What is GLP1… and why is it everywhere? with Rekha Kumar and Dhruv Khullar

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0:33This episode is brought to you by Planet Visionaries, a podcast in partnership with the Rolex Perpetual Planet Initiative. Planet Visionaries is the podcast celebrating the people creating practical, hopeful solutions for our planet's urgent conservation challenges. Season 6 launches this fall with bold, real solutions. Hear from Anna Rathman of the Jane Goodall Institute on protecting wildlife. Tom Pesach on his 396-day journey documenting the entire Amazon. And Lydia Oshie, a Guatemalan leader opening doors for Indigenous girls to access global education. Hosted by legendary climber and advocate Alex Honnold, each episode goes beyond the headlines to show what's actually working and who's making it happen.

1:18In partnership with the Rolex Perpetual Planet Initiative, this is Planet Visionaries. Listen or watch wherever you get your podcasts. Today's episode is sponsored by Kashi. Say hi to new Kashi Gut Health Granola, a straightforward, delicious way to fuel your gut, made with prebiotics, fiber, and cultures. My favorite flavor, blueberry almond, has perfectly crispy clusters, delicious almonds, and bursts of whole blueberries. It's an easy fit for a daily routine, whether that's for breakfast or a snack. In a world of overwhelm, it's a straightforward, delicious choice. Try new Kashi Gut Health Granola.

1:58This is TED Health, a podcast from TED, and I'm Dr. Shoshana Ungerleiter. I'm a board-certified practicing internal medicine physician, and I'm your host for today's show. I've been a practicing physician for more than 13 years, and in that time, I've learned that medicine isn't just about the body. It's also about the stories we tell ourselves about ourselves. Most recently, I see this playing out with GLP-1s. These medications began in many ways as a diabetes story. Then they became a weight loss story. And now with about one in eight American adults currently taking a GLP-1 medication, they've become a story about so much more.

2:39GLP-1s are challenging some of the assumptions that many of us have carried for years. That hunger is simple. That weight is mostly about discipline. That metabolism lives in one part of the body and mental health lives in another part. That a medication either treats disease or it doesn't. Instead, GLP-1s are prompting new questions about all sorts of things. The brain, hunger, inflammation, addiction, even desire. We're seeing these drugs reshape the world around us, rippling through our economy, our food systems, our workplaces, and the way we talk about willpower. And through it all, patients are navigating side effects and cost, stigma, long-term uncertainty, and a culture that can turn almost any health tool into a beauty standard.

3:26GLP-1s touch on some of the most difficult and personal topics in our lives, and naturally, these conversations can become heated and complex, and even traffic in misinformation. So today, we're going to slow down and ask some big questions, like what do these medications actually do? What do we know so far? What are we still learning? And how can both patients and doctors think about GLP-1s with hope and care. To help us do that, I'm joined by Dr. Rekha Kumar. Dr. Kumar is an associate professor of clinical medicine and an attending endocrinologist at Weill Cornell Medicine. She's senior medical advisor at Found, a digital health company focused on scaling access to treatment for obesity and metabolic disease.

4:10She specializes in adult primary care, endocrinology, obesity medicine, type 2 diabetes, PCOS, thyroid disease, and metabolic bone health. She was the first medical director of the American Board of Obesity Medicine, and she's closely involved in global health initiatives to help understand the effects of urbanization on metabolic health. She's traveled to Tanzania, China, and India to learn, teach, and practice medicine. I'm so excited to welcome her to the show today. Dr. Rekha Kumar, Welcome to TED Health. Thank you so much for having me. So I want to start with the basics here. When we say GLP-1 medications, what are we actually talking about and how do they work in the body?

4:53When people mention GLP-1 medicines or GLP-1 receptor agonists, they're often talking about Ozempic, Munjaro, Wegovi, and Zepbound. So they're talking about a class of medicines that's prescribed for type 2 diabetes and for obesity or overweight. GLP-1s regulate blood sugar, so they help your pancreas make insulin to balance blood sugar. GLP-1s slow stomach emptying, so you feel full for longer. And GLP-1 medicines also signal fullness to the appetite regulating center of the brain. So we know these drugs were first developed for type 2 diabetes, as you mentioned. What did they change for patients with type 2 diabetes?

5:41And what did clinicians begin to notice that expanded the story beyond just blood sugar? So we've been prescribing GLP-1s for type 2 diabetes and blood sugar management for about 20 years. In the early days of prescribing these, we also saw that these patients lost weight, had reduced appetites. And most interestingly, we were able to reduce the insulin requirements that these patients had. So we're talking about patients that had pretty complicated diabetes. They were on high doses of insulin to lower their blood sugar. But when we started them on GLP-1s, yes, their blood sugar normalized, but it was through multiple pathways, not just the GLP-1 lowering the blood sugar, but by reducing the appetite and improving how the body processes blood sugar.

6:34And what's striking is that those observations also challenge some of the very old assumptions about appetite and weight. A lot of people still think of hunger as maybe a stomach problem alone, but these medications seem to show us that hunger is deeply connected to the brain. So how do you explain that to patients? One of the greatest impacts of GLP-1s has actually been destigmatizing the conditions of overweight, obesity, and overeating. Not only did we believe that this was a stomach problem, but there are many people that felt this was a willpower problem and a moral failure if you were overweight, obese, or consumed large quantities of food beyond the average person.

7:20So there are many types of hunger, and that's what these medicines have taught us. Hunger isn't just about willpower or pleasure. It's about stomach fullness. It's about brain fullness and the communication between the gut and the brain. Yeah, it's so fascinating and something I don't remember learning much about in medical school, which was now almost two decades ago, but not that long ago, right? And I think that helps make sense of something that patients often describe in much more everyday language, this idea of food noise. And we hear that phrase, food noise, a lot now. What does that mean clinically?

7:57And what do patients tell you when that noise gets quieter? Yeah, so I agree with you. Medical school was 20 years ago for me too, and I don't recall learning this. I learned the phrase food noise from my patients. Food noise is not a medical term, but it is something that existed, I would say, in the eating behavior, eating disorder world, either through psychology, through the eating disorder therapy world. And it was new to me when I started to see patients say to me that their food noise is reduced. Well before we saw this in the mainstream, I was an early prescriber of off-label GLP-1s and women with PCOS are now called PMOS.

8:38and these are women with a lot of insulin resistance and a strong hormonal drive to eat carbohydrates. When we put these women on GLP ones, they would literally say, this is the first time I feel normal. It is the first time I am not constantly thinking about what I should eat, not to eat, what I have to eat for the next meal in order to not gain weight. And these were hormonal driven pathways in these women with insulin resistance. But as time went on, not just women with insulin resistance or PCOS, but rather other people that benefited from GLP-1s who spent their entire lives really white knuckling it to control their weight, to control their calories, to stop eating before their brain perceive fullness.

9:24And that's food noise. And that is quieted for a lot of people on these medicines. And that experience raises a deeper question about how we've historically thought about personal responsibility around eating and weight. And I want to come back to something you already mentioned. For someone listening at home who's wondering, well, isn't this just willpower in a syringe? Like, how would you respond? Willpower is an abstract concept. Something in a syringe is molecules, proteins, peptides that are measurable. They're dosed. They have a receptor. I don't think we could say that willpower has a receptor necessarily.

10:02It's a combination of factors. I don't want to over medicalize this. Yes, there is an amount of intention over what we eat, how we exercise and the choices we make, which is why we say these medicines should only be used as a tool. But if everyone has employed those foundational behaviors, they have repeatedly attempted to control their calories, they are exercising regularly, they're tracking what they're doing, yet nothing is working. They're continuing to gain. They have food noise or preoccupations with the entire process. I would say that that's where we have learned a tremendous amount about the biology of this.

10:47that when someone's doing everything right and then we add these medicines in as a tool and the only thing we change is the thing in the syringe and suddenly it all clicks, that shows us this isn't willpower. These people had willpower the whole time. Granted, these medicines are being used inappropriately. There are people that haven't established the foundational behaviors that are relying on these to become artificially or excessively thin. But in the people doing the right thing that are using this as a tool, there's no question that what you're putting in the syringe is not willpower, but rather a biological unlock.

11:24More of my conversation with Dr. Rekha Kumar after a quick break.

11:31This episode is brought to you by Planet Visionaries, a podcast in partnership with the Rolex Perpetual Planet Initiative. Planet Visionaries is the podcast celebrating the people creating practical, hopeful solutions for our planet's urgent conservation challenges. Season 6 launches this fall with bold, real solutions. Hear from Anna Rathman of the Jane Goodall Institute on protecting wildlife, Tom Pesach on his 396-day journey documenting the entire Amazon, and Lydia Oshie, a Guatemalan leader opening doors for Indigenous girls to access global education. Hosted by legendary climber and advocate Alex Honnold, each episode goes beyond the headlines to show what's actually working and who's making it happen.

12:16In partnership with the Rolex Perpetual Planet Initiative, this is Planet Visionaries. Listen or watch wherever you get your podcasts. Today's episode is sponsored by Kashi. Say hi to new Kashi Gut Health Granola, a straightforward, delicious way to fuel your gut, made with prebiotics, fiber, and cultures. My favorite flavor, blueberry almond, has perfectly crispy clusters, delicious almonds, and bursts of whole blueberries. It's an easy fit for a daily routine, whether that's for breakfast or a snack. In a world of overwhelm, it's a straightforward, delicious choice. Try new Kashi Gut Health Granola.

13:04so if we move beyond that willpower framework i think it becomes important to ask what these medications should realistically be expected to do and where their limits are so you're an expert on obesity and you think a lot about weight ideally what role should glp1s play in weight management and maintaining a healthy body and what can't they do? So we'll start with what can they do. So GLP-1s can provide that biological unlock for people who have what we call gut-brain disconnection. Their stomach fullness and their brain fullness are not on the same page. And when you really tease it out with these patients and you ask them, do you think your brain can eat beyond when your stomach is full?

13:49And some people will know exactly what you're talking about. And, you know, there's a scientist at the Mayo Clinic that characterized these different types of persona, hungry brain, hungry gut, hedonic eater, like eater for pleasure. There are sort of different groups of people that are hungry for different reasons. But the way that these medicines are supposed to work is that when somebody has optimized their lifestyle from a food exercise perspective, the medicines are supposed to play the role of fixing the gut-brain axis while you take these medicines. What they are not meant to do is permanently change the body.

14:28So you can't take these medicines for two weeks, five weeks, one year, and then say, now I'm at my goal weight, I'm going to stop them because you take away the thing that was fixed. The biological unlock is suddenly gone. And this is something I believe is related to the stigma of bigger bodies, obesity, and willpower is this idea that you should take this medicine for a short time and be able to get off of it. There's no science that supports that. We don't put those same beliefs on cholesterol medicine, blood pressure medicine. We don't say to someone, oh, your LDL cholesterol is at goal. Now stop your Lipitor and let's keep your LDL at 70.

15:08Why is that, right? We understand that high cholesterol and high blood pressure are chronic diseases that require long-term medicine in order to keep the condition away. The same is true for medically complicated obesity and overweight with a predisposition towards preclinical disorders. The caveat here is that we are seeing benefits of these medicines well beyond weight. This is where, to me, the science gets incredibly interesting. So these drugs are often discussed as weight loss medications, but the research now points to effects on other parts of the body and other functions. What feels most important and most surprising to you right now beyond weight loss?

15:56From a clinical perspective, what is most interesting, surprising, and beneficial to patients is this reduction in inflammation. And we can look at that in so many ways. There's the obvious. We know that obesity comes with inflammatory body fat. That's not good for you. It raises your risk of heart disease. Fine. That's understandable. And cancer. And cancer. Correct. So take that inflammation aspect a step further. And we talked about heart disease, what increases your risk of heart disease, inflammation in the blood vessels, And what was noted in the SELECT trial, which was a huge cardiovascular outcomes trial, was that cardiovascular benefit was seen even in patients that did not lose as much weight.

16:42So when we saw that people on Wegovi, an FDA-approved GLP-1 for weight loss, had a 30 % reduction in heart attacks, the first reaction was, of course, they lost weight. When the scientists went back and analyzed the data and saw that that cardiovascular benefit existed, even when people didn't lose the expected amount of weight, that led people to say, well, maybe there's something else going on here. And when you speak to patients, even ones that don't lose a lot of weight will say they feel less bloated, they feel less puffy. I'd say the anti-inflammatory benefit of these medicines have been the most interesting and most surprising to me.

17:22And where do we need to be careful not to overstate the science here at this point? I would be really cautious in prescribing these medicines just to reduce inflammation, which is somewhat of a vague concept unless there's actual laboratory evidence of it in somebody that doesn't meet the need for these medicines otherwise. So for example, somebody that says they are concerned about developing Alzheimer's and inflammation of the brain, but they are thin and fit and lean with normal blood sugar otherwise. That's where I would be cautious at this point. Can the inflammation be lowered if somebody has these other conditions and we feel comfortable prescribing as per what they're indicated for, but there's a secondary benefit of lowering inflammation?

18:12Absolutely great. But this idea of someone just saying, I feel inflamed, I'm inflamed, I want to go on a GLP-1, that's where we have to be careful. Right. And that same balance between genuine promise or potential and scientific restraint, I think seems especially important when we turn to the brain. There is growing interest in GLP-1s and the central nervous system. So looking at reward, craving, studies on addiction, even cognition. What is the strongest evidence right now? And what do you think is still mostly hypothesis? So targeting the pleasure reward center of the brain seems to be something real that we are seeing when patients take these medicines, when they should be on these medicines.

18:58They may also report, oh, I find that I desire alcohol less, or I used to have X number of drinks a week. Now I'm satisfied with less. I had a really interesting case where a patient appropriately was prescribed a GLP-1 by me in my office and she came back for a follow-up. She was doing well. And she said to me, Dr. Kumar, you actually helped me with something else. And I said, okay, what did I help you with? And she said, I was a compulsive reader. I would read 14 books a week and it was disrupting my life. I would hide in the bathroom to finish books. And I said, are you still reading? And she said, yes, I'm reading two books a week like a normal person.

19:36And so whatever stimulates your reward center, and that could be different for everyone. It could be something that is dangerous for an individual and their family, such as gambling, drinking, compulsive shopping, but perhaps it could be something else. Reading doesn't sound like a bad thing, but it's something that was obsessive and it was creating a reward circuit in her brain. And interestingly, we treated her for her weight, but she benefited in another way related to this reward circuitry in her brain. And so we are seeing that. We don't yet have the answer to say, do we prescribe these medicines for addiction?

20:19But like you said, the signal is there. The other thing that the brain pathways are teaching us is that perhaps cognitive impairment, dementia that comes with age, that's not Alzheimer's, that is some other type of dementia, is this insulin resistance of the brain, is this inflammation of the brain. And are these medicines treating that? These are the questions we still have, but we're not prescribing these medicines yet just for that. And of course, changing reward or motivation isn't automatically positive. And that seems like an important complexity to acknowledge. So on the other side of things, some people describe having brain fog or emotional flattening, lower libido, less motivation.

21:04How should patients and clinicians talk about those experiences without dismissing them or jumping to conclusions for patients taking GLP-1? This is why patients on these medicines, no matter how well they are doing, no matter how consistently they're losing weight, patients need consistent follow-up with a clinician, with a health coach, with people that are not only watching the scale, but people that are watching their mood, their stress, their social interactions. And so this concept of anhedonia or a reduction in the ability to feel pleasure is something real that can happen. And perhaps that's appropriate if the reward is derived from food or excess food.

21:49But when that starts affecting other areas of the life, we have to intervene. So in somebody that's having a tremendous benefit on these medicines that says that they're blah, they're brain fog, would I immediately stop the medicine? No, I would truly assess for low mood, things in their social history. But I would say, are you eating small, consistent meals on day one and day two when your appetite is so suppressed? Are you staying hydrated? Do you want to put a little bit of electrolytes in your water? And let's check in two weeks. If the mood's not better, we back down. If the mood's better, we push forward.

22:24That brings us to the broader question every patient ultimately should weigh, I think. What are the actual risks of taking these medications? So what are the side effects patients should know about before starting a GLP-1 from, you know, the common GI ones to the less common concerns that really do require medical attention, especially given that so many people are getting these medicines through compounding pharmacies or barely seeing a physician through a chat and getting prescribed as opposed to a telehealth visit or an in-person visit with your doctor. So however somebody is obtaining these medicines, we need to emphasize that they are strong pharmaceuticals that carry the potential for side effects.

23:04The most common ones are gastrointestinal, nausea, vomiting, constipation, diarrhea, less commonly, but are noted or gallstones, the risk of pancreas inflammation or pancreatitis. These are things we see a couple of times a year versus the regular gut side effects, nausea that we may be seeing 50 % of the time. So those would be the most common. And then more rarely, there's these subtle mood changes. And there are people that don't tolerate the medicine, just like every other medicine that exists. Somebody might not even tolerate the starting dose. And that doesn't mean that they're big or small.

23:42I have very petite women that can be on the highest dose. And I have 300 pound men that can't tolerate the lowest dose. And so you can't really look at somebody and know how they're going to react. The other thing we should address is non-responders. There's still a portion of the population that can have no response to these medicines. And that is where the innovation going forward is so important. The next generation of these medicines that work on different gut hormones. We're still really excited to see all of that.

24:13We'll be back in a moment.

24:18This episode is brought to you by Planet Visionaries, a podcast in partnership with the Rolex Perpetual Planet Initiative. Planet Visionaries is the podcast celebrating the people creating practical, hopeful solutions for our planet's urgent conservation challenges. Season 6 launches this fall with bold, real solutions. Hear from Anna Rathman of the Jane Goodall Institute on protecting wildlife. Tom Peshach on his 396-day journey documenting the entire Amazon. and Lydia Oshie, a Guatemalan leader opening doors for Indigenous girls to access global education. Hosted by legendary climber and advocate Alex Honnold, each episode goes beyond the headlines to show what's actually working and who's making it happen.

25:03In partnership with the Rolex Perpetual Planet Initiative, this is Planet Visionaries. Listen or watch wherever you get your podcasts. today's episode is sponsored by kashi say hi to new kashi gut health granola a straightforward delicious way to fuel your gut made with prebiotics fiber and cultures my favorite flavor blueberry almond has perfectly crispy clusters delicious almonds and bursts of whole blueberries it's an easy fit for a daily routine whether that's for breakfast or a snack in a world of overwhelm it's a straightforward delicious choice try new kashi gut health granola

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26:25So knowing what we know today and weighing still what we don't know, who are GLP-1s for? Who would you consider prescribing this to or do you prescribe it to? And who would you advise against taking this drug? So just to state the obvious, I would say who can we, without hesitation, consider these in or prescribe these in? Those would be people with existing type 2 diabetes, people with a body mass index of 30 or greater, or 27 or greater with a weight-related medical complication such as sleep apnea, high cholesterol, high blood pressure. That is textbook, but it has become completely standard of care and acceptable to prescribe these medicines for patients with prediabetes that are borderline on weight.

27:15The reason for that is that we have proper evidence that these medicines, especially trisepatide, can prevent the progression of prediabetes to diabetes by practically 95%. Is it indicated for that as per the FDA label? No, but that is a condition we feel comfortable with. Take it a step further. Perimenopausal weight gain, polycystic ovarian syndrome, off-label use, but tremendously beneficial. But then it becomes a slippery slope because we're starting to talk about people that don't meet criteria that are maybe normal weight. So where do you draw the line? I would be super careful with people that have had a recent eating disorder, people whose cancer screening isn't up to date, where their primary care is not up to date.

27:59We don't really want to treat people off-label if their foundational health isn't in place. And for real off-label use that I just want to lose five pounds, I want to lose 10 pounds for a vacation or my wedding, I would really steer away from that. That's really helpful framing. And for the people who are good candidates, there's another reality I think that can be easy to overlook. And that is this may not be a short-term intervention. You mentioned this earlier. These medicines can and often are long-term treatments. How do you help patients understand what may happen if they stop or only use them for a short while, especially when it comes to this conversation about appetite, weight gain, or weight regain, and metabolic health?

28:42I've started to tell my patients and my colleagues that I want patients to sign a GLP-1 contract with me. I haven't actually implemented the contract, but there's a few things on the list that I'd like patients to acknowledge when we meet for this purpose. Again, I do primary care and general endocrinology, so not all my patients are on these meds. But when they are, I want them to, number one, acknowledge that these are a tool or an adjunct to nutrition and exercise. So they aren't going to only use this medicine without engaging in some nutrition plan and fitness plan. Number two, these are going to be needed long term to sustain the results achieved on the medicine.

29:23Number three, I don't want patients comparing their results to other people. And this is something unique in medicine on this class of meds. Again, back to the cholesterol example. Do people compare their results on Lipitor and say, well, my LDL went down 20 points. Yours only went down 10 points. One is morally superior. So I don't want patients to compare to others. And the other thing I tell people is do not buy clothes at your lowest weight. So this idea of using the medicines to become a weight that your body has never seen as an adult. And for some, that needs to be true because they've always had overweight or obesity.

30:00But what we see, the typical pattern of somebody that is on these long term is they may reach a low weight that they get excited about. And they want to buy a whole new wardrobe, spend a lot of money, yet their brain recalibrates and they gain back like 2 to 10 percent of the weight from the low. And that is physiology. That's how the brain works. Even if they're still on the medicine, you're saying? It can still happen. It can happen on the medicine too, that you hit a nader weight and then you regain a bit. But in the big picture, say you lost 50 pounds and then you're at your adult low, you feel good.

30:34And say you gain back eight and that person refresh their wardrobe at that low. And then they're just a couple pounds up. They are healthy. Their blood sugar's good. Their body feels good. And they're just like, Dr. Kumar, I need to fit back into these clothes. I spent so much money. And it's just like, I don't want to medicate you for eight pounds when you've achieved this great health. So those are things in my contract that I want people to acknowledge. Yeah, those make great sense. I would love to hear once you start implementing it, you know, how that goes. And I think what's remarkable is that these individual treatment decisions are now beginning to ripple outward into entire industries.

31:13So GLP-1s are already changing the economy from food companies and restaurants to employers, insurers, telehealth platforms. I work for one myself. So what changes are you watching most closely? I am really interested in watching the employer health space because most Americans get their health insurance through their employer. and employers are incentivized to keep their population healthy. And so I am interested in seeing as certain companies and institutions see a large portion of their employee base on these medicines, what will that do to productivity, people's self-confidence, their interest in moving up in their careers?

31:59Because these are things that held people back due to metabolic health. And at the same time, access is better for these medicines, but still remains a big issue. What would it take from your perspective to make these medications benefit the people with the greatest medical need rather than simply becoming another advantage for people who can pay out of pocket or who happen to have excellent insurance? Yeah, this is tied into my other answer. I think the reason I find the employer health space so interesting here is that, yes, access is expanding. Drug prices are coming down, but these are still extremely expensive.

32:35And we're seeing employers put restrictions on their employees' ability to access it. So what would it really take for everyone that needs these to access these? It would take a tremendous overhaul, unfortunately, in our health care system in terms of how drug prices are determined, how health coverage is done, and also how we think about disease. Because when we say everybody that needs these, we're also saying, well, do they need them for addiction? Do they need them for dementia prevention? Do they need them for perimenopausal weight gain? There's so many prescriptions of these drugs being prescribed for conditions outside of the traditional indications, and those patients are benefiting.

33:14And so suddenly that changes how we think of health care versus sick care versus prevention in the United States. There are a lot of people that believe they should be using these preventatively, and that's completely different than how insurance coverage is determined. And so I believe it would take a significant overhaul of how we view health wellness prevention and coverage in the United States. And perhaps that question of access becomes even more consequential if these drugs are only the first chapter of something much bigger. What kind of future are we heading toward? Gosh, I wish I knew.

33:48It sounds super exciting. Not only is this just the tip of the iceberg of what we're going to see in biotech innovation, we're going to have medicines that build muscle and burn fat. We're just talking about increasing fullness and reducing body fat here, but we're soon going to see things that stimulate muscle growth, that reduce the rate of lean muscle loss. And people are getting their hands on these well before FDA approval. Combine that with AI tools, we're going to have an entire different system of people managing themselves. So I think, although I'm very excited, we have to be very careful.

34:25And as primary care doctors, we want to continue to build trust with our patients. I always tell physicians, even if you don't agree with how the patient obtained the GLP-1 or the off-label peptide or the non-FDA approved retitrutide, please keep the conversation open because if patients are going to do this anyway, you want the doctor in the conversation. Such a good point. And I think that feels like both an extraordinary possibility for the future and so much profound responsibility for all of us. Yes. And not everyone agrees with me. There are physicians that'll say that I want no part in this conversation.

35:02If patients are doing this on their own, I don't want to be part of it. But for me, because I do primary care and take care of people over their lifetime, sometimes I take care of three generations of the same family. I would rather be involved in all of it, even if it's a bit sketchy. Yeah. I just find GLP-1 so fascinating. It's just wild to think about when you switch one lever and the ripple effects, you know? It's wild. Yeah. I got into this such a long time ago. I was still an endocrinology fellow when I participated in the clinical trials that led to the FDA approval of these drugs and some of the early studies.

35:41And after I finished my training, people would say things like, you're so well-trained, why would you become a diet doctor? And now like, like everyone wants to talk to me now. It's so fun. Oh, well, I, yeah, I hear you. It's interesting how there can be a shift and then it opens up the door to like all of these kinds of conversations. It's so important. Dr. Rekha Kumar, thank you for your insights and for helping us think about this conversation with so much nuance. I really appreciate it. Thanks so much for having me for this topic. It's one of my favorite.

36:16And that's our show for today. Thanks again to Dr. Rekha Kumar for joining me. TED Health is a podcast from TED, and I'd love to hear your thoughts about this episode. send me a message on Instagram at ShoshanaMD. This episode was produced by me, Shoshana Ungerleiter, and Jess Shane. Edited by Alejandra Salazar and fact-checked by Vanessa Garcia-Woodworth. Special thanks to Maria Lages, Farrah Degrunge, Daniela Balarezo, Constanza Gallardo, Tansika Sangmarniwang, and Roxanne Heilash.

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