Why Isn't the Healthcare System Built to Support Lasting GLP-1 Results? (Part 3)

About this Podcast

This series started with a simple question: why do two out of three people regain the weight after stopping a GLP-1? Part 2 broke down the specific mistakes getting in the way of lasting results. In part 3, Zach Dancel and Stephanie Misanik close the loop by explaining why the support patients need is so hard to find in the first place, and what it actually takes to get real answers from the healthcare system.

There is no guest this week. This is part 3 of a Longevity Unfiltered conversation between Zach Dancel, COO of Nava Health, and Stephanie Misanik, Clinical Director at Nava Health, closing out their series on what actually determines whether a patient gets real, lasting results instead of a quick fix.

What this conversation covers: why the insurance-based system limits even a well-trained provider, the hormone study that shaped decades of care, the health crisis that changed how Zach sees the traditional system, and the five pillars that hold up no matter what phase of life you're in.

Why the System Doesn't Leave Room for a Deep Conversation

Zach opens with a blunt description of primary care today. Providers who accept insurance are working inside a structure that rewards volume, not depth. To keep a practice running, a provider often needs to see dozens of patients in a single day, which leaves only a few minutes for any one appointment. Stephanie adds a layer to that picture. Many of the patients she hears from online have already done real research. They show up to their appointment with printed studies and specific questions, hoping for a genuine conversation about the evidence, and too often leave feeling dismissed instead. Stephanie is careful to separate two different problems here. Some of that comes down to an individual provider having an off day or a narrow mindset. Far more of it comes down to a structure that rarely gives a provider, even a good one, the time to sit with a patient's research and work through it together.

The Hormone Study That Shaped Decades of Care

One example the hosts return to is the Women's Health Initiative, a large study that linked hormone replacement therapy to cancer risk and led a generation of providers to steer patients away from hormone therapy. Zach calls it one of the most consequential missteps in modern medicine. The findings have since been reassessed, and much of the original alarm didn't hold up under closer analysis. The problem, as Zach and Stephanie describe it, is that the correction has been slow to reach the exam room. A meaningful number of providers still repeat the original warning almost by reflex, telling patients that hormone therapy causes cancer, without knowing that conclusion has largely been walked back. Stephanie is direct about what that means for the patient in front of her. It isn't that those providers are choosing to withhold good care. It's that keeping up with a shifting body of research takes time the system rarely accounts for.

A Personal Story Behind Zach's Urgency

Stephanie ties Zach's intensity on this subject to something personal. Around fifteen years ago, Zach's mother was seriously ill, seen by a series of specialists, and eventually told there was little more traditional medicine could offer her beyond comfort care. A provider working outside the insurance based system took a broader view, looking at nutrition, gut health, and hormones alongside the standard workup, and her outcome changed. That experience is part of why Zach pushes so hard on the idea that comprehensive, unhurried care changes outcomes. It's also why both hosts frame this as a systemic issue rather than a verdict on any individual provider. The specialists who treated his mother were working within the tools and time they had. The difference came from a model that let a provider look at the whole picture instead of one piece of it.

Why Cash Based Care Often Costs Less Than People Assume

A common objection to stepping outside the insurance system is cost, and Stephanie pushes back on the assumption behind it. Having insurance doesn't mean a visit is free. Between premiums, deductibles, and copays, most people are already paying a meaningful amount for care that may only offer a few minutes of a provider's attention. Stephanie's point isn't that insurance has no value. It's that the real comparison isn't insurance cost against concierge cost. It's where a household chooses to direct money it's already spending on health, and how rarely that choice gets made on purpose. For many people, a direct conversation about the household budget, paired with a willingness to shift some of that spending toward proactive care, opens up options that seemed out of reach.

The Five Pillars That Hold Up No Matter What Phase of Life You're In

Zach closes the system conversation by returning to the five pillars he and Stephanie reference in nearly every episode: strength training, zone two cardio, high intensity interval training, mobility and function, and core and balance work. He argues those five pillars stay valuable through every phase of life, including training for a sport, recovering from childbirth, or moving through perimenopause. Stephanie connects that directly to hormone health. Perimenopause typically starts in the mid thirties, roughly fifteen years before the average age of menopause at fifty one, and estrogen doesn't decline in a smooth line. It drops in a pattern of surges and dips over more than a decade. As it falls, the body tends to hold more weight around the midsection, which is one reason women who haven't changed their habits still see their body composition shift in their late thirties and early forties. Stephanie also notes how often this overlaps with the postpartum period for women having children later in life, stacking two major hormone shifts close together. Her guidance for anyone in that stretch stays consistent. Protect the five pillars, and get a real hormone panel before assuming the number on the scale is the whole story.

Frequently Asked Questions

Why do primary care visits average five to ten minutes?

Providers working inside the insurance based system are often expected to see a high volume of patients each day to keep the practice financially viable, which leaves only a few minutes for most appointments.

What was the Women's Health Initiative and why does it still matter?

The Women's Health Initiative was a large study linking hormone replacement therapy to cancer risk. Later analysis walked back much of that concern, but many providers still repeat the original warning.

What are the five pillars of fitness for longevity?

Zach and Stephanie point to strength training, zone two cardio, high intensity interval training, mobility and function, and core and balance as the five pillars that support long term health at any age.

When does perimenopause actually start?

According to Stephanie, perimenopause typically begins in the mid thirties, well before the average age of menopause at fifty one, even though most women aren't told to expect it that early.

Listen to the full conversation with Zach Dancel and Stephanie Misanik on Longevity Unfiltered.

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