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: questions@fatsciencepodcast.com or dr.c@fatsciencepodcast.com

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.