Guest Lecture: Rekha B. Kumar, M.D., M.S.
“I really do see GLP-1s becoming part of a lot more people’s everyday health routines."
Feed Me is sponsored by Found today, which means there is no paywall. This is the last of a three-part partnership I worked on with them this summer.
Good afternoon everyone. This is a Mile High edition of Feed Me, which means I’m sending it from the sky.
Today’s letter includes: answers to your questions for Rekha B. Kumar, updates on the latest private jet influencer trip, and Hamptons claw clip theft.
Guest Lecture: Rekha B. Kumar, M.D., M.S.
Guest Lecture is a Feed Me series that captures the spirit of that (sometimes unhinged) guest lecturer who would come into your class on a Friday, drop more knowledge than you’ve heard all year, and then leaves forever.
This week, Rekha B. Kumar, M.D., M.S., Head of Medical Affairs at Found and board-certified endocrinologist, answers your questions about GLP-1 usage and fertility, “food noise,” and more.
“I’d love to understand why these medications seem to interact with birth control or affect fertility and why they are contraindicated for people with a family history of thyroid cancer.” - Amber
GLP-1s slow gastric emptying, which is fantastic for appetite control, but it also means your birth control pills might get absorbed more slowly and less predictably, so I always recommend backup contraception for the first month when starting or increasing doses.
While GLP-1s don't directly improve fertility, they're proving to be game-changers for women with PCOS or insulin resistance. Essentially, by improving insulin sensitivity and promoting weight loss, they can restore regular ovulation that may have been previously disrupted. That's amazing if you're trying to conceive—but can be a complete surprise if you're not! This is exactly why reliable contraception and candid conversations with care providers you trust are crucial.
The thyroid cancer warning specifically concerns medullary thyroid cancer and a genetic syndrome called MEN2. Animal studies flagged this risk, so the FDA took a cautious stance. If you have garden-variety thyroid issues like hypothyroidism or Hashimoto's, you're completely fine. Even common thyroid cancers like papillary or follicular aren't contraindications. As an endocrinologist who treats thyroid cancer, I have many patients with these histories successfully using GLP-1s–and, this is a decision you should make in close partnership with a provider who can help you assess what’s right for you.
“I’m interested in how it affects regular’ people — those who are just interested in shedding a few pounds and opt for the drug. Also how you might see the future of access to GLP1s. What might be the differences between how we get it today vs in the next few years.” - Dominga
This is such an important question, and I want to start by saying that we're in the middle of a major shift in how we think about metabolic health and using medication preventatively. Traditional BMI criteria were built on outdated frameworks that may have been influenced by weight bias—it's only recently that obesity was even recognized as a disease, and we're still in the early stages of fully understanding the wide range of benefits these medications might offer that go beyond weight loss.
Put simply, I believe we're moving from reactive to preventative care when it comes to metabolic health. At Found, we're expanding our criteria to help people before they technically meet "overweight" or "obesity" thresholds. Why wait until someone develops diabetes or significant metabolic dysfunction when we could intervene earlier?
Some people at "normal" BMIs have underlying metabolic issues—insulin resistance, inflammation, genetic predispositions—that make them excellent candidates for GLP-1s. Others might be metabolically healthy but struggling with food relationships or weight cycling that these medications could address. Having a more nuanced understanding and approach to when / how / why to use GLP-1s is the next phase of this cultural obsession. While we need to determine what’s best for someone on an individual basis, I think it’s possible that we aren’t thinking big enough when it comes to who GLP-1s might be a good fit for.
I don’t think it’s about dropping 10 pounds for a beach vacation, but instead recognizing that metabolic health exists on a spectrum, and the right intervention at the right time—with proper medical guidance—can prevent bigger problems down the road.
The future looks incredible: oral formulations, combination therapies, generics, and much broader access as we discover benefits for cardiovascular health, inflammation, even addiction. But most importantly, we're moving toward personalized medicine where decisions are made collaboratively between you and a provider who understands your unique metabolic profile—not just following arbitrary BMI cutoffs.
That's exactly the approach we take at Found: comprehensive evaluation, ongoing support, and treatment plans tailored to your individual health goals, not outdated one-size-fits-all criteria.
“Fo truly healthy individuals whose only goal is aesthetic weight loss? The risk-benefit equation rarely makes sense. We're talking potential serious side effects, significant cost, and ultimately.. we’re addressing the wrong problem entirely.”
“How many people are using their drugs who are considered thin with a BMI in the normal range, who just want to get even skinnier? And is it advisable/safe for these people to use weight loss drugs?” - Hajni
You're right to be concerned—some people with normal BMIs are using these medications just to get "even skinnier," which raises real red flags. This stems from unrealistic beauty standards and an unhealthy focus on body size rather than body health.
Here's what I see in practice: when someone at a healthy weight is fixated solely on getting smaller, that's usually not a medical problem—it's often rooted in something much deeper. The unfortunate reality is that no medication (alone) can fix that underlying relationship with body image.
That said, BMI doesn't tell the whole metabolic story. When I evaluate any patient, I'm looking far beyond weight—insulin sensitivity, inflammatory markers, family history, genetic factors, overall metabolic health. Some people at "normal" BMIs do have underlying metabolic dysfunction that warrants treatment.
But for truly healthy individuals whose only goal is aesthetic weight loss? The risk-benefit equation rarely makes sense. We're talking potential serious side effects, significant cost, and ultimately.. we’re addressing the wrong problem entirely.
The key is finding a provider who will honestly assess whether you're seeking medical treatment for a health concern or trying to medicalize normal body diversity and unrealistic / unhealthy aesthetic goals. At Found, we believe that sustainable health—not just a smaller body—should always be the goal.
“Are there ways to wean off of them without rebound weight?” - Molly
Some weight regain after stopping GLP-1s is almost universal. Our bodies are designed to maintain a certain set point, so while these medications fundamentally alter appetite signaling and metabolism while you’re taking them, our bodies try to recalibrate when we stop.
But! Not everyone who takes GLP-1s will need to be on them forever, and treating the medication period as intensive habit-building time can be really effective for certain types of patients. The two groups I see successfully transition to very low doses or intermittent use: Menopausal women who maintain a healthy diet and consistent exercise routine, and women with PCOS who maintain lifestyle adherence that works well for them.
I think the medication buys you time and mental space to build sustainable systems, and that if you use that window wisely—work with a coach, establish exercise routines that you actually enjoy, find a balanced approach to nutrition that gives your body the fuel it needs, address stress and sleep—you might be able to use GLP-1s as training wheels vs. a permanent solution.
“What lifestyle changes make GLP-1s safer/more effective (e.g. exercise, diet, or lack thereof)? Do we even have enough data to understand potential long term effects yet, or are current studies more projections? What do you think about how the psychology differs between those that have embraced GLP-1s and those that eschew them?” - Marcia
GLP-1s work dramatically better when combined with comprehensive lifestyle changes. Regular exercise, balanced nutrition, quality sleep, and stress management don't just enhance the medication's effectiveness.. they make side effects more manageable and build the foundation for long-term success.
For safety data, we have robust short- and medium-term evidence, especially from diabetes use spanning over a decade. Weight-loss specific research is newer, so we're still building the very long-term picture—but what we have looks promising.
In terms of the psychology: people who embrace GLP-1s tend to be pragmatic optimizers. They're growth-minded, solutions-oriented, and comfortable with the idea that health is something you actively manage rather than just hope for. They see medication as empowerment, not failure.
Those who avoid them often value self-reliance and natural approaches—they want to "earn" their results through willpower alone. Some worry about dependency or losing their sense of personal agency. Others have deep skepticism about pharmaceutical interventions or fear being judged for taking the "easy way out."
Both mindsets are completely valid, but your values around autonomy, control, and what constitutes "authentic" health matter enormously in treatment success. The most successful patients are those whose treatment approach aligns with their core beliefs about how change should happen.
At Found, we spend time understanding not just your medical history, but your health philosophy. Because the "right" treatment isn't just medically sound—it has to feel aligned for you.
“I keep seeing commercials for these where folks talk about ‘food noise’ being turned down on these medications. But could food noise just be...hunger cues? Or perhaps the incessant voice of diet culture and body shame that these drugs are claiming to sell a cure for? I'm not entirely anti-ozempic, I definitely see the nuance in how these can benefit a certain population, but have concern over the normalization of folks getting on these without support” - Mary
Food noise is a legitimate concern for many people.. and we’ve gone too far in vilifying hunger altogether. Healthy hunger cues are normal and necessary! We want our bodies to send us a clear message when it needs more fuel. What we don’t want is for those messages to become constant, distracting, or entirely disruptive.
GLP-1s really do turn down those constant hunger signals, and many people on GLP-1s have eliminated hunger cues entirely. The sense of relief some people feel initially because they’re no longer totally occupied by their thoughts around food.. I imagine it’s very empowering. But at some point, many of these same people start to complain that they miss feeling hungry. They crave the joy and excitement that comes with trying a new recipe to try for dinner, or going to a new local restaurant with friends. When people have gone from one extreme (thinking about food all the time) to the other (skipping meals because they forgot to eat), we have a problem. But the good news is that we can recalibrate, whether by adjusting the dose, or by discussing what’s at the root of your relationship with food and hunger.
It’s true that so much of what we feel / think / do around food comes from diet culture and body image pressure, and no medication can fix that. That’s why your point around support—whether that’s therapy, coaching, and/or a personalized care plan that includes dosing adjustments when necessary—matters so much. The meds can help with appetite and give you the training wheels to create more mindful habits, but changing your relationship with hunger requires a bit more help.
“I'm curious about GLP-1s and hair loss. I know someone who was recently on GLP-1s and she's now having issues with hair loss. I've also heard from a few others that they're having the same problem. Is this potentially due to hormonal changes caused by sudden (non-gradual) weight loss?” - Nicole
Hair loss isn’t related to the medication itself—it’s more about rapid weight loss and eating less / not getting the right amount of nutrients, which can lead to nutrient gaps. What we see is something called telogen effluvium, and the good news is it’s usually temporary and tends to improve as your body adjusts.
If you’re seeing a lot of shedding, talk to your doctor. They can check things like iron or zinc and help with supplements or diet tweaks. Sometimes, even treatments like minoxidil can make a difference. The big thing is making sure you’re getting enough nutrition and staying on top of it with your provider.
“Given that the ancillary benefits noted from GLP1 users have been many - do you see a world where GLP1s are part of most people’s every day regimen?” - KV
I really do see GLP-1s becoming part of a lot more people’s everyday health routines down the road! The science is moving fast—we’re talking benefits for heart health, inflammation, Alzheimer’s, fertility, PCOS, even things like addiction. I think we’re currently fundamentally redefining the future of preventative metabolic care and longevity.
“I really do see GLP-1s becoming part of a lot more people’s everyday health routines down the road!”
Do you have insulin resistance and a family history of diabetes and heart disease? Or have struggled to maintain a healthy weight for a significant portion of your adult life, and have a family history of cognitive disorders? I think you’re probably a candidate for some variation of GLP-1s.That said, they’re still medications and not without risks, so it’s not one-size-fits-all. Ideally, someone would work with a care provider who understands their situation and can help them make an informed decision that weighs the risks vs. benefits.
“I am curious about whether GLP1s have been looked at for treating eating disorders. I know it may sound counterintuitive, but I have a few people in my life who have been consumed in one way or another with food but are at normal weights. They have struggled with bulimia and binge eating disorders. They definitely have ‘the food noise’ and even at healthy weights and healthy behaviors, are possessed by thoughts of food all day long. It sounds like any old addiction to me, except extremely difficult to treat because you have to eat. Given GLP1s promise with other addictive behaviors, do any of them show promise for non-weight related food addictions?” - Tragedyplum
I absolutely love this question because you're thinking about this exactly right—it IS like treating an addiction, except you can't quit food cold turkey.
GLP-1s are showing real promise for binge eating disorder and bulimia nervosa precisely because they modulate the dopaminergic reward pathways in the brain—the same circuits involved in substance use disorders. They quiet the disruptive thoughts about eating, the constant mental negotiations. As I said on the other “food noise question,” what we're seeing in early studies is that these medications create more space between impulse and action.
What's particularly fascinating from a clinical perspective is that this benefit appears to exist independently of weight loss. For people at normal weights who are trapped in binge-restrict cycles or constant food preoccupation, GLP-1s might offer genuine relief by normalizing the dysregulated appetite signaling that underlines these disorders.
But eating disorders are never just about food. There might be trauma or other psychological drivers underneath. GLP-1s can quiet the neurochemical chaos enough to make dialectical behavior therapy and other evidence-based recovery work actually possible—but they're addressing symptoms, not the root causes.
Anyone considering this approach should consider working with an eating disorder specialist with experience in both psychopharmacology and eating disorder treatment.
The research is still early, but the preliminary data is genuinely promising for this population.
“What is the actual difference between brand name Zepbound, Mounjaro, Ozempic etc. and what is being offered by the ‘Compound Pharmacies’ and/or the Hims/Romans of the world? I want to get on Tirzapetide, but my main fear is needles (I know, I know). My understanding is that Zepbound comes in essentially an insulin needle that you barely feel. Is that only coming from Lilly or Novo, or do you get similar injection tools from the other brands? Talk me off the needle ledge.” - Mike
First, the good news: most people find injections much more manageable than they anticipate. Whether you're using brand-name medications like Zepbound, Mounjaro, or Ozempic, or working with high-quality compounded versions, the injection itself is typically quick and relatively painless when done properly.
Finding the right medication and delivery method for your specific situation is what you should be focused on. Some people are excellent candidates for brand-name medications, especially if they have insurance coverage or specific clinical needs. Others might benefit from compounded versions, which can offer more dosing flexibility and often better affordability.
When it comes to compounded medications, quality is absolutely crucial. At Found, we work exclusively with rigorously vetted compounding pharmacies that maintain high quality standards, including comprehensive testing for potency, sterility, and stability on every lot.
Related to the (many!) medication providers available today, it’s an unfortunate reality that several focus on getting you a prescription and shipping you a product. Found goes beyond that by providing comprehensive, personalized care that includes ongoing medical supervision, dosing optimization, side effect management, and lifestyle support.
For example.. the injection anxiety is real, and we'll work with you to make it as comfortable as possible—whether that's using numbing techniques, choosing the right injection site, or even exploring oral alternatives like Rybelsus when appropriate. We can guide you through that first injection and provide ongoing support to ensure you're successful with whatever medication approach works best for you.
“What are the risks of going on GLP-1s if you just want to lose 10-15 pounds and don’t have diabetes? Are any of the weight loss drugs on the market especially good (least bad?) for that?” - Molly
The conversation is shifting as we learn more about these medications' benefits beyond weight loss. What might have seemed like "just cosmetic" weight loss a year ago looks very different when we consider the emerging research on cardiovascular protection, metabolic health, and disease prevention. The reality is that we're moving toward a more preventative approach to metabolic health.
Some patients come to us having already achieved significant weight loss and want to maintain their results without the constant mental effort. Others are using GLP-1s preventatively—they have family histories of diabetes, metabolic syndrome, or cardiovascular disease, and those "10-15 pounds" might represent early intervention that prevents more serious health issues down the road.
From a clinical standpoint, I'm increasingly seeing patients who don't fit traditional obesity criteria but have clear metabolic dysfunction—insulin resistance, chronic inflammation, disordered eating patterns, or weight cycling that's disrupting their quality of life. For these individuals, early intervention with GLP-1s might be more about preventing disease progression than just achieving a number on the scale.
That said, no medication is without risks. GLP-1 receptor agonists can cause gastrointestinal side effects, and there are potential concerns around pancreatitis and gallbladder issues. The key is thorough evaluation: comprehensive metabolic profiling including fasting glucose, insulin levels, inflammatory markers, and lipid panels.
At Found, we're specifically expanding our criteria to serve this population because we believe preventative metabolic care shouldn't wait until someone develops diabetes or significant obesity. We conduct thorough assessments—looking at metabolic health markers, family history, eating behaviors, and overall health goals—to determine if GLP-1s align with your clinical picture, even at lower BMIs.
“Here's my clinical concern about metabolically healthy women using these primarily for modest weight loss: we may be medicalizing normal physiological weight fluctuations that don't require pharmacological intervention.”
“Some discourse out there around GLP-1s being a good idea for post menopausal women For healthy women of child bearing age who are just looking to shed pounds, what are the fertility implications (pos and neg)” - Emily
GLP-1 receptor agonists are often transformational for this population. Menopause brings a constellation of metabolic changes: declining estrogen leads to increased visceral adiposity, insulin resistance, and cardiovascular risk. These medications address multiple pathophysiological processes simultaneously—not just weight reduction, but improved insulin sensitivity, reduced inflammatory markers, and potential cardioprotective effects.
For reproductive-age women, the fertility implications are more nuanced and depend heavily on baseline metabolic status. GLP-1s don't directly impair fertility—in fact, for women with PCOS or metabolic syndrome, they can be fertility-enhancing by restoring normal ovulatory cycles and improving oocyte quality through better glycemic control and reduced androgen levels.
But here's my clinical concern about metabolically healthy women using these primarily for modest weight loss: we may be medicalizing normal physiological weight fluctuations that don't require pharmacological intervention. If you're metabolically healthy with normal insulin sensitivity and regular menstrual cycles, the risk-benefit ratio may not favor treatment.
The non-negotiable reproductive safety issue: GLP-1 receptor agonists must be discontinued 1-2 months before attempting conception, and they're absolutely contraindicated during pregnancy and lactation due to insufficient safety data in these populations. Animal studies show potential risks to fetal development.
If you're considering GLP-1s and pregnancy is in your future, work with a provider who understands reproductive endocrinology and can properly assess whether the clinical benefits justify the reproductive restrictions and potential unknowns.
I got more information on that private jet brand trip that we were discussing in the Feed Me chat over the weekend. The trip was for a canned beverage brand called Love, which was founded by Kurt Seidensticker. Kurt has had a fascinating career – he started as an aerospace engineer at NASA, transitioned into the e-commerce business in the early 2000s, and started the collagen peptide brand Vital Proteins in 2013. Nestle acquired Vital Proteins in 2020 for an undisclosed amount, but Merger Market estimates the deal was somewhere around $700-800mm. This year, Seidensticker started Be Love, the beverage brand that flew influencers to Aspen over the weekend for a music festival.
Cosmo launched a smoothie with SunLife.
There is a claw clip theft issue in the Hamptons, according to police reports. Every time I read about the steady rise in claw clip search terms (and robbery) I think of Emilia’s newsletter from a few years ago. “It followed me everywhere, and in every color,” she wrote of the ubiquitous hair accessory. “I saw it at Starbucks and Sweetgreen; in Prospect Park and Grand Central; at Bagel Pub in Park Slope and Joe Pop’s bar on the Jersey Shore. I saw it while camping and at a country fair. I even saw it at an airport in Portugal. I saw it on a lot white women, for sure. But really, the rectangular hair clip has mass appeal. Why? Where did it come from?”
I think it’s safe to say about 25% of Town & Country’s reporting these days is on elite colleges in America. Which is why it’s smart that they’re hosting an event for their readers with two of the world’s most sought-after admissions advisors. I’ll take one for the team and RSVP.
has been a joy to follow during Copenhagen Fashion Week. I like the way he’s using notes to share micro-observations throughout the week, along with photos and conversations he’s having. He’s part of this very new, very fresh style of fashion week coverage – it’s so nice to read about a city and clothes that happen to be paired for an event, without the superfluous thank you sooo much to this brand for inviting me, or I saw This Person and That Person at this dinner, and heard a lot of things I can’t tell you. The one piece of gossip he shared generously: “This is New York related, but I found out about it in Copenhagen. There’s a new multi-brand store coming to the West Village.”
JP Morgan paid $3B for a new skyscraper at 270 Park Avenue. Employees are angry that they’ll have to pay for the gym (including group fitness classes and nutritionists) themselves.
Crypto psychopaths and Brandy Melville and collars from Agent Provocateur and Sartiano’s and $10,000 dinners at Raoul’s and private jets to Kentucky and Hamptons nightclubs and private chefs who poison their diners? There is nothing this New York Magazine cover story by Ezra Marcus and Jen Wieczner doesn’t have. What a town. (Big week for Ezra, who is now also a J.Crew model!)
Israel killed four more Al Jazeera staff in Gaza over the weekend. According to the CPJ, at least 186 journalists have been killed in the current conflict, making it the deadliest period for journalists since they began recording deaths over 30 years ago.
I'm surprised that more of the discourse around GLP's doesn't discuss some of the other impacts these drugs have on at least some people - several people close me to who are on them talk about a "post-desire" life - it's not just food noise that's tamped down, it's sex noise, drinking, shopping, smoking you name it. Some of those things we all want to be free (or freer) from, but for some not-insignificant number of people it really does a number on your sex drive. I've watched my beloved SO drop 30 pounds, but I've also watched him go from big ribald personality who loved one bourbon too many to .... something much calmer. I know from other folks that this is not unique. I love to cook, I love wine, I love my desirous craving personality - so I'll be the last affluent person in America who is 10 pounds overweight!
GLP-1s are clearly a fascinating and important topic, and I can see why you’re featuring them so prominently in your newsletter. But it might help the conversation to include in your coverage other evidence-based perspectives from experts who don’t have any vested interests in these medications.