The Fat Doctor Podcast

The Lesser Known GLP-1 Lies

• Dr Asher Larmie • Season 6 • Episode 17

Share episode

Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.

0:00 | 40:25

Send us Fan Mail

GLP-1s are being prescribed for everything from arthritis to sleep apnea to low testosterone — with almost no evidence they treat any of it. In this episode, I expose the industry-funded research underpinning the semaglutide gold rush, the risks nobody's talking about (including one that affected a quarter of participants in the study used to license the highest dose), and the logical fallacy that's driving doctors to reach for Ozempic no matter what's wrong with you. You deserve to know the truth before you pick up that pen. 

Pre-order your copy of No Weigh! here 


Got a question for the next podcast? Let me know!

Connect With Me

Find me on Instagram, YouTube, and LinkedIn.

Hello, and welcome to Season 6, Episode 17 of the Fat Doctor Podcast. I'm your host, Dr Asher Larmie. Today we are going to be talking about GLP-1s.

Yes, I know, yet another podcast on GLP-1s. I have to say, I spend very little time talking about them. I know that they are the buzzword, I know that you're constantly being bombarded with information about them, but I am trying not to give them any more airplay than they already have. I feel like the marketing frenzy is like chum in the water, you know? It's a feeding frenzy, and fat people are the victims with the chum in the water. And so I don't really want to add to that. But today I am going to be talking about GLP-1s. I'm going to be talking specifically about exposing the corruptness of the two drug companies that manufacture them. I should say, Mounjaro is not technically a GLP-1 — it's got other actions too. But for the purpose of this podcast, I'm talking about semaglutide, which is Wegovy and Ozempic, and tirzepatide, which is Mounjaro and Zepbound. You only have Zepbound in the US, so I've not come across it. But anyway, that's what we're talking about today.

Did you know that Mounjaro and Ozempic were the second and third highest grossing drugs in the world in 2025? You should know that, because I mentioned it in the last episode. If you didn't know that, you either didn't listen to the last episode, or you weren't paying close enough attention.

Eli Lilly became the top drug company by sales in 2025. It didn't even rank in the top 10 in 2024, and by 2025, it was the top drug company. Mounjaro was the second highest grossing drug. It beat Wegovy, it beat Ozempic. I bet nobody at Novo Nordisk was pleased. But I'd love to have been in the boardroom when they found that out — that Eli Lilly won.

Anyway. How did it all start? Just a little recap.

Semaglutide was approved for weight loss by the FDA in June 2021, about four months after the landmark study was published in the New England Journal of Medicine, headed by Professor John Wilding. The first thing you need to know about this study is that all 15 of the co-authors had personal financial ties to Novo Nordisk, the manufacturers of semaglutide. Three of the co-authors were actual employees of Novo Nordisk. Two actually owned stock in Novo Nordisk.

Just so we're clear. If you read the Conflicts of Interest page, it's so long — I think it's two pages. It's crazy.

Here's another thing you need to know about this landmark study that everyone goes on about — oh, isn't semaglutide amazing, it makes people lose weight. This study was designed by Novo Nordisk. The entire process was overseen by Novo Nordisk. All of the data was collated and analyzed by Novo Nordisk. They monitored the sites. Their own statistician analyzed the data. Then a medical communications company wrote — or at least substantially assisted with the writing of — the manuscript, the thing that got published in the journal. Professional writers who were paid to make everything look good. Again, all funded by Novo Nordisk. That's what you need to know about this study.

You know, sometimes you look at a study and you see lots of authors, and they all have titles and multiple letters after their names, and they all look very professional, and you think — wow, they must have worked hard. They got together, they designed a study, they recruited people, they treated them, they monitored them, they analyzed all the data, then they wrote up this incredible report, and they submitted it to journals, and it went through peer review, and it got published — isn't that amazing? That's not what happened.

Novo Nordisk did all of that, and then basically got 15 co-authors to sign their names to it. I'm not saying they did nothing — of course they did some things. But they didn't do all of the things, because it says very specifically at the bottom of the trial that Novo Nordisk was responsible for the design of the trial, they oversaw the conduct, they monitored the sites, they collated and analyzed the data, they paid for a statistician to analyze the data, they paid for a medical communications company to write the manuscript and present the data. And this is really important — as you'll see later — because how we present data, how we present results, the graphs we use, the way we downplay certain things and highlight other things, even the colour, the fonts, everything — all of that stuff. There are people who are paid a lot of money, whose sole job in life it is to convince us that this study is one to pay attention to, that these are the results you should focus on, this is the graph you should look at. It's amazing!

If I wanted to create a study, I would have to do all of that stuff on my own — kind of like when I was writing a book. Some people get a book deal. Then they get editors and proofreaders, and someone to design a cover, and someone to format the book, and all of that stuff. I had to do it all myself. And that's what happens to independents — people who are not part of this pharmaceutical industrial complex. Independent research very rarely gets published, because they don't have medical communications companies writing it for them. And that is a problem.

So there's a problem with the fact that all of the authors have financial ties to Novo Nordisk, who paid for this entire study.

It's industry standard, by the way. They didn't do anything illegal or unethical — this is perfectly legitimate, this happens all the time. I just don't know that you know it. I don't even know that my colleagues know it. I don't know that my colleagues actually sit down and think, oh, this is all industry-funded. I certainly never gave much thought to it. I never read the disclosure of interest, because it's not even in the paper — you have to go and find a separate document, it's an appendix. It's usually in very small font. It's deliberately hidden.

So yeah, that's a real problem, isn't it? It's industry standard, but it doesn't make it ethical.

Right, moving on.

What do we know about GLP-1s? I'm going to tell you what we do know, and what we don't know.

You probably know this: GLP-1s were designed to reduce insulin resistance in diabetics. That's what they were for. Every time you take a GLP-1 and eat a meal, it forces the pancreas to release insulin. It also increases insulin sensitivity — or reduces insulin resistance, whichever way you want to look at it. So it's really good for diabetes. It's one of the many drugs used to treat diabetes.

It has many side effects. One of the side effects is to switch off the appetite receptors in your brain — to turn the volume down, put them on mute. And so people who take them don't feel hungry. It's just a side effect. There are lots of side effects for these drugs: abdominal pain, nausea, vomiting, diarrhoea, headaches, fatigue, dizziness, bloating — all side effects of GLP-1s. And reduction in appetite — another side effect.

Now, to treat diabetes, doctors will use the minimum dose required to avoid the side effects. What is the dose that we can give to actually improve your diabetes without you developing all the complications, all the side effects? Because then you won't want to take it. That's what we do.

But in order to optimise weight loss, we need to reduce appetite. So we have to turn the appetite reduction up. But you can't just pick one side effect — you pick one, you pick all of them. Which means that to optimise weight loss, doctors are prescribing the highest dose possible. They're giving patients all the side effects. You can't just select one. All of them.

Semaglutide for diabetes — Ozempic — is licensed up to 1mg every week, as a subcutaneous injection. There's also a tablet form called Rybelsus. I can't remember the maximum dose of that — I'm going to say 14 milligrams. I think it's 3, 7 and 14? I'm not 100% sure, because I don't very often prescribe it. But generally it's the injection, 1mg, once a week.

Wegovy, for weight loss, used to be licensed up to 2.4 milligrams once a week. Now, Wegovy has been licensed in doses up to 7.2mg per week. Are you hearing that? 7.2 milligrams. Most diabetics don't go above 0.75 milligrams.

Wegovy for weight loss is licensed at ten times the dose. That's ten times the side effects. And ten times the risks.

The licensing of up to 7.2 milligrams is based on one study, and in this study, 23% of subjects experienced dysaesthesia at this dose. What is dysaesthesia? It is an unpleasant, abnormal sense of touch caused by neurological damage. It can be painful. It can be spontaneous, it can occur when you touch your skin, or it can just happen on its own. It can feel like burning, like electrical shocks, like pins and needles. It can feel really excruciating. Nobody wants dysaesthesia.

Nobody should volunteer to get dysaesthesia. 23% of people in this study — that is a quarter of them — developed this side effect, and they still licensed it. Does it disappear? Does it go away, or is it for life? If you stop taking the drug, is the neurological damage permanent? I don't know. I really don't know.

More importantly, why is that okay?

I've had dysaesthesia. I had it for two weeks. It was probably viral. For a while there, we thought I might have trigeminal neuralgia. I couldn't do anything. I just didn't want to get out of bed. It was the worst. Two weeks. Honestly, I'm trying to think of a time that was more painful, because it's neurological pain, and anyone who's experienced neurological pain knows — it is a specific type of pain. This is coming from somebody who went through labour. 48 hours the first time round, 24 the second time round. My point is, I've been through childbirth. I've experienced some pain. And neurological pain — that's a different kind of pain. That is something else. Why is that okay?

How can we justify putting fat people through that, just so they can get thinner?

Because this is the thing — as you'll soon see — GLP-1s make you lose weight. That's it. That's all they do.

But I want to stick with the risks, because I've talked about the side effects, I've talked about the dysaesthesia, I've talked about all of the common side effects. There are actually some very serious side effects with GLP-1s that we already know about. Not the ones that we don't yet know about — the ones we already know about. It can cause acute pancreatitis, which can be a life-threatening situation. It's also linked to a rare form of thyroid cancer. In fact, in 2017, Novo Nordisk paid more than $58 million to the US government for downplaying cancer risks for one of their GLP-1s.

So they were telling their drug reps: tell the doctors it's not that big a deal. And so it was so bad that the FDA got involved, and they went to trial, and they had to settle for $58 million. Which you might think is a lot of money, but for a drug company, not really — not considering how much money they're making from this drug. But yeah, just in case you were wondering whether Novo Nordisk is a trustworthy drug company — they were downplaying cancer risks. They're also price gouging insulin. Different story for a different time. They price gouged insulin during the first Gulf War. The way they abused people in certain parts of the world, just to make money — it takes a certain level of depravity to do that, but Novo Nordisk didn't seem to care. They got fined by the US government for that too.

Anyway, is it okay to put people through all of this? Is it okay, actually — forget all of the side effects for a second — is it okay to reduce a person's appetite?

I know that everyone thinks: oh, it's a good thing. That's what we want to do. We want to reduce this fat person's large appetite, and things will get better. But is it? Is that a good idea?

Appetite exists for a reason. If I could give you a drug that stops you from needing to go for a wee — because sometimes we're busy. When I was working as a doctor in clinical medicine, I didn't have time to go for a wee. I had to see a patient every ten minutes. My clinics would last from 8.30 in the morning until 1.30 in the afternoon. Would it have been okay if someone said, here's a drug that will just stop you from having the urge to go to the toilet, so you just won't feel it? Would that be okay?

Because appetite exists for a reason. And I know that you've been told there's something wrong with your appetite. You've been told that you're greedy, and that you eat too much, and that it needs to be fixed. The opposite is true. You're hungry all the time because you're not allowing yourself to eat what you want to eat. You're hungry all the time because you're restricting. And this drug is going to make it worse.

Everyone goes, oh, it stops all the food noise. It doesn't stop the food noise, it just stops you from eating. It stops your appetite. You just don't feel hungry anymore. But that's not a good thing. You're supposed to be in touch with all of your natural bodily functions. Your body is fantastic. It is supposed to work. You leave it alone, and let it function as it will. When you're hungry and you feel hunger, that's your body's way of saying it's time to eat. Should we be switching that off? Probably not.

Especially in people who have a history of disordered eating. It's really not a good idea to do that — especially in people who have a history of eating disorders. Because now we're literally messing with people's lives. Eating disorders are the deadliest mental health condition out there. The worst thing you can do to somebody with an eating disorder is mess around with their appetite. You're literally giving them an eating disorder. In fact, taking weight loss drugs predisposes people to eating disorders — up to 18 times the risk. Eighteen times.

So should we be messing with people's appetites? I would argue no. I would argue that's a very, very dangerous thing to do. I would argue that just the risk of eating disorders alone should give everyone pause. On the one hand, it will make you thinner, but on the other hand, we're potentially giving you an eating disorder. If I had to choose between one or the other — as a doctor, I've been told I'm supposed to make you thin — but the risk of eating disorders should trigger enough of a response to at least think twice. But we don't. We don't think about it at all, because we have been told that thinness is more important than anything else. And if reducing your appetite messes with your mental health, who cares? Mental health isn't as important as being thin. That's what we've been taught. And if it gives you an eating disorder — who cares? That's what we've been taught.

Moving on.

We only have data that lasts for a year — two years, three years max — for the GLP-1s. People often ask, what are the long-term risks, Asher? I don't know! It was approved in 2021, the study came out in 2021, it's only 2026. How am I supposed to know about the long-term risk? It hasn't been long-term yet!

I do know that there are many instances in history where we rushed the process of approving a weight loss drug through, and the FDA just went, yep, that's fine, and then a few years later went, oh, I'm sorry, it causes cancer. Oh, I'm sorry, it causes heart disease. Look, people are having strokes on this weight loss drug, we better pull it off the market. By that point, the damage was done. But more importantly, the very thing they told us was caused by being fat is the very thing that happened as a result of making you thin with a weight loss drug. We tell you you're too fat and you're going to have heart disease, we give you a drug that causes heart disease, and then we go, oops. Try another one. That's how the medical profession thinks.

Anyway, so what are the long-term implications? I don't know. Nobody knows.

Five years after the approval of Wegovy in 2021, there is still no long-term data. Most of the studies end after a year. There is one study that followed participants up for two years — the Step 5 study. It followed them up for two years, and it concluded that semaglutide led to substantial, sustained weight loss over 104 weeks versus placebo. 104 weeks is two years, but you know, it sounds better if you say 104 weeks — because we've got a medical communications company writing the abstract.

What the medical communications company and authors failed to mention was that most of the weight loss occurred in the first 20 weeks, and it peaked somewhere around 60 to 68 weeks. And from that point onwards, there was a clear upward drift — and you only know that if you look at the graph on a computer and enlarge it enough to see what I'm talking about. There is an upward drift from 60 to 68 weeks, which is roughly the nadir — the peak of the weight loss. About 10% of the weight that they lost was regained by the end of the study.

By the way, that was after a third of the treatment group had dropped out. A third of the treatment group couldn't even finish the study because of the side effects of the medication. Only the people who were most determined to get to the end of the race remained. And even they started gaining weight whilst on the drug — not when they stopped it, whilst on the drug.

If it took just eight months to regain approximately 10% of the weight, what would have happened if they had left it for another year, two years, three years? We'll never know. They stopped it. How very convenient for them.

The longest study we have is the SELECT study, and that was up to four years' worth of data, an average of about three. But it only covers a very specific group of people — older, predominantly white men who had recently had a heart attack. That is not representative of the majority of the world who are taking these weight loss drugs. A very select group. Select — get it? I don't remember what SELECT stands for, but that's the name of the study.

So we do know that people lose weight when they take these drugs. That we know. I'm not disputing that. To be fair, everyone on any one of these trials is not just taking the injection — they are also on a calorie-controlled diet, in an energy deficit of 500 fewer calories than they need every day, plus they're on an exercise programme, plus they have behavioural therapy. So they are already on a diet, and they use the weight loss drug in addition. It's not just the weight loss drug. But they do lose weight — there's no question about that.

We also know that weight regain begins the moment you stop, and we know this for two reasons. Number one: a year after the first trial — the one published in 2021 — ended, the data showed that the average patient had gained back two-thirds of their weight within a year. People were allowed to continue taking the drug off their own back; it just wasn't part of the trial anymore. There's a better study, personally, which is the Step 4 study. What they did was give everyone semaglutide to begin with, and then — I think at around 16 weeks — they swapped half of the group to a placebo, a water injection, and the other half carried on with the semaglutide. By the end of the study, the people who stayed on the semaglutide had lost a lot of weight, and the people who were given the placebo — the moment they came off the semaglutide, their weight went straight back up. Straight back up.

So weight regain is inevitable the moment you stop these drugs. Recent studies have shown that weight regain after stopping GLP-1s is significantly faster — far more rapid than after traditional weight loss methods, whatever those might be. So there's a concern there. What is happening to your body when you lose this drastic amount of weight? We don't know. There's no long-term data. How is it impacting your heart, your hormones, your stress levels? Does it cause long-term inflammation? We don't know any of that.

And also — once you stop it, possibly even whilst you're still on it and you start to regain the weight, what happens then?

These drugs cost a lot of money, so a lot of people commit to them without thinking about the fact that, actually, if I'm committing now, I'm committing for life. I'm going to have to fork out this money for the rest of my life. Most people can't afford that. They think, I'll just take it for a short period of time. And so they do, and then they lose weight, and then they gain it all back again, really quickly. What's that doing to the body? We don't know. We don't know, because we don't study it.

So, should doctors be prescribing GLP-1s? Doctors want to prescribe them for everything. I had somebody tell me they were diagnosed with low testosterone. I was like, oh, well, it's relatively easy to treat — just give you testosterone therapy. I take it every day, it's just a gel, you rub it on. And they said, no, I was told to go on a GLP-1. Why? There's no evidence that GLP-1s are going to improve your testosterone. Where's the study to show that? The doctor's reasoning was: you're fat. And so they were told to go on a GLP-1.

Doctors are doing it for everything. My joints hurt — take a GLP-1. I've got sleep apnea — take a GLP-1. I've got PCOS — take a GLP-1. I've got inflammation somewhere in my body — take a GLP-1. I've got rheumatoid arthritis — take a GLP-1. Based on what? What study? Show me the study that proves that that's beneficial. It doesn't exist. And let me explain why.

Here's what we do know. We know that it causes weight loss — the Step trials 1 through 8 showed us that. Step 9 showed that taking a GLP-1 had a modest improvement in knee arthritis pain. The group all had relatively mild arthritis to begin with. There was no improvement in the cartilage of the knee, no actual improvement in the underlying arthritis — but it improved pain levels. That said, there was also a massive improvement in the placebo group. So if you see a massive improvement in both the placebo group and the treatment group, you've got to wonder what's going on there. Was it the weight loss, or was it something else?

As I mentioned, the SELECT trial — older, predominantly white men who had pre-existing heart disease — had a 1.5% reduction in cardiovascular events in people using semaglutide versus those who weren't. Does that mean that GLP-1s prevent heart disease? Absolutely not. It means that in people who had already had a heart attack, taking a GLP-1 may reduce their risk of a further cardiac event by about 1.5%, roughly, according to population data. That's what we do know, and that's it.

Interestingly, there is also evidence that taking GLP-1s may increase the risk of developing arthritis of the hip and knee — in people who don't have it to begin with, and then develop it because they're taking GLP-1s. Those of you who were taking GLP-1s for diabetes and a few years later developed arthritis in a joint — you might want to look into that. You might want to look at whether there are any lawsuits in your area and whether you can be part of that, because this is emerging data. It's possible that taking these drugs is actually causing joint pain. I don't want to say for sure, because it's early days and we don't have enough data, but it's interesting. Keep your eye on that.

So what's happening in real life? Why are doctors prescribing this drug for literally everything you can imagine? It's because they're making completely illogical assumptions. They'll say: here's a condition that we associate with obesity, with being fat — you name it, PCOS, joint pain, whatever — every condition that's linked to being fat, including all the new ones they're constantly coming up with. GLP-1s cause weight loss. So they put two and two together and say: GLP-1s cause weight loss, this condition is associated with being fat, therefore the GLP-1 will treat the condition.

But here's the problem. Just because a condition is associated with something doesn't mean it is caused by something. Doctors assume that because it is associated, therefore being fat caused it — because that is the only reason you would recommend weight loss. You'd only recommend it if you genuinely believed that being fat caused the condition in the first place. But here's the thing: being fat doesn't cause conditions. It just doesn't. There's no evidence of causation — none whatsoever. Not a shred of evidence that is remotely reliable and stands up to any level of scrutiny.

Smoking causes cancer. People who smoke are up to 30 times more likely to develop lung cancer. The more you smoke, the higher your risk. If you stop smoking, your risk of lung cancer reduces. Now let's compare that with weight. People who are fat are maybe 1.3 to 1.5 times more likely to develop some condition. Far less convincing. The fatter you are doesn't mean the more likely you are to develop a condition — it's not a dose-response, or a linear relationship. So that doesn't make sense.

Weight loss doesn't treat the condition. Stopping smoking reduces your risk of lung cancer. Getting thinner does not reduce your risk of anything. The two are not the same.

We've got to stop saying that being fat causes, because there's no evidence of causation — none whatsoever. There isn't a shred of evidence that is remotely reliable and stands up to any level of scrutiny. If you feel you have evidence that proves me wrong, feel free to send it to me. Bring it over. I'll have a little look at it for you, and I'll send it back with some comments in the margins — some big crosses and big circles to point out the problems. Because it doesn't exist. The evidence doesn't exist.

There is no evidence that being fat causes any condition, and therefore there is no evidence that making people thinner is going to improve that condition. Which is why the two and two does not make four.

Doctors should know better. Because you studied epidemiology in the first year of medical school. You understood these logical errors from day one. This is basic. Did you forget it? Or are you conveniently forgetting it? Are you being selective in your memory?

If you want to prescribe a drug for a condition, you need evidence that that drug treats that condition. It's that simple. You don't even have to be a doctor to know that.

So if you want to prescribe me a GLP-1 because you think it's going to treat my arthritis — fine. Do that once the evidence is in. The STOP Knee OA trial — which stands for Subcutaneous Tirzepatide Once Weekly in Patients with Obesity and Knee Osteoarthritis — is currently underway. Good news! The study has begun. The results will be in May 2037. That's only 12 years from now, according to the website when I last looked.

So, if you want to prescribe me a GLP-1 for my arthritis of the knee, you can wait until the results of the study are in. And hey, if it's looking really positive, they'll probably publish the data sooner. Maybe 2030, 2032, 2033. Watch this space. But until then, what I'd like you to do is prescribe a treatment that actually works. Because there are plenty of treatments for arthritis of the knee that actually work — we have evidence that they work, they've existed for a long time. Give me one of those.

Don't prescribe me a GLP-1 unless you have evidence that it works. So when a doctor says to you, take a GLP-1 for whatever condition, you say: which study was that? Can you just remind me the name of the study so I can go and look it up? The one that shows that taking a GLP-1 is going to improve this condition. Just name the study, and I'll go look it up and get back to you.

Guess what? It doesn't exist. I've told you all the studies that exist, so you know which they are.

You're not obligated to take a drug just because a doctor recommends it. You know that, right? You don't have to take it just because they say so. If they say, you've got low testosterone, take a GLP-1 — you can just say no. You can say, where's the study that shows that taking a GLP-1 is going to improve my testosterone? Name it, please, so I can go and look it up for myself. And when they can't name it, you can say: no, give me the testosterone, which I know will actually treat my testosterone. It's that simple.

You've got sleep apnea? Great, I know how to treat that with CPAP. Give me the CPAP. Whatever the condition is — and there are going to be some conditions that don't need treating, and some that don't have a treatment — that doesn't mean GLP-1s are the answer either. I get it. In situations where there aren't any options, you're inclined to think: GLP-1, let's just try it. And to be fair, when there really are no alternative treatments, it seems more reasonable. But then you have to weigh up the pros and the cons, the risks and the benefits — and remember that most of the risks are unknown.

So you have to think: do nothing versus taking this drug. Write up a pros and cons list for both. Add them up, and decide for yourself. You don't just take it because, what the hell, let's have a go.

That was my little spiel on GLP-1s. I hope you found it helpful. I know I didn't cover everything — I can't possibly cover everything to do with GLP-1s. There's more about them in the book — an entire chapter dedicated to them, in fact.

The book is No Weigh: Everything You've Been Told About Weight Loss Is A Lie. It is available to pre-order on Amazon right now. Publication date is the 20th of May. If anything you've heard today resonated with you and you want to see a lot more of that, get the book! Everything we've covered in this episode, everything we've covered in this season, will be laid out in full, with all the evidence, all in one place, so that never again will someone say to me, cite your sources. Pre-order it now, and it'll land in your device on the 20th of May. The link is in the show notes.

If you signed up to my newsletter, I'm going to be inviting you to a very special launch party, so please, if you're not signed up already, sign up and be part of the No Weigh family.

As always, if you know somebody who is struggling with GLP-1s and wants some no-nonsense advice about them, please send them a link to this episode and send them a link to the book. Remember that everything you've been told about weight loss is a lie, and you'll find out all about that when my book comes out on the 20th of May. In the meantime, take care of yourself. Next week, I'm going to be talking a little bit more about Novo Nordisk and Eli Lilly, and just how harmful Big Pharma is, just how they're influencing your life in ways you're probably not aware of. So yeah — you don't want to miss it. Take care. Bye.