Dr. Spencer Nadolsky
speaker
117 appearances
1 recordings
1 series
first heard May 2025
last heard May 2025
Dr. Spencer Nadolsky’s voice in public audio — every appearance, attributed to the second.
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You know, do you get 30% to 40% or more total body weight loss? Pretty drastic. People are like, oh, God, I got to get surgery? It's like, great. So that's why in 2021, when semaglutide Wegovy was approved at that 15% total body weight loss, things changed so much. That's why everybody's like, it's a game changer. Because we were really limited in how we helped people.
It was like resources for intensive coaching. That takes a lot to get people. And then it's very frustrating because Everybody says they know what they do. I mean, my patients aren't idiots. Some people are. Some people are idiots. They don't know what to eat. I remember a patient, I was like, hey, let's try to eat more protein, whatever.
And they came back and they're like, I don't know, I'm eating more protein, but I can't lose weight. And I was like, well, tell me what you're eating. And they're eating a bunch of spare ribs. And I'm not saying this person is idiot, but it was clear that even though I gave a list of the foods, like spare ribs, that was what they were eating for protein.
And it was, you know, along with a bunch of other things. But most people understand that, hey, I should probably eat more broccoli instead of French fries. Like it's just very, very, most people have that. And a lot of these people have been trying for their whole life. And so like for them to come to a weight loss doctor specialist, obesity specialist, and
and me basically going okay here's what we need to do i got these other drugs that maybe you're not going to tolerate but like let's really focus on these behaviors they're like i already know these things it's it's it was very frustrating from a doctor's standpoint a clinician standpoint and then also from a patient standpoint it's like so that's why they go and get the 300 a month detox from someone online or whatever that promises to rid them of their fat and then they
lose all their money doing that. And it's just very frustrating. So that was what it looked like before these drugs.
And I was like, yeah, that's pretty much it. And I don't even blame... I was just on another podcast. I don't even get mad at these people because I had it myself. I was a young wrestler before. pretty jacked dude and been like, why, why aren't these people just like eating better and exercising? Why? It seems like it's just a, they're lazy and gluttonous or something like that.
It wasn't until, you know, going through med school and then going to conferences, talking to very smart neurobiology experts and researchers and other obesity doctors, and then talking to patients and really seeing the pattern where I started to understand it. And actually it was when I did a bodybuilding competition and got a that brought my calories just to 20.
I'm trying to eat 2,200 calories, which is probably what most people would be like, that seems like a lot. I was starving on 2,200 calories. And I was, I, I couldn't stop myself from eating Pringles. And like, I like started kind of having disordered eating. Like I couldn't, I couldn't stop. I was like, I was so ravenously hungry and craving. And I, and what my patients described was kind of that.
So I could imagine them being you know, in a 300 pound or 250 pound body with a lot of excess adipose tissue, trying to lose weight and feeling that way, just that, you know, I was already really lean, but like they're feeling that way at a higher body fat. That's what made me go like, oh man, I think I missed the mark.
And so there's two different things because people think of the disease in two different ways. The disease, the way the AMA kind of described it back in 2013, the criteria of like certain signs and symptoms, certain associated with morbidity, mortality, those types of things, like definition of disease. a disease versus the pathophysiology of what drives it.
So right now, there's the Lancet Commission just came out with their whole definition of obesity, and they tried to describe basically preclinical obesity. So basically people that don't have those sequelae or issues from their excess adipose tissue, they're healthy, basically, other than just a lot of adipose tissue.
Then they talk about clinical obesity and that those are people with, say, like type 2 diabetes or prediabetes, hypertension, some issues arising from the excess adipose tissue. So that's how some people talk about the disease of obesity. But what I think you're getting at and what I like to talk about is that the pathophysiology of what drives that adipose gain. Why is it that some people
you know, they just change their habits a little bit and lose the weight and never gain it back versus other people. They try to lose the weight and their body fights them tooth and nail and they essentially just cannot lose the weight or keep it off without some extra tool despite their best efforts and all the the amount of effort that they put into it.
So it's that pathophysiology that I think is really what people need to understand because otherwise they just think it's a choice. Yes. You just think they're just like, I don't understand. It's just a calorie deficit. It can't be a disease. And it's like, whoa. I was like, what is choice? Even if it were a choice, that doesn't mean that this person doesn't have a disease.
For the bros out there, I'm always like, let's say if you knew... that this woman out there had gonorrhea. Let's make it really clear. And you choose to still have intercourse with her and you get gonorrhea. Do you not have a disease because you chose that? No, that doesn't even make sense. You got to think of that. Good point. And then I always talk about like, what about type two diabetes?
We don't think of it that way. Do we say people choose to have type two diabetes? No. So the choice thing doesn't have anything to do with it. But going into the pathophysiology though, it's like, If it truly, even if, like, it's not a choice, though. It's not a choice because, like, people would never choose to have obesity. And people are like, well, they're choosing the habits.
They clearly chose an extra serving, an extra helping at dinner when they didn't have to. It's like, no, they're It's the underlying appetite dysregulation or derangement that's driving it. The biology drives the behavior. And of course, the environment. So like, you know, Cali Means and all these other people will say, like, no, we don't need drugs. We need to change our environment.
We do need to change the environment. The environment will help prevent the obesity from occurring in the first place. But once that obesity develops, their brain... Is changed. Yes. Their genes are changed.
Yeah. I describe it as like, think about the circuits in our brain and the circuits in our brain control a lot of our processes in our body. One of them being appetite. In a normal brain, someone that doesn't have obesity or struggles with their appetite, all the circuits are working well. But think about someone that struggles with their obesity and losing that weight and keeping it off.
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