The Obesity Doctor Podcast

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

Do GLP-1 medications affect bone health?

GLP-1 medications have transformed obesity treatment, but they've also sparked important questions about bone health, bone density, and fracture risk.

In this episode, I’m joined by obesity medicine specialist Dr. Sandra Cortina to unpack what the current evidence actually shows about bone health during GLP-1 therapy. We separate evidence from headlines and explore how clinicians and patients can make informed decisions while balancing the substantial benefits of GLP-1 therapy with potential risks. This is a nuanced, evidence-based conversation for anyone interested in the science of obesity treatment.

Find Dr. Cortina:
Instagram @cortinaweightmedicine

Website
www.cortinaweightmedicine.ca in British Columbia, Canada

Home Exercises Referenced by Dr. Cortina:
https://www.youtube.com/@silversneakers

You're eating healthy, exercising, and doing everything you think you should, but the scale isn't moving. So what's going on?

In this episode, we explore the five most common reasons weight loss stalls, including hidden calorie intake, chronic under-fueling, metabolic adaptation, and lifestyle factors like sleep, stress, and movement. You'll learn why your body isn't broken and how building consistent, sustainable habits is the key to long-term success.

In This Episode
- Why healthy eating doesn't always lead to weight loss
- The difference between overeating and under-fueling
- How chronic dieting can affect your metabolism
- The importance of protein, balanced meals, and consistency
- Why sleep, stress, strength training, and patience matter

Mentioned in This Episode
- Episode 170: Why Eating 1,200 Calories Is Working Against You: https://www.sashahighmd.com/podcasts/the-obesity-doctor-podcast/episodes/2149162617

- Resting Metabolic Rate (RMR) Calculator:
https://www.calculator.net/bmr-calculator.html

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

Menopause is something every woman will experience, yet many still feel confused, dismissed, or overwhelmed when symptoms begin. In this conversation, I’m joined by Dr. Sheila Wijayasinghe to unpack the realities of perimenopause, menopause, and hormone therapy in a practical, evidence-based way.

We talk about what the menopause transition actually looks like, why symptoms can begin years before periods stop, and why so many women are told their labs are “normal” even when they don’t feel normal. We also break down some of the biggest misconceptions around hormone therapy, including safety concerns, breast cancer risk, cardiovascular risk, and whether bloodwork is actually useful in making a diagnosis.

In this conversation, we cover:
- The difference between perimenopause and menopause
- Early symptoms women may notice in their 40s
- Whether hormone testing is necessary
- What menopausal hormone therapy (MHT) is and who may benefit
- The difference between regulated bioidentical hormones and compounded products
- How hormone therapy may impact sleep, mood, bone health, urogenital symptoms, and brain fog - Non-hormonal approaches to symptom management
- How women can advocate for themselves if they feel dismissed in healthcare settings

My hope is that this episode helps bring clarity to a stage of life that still carries so much confusion and misinformation, and that women walk away feeling more informed and empowered to make decisions about their health.

Links & Resources

You can follow Dr. Sheila Wijayasinghe on Instagram at @drsheilaw and check out the Doc Talk Podcast for more evidence-based health conversations.

Menopause Management Resource from the Centre for Effective Practice
https://cep.health/clinical-products/menopause-management/

Menopause Symptom Tracker
https://menopausefoundationcanada.ca/resources/menopause-symptoms/

I’m joined by Dr. Lauren Colenso-Semple to unpack the rapidly growing world of wellness peptides — from BPC-157 and CJC-1295 to Ipamorelin, Tesamorelin, NAD, and the so-called “fat-burning” and “healing” peptides taking over social media. We discuss what peptides actually are, why they’ve become so popular, and how legitimate medical therapies have blurred into a largely unregulated wellness industry.

We also break down the claims being made about popular peptides marketed for fat loss, recovery, anti-aging, and performance enhancement, while taking a closer look at what evidence truly exists (and what doesn’t). Dr. Lauren shares important insight into the safety concerns, marketing tactics, and cultural obsession with optimization that are fueling this trend online.

If you’ve been curious about peptides or wondering whether the internet hype matches the science, this episode will help you think more critically before jumping on the trend.

Check out Dr. Lauren Colenso-Semple’s work here: https://www.drlaurencs.com/