It’s Beyond The Food: Non-Diet Health Coaching
May 28, 2026 · 1 hr · 12 segments
The science on GLP-1 drugs is not what the marketing says it is. Ragen Chastain has been studying weight science, weight stigma, and healthcare practice for over 20 years. In this episode, she gives…
Ragen ChastainGuestStephanie DodierHost
Okay, so the, the big overarching thing is that, first of all, these are solid drugs for type 2 diabetes.
Uh, they may not necessarily be frontline drugs because they do have more side effects and more serious side effects than some other drugs, but they work well for people who are contraindicated for other drugs.
They work well for people who couldn't get the glycemic management they were looking for on other drugs.
Um, what happened was at the same time that these drugs, uh, that they were showing kind of a little bit of weight loss in patients with type 2 diabetes, Eli Lilly and Novo Nordisk, who were two of the three companies that were essentially price gouging insulin to make a fortune, especially like here in the States, learned that the government was planning to put price controls, and so they were gonna lose that profit.
And at that time, the CEO of Novo Nordisk said, "We're taking a bet on, quote, 'obesity,' and we will create the market." And again, Louise really goes into that-
Um, and so they were li- they said, you know, "Okay, well, these drugs at the type 2 diabetes dose create a little bit of weight loss.
What if we gave people a mega dose? Would that create more weight loss?" And it did, and that's how it became, quote-unquote, "weight loss medication." So the thing about that is the weight loss is a side effect of the type 2 diabetes medication.
And so when we dose and titrate for type 2 diabetes, the goal is to give the minimum dose that's needed to get the glycemic management someone wants, and to minimize the side effects of the drug, which again, can be serious and even fatal.
With weight loss, the goal is to get the person up to the maximum dose they can possibly tolerate, or the maximum dose allowed, preferably, to maximize the side effect of weight loss, and you can't do that without maximizing all the other dose-dependent side effects.
Right? So, uh, for semaglutide, for example, the minimum therapeutic type 2 diabetes dose is .5 milligrams.
Here in the States it's been pushed to two, but a lot of places outside of the States, it's still one milligram.
Right? So we're talking about almost two and a half times the, that original maximum dose, almost five times that original, uh, minimum dose.
And then most recently, they have approved semaglutide at 7.2 milligrams, so 14.4 times that minimum effective type 2 diabetes dose.
For that larger dose, you get more side effects, more of some specific side effects, and people lost about nine additional pounds, eight to nine additional pounds.
But at the prices that Novo Nordisk's pharmacy charges, they would've paid about $900 for those eight to nine pounds.
Because I just wanna pause you, so for everybody to be clear, because some people listening to this may not be aware of the systemic problem here of capitalism.
Okay, so the, the big overarching thing is that, first of all, these are solid drugs for type 2 diabetes.
Uh, they may not necessarily be frontline drugs because they do have more side effects and more serious side effects than some other drugs, but they work well for people who are contraindicated for other drugs.
They work well for people who couldn't get the glycemic management they were looking for on other drugs.
Um, what happened was at the same time that these drugs, uh, that they were showing kind of a little bit of weight loss in patients with type 2 diabetes, Eli Lilly and Novo Nordisk, who were two of the three companies that were essentially price gouging insulin to make a fortune, especially like here in the States, learned that the government was planning to put price controls, and so they were gonna lose that profit.
And at that time, the CEO of Novo Nordisk said, "We're taking a bet on, quote, 'obesity,' and we will create the market." And again, Louise really goes into that-
Um, and so they were li- they said, you know, "Okay, well, these drugs at the type 2 diabetes dose create a little bit of weight loss.
What if we gave people a mega dose? Would that create more weight loss?" And it did, and that's how it became, quote-unquote, "weight loss medication." So the thing about that is the weight loss is a side effect of the type 2 diabetes medication.
And so when we dose and titrate for type 2 diabetes, the goal is to give the minimum dose that's needed to get the glycemic management someone wants, and to minimize the side effects of the drug, which again, can be serious and even fatal.
With weight loss, the goal is to get the person up to the maximum dose they can possibly tolerate, or the maximum dose allowed, preferably, to maximize the side effect of weight loss, and you can't do that without maximizing all the other dose-dependent side effects.
Right? So, uh, for semaglutide, for example, the minimum therapeutic type 2 diabetes dose is .5 milligrams.
Here in the States it's been pushed to two, but a lot of places outside of the States, it's still one milligram.
Right? So we're talking about almost two and a half times the, that original maximum dose, almost five times that original, uh, minimum dose.
And then most recently, they have approved semaglutide at 7.2 milligrams, so 14.4 times that minimum effective type 2 diabetes dose.
For that larger dose, you get more side effects, more of some specific side effects, and people lost about nine additional pounds, eight to nine additional pounds.
But at the prices that Novo Nordisk's pharmacy charges, they would've paid about $900 for those eight to nine pounds.
Because I just wanna pause you, so for everybody to be clear, because some people listening to this may not be aware of the systemic problem here of capitalism.
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