#300 - Who Should Take GLP-1s? The Science of Obesity, Appetite & Weight Loss | Dr. Robert Kushner & Mike Haney

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What are GLP-1 drugs actually doing in the body, who are they for, and why might some people want to think twice before treating them like a six-month shortcut?

For years, obesity treatment focused largely on behavior: eat less, move more, stay motivated. Yet many people lost weight only to regain it. According to obesity medicine pioneer Dr. Robert Kushner, that wasn’t a failure of willpower. It was a failure to fully understand the biology driving weight regulation.

In this episode of A Whole New Level, Mike Haney sits down with Kushner, one of the leading figures in obesity medicine and a lead investigator on the landmark STEP trials, to discuss how GLP-1 medications are changing the field. He explains why these drugs may be the first treatments capable of helping patients “fight biology with biology,” why appetite regulation appears to work differently in different people, and why many patients describe a dramatic reduction in food noise after starting treatment.

But this conversation goes beyond how the drugs work. Kushner also addresses one of the biggest questions facing obesity medicine today: who should actually take these medications? He explains why obesity specialists evaluate far more than a number on the scale, why someone hoping to lose a modest amount of weight may want to think carefully before pursuing treatment, and why successful long-term health still requires changes that no medication can provide.

They also discuss obesity as a disease, the promise and limitations of telehealth prescribing, and why maintaining weight loss often requires something deeper than motivation: a shift in identity.

🎙️ About the Guest:

Dr. Robert Kushner is Professor Emeritus of Medicine and Medical Education at Northwestern University Feinberg School of Medicine and one of the pioneers of modern obesity medicine. He is a past president of The Obesity Society, founder and former chair of the American Board of Obesity Medicine, and a lead investigator on the landmark STEP clinical trials that helped establish semaglutide as a treatment for obesity.

📍What Dr. Robert Kushner & Mike Haney discussed:

2:06 — Why obesity is more than willpower

4:34 — The benefits and drawbacks of calling obesity a disease6:27 — Clinical vs. preclinical obesity

17:36 — What obesity medicine misunderstood about weight regain

18:44 — “Fight biology with biology”

25:07 — Why weight maintenance is a different challenge than weight loss

26:49 — The identity shift that helps people keep weight off

27:52 — How GLP-1 drugs actually work

31:09 — Why some people experience constant food noise

34:09 — Why GLP-1s treat obesity but don’t cure it

42:17 — The STEP and SELECT trials

44:15 — Who should consider GLP-1 medications?

45:44 — Why obesity treatment is more than an online prescription

50:44 — What happens after you stop taking GLP-1s?

🔗 Helpful Links:

Watch the conversation: ⁠https://youtu.be/qdssFUAWVck

Dr. Robert Kushner: https://drrobertkushner.com/about/

Northwestern Faculty Profile: https://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=11686

STEP Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

SELECT Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa2307563

👋 Who we are:

Levels helps you understand your metabolic health with personalized data, expert guidance, and tools that connect your daily choices to measurable changes in your body. Our goal is to help you make better decisions about food, exercise, sleep, and long-term health.

Look for new shows every month on A Whole New Level, where we have in-depth conversations with thought leaders about metabolic health.