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In this second half of their powerful conversation, Dr. Supatra Tovar and quadruple board certified psychiatrist Dr. Vikas Gupta, founder of Wellness Psychiatry, tackle the topics that most GLP-1 discussions avoid: compounded medications, people who do not respond to GLP-1s, the explosion of disordered eating, and why a multidisciplinary, weight neutral approach is urgently needed.

Dr. Gupta begins by addressing the reality many patients face. When FDA approved GLP-1 medications are hard to access, people turn to compounding pharmacies, online prescribers, and social media dosing advice. He explains why the FDA does not endorse compounded GLP-1s, what that means for quality and safety, and the practical steps patients can take if they have relied on compounded versions in the past. Planning ahead with a prescriber, exploring manufacturer assistance programs, and maintaining a “metabolic scaffolding” of structured meals, hydration, and resistance training become essential if access changes.

They also discuss a risk that is rarely named out loud. Many people are now crowd sourcing their dose from the internet, posting syringe photos and asking strangers what to inject. Dr. Gupta underscores why dose decisions belong in a medical visit, not on a message board, and how honest conversations with a trusted clinician can protect both body and mind even when a patient has obtained medication elsewhere.

From there, the episode turns to non responders. What if you are on a GLP-1 and do not lose weight, or even gain? Dr. Gupta outlines the biological and behavioral reasons this happens, including receptor variability, dose issues, medication interactions, inflammation, thyroid function, sleep, and the way appetite suppression can quietly reduce movement and muscle. Dr. Tovar adds a deep dive into the body’s evolutionary response to restriction, explaining how aggressive calorie cuts trigger thermogenesis downshifts and “rebound” weight gain unless hunger, fullness, and nutrient quality are respected.

The heart of Part Two is an honest look at eating disorders and disordered eating in the GLP-1 era. Drawing on his work with higher levels of care, Dr. Gupta explains why GLP-1s are not appropriate in anorexia, atypical anorexia, or restrictive presentations, and why even a past history of an eating disorder should be a serious red flag. Together they explore how appetite suppression, rapid weight changes, and cultural praise for thinness can reactivate restriction, binge restrict cycles, and compulsive body checking.

Dr. Tovar highlights the role of weight stigma, comments on other people’s bodies, and the limits of BMI as a proxy for health. Both emphasize the need for Health at Every Size aligned care, screening tools like the EAT-26, and teams that include therapists, psychiatrists, and dietitians who understand eating disorders, trauma, and metabolic health.

The episode closes with Dr. Gupta’s hopeful vision for the future of psychiatry. He describes an upcoming landscape where metabolic data, genomics, microbiome s

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