Topics We Cover:
00:00 – New data from Harvard/Mass General may classify nearly 70% of adults as having obesity
03:00 – A new oral triple agonist shows record-setting absorption rates
07:00 – Fractal Health’s Revita procedure: weight maintenance after stopping GLP-1s
12:00 – Zepbound vial prices drop (full breakdown by dose)
16:00 – Dave’s personal experience switching off Mounjaro and intense hunger return
22:00 – Novo Nordisk’s EVOKE/EVOKE+ Alzheimer’s trial: what the data really means
29:00 – Why GLP-1 neurological research is just getting started
33:00 – Updates on access, partners, and major news coming soon for Medicare patients
If you’re on Wegovy, Mounjaro, Zepbound, Saxenda, Trulicity, or compounded versions, this episode gives you the insight and context you need to have more competent and confident conversations with your doctor.
Bullet Point Summary of the Podcast Episode
Harvard and Mass General propose adding waist circumference to BMI to better diagnose obesity.
Traditional BMI misses key factors like muscle mass and body composition.
Using the updated measure, Americans classified as obese jumps from ~43% to almost 69%.
This means 7 out of 10 U.S. adults would now qualify as having the disease of obesity.
Dave notes this validates many people who “feel” metabolically unwell despite a “normal” BMI.
Reinforces his claim that “most people should be talking to their doctors about GLP-1s.”
From Ascletis (A-S-C-L-E-T-I-S), developing an oral triple agonist targeting:
GLP-1
GIP
Glucagon
Similar in mechanism to retatrutide, expected around 2027.
Preclinical (animal) data show stunning results:
Oral bioavailability of 4.2%
9× higher than tirzepatide
30× higher than oral semaglutide
6× higher than oral retatrutide
57× greater drug exposure than oral retatrutide
Half-life ~56 hours
Stronger receptor activation than retatrutide in vitro
Suggests potential for the first powerful oral triple agonist—worth watching.
️ 3. Discussion of the Gray Market / TikTok Experience
Dave briefly recounts losing his TikTok account and landing in an algorithm filled with teenagers promoting gray-market “retatrutide.”
Expresses concern over unregulated peptide sales, especially to minors.
New results from the Reveal One study (Fractal Health).
Participants: lost 24% of body weight on GLP-1s → stopped injections → got one Revita procedure.
At 6 months post-GLP-1 discontinuation:
Weight changed only 1.5% (vs. ~10% regain in typical off-drug trials)
HbA1c barely shifted
Safety profile clean
Suggests possible long-term weight maintenance without injections through gut mucosal re-lining.
Dave describes his own recent attempt to switch drugs and significant hunger return.
Dave discusses how stopping Mounjaro caused terrifying, primal hunger.
Describes the distinction between:
Food noise (brain-based thoughts)
Hunger signals (biological/animalistic)
Reinforces why many patients cannot maintain weight loss without support.
Eli Lilly drops cash-pay vial pricing:
2.5 mg: $349 → $299
5 mg: $499 → $399
7.5–15 mg: $499 → $449
Community feedback (informal poll):
Most say still too high to leave compounded versions.
Many would switch to branded if price hit $200–$300.
Dave notes the Most Favored Nations agreement will push GLP-1 prices toward $250/month within 24 months.
Oral semaglutide (Rybelsus, 14 mg) did not slow Alzheimer's clinical progression.
Biomarkers improved but daily function and cognitive decline did not improve vs placebo.
Important context:
Oral Rybelsus is a weak form of semaglutide; stronger versions (like Wegovy 2.4 mg or upcoming high-dose oral Wegovy) not tested.
Weight loss is not desirable in Alzheimer’s patients, influencing drug selection.
Dave emphasizes:
This was a nearly $700M trial and an act of scientific courage.
This is NOT the end of GLP-1 Alzheimer’s research.
Future molecules may target neurological pathways without suppressing appetite.
Mentions Lilly’s brenipatide, a GIP receptor agonist being developed for:
Addiction
Opioid dependency
Possibly asthma
️ 8. Access, Cost, and Patient Empowerment
Highlights Shed as a partner offering telehealth GLP-1 access.
Notes many patients hide GLP-1 use from their primary care doctors.
Reinforces OTP’s mission: better, more honest conversations with clinicians.
Dave explains how the Shapa numberless scale helped him stay engaged during weight fluctuations.
Finds stepping on “zones” (green/gray/blue) less emotionally damaging than numbers.
Promises upcoming Eli Lilly savings card update.
Encourages subscribing, liking, and enabling notifications for algorithm visibility.
Thanks OTP community for amplifying patient-centric obesity medicine news.
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