of my podcast episodes to gently guide you as you begin your journey. https://www.sashahighmd.com/podcast-guide

FOLLOW SASHA
Instagram - https://www.instagram.com/sashahighmd/

Summer brings travel, restaurants, BBQs, cottage weekends, and more social eating—which can make weight loss feel impossible.

In This Episode

We cover practical strategies to:

- Plan ahead: Map out your week and anticipate social meals.
- Stay consistent: Keep your usual protein-rich meals and snacks on non-social days.
- Navigate restaurants: Check menus ahead of time and have a few go-to balanced options.
- Move beyond "cheat meals": Enjoy pizza, dessert, or other foods without the "I've blown it" mentality.
- Aim for B+ work: Focus on consistency rather than nutritional perfection.
- Be intentional with alcohol: Plan when and how much you want to drink.
- Limit everyday culprits: Pay attention to added sugars and highly processed foods that may not keep you satisfied.

The Mindset Shift

Instead of: "How do I stay on my diet this summer?"
Ask: "How can I make choices that support my health while still enjoying my summer?"

You don't need to choose between making progress and living your life.

You can travel, eat out, enjoy dessert, and spend time with family and friends—all while building sustainable habits.

WORK US
O​ntario-Wide Virtual Obesity Management Clinic
https://www.highmetabolicclinic.com

Join my Weight Loss Coaching Program for women, Best Weight https://www.sashahighmd.com/bestweight

Recover Strong for Binge Eating
https://www.sashahighmd.com/bed

Taking the first step toward weight loss can feel overwhelming — but you don’t have to do it alone. I’ve created a curated list of my podcast episodes to gently guide you as you begin your journey. https://www.sashahighmd.com/podcast-guide

FOLLOW SASHA
Instagram
https://www.instagram.com/sashahighmd/

RESOURCES
Names for sugar on your food label:
https://www.healthline.com/nutrition/56-different-names-for-sugar

Episode 139. Reconsidering Alcohol:
https://www.sashahighmd.com/podcasts/the-obesity-doctor-podcast/episodes/214898613