Fat Science Mailbag: The Dangers of Restricting Calories, Bariatric Plateaus, GLP-1 Dose Adjustments, Weight Expectations & More

This week on Fat Science , Dr. Emily Cooper, Andrea Taylor, and Mark Wright open the Fat Science mailbag to answer listener questions from around the globe. This episode covers real-world metabolic challenges—from navigating calorie restriction and GLP-1 medications to the complexities of bariatric surgery, prednisone’s impact on weight, and menopause. Dr. Cooper offers clear explanations and practical advice for healthcare professionals and patients alike on understanding metabolic dysfunction, interpreting lab results, and setting realistic weight loss expectations. Key Takeaways: Calorie restriction and intermittent fasting can destabilize metabolism, making recovery complex for some patients—gradual changes and medical monitoring are essential. Bariatric surgery can be an effective intervention for those with significant insulin resistance or high hunger signals. Pre-surgery metabolic testing (like insulin, glucose, and ghrelin levels) is valuable in assessing the likely benefit. Plateaus after surgery, persistent weight struggles, and the role of genetics highlight the need for root-cause investigation, not just symptom management. Prednisone and hormone therapies (including MHT for menopause) can affect metabolic health; small dietary adjustments, body composition testing, and tailored exercise are crucial for optimizing outcomes. Guidance on GLP-1 medication maintenance: Most patients benefit from staying on weight loss meds long-term, but dose adjustment is possible when side effects arise. Stability over many months is critical before considering any taper. Personal Stories & Practical Advice: Andrea shares her experience with bariatric surgery and ongoing metabolic management, emphasizing realistic expectations and the benefit of medication-surgery synergy. Listeners ask: how to evaluate readiness to stop weight loss meds, address side effects, and balance hormone needs during menopause. Resources from the episode: Fat Science is a podcast on a mission to share the real science behind why we get fat, addressing stigma and confusion with facts, hope, and empowering stories. Updates on Dr. Cooper’s upcoming virtual metabolic health training—ideal for practitioners in the UK and beyond. Information about Melanocortin pathway testing programs for severe, persistent obesity. https://uncoveringrareobesity.com/ Link to previous show. “GLP-1s: Will I Have to Take Them Forever?” (5/19/25) https://open.spotify.com/episode/1GZA71gTMSz0idbnEYblVO?si=gJXxNkbYTHykhNDw0Ebltg Connect with Dr. Emily Cooper on LinkedIn. Connect with Mark Wright on LinkedIn . Connect with Andrea Taylor on Instagram . Fat Science is a podcast on a mission to explain where our fat really comes from and why it won’t go and stay away. We are committed to creating a world where people are empowered with accurate information about metabolism and recognize that fat isn’t a failure. This podcast is for informational purposes only and is not intended to replace professional medical advice. If you have a question for Dr. Cooper, a show idea, feedback, or just want to connect, email us at info@diabesityinstitute.org or dr.c@fatsciencepodcast.com . Fat Science is supported by the non-profit Diabesity Institute which is on a mission to increase access to effective, science-based medical care for those suffering from or at risk for diabesity. https://diabesityresearchfoundation.org/