Fat Science

The Science Behind the New Wegovy Pill (with Novo Nordisk’s Dr. Jason Brett)
What actually makes a GLP-1 pill work in the real world—and why does taking it come with such specific rules? And if these meds improve health beyond weight, why does the conversation still get stuck on the scale?
This week on Fat Science, Dr. Emily Cooper, Mark Wright, and Andrea Taylor are joined by Dr. Jason Brett of Novo Nordisk to break down the science behind the newly approved Wegovy pill. They talk about what it takes to deliver a peptide medication orally, what the dosing and day-to-day routine really look like, and why access and pricing remain such a big part of the story. The conversation also zooms out to the bigger point: treating obesity is about improving health outcomes—like liver and cardiovascular risk—not just weight.
Key Takeaways
Oral semaglutide requires specific formulation technology to survive the stomach and be absorbed at a meaningful level.

The “30-minute rule” isn’t random—it’s part of how the pill has a chance to work as intended.

Treating obesity is about improving health outcomes (like liver and heart risk), not just “moving a number on a scale.”

Pricing and access shape who can actually benefit, even when the science is strong.

Calorie-restriction messaging can backfire for people already dealing with metabolic adaptation and under-nutrition.

Notable Quote
"Fat Science has no financial relationship with Novo Nordisk. No sponsorship. No consulting fees, no affiliate arrangements. Zero." — Mark Wright
Links & Resources

Podcast Home: fatsciencepodcast.com

Cooper Center for Metabolism: coopermetabolic.com

Resources from Dr. Cooper: coopermetabolic.com/resources

Join Our Community: patreon.com/cw/FatSciencePodcast

Submit Your Question: [email protected] or [email protected]

Fat Science is supported by the Diabesity Institute, a nonprofit dedicated to increasing access to effective, science-based metabolic care.
Disclaimer: This podcast is for informational purposes only and is not intended as medical advice. Please consult with a qualified healthcare provider for personalized recommendations.

Mailbag: Your GLP-1 Questions on Pregnancy, Dosing, and Why Diets Cause Fat Gain
What happens when you stop GLP-1 medications before getting pregnant? Why might your thyroid numbers change on Zepbound? And why do people gain more body fat after dieting — even when they're still eating well? Dr. Cooper tackles your toughest questions.
This week on Fat Science, Dr. Emily Cooper, Mark Wright, and Andrea Taylor answer listener questions covering pregnancy planning on GLP-1s, unmasked thyroid problems, injection site reactions, mechanical eating after bariatric surgery, why diets cause fat regain at a cellular level, and discussing with your doctor whether you should (or shouldn't) increase your medication dose.
Key Takeaways
GLP-1 medications aren't causing gestational diabetes — they may have been masking underlying metabolic dysfunction that becomes visible when the medication is stopped

Thyroid problems can be "unmasked" by GLP-1 treatment because the medications signal to your brain that you're not starving, allowing the pituitary TSH to rise, sometime uncovering a pre-existing thyroid issue

Zepbound may improve iron absorption — if iron levels go too high, testing for hemochromatosis may be warranted

To reduce injection site reactions: warm the medication to room temperature, clean and prep skin but don't over-rub with alcohol, inject at exactly 90 degrees, don't pinch the skin, and stay relaxed

Diets cause fat regain at the cellular level — it's chemistry, not willpower — and the fat often accumulates in the visceral area around organs

There's no need to increase your GLP-1 dose if you're making good progress — an annual weight loss rate of 15% or higher is considered strong

Notable Quote
"You can't think that just because somebody's weight is high, it's because something they're doing is wrong. That is just not founded in science whatsoever." — Dr. Emily Cooper
Links & Resources
Podcast Home: fatsciencepodcast.com

Cooper Center for Metabolism: coopermetabolic.com

Resources from Dr. Cooper: coopermetabolic.com/resources

Join Our Community: patreon.com/cw/FatSciencePodcast

Submit Your Question: [email protected] or [email protected]

Fat Science is supported by the Diabesity Institute, a nonprofit dedicated to increasing access to effective, science-based metabolic care.
Disclaimer: This podcast is for informational purposes only and is not intended as medical advice. Please consult with a qualified healthcare provider for personalized recommendations.

Wegovy Pill: Who's It For?
The new Wegovy pill is generating massive buzz — but is it actually better than the injection? Before you ask your doctor to switch, there are some surprising requirements that could make or break whether this option works for you.
This week on Fat Science, Dr. Emily Cooper, Mark Wright, and Andrea Taylor break down the new oral semaglutide approved for obesity treatment. They explain how the Wegovy pill differs from Rybelsus, who's a good candidate to switch (and who isn't), the strict dosing protocol most people don't know about, and what's coming next in the GLP-1 pill landscape — including a less fussy competitor from Eli Lilly.
Key Takeaways
The Wegovy pill uses an upgraded "version two" formulation with enhanced absorption — it's not the same as Rybelsus

Semaglutide targets deep metabolic dysfunction, not just appetite — reducing inflammation, visceral fat, and cardiovascular risk

The pill must be taken first thing in the morning on an empty stomach with minimal water, then nothing else for 30 minutes — breaking this protocol negates effectiveness

The pill is slightly less effective than the highest-dose Wegovy injection, so switching isn't ideal for patients still making progress at maximum dose

Novo Nordisk's cash pay program starts at $149/month for lower doses and $299/month for the highest dose

Eli Lilly's upcoming orforglipron pill uses small molecule technology that won't require the strict dosing ritual

Notable Quote
"When people say it works because it just makes you eat less, that's really missing the point of the sophistication of these meds." — Dr. Emily Cooper

Links & Resources
Podcast Home: fatsciencepodcast.com

Cooper Center for Metabolism: coopermetabolic.com

Resources from Dr. Cooper: coopermetabolic.com/resources

Join Our Community: patreon.com/cw/FatSciencePodcast

Submit Your Question: [email protected] or [email protected]

Fat Science is supported by the Diabesity Institute, a nonprofit dedicated to increasing access to effective, science-based metabolic care.
Disclaimer: This podcast is for informational purposes only and is not intended as medical advice. Please consult with a qualified healthcare provider for personalized recommendations.

What if the scale isn't moving, but your health is dramatically improving?
If you've ever felt discouraged because the number on the scale won't budge—even on a GLP-1 medication—this episode will change how you think about these drugs. Dr. Cooper breaks down the research showing that the biggest benefits have nothing to do with weight loss. It's all about metabolic health.
This Week on Fat Science
Dr. Emily Cooper, Mark Wright, and Andrea Taylor explore the research proving GLP-1 medications are far more than "weight loss drugs." The team explains how cardiovascular outcome trials revealed unexpected heart protection, why inflammation reduction may be the real mechanism behind these benefits, and what the latest FDA approvals for kidney disease, sleep apnea, and fatty liver mean for patients. Plus: the new oral Wegovy pill, what's coming next in metabolic medicine, and why everyone should be screened for metabolic dysfunction regardless of weight.
What You'll Learn
Why two-thirds of cardiovascular risk reduction from GLP-1s is completely independent of weight loss

How these medications reduce inflammation, stabilize arterial plaque, and improve vascular function

The difference between MASLD and MASH—and why the name change matters

What the Flow Trial revealed about kidney protection (and why it was stopped early)

How Zepbound earned FDA approval for sleep apnea

Why metabolic screening should happen regardless of what the scale says

Notable Quote
"You can still become incredibly healthier even if the weight is more stubborn. So I think that's the thing, is to discuss with your doctor not 'Oh, I want to lose X amount of pounds' or 'How much weight do you think I should lose?' That is not the conversation. It's more, let's take a look at the health parameters."
— Dr. Emily Cooper
Links & Resources
Podcast Home: fatsciencepodcast.com

Cooper Center for Metabolism: coopermetabolic.com

Resources from Dr. Cooper: coopermetabolic.com/resources

Submit Your Question: [email protected] or [email protected]

Fat Science is supported by the Diabesity Institute, a nonprofit dedicated to increasing access to effective, science-based metabolic care.
Disclaimer: This podcast is for informational purposes only and is not intended as medical advice. Please consult with a qualified healthcare provider for personalized recommendations.

This week on Fat Science, Dr. Emily Cooper, Mark Wright, and Andrea Taylor answer listener mailbag questions from California, the UK, France, Washington, Wyoming, and beyond. 
The team breaks down why Dr. Cooper does not recommend calorie tracking (and when limited tracking can make sense), how to build confidence in eating without data, and why “mechanical eating” sometimes needs medical customization—especially for people with slow gut transit or gastroparesis-like symptoms. 
They also dig into bile acid malabsorption after gallbladder removal, when metformin side effects deserve a second look, what we currently know about COVID-19’s potential impact on metabolic health, and why metformin and GLP-1 medications can be complementary—particularly in PCOS.
Key Takeaways
• Long-term calorie tracking can override physiologic cues and reinforce diet mentality.
• Short-term, targeted tracking may be useful when guided by a clinician (e.g., nutrient deficiencies ).
• Obesity and abnormal appetite are both manifestations of metabolic dysfunction—not simple cause and effect.
• Mechanical eating is a framework, not a rigid rule—timing and food choices may need medical tailoring.
• Post-gallbladder diarrhea may reflect bile acid malabsorption and can be treatable.
• Metformin and GLP-1s often complement each other because they target different metabolic states (fasting vs fed).
Dr. Cooper’s Actionable Tips
• Stop daily calorie counting—focus on consistent patterns and metabolic nourishment.
• Use mechanical eating basics: eat every few hours, include all food groups, and reduce chemical additives when possible.
• If you’re transitioning away from tracking, consider a dietitian skilled in diet-mentality recovery.
• If frequent eating worsens sleep or bloating, work with a medical dietitian to adjust intervals and food types (especially with slow GI transit).
• If chronic diarrhea appears (especially after gallbladder removal), ask your clinician about bile acid malabsorption and treatment options.
• Use labs to guide therapy: fasting insulin can signal metformin benefit; post-meal patterns can point toward GLP-1 needs.
Notable Quote
“Once you start using tracking to stay in a calorie range or a carbohydrate range, you’re putting your brain in front of your physiologic intuition—your body is sending you important cues all the time.”
—Dr. Emily Cooper
Links & Resources
The Metabolic Links to PCOS, Release Date 2/24/25
The COVID Connection to Diabetes & Metabolic Health, Release Date 12/16/24
Podcast Home: https://fatsciencepodcast.com/
Episode References: https://fatsciencepodcast.com/wp-content/uploads/2025/06/Scientific-References-Fat-Science-Episodes.pdf
Cooper Center: https://coopermetabolic.com/podcast/
Resources from Dr. Cooper: https://coopermetabolic.com/resources/
Submit a Question: [email protected]

*Fat Science: No diets, no agendas—just science that makes you feel better. This podcast is for informational purposes only and is not intended to be medical advice.