Docs Who Lift finally got a big pharma exec on the show. Dr. Ken Custer is President of Lilly's Cardiometabolic Health, and he came straight from the EASD conference in Milan with fresh data on what's coming after tirzepatide.

If you've been waiting on retatrutide, this is the episode. Spencer and Karl get Custer to walk through the new phase 3 results and the tirzepatide plus eluralintide combination, including why stacking these mechanisms seems to deliver more than drug developers usually get. You'll hear how amylin works on a completely different set of brain pathways than GLP-1, why Lilly walked away from one version of the drug in favor of another, and what the early tolerability data looks like. That last part matters if you're one of the people who couldn't handle a GLP-1, or you've been too nervous to try one.

The conversation then opens up to the questions patients actually ask. What's next if you hit a wall on tirzepatide and still have weight to lose. Whether these medications will ever be approved for people who aren't sick yet, just heading that direction. And why it's getting harder to run trials at all when everyone can tell whether they're on the real drug.

The back half goes behind the curtain. Custer is honest about how often drug development fails, what these trials cost, and what it was like to be in the room the day Lilly chose tirzepatide, a molecule he's now spent 12 years on. He takes on the pricing question directly, explains where coverage is headed, and makes his case for why access is still the biggest problem.

It ends where you'd want it to. The gray market, what regulation actually gets you, and how to think about doctors who work with pharma versus the people calling them shills while selling supplements with zero data behind them.

Nobody got paid for this one.

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Dr. David Allison and Dr. Emily Dhurandhar join Dr. Spencer Nadolsky and Dr. Karl Nadolsky to break down their new research on food noise. Patients on GLP-1s kept describing the same thing: the constant background chatter about food finally went quiet. Allison and Dhurandhar convened an expert panel of physicians, psychologists, statisticians, and eating disorder specialists to define it properly and build a validated questionnaire to measure it.

Their definition: persistent, unwanted, unpleasant thoughts about food that harm your social, physical, or mental health. The data revealed three distinct parts. Preoccupation with food, how inescapable it feels, and how distressing it is. That third piece, the dysphoria, is what separates food noise from hunger and cravings. Cravings can be enjoyable. Food noise is not.

The conversation covers why food noise correlates with other appetite measures without being the same thing, patients who lose almost no weight on medication but refuse to stop taking it because of the mental relief, and whether food noise alone could justify treatment. They also share where the research is headed, from translations into ten languages and a new adolescent validation to a study testing whether food noise affects driving safety. And they answer the claim that Big Pharma invented the term.

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Dr. Christian Rodriguez joins the show straight from Pennington Biomedical, where he works alongside obesity research legends Eric Ravussin and Steve Heymsfield. He breaks down his new review on metabolically healthy obesity and why the old "zero metabolic syndrome criteria" definitions are so inconsistent. The conversation dives deep into the Lancet Commission's new obesity framework, comparing it to the ACE staging system and picking apart where each one falls short, including the controversial call to leave type 2 diabetes out of the "preclinical" category. Rodriguez also previews his upcoming study on people with a BMI of 60 and above, a group that's rarely studied because researchers aren't sure it's safe. The episode wraps with a candid discussion on GLP-1 stigma and why treating obesity early matters more than chasing a number on the scale.

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