March 10, 2026 | The healthcare industry has a weight problem—a weight bias problem, according to Ashley Koff, RD, founder of The Better Nutrition Program. During her plenary keynote at February’s Integrative Healthcare Symposium, Koff addressed the urgent need to rethink approaches to weight, metabolic health, and the use of GLP-1 medications. Healthcare is at an inflection point, and rather than introduce new science, Koff challenged practitioners to reconsider where the field has fallen short and to correct course.
Koff recounted her personal history as her own “first patient.” As a child, she was bullied for having a belly and internalized that she had a “weight problem.” Through the years, she tried various diet strategies, from commercial programs to cleanses (including a seven-day goat milk cleanse—that she did not recommend) to disordered eating behaviors. All the while, Koff was regularly taking antibiotics, which disrupt the lining of the digestive tract. Each visit to the clinic had the doctor give the same solution: diet, exercise, and lose weight.
The turning point came when a practitioner—not a protocol-focused clinician—suggested she take probiotics. He did not focus on Koff’s weight. Rather, he was “curious.”
“Whenever I say the word curious, I think about the incredible leader that we heard from, Dr. Tieraona Low Dog, who taught me early in my career that the job of a practitioner is to be curious,” said Koff.
It was this practitioner’s curiosity that revealed a deeper, underlying issue for Koff. Her body lacked what it needed to optimally function. The problem was not weight or willpower or diet. It was impaired physiology. This experience shaped Koff’s professional mission of helping patients optimize their weight health.
We live in a weight versus health society, states Koff. She rejected the idea of the “non-compliant patient,” the patient who does not adhere to their treatment plan. Recounting her own experience of seeing patients who had undergone bariatric surgery, she noticed a reversal in diabetes for the patients and how they reported reduced appetite or not even thinking about food. Initially, Koff thought their smaller stomach sizes were the main reason, but it was actually the patients’ incretin hormones, including endogenous GLP-1s.
It clicked. Koff realized her weight composition was affected by these GLP-1s not working properly due to several factors, including regularly taking antibiotics.
The emergence of GLP-1 receptor agonists marks what Koff calls the “GLP-1 era.” These drugs have undoubtedly made a huge impact across healthcare and other industries. GLP-1s have taught clinicians how the body truly works. They do not just regulate appetite; they also influence insulin, glucagon, inflammation, bone repair, gastric emptying, hydration signaling, and more. In essence, GLP-1s are hormone replacement therapy. They activate downstream pathways but do not repair upstream dysfunction. An integrative approach will use the tool, while also addressing the upstream drivers of dysfunction.
“If you go on a GLP-1 agonist and you anoint it a solution, or you anoint any drug a solution … and you don’t fix what’s going on underneath ... you have to stay on it forever” Koff says. But the drug is one of many tools.
Koff addressed weight bias—not just in media and society, but also in medical practices. Oftentimes, patients feel successful when losing weight on medication—and come off them—but feel ashamed when the weight returns. They then feel disempowered, resulting in a psychological framing that discourages using the tools that helped them lose weight in the first place.
“Where was their practitioner when they gained five pounds back?” Koff asked. “Where was the system that said to them, ‘Why aren't you going back on the tool?’”
Weight bias has caused patients to feel like they are failures and clinicians to not address the underlying health issues. Koff argues for normalization: if a tool works, then it should be used without any prejudice or bias.
Koff emphasized that healthcare must move beyond standardized guidelines and outdated dietary reference intakes toward a more individualized approach. “We need smart goals, not guidelines,” she said. “We need to look at the body as an ecosystem.”
A patient-practitioner partnership is the foundation of maintaining this ecosystem. Koff emphasized the importance of practitioners trained in—not just having knowledge of—nutrition. Physicians diagnose and prescribe; nutrition practitioners assess digestion, hydration status, nutrient sufficiency, and lived experience. Neither role by itself is enough to help patients.
Koff offered a “pizza” metaphor to structure intervention.
- Crust: Digestion and hydration.
- Sauce: Optimizing nutrition.
- Cheese: Lifestyle choices.
- Toppings: Supplements, medications, and treatments.
No food is healthy or unhealthy, she said. The key is whether the body can extract, deliver, and utilize nutrients effectively and appropriately. Supplementation can support hormone optimization (e.g. probiotics, microbial balance, and amino acid sufficiency), but supplements are not replacement for endogenous GLP-1s.
“Hopefully, this time next year, we can be in a space of weight health [instead of] weight management and weight loss,” Koff said. “Maybe the introduction of the GLP-1 agonist … can actually be the modern-day solution that pivots us to a place where patients are empowered to be able to make and maintain their operating systems.”