Run the List Podcast: Overview of Obesity

Hosts: Walker Red (Primary), Dr. Brooke Mattson (Endocrinologist, UNC)
Date: January 5, 2026
Episode Theme:
This episode provides a high-yield, clinically grounded overview of obesity for healthcare practitioners. The conversation focuses on approaching obesity with sensitivity, reviewing causes, discussing lifestyle and pharmacologic management, and aligning current treatment options with evidence-based practices. Listeners are equipped with practical tips for managing obesity in outpatient and inpatient settings.

Main Takeaways

• Obesity is a complex, chronic disease and should be treated as such—without patient blame.
• Management is multimodal: a combination of lifestyle modification, pharmacologic therapy, and, for some, surgical intervention.
• New pharmacotherapies show dramatic efficacy, but adherence to lifestyle change remains foundational.

Patient-Centered Approach to Discussing Obesity

[02:53] Dr. Brooke Mattson:

• Remove blame: “If a patient’s coming to you looking for help with weight management, they shouldn’t be made to feel like that it’s their fault that they’re living with obesity… It’s a complex interaction between genetics and our environment.”
• Use person-first language: Refer to a “person with obesity” or “person living with obesity,” not “an obese person.”
• Chronic disease model: Obesity requires persistent, chronic management like hypertension or diabetes.

[04:05] Dr. Brooke Mattson:

• Goals of treatment: Aim for weight loss to prevent comorbidities (hypertension, type 2 diabetes, sleep apnea, etc.), not achieving a specific BMI.
• “There are health benefits from losing even just a small amount of weight, such as 5%.”

Lifestyle Modifications: Core Foundation

Medication Review

[05:09] Dr. Brooke Mattson:

• “This list includes medications like steroids, beta blockers, certain diabetes treatments including insulin, sulfonylureas, lots of centrally acting medications such as SSRI, SNRIs, TCAs, antipsychotics, seizure medications, and pain medicine like gabapentinoids...also some contraceptives including OCPs and Nexplanon and Mirena.”
• Goal: Remove “low hanging fruit” that may hinder weight loss.

Nutrition & Diet

[05:55] Dr. Brooke Mattson:

• “There’s not one single recommended diet that is best… The best diet is the one that the patient can adhere to.”
• Focus: Reduce calories, improve quality of food.

Physical Activity, Sleep, and Mental Health

[06:25] Dr. Brooke Mattson:

• Guidelines: At least 150 minutes of aerobic activity/week + 2 strength sessions.
• Individualize for weight/pain limitations.
• “Movement is important, in any way that they’re able to or any way that they like to do.”
• Emphasize sleep quality and duration (“even just a small amount of sleep deprivation can induce insulin resistance”).
• Address mental health barriers; therapy/groups may help integrate nutrition and mental wellbeing.

The Team Approach

[07:50] Dr. Brooke Mattson:

• Involve dietitians, physical therapists/personal trainers, and community programs (e.g., Diabetes Prevention Programs at YMCAs).

Pharmacologic Management of Obesity

Who’s a Candidate?

[09:09] Dr. Brooke Mattson:

• FDA-approved for adults with BMI ≥27 with a weight-related comorbidity, or BMI ≥30.

Older/Non-GLP1 Agents

• “These medications… cause up to about 5% weight loss.”
• Examples: Qsymia (Phentermine/Topiramate), Contrave (Bupropion/Naltrexone), Metformin, SGLT2 inhibitors.
• Still useful, especially if GLP1s not covered by insurance.

GLP1 Receptor Agonists and Beyond

[10:38] Dr. Brooke Mattson:

• “They are the most effective medications that we have for weight loss at the present time. We can expect anywhere from about 10 to 20% or even more [weight loss].”
• Agents:
  • Liraglutide (Saxenda) – daily injection
  • Semaglutide (Wegovy) – weekly injection, greater efficacy than liraglutide
  • Tirzepatide (Zepbound) – weekly GLP1/GIP co-agonist; highest reported weight loss (~20%+), now also FDA-approved for sleep apnea management
• “People with obesity without diabetes generally tend to lose more weight on these medications.”

Prescribing and Patient Counseling

[11:36] Dr. Brooke Mattson:

• GLP1s: Not approved for pregnancy/breastfeeding; counsel on contraception.
• Side effects: Mainly GI (nausea, vomiting, diarrhea, constipation)—mitigate with small portions, slow eating, paying attention to satiety.
• “[Obesity] is a chronic disease requiring chronic management…I frame the discussion about continuing these agents long-term.”
• Weight often regains if medication stopped — set expectations accordingly.

Practical Barriers

[13:44] Dr. Brooke Mattson:

• Insurance coverage fluctuates; frustration with shortages.
• Caution against compounded GLP1 products: “I just can’t feel comfortable recommending them… these were not the same products that were tested in clinical trials.”

Notable Clinical Pearl

[15:00] Dr. Brooke Mattson:

• “I really hammer home the importance of strength training and maintaining muscle mass while they’re on these medicines as well,” to mitigate loss of lean body mass with rapid weight loss.

Bariatric Surgery

[15:16] Dr. Brooke Mattson:

• Indications: BMI ≥35 + comorbidity or BMI ≥40.
• Procedures:
  • Sleeve gastrectomy (restrictive)
  • Roux-en-Y gastric bypass (restrictive + malabsorptive)
• “We can expect up to about 30% weight loss with bariatric surgery… The medications are catching up quickly, but that’s kind of where we are right now.”

Summary and Key Take-Home Points

[16:01] Dr. Brooke Mattson:

• “Obesity is a chronic disease and it should be treated as such… It should be divorced from patient blame.”
• “The goal is not to achieve a normal BMI, but… weight loss for prevention of weight related comorbidities.”
• “Lifestyle interventions and pharmacotherapy are synergistic… Medicines are not an easy way out.”
• “Tirzepatide or Zepbound is currently the agent that leads to the greatest amount of weight loss, though there are a lot of other medications coming down the pipeline that may supersede this in the future.”

Notable Quotes

• On Blame and Approach:

  “If our listeners take away nothing else from this episode, those are the couple most important points. Right. Helping the patient understand that you are not placing blame on them as an individual, that they are someone who is living with this condition, and that we’re here to help them in a totally nonjudgmental way.”
  — Walker Red, [03:41]

• On Weight Loss Goals:

  “There are health benefits from losing even just a small amount of weight, such as 5%. Even a small amount can make a big difference.”
  — Dr. Brooke Mattson, [04:05]

• On Dietary Interventions:

  “The best diet is the one that the patient can adhere to.”
  — Dr. Brooke Mattson, [05:55]

• On GLP1 Agonists:

  “They are the most effective medications that we have for weight loss at the present time. And we can expect anywhere from about 10 to 20% or even more with individual GLP1 receptor agonist.”
  — Dr. Brooke Mattson, [10:38]

• On Obesity as a Chronic Disease:

  “When people’s blood pressure is better, we don’t stop their blood pressure medicine... that’s kind of how I frame the discussion about continuing these agents long term.”
  — Dr. Brooke Mattson, [14:34]

Essential Timestamps

• 02:53 — Patient communication: blame-free discussion and chronic disease framing
• 05:09 — Medication review for weight-promoting agents
• 06:25 — Lifestyle: exercise, sleep, mental health
• 09:09 — Pharmacologic therapy: candidates and history
• 10:38 — GLP1 agents overview and counseling
• 13:44 — Practical barriers (insurance, compounded meds)
• 15:16 — Bariatric surgery overview
• 16:01 — Take-home points

Final Note

This episode provides a concise, high-yield summary for clinicians seeking to update, deepen, and humanize their understanding of obesity and its management. It emphasizes compassion, patient partnership, pragmatic steps, and updates on rapidly evolving treatments.