Episode 164: Your Body Was Never Broken — Your Weight Health Hormones Are Just Dysregulated
- 7 hours ago
- 14 min read
"Weight health is the foundation of optimal health. For everybody."
— Ashley Koff, RD
You have done everything right. The diet. The workouts. The restriction. And the body still holds on. This is not a willpower problem. Trauma disrupts the weight health hormones your body uses to regulate metabolism, appetite, and fat distribution — and GLP-1 is just one signal in a much larger biological ecosystem. Registered dietitian Ashley Koff has been working with the biology of weight health since 2004 — long before GLP-1 became a household word — and what she found changes everything.
Weight health hormones like GLP-1, leptin, and ghrelin run a sophisticated metabolic ecosystem. When trauma imbalances the nervous system, that ecosystem gets disrupted — no diet addresses that. The number on the scale never tells you that story. Nervous system regulation isn't separate from metabolic regulation. It is metabolic regulation. The body keeps the score, and it keeps it in your hormones.
In This Episode You'll Learn:
(00:00) Introducing the connection - weight, metabolism and GLP-1
(03:06) The weight-trauma connection: Why the body holds on despite every effort
(04:04) What “weight health” means biologically — and why weight loss as a goal misses the point
(07:17) The incretin discovery: How GLP-1, leptin, ghrelin, and seven other weight health hormones regulate your biology
(10:53) Why 93% of Americans show signs of suboptimal metabolic health — and what that actually means for you
(11:36) Ashley’s pizza framework: The right sequence for assessing your metabolic ecosystem
(16:00) How to assess your weight health hormones — and why a blood test alone won’t tell you what you need to know
(24:03) Perimenopause and menopause: Why digestion fails first — and how that drives belly fat and brain fog
(31:25) Learned behaviors vs. hormone imbalance: How to tell what is biology and what is a survival strategy from childhood
(38:33) Where to start: Ashley’s first step for anyone wanting to optimize weight health
(41:52) The deliciousness signal: Why a “seven or above” is a physiologic mechanism, not a preference
(45:08) Ashley’s final message — where to find (her book) Your Best Shot and her clinical resources
Notable Quotes
Dr. Aimie: "How do you tease out what is a hormone imbalance — and what is a learned behavior? That's your trauma."
Ashley: "We just get curious. Instead of saying there's a right answer — we get curious."
Ashley Koff, RD
"Weight loss actually doesn't achieve anything other than a lower number. If there is an underlying problem, nothing gets fixed."
"It’s not about a number on the scale…Anyone who's still talking about weight loss doesn't understand how the body works."
When the body creates belly fat, it is a massive signal. When the body sends fat where it’s not supposed to go, that’s a big wake up call.”
"Weight loss is not the right goal, it's not the right approach — and it is one that will leave you disempowered."
"Let's break up with the myth of the noncompliant patient. I was so compliant. I did everything under the sun. I'm trying everything and I'm not actually decoding my body's signals. We are never actually respecting the body as an operating system."
"When estrogen and testosterone start to be lower, one of the primary things that happens is they throw digestion off course — which directly impacts weight health.
"Joy is a signal. When we can experience gratitude, we are in our bodies in a space where we are in rest and digest. That means part of our weight health system is working properly."
"What's bad for you (is not the food) is the way you're talking about yourself right now."
"If something is less than a seven on deliciousness, your body is unsatisfied. It has not achieved that satiety signal yet."
"Deliciousness is not a nice-to-have. It is actually a physiologic response."
“Unintentional bullying when a doctor had said you don't have a health issue, but you have a weight issue and here's what you need to do. But I don't think anyone bullied me as badly as I bullied myself. And I think that's what you're unpacking and what I love in Biology of Trauma is just how important it is that we actually understand our biology and we understand our physiology. And when we do that, we actually don't get to be mean to ourselves.’
“These (GLP-1, GIP) are weight health hormone replacements — just like taking testosterone when you don't have enough testosterone."
Dr. Aimie
"Choice. What a powerful word to bring into the conversation around food. That is what many people still do not feel they have."
“ The biology of trauma — imbalances our hormones, metabolism, and energy."
"The body is not the same person today as we were yesterday, a week ago — especially in the perimenopause years. So why would we think this is ever something we are done with?"
“And sometimes just getting started is the hardest step, and then we build the momentum and it becomes easier and it becomes fun at one point, and then things open up as we see, wow, I can do this.”
“We’re looking at the biology and physiology underneath those symptoms. Just like emotional eating, irritability or guarding — those are always just symptoms and we want to look at the underlying biology. This is what allows us to be more precise with our healing journey - finding exactly what is holding my body back from its innate ability to heal, even after trauma.”
Episode Takeaway
I’ve said it many times: trauma becomes biology. Ashley shows exactly where that imprint lands — in hormones, in digestion, in the way the body holds fat in places that signal something deeper is happening. For years my own body responded to weight in ways conventional rules couldn't explain. I was doing everything right. The body had other priorities.
What the Biology of Trauma® framework and Ashley's weight health model share is a refusal to pathologize the body's adaptations. The body holds onto weight because a nervous system in survival mode redirects resources, suppresses non-essential weight health hormonal signaling, and keeps core systems online. That's adapted, not wrong.
The vagus nerve is where these two frameworks meet most precisely. It governs felt safety and delivers metabolic health hormone signals — including GLP-1. When the nervous system is stuck in a low-grade threat state, the vagus cannot do both fully. The body chooses safety over metabolism. Every time.
If you have been working hard on weight, nutrition, supplements — and the body still isn't responding — start where Ashley starts: digestion and hydration. Start where I start: safety. The body's capacity to regulate metabolism opens when the survival state begins to shift. That's the sequence. That's the work.
Resources/Guides:
• Your Best Shot by Ashley Koff, RD: The Personalized System for Optimal Weight Health — GLP 1 Shot or Not
• Ashley Koff’s website — For more on digestive, metabolic, and hormone health optimization
• The Biology of Trauma Book by Dr. Aimie Apigian — Where you can find the framework for finding your block in Chapter 12
Related Podcast Episodes:
• Episode 151 — Why Healed Trauma Returns in Perimenopause: Chinese Medicine Lens with Dr. Lorne Brown
About the Guest: Ashley Koff is a registered dietitian, educator, and author of Your Best Shot — a clinical playbook for weight health optimization with or without GLP-1 medications. She has been working at the intersection of weight health hormones, metabolic function, and personalized nutrition since 2004, when she first identified the incretin effect as the key missing variable in conventional dietary approaches. Her practice focuses on the full weight health ecosystem: digestion, hydration, lifestyle factors, and hormonal signaling — rather than scale weight or caloric restriction.
Your host: Dr. Aimie Apigian, double board-certified physician (Preventive/Addiction Medicine) with master's degrees in biochemistry and public health, and author of the national bestselling book "The Biology of Trauma" (foreword by Gabor Maté) that transforms our understanding of how the body experiences and holds trauma. After foster-adopting a child during medical school sparked her journey, she desperately sought for answers that would only continue as she developed chronic health issues. Through her practitioner training, podcast, YouTube channel, and international speaking, she bridges functional medicine, attachment and trauma therapy, facilitating accelerated repair of trauma's impact on the mind, body and biology.
Does Trauma Affect Your GLP-1? The Biology of Weight Health, Hormones, and the Nervous System
When trauma keeps the nervous system in a survival state, the vagus nerve — the primary pathway for GLP-1 hormone signaling — cannot function optimally. Weight health disruption is a biological consequence of chronic nervous system dysregulation, not a personal failure.
Every week, someone in the Biology of Trauma® community describes the same experience: they have tried every approach to weight and metabolism. They eat well. They exercise. They take the supplements. And the body holds on anyway. The shame that follows is real — and it compounds the very biology that made the body hold on in the first place.
This is one of the places where the Biology of Trauma® framework and the emerging science of weight health hormones tell the same story from different angles. In a recent episode of the Biology of Trauma® Podcast, I spoke with registered dietitian Ashley Koff, author of Your Best Shot, about what her twenty years of clinical work revealed: weight health is a hormonal ecosystem — and trauma disrupts that ecosystem at a biological level.
What Are Weight Health Hormones — And Why Have You Not Heard of Most of Them?
Weight health hormones — GLP-1, leptin, ghrelin, PYY, CCK, amylin, oxyntomodulin, and adiponectin — regulate body composition, appetite, blood sugar, inflammation, and cognition. Most people know only one or two of them.
In 2004, Ashley Koff was working with bariatric surgery patients when a surgeon mentioned the 'incretin effect' — the mechanism by which gut hormones prompt insulin to work. That moment changed her clinical approach entirely. She had assumed insulin was the starting point. It was not. GLP-1 and GIP were the spark plugs.
What she uncovered was a category of hormones she began calling weight health hormones. These include GLP-1, leptin, ghrelin, PYY (peptide YY), CCK (cholecystokinin), amylin, oxyntomodulin, and adiponectin. Together they regulate appetite and satiety, blood sugar, bone density, muscle mass, fat distribution, hydration, inflammation, cardiovascular function, and cognitive clarity.
When this system is operating optimally, the body manages its composition with relative efficiency. When it is not — when any part of the ecosystem is suboptimal — the body's signals become unreliable, contradictory, or absent. The scale number changes. The body composition shifts. The energy drops. None of that is a character flaw.
What Does GLP-1 Actually Do — Beyond the Weight Loss Headlines?
GLP-1 is an incretin hormone that signals insulin release, regulates appetite, supports heart health, reduces inflammation, and affects cognition — all within a two-to-five minute natural signaling window.
GLP-1 medications like semaglutide and tirzepatide have become some of the most prescribed drugs in the country. Most people understand them as weight loss medications. Ashley Koff's clinical framing is more precise: these are weight health hormone replacement therapies.
When the body's own GLP-1 production is suboptimal — due to digestive dysfunction, vagal dysregulation, nutrient depletion, or chronic stress — replacing that hormonal signal is analogous to replacing estrogen when estrogen is low. The medication fills a gap in the body's own capacity to regulate. That is a very different conceptual frame than 'taking a drug to lose weight.'
The distinction matters for clinical decision-making. Someone on a GLP-1 agonist who is not seeing sustained results may not need a higher dose. They may need the foundational layer — digestion, hydration, nervous system state — addressed first.
How Does the Nervous System Connect to GLP-1 and Metabolic Health?
The vagus nerve is the primary delivery pathway for GLP-1 signaling from gut to brain. Vagal dysregulation — a hallmark of trauma biology — impairs this signal and reduces metabolic hormone efficacy across the board.
This is where the Biology of Trauma® framework and weight health science intersect most directly. The vagus nerve is central to both.
In the Biology of Trauma® model, a dysregulated vagus nerve reflects a nervous system that has been in chronic survival mode. Polyvagal theory, developed by Dr. Stephen Porges, describes how the ventral vagal state — the state of felt safety and social engagement — is required for full physiological regulation. When the system is stuck in a sympathetic (fight-or-flight) or dorsal vagal (freeze, shutdown) state, the body's regulatory capacity across all systems is reduced.
Ashley Koff's clinical findings align: when the vagus nerve is dysregulated, GLP-1 cannot travel efficiently from the gut to its target tissues. The hormone is released, but the signal delivery is impaired. The body may produce adequate GLP-1 and still not receive its benefits — because the infrastructure that carries the message is compromised.
Research on the gut-brain axis published in journals including Neurogastroenterology and Motility has documented the bidirectional nature of vagal signaling and enteric hormone function. Chronic stress and dysautonomia reduce vagal tone and impair the incretin response. The clinical implication: addressing nervous system regulation is not separate from metabolic health. It may be the prerequisite.
Ashley Koff's Weight Health Ecosystem: The Pizza Framework
Ashley Koff's pizza framework organizes weight health assessment by sequence: digestion and hydration (crust) must be optimized before nutrition (sauce and cheese) or supplements and tools (toppings).
Ashley Koff uses a framework that addresses the weight health ecosystem in the right sequence — what she calls the pizza model. The crust is digestion and hydration. Without a functional crust, no topping improves the meal.
Digestion here refers not just to stool regularity but to the full sensory and absorptive process: smell, taste, enzymatic breakdown, nutrient transport, and cellular availability. Hydration refers not to fluid intake but to intracellular and extracellular water distribution — whether the body's water is going where it is supposed to go and doing what it is supposed to do.
The sauce and cheese represent lifestyle factors — sleep quality, stress, breathing patterns, movement, and joy. These are not optional additions. They directly govern whether the hormonal ecosystem can function.
The toppings are the tools and supplements — including GLP-1 agonists, berberine, cold plunge, and other targeted interventions. These are valuable. They also do not work well on a pizza that has no crust.
This sequence mirrors the Safety → Support → Expansion framework in the Biology of Trauma® model. You cannot optimize what has not yet been stabilized.
What Happens to Weight Health During Perimenopause and Menopause?
When estrogen, progesterone, and testosterone shift during perimenopause, digestion is one of the first systems affected — which directly disrupts weight health hormone function and drives belly fat accumulation.
One of the most common and least explained experiences for women in midlife is the appearance of belly fat in someone who has previously not carried weight in the midsection. For many, this is the moment the body feels most foreign.
Ashley Koff's clinical explanation: when sex hormones decline during perimenopause and menopause, digestion is among the first casualty systems. The downstream effects include impaired GLP-1 signaling, altered blood sugar regulation, reduced bone density, brain fog, and visceral fat accumulation. These are not separate menopausal symptoms. They are interdependent biological signals from a destabilized ecosystem.
The Biology of Trauma® framework adds another layer: many women in midlife are also managing the accumulated biological load of earlier life stressors. The nervous system has been in a low-grade threat state for years. Hormonal shift during perimenopause removes a buffer the body had been relying on. What shows up is not a new problem. It is the older biology, now visible.
The clinical implication: addressing weight health in midlife requires attending to the foundational layer first. This means digestion, nervous system regulation, and hormonal support — in that sequence — rather than beginning with the scale number.
What Is 'Deliciousness' — And Why Does It Matter Biologically?
When food registers as a seven or higher on a sensory satisfaction scale, the body efficiently triggers GLP-1 and other satiety signals. Below seven, the body may overconsume seeking the signal it has not yet received.
One of Ashley Koff's most counterintuitive clinical insights is that pleasure in food is not a luxury. It is a physiologic mechanism.
When the taste, smell, and appearance of food register as genuinely satisfying — what she calls a seven or higher on a deliciousness scale — the body begins hormonal signaling more efficiently. GLP-1 activates more readily. Satiety signals arrive on time. The meal achieves its biological purpose.
When food is below a seven — eaten out of obligation, compliance, or circumstance — the body does not get the anticipated signal. It compensates by seeking more quantity. The overconsumption that follows is not a failure of discipline. It is the body trying to receive a signal it has not yet gotten.
This connects to a broader principle in the Biology of Trauma® framework: the body has wisdom. When we work with its signals rather than overriding them, the biology moves in the direction of regulation. When we override the body's sensory cues — including pleasure and satisfaction — we disrupt the regulatory sequence.
How the Shame Cycle Suppresses Weight Health Biology
Shame activates the sympathetic nervous system. That activation suppresses vagal tone, impairs digestion, and reduces GLP-1 signaling — creating a biological feedback loop that makes metabolic regulation harder.
Both Ashley Koff and I came to our respective frameworks through personal experience with this cycle. She describes being told by physicians that her health was fine but her weight was a problem. The bullying she describes most acutely was her own — the internal dialogue that kept her nervous system in a state of chronic low-grade threat.
From a Biology of Trauma® perspective, that shame state is not psychological noise. It is a neuroception signal — the body's subconscious threat detection system, described by Dr. Stephen Porges, reading the internal environment as unsafe. A shame-activated nervous system is a survival-mode nervous system. And a survival-mode nervous system suppresses the very hormonal infrastructure that weight health requires.
The implication for clinical work: metabolic optimization cannot be separated from nervous system safety. The body that feels chronically criticized — internally or externally — will default to metabolic survival patterns. That is not a character flaw. It is biology doing exactly what biology does under threat.
What This Means for the Healing Journey
The Biology of Trauma® approach and Ashley Koff's weight health model reach the same clinical conclusion from different directions: sequence matters. Before optimizing hormones, address the nervous system. Before addressing the nervous system, establish safety. Safety first. Support second. Expansion third.
For anyone working on weight health — with or without GLP-1 medications, with or without a perimenopause diagnosis, with or without a known trauma history — the foundational questions are the same. Is my digestion functioning? Is my nervous system safe enough to digest? What is the body signaling through belly fat, brain fog, or blood sugar irregularity?
These questions do not require a diagnosis. They require curiosity. And curiosity, as both Ashley Koff and the Biology of Trauma® framework affirm, is the most important clinical tool we have.
FAQ
What is weight health and how is it different from weight loss?
Weight health refers to the optimal function of the body's weight health hormones — including GLP-1, leptin, ghrelin, PYY, CCK, and adiponectin — and the biological ecosystem that supports them. Weight loss refers only to a reduction in scale number. Weight health addresses the underlying systems that regulate body composition, appetite, blood sugar, inflammation, and metabolic function. According to clinical data, approximately 93% of Americans show signs of suboptimal metabolic health by this standard.
How does trauma affect weight health hormones like GLP-1?
Chronic trauma keeps the nervous system in a low-grade survival state. That state dysregulates the vagus nerve, which is the primary delivery pathway for GLP-1 signaling from gut to brain. It elevates stress hormones that create leptin resistance. It impairs digestion and hydration — the foundational layer of the weight health ecosystem. The result is that even healthy food choices and targeted supplementation cannot produce optimal metabolic function when the underlying nervous system state remains unaddressed.
What is GLP-1 and why does it matter beyond weight loss?
GLP-1 (glucagon-like peptide-1) is an incretin hormone produced in the gut that signals insulin release, moderates appetite and satiety, supports cardiovascular health, reduces inflammation, and affects cognitive function. GLP-1 agonist medications extend the natural two-to-five minute signaling window to seven days. Ashley Koff frames these as weight health hormone replacement therapy — comparable to estrogen or testosterone replacement — rather than a weight loss drug category.
What should someone do first to improve their weight health?
Ashley Koff's clinical framework begins with digestion and hydration — the foundational layer of the weight health ecosystem. No nutritional or hormonal optimization is possible when the gut cannot absorb and transport nutrients properly. This mirrors the Safety → Support → Expansion sequence in the Biology of Trauma® framework: establish the foundation before moving to the next layer. Assessing digestion — including sensory responses to food, stool quality, hydration patterns, and BOLT score — provides the baseline.
Helpful Research
1. Müller et al. (2019) — GLP-1 biology and metabolic functions Müller TD, Finan B, Bloom SR, et al. Glucagon-like peptide 1 (GLP-1). Molecular Metabolism. 2019;30:72–130.
2. Holst (2007) — GLP-1 physiology and vagal transmission Holst JJ. The physiology of glucagon-like peptide 1. Physiological Reviews. 2007;87(4):1409–1439.
3. Porges (2009) — Polyvagal theory and autonomic nervous system Porges SW. The polyvagal theory: New insights into adaptive reactions of the autonomic nervous system. Cleveland Clinic Journal of Medicine. 2009;76(Suppl 2):S86–90.
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