{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Mikkipedia","title":"Dr Robert Kushner on GLP-1s, appetite biology and coming off the drug","html":"","width":"100%","height":180,"duration":4279,"description":"Episode Summary\nThis week Mikki talks with Dr Robert Kushner, an obesity medicine physician, educator and researcher with over four decades in the field. He is Professor Emeritus at Northwestern University Feinberg School of Medicine, a founder and the first chair of the American Board of Obesity Medicine, and a past president of The Obesity Society. He was also the corresponding author on the STEP 1 semaglutide trial published in the New England Journal of Medicine in 2021, and sat on the steering committee for SELECT — so he has watched this field from the inside, before and after GLP-1 receptor agonists arrived.\nThe conversation traces what clinicians actually understood about obesity in the 1980s and 90s, Bob's own leptin trial and why it did not deliver, and how reframing obesity as a biological disease led researchers to the gut hormones. From there it moves into the practical territory: how the clinical conversation has shifted from counting calories to diet quality, which side effects are real and which are social media noise, what happens to muscle mass and physical function, how dose escalation should actually work, why hunger returning is not the same as weight regain, and what the evidence says about stopping. Bob is careful throughout to separate what the trials show from what is still unknown, which makes this a useful listen whether you work with clients on these medications or are weighing them up yourself.\nKey Topics\nWhat clinicians believed about obesity three decades ago — excess body fat was known to cause system-wide harm, but the mechanisms, and appetite dysregulation in particular, were not understood, and weight regain after lifestyle intervention was already expected\nBob's own leptin trial in the 1990s, published in JAMA, and why leptin turned out to be a useful biological signal rather than a treatment — it defends against weight loss but was never built to stop overeating\nThe STEP 1 result and why it changed the field: 15% average...","thumbnail_url":"https://img.transistorcdn.com/5uUjJw6NUZC5FWMQgLCI47ibFa6tBB2C0z8A_feCZiY/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS8wNjI2/NTEwMjAyMWQ2M2Iy/ZjliYjA4ZGFhMTBh/N2E2Ni5qcGc.webp","thumbnail_width":300,"thumbnail_height":300}