{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Next Phase Human ","title":"Why Weight Comes Back (And What Actually Works)","html":"","width":"100%","height":180,"duration":4201,"description":"Show Notes\nDr. Ayad has been board-certified in obesity medicine since 2013 and has practiced only weight management for over 12 years. His path started during his family medicine residency in Wheeling, West Virginia, where he watched the same patients readmitted again and again with ever-longer medication lists, and concluded the weight itself had to be treated.\nHe explains the Obesity Medicine Association’s definition of obesity as a chronic, treatable, progressive, relapsing, multifactorial disease, with genetics, environment, physiology, and behavior all contributing. He breaks down food noise and why patients who regained weight after sleeve and bypass surgery often still had it, until medication quieted it.\nOn weight regain, he outlines the three forces of metabolic adaptation: a lower metabolic rate that lags behind regain, elevated ghrelin, and reduced leptin. He covers why BMI misses visceral fat, why Asian populations use lower BMI cutoffs (overweight from 23, obesity from 27), and why body composition matters more than the scale.\nThe medication tour covers phentermine and its cardiac cautions, Qsymia’s evening craving coverage and teratogenic risk, Contrave for emotional eating (avoid with seizures or opioids), orlistat’s limits, and metformin for insulin resistance and PCOS. He explains how GLP-1s mimic our natural gut hormones with a longer half-life, why that causes nausea and constipation, how he chooses between semaglutide and tirzepatide, and the SELECT trial’s cardiovascular benefit. He contrasts oral Wegovy (semaglutide, taken on an empty stomach) with Foundayo (a different molecule, any time of day), and previews retatrutide and CagriSema.\nSafety topics include protecting muscle and bone with 1.5 to 2 g/kg of protein and resistance training, dizziness from overtreated blood pressure or rebound hypoglycemia, dehydration, contraindications including GLP-1–triggered pancreatitis and medullary thyroid cancer, stopping two months before conception,...","thumbnail_url":"https://img.transistorcdn.com/8L-nuimlDDYZRLTRShB5TuOVQoW-K4IcHfnKlMch4gk/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS83NWVm/YWIyNzUwNjcwNDJl/NzI1YzEwYzE0ODM2/MTlhNi5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}