GLP-1 & Weight Management

Look at those TEEFS. That is one good nap. Sally the mini has apparently mastered something most of us struggle with. If you saw the video of her flat-out asleep in the sun this week, that is not laziness. That is a horse doing exactly what her body needs, and it turns out the rest of us could learn something from her. Sleep gets treated like a luxury, something to sacrifice when life gets busy. For anyone working on weight management, that trade-off costs more than most p

When GLP-1 medications first arrived, the pitch was simple: slow down your stomach, so you eat less and lose weight. That was supposed to be all that happened. Nobody expected this drug class to end up touching addiction, kidney disease, and even brain health along the way. Some of what researchers have found is genuinely exciting. Some of it turned out to be a letdown. Here is an honest look at both. Let's start with the wins that have real evidence behind them. Sleep apnea

Real fitness. The kind that moves manure. A lady caught me at my last horse show, frustrated that her BMI looked fine on paper but she felt weaker in the saddle than she had five years ago. Her weight had barely changed. Her strength had not kept pace. That mismatch has a name, and it deserves a lot more attention than it gets. Sarcopenic obesity is the combination of excess fat and low muscle mass and function happening in the same body at the same time. It hides well. A

Best view in the world GLP-1 medications work by quieting appetite, and for most patients that is exactly the point. Less hunger, smaller portions, steady weight loss. What gets less attention is what happens when appetite suppression goes far enough that patients simply are not eating enough to meet their nutritional needs, and why that matters more than most people realize. A recent case review brought this into sharp focus. Researchers identified several patients on se

Mini dosing. Not just for mini horses. I get some version of this question almost every week now. A patient will lean in at the trailer, or send me a message through the app, and ask if she should be "microdosing" her semaglutide instead of following the standard schedule. Sometimes it's a friend who saw a TikTok. Sometimes it's a patient who's already on a compounded product from somewhere else and wants to know if the dose she's on counts. Let's talk about what microdosin

Every horse person I know already understands a piece of nutrition science that most physicians never mention to their human patients. Feed hay before grain. Never turn a hungry horse loose on a full grain bucket with an empty stomach. Get some forage into that gut first, then let the concentrate follow. You do this because it works, and it turns out researchers have actually measured why. A 2020 study out of the Journal of Equine Veterinary Science tested exactly this...

A study published last month in Annals of Oncology followed over 160,000 adults with obesity and no diabetes. One group took GLP-1 medications like semaglutide or tirzepatide. The other group received diet and exercise counseling only. Researchers tracked who developed obesity-associated cancers over two years. People on GLP-1 medications had a 41% lower incidence of obesity-related cancers. Forty-one percent. Take a breath and let that number register, because it is a big o

Stress management techniques Here is a truth that most weight loss programs do not want to tell you. Weight is not just about willpower. It is not just about what you eat or how much you move. It is a system. A complicated, layered, deeply personal system. If you have ever felt like you were doing everything right and still not getting the results you expected, it is probably because you were only pulling one or two of the levers available to you. At PresenceMD, we look at

It's Not Over One of the biggest hesitations I hear from people considering GLP-1 medications is the worry that you might have to take them for the rest of your life. I immediately agree with people when they share that worry. Why wouldn't we want to continue a medication that decreases your risk of heart disease, kidney disease, strokes, and many types of cancer? Of course we want to continue this medication! I think part of this worry is rooted in weight stigma. The last

Annie drunk at the vet You are standing in a barn at 6am, wrapping legs, hauling hay, running on coffee and sheer determination, and somewhere between classes you found a reel that told you to get your cortisol checked, your DUTCH test done, your vitamin D optimized, your hormones mapped, and your adrenal function evaluated. The reel had 400,000 likes and a very pretty graphic. The woman in it had a medical title that sounded official. Here is what she did not tell you: mos

My cell phone has this little widget that likes to pull old photos from my camera roll and show them to me. I love seeing pictures of my kids from years ago, a quick shot of my horse, and or a photo that makes me question what in the world I was doing and why is that still on my camera roll?? My phone served me a photo from a few years ago (before I went on a GLP1) when I was at Disney World with my family. My first thought was, "Wow. I looked a lot heavier then." My seco

You swapped the sugar. You read the labels. You picked the diet soda, the sugar-free yogurt, the protein bar sweetened with erythritol. You did everything right. Except maybe you didn't. A new article in Medscape is making the rounds in the medical world, and it is one I want every single one of my patients to read. The headline says it all: "The Sweetener Trap: Are Sugar Alternatives Backfiring?" Spoiler alert -- the answer is looking more and more like yes. Here is what y

Feeding Time Let me guess. You are trying to lose weight, you are eating less than you used to, and somewhere around 2pm every day, you feel like you have been hit by a slow-moving truck. Your workouts feel harder than they should. You are losing weight, which is great, but you are not sure if what you are losing is actually fat or if your body is quietly cannibalizing the muscle you spent years building. This is where creatine comes in. Creatine is one of the most studied

Tough enough to rope with pink Wegovy and Zepbound are all the rage in the media right now because they work for weight loss. We prescribe Ozempic and Mounjaro because they work for diabetes. But a study just dropped in JAMA Network Open that made me sit up straight in my chair — and I want every woman who takes one of these medications to know about it. Breast cancer is the most common cancer in women in the United States, and if you have obesity or type 2 diabetes when yo

The prescription is the easy part There is a decent chance you have seen the ads. Hers. Ro. Found. Noom. Some version of a clean website, a smiling woman, a promise of GLP-1 medications delivered to your door in a few days after a quick online questionnaire. Maybe you have clicked on one. Maybe you have wondered if it was too good to be true. Maybe you signed up. I am not here to shame anyone for that. The healthcare system has failed a lot of people for a long time, and wh

When I was in medical school, we were told that weight loss was easy. Take in fewer calories than you expend. Eat less, move more. You just need to work harder, and weight loss is easy. What we now understand is that model is just... wrong. We have evolved over millions of years to not starve to death, and we are REALLY good at it. Our ancestors had to tolerate weeks to months of little food but still be able to walk for long distances and not die. If they couldn't do t

Some fancy fruity drink. With a flower. My kids did two years of school at home during COVID. My husband's immunosuppressed, and we really weren't sure how he would tolerate a COVID infection during those early days. Our family closed ranks, and I added yet another job to my list at the time: doctor, military commander, farmer wife, elementary/middle school teacher. One of those jobs was not my strength, and shout out to all the people who educate our children because th