The Dr. Tyna Show
Obesity Isn’t A Willpower Problem: The Role Of GLP-1s | Dr. Spencer Nadolsky
Thu, 15 May 2025
EP. 212: Today I’m joined by Dr. Spencer Nadolsky, obesity specialist, Lipidologist, and founder of Vineyard, a cutting-edge direct care platform. We’re diving deep into the conversation you’ve been asking for: the real story behind GLP-1s, obesity as a chronic disease, and why treating it goes far beyond weight loss. We break down everything from proper dosing, common side effects, and the dangers of vanity prescribing to the systemic issues with telemedicine and PBMs. Dr. Nadolsky and I also discuss strength training, preserving muscle mass, and how GLP-1s may support metabolic and cardiovascular health beyond their FDA indications. This episode cuts through the noise and misinformation. If you care about metabolic health, this one’s essential. Topics Discussed: What are the real benefits of GLP-1 medications beyond weight loss? Is obesity truly a chronic disease, and how should it be treated? What are the risks of GLP-1 vanity dosing and fast titration? How do GLP-1s impact muscle mass and metabolic health? Why are telemedicine and PBMs problematic for obesity treatment? Sponsored By: Maui Nui Venison | Head to mauinuivenison.com/DRTYNA to secure your access now. LMNT | Get your free Sample Pack with any LMNT purchase at drinkLMNT.com/drtyna Qualia | Go to qualialife.com/DRTYNA for up to 50% off your purchase and use code DRTYNA for an additional 15% Liver Love | Go to https://store.drtyna.com/products/liverlove Use code LIVER20 for 20% off On This Episode We Cover: 00:00:00 – Introduction 00:02:48 – GLP-1 Dosing 00:06:35 – Side Effects of Vanity Dosing 00:08:51 – Reducing GLP-1 Dosing 00:12:27 – Med Spas & Telemedicine Risks 00:14:20 – Slow Titration for Better Tolerance 00:18:44 – Pharma Profits & Overdosing 00:20:49 – Obesity Treatment Pre & Post GLP-1s 00:27:58 – Obesity Is a Chronic Disease 00:32:45 – Defining obesity 00:36:16 – The Role of Genetics in Obesity 00:38:59 – Lifestyle Factors Beyond Genetics 00:40:46 – Insurance Barriers & PBM Costs 00:44:37 – Anti-GLP-1 Bias in Healthcare 00:46:22 – Why Strength Training Matters 00:51:39 – New Doctors & Role of AI 00:53:38 – Protecting Muscle on GLP-1s 00:58:55 – No Shortcuts to Health 01:02:01 – The Vineyard Show Links: Glp-1s Can Help Employers Lower Medical Costs In 2 Years, New Study Finds Further Listening GLP1 Uncovered FREE 4 Part Video Series Ozempic Done Right Playlist EP. 202 | The Fight for Affordable GLP1s & the Truth About Big Pharma | Dave Knap Check Out Dr. Spencer Vineyard Instagram Website Podcast Disclaimer: Information provided in this podcast is for informational purposes only. This information is NOT intended as a substitute for the advice provided by your physician or other healthcare professional, or any information contained on or in any product. Do not use the information provided in this podcast for diagnosing or treating a health problem or disease, or prescribing medication or other treatment. Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or other supplement, or using any treatment for a health problem. Information provided in this blog/podcast and the use of any products or services related to this podcast by you does not create a doctor-patient relationship between you and Dr. Tyna Moore. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent ANY disease.
Chapter 1: Who are the guests and what is the focus of today's episode?
You are tuned into the Dr. Tina Show with Dr. Tina Moore. For more, visit drtina.com. On this episode of The Dr. Tina Show, I'm so excited to bring on Dr. Spencer Nadolski. Dr. Nadolski is someone I've been following for a long time on Instagram. He's an obesity specialist. He's a lipidologist. He also is the owner and founder of Vineyard, which is an online direct care model.
He specializes in GLP-1s and we are going to have the obesity conversation that you all have been asking me for. You know I've been talking about these peptides for a long time outside of weight loss, outside of type 2 diabetes, although my message has been skewed over the past few years.
I've been trying to talk about them in relation to all of the other benefits throughout the body that they may or may not have in the clinical data. That said, this is an important conversation to have. We need to talk about obesity as a disease, and I need folks to really understand what that means. And I can't think of a better person for the job than Dr. Nadolski.
So without further ado, let's jump in. Dr. Spencer Nadolski, I'm so excited to have you on the Dr. Tina show today. And we are going to talk all things obesity, GLP-1s. This is a conversation I wanted to have because I've been trying to
seeing the praises of glp-1 agonists outside of obesity and weight loss and type 2 diabetes just more in a metabolic health cardiovascular uh you know neuroprotective way and everybody's been begging me to bring on an obesity doctor and a specialist like yourself so here we are thank you for coming we're doing it yes i'm excited i'm excited so i've been following you for years and i'm a huge fan of your work and i see more often than not these days
You sort of playing pickleball with all the GLP-1 misinformation and nonsense that comes constantly into our inboxes. I don't even get into it. I just let you do it.
It's exhausting. It's exhausting. Like a game of pickleball could be, I suppose.
Yes, yes. And then you have... really created this awesome, innovative direct care platform called Vineyard. So we're going to talk about that too, because I think what you're doing is exciting. I think you and I agree on a lot of things.
One is that these telemed companies for the most part, and I have heard good feedback from a few of them for really uncomplicated cases for people who really just needed a little something, something. But in the case of most people and most patients, especially those dealing with
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Chapter 2: What are the risks of improper GLP-1 dosing and vanity prescribing?
at least a moderate to more excessive amount of obesity and or type 2 diabetes i think that docs or patients need a much better care system and i see you talking about that online can you extrapolate on that a bit more yeah you know these medicines are amazing i would call them miracle medicines but they there's no there's never a free lunch and you may be one of the people um
that do just fine on a little dose and go through your journey, just fine, no issues. And that does happen. However, I would say it's not rare. It's still uncommon, but common enough when you have hundreds of patients that you see some of these side effects, especially at the higher doses that get brushed off by someone if they don't listen.
For example, the one that I'm seeing more recently and I've made some videos on is anhedonia, just kind of feeling meh, blah. And it actually happened quickly in 2022 when Manjaro came out. We were all using it off-label. Everybody's like, oh, how dare you use that drug off-label? I'm like, well, the Surmount trial was out. It just wasn't available as that found yet.
It wasn't approved yet, but the Phase 3 trial was out. So we were using it for obesity a lot. And people were feeling tired. And you see it with WeGoV2, the semaglutide. But terzapatide, we were seeing it and people were like, well, it's got to be from the calorie deficit. And that makes sense that people would feel tired from a calorie deficit.
However, there were people that weren't losing weight, any weight. They didn't feel like any appetite suppression, but they were feeling tired. And so it's kind of like, okay, if they're not losing weight, they're not in a calorie deficit, they don't even feel the appetite suppression, but they're feeling tired, it's probably something beyond the calorie deficit that's making people feel tired.
And when you talk to them, is it like, do you just want to go to sleep tired? For some people it is, but what I'm seeing is just kind of like a lack of motivation. So before... They were going to the gym, they're trying to be healthy, doing all the physical activity stuff. And now all of a sudden they're just kind of like, oh, I don't feel like eating.
But I also don't feel like working out anymore. And that defeats the whole purpose. We're trying to get people healthier. So despite their adipose tissue or whatever, physical activity has many... I mean, I know you've talked about this all the time.
Yeah, we're going to get into that. We're going to talk about the strength training because that's the other thing that we definitely jive on.
Yeah, physical activity is super important regardless of the number on the scale. So that's like, okay, that started... I saw it so many times. And then I made a video recently about it. And then all of a sudden I got tons of messages from patients because they didn't report it. They didn't even know it was a thing.
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Chapter 3: How did obesity treatment evolve before and after GLP-1 medications?
She started going to the gym, broke through a plateau, lost 10 pounds, even though she'd been plateaued for months on the highest dose. And this doesn't break the laws of thermodynamics. People are like, it's all calories in, calories out. Yeah, she didn't feel like moving anymore because the drug was... And now I always talk about the drug facilitating behavior change.
But once it gets past that point and now all of a sudden the behavior change isn't occurring because they're... Their dopamine is so dampened down. That's not good either. So, yeah, it was pretty cool. It was really interesting. I was like, please, can I share your story? And that's what I did. And then tons of people started messaging me going, I think that's me.
And I'm like, holy cow, this might be a bigger problem than people understand.
I think it is. I think there's a sweet spot for each individual. And I think it depends on factors personally. And I know you've dealt with this a lot more in the obesity realm and probably with way more patients. But the factors that I see impacting it are how active are they? What's that sweet spot where you can get appetite suppression but not crushing it? You know, more of appetite control.
We just want appetite control. I guess in some cases we would want some suppression, but generally speaking, I just want people to feel in control of what's happening with what they're choosing to put in their mouth. And then past that, you get into this... The blahs. And then they do stop moving. And so you lose thermogenesis because they're just like this on the couch.
You're not getting any of that neat. You're not getting any of that. Even people who... I really do believe that a lot of folks stay lean just because they're fidgeters. Like I'm a fidgeter. It keeps me, you know, that's how I keep going. And when you lose that desire to get up and go and bustle around, and you can dose people into that place. And I think that that's probably happening.
And I really, my biggest concern at this point is the... these medispas and like what the actual hell is going on there. And then a lot of the telemedicine companies, I think some of them again are doing, are trying to do a better job and really do care. But there's others that are just like fly by night. And then there, what I don't think people understand is they're,
giving kickbacks to influencers.
Yeah.
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Chapter 4: Why is obesity considered a chronic disease and how does it affect the brain?
So what you have probably seen out there is never at all what I started talking about. It got twisted. along the way.
And I am glad that the conversation opened about a more personalized dosing strategy, which is really what I was trying to say is like, if you are going to use it for weight loss or type two diabetes, could we potentially start people at a dose that doesn't make them vomit profusely for two weeks while they adapt? Like, could we onboard more gently? That seems reasonable.
Very reasonable. And honestly, it's needed sometimes. In other countries, they have clickable pens that you can do. Well, Ozempic actually has a clickable pen, and that's here in the United States. But Wegovy doesn't have it. Zetbound doesn't have it. Manjaro doesn't have it. So you see a lot of people going to the compounding route, which is kind of going by the wayside now.
But like in other countries, there are quick pens that you can do terzapatide in between doses. And it really is needed. It's more for semaglutide. Semaglutide is not as well tolerated. So it's nice to have that for semaglutide. But even terzapatide, the starting dose is 2.5. And sometimes I'm like, I really wish I could do a one milligram because this person's a high responder to this stuff.
They're losing weight too quickly, even on the lowest dose. It would be nice to just go a little bit lower, even half of that. But you can. You'd have to You have to get the vials, and the vials are a single-use vial, or you'd have to inject the pen into and make your own bacteriostatic violators. It's ridiculous. And then it starts getting a little bit potentially dangerous there.
So yeah, it would be nice if, and that comes down to, and we can get into the corporate greed, the pharmaceutical greed, but they don't want people splitting them up because otherwise we could just prescribe 15 milligrams of Zepbound or Monjaro and just have them split up into the smaller doses and have it last longer. They don't want that.
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Chapter 5: What role do genetics and lifestyle factors play in obesity?
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Chapter 6: How do telemedicine and PBMs impact obesity treatment?
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Yes.
If we need to cut a tablet in half. I mean, that's how I've always understood compounding pharmacies and what I've used them for was when the dose needed to be something different or maybe they didn't want the dyes that were on the medication or there was filler or there was corn additives or whatever.
Chapter 7: Why is strength training important for those on GLP-1 therapy?
Chapter 8: What is the importance of personalized dosing and careful management of GLP-1s?
One is that these telemed companies for the most part, and I have heard good feedback from a few of them for really uncomplicated cases for people who really just needed a little something, something. But in the case of most people and most patients, especially those dealing with
at least a moderate to more excessive amount of obesity and or type 2 diabetes i think that docs or patients need a much better care system and i see you talking about that online can you extrapolate on that a bit more yeah you know these medicines are amazing i would call them miracle medicines but they there's no there's never a free lunch and you may be one of the people um
that do just fine on a little dose and go through your journey, just fine, no issues. And that does happen. However, I would say it's not rare. It's still uncommon, but common enough when you have hundreds of patients that you see some of these side effects, especially at the higher doses that get brushed off by someone if they don't listen.
For example, the one that I'm seeing more recently and I've made some videos on is anhedonia, just kind of feeling meh, blah. And it actually happened quickly in 2022 when Manjaro came out. We were all using it off-label. Everybody's like, oh, how dare you use that drug off-label? I'm like, well, the Surmount trial was out. It just wasn't available as that found yet.
It wasn't approved yet, but the Phase 3 trial was out. So we were using it for obesity a lot. And people were feeling tired. And you see it with WeGoV2, the semaglutide. But terzapatide, we were seeing it and people were like, well, it's got to be from the calorie deficit. And that makes sense that people would feel tired from a calorie deficit.
However, there were people that weren't losing weight, any weight. They didn't feel like any appetite suppression, but they were feeling tired. And so it's kind of like, okay, if they're not losing weight, they're not in a calorie deficit, they don't even feel the appetite suppression, but they're feeling tired, it's probably something beyond the calorie deficit that's making people feel tired.
And when you talk to them, is it like, do you just want to go to sleep tired? For some people it is, but what I'm seeing is just kind of like a lack of motivation. So before... They were going to the gym, they're trying to be healthy, doing all the physical activity stuff. And now all of a sudden they're just kind of like, oh, I don't feel like eating.
But I also don't feel like working out anymore. And that defeats the whole purpose. We're trying to get people healthier. So despite their adipose tissue or whatever, physical activity has many... I mean, I know you've talked about this all the time.
Yeah, we're going to get into that. We're going to talk about the strength training because that's the other thing that we definitely jive on.
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