Tolerance, metabolic adaptation and appetite changes

Today, Dr. Priya Jaisinghani joins us to cut through the headlines. We move beyond the "cheating" narrative and explore the biology of obesity as a chronic disease. We discuss the phenomenon of "Food Noise"—the constant mental static about eating—and why silencing it is a matter of brain chemistry, not willpower.

We get into the weeds of patient selection, explaining why BMI is a broken metric (especially for South Asian populations) and why being "skinny" doesn't mean you’re metabolically healthy. We also tackle the serious risks: the "muscle crisis" (sarcopenia), the dangers of unregulated compounding pharmacies, and what happens when you stop these drugs.

What We Discuss:

• The "Food Noise" Phenomenon

• Patient Selection & The Broken BMI

• The Muscle Crisis: Quality vs. Quantity

• Safety, Side Effects & The Compounding Trap

• The Future of Metabolic Medicine

Resources & Links:

Connect with Dr. Jaisinghani:

• NYU Langone Profile: Dr. Priya Jaisinghani

• Instagram: @DrJ_NYU

• LinkedIn: Priya Jaisinghani, MD

Studies & Literature Mentioned:

• SURPASS-3 MRI Sub-study: Reduction in Liver Fat and Muscle Fat with Tirzepatide

• SELECT Trial: Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (The "MACE" reduction data)

• FLOW Trial: Semaglutide in Patients with Type 2 Diabetes and Chronic Kidney Disease

• GRAMS Trial (Upcoming): GLP-1s and Musculoskeletal Outcomes

• Medscape Article: Do GLP-1s Have Deleterious Effects on Muscle?

Podcasts & Videos Mentioned:

• Podcast: Drug Story by Thomas Goetz (Episode on GLP-1s)

• TEDx Talk: Dr. Melanie Jay: Weight Bias in Medicine

Concepts & People:

• Dr. Gabrielle Lyon: Muscle-Centric Medicine

• Dr. Spencer Nadolski: Lipidologist & Obesity Physician

Want to work with Dr. Raja?

• Refining Health & Performance is opening a limited number of founding member spots for the telemedicine practice. We focus on health span, longevity, and performance using a Medicine 3.0 approach. Apply at RefiningHealthRx.com.

Guest Bio:

Dr. Priya Jaisinghani is a triple-board certified physician in Internal Medicine, Endocrinology, and Obesity Medicine, and currently serves as a Clinical Assistant Professor at NYU Grossman School of Medicine.

She completed her training at Weill Cornell and New York-Presbyterian Hospital before becoming a key architect at NYU Langone, where she helped build their official obesity clinical care pathway.

Dr. Jaisinghani is a leading voice in the cardiometabolic space, specializing in the intersection of hormonal health and metabolic dysfunction. She is deeply passionate about treating obesity as a chronic, complex disease rather than a willpower failure.

Beyond her clinical practice, she is a dedicated educator who has secured grant funding to develop tools that teach residents how to dismantle weight bias in the exam room. She serves as a vital bridge between endocrinology, bariatric surgery, and sports medicine to treat the whole patient.