In this episode I’m joined by Elizabeth Kazarian, a physician double board-certified in Family Medicine and Obesity Medicine, practising in Washington DC. She spends her days doing the thing most of the internet’s loudest voices on this topic have never done: sitting across from real patients, writing prior authorisation letters, arguing with insurers, and deciding case by case what will actually help someone get healthier.
GLP-1 medications have become one of the most polarising subjects in health. Roughly one in ten American adults now reports using one, and the conversation has collapsed into two camps: people who treat these drugs as a shortcut, and people who treat them as a miracle. Neither camp spends much time on the questions Elizabeth deals with daily, which are who these medications are for, what good care around them looks like, and why the biggest barrier facing her patients isn’t the science at all, it’s the system sitting between them and a prescription.
What We Cover
- Why she argues that treating obesity is treating the brain, and what that does to our assumptions about willpower
- The point at which she stopped asking patients to “earn” medication with six months of failed dieting
- What BMI actually tells you, and why she is forced to work with a tool whose sensitivity is under 50%
- Why tirzepatide is often the better drug and semaglutide is often the one you will be given
- What the data really show when people come off these medications, including the part nobody quotes
- Whether compounded GLP-1s are a reasonable workaround or a gamble
- Her case that menopause does not slow your metabolism, and what is actually changing
- Why she believes family medicine, not biohacking, is the original longevity medicine
What I appreciated most about this conversation is that Elizabeth refuses the easy version of either side. She will tell you plainly where the evidence is strong, where it is missing, and where she is making a judgement call with a patient sitting in front of her, which is exactly the kind of honesty this topic has been short of.
You can follow Dr Elizabeth Kazarian’s work on Instagram, where she shares evidence-based education on obesity medicine, GLP-1 therapies, and women’s cardiometabolic health.
- Is Diet Soda Bad for You? Sweetener Myths Debunked (00:00)
- Wellness Influencers vs Real Medical Training (05:39)
- Obesity Stigma and the GLP-1 “Easy Way Out” Myth (12:40)
- Telehealth GLP-1s, Compounding Risks, and BMI Cutoffs (21:54)
- Tirzepatide vs Semaglutide: Which GLP-1 Gets Covered? (33:07)
- How Doctors Should Talk About Your BMI (37:31)
- GLP-1 Gatekeeping, Food Noise, and Alcohol Cravings (47:00)
- GLP-1 Dosing and Weight Regain After Stopping (57:00)
- Health Markers Over Goal Weight: 2026 Cholesterol Guidelines (01:02:43)
- How to Manage GLP-1 Nausea, Constipation, and Hydration (01:10:57)
- Do Peptides Work? Biohacking vs Real Longevity Medicine (01:18:51)
- PBMs, GoodRx, and Cost Plus Drugs Explained (01:27:17)
- Ozempic Babies, PCOS, and GLP-1 Fertility Effects (01:34:10)
- Pilates, Exercise, and Menopause Belly Fat (01:47:29)
- Is HRT Safe? Menopause Treatment vs Product Scams (01:53:33)
- Health Care Is Political: How to Fix US Healthcare (02:03:19)
Resources and links:
- Carcinogenicity of aspartame, methyleugenol, and isoeugenol
- The effects of low-calorie sweeteners on energy intake and body weight: a systematic review and meta-analyses of sustained intervention studies
- Use of non-sugar sweeteners: WHO guideline
- Gut-microbiota-targeted diets modulate human immune status
- Obesity and Severe Obesity Prevalence in Adults: United States, August 2021-August 2023
- Definition and diagnostic criteria of clinical obesity
- Diagnostic performance of body mass index to identify obesity as defined by body adiposity: a systematic review and meta-analysis
- Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies
- Clinical review: Drugs commonly associated with weight change: a systematic review and meta-analysis
- Persistent metabolic adaptation 6 years after “The Biggest Loser” competition
- KFF Health Tracking Poll: Prescription Drug Costs, Views on Trump Administration Actions, and GLP-1 Use
- Once-Weekly Semaglutide in Adults with Overweight or Obesity
- Tirzepatide Once Weekly for the Treatment of Obesity
- Tirzepatide as Compared with Semaglutide for the Treatment of Obesity
- Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes
- In adults with moderate-to-severe OSA and obesity, tirzepatide reduced apnea-hypopnea events vs. placebo
- Oral Semaglutide at a Dose of 25 mg in Adults with Overweight or Obesity
- Orforglipron, an Oral Small-Molecule GLP-1 Receptor Agonist for Obesity Treatment
- CMS’ GLP-1 Bridge Demonstration-Questions and Potential Consequences
- Lilly lowers the price of Zepbound®(tirzepatide) single-dose vials
- FDA approves Lilly’s Foundayo™ (orforglipron), the only GLP-1 pill for weight loss that can be taken any time of day without food or water restrictions
- Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension
- Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial
- Once-Weekly Semaglutide in Adults With Alcohol Use Disorder: A Randomized Clinical Trial
- Lipid-Lowering Therapy in the 2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia: A Perspective From China
- Reflections on the journey to renaming polycystic ovary syndrome to polyendocrine metabolic ovarian syndrome
- Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome
- Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS)
- Novo Nordisk. Wegovy (semaglutide) US Prescribing Information.
- Eli Lilly and Company. Zepbound (tirzepatide) US Prescribing Information.
- Empagliflozin in Heart Failure with a Preserved Ejection Fraction
- Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction
- Dapagliflozin in Patients with Chronic Kidney Disease
- Daily energy expenditure through the human life course
- Changes in body composition and weight during the menopause transition
- Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases
- The 2022 hormone therapy position statement of The North American Menopause Society
- Global Consensus Position Statement on the use of Testosterone Therapy for Women
- Pharmacy Benefit Managers: The Powerful Middlemen Inflating Drug Costs and Squeezing Main Street Pharmacies
- Mark Cuban Cost Plus Drug Company. Pricing and markup.
- US Food and Drug Administration. Tirzepatide and semaglutide injection shortage resolutions.
- IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 56. Lyon: IARC; 1993.
Subscribe and stay connected:
Subscribe to The Proof on YouTube, Apple Podcasts or Spotify to ensure you never miss an episode. And don’t forget to follow me on Instagram and X for more insights and updates.
This episode is brought to you by:
38TERA
38TERA’s BDR is a clinically dosed gut health supplement for improved digestion, less bloating, better bowel movements and a healthier microbiome. Use code THEPROOF for a discount at checkout.
38Tera ships to the United States, Australia, and New Zealand.
Shokz
Shokz OpenFit Pro brings Open-Ear Noise Reduction to open-ear listening, so background noise feels farther away while you stay connected to your surroundings. Head to shokz.com/THEPROOF and use code THEPROOF for a long-term discount on all Shokz products, stackable with other official promotions.
Gusto
Gusto is online payroll and benefits software built for small businesses, handling payroll, tax filing, benefits, and onboarding in one place. Try Gusto today at gusto.com/THEPROOF and get three months free when you run your first payroll.
SwimClub
SwimClub is a science-backed supplement designed to support male fertility, sperm health, and reproductive wellness. Head to swimclub.co to get $20 off your first order with code THEPROOF.
Function Health
Make knowing your health part of your holiday plans. Function gives you access to 160+ lab tests for $365 a year—about a dollar a day. Join at functionhealth.com/SIMONHILL and use code SIMON25 for a $25 credit.
Function Health ships to 48 U.S. states, excluding Rhode Island, Hawai‘i, and Puerto Rico.
IM8
With 92 nutrients, including Vitamin B12, Iodine, Selenium and Vitamin D, in highly absorbable forms, IM8 Daily Essentials is the perfect all-in-one daily multi-vitamin to ensure you meet your daily micronutrient needs. IM8 is offering an exclusive 10% off your first order with a free welcome kit when you enter the promo code SIMON at checkout on im8health.com.
IM8 ships to 27 countries including the U.S., Canada, the U.K., Australia, and many regions across Europe, Asia, and South America.
WHOOP
Whoop, the most advanced fitness and health wearable available. Your personalised fitness and health coach to recover faster, sleep better, and train smarter. Claim your first month free on join.whoop.com/simon.
Whoop ships to 56+ international markets, including the US, Canada, most of Europe, Australia, New Zealand, UAE, Singapore, and parts of Asia.
More about Dr Elizabeth Kazarian
Dr Elizabeth Kazarian is a physician double board-certified in Family Medicine and Obesity Medicine, based in Washington D.C. Alongside full-time clinical practice, she has built an audience of more than 150,000 followers by translating complex medical evidence into accessible health education and examining the industries, policies, and systems that shape American health.
Her work focuses on obesity and GLP-1 therapies, women’s cardiometabolic health, and the role of primary care in prevention and true longevity. She also explores how insurance barriers and commercial interests influence the care patients receive. Through her clinical practice and public education, Dr Kazarian challenges medical misinformation and advocates for evidence-based care grounded in the realities of patients’ lives, mostly trying to keep it real.
