Listener Mailbag: Set Point Theory, Trauma & Metabolism, and Why 1200 Calories Can Still Lead to Weight Gain

This week on Fat Science , Dr. Emily Cooper, Mark Wright, and Andrea Taylor answer listener questions about BMI cutoffs, weight cycling, metabolic adaptation, trauma, GLP-1 differences, and why some people gain weight on ultra-low calories. Dr. Cooper explains what’s really happening inside the metabolic system and why individualized treatment—not dieting—creates sustainable change. Key Questions Answered If my BMI doesn’t “qualify” for GLP-1s, is Naltrexone + Bupropion helpful—and what labs matter first? Does being overweight always indicate metabolic dysfunction, and why are U.S. rates so high? If diets damage metabolism, what do you do when you’re already 80 pounds overweight? How long does it take for leptin and ghrelin to stabilize with mechanical eating? How can someone gain weight on 1,200 calories/day? After sleeve gastrectomy, how do you eat enough while on a GLP-1? Is set point theory real—and how does the melanocortin pathway influence it? If obesity runs in my family, will I need meds like Zepbound for life? How do trauma and stress alter long-term metabolic health? Can GLP-1s offset weight gain from steroids, mood meds, or hormones? Why might Ozempic work well while Mounjaro causes weight gain? Key Takeaways 1. BMI rules don’t reflect metabolic truth. A mid-20s BMI can still mask significant dysfunction, especially with weight cycling. 2. Weight cycling is metabolically stressful. Repeated losses/regains increase visceral fat, insulin abnormalities, and cardiovascular risk. 3. Obesity is a multi-hormonal disease. Most people need pharmacology plus sleep, fueling, and movement—not restrictive dieting. 4. Metabolic adaptation is powerful. Under-fueling lowers thyroid output, suppresses fat-burning, and slows metabolism dramatically. 5. After bariatric surgery or on GLP-1s, frequency matters. Frequent, nutrient-dense snacks protect muscle, metabolism, and energy. 6. Set point changes with better signaling. GLP-1s and related therapies help the brain accurately detect weight and lower the defended level. 7. Genetics often mean lifelong support. Family patterns of obesity usually indicate long-term need for metabolic medication. 8. Trauma amplifies metabolic risk. Childhood trauma disrupts IGF-1, sleep, stress hormones, insulin, leptin, and ghrelin. 9. Medications can cause weight gain—GLP-1s can help counteract it. Steroids, mood meds, hormonal agents, and more can be metabolically unfriendly. 10. “Newer” isn’t always better. Some people respond poorly to the GIP component in Mounjaro/Zepbound. Individual physiology rules. Dr. Cooper’s Actionable Tips Request deeper evaluation: DEXA, visceral fat, fasting insulin/glucose, leptin, reproductive hormones. Stop restrictive dieting permanently—mechanical eating protects metabolic stability. Work with a fueling-focused dietitian (often ED-trained). Review your medication list for drugs known to cause weight gain. Don’t switch GLP-1s or chase higher doses if your current regimen works. Notable Quote “Obesity isn’t a willpower problem. It’s a metabolic disease, and when the underlying system is supported, the body finally has permission to change.” — Dr. Emily Cooper Links & Resources Podcast Home: Fat Science Podcast Website Submit a Show Question: questions@fatsciencepodcast.com or dr.c@fatsciencepodcast.com Dr. Emily Cooper on LinkedIn Mark Wright on LinkedIn Andrea Taylor on Instagram Fat Science is your source for breaking diet myths and advancing the science of true metabolic health. No diets, no agendas—just science that makes you feel better. The show is informational only and does not constitute medical advice.