A Physician's Personal Reckoning with GLP-1s and the Future of Weight Management: Dr. Christle Guevarra, DO, Family and Sports Medicine Physician

Lindsey Smith

Hi, I'm Lindsey Smith welcoming you to Raise the Line from Elsevier, an ongoing exploration about how to improve health and healthcare. 

The arrival of GLP-1 medications such as Ozempic and Wegovy have upended decades of conventional thinking about weight management, raising important questions about who should use them, how they work best, and what role nutrition and physical activity still play in lasting results. 

We're going to explore these issues today with Dr. Christle Guevarra, a board certified family and sports medicine physician and author of The Beginner's Guide to GLP-1s. She currently maintains a telemedicine private practice and serves as a traveling team physician for U.S. Figure Skating. 

Dr. Guevarra is also a former competitive powerlifter and has become a prominent clinical voice on GLP-1 therapies, bringing perspective that is at once scientific, athletic and personal. She's also raised concerns about gaps in nutrition education in medical training, so we'll be sure to ask her about that as well. 

Thank you so much for joining us today, Dr. Guevarra.

Christle Guevarra

Thank you so much for having me on.

Lindsey Smith

So let's kick things off by learning a little bit more about you. What first got you interested in sports, medicine, and nutrition? And how did those interests all come together?

Christle Guevarra

It was a very long winding road. The nutrition part, mostly out of my own personal journey, always thinking about weight loss growing up in the eighties and nineties...we can talk about in a little bit about how that led me to where I ended up. But I've always liked sports, and I think for a lot of people who end up in sports medicine, liking sports growing up was always a huge thing. But I also knew very early on that genetics is also a real deal. So as somebody who is at four eleven, I really enjoyed playing volleyball, and I think once high school hit, I soon realized that probably a career as an athlete in volleyball is probably not in the cards for me, and that's okay. So I spent a long time kind of thinking about how else can I be involved in sports that doesn't necessarily include me, you know, being an active participant. 

In undergrad, I looked at a couple of different routes, but I really fell in love with chemistry, and I took a bit of a detour and wanted to be an organic chemistry professor for a while and really work on the drug development side, and then finally ended up making my way back into medicine a little bit later in life and ended up in medical school in my late twenties, early thirties. Wow, that seems like so long ago. 

I just, really loved family medicine because I couldn't say no to one particular thing. I loved the variety that family medicine afforded me, and it really just gave me a nice sort of wide variety of patient population. So once I ended up in sports medicine, a lot of the stuff that I ended up learning as a family medicine physician just became incredibly applicable.

Lindsey Smith

I love that. I think it's always so interesting to hear how all these pieces kind of come together. But to play that back a little bit for our audience, you went from being an athlete to getting into chemistry, then you get into medical school, and now you're a practicing physician in family medicine, but you're also the team doctor for USA figure skating. What a journey.

Christle Guevarra

Yeah, yeah, it's been quite the road of ups and downs and things that are uncertain. But if I could go back and do it all over again, I would do the exact same thing.

Lindsey Smith

Absolutely. So I want to come back to something you said about nutrition, and you talked about your personal own experiences, and you've been really open about your experience with body image and weight loss, which I know resonates with so many people, myself included. Can you share what that journey has been like for you and how it's shaped the work that you do today?

Christle Guevarra

It's been one of the things that I have struggled with from as early on as I can remember. I always remember feeling like I was just slightly bigger than the rest of my peers. Growing up -- even as young as like two or three years old, because I had a next door neighbor who we were the same height, and she was always about twenty pounds lighter than me, and her appetite was notably different -- I just always felt like I was part of the clean plate club, and I was such a good eater because I would always just eat everything that was on my plate. 

I always remember just feeling hungry and not being sure why and thinking early on like, it's just gotta be a willpower problem, like, I just need to work harder, I need to try harder. And that has shaped pretty much every decision that I have made academically and professionally, because for a very long time I thought, well, I can't solve this other problem, I'm always just gonna be slightly overweight, maybe even into the obese category, but if I just do very well in all these other things, if I just excel as, you know, be the best med student I can be, be the best grad student I can be, and get all these awards and have this long CV with all these accolades, like, it'll make up for the fact that deep down inside, I just always felt like this hunger was this deep, dark secret of shame that I couldn't get past. 

It wasn't until the GLP-1 medications came around, and I finally, after giving it a lot of thought and back and forth, I just finally said, all right, let's just give this a try, that I just didn't realize how much that took up my cognitive bandwidth until finally the noise in my head just quieted down.

Lindsey Smith

That's a really personal journey to share. So first of all, thank you for being so open about it. I think it adds so much depth to the work that you're doing and how you're able to connect with your patients. So you mentioned GLP-1 medications, let's come back to that. Obesity medicine has changed dramatically in a short period of time with the arrival of GLP-1 medications. Wearing your clinical hat, what's the most significant shift you've seen in how we think and treat excess weight?

Christle Guevarra

First, these medications aren't anything new. We've been prescribing these medications for Type 2 diabetes for decades prior to this, and it wasn't until just a couple years ago that the half-life of semaglutide changed, and the amount of weight loss that people could achieve and sustain also became very significant that people really started to take notice.

So nowadays, with the introduction of these medications, I think the biggest thing is trying to reframe how we approach weight loss. It's not just a willpower problem, it is a neurobiological problem, and now we have these medications that can address that. So now we have to start thinking about all sorts of other things. How are we gonna incorporate that lifestyle component into it, which is so, so important? And how are we gonna build a system that allows us to deliver that type of care to the general patient population? \

Because I've seen this happen. I've seen how the evidence-based fitness community and social media has been handling this for the last decade, but that doesn't translate to how physicians have been sort of approaching this. And I would like to see us kind of moving more towards, you know, a much more streamlined, integrated approach where we do lean in on our colleagues, our dieticians, personal trainers, because we can't do it, as a physician, can't do it all. It's just damn near impossible with the system that's in place right now.

Lindsey Smith

Right. That does feel like a big shift, not just how we treat it clinically, but how we kind of understand it. And I liked what you said there, that it kind of starts to move the conversation away from blame and willpower and towards something more grounded in biology, which changes a lot for patients. For our listeners who may still be catching up a little bit, can you rewind and explain how GLP-1 medications work?

Christle Guevarra

Yeah. So GLP-1 is a natural hormone that we produce in the cells in our intestines. We eat food, the nutrients go down, go through the stomach, and then get kind of pumped into the intestines. The intestines figure out, hey, there's food coming in, there's nutrients coming, so we need to do something about this, and they release GLP-1 hormones. 

The GLP-1 hormone tells the body to do a couple different things. It tells the pancreas, hey, release some insulin, because we've got glucose coming, we need to store it and do all sorts of good things with it. It slows down digestion, and then it signals, hey, you're full, you just had a whole bunch of nutrients coming down, so we should probably stop eating. The problem with our normal hormone is that the half-life is pretty short, so it's on the order of three to five minutes. 

There are two enzymes in our bodies that break it down pretty quickly, DPP4 and, I think, neprilysin, so, for a lot of people, it kind of goes away pretty quickly. And so with these GLP-1 agonists, what they are is that they, a lot of them, look pretty similar to the GLP-1 hormone, so it can attach to a receptor and do all the types of things that our normal hormone is able to do. However, it's chemically just a little bit different, so it can dodge the DPP4 and the neprilysin, so it stays in our bloodstream, stays in our system a lot longer, so it can keep us satiated for longer. It can do all those types of things that we want it to do without having it, like, go away. So instead of a three to five minute half-life, we have a week long half-life, which is pretty awesome.

Lindsey Smith

That's a really helpful explanation, and I think you made it really clear there why it's not just another diet drug but something fundamentally different in how it kind of interacts with the body. You also have a book, A Beginner's Guide to GLP-1s, which I want to plug really quickly here. Where can our listeners check this out?

Christle Guevarra

Yeah, so right now it's on my Instagram, in my bio, it's downloadable, it's free, it's a PDF guide, and I believe I'm pretty close to having it on my direct website, which is about to be up very shortly as well.

Lindsey Smith

Awesome. We will be sure to include the links in the show notes of the podcast for our listeners to check out. Let's kind of go back to you for a moment here. So you've spoken openly about using GLP-1 medication yourself. What was that decision like as a physician, and what has that experience taught you that you couldn't get from clinical literature alone?

Christle Guevarra

Yeah, so the GLP-1...I will say that that medication was not the first time I was prescribed a medication for weight management. Prior to that, in residency, I had tried and failed a bunch of other medications my doctor had prescribed for me for weight management at the time. So by the time my doctor recommended a GLP-1, it was 2020, it was in the middle of the COVID pandemic. I was a sports medicine fellow, and I was just like always putting out a fire. It was kind of a crazy time to be in medical training and so when I initially thought of it, I said no for quite a few different reasons. 

One, I feared needles. Other medications I took were oral, and it just seemed a lot easier. The ick of having to inject once a week for whatever reason kind of threw me off. Two, I don't think my insurance at the time covered it -- university insurance is hit or miss -- so I'd have to pay out of pocket. It was about a thousand dollars a month, and I definitely, as a fellow in an academic institution, I could not afford that. And three, just ego. I thought that maybe if I just tried harder -- I'm in medical training right now, it's COVID, things are hectic, once I get out of medical training, I'll have this way more sustainable lifestyle and whatever -- so I put it aside for about a year or two.

I finally returned back to it in January of 2022, when I started to realize that my attending life is a lot calmer, but my ability to lose weight or sustain a calorie deficit was still pretty difficult. I was still having a lot of food focus, I couldn't sleep at night, and just had ruminating thoughts about food. And so I finally decided that, you know, maybe this is just the genetic hand that I've been given, and maybe I do need a little bit of help, and worst case scenario, if it doesn't work for me, I will have to try something else. And that's when I went on Wegovy, in January 2022.

Lindsey Smith

I feel like you have such a unique perspective, having experienced both sides as a physician and as a patient. You talked about some of the barriers to entry for starting GLP-1 medication, and I want to shift and talk about a concern in the field about muscle loss with rapid weight reduction in patients using GLP-1 medication. What's your take on that?

Christle Guevarra
Yeah, it's a very real thing to think about and be concerned with, but I also would like to challenge that and say that those are pretty solvable problems, especially when you think about the rate of weight loss, the duration of weight loss, and resistance training as being like a non-negotiable...all things that I've seen plenty of athletes, recreational athletes, and professional athletes end up doing -- even dieting without a GLP-1 or losing fat without a GLP-1. I've seen so many natural bodybuilders get lean without any type of medical, assistance whatsoever. 

So I've just seen them all be able to do all of that -- protein as a focus, resistance training, and really making sure that they take into consideration the rate of weight loss and the duration of weight loss, and recovery also as a non-negotiable. When you take all of those factors into play, on paper that becomes really easy to talk about. The thing that makes it a lot more challenging is when you are working with the general population, you really wanna be mindful that these people aren't professional or natural bodybuilders. They have real lives, they have families to take care of, they have jobs to go to. 

And so I think one of the biggest things that I tend to really impose upon with patients that I'm working with is that this isn't gonna be like a ninety day challenge or a six month challenge, this is gonna be the rest of your life, and so we really need to take our time when it comes to building those habits, when it comes to really making sure we're not losing too much weight too quickly, and also making sure that we're not in a calorie deficit for any prolonged periods of time.

Lindsey Smith

I appreciate how you challenged that muscle loss concern, and, you know, stating that medication alone isn't the entire solution, but rather one tool in the overall toolbox. So you mentioned GLP-1 therapies in the long term a little bit in your response there. How do you think about the role of GLP-1 therapies in the long term? Are we talking about a treatment of patients who stay on it forever, or is the goal to eventually taper off? And what does the evidence say today?

Christle Guevarra

The literature currently says that the majority of the patients who come off of the medication end up gaining, what is it, two-thirds of the weight back. So that's what the literature says. And I think for the most part, I think that's a good way to ensure that when you're having these conversations with patients is emphasizing that being on this medication is not a moral failure. I think knowing that this is a neurobiological problem -- once you take the GLP-1 medication it removes that food noise, removes that signal -- right now, with our current understanding of how these medications work, it makes sense that once you remove the drug, the food noise comes back, and it becomes way more challenging to either sustain a calorie deficit or maintain a certain body weight without it, and that's okay. 

I think the research still hasn't caught up with the fact that there's always going to be an individual response. I have seen people who have been on the drug for a while and for whatever reason end up coming off of the medication -- whether it's because of insurance issues, cost, personal choice -- and still end up doing well without it. A lot of the times these people have had the lifestyle in place. They have the resistance training, they have the protein, the fiber, hydration, all of that, you know, is sustained, like that's still going to be non-negotiable. And, you know, the drug, for whatever reason, shut down that food noise, and they still end up doing well. 

I always tend to become a little bit more conservative and frame it as, we're probably gonna be on this medication forever, because obesity is a chronic complex disease, and that's okay. There may be a time where we cut down on the dose, there may be times where we increase the dose depending on how things are going, your response, side effects, all of it, you know. There's so many different factors that need to come into play as far as the lifestyle and nutrition goes, that patients just really need to be flexible, and having that honest ongoing conversation with their physician about what they're feeling, what symptoms are they having, are they actually eating? Because that becomes the new problem. It's not like the food noise goes away and everything's hunky dory. Now the challenge becomes, how do I live my life without food noise? How do I intentionally fuel my body to live my best life? And that becomes a very tricky thing to kind of navigate, and there's no one size fits all approach. You have to meet your patients where they are and go from there.

Lindsey Smith

That's a really helpful way to frame expectations, especially for patients who might feel anxious about what “long-term” really means. Nutrition is another piece of this puzzle that you've been vocal about, and you have been critical about the lack of nutrition education in medical school. How significant do you think this gap is, and how does it show up in the care patients actually receive today?

Christle Guevarra

Man, have I been really critical? Boy, I guess I have, just a tad. As an attending physician, I've been a little bit knee jerk in my reaction when I have seen attending physicians say that nobody taught this to me in medical school. And I would challenge them by saying, hey, we have this thing called continuing medical education, and we are mandated to take extra courses or keep up on our clinical skills, and so it's an opportunity to learn.

I think the problem is not necessarily more education, at least right now. I think the problem is how are we gonna execute? Because you can have all the education in the world, but when you are a family medicine doctor or in internal medicine and you've got a fifteen minute patient visit and you're supposed to solve everything... I remember trying to throw in information on nutrition at the end of the appointment, and I don't feel like I did a very good job. With these fifteen minute, even twenty minute, patient visits, you know, building that rapport with somebody is just not gonna happen. You can't build that on fifteen minutes every three months. It's just not gonna happen. 

So I'm not quite sure, and I don't know what the answer is. I've seen people who just focus on GLP-1 weight loss, and I think that might be the route that we need to start going towards, just because there's so many different parts that come into play with the lifestyle component, the nutrition, and the resistance training that it’s really difficult to solve at a regular brick and mortar clinic practice.

Lindsey Smith

That's a great suggestion with the CMEs. I think we had a doctor on the podcast who said, my goal in the first visit is to get to the second visit, which I think applies here as well. But let's go ahead and switch gears slightly here. There's so much noise in the fitness and wellness space around diets, supplements, and quick fixes today. What do you wish patients understood before they walked into your office?

Christle Guevarra

That supplements are meant to supplement, and it is not the foundation. If you're not going to the gym consistently at least twice a week, or resistance training at home twice a week, or getting good sleep, managing your stress, and having a well-balanced diet that includes lean meats or lean sources of protein, fruits, vegetables, healthy fats, all the supplements in the world aren't going to fix that. If you look at the literature, the magnitude of like actual effect that any type of supplement has is very small in comparison to showing up consistently over time, building the healthy building blocks of exercise and nutrition, which have a much greater effect on health and wellbeing than any of the supplements out there in the wellness space.

Lindsey Smith

That's great advice, and especially in an environment wherein people are being pulled in so many different directions. Let's talk sports medicine a little bit here. So sports medicine gives you a particular lens on body composition, performance, and health. Can you share your experience of being the traveling team physician for U.S. Figure Skating?

Christle Guevarra

Yeah, yeah. It's really awesome to see what amazing genetics, hard work, talent, discipline with practice...seeing all of that sort of come together. When I travel, it's mostly to competitions, it's usually for a week at a time, and it's really awesome to just watch them kind of perform. And so a lot of the times I just remind them that I’m here if they need anything. I guess being sort of an athlete as well, I know that everybody's got their own routine, everybody's got their pregame kind of performance. So I always come in and always let them know I am here wherever. I will always be watching in the corner, but I always kind of stand off to the side, just because this is your week. You guys have been working so hard for months at a stretch to make this week happen, you've traveled over twenty-four hours to some remote destination in the world, and I just want to make sure that I can be supportive, but I also want to make sure like this is your time to shine, and you guys have done everything to get here, and I want you guys to, you know, whatever you need to do, just do it, and I'm here to just to be a support. 

So it's really good to see not just the athletes, but also the parents and the coaches and also the other support staff, the team leaders who also come for the week. And so, yeah, it's such a fun time, I don't know how else to describe it. Most of the time I end up going to junior events, and so it's always really great to see young athletes at the very beginning of their athletic career and kind of catching them at that point in their career. 

Lindsey Smith

What a great experience. You get a sneak peek behind the scenes and get a look at all the work and the training that goes into this before they get to the performance. And I know it was exciting as a spectator to see Team USA have a standout 2026 Olympics.

Christle Guevarra

Yeah, my gosh. It is really awesome to see. A lot of the people who ended up going to the Olympics as support staff are people that I had met very early on in my sports medicine fellowship journey, and everybody is just so supportive. I really, really love that environment, and it's just been such a blessing.

Lindsey Smith

Let's pivot briefly to education and the future. As you know, Elsevier is an education company, and we're always thinking about how to close knowledge gaps. Is there a topic that you think deserves more attention?

Christle Guevarra

Off the top of my head, I can't say there is t a particular topic that I can think of that deserves particular attention. I know that peptides have been a really hot button that have come up very recently, but as far as any particular topic, I don't think there's one that everybody needs to touch upon. I think what's going to be important is that good information -- clinically accurate information that isn't trying to sell a product or sell people stuff -- is what we need, because the wellness influencers have really done a great job of filling in a gap that I think that medical professionals have kind of neglected for a really long time.

Back in my day -- oh boy, I feel really old -- I remember that social media was kind of frowned upon, and putting out information was also kind of frowned upon, just because people were hyper concerned that information was gonna be taken out of context -- which are real things to consider, and I think they were very valid concerns -- however, we've seen that if medical professionals and other clinicians weren't gonna put out information, somebody else was gonna fill in that gap. 

I think once somebody pointed that out to me was when I decided to go all-in and start sharing my experiences, start putting information out there, because, as long as I'm not trying to sell stuff, I think the information I'm trying to put out there -- eat a nutritious diet, resistance train -- like these are all basic things and I don't have a product to sell people. 

There was a recent debate where I think even Dr. Mike was encouraging more physicians to go out there and provide information on these social media spaces. I think that's something that physicians, especially if they have the bandwidth and they're willing to do it, I think they should do that in order to combat misinformation.

Lindsey Smith

Yeah, couldn't agree more. Trusted content is so important, probably more than ever today, and a key pillar for Elsevier. Before we close, I'd love for you to speak directly to the next generation. We have many students and early career health professionals in our audience. What advice would you give them?

Christle Guevarra

Especially with the landscape changing so much with AI and all these other tools, it's okay to not have everything figured out. Remember, especially for medical students in particular, you are smart, and you are capable of learning all sorts of new things. I guess me looking back, once the COVID pandemic hit, my career did take a pivot. I thought I had my whole career planned out, like this is what I was gonna do, and so COVID kind of threw a little wrench in that, and my career took a detour. I worked on a YouTube channel, I was doing marketing research, I was doing some social media content stuff, and now looping back around and getting more into kind of clinical work and returning to it. 

None of that time was wasted. I've learned so many new skills. I have learned so many new things that, yes, they're not directly clinical, but they're still very applicable to my patient population and educating the public about topics like GLP-1. I wouldn't have done any of that had I not just gone all in and just figured it out. Because, worst case scenario, things don't work. 

And so I want people to stay open to learning new things. You're not gonna have all the answers, and things might be a little bit uncertain, but I think being able to adapt and adapt quickly is going to be very beneficial, and I think a lot of people are able to do it. You're much stronger than you think. Keep that in mind, and I think you'll be good.

Lindsey Smith

It feels like it all worked out for you, but in particular in the end. The advice that you shared there -- it's okay not to have everything figured out, you are capable, it's okay to pivot and adapt – is really thoughtful advice. Thank you so much for sharing. Before we wrap up today's episode, is there anything that we didn't cover that we should have?

Christle Guevarra

I don't know if we necessarily didn't cover it, but I just wanted to re-emphasize it. Resistance training, strength training is for everybody. Whether you're young, whether you're old, whether you're male or female, it is going to be the most important. If there's one piece of advice that I could encourage people to do it is resistance training, because not only is it going to provide you all sorts of benefits, but I think as the population starts to age, you start to really appreciate strength and building muscle, just even for simple everyday tasks. The sooner you start, the sooner your ten-years-down-the-road self will thank you for it. 

So, if I didn't emphasize that during this talk, that's what I would love to have people take home. Start today. It doesn't have to be perfect – it could be once a week, could be once every two weeks -- but just find some time to do things consistently over time.

Lindsey Smith

That is a great note to end on, Dr. Guevarra. Thank you so much for your honesty, insight, and for helping bring clarity to a rapidly evolving and deeply human topic. Thanks so much.

Christle Guevarra

Thank you so much for having me on.

Lindsey Smith

And that does it for our show today. As GLP-1 medications reshape the conversation around weight management, it's clear the story doesn't end with a prescription. It extends to education, movement, nutrition, long-term support, and behavioral changes. Today's conversation reminds us that sustainable health is rarely about one tool alone, but about how thoughtfully we use the tools available to us together. Dr. Guevarra, thank you for sharing your expertise and for helping bring clarity, nuance, and humanity to a topic that affects so many. I'm Lindsey Smith. Thanks for checking out today's show. Remember to do your part to raise the line and strengthen the healthcare system. We're all in this together.